Hospital Charges

Proposed CMS Physician Fee Schedule
Proposed CMS Physician Fee Schedule could cut paperwork and payments
February 18, 2020

When you see a hospital charges an average of 2.5 .Medicare, did you know there are 5 pay rates?

Independent ambulatory surgery centers ASCs and PCPs only get 1/3 to 1/2 system owned clinics and remote surgery centers. But charges (retail we are billed for by system owned) can be 4x , 8x or unlimited x —even though they don’t expect to get that? “Chargemaster” rates are considered a trade secret but are how much every hospital marks up Medicare rates to bill us and our insurance.

When you read the AHA – the hospital lobby- sued POTUS to fight transparency mandates by Executive Orders, it revolves around these types of secrets.


CPT code Current rate Proposed
99201 (Level 1) $45 $44
99202 (Level 2) $76 $135
99203 (Level 3) $110 $135
99204 (Level 4) $165 $135
99205 (Level 5) $211 $135


Don’t get the Coronavirus

February 17, 2020

So the public should do “what you do every cold and flu season,” said Dr. John Wiesman, the health secretary in Washington state — where the first US case of Wuhan coronavirus was confirmed. That includes washing your hands often with soap and water for at least 20 seconds.

If you’re the one feeling sick, cover your entire mouth and nose when you cough or sneeze. But don’t use your hands. Use either your bent elbow or tissue that you throw away immediately afterward.

WHO also recommends staying at least 3 feet or 1 meter away from anyone who may be infected.

Where Coronavirus has been confirmed

Value-Based Care is 3.0

New Primary Care Models
New Primary Care Models, Delivery Methods Save Money, Enhance Care
February 16, 2020

Valuebasedcare is 3.0 and DirectPrimaryCare is 2.0 an expert in primary care models told me Tuesday over fish tacos.

Here’s why he’s wrong:

  • VBC relies on the kindness of BUCAH.
  • Yet they are directly competing for PCPs.
  • So can set the amount they pay below realistic economics to drive VBC ACOs to their knees.
  • Like they did with dozens of services like independent imaging or orthopids or DME.
  • They will do the same to independentACOs married to VBC in primarycare then “rescue” them. Buy em cheap. They can later pay themselves a fair rate. A fat profit, in fact, because it’s not their money. It’s ours.

DPC is more resilient to this game largely opting off the tilted game board.

Why would they do this if VBCs offer great value? Because they can.

Call me a jerk, but VBC appears a race to the bottom until BUCAH owns it all. It’s so clear.


“We can get typecast as anti-insurance or anti-government,” Umbehr said but likes the idea of insurance used appropriately.

“Insurance is perfect for expensive things, hospitalizations, major car wrecks, your house catches on fire, but … you don’t submit an insurance claim to wash your car, to paint a new room in your house, [or get] an oil change. … Insurance is a great tool, but not for affordable things,”

A Healthcare App with 90% Engagement?

The Dawn of Consumerism: Key trends and strategies for healthcare consumerism
February 14, 2020

Wellsmith is an elegant frictionless Uber-like healthcare app w 90% engagement.

Consumers are actively demanding better access and more information so they can make informed decisions. High costs and general inconvenience are creating this revolution. They want healthcare to work like Netflix and Amazon, where personalized algorithms help guide them through their course of treatment and wellness regimen. They demand immediate, easy, and convenient access to caregivers. And they want content that is useful and relevant. It is only after they understand the benefits and risks, and have read provider reviews, that they seek the care they decide is most suitable for them.

What I Learned from Marilyn Bartlett

Marilyn Bartlett
Fortune names Montana woman among World's 50 Greatest Leaders
February 12, 2020

At the #healthrosetta conference, I learned from #MarilynBartlett

  • 340(b) set up in ‘92 by feds to allow non-profits wholesale access to Meds—so to fulfill the mission serving the poor.
    No provision forced anyone to pass this through to the needy so it became a cash cow.
  • Bigs hijacked it so today most of the 67,000 players shuffle profits from pharma into the hospital. Ex Humira costing 1 penny is charged out at $5000. Hospitals enjoy the difference. Other middles. I was asked by a CEO do docs get rich off drugs they sell? No, that’s not how medicine works— but was half wrong. That IS how medicine works for Bigs, Community Clinics, “Charitable” players some of whom ignore mission statements invoking God. Serving. And those some often have skyboxes, private jets, and offshore accounts. They’ve lost their way. Confused by abundant opportunity to drive EBITDA.

States are reeling this boondoggle in. State AGs with ambition and cajones will revoke nonprofit charters.

New Healthcare Is Restorative

Medicine: A profession of sacred trust
February 11, 2020

New Healthcare is restoring two sacred trusts that the Bigs have almost destroyed.

  • The doc/patient exam
  • The employer/ employee pact

The Golden Triangle of doctor, patient /employee and employer is our pivot point to best holistic answers repairing sacred trusts.

New wave benefits restore the pact that working for a company – “ good insurance “ saves from financial and health ruin. Nest vs the Wild.
We employers find healthcare buried treasure

  • Reduced spends of 20-25% easy 40-60% tougher.
  • Friction is eliminated
    1. zero deductibles/ copays
    2. texting or calling or seeing a PCP 24/7.

    So once I found 18 more days per employee of reduced absenteeism I broke even

  • Retention savings
    • I had no downtime
    • training
    • recruiting
  • Presenteeism is down. Med/doc access is easy now

…trust is established, a conversation occurs as if two friends are talking since the initial wall between doc and patient is broken down, and more intimate things are shared—in that intimacy that the sacred trust manifests, and unfiltered conversation happens, even if just for a little while.

Medicine: A profession of sacred trust

Paying for Direct Primary Care

The advantage of paying for medical care directly
February 10, 2020

My 2-year experience as an employer paying for #DirectPrimaryCare

  • #Turnover was zero 2019. Three days of less turnover per employee paid for my annual cost. I’m ahead.
  • In January we needed four MAs. Takes 60-80 candidates to find four A players. We stopped all interviews at #5 because now we attract an excellent pool of advertising-free healthcare.
  • #Absenteeism is half because 6-hour time suck Medicaid exams to get a 7-minute visit and script is replaced by a call or text at their desk.
  • #Presenteeism I don’t measure, but intuitively way down since my team, with 24/7 bilingual #PCP access is healthier.

I live in a future where everyone wins: employer, employee, and doctors. Cannot imagine going back to #highdeductibles, copays, clipboards, long waits #factorymedicine and shocking lab bills.

I feel in full integrity with promised safety.

This emphasis on the doctor-patient relationship has contributed to the growth of an innovation commonly referred to as Direct Primary Care (DPC).

For the patients, the benefits are clear. They now make their own health care decisions, with the advice of their providers and full knowledge of what the costs will be.

Brodie is Big Fan of New Authors

February 9, 2020

#PaulBrodie is an unabashed fan of new authors. That’s my kinda guy!

About the Coronavirus

February 5, 2020

Coronavirus trajectory

  • Dec 31 – 8 cases
  • January 17 – 41 cases
  • January 20 – 198 cases; President Xi Jinping took over.
  • Jan 23 – unprecedented lockdown on Wuhan, the economic engine and transportation hub of China’s central heartland
  • Feb 4 – 20,000 cases
  • Scores of cases have also been confirmed in several countries in the Asia-Pacific region as well as Europe, North America and the Middle East.
  • Over five million people had already left the city for the Lunar New Year holiday.
  • Now, the virus has spread to every region in the country
  • Scores of cases have also been confirmed in several countries in the Asia-Pacific region as well as Europe, North America, and the Middle East. Two deaths only outside China in Hong Kong, Philippines

The U.S. has imposed its first federally required quarantine since the smallpox era, half a century ago. Airline passengers from China are now subject to two weeks in isolation.

Another Grand Fix for American Healthcare

February 2, 2020

This #Forbes article is actually pretty funny. Supposed to announce yet Another Grand Fix for the hot mess called #AmericanHealthcare.

You decide :

Plan A)Retrofit ”complex administrative operation of multiple networks and payers as well as the lack of standardization in information technology.”

Plan B) invent a model eliminating #administrativebloat and artificial #EHRmandates  and join the #DirectPrimaryCare -a #movement where everyone wins  #Doctors #Employees #Employers


According to JAMA, there is an estimated $1T of waste in the US healthcare system, making it the world’s most expensive health system per capita. One of the main sources of waste is the complex administrative operation of multiple #networks and #payers as well as the lack of standardization in #informationtechnology. Another major bucket is the unwarranted variation in #healthcare delivery, driven mostly by low-value care and over-treatment.