This is fantastic! I work for Intermountain Healthcare in Utah. Our new system President & CEO Marc Harrison, is obsessed with fulfilling the call of delivering the highest quality healthcare to all at the lowest possible cost. I am a Department Nurse Manager. Part of our yearly goals every year is to reduce usage and cost on our departments any way we can to help reduce the cost to our community. Under his lead the system has started Civica RX which is a drug company created to produce some of the medications that the pharmaceutical companies are price gouging on. They produce it and supply it at a drastically lower cost to hospitals to deliver to patients at a significant lower cost. This is only one innovative ways he is leading our system to change the mindset of what healthcare should be and how much it should cost. ZDoggMD...you should do a piece on how flipping amazing this system is and what we are doing to decrease our patients cost.
This is probably one of the best podcasts I have ever heard. I literally got goosebumps several times during this interview! I posted it on my LinkedIn account. I would work for any organization with this vision and these values! Thank you Drs. for honoring your oath and your vocation. Hats off to you for your fearlessness!
YES!! Becoming a "grownup" 30 years ago I was astounded at how healthcare worked in relation to other businesses. Now as an RN I'm still astounded. I relate to my patients on a RealTalk level where we have conversations about how their insurance coverage factors in to the care my clinic provides. We talk to them like the consumers they are to try and minimize the surprises, but there is so much we as providers don't know either!
This is exactly what I'm talking about, when I tell people it isn't just one part of medicine and healthcare that's broken! This is a big part of it, but so many people just want to take a one facet approach and it's a multifaceted problem! Thank you Dr. Makary and ZDogg, for helping shed light on the real problems with the healthcare system!
I've been working for years on a concept for scaling Direct Primary Care -like models into full-scale hospital options, which could offer sliding-scale rates but still operate remuneratively. It's SO EXCITING to see a conversation like this and to be able to learn from what you guys have to share. Thank you for publishing this! I love this kind of material and it's a vital source of self-education for aspiring future hospital administrators like me!
You are both heroes; please keep your voices strong and continue to speak truth to power. I am an occupational therapist and have the same experience even at the level of rehabilitation. And don't even get me started about SNF. Thank you.
You are touching on people's pain, great speech, this is a great plateform to start with for futue change. Appreciate your patience, strength, professionalism and humanity. I would love to be in your team.
Without fail, when i talk to friends, family or patients who arent in medical field and show distrust in doctors the fear/anger is based on feeling they are commodities. That they are being scammed in some way. Primary way ive heard the trust has been broken. Super sad as doctors are just as frustrated if not more with price gouging. Thank you for taking time to address this.
It's horribly frustrating to think we're complicit in the financial RAPE of our patients, because that's exactly what it is. We need to stand up together and say ENOUGH.
This is important. Pull the blinders back on the hidden financial practices going on behind healthcare today. Shine the light of truth on what is going on. Transparency is so important for a true renewal of healthcare. Kudos to you. More of this please.
As a frequent flier patient, when it comes to over treatment, trust your patients to trust you. Especially with younger patients who are chronically ill, we probably come in wanting to know if what is wrong is normal or if we should be worried. If you tell us it's a normal connection to our conditions, we usually trust you. We don't need excess testing or added medications. I don't enjoy that I now have needle scars like a heroin addict. Everytime I go into the doctor, even just to get my Ritalin perscription, if I make any complaints- their immediate react will always be to look at the list of medications I haven't tried and think of tests that will placate me. They don't do it for money or anything nefarious, they really mean good for me. But it's not what I want. I just want communication. communication communication communication. *communication.* I went into the ER last year for a horrible headache, so bad I was in and out of consciousness. I was worried it was related to a metal plates in my head that I had put in as a kid- the pain was concentrated mostly around them (which is the whole left half of my skull). The Doc explained that it was almost certainly just my migraines, that were getting worse from stress. He then asked if I wanted a referral to a Neurosurgeon and Opiods. He was shocked when I said I just wanted Neurology. He was surprised that I trusted him. Probably not that flat, but he auto- assumed that I would want to dig deeper. He seemed quite happy when I took the perscription for ibuprofen and went on my way. I was back in for chest pains two weeks later (my mother died of a heart attack at 38, so it was a serious worry). Again, this doctor was surprised when I nodded being told that it was inflamation of my rib cage courtesy of Fibromyalgia, and indigestion from the Ibuprofen- even more surprised when I was fine not being persciribed anything. I've tried and had nasty side effects to pretty much all pain meds but Opiods, and I don't want to touch those with my family history of addiction. And they upset my tummy, so it wouldn't have helped the indigestion. Interesting but unrelated, I'm with a new Neurologist who has persciribed me Ajovy for my migraines. It's actually working amazing, just gave myself my fourth dose yesterday. I cried, but it's worth it. And medicare actually covers it, since I've failed on every other treatment. P.S. Your channel makes me really respect my team, and I am so proud to say that my local healthcare network follows your healthcare 3.0. I'd bet the people in charge here are fans.
I am so excited to see this. I will be getting the book. After working in healthcare for the last ten years and seeing the moral corruption going on at patient expense I just couldn't take it anymore. I went into healthcare to help others and found the disconnect was so deeply seeded on so many levels I couldn't help much at all. I have spent the last 2 years wanting to scream from the rooftops about what I have seen and experienced. Good for you for giving a voice to all I have seen.
You could start by getting the MBAs out of hospital adminitstration and the health provider networks. The financial mindset is Mars, while doctors and nurses are Venus. Two different mindsets, two different goals.
erynlasgalen1949 I would say that going after the MBAs is an elephant response. It seems to me that it will take people with a financial mindset, a medical mindset, a political mindset and an ethical mindset to solve the problem. (And no I do not think they are mutually exclusive.)
Please don't assume the worst of people in administration -- a lot of us are going into it specifically so that we can help fix these problems. Although I confess, I'm coming from a clinical background and I have a strong passion for the clinical side of things and feel like I'm sacrificing that in order to focus on becoming a hospital administrator ... so maybe you do have a point haha
Excellent job you guys are doing by exposing the truth and proposing feasible solutions to this mess... this give us hope that things can actually improve in the future! 👍👍👍❤
Once again, excellent information! Wonderful guest and enlightening. I work for an independent imaging company and yes, there's still some "mark-up", but it's NOTHING compared to the health systems in our area. Also, the ambulance companies around here are absolutely ridiculous re: costs. I will be getting this book for Kindle and recommending it to my friend's in the medical field and outside of it. Thank you!!! ❤️❤️❤️
OMG....there is SOOOOOOOOO much I could say about this broadcast Z....what an amazing hour with Dr. Marty!!! I feel like I want to buy a few cases of his book just to give to the docs, RNs and residents at my work. Having witnessed so much of this as a lab rat, it is so disheartening to see that vibrant life is being sucked out of the medical profession. I see so much unnecessary lab testing being done by residents who have either never been taught or fail to use critical thinking in the treatment of patients. The residency program at my work place could be so much improved if the leadership of the program WOULD BE WILLING to engage with those of us who have been in the field frontline. I cant tell you how many residents DO NOT KNOW how to order labs or dont know what tests are in the panels they order or just outright don't have a clue as to why they are even ordering such labs. What's worse is I have only seen it happen twice where an attending has called out their resident on why they ordered what they did. Neither times was the resident able to give an answer....how sad. It's like they are just throwing anything at the wall to see what sticks in terms of results and disgnosis. There IS NO COMMUNICATION between docs/ nurses to the pt most times because when I show up to the pts room to draw labs they are asking me... in much frustration I might add...why they are being poked AGAIN. All they know is we keep taking blood samples but nobody is telling them results or why they need to have frequent blood work done in the first place. As a phleb, I cant tell them anything about results... I tell them they need to talk to the doctor of which they quickly retort, " I HAVE YET TO SEE ONE!!" ..and the patient has been in the hospital three days already. I realize some patients fail to remember the doc visiting so that isn't always the case but the point is more how much I hear that. At the end of your talk with Dr. Marty he's states that nobody is asking for the input of frontline workers or else things would probably change at a quicker rate. Well unfortunately, I have to respectfully disagree with him at least concerning where I work. The hospital annually issues an "employee engagement survey" of which every employee is all but harassed into completing. It asks for ways to improve all the areas of the care we provide. I personally end up writing what could be considered full letters on things I see yet nothing ever changes.... I still see the hospital operate understaffed, many units without charge RNs or sufficient CNAs, constant waste of resources in areas that can easily rectified. In the lab we are continually dealing with being forced to work with garbage supplies that have intentionally replaced quality supplies for the sake of saving money, yet the hospital will overlook the egregious waste of money in other areas. IT'S UNBELIEVABLE!! I dont know why they waste money and our time on the stupid survey if they really dont listen and make quality and valuable changes. It says something when even the doctors think the way the hospital runs is a joke as well as the quality of residents hitting the market. I talked with one doc a couple weeks ago and asked them what their opinion was on the education of the residents and their ability to truly provide quality care to the public. The response was not good.... this doc is mystified at how incompetent their residents are with just the basics of care. I was told that if many of the residents they work with had to do a residency program where they did theirs, the residents would be kicked out of the program within weeks of starting. This doc is also frustrated at how the hospital has a mission statement that is in such conflict with its actual practice ...you can't be the best provider of care when you refuse to invest in those who provide the actual care...it just cant happen. I believe TurnTable health/Healthcare 3.0 and Dr. Marty along with others of us who are invested in seeing a better future for our profession come to pass will be the only reason that someday future generations will have the benefit of experiencing. This healthcare system is criminal and needs to be dumped, taking with it all the garbage practitioners who are without conscience and dont care other than to make money. Rant complete............for now!!
I wonder if that's what was going on with my doctor last year. I went in for a annual physical and talked to him about a problem with a med. I was charged for two office visits. One for the physical which was covered by the insurance and one for talking about the med, which I had to pay because my deductible hadn't been met. A month later I had a follow up with him and was charged for another office visit, which I paid because my deductible still hadn't been met. A couple months later he wanted another follow up, but I didn't go because the issue was resolved and I didn't need to pay for another office visit. At the follow up I did go to, he only talked about that one issue even though he had my blood work results and there were a couple issues on it. I'm moving to another doctor because I don't feel I'm getting quality care when the doctor will only talk about on issue per visit, and when he won't talk about some issues at all.
We actually originally streamed this interview live for Facebook Subscribers back in June, but wanted to release it to the full public closer to when Marty's book was coming out. I need to listen to Peter's interview, he's amazing!
Circa 2010. As a medical student my wife went to an obgyn at the university medical center and our university insurance paid for everything except the thyroid test, which WAS medically indicated, but which the insurance decided not to cover. A single tsh was billed at $414. I proposed that the charge seemed excessive compared to reasonable and customary... they informed me that they would not reduce the bill... and would make sure that i did not receive my degree until i paid.
These people are disgusting, I myself had a bill for almost 4 grand for 3 sutures and a tetanus shot. Thanks, for-profit UHS system, thanks a lot. Zero transparency, and I was ON STAFF there.
That's insane the tsh test only costs maybe $20 per test in that reagent(if it is similar test to what I run at work) $20 for the person +/- $2 for shift diff and maybe $5-$10 for the electricity that powered the machine for that test.
I am loving this video, ive preordered the book. My question as a nurse is how do we get on board so there is transparency to how we are staffed, why when nurses leave for whatever reason they arent replaced by new hires either ever or 6 mos to a year. Reason were given is cost saving, hospital in trouble, be a team player. Being the tyoe that makes up nurses of course we want to help out,
Leading my young adult children into the world of health care is like walking them through a mine field: "Ok, watch out for this...this one'll get you...take notes with name date and time EVERY conversation "
Also - Check out the Rosetta people who are working with major employers who are paying all direct medical costs for their employees. These employers are a key to solving the price gouging medical system. (self-insured employers) .
ZDogg, this may be off topic of this incident report, but could you do a report on the state of the American Board of Medical Specialties and the law suits against it? It is part of the idea of egregious gouging of the medical system, in this case physicians themselves. I view it as part of the overall control mechanism of the medical system and forcing compliance of physicians to play the game.
Excellent! And dont get me started on double billing! (The hospital sending you the full bill before sending it to the insurance and people paying it on top of the insurance paying it) As a led student, PREACH IT Z!!!! We need to reform this. There's no need for the state covering 2000 bucks for 3 stiches. A CAT scan does not cost thousands! The true cost is maybe 150-200usd.. an aspirin is not 2-3 bucks each, they are 5-10cents each. Think about it, lets say you get 5 150 usd stiches, 5 2 usd aspirins and 2 scans.... thats almost 6000 usd. Now lets see the same in the real price which is about 310.10c Thats a 19x mark up. A 44k bill would in reality be closer to 2315 usd. Now, i cant pay a 44k bill... but i'm able to do 2315 bucks in 12 payments of 193. Hell, i'll do 200 bucks a month. This is outrageous. Sure, the most poor will not be able to do 200 a month, but most will, and those wo cant can easily be fit into pro bono or charity. A clear and direct pricing is enough to make healthcare accesible to all. Think about it, the 44k bill is the work of a couple docs in a couple of hours.... that takes maybe 2 hours for a couple docs. Lets say the 2300 is 100% cost of materials and space. Ok, then bill 3000, thats 700 bucks for 2 hours of work. 350 an hour for each doc is plenty, thats over 3 quarters of a million a year @40hs a week. Hell, give 150 as revenue to the hospital, make the doc get 200 an hour. Thats almost half a million a year @200 usd @40 hours. And the hospital would make 150 bucks per doctor hour of revenue + material's cost. If there are 50 docs, that 150 per hour is 64 million a year. Sure these may be a little inflated, cut it in half. Is still 32 million for nothing. After all mterials, space, etc. Costs'
I paid all of my bills as they arrived. I got a bill to complete the charges my insurance did not pay for $1.37 . I didn’t pay it, not maliciously, I just figured it would go away. I had paid thousands. My bill was given to a debt collector. My credit rating went down.
So the takeaway is... 1) Inappropriate Care - like unnecessary tests/exams, just to collect the data, instead, we should ask how the result of a test will change how the doctor will proceed... I've heard it said that the majority of costs are incurred to extend the end-of-life by a couple years. I think this latter problem is a result of a death-phobic-culture. See Stephen Jenkinson! 2) Pricing Failures - for example, the lack of transparency. Every hospital bill is negotiable, if you can find the right person in charge! I've heard Dr. Marty say that a person should know whether they need a diagnostician, or a proceduralist doctor. The surgeon, for example, should have plenty of experience (volume) and be responsive (ask the nurses if the doctor is harder to reach when there are post-surgery complications). Would love to hear Dr. Marty's thoughts on Chris Kresser's approach outlined in 'UnConvential Medicine'.. where he suggests strategies to lower costs, including increasing the scope of RNs to do the more common tasks that only doctors are allowed to do. See the a16z podcast with Patrick Conway where he discusses how Blue Cross Shield of North Carolina is trying to change the way insurance companies work!
My aunt had to have a double lung transplant to live. She will owe that hospital for the rest of her life. On top of all this debate, the non-profit hospitals don't want competition to come in either, they'll do anything to convince the community that we don't need more hospitals in the area. If anything we need another one of their hospitals. I feel like i shouldn't have to travel hours away to get healthcare that i can afford.
"When was the last time I ate at a hole-in-the-wall Chinese restaurant with bullet proof glass?" Uh, every take out Chinese restaurant in bad neighborhoods...
Refusel to except payments on bills hurts the poor, its also poor shaming, my moms refusing to see her doctor because of this. I got health issues to & i avoid the er because apparently if your poor, fat, ugly, take meds for multiple invisible illnesses its we cant find nothing wrong, one time when i was leaving the ER i heard someone refure to me as a drug seeking hyperchondriact. I went home had an asthma attack that caused me to black out when it was over i refused to go back to ER because i figured if I wasn't wheezing or coughing i must be faking. I stared going back in 2012 but after injuring my knee in 2018 im not going back again especially after reading the reviews for the ER of a local hospital, people being denied care & called druggies, one person went to another hospital & found out she had brain bleed, another women had dead fetus inside her & they refused to remove it claming abortion. It was dead... This is why i dont trust & hate doctors. Sorry nothing against you but i had to share my feelings.
I think we need a law, not just a Presidential Executive Order, that says all prices must be transparent and on the web, like the Surgery Center of Oklahoma. And that the price must be no more than 5% (or whatever is supported) than the best price they accept from a payer. That doesn't include charity cases they provide at a reduced rate and not the government mandated Medicate/ Medicaid price, but the price they accept from their best customer or private carrier. What say you?
Sorry guys. In the USA, there is no conservative free market plan plan/model for health care. Germany can make it work by regulating private insurance companies like utilities. In the USA the insurance companies will fight tooth and nail to deregulate. That's why we are stuck debating Medicare for all.
Im on medicaid & Medicare if a hospital or doctor ever did that to me when i only get $800 a month from ssi that would be the last time i speak to a doctor or go the er. Hospitals in Africa hold patients hostage till they pay up.
My daughter has lost weight at an alarming rate, is anemic and throws up almost daily. btw she has been on insulin since she was 4. The GI doctor in network can't even scope her until the endoscopy center gets their 500 copay. not that it matters its probably autoimmune gastric aphoresis. I would be better off using the money to take her on a vacation.
Yeah medical field price gouge the hell out of its patients nothing like getting charged $4000 for 1 or 2 bags of fluids a shot of muscle relaxers, weak pain meds(heck if you are charging me that much give me the dang good stuff for my pain) and anti-nausea meds! I bet they upcharge cause the doc banged her head on the light while in the room with me lol pfft fixing the opioid crisis my butt I'd run the risk of overdosing before I ever go back to that expensive ER!
$200,000 helicopter?? What a lie! The medical equipment inside costs more than that. How about multiple MILLIONS to buy a helicopter? And hundreds of thousands of dollars a year just in maintenance alone? You have no idea what you're talking about.
This is fantastic! I work for Intermountain Healthcare in Utah. Our new system President & CEO Marc Harrison, is obsessed with fulfilling the call of delivering the highest quality healthcare to all at the lowest possible cost. I am a Department Nurse Manager. Part of our yearly goals every year is to reduce usage and cost on our departments any way we can to help reduce the cost to our community. Under his lead the system has started Civica RX which is a drug company created to produce some of the medications that the pharmaceutical companies are price gouging on. They produce it and supply it at a drastically lower cost to hospitals to deliver to patients at a significant lower cost. This is only one innovative ways he is leading our system to change the mindset of what healthcare should be and how much it should cost. ZDoggMD...you should do a piece on how flipping amazing this system is and what we are doing to decrease our patients cost.
This is probably one of the best podcasts I have ever heard. I literally got goosebumps several times during this interview! I posted it on my LinkedIn account. I would work for any organization with this vision and these values! Thank you Drs. for honoring your oath and your vocation. Hats off to you for your fearlessness!
When is the last time you ate at a restaurant, paid your check, only to receive by the mail bills from the chef, busboy, dishwasher, and doorman ?
And they sometimes show up MONTHS later.
With no prices listed.
bonus points if there are codes for tests that you don't remember being done.
Perfect analogy
YES!! Becoming a "grownup" 30 years ago I was astounded at how healthcare worked in relation to other businesses. Now as an RN I'm still astounded. I relate to my patients on a RealTalk level where we have conversations about how their insurance coverage factors in to the care my clinic provides. We talk to them like the consumers they are to try and minimize the surprises, but there is so much we as providers don't know either!
This is exactly what I'm talking about, when I tell people it isn't just one part of medicine and healthcare that's broken! This is a big part of it, but so many people just want to take a one facet approach and it's a multifaceted problem! Thank you Dr. Makary and ZDogg, for helping shed light on the real problems with the healthcare system!
I've been working for years on a concept for scaling Direct Primary Care -like models into full-scale hospital options, which could offer sliding-scale rates but still operate remuneratively. It's SO EXCITING to see a conversation like this and to be able to learn from what you guys have to share. Thank you for publishing this! I love this kind of material and it's a vital source of self-education for aspiring future hospital administrators like me!
You are both heroes; please keep your voices strong and continue to speak truth to power. I am an occupational therapist and have the same experience even at the level of rehabilitation. And don't even get me started about SNF. Thank you.
Susan Merrill....what is SNF?
Skilled Nursing Facility
This is your best guest yet!
Thank you. My heart rate has been 80% of max for an hour and a half. Now I don't have to do my cardio today.
You are touching on people's pain, great speech, this is a great plateform to start with for futue change. Appreciate your patience, strength, professionalism and humanity. I would love to be in your team.
This guy need to go on Joe Rogan as well. Great podcast. I already pre-ordered the book.
Without fail, when i talk to friends, family or patients who arent in medical field and show distrust in doctors the fear/anger is based on feeling they are commodities. That they are being scammed in some way. Primary way ive heard the trust has been broken. Super sad as doctors are just as frustrated if not more with price gouging. Thank you for taking time to address this.
It's horribly frustrating to think we're complicit in the financial RAPE of our patients, because that's exactly what it is. We need to stand up together and say ENOUGH.
I’m so grateful Dr. Marty (Sir, just know you’re friggin awesome) frequents DC. That this is getting bipartisan support.
This is important. Pull the blinders back on the hidden financial practices going on behind healthcare today. Shine the light of truth on what is going on. Transparency is so important for a true renewal of healthcare. Kudos to you. More of this please.
One of the major problems in health care delivery is the medical decisions are now made by accountants.
As a frequent flier patient, when it comes to over treatment, trust your patients to trust you. Especially with younger patients who are chronically ill, we probably come in wanting to know if what is wrong is normal or if we should be worried. If you tell us it's a normal connection to our conditions, we usually trust you. We don't need excess testing or added medications. I don't enjoy that I now have needle scars like a heroin addict.
Everytime I go into the doctor, even just to get my Ritalin perscription, if I make any complaints- their immediate react will always be to look at the list of medications I haven't tried and think of tests that will placate me.
They don't do it for money or anything nefarious, they really mean good for me. But it's not what I want. I just want communication. communication communication communication. *communication.*
I went into the ER last year for a horrible headache, so bad I was in and out of consciousness. I was worried it was related to a metal plates in my head that I had put in as a kid- the pain was concentrated mostly around them (which is the whole left half of my skull). The Doc explained that it was almost certainly just my migraines, that were getting worse from stress. He then asked if I wanted a referral to a Neurosurgeon and Opiods. He was shocked when I said I just wanted Neurology. He was surprised that I trusted him. Probably not that flat, but he auto- assumed that I would want to dig deeper.
He seemed quite happy when I took the perscription for ibuprofen and went on my way.
I was back in for chest pains two weeks later (my mother died of a heart attack at 38, so it was a serious worry). Again, this doctor was surprised when I nodded being told that it was inflamation of my rib cage courtesy of Fibromyalgia, and indigestion from the Ibuprofen- even more surprised when I was fine not being persciribed anything. I've tried and had nasty side effects to pretty much all pain meds but Opiods, and I don't want to touch those with my family history of addiction. And they upset my tummy, so it wouldn't have helped the indigestion.
Interesting but unrelated, I'm with a new Neurologist who has persciribed me Ajovy for my migraines. It's actually working amazing, just gave myself my fourth dose yesterday. I cried, but it's worth it. And medicare actually covers it, since I've failed on every other treatment.
P.S. Your channel makes me really respect my team, and I am so proud to say that my local healthcare network follows your healthcare 3.0. I'd bet the people in charge here are fans.
I am so excited to see this. I will be getting the book. After working in healthcare for the last ten years and seeing the moral corruption going on at patient expense I just couldn't take it anymore. I went into healthcare to help others and found the disconnect was so deeply seeded on so many levels I couldn't help much at all. I have spent the last 2 years wanting to scream from the rooftops about what I have seen and experienced. Good for you for giving a voice to all I have seen.
You could start by getting the MBAs out of hospital adminitstration and the health provider networks. The financial mindset is Mars, while doctors and nurses are Venus. Two different mindsets, two different goals.
erynlasgalen1949 I would say that going after the MBAs is an elephant response. It seems to me that it will take people with a financial mindset, a medical mindset, a political mindset and an ethical mindset to solve the problem. (And no I do not think they are mutually exclusive.)
Please don't assume the worst of people in administration -- a lot of us are going into it specifically so that we can help fix these problems. Although I confess, I'm coming from a clinical background and I have a strong passion for the clinical side of things and feel like I'm sacrificing that in order to focus on becoming a hospital administrator ... so maybe you do have a point haha
Excellent job you guys are doing by exposing the truth and proposing feasible solutions to this mess... this give us hope that things can actually improve in the future! 👍👍👍❤
Thank you both for all that you do. I just purchased The Price We Pay book.
Once again, excellent information! Wonderful guest and enlightening. I work for an independent imaging company and yes, there's still some "mark-up", but it's NOTHING compared to the health systems in our area. Also, the ambulance companies around here are absolutely ridiculous re: costs.
I will be getting this book for Kindle and recommending it to my friend's in the medical field and outside of it.
Thank you!!! ❤️❤️❤️
ZDogg - You've GOT to watch the Big Short! He's right and this movie is the perfect example of how to tell this story.
OMG....there is SOOOOOOOOO much I could say about this broadcast Z....what an amazing hour with Dr. Marty!!! I feel like I want to buy a few cases of his book just to give to the docs, RNs and residents at my work. Having witnessed so much of this as a lab rat, it is so disheartening to see that vibrant life is being sucked out of the medical profession. I see so much unnecessary lab testing being done by residents who have either never been taught or fail to use critical thinking in the treatment of patients. The residency program at my work place could be so much improved if the leadership of the program WOULD BE WILLING to engage with those of us who have been in the field frontline. I cant tell you how many residents DO NOT KNOW how to order labs or dont know what tests are in the panels they order or just outright don't have a clue as to why they are even ordering such labs. What's worse is I have only seen it happen twice where an attending has called out their resident on why they ordered what they did. Neither times was the resident able to give an answer....how sad. It's like they are just throwing anything at the wall to see what sticks in terms of results and disgnosis.
There IS NO COMMUNICATION between docs/ nurses to the pt most times because when I show up to the pts room to draw labs they are asking me... in much frustration I might add...why they are being poked AGAIN. All they know is we keep taking blood samples but nobody is telling them results or why they need to have frequent blood work done in the first place. As a phleb, I cant tell them anything about results... I tell them they need to talk to the doctor of which they quickly retort, " I HAVE YET TO SEE ONE!!" ..and the patient has been in the hospital three days already. I realize some patients fail to remember the doc visiting so that isn't always the case but the point is more how much I hear that.
At the end of your talk with Dr. Marty he's states that nobody is asking for the input of frontline workers or else things would probably change at a quicker rate. Well unfortunately, I have to respectfully disagree with him at least concerning where I work. The hospital annually issues an "employee engagement survey" of which every employee is all but harassed into completing. It asks for ways to improve all the areas of the care we provide. I personally end up writing what could be considered full letters on things I see yet nothing ever changes.... I still see the hospital operate understaffed, many units without charge RNs or sufficient CNAs, constant waste of resources in areas that can easily rectified. In the lab we are continually dealing with being forced to work with garbage supplies that have intentionally replaced quality supplies for the sake of saving money, yet the hospital will overlook the egregious waste of money in other areas. IT'S UNBELIEVABLE!! I dont know why they waste money and our time on the stupid survey if they really dont listen and make quality and valuable changes.
It says something when even the doctors think the way the hospital runs is a joke as well as the quality of residents hitting the market. I talked with one doc a couple weeks ago and asked them what their opinion was on the education of the residents and their ability to truly provide quality care to the public. The response was not good.... this doc is mystified at how incompetent their residents are with just the basics of care. I was told that if many of the residents they work with had to do a residency program where they did theirs, the residents would be kicked out of the program within weeks of starting. This doc is also frustrated at how the hospital has a mission statement that is in such conflict with its actual practice ...you can't be the best provider of care when you refuse to invest in those who provide the actual care...it just cant happen.
I believe TurnTable health/Healthcare 3.0 and Dr. Marty along with others of us who are invested in seeing a better future for our profession come to pass will be the only reason that someday future generations will have the benefit of experiencing. This healthcare system is criminal and needs to be dumped, taking with it all the garbage practitioners who are without conscience and dont care other than to make money.
Rant complete............for now!!
I wonder if that's what was going on with my doctor last year. I went in for a annual physical and talked to him about a problem with a med. I was charged for two office visits. One for the physical which was covered by the insurance and one for talking about the med, which I had to pay because my deductible hadn't been met. A month later I had a follow up with him and was charged for another office visit, which I paid because my deductible still hadn't been met. A couple months later he wanted another follow up, but I didn't go because the issue was resolved and I didn't need to pay for another office visit. At the follow up I did go to, he only talked about that one issue even though he had my blood work results and there were a couple issues on it. I'm moving to another doctor because I don't feel I'm getting quality care when the doctor will only talk about on issue per visit, and when he won't talk about some issues at all.
Slow clap for the Zdogg...👏...👏...👏
Lol literally just finished listening to him talking to Peter Attia for 3hours lmao! Must watch this one too for some added Zdogg spice
We actually originally streamed this interview live for Facebook Subscribers back in June, but wanted to release it to the full public closer to when Marty's book was coming out. I need to listen to Peter's interview, he's amazing!
ZDoggMD they made mention of the fab Dr Z in Pete’rs podcast
Looking forward for the book:) Glad you guys are talking about this.
Circa 2010. As a medical student my wife went to an obgyn at the university medical center and our university insurance paid for everything except the thyroid test, which WAS medically indicated, but which the insurance decided not to cover. A single tsh was billed at $414. I proposed that the charge seemed excessive compared to reasonable and customary... they informed me that they would not reduce the bill... and would make sure that i did not receive my degree until i paid.
These people are disgusting, I myself had a bill for almost 4 grand for 3 sutures and a tetanus shot. Thanks, for-profit UHS system, thanks a lot. Zero transparency, and I was ON STAFF there.
That's insane the tsh test only costs maybe $20 per test in that reagent(if it is similar test to what I run at work) $20 for the person +/- $2 for shift diff and maybe $5-$10 for the electricity that powered the machine for that test.
I am loving this video, ive preordered the book. My question as a nurse is how do we get on board so there is transparency to how we are staffed, why when nurses leave for whatever reason they arent replaced by new hires either ever or 6 mos to a year. Reason were given is cost saving, hospital in trouble, be a team player. Being the tyoe that makes up nurses of course we want to help out,
Hopefully we’ll get a lot more transparency in medicine over the next few decades
Exactly. Price and quality transparency are absolutely requirements.
Leading my young adult children into the world of health care is like walking them through a mine field: "Ok, watch out for this...this one'll get you...take notes with name date and time EVERY conversation "
Also - Check out the Rosetta people who are working with major employers who are paying all direct medical costs for their employees. These employers are a key to solving the price gouging medical system. (self-insured employers) .
Reading the book!!!!
I just retired from laboratory medicine. I am absolutely shocked and disgusted by this. WTH!!! I am going to get the book STAT!! Just furious!!!
ZDogg, this may be off topic of this incident report, but could you do a report on the state of the American Board of Medical Specialties and the law suits against it? It is part of the idea of egregious gouging of the medical system, in this case physicians themselves. I view it as part of the overall control mechanism of the medical system and forcing compliance of physicians to play the game.
Excellent! And dont get me started on double billing! (The hospital sending you the full bill before sending it to the insurance and people paying it on top of the insurance paying it)
As a led student, PREACH IT Z!!!! We need to reform this. There's no need for the state covering 2000 bucks for 3 stiches. A CAT scan does not cost thousands! The true cost is maybe 150-200usd.. an aspirin is not 2-3 bucks each, they are 5-10cents each.
Think about it, lets say you get 5 150 usd stiches, 5 2 usd aspirins and 2 scans.... thats almost 6000 usd.
Now lets see the same in the real price which is about 310.10c
Thats a 19x mark up. A 44k bill would in reality be closer to 2315 usd. Now, i cant pay a 44k bill... but i'm able to do 2315 bucks in 12 payments of 193. Hell, i'll do 200 bucks a month.
This is outrageous. Sure, the most poor will not be able to do 200 a month, but most will, and those wo cant can easily be fit into pro bono or charity. A clear and direct pricing is enough to make healthcare accesible to all.
Think about it, the 44k bill is the work of a couple docs in a couple of hours.... that takes maybe 2 hours for a couple docs. Lets say the 2300 is 100% cost of materials and space. Ok, then bill 3000, thats 700 bucks for 2 hours of work. 350 an hour for each doc is plenty, thats over 3 quarters of a million a year @40hs a week.
Hell, give 150 as revenue to the hospital, make the doc get 200 an hour. Thats almost half a million a year @200 usd @40 hours. And the hospital would make 150 bucks per doctor hour of revenue + material's cost.
If there are 50 docs, that 150 per hour is 64 million a year.
Sure these may be a little inflated, cut it in half. Is still 32 million for nothing. After all mterials, space, etc. Costs'
I paid all of my bills as they arrived. I got a bill to complete the charges my insurance did not pay for $1.37 . I didn’t pay it, not maliciously, I just figured it would go away. I had paid thousands. My bill was given to a debt collector. My credit rating went down.
So the takeaway is...
1) Inappropriate Care - like unnecessary tests/exams, just to collect the data, instead, we should ask how the result of a test will change how the doctor will proceed... I've heard it said that the majority of costs are incurred to extend the end-of-life by a couple years. I think this latter problem is a result of a death-phobic-culture. See Stephen Jenkinson!
2) Pricing Failures - for example, the lack of transparency. Every hospital bill is negotiable, if you can find the right person in charge!
I've heard Dr. Marty say that a person should know whether they need a diagnostician, or a proceduralist doctor. The surgeon, for example, should have plenty of experience (volume) and be responsive (ask the nurses if the doctor is harder to reach when there are post-surgery complications).
Would love to hear Dr. Marty's thoughts on Chris Kresser's approach outlined in 'UnConvential Medicine'.. where he suggests strategies to lower costs, including increasing the scope of RNs to do the more common tasks that only doctors are allowed to do. See the a16z podcast with Patrick Conway where he discusses how Blue Cross Shield of North Carolina is trying to change the way insurance companies work!
Just bought the book!
My aunt had to have a double lung transplant to live. She will owe that hospital for the rest of her life. On top of all this debate, the non-profit hospitals don't want competition to come in either, they'll do anything to convince the community that we don't need more hospitals in the area. If anything we need another one of their hospitals. I feel like i shouldn't have to travel hours away to get healthcare that i can afford.
"When was the last time I ate at a hole-in-the-wall Chinese restaurant with bullet proof glass?" Uh, every take out Chinese restaurant in bad neighborhoods...
Good stuff!
So glad to NOT HEAR OR SEE Narcissist Tom who is your fawning sycophant. You don't need flatterers.
Refusel to except payments on bills hurts the poor, its also poor shaming, my moms refusing to see her doctor because of this. I got health issues to & i avoid the er because apparently if your poor, fat, ugly, take meds for multiple invisible illnesses its we cant find nothing wrong, one time when i was leaving the ER i heard someone refure to me as a drug seeking hyperchondriact. I went home had an asthma attack that caused me to black out when it was over i refused to go back to ER because i figured if I wasn't wheezing or coughing i must be faking. I stared going back in 2012 but after injuring my knee in 2018 im not going back again especially after reading the reviews for the ER of a local hospital, people being denied care & called druggies, one person went to another hospital & found out she had brain bleed, another women had dead fetus inside her & they refused to remove it claming abortion. It was dead... This is why i dont trust & hate doctors. Sorry nothing against you but i had to share my feelings.
why hasn't this gained 50 mill views yet!?
(Don't answer, I already know why)
Yikes. Prior to PA school, I was being sued for 79k. I had to settle on 16k.
I think we need a law, not just a Presidential Executive Order, that says all prices must be transparent and on the web, like the Surgery Center of Oklahoma. And that the price must be no more than 5% (or whatever is supported) than the best price they accept from a payer. That doesn't include charity cases they provide at a reduced rate and not the government mandated Medicate/ Medicaid price, but the price they accept from their best customer or private carrier. What say you?
Sorry guys. In the USA, there is no conservative free market plan plan/model for health care. Germany can make it work by regulating private insurance companies like utilities. In the USA the insurance companies will fight tooth and nail to deregulate. That's why we are stuck debating Medicare for all.
Hca is sueing employees in TN and TX so they arent squeaky clean
Doc, loving the beard and 'stache!
“How about we actually do Capitalism/ Free Market (vs Predatory Capitalism).” Zdogg☝️🎯💯
D##m.. you are railing the calming side of me zdogg
Im on medicaid & Medicare if a hospital or doctor ever did that to me when i only get $800 a month from ssi that would be the last time i speak to a doctor or go the er. Hospitals in Africa hold patients hostage till they pay up.
When will this be available as a talkin' book?
Not yet! Lol. It's a testimony to how much I want to read it that I got the Kindle version rather than waiting for the Audible
My daughter has lost weight at an alarming rate, is anemic and throws up almost daily. btw she has been on insulin since she was 4. The GI doctor in network can't even scope her until the endoscopy center gets their 500 copay. not that it matters its probably autoimmune gastric aphoresis. I would be better off using the money to take her on a vacation.
They don't diss Martin Skreli do they?
Yeah, Queens Med HI!!
I think it's a governmental issue; could taxes pay for reduce cost? If I had to pay 6k for a treatment I'd just call it a day
Im furious. :(
Yeah medical field price gouge the hell out of its patients nothing like getting charged $4000 for 1 or 2 bags of fluids a shot of muscle relaxers, weak pain meds(heck if you are charging me that much give me the dang good stuff for my pain) and anti-nausea meds! I bet they upcharge cause the doc banged her head on the light while in the room with me lol pfft fixing the opioid crisis my butt I'd run the risk of overdosing before I ever go back to that expensive ER!
😍
Hey _”everyone else”_ cuties 😉😘
i find it weird that the profit margin of the healthcare industry averages around 5%. That's lower than tech
Great interview until "Highly attentive, eager, able body high school students" doing wound care. In other words, nurses are too expensive.
You are talking about America. The rest of the world have medicare. Get smart.
$200,000 helicopter?? What a lie! The medical equipment inside costs more than that. How about multiple MILLIONS to buy a helicopter? And hundreds of thousands of dollars a year just in maintenance alone? You have no idea what you're talking about.
time for universal healthcare. so that we the people can negotiate prices drug companies. vote Bernie Sanders FTW!!!!!
This is why we need medicare for all.
I wonder if that is ultimate goal..
I think the predators would find a way to gouge through the co-pays. Most people pay premiums for Medicare as well.
Vote Bernie!
No way. government control is all they want. the free mentality is a trap. learn from history