Fulcrum Strategies, analyzing changes in health care and how they affect you

If proposed legislation allowing Americans to buy a Medicare policy at age 50, instead of 65, passes - who benefits? Is this a good idea we should be embracing immediately? Or is there a flip side to this coin that we haven't fully investigated? Ron discusses what moving the Medicare eligible age to 50 could mean for patients, employers, insurance companies, and healthcare providers.

A recent Kaiser Foundation study indicates we could save 350 billion dollars annually if we paid all physicians and hospitals at Medicare rates. It sounds good in theory, but what's the rest of the story? You can't reduce one person's expense without cutting another's revenue, so who bears the real cost of our "savings"? Ron discusses the real-world impact of the study on the medical community.

2020 is over, back to normal - right? What can medical practices expect in 2021 as all of America tries to get back to what we had before the pandemic? Ron discusses patient volume, politics, and more as we look forward to a new year.

Congress is, to hopefully no one's surprise, overreacting. They're proposing legislation to limit the ability of hospital-based physicians to make a living, and decide for themselves the kinds of business relationships they enter, by passing a law forcing them to accept an arbitrary standard set by entities who stand to make a profit by doing it. It's like paving your entire yard because you have a few weeds. Actually, it's like having a government agent walk up to your door, tell you you have a weed problem, then inform you they're going to pave your yard whether you like it or not. Blanket surprise-billing legislation is not the answer to the anecdotal stories about big bills from non-contracted practices. Ron discusses some of the reality of Surprise Billing and what it could mean for physicians, and those of us who rely upon them.

Ron discusses what could happen if COVID ran unchecked through America.

"COVID Fatigue" has become a real force in our lives. From the monotony of isolation to the stress of loss, it affects those of us "behind the lines" in real ways. What about those on the front lines of the fight? For them, the fatigue is littoral. Doctors, nurses, EMS, hospital staff, they've been at it non-stop for nine months, and if they tire, if they're "overrun", there's just us to try to hold back the tide. Ever been to the beach? Ever tried to hold back the ocean? Ron discusses the state of front-line healthcare workers and what we might do to help.

It applies to so many situations, "don't hate the player, hate the game". Insurance companies are playing the game according to the rules they have and they're making record profits. Do we hate them? Or the game they're forced to play to maximize their shareholders' investments? The system we have now incentivizes payers to make life miserable for the 5% of health care consumers who account for 50% of all health care spending. They use tools like prior-authorization, pre-certification, fail-first pharmacy and more, all to try to make expensive members go somewhere else. What if we changed the system? Ron explores what we might be able to do to change the rules of the game and move payer's focus off shedding expensive members and onto efficiently caring for them.

So much is "up for grabs" in the next few months. Depending on the results of the election and the confirmation hearing, we could see Democrats take the Presidency and control of the Senate, as well as Republicans get the Affordable Care Act struck down by the Supreme Court. What would it mean if both sides got their way? What would happen to physicians? Hospitals? Us? Ron discusses this possible scenario and its impact on society.

President Trump spoke on Thursday about his plans for the future of health care in our country. He even signed executive orders designed to advance his agenda - but what did they accomplish? Will the directives actually change healthcare as we know it, or were they primarily political "press releases" and little more? Ron discusses his take on the plans released yesterday by the Trump administration.

Candidate Biden has released a number of details regarding what he would do for health care in America if he becomes president. Ron reviews the proposal point by point and describes how Biden's planned changes would affect American consumers and the doctors who care for them. What should physicians do to prepare for the eventuality that some or all of these changes happen? Listen to our latest podcast and find out.

Ron discusses his thoughts on moving on with "life with COVID" and how moving forward can be more useful than continuing to hold onto past arguments regarding the virus.

We're six months into dealing with COVID as a fact of everyday life, what've we learned so far? So much has changed, and the outlook is mostly positive, but it's worth noting that the knowledge we've gained to now has been hard won at times. Ron discusses what we've learned and mistakes we've made as we've all dealt with novel Corona Virus 19.

While the COVID crisis' impact on health and health care is unprecedented in many ways, its impact on the economy may be even more severe. The US GPD dropped 40% in one quarter, we've had the highest first-time unemployment claims ever in our history. We're spending money as fast as we can to try and climb out, more money than almost the rest of the world combined, but that's left us with a debt-to-GDP ratio of 136%. What will this mean for health care in the future? Medicine is the single largest industry in our economy, when the time comes to start paying for the debt we're racking up now, health care is going to be in the spotlight. Ron Howrigon discusses ramifications of the economic impact of COVID in our new podcast.

Everyone thinks they're they best, that they're doing a great job, that they have their ducks in a row - right up until someone starts publishing "report cards". As the payers publish their ratings of your performance, are you prepared to respond? How will you stack up? Can you combat mistakes, can you answer to shortfalls? Today's patients are connected, they read reviews, they research ratings, they'll compare medical practices just like anything else before they commit. If you're not keeping tabs on your own performance, rest assured someone else is. Listen as Ron Howrigon discusses transparency and ratings and how they can affect your practice.

You've heard it before, America has the most expensive healthcare in the world and we don't have much to show for it. The W.H.O. tells us our quality ranks 37th in the world behind countries like Columbia and Morocco. Does it? Take the politics out of it, and what's the real story? Even with unhealthy lifestyles - obesity, substance abuse, diabetes - our healthcare system is keeping Americans alive through serious events like heart attacks and strokes better than anyone else. Ron discusses the numbers you may not have heard in the soundbites about clinical quality in the US.

2019 seems like a decade ago. We were already concerned with the rising cost of health care and the portion of our total economy it accounted for. After COVID, health care finance will be even more brightly spotlighted. We spend more per capita than any other country on health care, nearly twice what the next country on the list spends, and we can't keep going this way. The next president, whoever it is, will have an economy severely wounded and in dire need of emergency treatment. In our new series, Ron delves into what he thinks can be done to fix the mess and get us back on track.

Capitation is coming back to some markets, are you ready? It can be helpful or harmful, a life-saver or devastating - it all depends on how you use it. Are you ready? Can you tell if a new cap agreement is good for you or bad? Do you have the data, and the knowledge, to compare a capitation contract to your current one? Ron discusses what practices need to know about getting started with a new capitation contract.

Value based reimbursement has been talked about for years, but could the combination of a massive deficit, a wounded economy, and a world wide pandemic finally be what it takes to see it happen? Ron discusses why COVID may finally be what sets the dominos in motion on widespread adoption of value based reimbursement programs.

A few months ago we were watching cases climb and predicting dire consequences for the US and the entire world. A few weeks ago we watched new cases decline and everyone was eager to get "back to normal". But did we? And have we made things worse? Ron discusses the second wave of COVID, and why a much needed attitude adjustment may help us get back on track.

We've asked it before, what will it be like for doctors in a post-COVID world? We take a closer look at three factors that will shape the new landscape: the economy, the rise of Telehealth, and the upcoming election. What can practices do to ensure they're successful "after"? You won't have to be perfect, but you will have to be better than the competition.

After the pandemic, when life returns to something resembling "normal", what will medical practices need to do to stay afloat in a perhaps seriously damaged economy? The same challenges all businesses face will still be there, but what new obstacles will be placed in your path? Ron discusses the importance of developing both strategies and tactics that will increase practices' chances of success in a post-COVID marketplace.

Evolved consumers will have new demands of their physicians. Successful practices will identify and adopt strategies to work with their highly-informed patients. Practices that cling to the old ways of seeing and treating patients may find their patient populations shifting increasingly toward Medicare and Medicaid as more demanding and better-equipped consumers find doctors who will meet their expectations.

After the pandemic many industries will likely change the way they do business going forward. What could this mean for physician practices, and how must they evolve to survive and thrive? We'll discuss the possibilities of altered and reduced benefit plans, and their impact on physician business strategy as employers look for places to reduce expenses.

What will the landscape look like after we've come through the other side of COVID and a presidential election? Depending on who wins, we could see very different approaches to getting the economy back on track, with very different consequences for medical providers. Ron discusses some of the possible steps Trump and Biden could take to help rebuild the economy when it comes to health care spending.

Economists are concerned we're heading for a "perfect storm", driven by COVID and made more severe by pre-existing economic pressures. In this series we'll be looking at the individual components, how they came together to form this perfect economic storm, and what physician practices can do to safely weather the deluge.

We continue our look into what health care could look like post-COVID. We know a new, digital-native consumer will likely dominate the patient pool, but what other changes are we likely to see? What changes will a successful practice need to make to keep up - and ahead of - changing times?

We've all spent a month or more in government-ordered quarantine, is it finally time to open businesses and get back to "normal" life? The economy has taken an immense hit, but what are the health consequences of abruptly reversing our social distancing measures? Polar opposite answers to these questions have emerged, and as usual, the best answer is probably somewhere in the middle.

What will the new consumer of health care look like after the pandemic? What will practices be looking for in "the right patient"? The digital age is going to catch up to practices, a successful group will have to be ready to accommodate patients who've grown up with instant access and digital self-service right from their phones. Phone prompt menus and paperwork in triplicate will not satisfy the digital natives who now make up a large part of the patient population.

The massive impact the coronavirus has had on our economy has us asking what our government can do to help. Washington has taken a massive step with the recent stimulus, but what else can be done to help allocate resources for those most in need?

While there's no doubt the current steps we're taking to slow the spread of the virus has been harming the economy, it's important to remember health care providers and first responders aren't just braving infection to care for us, they're doing so while suffering the same financial harm many other businesses are. Visits are down, elective procedures have been called off, most physician groups are seeing substantial reductions in revenue - all while continuing in their mission to provide care to those in need.

We've all heard some version of what a "Surprise Billing" law might do - namely, protect us from huge bills from out-of-network physicians when we go to an in-network hospital. But what would it really mean for such a law to be put in place?

Ron Howrigon weighs in on recent statements, the advance of the virus, and the stimulus bill that remains "in the works".

Helping stop the coronavirus spread is essential not only to our own health, but to the health of the economy. The world is dealing with a health crisis unparalleled in most of our experiences - but once we get through it, what challenges might we face with the economy? We discuss the possible impact of the COVID-19 virus on the world's financial health.

What would it actually cost to implement Medicare for All? Several candidates are championing the idea, but is it feasible? What would it do to the economy if we attempted it? What would happen to the demand for care and how would physicians and hospitals respond to such a program? Ron Howrigon of Fulcrum Strategies discusses his take on these questions in this episode.

This is the first installment in a series of podcasts from Fulcrum Strategies president Ron Howrigon devoted to his book, Flatlining: How Health Care Could Kill the US Economy.