Podcasts about rvu

Summary Dr. Elisa Chiang discussed strategies for creating predictability in unpredictable economic times, emphasizing that the fundamentals of the economy are generally sound, with current uncertainty stemming from external factors. She highlighted the importance of understanding economic interrelations and the potential impact of challenging international relationships. Dr. Chiang suggested that individuals and businesses should evaluate their dependencies and explore ways to become more self-reliant. For physicians, this includes recognizing the value of their skills and exploring options beyond traditional employment, such as private practice or becoming invaluable within their current roles. She also emphasized the importance of diversifying income streams and managing personal finances to reduce reliance on a single paycheck. The conversation also covered strategies for physicians to increase their income, such as specializing in high-value procedures, leveraging support staff, and improving efficiency. Dr. Chiang advised questioning fixed mindsets, challenging existing beliefs, and experimenting with new approaches to adapt to unpredictable times. She also discussed tax planning, investment strategies, and the importance of maintaining a long-term perspective when dealing with market volatility. For those nearing retirement, she recommended assessing risk tolerance, diversifying portfolios, and building a cash cushion. Dr. Chiang offers one-on-one coaching to help individuals navigate their financial situations and achieve their financial goals. Her podcast, 'Grow Your Wealthy Mindset,' provides financial literacy in bite-sized pieces, helping listeners build the knowledge and mindset needed to create financial stability. Chapters Introduction to Predictability in Unpredictable Times Elisa Chiang was invited to discuss creating predictability in unpredictable economic times. The discussion is framed as non-political, focusing on the factual unpredictability of the world. The goal is to provide strategies for individuals to make their financial situations more predictable. Economic Fundamentals and Global Interdependence Chiang stated that the fundamentals of the economy are still good, unlike the issues in 2008 with banking regulation. The current uncertainty is attributed to the actions and statements of certain individuals. The discussion highlights the importance of understanding the complexities of economics and global interrelations. Anytime decisions are made from an independent place, you start to realize we're actually not independent at all. Challenging Independence and Embracing Interdependence Chiang suggests challenging the idea of complete independence and recognizing interdependence on others. Asking questions about dependencies and self-reliance is valuable, but actions must be carefully considered. Many people feel dependent on their paycheck, but physicians have options due to the physician shortage. Separating the ability to produce income from the current job can create stability. Creating Independence and Managing Control The discussion covers the mentality behind creating a private practice and the desire for independence. It's noted that even in private practice, there is still interdependence on systems and people. The focus should be on how to become independent and self-determining results in situations where you don't have control over all of these things. It's important to understand what you can and can't control. Strategies for Exerting Independence Chiang suggests becoming an entrepreneur within your job to make yourself invaluable. This involves attracting patients directly and highlighting your value to the practice or institution. Employers care about generating income, so making yourself invaluable in this area is crucial. Taking care of personal finances and creating multiple income streams reduces reliance on a single paycheck. Translating Value into Income The inherent value of experience, training, and knowledge is highlighted. Physicians translate this value into income through their actions. The trap of trading time for money limits income potential unless value is translated into different income streams. The discussion explores ways physicians can generate income outside the classic RVU model. Increasing Income within the Physician Realm Specializing in specific procedures or surgeries can elevate income. Leveraging other people, such as nurse practitioners, can double clinic output. Hiring scribes can increase productivity and collections. Physicians should work at the top of their income level, delegating tasks to others. Mindset Shifts for Unpredictable Times Adopting a growth mindset can help individuals respond more effectively in unpredictable times. Questioning current beliefs and challenging the status quo is important. Comparing oneself to others who are thriving can provide insights and motivation. Willingness to spend money to make money and accepting failure are key to success. Helping Individuals Deal with Change Questioning the truth of current situations and exploring potential changes is crucial. Experimenting with small changes and learning from others can lead to improvements. Advocating for necessary resources, such as dedicated scrub techs, can increase efficiency. Believing in the potential for change and presenting a clear case for it is essential. Financial Viability in Private Practice A simple formula for private practice success is income minus expenses minus tax burden. All three factors can be influenced in different ways. Leveraging people, doing more cases, and optimizing income streams are ways to increase income. Tax burden can be managed through various strategies. Tax Planning and Side Businesses Every time is unpredictable, so framing the mindset accordingly is important. The more we think like, yeah, the world is doing whatever it's worlding. The world is doing whatever it's doing. We can make our own predictivity, then we don't have to keep thinking like, oh, it's unpredictable, and we have no way to affect it. It's just always unpredictable. As a W-2 employee, there are limited options for tax reduction. Having a side business can provide opportunities to write off personal expenses. Side hustles should align with passions and translate into value and money. Time Management and Productivity Finding something else that you need to find you having to find more time in order to do something helps you structure your time so that you are most efficient with your time. Limited time resources require careful management. Calendaring and time-blocking can improve efficiency. Having a list of tasks that can be done in 10-15 minute intervals can boost productivity. Managing Retirement Funds If retirement is 10 years or more away, continue with the financial plan and consider contributing more. Maximize retirement accounts and explore other savings options. Buying stocks when they are on sale can be a great strategy. Establish a risk tolerance and adjust investment strategies accordingly. Investment Strategies and Risk Tolerance The stock market tends to go up over time, especially with more people investing. Investing during downturns can lead to better outcomes. Even in retirement, there is still a long investing career ahead. Avoid panic selling and maintain a long-term perspective. Retirement Planning and Withdrawal Rates Assess investment strategies and consider shifting to a more conservative portfolio if nearing retirement. Develop a cash cushion to avoid selling stocks during the first few years of retirement. Understand what money is for and focus on enjoyment and security. Consider a Monte Cristo analysis to assess the chances of running out of money. Dr. Chang's Coaching and Podcast Chiang offers one-on-one coaching to help individuals reach their financial goals. She provides a judgment-free zone to discuss finances and job transitions. Her podcast, 'Grow Your Wealthy Mindset,' provides financial literacy in bite-sized pieces. The podcast helps listeners learn the information and mindset needed to create financial stability. Action Items Dr. Chiang suggested individuals and businesses should evaluate their dependencies and explore ways to become more self-reliant. Dr. Chiang advised physicians to recognize the value of their skills and explore options beyond traditional employment. Dr. Chiang emphasized the importance of diversifying income streams and managing personal finances. Dr. Chiang recommended questioning fixed mindsets and experimenting with new approaches. Dr. Chiang advised assessing risk tolerance and diversifying portfolios. Dr. Chiang recommended building a cash cushion for those nearing retirement.Growyourwealthymindset.com

Proven Strategies to Earn More While Working LessWhat if cutting your hours didn't mean cutting your income? In this episode, Tracy unpacks exactly how to negotiate your compensation when you make the leap to part-time work—and spoiler alert: you can earn more while working less.Most clinicians default to accepting prorated salaries without question, but that doesn't have to be your story. There are smarter, more strategic ways to structure your pay—and this episode shows you how to ask for them with confidence.

 Think going part-time means slashing your salary? Think again. In this episode, I'm busting the biggest myth about part-time clinical work—that you have to earn less. I'll walk you through creative ways to get paid that aren't salary, from hourly rates and RVU-based pay to bonuses and side gigs. You'll learn how to structure your compensation to increase income, maximize flexibility, and negotiate like a pro. If you're ready to work fewer hours without sacrificing your financial goals, this episode is a must-listen. Plus, I've got free resources to help you make the leap and expert support for your part-time pivot. Let's build a role that fits your life. part-time PA jobs, salary negotiation, RVU pay, productivity-based pay, hourly clinical roles, part-time provider income, shift differentials, clinician side gigs, PA compensation tips, work-life balance, provider coaching, physician associate podcast, clinician burnout recovery, PA work schedule flexibility, healthcare income tips, part-time clinician strategies, negotiating part-time contracts, PA work-life balance, creative compensation models, flexible healthcare jobs, PA career coaching

February 28, 2025 Scott, Mark, and Dr. Ray Painter break down the challenges of securing fair compensation for extra work performed in urology procedures when using modifier 22, unlisted codes, or Category III codes. They discuss effective strategies for communicating with payers and contract administrators, ensuring proper documentation, and negotiating fair work RVU adjustments.Free Kidney Stone Coding CalculatorDownload NowPRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a Quote Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ 

This week we enter the world of cardiac CT for congenital heart disease reviewing a recent report of a survey of congenital cardiologists who perform congenital heart CT scans. What have been the important trends seen in the past decade beyond expansion in the field in general? Why has the use of the CT scan grown at such a rapid clip? How much radiation does a present day CT scan represent for a patient? How are cardiology fellowships responding to the growing role of this modality in the field? How can we more properly assign accurate relative value units (RVU's) to the significant work effort involved in the performance and reporting of this novel modality. We speak with the first author of this week's work, Assistant Professor of Pediatrics at Weill Cornell, Dr. Rebecca Epstein.  doi: 10.1016/j.jcct.2024.02.002. Epub 2024 Feb 15.

“Labor is supposed to happen naturally. It's not this big medical intervention that occasionally happens naturally. It's this natural process that occasionally needs medical intervention.”Paige Boran is a certified nurse-midwife from Fort Collins, Colorado. She and her colleague, Jess, practice independently at A Woman's Place. They have rights to deliver babies at the hospital but are not employed through the hospital system so they are not subject to physician oversight. Their patients benefit from a low-intervention environment within a hospital setting but without the restriction of hospital policies.Lily Wyn, our Content Creator and Social Media Admin, joins us today as well! Lily shares why she chose Paige to support her through her current VBAC pregnancy. Lily is a beautiful example of how to diligently interview providers, keep an open mind, process past fears with the provider you choose, and what developing a relationship looks like to create an empowering birthing experience. Paige shows us just how valuable midwifery care can be, especially when going for a VBAC. If you're looking for a truly VBAC-supportive provider, this is a great episode on how to do it! The VBAC Link's VBAC Supportive Provider ListA Woman's PlaceHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Paige: Yeah, so I'm a certified nurse-midwife. I work in northern Colorado in Fort Collins at A Woman's Place. We're a small midwifery-owned practice. Right now, there are just two CNMs. That's the whole practice. It's just me and my colleague, Jess, who owns it which is really cool because we get to push the boundaries because we are not really locked into the hospital system. We are able to catch babies there but we are not actually employed through the bigger hospital systems which is nice because we don't have that physician oversight and stuff like that. I think we are able to do a lot more and honor that midwifery care model which is really cool. Sometimes people feel locked into policies and their overseeing physician and things like that but when it's just two midwives, we get to do what we want and what feels best for the patient. I really like that. That was a big thing when I first got into the certified nurse midwifery world. I was like, where do I want to work? I had offers from bigger hospital systems and it just didn't feel like the right fit so working at a small, privately-owned practice felt like the right answer for me so I was able to practice in a way I felt was right for people. I didn't want to be locked in by a policy and overseeing physicians. I just wanted to grow with other midwives. Meagan: Yes. I love that so much. I don't know. Maybe I should say I know it feels to me– I don't know it as an actual fact, but that feels like a unique situation and a unique setup to me. We don't really have that that I know of here in Utah. We either have out-of-hospital CPMs or we have in-hospital CNMs who are just hospital. I know that one hospital system is trying to do the attached birth center, but it is still very different. They are still the hospital umbrella midwives I guess I could say. So is that unique or is that just something that feels like it?Paige: I think it's unique because where I came from in Florida, if you were a CNM, you 100% practiced in the hospital which we do but it was that you were owned by a larger group of physicians essentially. Florida was working towards independent practice when I was there. Colorado is an independent-practiced state for nurse practitioners which is really cool because we don't have to have that oversight. I don't know if Florida ever got there but I know it varies state to state on if you have to be overseen by a physician or not. Honestly, that's why a lot of people when they are ready to become a midwife, if they don't have independent practice rights as a CNM even if they are a nurse, they will go for a CPM which is a certified professional midwife because they actually have more autonomy to do what they want outside of the hospital because they are not bound by all of the laws and stipulations which is interesting. Meagan: Exactly. I think that's a big thing– the CPM/CNM thing when people are looking for midwives. Do you have any suggestions about CPM versus CNM? If a VBAC mom is looking at a CPM, is that a safe and reasonable option?Paige: Absolutely. Yes. I think CPMs and CNMs are both reasonable, safe options. They both have training in that. They both can honor your holistic journey. I would say the biggest thing is who you feel most connected to because I think trusting your team, you will have people who have the worst birthing outcome and horrible stories but they are like, “I look back and I feel so good about it because I trusted my team.” I think that is what's important. If a CPM seems like your person and that's who you are going to trust, then that's who you should go for whereas a CNM, if that seems like that's your person and who you trust, I think that would be a good route too. I think a lot of people think, “Oh, they do home births. They must catch babies in a barn and there is no regulation. Even sometimes when I say, “midwife,” people are like, “What? Do you dress like a nun and catch babies in a barn?”Meagan: Yes, this is real though. These are real thoughts. If you are listening, and not to make fun of you if you think this, this is a real thing. This is a myth surrounding midwifery care, especially out-of-hospital midwives where a lot of people think a lot of different things. Paige: Absolutely. Meagan: I think I had a chicken chaser or something where a dad was like, “Do you chase chickens?” I was like, “What?” He said, “Well, that's what the midwives do so that's what the doulas do.” I'm like, “What? No, we don't chase chickens.” Paige: That is such old-school thinking but realistically, midwives started in the home and that was their history. It's cool that they've been able to step into the hospital and bring some of that back into the hospital because I think that is needed. Meagan: It is needed, yeah. Paige: We are starting to see that physicians are starting to be a little bit more holistic and see things in the whole picture, but I'm glad that the midwives did step into the hospital because I think that needed to be there but I'm so glad that people are still doing it at home because I think that is such a good option for people. Meagan: Yeah, so talking abou the midwives in the hospital, a lot of people are talking about how they are overseen by OBs. Is this common? Does this happen where you are at? You kind of said you are separated but do the hospital midwives in your area or in most areas, are they always overseen by OBs? Paige: Not necessarily. It would vary state to state and hospital to hospital. We actually just got privileges and admitting privileges a couple of years ago. Actually, my boss, Jess, who owns the practice where I work, had worked in Denver where they were allowed to admit their patients and everything. They didn't have to have any physician oversight but when she was there, she had to have physician oversight. She was like, “It's an hour drive north, why would that make a difference?” It was the same hospital system so she fought when she bought the practice and the physician who owned it prior left, she was alone and she had to have that physician oversight so she fought for independent practice privileges and she got it. Some of the midwives at first weren't so happy about it because they had liked being overseen by the doctor and someone signing off on all of their things. Some of the midwives were like, “Finally. We should be able to practice independently.” It's going to vary at each place. But I think that's a good thing to ask, “If something is going wrong, will a physician just come unannounced into my room in the hospital?” That's not the case with ours. We have to invite them in and if we are inviting them in, we've probably had a conversation multiple times with the patient where it's like, we need to have this. Meagan: Yeah. For the patients who do have the oversight of the OBs, do you have any suggestions? I feel like sometimes, at least here in Utah with my own doula clients when we have that situation, it can get a little confusing and hard when we've got an OB over here saying one thing but then we've got a midwife saying another. For instance with a VBAC candidate, “Oh, you really have a lower chance of having a VBAC. I'll support it. I'll sign off, but you have a really low chance,” but then the midwife is like, “Don't worry about that. You actually have a great chance. It is totally possible.” It gets confusing. Paige: Yeah, and it's like, who do you trust in that scenario? I think that's where evidence comes in because I think midwives and physicians both practice evidence-based but some people may have newer evidence than others. I've worked with OBs who probably roll over in their grave when I say certain things because it wasn't the old way but it is the new way. If somebody can come in with their own evidence and they're like, “I've looked into this and I think I'm a good candidate for x, y, and z,” I think physicians respond well to that because they are like, “Okay, they've done their research. Maybe I need to do some research.” Meagan: Yeah. Paige: When they have that thought, they know that this is an educated person and I can't just say whatever I want and they're going to take my word as the Holy Bible. Meagan: Yeah. No, really. Exactly. It always comes down to education and the more information we can have in our toolbelt or in our toolbox or whatever it may be, it's powerful so I love that you point that out. I think it's also important to note that if you do have two providers saying different things, that it's okay to ask for that evidence. “Hey, you had mentioned this. Can you tell me where you got that from or why you are saying that?” Then you can discuss that with your other provider. Paige: Yeah, and following intuition too. I think you can have all of the evidence in the world. What is your gut telling you too? Who do you trust more and what feels right in your body in the moment? I think we are all experts of our own bodies and there's a lot that goes into a VBAC and stuff like that. It's more than just the evidence. People have to feel mentally and physically ready for it too. I wish more people focused sometimes on the mental and spiritual aspect of it because I think a lot of people get ready physically but maybe mentally they weren't prepared for the emotional switch there. Meagan: Totally. Thinking about that, Paige, I mean Lily, tell us a little bit about why you went the midwifery route. I know you really wanted to find the right provider. Lily: Yeah. So I think for me, I have always been drawn to midwifery care. I was a little bit of a birth nerd prior to even working for The VBAC Link or even having my own kiddos. Prior to my son, we had a miscarriage and an ectopic pregnancy so I experienced OB care with my ectopic. I was bounced around a lot in a practice and had OBs who were great and equally some OBs where it was such a rushed visit that I had an OB miss an infection in my incisions because my pain was dismissed and just some really tough stuff. When it came to getting our rainbow rainbow baby, I was like, I really don't want to be in a hospital at all. I want midwives. That's the route that we went. The very brief story of my son is that he flipped breech 44 hours into labor and that's when we legally had to transfer to the hospital and I had my Cesarean. So in planning my VBAC, I planned to go back to the birth center and was a little devastated when it was out of our financial means this time. I was so panicked. I remember texting you, Meagan, and being like, “What do I do? I can't be at the birth center anymore and I don't want to be in a hospital.” We interviewed another birth center that's about an hour away that is in network with our insurance and talk about trusting your gut, it just didn't feel right. It didn't feel warm and fuzzy. Those are the feelings I got with our first birth center. I loved them so much and I still do. Then I met with Paige and her practice partner, Jess, and I came in loaded to the teeth. I was prepared to fight with someone because that's what I had in my brain and that's what I expected. I sat down with them. They met me after hours after clinic. I sat down with my three pages of questions and by the way, if you are listening and you have questions, we have a great blog on it and some social media posts of the questions that I specifically used. We talked for over an hour and every question I asked, they just had the ultimate answer to. I felt so at peace after talking with both of them and I remember telling my husband going into it, “I'm really worried that I'm going to like these people because I don't want to deliver at a hospital and then I'm going to have to choose a far away birth center that is out-of-hospital or providers that I like but it's a hospital.” It just feels like everything has been serendipitous for us. Our hospital opened a low-intervention portion of their birth floor so I'll still get to have the birth tub and all of the things, but truly have just been blow away by Paige and have just buddied up. She's dealt with all of my anxiety in pregnancy and VBAC and all of my questions. It just feels like such holistic care compared to my experience with OBs in the past. Meagan: That is so amazing and I was actually going to ask how has your care been during this pregnancy? It sounds like it's just been absolutely incredible and exactly what you needed. I remember you texting me and feeling that, oh crap. I don't know what to do. What do I do? You know? I just think it's so great that you have found Paige. Did you say that Jess is your partner? Paige: Yes. Meagan: Jess, yeah. I'm so glad that you found them because it really does sound like you are exactly where you need to be. Lily: Yeah. It made a huge difference for me and I just tell Paige all the time I truly didn't know that care in a hospital setting could look the way that it does. I feel like I'm getting– I experienced birth center care. I had an out-of-hospital experience until we transferred and I can say with confidence that my care has been the same if not better with Paige and just having the conversations and the good stuff and feeling really safe and confident. One thing that they pointed out that I thought was great when I went in and asked all of my questions is that Jess looked at me and she was like, “Okay, it sounds like you have a lot of anxiety around hospital transfer.” And I did. With my son, that was my worst fear and it came true. I had a lot of anxious, what if I have to transfer? She was like, “The thing is there is no transferring. We can induce you if you need to be induced and we can come with you into the OR with your Cesarean if that ever happened to be another thing.” For me, that brought a lot of peace to know that no matter what, the provider that I know and feel comfortable with is going to be with me. I again, didn't expect to feel that way, but it's been a really great reassurance for me personally. Meagan: Yeah. It's the same with a doula. Knowing that there's someone in your corner that you know who you've established care with who can follow you to your birth with you in your journey is just so comforting. So Paige, I wanted to talk about midwifery care and also just lowering the chance of Cesarean. Sometimes people do choose midwifery care specifically because they are like, “I think I have a lower chance of a Cesarean if I go the midwifery route.” Can we talk to that a little bit?Paige: Yes, that's true. A lot of people know that there are benefits to midwives but I think when people think of midwives, it's just like, “Oh, it's just a better experience. I trust my team more.” That's definitely there. There have been studies and people felt more at peace and empowered through their birthing journeys with midwives than they did with OBs. It's been studied but there is also a decrease in C-section risk. Your C-section risk drops 30-40% when you have a midwife which I think is a pretty significant drop. Meagan: Yeah. Paige: Yeah, especially when we look at the United States at our birthing outcomes and birthing mortality and C-section rates, it is way too high for as developed of a country as we are. I think that's really where midwifery care is stepping in and starting to help lower those rates to get it down to where it should be. The World Health Organization has been nominating and promoting midwifery care because it really is the answer to how we get these C-section rates lowered and these bad outcomes lowered. Midwives also have lower chance of an operative vaginal birth. That would be with forceps or a vacuum or an episiotomy so lower chances of those things as well. Lower chance of preterm birth which is interesting and probably because one, we do take lower-risk people. I think that's true but also because we are looking at it holistically. We are looking at everything. We are not just looking at you as a sick person. A lot of people look at pregnancy as an illness and pregnancy is not an illness. It's just a natural part of life and we've got to look at the whole picture of life if we're just going to look at the one thing too. I think that helps to reduce preterm birth risk. We also have lower interventions just overall. We're more in tune with people's bodies and we want to honor what their bodies are meant to do. Labor is supposed to happen naturally. It's not this big medical intervention that occasionally happens naturally. It's this natural process that occasionally needs medical intervention. The midwifery model is so important. I think when you go to the traditional medical model, you look at the present illness so they see pregnancy as an illness. What can go wrong? Don't get me wrong. There are a sleu of things that can go wrong in pregnancy and you do have to watch for them. But I think with midwifery care, you know when to use your hands but you also know when to sit on them. Meagan: Yes. Oh my gosh. I love that so much. I feel like we need– we used to get quotes from our podcast episodes and turn them into t-shirts and I feel like that is a t-shirt podcast quote-worthy. Oh my gosh. It's a worthy quote. That is amazing and it's so true though. Paige: It is. Meagan: It's not to rag on OBs. You guys, OBs are amazing. They are wonderful. They do an amazing job. We love the. But there is something different with midwifery care. You mentioned preterm birth. I remember when I was going through my interview process to have my VBAC after two C-section baby and I finally established care mid-pregnancy because I switched. That was one of the things in the very beginning that my midwife was like, “Let's talk about things. Let's talk about nutrition. Let's talk about supplements. Let's talk about where you are at.” It was just honing in on that which I was surprised by because I figured she'd be like, “Let's talk about your history. Let's talk about this,” but it was like, “No. Let's talk about what we can do to make sure you have the healthiest pregnancy,” but also started commentingo n mental stuff. It helped me get healthy in my mind. I just would never have had that experience with OB where they wanted to learn what I was scared about and what I was feeling and all of those things. Not only was I learning how to nourish myself physically, but mentally and it was just a really big deal. I do feel like it played a big impact in my labor. Paige: Yeah. A lot of people discredit how much nutrition and debunking fears and stuff like that can go because I think a lot of that– I mean, we look at nutrition-wise and we could avoid almost all of preeclampsia with nutrition alone which is incredible. I'm like, “I really think you should read Real Food for Pregnancy and people are like, “Oh, but it's such a big book,” and I'm like, “But it's so important to know this information about what we should be putting in our bodies.” 100 grams of protein– you've already got it. Meagan: I want to see how many pages for it. It's got, okay. We've got 300 pages but it has recipes and all of these amazing things in the end so it's not even a full book. Paige: Yes. People are like, “Oh man, I don't know if I want to read the whole thing,” but I'm like, “It's so important.” I think when people do read it, they come back and are like, “Did you know that I could decrease my risk of this if I ate more Vitamin A?” I'm like, “Yes. That's why I wanted you to read this book.” It is a wealth of information and I have such healthier pregnancy outcomes when people follow that high protein diet and looking at micronutrients with their Vitamin A, their choline, and all sorts of things. Meagan: Yeah. All of the things that we talk about a lot here on the podcast because we are partnered with Needed and we love them so much because we talk about the choline and the Vitamin A and the Vitamin B's and the Vitamin D's. Lily Nichols, not this Lily on the podcast today, she also wrote Real Food for Gestational Diabetes and that's another really powerful book as well. But yeah. It's just hard because OBs don't tend to have the time. I think some OBs would actually love the time to sit down and dig deep into this but they don't have the time either. I do think that's a big difference between OBs and midwives. What does your standard prenatal look like? When a mom comes in, a patient comes in, what do you guys do through a visit? Paige: Yeah. We follow the standard what everywhere in America does like once a month roughly in the first trimester and second trimester then when you hit 28 weeks, every 2 weeks, and then when you hit 36 weeks, every week. If you go to 41, we'll see you twice in that week. We follow those stipulations but our appointments are a little bit longer. When you are in a big practice, a lot of time it's driven by RVU use so the more patients somebody can see, the more they are going to get paid and the bigger their bonus is at the end of year. A lot of people feel like they are running through the cattle herd and they've been in and out in 15 minutes if that. At my practice, it's a little bit different because we are not RVU based. We're not getting any bonus. We're not trying to see as many patients as we can. Will we ever be the richest at what we do? No, but that's okay with me and Jess. We are small on purpose and we love to take the time. At Lily's appointments, we always book her for at least 30 minutes because we know that me and her like to talk. We've done an hour for some people because we know there is always going to be that long conversation. Don't get me wrong though, that fourth mom whose had three vaginal births and going for her fourth, she may be like, “Paige, there's really nothing to talk about today and that's okay.” Sometimes they are 15 minutes. Sometimes they are 30. Sometimes they are an hour. Our first appointment is always an hour because there is just so much to dive into with how we can be preparing ourselves, what does your history look like especially if they are brand new to our practice and we've never met them before, starting to build that relationship early on. It just depends on how far along they are, who the person is, and those things. But I do like that I can spend as much time as I need. Sometimes I tell my people, “Bring a book because I tend to get behind because I tend to talk to people longer than I book for,” but that's okay. We know that we can do that because we are a smaller practice. I think when people are thinking about what kind of care they want, they should probably consider how are these people paid? Is it by how many they can see in a day? Because you're probably going to get a different level of care than a practice that isn't drive by those RVUs. Yeah, that's a really good point. I feel like my shortest visit with my midwife was 20 minutes. Paige: Yeah. Lily: Yeah. Meagan: Which to me is pretty dang long because when I was going with my other two daughters, I think it was probably 6-7 minutes if that with my provider. I mean, it was get in. My nurse would check my fundal height and all of that and then oh, the doctor will be in here. Then came in, quick out. Yeah. It is really, really different. Lily: I know for me too, I love that we don't just talk about nutrition and things like that but even in my last appointment, I was talking with Paige about the things that can be triggering coming back into labor and going back into a hospital so my ectopic pregnancy was at the hospital that I'll be delivering at and I had to go into the emergency room and the way that you go to labor and delivery after hours is through the ER so Paige and I were talking. She was like, “I can just meet you outside. We will badge you in and we will avoid the emergency room if that feels triggering.” It's just those things that you don't get with an OB necessarily to talk through tiny little triggers. They are probably generally less accommodating to those little things of, “Well that's just the standard. You're going to have to get over that and just go through the ED and come on up.” I think that's been huge. I also have a dear friend who is going to school to be an OB. I told Paige at my last appointment that she may possibly be at my birth. She's my crunchy friend so she'll be a great OB but I have such a desire to be like, “Come see a VBAC. Come see it so that you have it in your brain and you know that they can be safe and look at what can be done,” so I think that is so huge too as we continue to train and uplift our next generation of providers. What does that look like to show them? I think her internship or something is going to be a midwife and OB partnership practice which is really cool but I'm like, “Yes. Come. Come to my birth. Please. I want you to see all the things.” That's really cool too and that Paige is open to, “My friend might be there.” Meagan: Yeah. Paige: Bring whoever. Meagan: I love that. I love that you were pointing out too this next generation of providers. Let's see that birth and VBAC is actually very normal and very possible because there's a lot of people who have maybe seen trauma or an unfortunate situation which could have happened because we blasted them with interventions or could have happened out of a fluke thing. You don't know all of the time. But I do think if we can keep trying to get these providers, these new provider to see a different light, we will also see that Cesarean rate drop a little bit. We really, I always tell people that we have a problem. They're like, “It's really not that big of a deal.” I'm like, “No, it's a very big deal. It's a very, very big deal. We have a problem in this medical world.” I do believe that it needs to change and midwifery care is definitely going to impact that. I hope that what you were saying in the beginning how policies don't trump a lot of the midwives. I wanted to ask you. This isn't something we talked about, but is it possible to ask your midwife, “Hey, what policies do you lie under?” Is that appropriate? Paige: Yes. Actually, that was one of my favorite things when Lily came in to meet and greet us. She came and she was like, “What are the policies for a VBAC?” We dove into that. We've been diving into that and what are we going to be okay with and what are we not going to be okay with? That's the beauty is that I'm not employed by the larger hospital system that I work under so I feel like a policy is not a law. I feel like there is informed consent and I think informed consent is so important but at the same time, there is informed declination and you should be able to decline anything. That's true. We can never force anybody into surgery. We can never force anybody into anything. I think a lot of people aren't having those conversations where it's actually informed so then people are like, “Oh, they are just refusing everything.” I hate the word refuse because no, they are not refusing it. They are declining it because they are informed. They know the risk. They have all the information at their fingertips and they know that this is the best decision for them and their baby and we have to honor that. That's why I'm really glad that I'm able to practice in that way, but I do know I've met and I've worked with people who feel like they are boxed in and have to follow those policies. We've started to talk about what our policies are with TOLACs and VBACs and things like that. One of them is that they are supposed to have two IVs. I've already gone against that before and I've had a beautiful, unmedicated VBAC. She walked in. I said, “We've talked about it. She was also laboring outside when we talked about it. It's not an issue when you come in. You know what? When we get up there, I'm just going to tell them that you know why they recommend two IVs and you are declining.” She walks in and she's clearly going to have this baby within the hour. I told the nurse, “We're not doing the IVs. We've talked about it. We're going to decline them.” That was the end of the discussion. We didn't have to talk about it again which was nice. She shouldn't have had to advocate in that moment for herself. We've already had those conversations. Meagan: Yes. Paige: Another one is continuous monitoring and the whole idea is if you start to rupture, that's how we are going to catch it. The baby is going to tank and that's how we are going to save the baby's life. Don't get me wrong. I think continuous monitoring can be really valuable for a lot of things but it's actually not evidence-based. We have not improved neonatal outcomes with continuous fetal monitoring. We've talked about that with Lily and she's going to opt for intermittent oscillation and I think that's very appropriate because she plans to go unmedicated. Let's be honest, if you are unmedicated and your uterus starts to rupture, moms will tell me that something is not right. This is beyond labor. Her saying that and being aware of that, we would notice it a lot sooner than we would the baby tanking kind of thing. Meagan: Yeah. I do know that with uterine rupture, we can have decelerations but like you were saying, there's usually so many other signs before baby is actually even struggling and I know a couple of uterine rupture stories where providers didn't believe the mom that something was going on because that one thing wasn't happening. The baby wasn't struggling. Paige: Yes. Meagan: It's like, you guys! When it comes to continuous fetal monitoring in the hospital, people have to fight to have that intermittent. It's yeah. Anyway. These policies are not law. I love that you said that too. There's another t-shirt quote. Paige: I think people should start asking if they are planning a VBAC, start asking what is the policy and start thinking, is that what they want? I do have some moms who are like, “No, I want the two IVs because it's hard for me to get a stick,” and they need that backup in case. That makes them feel more at peace but other people are like, “It makes me feel like a patient. I don't like it.” People don't like needles and that's okay. They have that right to say no. I tell people that in a true emergency, we will get an IV in you if something really, really bad were to be happening. That's part of training if somebody walks in off the street. We're not going to be like, “Oh, when was the last time you ate? Sorry, you can't have the surgery.” We know something bad is happening right now. We will get the IVs. We will do all of the things. Getting the IVs really won't save as much time as people think it will. Meagan: Yeah, and there are other things. Say we are having our baby and we are having higher blood loss than we would like or we have some concern of some hemorrhaging, there are other things that we can do. We can put Pitocin in a leg. We can do Cytotec rectally. There are things that we can do. We can get that baby to our breast and start stimulating and try to help that way. There are things that we can do while we are waiting for an IV, right? Paige: Yes. I tell people that all the time. Most of the postpartum hemorrhage meds that we use can be given without an IV. There is only one that truly has to be given through an IV and that's TXA but the rest can all be given other routes. A lot of times, those work better than IV Pitocin. Sometimes the ion Pitocin works better. Sometimes the ion Methergine works better. It's not this, oh we have to have a little just in case kind of thing because if there was a just in case moment, yes. We can be working on the IV and doing other things. I have to be kind of secretive about it. I have tinctures and stuff with shepherd's purse and yarrow. Those things actually have great evidence. They are really helpful for postpartum blood loss. I have a lot of moms who are more interested in doing something more holistic and natural before they try medication. Cypress essential oil, you can rub that in. I'll have doulas use my cypress roller and give them a massage while I'm trying to manage the hemorrhage and that cypress oil can help a lot too. Sometimes going back to our instinctual, old medicine that we have been using well before medicine was used for birth. Meagan: Yeah. This is a random question for both of you. Lil, I really wonder if you have seen it or heard about this too because you are so heavily in our DMs. This is going to be weird. People are going to be like, what? But I did this. We did this because we weren't sure. We cut the umbilical cord and put it in our mouth. It's really weird. Paige is like, what? You put it down in the gum area like in between your teeth and your cheek. It sits there. Okay, you guys. I've seen it just a couple of times, myself included. Yes, I put my umbilical cord in my mouth. Yes, it's weird. Paige: That's okay. Meagan: It felt like a little gummy. It was fine. I wasn't chewing on it. It was just sitting there. But anyway, it's weird but with my other client too we did it and all of her hemorrhaging symptoms just went away. Paige: That's cool. Meagan: I know this is really random but we just cut a little piece of our umbilical cord and put it in their mouth. Paige: That's so interesting. So a piece of the umbilical cord or the entire thing once it's clamped and cut and still attached? Meagan: They clamped and cut it, cut a piece, and put it in my mouth. Paige: I would be so willing to try that. I mean, what is there in that nun? Meagan: I don't know. I don't know, but it did diminish the hemorrhaging symptoms. Paige: Cool. Meagan: So very interesting, right? Okay, so are midwives restricted when it comes to VBAC on what they can accept? Lily, you are a VBAC. I was a VBAC after two C-sections. You can obviously take Lily. Could you accept me?Paige: Yes. Luckily in midwifery care, at least in Colorado, there is a lot of gray for certified nurse midwives. It's not always black and white. VBACs are okay but there is no direct, “Oh, if you have this many C-sections, we can't do it.” I think that's because ACOG also strangely doesn't have an opinion on that. They actually agree. There is limited evidence beyond one C-section. My practice has done several VBACs after two Cesareans. I don't think we've ever done one for a third or greater than two probably because I think those people a lot of times don't even consider VBAC and they just already have been seeing their doctor for their repeat C-section with each pregnancy. But I'd love to see more people going for a VBAC after multiple Cesareans because I think VBACs after two Cesareans have a whole different level of feeling empowered after that. I thin that's really cool and even special scars and stuff, there is really limited evidence on all of these things and I'd like to see more people pushing the limits a little bit. Especially since I am in a hospital, I do have an OB hospitalist on call 24/7 at the disposal of my fingertips if I need them. We are close to an OR so I think if for somebody the fear is there and they are like, “I just don't know if it's more risky because of this,” I think it's worth it to try because the more people who go for it and are successful, the better evidence we're going to get from it. Meagan: Yeah. That is exactly what I am thinking. There's not a lot of evidence after two Cesareans because it's just not happening. It hasn't really been studied and a lot of that is because people aren't even given the option. Paige: Yeah. I'll have people where it is their third or fourth C-section and they were never even given that option. They were told, “Oh, I was told I have CPD.” I'm like, “The chances of you actually having CPD are low.” Then you look at their records and it was fetal distress or something like that. Yeah. CPD is so rare. I've heard it so many times. “Baby is never going to come out of that pelvis ever.” That breaks my heart every time I hear it because there are times when I'm like, I don't know and then an 8-pound baby comes out. We can't go off of those things because the body does what it's supposed to in those moments. Don't get me wrong. Things do go wrong and C-sections do happen sometimes but yeah. To hear everybody has CPD just because they've had three C-sections, I'm like, I don't know. That would be quite a few people. Way more than we know are true. Meagan: Yeah. We're all walking around with tiny pelvises. That's just what everyone thinks anyway.Lily, being in our DMs, hearing the podcast, understanding and seeing so many of these people and what they say, do you have any advice for them when they are looking for their provider or just any advice in general? Do you have any advice from a VBAC-prepping mom? Lily: Yeah, I think for me, it is to go into it open-handed. I think we hear so many horror stories about providers often and I think that's why I went into looking for a provider with both fists up ready to fight and what has surprised me the most is just I think I said earlier that I didn't know hospital care could look like this. I remember we even posted something and I had posted on The VBAC Link that a hospital birth can be equally as beautiful as an out-of-hospital birth and there were people arguing and people saying, “No, absolutely that's not possible. That's not a thing.” Gosh, how discouraging if we go into things thinking that we can't have beautiful outcomes in different settings. Certainly, there are areas around our country that need improvement. There's not a low-intervention floor at every hospital and there are not midwives who are doing what Paige is doing everywhere but I think the more that we seek out that care and look for that care and advocate for that care, the more we will see it. As much as it sucks that we have to be our advocates, it's also a really cool opportunity that we pave the way for VBAC moms and the moms who have never had a C-section that we are paving the way for care that doesn't end up in a Cesarean. I would just say to be open-handed and yes. You can be prepared to fight and you can be prepared with your statistics. Be prepared to ask the why behind questions, but ultimately, I think that care can be so much more than we expected if we go into it thinking, Gosh, well what can I get out of this and how can I make these things happen? Like Paige said, we've had lots of conversations around, Well, this is the policy, but the policy is not the law. I'm here to support you in that. At our last appointment, she was like, “Hey, make sure you bring your doula to your appointment where we are going to talk about your birth plan because I want to make sure that she is there, that we all hear each other, that we are on the same page.” I think that's helpful too. And then having a doula. My doula was my doula with my C-section. She was with us. She was whoever was on call at the birth center actually and again, I think it was so serendipitous because she is a VBAC mom. I think I needed her then and I'm so stoked to have her now that she is just a really special human who I know is also always in my corner and constantly texting her like, “Oh my gosh, look at the new birth rooms. Oh my gosh, I had this great conversation. Oh my gosh, I'm so excited.” I think having your doula there to be your partner in advocacy is really helpful too. Meagan: Yes. Okay, that's a good question too when it comes to doulas and midwives. Sometimes I think people think that if I'm hiring a midwife, I don't need a doula and then we of course know that a lot of people just mistake doulas and midwives together. But Paige, how do you feel about doula care and working with doula care? Is it necessary? How do you work together as doula and midwife?Paige: Yes. I love doulas. I wish everybody had access to a doula truly because doulas, just like midwives, have been studied and they have better birth outcomes, more empowered births, and all of the things. Doulas are so important and doulas and midwives work really closely. I think a doula is there with that constant presence, that constant helping with anything and a really good advocate which I think is important especially if you don't have a good relationship with your provider maybe or you don't know who you're going to get. Maybe you see 7 different providers and you get who you're going to get when you're in labor. So to have that doula there to constantly be advocating for you is such an important piece. Yeah, I really wish everybody could have access to a doula because it just makes a world of difference. I can't think of any bad outcomes I've ever had when a doula was present. It's just a different level of care. Usually, people who have sought out a doula have also taken the time to seek out and do all of the things that are going to make a healthier pregnancy and a better birthing outcome. It's why I think everybody deserves doula care. It's because it does lead to better outcomes. Midwives are always known to work closely with doulas and really support them. It's a team effort. Meagan: Yeah. Yeah. We love our relationships with our midwives here. It's really great to just know how we work and know how we need to support the client and it is sometimes hard when we go to a hospital and we don't know who we are getting. And sometimes that OB or that midwife we have worked with before and sometimes it's a whole new face so it does bring us comfort to know that the client and the family know us and we know them and we can all work together. I love that. Okay, do either of you guys have anything else that you would like to say to our beautiful VBAC community before we go? Paige: I don't think so. Yeah, thank you so much for having me. This was wonderful and I just hope that everybody who is thinking about a VBAC really does their research and looks for the best provider and really finds that perfect fit because there are so many good providers out there– OBs, midwives, professional midwives, all the things. Meagan: I agree. It's okay to interview multiple people. It's also okay that if mid-pregnancy, the end of pregnancy, during, and even in labor that if something is not feeling right, you can request a different provider. You can go out and start interviewing again and find that provider that is right for you. Paige: Yes. Meagan: Well, thank you Paige and Lily for joining us today, and thank you so much for doing so much in your community. I really love your setup and hope that we can see that type of setup happening in the US because it just feels perfect in a lot of ways. Yeah. Yes. I'm loving it. Okay, ladies. Well, thank you so much. Paige: Thank you. Lily: Yeah, thanks, Meagan. Meagan: Bye. Lily: Bye!ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Dr. Temi Ajao is a wife, mother of two, board-certified emergency physician, money mindset coach, entrepreneur, and real estate investor. A first-generation Nigerian American, she was raised in the Bronx. She earned her BA in Psychology and Africana Studies from SUNY Binghamton and later her medical degree from the George Washington School of Medicine. Dr. Ajao completed her residency at Baylor College of Medicine with a strong interest in pursuing a fellowship in global health. However, burdened with nearly half a million dollars in student loan debt, she decided to pause her fellowship dreams to tackle her financial obligations. She began practicing emergency medicine in a community setting, aiming to pay off her debt, build a nest egg, and eventually return to academia.  Unexpectedly, after five years working in a high-acuity environment, Dr. Ajao experienced career burnout. Her financial stress worsened when her employer transitioned from physician-owned to corporate-owned, increasing pressure to meet RVU targets, patient satisfaction scores, and quality metrics—none of which directly improved patient outcomes.  Feeling disillusioned and losing passion for the field she once loved, Dr. Ajao decided it was time for a change. She negotiated higher pay with local hospitals, reduced her clinical hours, and pursued a career in locum tenens. Additionally, she began focusing on her money mindset, shifting from a scarcity mindset to one of abundance and success.  Drawing on her personal experiences with burnout and financial stress, Dr. Ajao founded the Money Mindset Academy. Through this coaching program, she empowers women physicians to master their relationship with money, helping them double their net worth and regain control of their financial futures. Moneymindsetmd on all platforms

September 13, 2024 Mark, Ray, and Scott discuss questions from the PRS Community.Hi,   In your Urology Times article on July 30th, there is mention of a proposed change to the practice expense component of cystoscopy due to updates in the supply valuation by CPT RVU Update committee.  It talks about "packs SA045, SA058 and SA042".  What are these packs and can you explain further how this will impact the in-office RVU for CPT 52000? thanksWe are looking for some guidance regarding images and the accessibility.  When coding procedures such as 50431 (images included in code) or 51600 or 51610 (images billed separately).  Does the coder physically need to see the images before submitting charges?  Or can charges be submitted if provider clearly documents images available? We know the images are readily available and are attempting to prevent additional work uploading to the chart for coder review.  Should we consider having a written policy in place?  Appreciate any advice or suggestions y'all may have.      PRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a QuoteUrology Advanced Coding and Reimbursement Seminars - In-Person SeminarsRegister Now for the Urology Advanced Coding and Reimbursement SeminarClick Here for Information and RegistrationEvent DetailsLocation:Las Vegas: December 6-7, 2024, at HorseshoeNew Orleans: January 31-February 1, 2025, at Harrah'sTime: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pmIncludes: Breakfast and Lunch on both days, plus 14 AAPC CEUs   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/    Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

Healthcare economics is complex, but ASCRS member, RUC Advisor and AMA Delegate Dr. Kelly Tyler joins us to shed light on the matter. Listen as they discuss RVU's, downstream revenue and benchmarking, the role of the AMA and much more in this informative episode.

This episode is brought to you by Equity Multiple. Dedicated to assisting physicians in simplifying their investment journey, Equity Multiple enables passive investment in vetted, professionally managed commercial real estate. Learn more at www.equitymultiple.com. Join Jon as he delves into the complexities of compensation structures, highlighting why understanding your contract is crucial. From salary versus bonuses to RVU calculations and proration, Jon explains how different compensation models—whether salary, shift rates, or collections—can impact your earnings.  Discover the importance of clear contract terms, the role of data sets in fair market value, and how benefits like vacation and retirement plans can affect your overall compensation. Tune in for essential insights to navigate and negotiate your compensation effectively. Jon invites individuals to contact Contract Diagnostics through phone, chat, or email for personalized assistance, visit www.ContractDiagnostics.com

Na vijf jaar cel en velen mensen te hebben opgelicht, leeft Danny Klomp het leven van een jetset-miljonair in Marbella. In 2006 richtte hij samen met zijn toenmalige collega Remco Voortman Palm Invest op en beloofde zijn klanten een sprookje. Maar van zijn fouten heeft hij niet geleerd, want ook nu licht hij weer mensen op. Hoe kan dit? Onderzoeksjournalist Patrick Pauw legt dit uit in deze nieuwe aflevering van het Telegraafkwariter. En: de tijdelijke vroegpensioenregeling, RVU, loopt maar tot eind volgend jaar. Financieel verslaggever Connie de Jonge vertelt waarom dit voor veel werknemers een probleem is.See omnystudio.com/listener for privacy information.

May 10, 2024Mark and Scott discuss FAQs that came into the Urology Coding and Reimbursement Group.MRI fusion biopsy updateHi,Can you please help us with the below questions. Pessary Insertion – does it require a physician to be onsite? What about Pessary cleaning?Urodynamics – we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?Biofeedback - we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?Hi, a question regarding NCCI edit pls. When unbundling is not allowed between two CPT, due to an indicator "0", never billed together. If the secondary CPT has more work-RVU than primary CPT, i.e. 51705 (primary) wRVU 0.9; and 52000 (secondary) wRVU 1.53, Are there any rules that we must bill Primary 51705? VS Can we choose to bill 52000 instead, knowing that 52000 has more wRVU than 51705? Thank you,  Urology Advanced Coding and Reimbursement VIRTUAL SEMINARRegister Now for the Urology Advanced Codingand Reimbursement Virtual SeminarJoin us on July 27th, 2024, for a live Zoom meeting from 9:30 am to 1:30 pm EST, and master the latest in urology coding and reimbursement with ease.Click Here for Information and RegistrationPRS Billing and Other ServicesClick Here to Get More Information and Request a Quote   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/    Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

This episode is sponsored by PearsonRavitz– helping physicians protect their most valuable assets.  Jon from Contract Diagnostics shared the successful renegotiation of a family practice sports physician's contract, extending it for four years with improved terms.  Through thorough analysis and communication with the employer, they reached a mutually beneficial agreement, addressing compensation, retention bonuses, RVU rates, staffing issues, time away, reporting problems, and equipment needs. Despite some delays, both parties were satisfied with the outcome.  Jon invites individuals to contact Contract Diagnostics through phone, chat, or email for personalized assistance, visit www.ContractDiagnostics.com

This episode is sponsored by Freed.AI - Get 50% off your first month of using their AI-powered medical scribe software! Add FR50 to your cart! Jon from Contract Diagnostics addresses the increasing trend of employers providing addendums or changes to physicians' compensation structures.  He emphasizes the importance of promptly seeking professional assistance, like Contract Diagnostics, when receiving such addendums, especially since they often come with short timeframes for review and acceptance. Jon advises physicians to thoroughly understand the proposed changes, not just focusing on apparent benefits but considering the broader impact on various aspects of compensation. He highlights potential pitfalls, such as alterations to RVU conversion factors or changes in stipend structures, and urges physicians to rally colleagues to collectively negotiate and seek clarification from the employer. Jon stresses the significance of asking comprehensive questions, understanding if the proposed changes apply uniformly across the division, and considering the implications for future hires. He encourages physicians not to feel rushed, request extensions for thorough reviews, and assures viewers that Contract Diagnostics is available for timely assistance. Jon invites individuals to contact Contract Diagnostics through phone, chat, or email for personalized assistance, visit www.ContractDiagnostics.com

This episode is sponsored by Freed.AI - Get 50% off your first month of using their AI-powered medical scribe software! Add FR50 to your cart! Jon from Contract Diagnostics discusses creative negotiation strategies for physician contracts. Using a hypothetical scenario where the base salary is $300, and the physician desires $325, Jon explores various creative approaches to negotiation.  He suggests considering alternatives such as negotiating for future years, additional benefits like extra vacation or flexible start dates, modifying non-compete clauses, proposing buyout clauses, and exploring creative compensation structures, like tiered RVU rates or unique scheduling arrangements. Jon emphasizes the importance of thinking creatively and finding a fair compromise that benefits both parties. He encourages viewers to reach out to Contract Diagnostics for assistance in navigating and negotiating physician contracts. LINKS: www.ContractDiagnostics.com

In this special Year In Review edition of RV U, Angie sits down with Brett Davis, NIRVC's Founder and CEO. Brett and Angie discuss milestones in 2023 and the RV Revolution. Tune in to hear what Brett has to say about the RV Revolution and outlines amazing new resources that are in the works for 2024. You are the reason we are here! If you believe in the RV Revolution, help us out: give us a good rating, write a review, share it with your friends, and make sure to subscribe, so you don't miss a single episode.If you missed a previous edition of RVU now you can get all caught up!Looking to upgrade your motorhome? Click here.  Special thanks to our sponsors!National Indoor RV CentersNIRVC has a wide selection of Class A, B and C RVs. Experience the NIRVC difference today at NIRVC.com All Inclusive Motorhome (AIM) ClubGet connected with fellow RV enthusiasts from all across the country and enjoy exclusive benefits, discounts and access to amazing events! Join the AIM Club today! 

This episode is sponsored by Eckard Enterprises. To start empowering your financial future, visit www.EckardEnterprises.com Jon from Contract Diagnostics is addressing the question of how often one should expect an increase in pay. He explains that pay increases can vary depending on the employer and the terms outlined in the employment agreement. Some employers offer annual pay increases, while others may base it on factors such as MGMA data or blended survey data.  Jon emphasizes that if an employer does not proactively offer pay increases, it may be necessary for the employee to raise the topic themselves.  He encourages individuals on auto-renewing contracts to reach out to Contract Diagnostics for assistance in evaluating their compensation and determining if adjustments can be made. Jon highlights the importance of understanding one's income potential and ensuring fair compensation. He mentions that transparent access to relevant information like RVU numbers, collections, and efficiency rankings is crucial for evaluating one's compensation.  Contract Diagnostics offers coaching and guidance for having discussions about compensation with employers.  Jon invites individuals to contact Contract Diagnostics through phone, chat, or email for personalized assistance, visit www.ContractDiagnostics.com

This summary discusses the Collections Compensation Model, commonly used in private practice medical settings to determine physician remuneration. In this model, rather than being paid upon production (like in the RVU model), physicians are compensated based on when the service is reimbursed to the practice. There can be many variations to this model, such as a base salary with a percentage of net collections beyond a threshold or simply receiving a percentage of all net collections. Another variation involves taking home the collections after overhead costs have been settled. It's crucial to negotiate effectively under this model and understand opportunities for increasing collections or decreasing overhead costs.  The system encourages practice efficiency, but one must also consider situations when collections are generated when the physician isn't present. LINKS: www.ContractDiagnostics.com

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, firewalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. There's two main groupings of said waste, turns out. The first is in administrative failures. There's three subcategories here: fraud, waste, and abuse; administrative complexity; and pricing failures. Then there's the clinical failures side of the waste house. There's three subcategories here as well, and they are failures in care coordination, failure in care delivery, and then low-value care. Dr. Shrank digs in a bit on each of these in the interview that follows, but I have to say, I go in fast for the now what. Great that we know where the waste is coming from, because gotta know the problems to solve for them. But really, what's the best way to solve for this waste? You know me by now, so I, of course, point out immediately that someone's waste is someone else's profit. So, that's a wrinkle. And it's a really rough wrinkle, because now you have groups lobbying to basically protect the waste. As just one example, what are pricing failures, after all, if not someone else's margin? Major spoiler alert here, but Dr. Shrank says one sort of broad-stroke solution is aligning incentives with higher-quality care, paying for the longitudinal patient journey, and paying for outcomes. If you do this, then at least the clinical failures side of the equation could improve. The implication here is that if the incentive is to be accountable for value—which is, you know, numerator quality denominator cost—then the supply chain has an incentive to reduce its own waste because effectively, at that point, it's coming out of their pocket as opposed to somebody else's. Will this resetting of the financial model happen overnight? That was a rhetorical question that we all know the answer to. Commercial payers are slow to change, and all but the best employers have been (historically, at least) busy making extremely lateral moves and going nowhere fast. Few seem super inclined to reward and pay for what they care about rather than just negotiating a price. I sort of say this to Dr. Shrank, and he says, yeah, true enough. I'm paraphrasing with a lot of creative license right now, but he says, let's reset our expectations with reality. We've actually come a pretty long way, baby, in not a particularly long time if you consider the whole value-based thing really only started not that long ago, relatively speaking. So, there will be problems to overcome and bumps in the road. We should expect that, and we haven't had the time to work them all out yet. I think a couple of other interesting insights for me, one was a little sidebar we go off on about the power that PCPs might find themselves wielding if they can gang up and harness it. And this is kind of starting. We'll see if it goes anywhere. I recently heard a story about a bunch of employed PCPs who went to their health system bosses and asked to stand up an APCP (advanced primary care practice) able to coordinate care, etc, do all the things that at this juncture we know are the right things to do for patients. Now they got shot down—bam!—with the backhands from above. I hope those engaged and activated PCPs quit and start up their own thing. Maybe they will. PCPs getting together here could be a way to solve for waste if they can gang up and harness it. And that's actionable if you happen to be a PCP or are looking to continue to employ them moving forward. The potential rising power of PCPs might cause some health systems to rethink some of the choices they are making (ie, the choice to employ PCPs as RVU [relative value unit] referral machines). PCPs, better than anyone, can see the harm inflicted by the business model that forces a drive-by PCP level of care. Moral injury is at an all-time high, and in addition, I just saw that study recently that showed to do all the administrative work of a PCP these days, it would take longer than 24 hours in a day. If you're a self-insured employer, I'd also kind of take note of this because it also could be actionable for you. Someone who would know told me recently that if enough employers demanded some value-based accountability, some advanced primary care going on, even a dominant consolidated health system would listen. So there seems to be some alignment here between employers and PCPs if these groups can come together and collaborate. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. Can I just share with you some of the reviews that we got on iTunes recently? They make my heart so warm. I just want to acknowledge these individuals who took the time to write reviews. Here's the first one. It's from Jspeaks1987. He wrote, “[RHV is] my weekly go-to for smart takes on VBC [value-based care]. I have recommended this podcast to literally hundreds of people (including onstage at our recent customer success summit). Anyone who cares about the sustainability of our healthcare system owes it to themselves to give [Relentless Health Value] a permanent spot on their playlist. Always smart, often provocative, scrupulously fair [I like that … scrupulously fair], it's well worth the listen.” Thank you so much, Jspeaks1987. Here's another one. And this is from happygilmore80. I know who you are, happygilmore. “RHV is an amazing podcast and sorely needed in the healthcare community. I tell everyone about it. … I'm a recent listener and have learned so much from [episode] 399 and 400 [which are the manifestos]. Episode 410 was packed with knowledge, 407 was great, etc. Let's start a hundred RHV communities across the US where we implement small experiments so change is grassroots and ubiquitous. Then the status quo will concede.” And yeah, for sure with that. If anyone is interested in creating a meetup or something in your local area, reach out. I'll try to hook you up with others in the Relentless Tribe. Here's a third one, and this is by Miriam. Thank you so much for this, Miriam. Miriam says, “I scoured the podcast world to find a healthcare industry podcast that offers intelligent, relevant, clear information and dialogue. I found it. Stacey and RHV cover the US healthcare industry across all sectors while managing to go deep within those sectors. Most importantly, [RHV] highlights how all of those sectors interact, supposedly with the patient at the center, while performing as businesses that are really driven by capitalism.” Miriam says she never misses an episode. To the three of you, thank you so much. It's actually reviews like this that keep me and the team going over here.   You can learn more by connecting with Dr. Shrank on LinkedIn.     William H. Shrank, MD, MSHS, is serving as venture partner, bio and health, at Andreessen Horowitz. Previously, Dr. Shrank served as chief medical officer for Humana, where his responsibilities included implementing Humana's integrated care delivery strategy, with an emphasis on advancing the company's clinical capabilities and core objective of improving the health outcomes of its members. Dr. Shrank previously held the position of chief medical and corporate affairs officer, during which time he oversaw government affairs. From 2016 to 2019, Dr. Shrank served as chief medical officer, insurance services division, at the University of Pittsburgh Medical Center. Previously, Dr. Shrank served as senior vice president, chief scientific officer, and chief medical officer of provider innovation at CVS Health. Prior to joining CVS Health, he served as director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation. Dr. Shrank began his career as a practicing physician with Brigham and Women's Hospital in Boston and as an assistant professor at Harvard Medical School. He has published more than 270 papers on improving the quality of prescribing and the use of chronic medications. Dr. Shrank received his MD from Cornell University Medical College. He completed his residency in internal medicine at Georgetown University and his fellowship in health policy research at the University of California, Los Angeles. He also earned a master of science in health services from the University of California, Los Angeles, and a bachelor's degree from Brown University.   05:56 Can we cut healthcare waste while improving patient care? 06:35 What does “healthcare waste” consist of? 06:48 What are the six categories of “healthcare waste”? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O'Neill. 25:04 Dr. Shrank's warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models.   You can learn more by connecting with Dr. Shrank on LinkedIn.   @WillShrank discusses #healthcarewaste, #vbc, and #PCPs on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer  

You've probably heard by now that you NEED to know your value as a provider, right? If you ask me, it should be right at the top of your priority list as a clinician.  Have you ever wondered why the administrators and practice managers care so much about those end-of-the month RVU spreadsheets? What's the big deal with the data?  How could truly having a handle on your numbers, your revenue, and your productivity and value as a provider change your understanding of your objective value?  PA PAY ONE SHEET https://www.tracybingaman.com/one  COACHING CONSULT https://calendly.com/the-pa-is-in/gen-call  MEG LEDDY's SHOW https://podcasts.apple.com/us/podcast/burnout-what-i-have-learned-so-far-with-meg-leddy/id1582720035  SHOW NOTES https://www.tracybingaman.com/blog TRACY ON INSTAGRAM https://www.instagram.com/mrstracybingaman/ ON LINKEDIN https://www.linkedin.com/in/tracybingaman/

Healthcare transparency is essential for patients to make informed decisions, yet price disparities in the industry remain a major issue. In this podcast episode, we explore how financial incentives and contracts between hospitals and insurance companies can misalign the incentives of brokers, employers, doctors, and patients. We discuss the importance of understanding the influence of these incentives and the need for accountability in developing an equitable healthcare system. Through transparent communication and a focus on an equitable system, we can help ensure that patients receive the care they need and deserve.Episode Outline:(00:00:02) Healthcare Transparency(00:04:42) Price Disparity in Healthcare(00:09:37) Health Insurance Incentives(00:14:21) Doctor Compensation Metrics(00:19:05) Incentive MisalignmentQuotes:(00:03:21) The thing that boggles my mind about healthcare is that in most of healthcare, neither the consumer, which in healthcare is the patient, nor the provider of the goods or services, which in most cases is the doctor, neither one of those parties know what the price is going to be until long after the services are already rendered.(00:09:10) You might only be paying a copay or you might only be paying your $200 and $5500 out of pocket that's falling off of your coinsurance. And they have no idea until they get the EOB what the build charges were and what the allowed charge was. So I think they're so disconnected from how much health care actually costs.(00:12:23) But I'm going to put it really bluntly and I think I got this from Dave Chase, this little metaphor here. But imagine for a minute if fire departments only got paid when there was a fire, they would want as many fires to occur as possible. And the bigger the fire, the more money they get.(00:17:22) And not only that, I think to deny that you're influenced by the financial incentives is to deny you're human. I mean, we've operated on financial incentives long before currency even existed.(00:21:08) I challenge you, if you are not already, if you're a consultant, even if you're a patient, if you're an employer, figure out what you can do. What one thing can you do differently to turn that incentive around?Social Post:Are you tired of feeling like you have a healthcare hangover? We've all been there. That's why we created the Healthcare Hangover podcast. We dive into the headaches we've been encountering in the healthcare system that are leaving us feeling a little hungover. In our latest episode, we talk about the importance of healthcare transparency. We heard a story about a patient who was charged $475 for an X-ray at a hospital, when they could have gotten the same X-ray at a chiropractor's office for less than $75. We also spoke with a hernia surgeon who was able to do the same procedure for $7,200 instead of the $20,000 quoted by a local general hospital. Tune in to the Healthcare Hangover podcast to learn more about the importance of healthcare transparency and how it can save you money.Are you curious about how doctors are paid? Tune in to the latest episode of The Healthcare Hangover podcast to find out! From patient volume to RVUs, David Contorno and Emma Fox break down the complex system of doctor pay and how it influences health care decisions. Plus, they discuss how traditional brokers are put in an unfair position and how financial incentives can be used to deliver better outcomes. Don't miss out on this eye-opening episode! #TheHealthcareHangover #DoctorPay #HealthcareAre you tired of the broken healthcare system? Tune in to the latest episode of The Healthcare Hangover to learn how the system was designed to benefit certain people and how you can help turn the incentives around! From the perverse incentives of commission-based compensation to the Cigna CEO's 20 million dollar salary, David Contorno and Emma Fox will take you through the details of the current system and how you can help build an alternative. Don't miss out! #TheHealthcareHangover #BrokenHealthcareSystem #IncentivesBlog Post:The healthcare system is broken, and it's time to start fixing it. In this episode of Healthcare Hangover, hosts David Contorno and Emma Fox explore the lack of price transparency in healthcare, and how providers are taking advantage of patients by charging them more than necessary. Insurance companies make money by renewing plans every year, regardless of how much they pay out, and people often think that more expensive care results in better outcomes, which is not true. Unfortunately, people often cannot afford their out-of-pocket costs, leading to debt or even lawsuits. Insurance companies do not provide any positive benefits to doctors, employers, or patients, and people have been led to believe that they need health insurance to get quality health care, which is false. The hosts also discuss how fire departments operate on a fixed budget, while health care systems make more money the sicker people are. Health insurance companies have a massive workforce that they pay very little to, and they have bonus programs for brokers that are available on their websites. Hospitals are not changing their practices due to lack of consumer demand, and MRF (Machine Readable File) is not human readable, requiring a middleman to translate the data. Additionally, hospitals often put programming on their website to prevent spiders from finding the data. David Contorno and Emma Fox also discuss how cash prices are almost always the lowest prices on hospital spreadsheets, and the disparity between prices for the same procedure from different carriers is outrageous. Commercial carriers pay the highest reimbursement rate to hospitals, and patients are disconnected from the cost of healthcare due to copays and coinsurance. To illustrate this, David Contorno visited a chiropractor for an X-ray of his shoulder and was asked if he was okay with the price before the X-ray was taken. The X-ray cost $75 at the chiropractor's office, but the same X-ray would have cost $475 at Atrium, the hospital system next door. Michael Reinhorn, a hernia surgeon in the Boston area, charges $7,200 for hernia surgery, while a local general hospital charges $20,000. The hosts also compare the healthcare system to the veterinary system, noting that veterinarians often give customers options and prices up front before giving any treatment. Doctors, on the other hand, are typically paid based on two metrics: patient volume and RVU (Revenue Value Unit). Patient volume is the number of patients seen in a day, with some doctors having minimum patient volume requirements of up to 30 patients per day. RVU is a measurement of how much revenue a doctor is helping generate for the health system, often in areas outside of their office. Doctors are incentivized to prescribe opioids to deal with pain, and to send patients to the most expensive care, regardless of whether it is the appropriate treatment. The most likely outcome of back surgery in the US is a second back surgery. Additionally, traditional brokers are paid more when they retain their book of business and cross-sell additional products that benefit the carrier they represent. Healthcare and health insurance employees often think they are doing good, even though the results they keep delivering are bad. The company bills their clients and has a performance bonus for achieving the client's goals of paying less for healthcare. Ultimately, the hosts conclude that people should focus on changing one thing at a time to build an alternative system that is more affordable. The Cigna CEO made 20 million dollars last year, and the sicker people are, the more money they make. It's time to start demanding more transparency and accountability from health insurance companies, and for patients to take control of their own healthcare. We have the power to create a system of trust between providers and patients, and to make healthcare more affordable and accessible.Episode Links:Connect with Emma FoxWebsiteEmma's WebsiteConnect with David ContornoLinkedInWebsiteOther MaterialsThese materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.

In this episode, co-hosts Drs. Ally Baheti and Mike Barraza interview Dr. Ted Wen of Texas Radiology Associates and Dhruv Chopra of Collaborative Imaging about perspectives and helpful technology when managing an independent radiology practice. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Wen shares reasons why he and his colleagues chose to keep their practice independent. The fast-growing group spent eight years doing due diligence about private equity (PE) to decide if that was the right model for them. Dr. Wen met with PE firms around the country to explore the process of transitioning into PE practice ownership and its implications for current colleagues and future physician hires. Selling to PE would disproportionately benefit senior partners, who were ready to be bought out, over junior partners who would not qualify for the same deal. Additionally PE management could have the power to raise minimum RVU requirements and enforce highly restrictive noncompetes. Texas Radiology Associates ultimately decided that in order to compete in the radiology marketplace as an independent practice, they needed to make significant investments in technology to better serve their patients. They started to connect with Collaborative Imaging to pursue this mission. Dhruv notes that PE has the potential to bring in financial support, strategic relationships, and pathways to growth, but he also warns the audience that not all PE contracts are transparent nor designed to benefit physicians. Workflow, staffing, and collaboration with referring doctors can be extremely difficult when firms value cost savings and RVUs over patient care. All of these stressors have negatively impacted the radiology burnout rate. Dhruv describes the start of Collaborative Imaging, in 2018, as an attempt to integrate a revenue cycle management (RCM) system with radiology workflow at Texas Radiology Associates. This provided a cost-efficient solution that frees up funds to invest in other areas of the practice. Collaborative Imaging is currently working on an AI-driven system to notify patients of actionable findings that come up in their imaging. They are also exploring technology that will adapt the style of radiology reports to different referrers' preferences. Both guests discuss the common inefficiencies that independent radiology practices face, including RCM, clarification over patients' payment plans, and office wait times. Collaborative Imaging is working with practices around the country to build solutions. Radiology groups can contribute a percentage of their revenue into Collaborative Imaging and receive dividends, or they can license the RCM solution. --- RESOURCES Ep. 277- Private Equity and the Radiology Job Environment with Dr. Ben White: https://www.backtable.com/shows/vi/podcasts/277/private-equity-the-radiology-job-environment Texas Radiology Associates: https://texasradiology.com/ Collaborative Imaging: https://collaborativeimaging.com/

Hoe diverser de samenstelling van bacteriën in darmen hoe beter, maar hoe stimuleer en vul je de juiste bacteriën aan en maak je je darmen gezonder? Zijn voedingssupplementen zoals pre- en probiotica uit potjes en zakjes een goede snelle oplossing of kun je je beter richten op de ingrediënten in de pan?    Verslaggever Sander Nieuwenhuijsen (https://www.instagram.com/sandeur/) gaat op onderzoek uit. Als consument in de supermarkt en de drogisterij koopt hij voeding voor de darmen. Een zakje met dertig miljard ‘goede' bacteriën en butyraat in de vorm van een pil. Op het gezonde boodschappenlijstje van kok Jesse Stey staan veel gefermenteerde producten en vezelrijke ingrediënten zoals andijvie en pastinaak. Hoe blij werd hij er zelf van? Lara Billie Rense vraagt het hem.     Boodschappenlijstje voor het recept uit de aflevering

The theme of 2023, between workforce studies and payment models, is everyone's favorite: the RVU. Who's got 'em? Who needs 'em? Does it matter? Do we care? Join me in digital nerd town for a general overview of yearly metrics! --- Earn free CME for this episode: https://earnc.me/E9XHPi www.becktamd.com www.photonmedia.org Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

On this episode of BackTable Urology, Dr. Jose Silva and Dr. Jay Simhan, director of reconstructive urology at Fox Chase Cancer Center, discuss how urologists can demonstrate their value to hospital systems. --- SHOW NOTES First, Dr. Simhan explains the changing nature of urology practice. He opts for the term “health systems urologist” over “private practice urologist” because many urologists are managed by smaller medical groups that are owned by larger hospital groups. He notes that this multi-tiered system of management can cause tension around decision making and increase senior leadership turnover when hospital finances change. Then, Dr. Simhan explains the four ways that doctors can generate value, which is clinical productivity, departmental service, academics or research, and teaching. Clinical productivity is often measured by the RVU system, which assigns a certain number of value units to a procedure. Hospital systems may encourage urologists to choose surgical procedures over office-based procedures to increase RVUs. Although RVUs are arbitrarily set by the Centers for Medicare & Medicaid Services (CMS), each hospital or medical group can increase the number of RVUs per procedure to their own discretion. Dr. Simhan believes that urologists should band together to negotiate fair RVU systems. Finally, they end the episode by discussing concrete ways to demonstrate value as a urologist. Generally, minimizing complications and maximizing RVUs is helpful. Dr. Simhan advises urologists who are joining a new system to build their name and referral network to earn a long term contract. Usually, there is no RVU requirement in the first employment contract. In the later years, he recommends putting in the effort to understand productivity metrics and downstream costs and revenues in order to maximize earnings and potential.

This is a conversation about physician compensation, which is often oddly misaligned from the way that the whole physician or provider organization is getting paid. Now, first thing to point out: There are lots of different kinds of physicians doing all kinds of different things. As with most everything in healthcare, lumping everybody together and making general proclamations about what is best is a really cruddy idea. With that disclaimer, if you think about the main models of physician compensation, there are two; and this is oversimplified, but let's call one fee for service (FFS), which is really getting paid for generating RVUs (relative value units)—in short, getting paid for volume. The more you do (especially the more expensive things you do), the more you get paid. And then we have getting some kind of capitation payment. A capitated payment is some kind of per member per month-ish flat payment to ideally keep patients healthy, and you will make the most money if you can figure out how to have the least volume of expensive stuff. As an individual doc getting a salary to care for a patient panel of a certain size, let's just consider commensurate with that. These incentive models obviously have a big impact on any given doctor's ability to get paid to do things that they think they should be doing. For example, the current fee-for-service RVU fee schedule frequently rewards those doing the stuff a lot of specialists do much more than those doing primarily cognitive work, including those doing work for patients who aren't sitting in the exam room at the time—like a PCP arranging for a patient to go to hospice or answering patient portal questions. In my opinion, the goal here should be to pay docs and others fairly for providing high-value care. These payments also should actually be proven to actually incent that high-value care. Here's the obvious problem: Neither of these two things, either the quantifiable definition of high-value care and/or the best way to pay for it, has any kind of canon. There are no rules which are considered to be particularly authoritative and definitive here, really. So, what is the downside of not aligning physician compensation models to what good looks like, meaning to the kind of care that patients really need in that particular community? A couple of downsides for you: One is moral injury. Not the only reason, but a reason for moral injury is getting paid in misalignment with what is best for patients. That sucks. You want to help your patients as best you can, and then you can't earn a living and/or you get in trouble with the boss if you do what you think is right. This can cause real mental anguish for especially PCPs but also others who see the need to do anything that doesn't have a billing code. Here's another downside to not worrying about physician compensation, and it's for plan sponsors (employers, maybe) who are trying to get integrated care or a medical home for their employees. I was talking to Katy Talento about this. She was telling me that in ASO (administrative services only) contracts, there are often line items for value-based care and for capitated payments. So, good news? Well, let's follow the dollar here, because we wind up with a disconnect that doesn't help patients but certainly can earn a nice little kitty for those who can get away with it. Here's where that dollar goes: This VBC (value-based care) or capitated payment kitty may go to a health system that the ASO says is to be a medical home for employees or plan members. But the PCPs mainly who are treating members in those medical homes are getting paid, it often turns out, fee for service with maybe some quality kickers. So, the plan is paying a value-based care payment, but the PCPs are getting paid FFS. Is anyone shocked when the members report that they don't actually feel like they are getting integrated care, that they are getting rushed in and out because maximizing throughput becomes a thing when you're getting paid for volume? Dan O'Neill also talks about this at length in episode 359, because IPAs (independent physician associations) are doing kinda the same thing. Getting so-called value-based care contracts with MA (Medicare Advantage) plans or CMS or employer groups, I'd imagine, and then paying all the individual practices or the solo practitioners fee for service and scooping up the excess payments themselves, most docs manage to provide high-enough-quality care that the contract holder can scoop up the profit off the capitation without actually having to share the capitation to achieve this high-enough-quality care. In this healthcare podcast, I am digging into all of this physician compensation ballyhoo with Rachel Reid, MD, MS. She was an author on a study at the Center of Excellence on Health System Performance at RAND. This study specifically set out to look at how health systems and provider organizations (POs) affiliated with those health systems incentivize and compensate the physicians who work there. Short version: Yeah, it's confirmed. Most docs are paid using the classic RVU productivity measures representing a big chunk of their compensation, even PCPs. There's frequently some kickers or extra payments to achieve some kind of quality metric, but this is the icing, not the cake. The cake is still very fee for service-y. This is true regardless of how the physician organizations, the provider organizations themselves are getting paid by payers. I asked Dr. Rachel Reid a bunch of questions about this, but one of them was (this seems weird, a weird misalignment), Why is this happening? And Dr. Reid listed out five reasons beyond the macro existential question of what is value and do we even know how to change human behavior to get it. 1. The payment is not big enough from the payer for the physician organization to go through all the time and trouble and risk frankly of changing the whole comp model. 2. The value-based payment arrangements that do exist at the organizational level often have a fee-for-service chassis with an icing of quality payments or some kind of value payment on top of it. So, maybe there's actually more alignment than we might think. 3. It's hard to try to change comp models—it's a thing. And there is risk in messing it up. 4. Inertia. The ever-present inertia. 5. We know what we want to move from, but what exactly are we moving to? And this “What do we want to move to?” is going to change for PCPs and for every single different specialty and could even vary by patient population. I then also asked Dr. Reid what could be done by plan sponsors, for example, to pay docs in alignment with the goals of the contract; and she said, write physician comp expectations into the contract. Something to think about. We dig into all of this today. Shows that you should, for sure, listen to for additional insights include the one with Dan O'Neill (EP359) as aforementioned. Also the show with Brian Klepper, PhD (AEE16), where we dig into how the RUC is behind some of these FFS rates. Also episode 391 with Scott Conard, MD. My guest today is Rachel Reid, MD, MS. She is a physician policy researcher at RAND Corporation and a primary care physician at Brigham and Women's Hospital.   You can learn more about Dr. Reid, her publications, and the work she has done on the RAND Web site.     Rachel Reid, MD, MS, is a physician policy researcher at the RAND Corporation. Also a practicing primary care physician, her research focuses on measuring cost, quality, and value in healthcare. She has particular interest in the primary care delivery system, physician payment and compensation, and delivery and payment system reform. Dr. Reid has been engaged in the RAND Center of Excellence on Health System Performance, assessing health systems' compensation and incentives for physicians, leading work related to assessing low-value healthcare delivery, and measuring primary care spending. She is the principal investigator on an NIH-funded grant assessing novel Medicare billing codes for transitional care provided after hospital discharge. Prior to joining RAND, Dr. Reid worked in the Research and Rapid Cycle Evaluation Group at the Centers for Medicare & Medicaid Services' Innovation Center. Her clinical work has included ambulatory primary care and hospital-based internal medicine. She is an associate physician at Brigham and Women's Hospital and an instructor in medicine at Harvard Medical School. Dr. Reid received her AB in biochemical sciences from Harvard University and her MD and MS in clinical research from the University of Pittsburgh School of Medicine.   07:13 What did Dr. Reid's recent study show about how doctors are currently being paid and incentivized? 08:11 Why Dr. Reid decided to do the study in the first place. 09:49 What are the main foundations of what doctors are paid on? 10:31 Why is value-based compensation still just the “icing” on the cake? 13:08 What is the biggest value add for doctors, and does it vary between specialties? 14:32 Why wouldn't a physician organization change their comp models? 19:55 Are we at a moment of evolution? 20:20 “Tying dollars to measured quality gaps doesn't necessarily produce results.” 20:42 EP295 with Rebecca Etz, PhD. 22:04 “I don't think there's a current gold standard for how to pay doctors.” 25:37 Job one: What are we trying to incent? 31:28 From the payer or insurer perspective, what's the leverage they have to change doctor compensation?   You can learn more about Dr. Reid, her publications, and the work she has done on the RAND Web site.   Rachel Reid, MD, MS, of @RANDCorporation discusses on our #healthcarepodcast how doctors get paid. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry

In this episode of BackTable ENT, Dr. Varun Varadarajan speaks with Michael Johnson, a business lawyer, about advice for negotiating academic and hospital employment contracts. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/0aliK0 --- SHOW NOTES First, the doctors talk about the RVU system of compensation used by many hospitals and academic centers. They discuss what the price per RVU means and additional bonuses after the expected RVU goal is met. Michael adds that it may be beneficial to negotiate for more resources to earn more RVUs instead of negotiating more compensation, as the former strategy can lead to higher compensation. Additionally, he notes that subspecialty clinicians and surgeons have more leverage to negotiate their contracts if they are the first subspecialists in a large system. He recommends that physicians start negotiating at least a year in advance of their anticipated start date. They also discuss the compensation models based on productivity versus a flat salary. Then, the doctors explain how to handle verbal offers from academic centers. Michael recommends talking to multiple employers at a time when starting the hiring process in order to weigh multiple options. However, he recommends physicians to be upfront about where they are interviewing with each employer. He notes that some academic institutions will send a letter of appointment, and not an employment contract, but physicians can still negotiate for firm deal breakers in the letter of appointment. He then explains different clauses in the contracts, such as restrictive covenants (non-compete and non-solicit clauses), non-disclosure agreements, and malpractice tail insurance. He advises against comparing salary offers to the MGMA compensation data, as different jobs require different obligations. Instead, he recommends making sure that the compensation matches the job obligations. Finally, the doctors end the episode with reviewing common employer tactics, such as pressuring doctors to sign contracts quickly and only offering negotiation on the base salary and signing bonus. Michael explains that it is worthwhile to engage in higher levels of administration in the negotiation process if necessary. --- RESOURCES Michael Johnson's Website: https://www.michaeljohnsonlegal.com/physician-contracts/ Michael Johnson's Instagram: https://www.instagram.com/physiciancontracts/ Episode 45- Private Equity: Savior or Existential Threat? https://www.backtable.com/shows/ent/podcasts/45/private-equity-savior-or-existential-threat

In this episode of BackTable ENT, Dr. Varun Varadarajan speaks with Michael Johnson, a business lawyer, about evaluating and negotiating physician employment contracts in private practice and academic settings. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/nqV1Cs --- SHOW NOTES First Michael explains how hiring a contract lawyer can help physicians understand their employment contracts and prioritize their negotiations. He notes that there are pros and cons to all of these contracts, but they are not written to be read very easily by people without legal backgrounds to understand. He adds that although local lawyers may have intimate knowledge of the geographic area, finding a physician contract lawyer is most important. Then, he explains the “trinity of physician contracts”, which are the three most important factors of employment: compensation, obligations, and exit strategy. Additional clauses include non-compete clauses, non-solicit clauses, and malpractice tail expenses. He explains that accepting a base salary does not prevent future salary negotiations. Next, Michael talks about private practice contract considerations, such as business risks, salary growth, the potential of selling the practice, private equity, and partnership tracks. He advises delaying partnership track if buy-in is too high or if the physician has different financial priorities. Advantages to partnership include more decision-making, autonomy, and ancillary revenue. Other factors he advises to research before signing a contract include payer mix distribution and the distribution of patients. He briefly explains what hospital recruitment agreements are. Although they may offer more competitive salaries than a stand alone private practice contract, they are often more complicated to understand. Then, he discusses academic medicine contracts, which can offer different opportunities than just increased profits. He warns physicians to be aware of changes in administration and department turnover, as these events can lead to unplanned and unwanted shifts in obligations. He also notes that through the RVU system, teaching and administrative duties are not compensated. Thus, one of his goals is to protect physicians from being overworked. --- RESOURCES Michael Johnson's Website: https://www.michaeljohnsonlegal.com/physician-contracts/ Michael Johnson's Instagram: https://www.instagram.com/physiciancontracts/ Episode 45- Private Equity: Savior or Existential Threat? https://www.backtable.com/shows/ent/podcasts/45/private-equity-savior-or-existential-threat

Did you know that the coaching industry is the second-fastest growing sector in the world and is projected to increase to a $4.5 billion industry? In addition, The Institute of Coaching reports 80% of people who receive coaching report increased self-confidence, and over 70% benefit from improved work performance, better relationships and better communication.. So what if you combined your skills as an Advanced Practice Nurse (APN) with Coaching tools to create more freedom, flexibility and income-earning potential in your life? What if you reinvented what it means to be an APN and how to help people in a way that doesn't involve 15 minute visits and bandaid solutions? That's exactly what I'm going to show you in my FREE training.. How to Reinvent Your APN Career with Coaching Let's say goodbye to burnout, toxic workplaces and RVU drama for good. Click here to sign up for this FREE training: https://authentic-koaching-llc.mykajabi.com/pl/2147672552

Looking for ways to optimize your compensation and better understand how other colorectal surgeons are compensated?  Join Avery, Biddy, Jon and Sam as they share their personal stories, perspectives and tips regarding colorectal surgeon compensation.    CO-HOSTS Avery Walker, MD, FACS, FASCRS El Paso, TXAvery Walker is dually board-certified in General Surgery and Colorectal Surgery. He earned his medical degree at the University of Illinois in Chicago, his General Surgery residency at Madigan Army Medical Center in Tacoma, Washington, and his Fellowship in Colon and Rectal Surgery at The Ochsner Clinic in New Orleans. A former active-duty officer in the United States Army, Dr. Walker served 13 years as a general and colorectal surgeon with his most recent duty station in El Paso, TX at William Beaumont Army Medical Center. While there he was the Chief of Colon and Rectal surgery as well as the Assistant Program Director for the general surgery residency program. He currently practices colon and rectal surgery at The Hospitals of Providence in El Paso, TX. Dr. Avery Walker is married and has two daughters aged 13 and 9.   Biddy Das, MD, FACS Houston, TXDr. Bidhan “Biddy” Das has board certifications for both colon and rectal surgery, and general surgery. His passion for medical education and medical process improvement has resulted in book chapters and publications, and national and regional presentations on those subjects. Highlighting his medical expertise on fecal incontinence, he has been featured on patient education videos and national and international television and radio as a featured expert on these colorectal conditions. Dr Das also has a particular interest in surgeons redefining their careers -- he serves as both a software consultant and private equity consultant in Boston, New York City, and Houston.   Jonathan Abelson, MD, MS Arlington, MADr. Abelson was born and raised in Scarsdale, New York in the suburbs of New York City.  He has 2 older brothers and both of his parents are dentists.  Dr. Abelson went to college at University Pennsylvania, took 2 years off between college and medical school to work in healthcare consulting.  He then went to medical school at University of Virginia, returned to New York for general surgery residency at Weill Cornell on the upper east side of Manhattan.  Dr. Abelson then did colorectal fellowship at Washington University in St. Louis and am now at Lahey clinic in Burlington, Massachusetts for my first job after training. He is 2 years into practice and has a wife and two sons. His wife works in wellness consulting and they have a dog named Foster who we adopted in St. Louis.   Sam Eisenstein, MD La Jolla, CA   Sam Eisenstein is an Assistant Professor of Colon and rectal surgery and director of Inflammatory Bowel Disease surgery at UC San Diego Health.  He has worked there for the past 8 years after graduating both residency and fellowship at The Mount Sinai Medical Center in New York.  Sam is best known as the founder and organizer of the IBD-NSQIP collaborative, a large multi institutional data collaborative examining outcomes after IBD surgery, but he also is involved in several clinical trials for perianal Crohn's and has extensive experience with stem cell injections for anal fistulae. He is also on the scientific advisory board for the Crohn's and Colitis Foundation for his work on the next big IBD data collaborative, IBD-SIRQC (Surgical Innovation, Research and Quality Collaborative).  Sam has a Wife and 3 kids (6,8, and 3) and spends most of his free time running around after them these days, but also enjoys traveling and getting out into nature with his family.

So the notion of picking and choosing patients based on their insurance coverage might be met with a little resistance, or frustration or maybe even righteous indignation! Bear with me. I'm guessing you went into medicine to care for ALL patients, regardless of gender, race, ethnicity or any other differentiating factor. Thank you. It is important to understand that while all patients are created equally, not all insurance payers are created equally. Some pay above your cost, and some pay below it. In Episode 9 of Medical Money Matters, we talked about your cost structure per RVU and in today's episode, we'll drill down on that a bit more, so that you can understand clearly how you are being reimbursed and what it means to your practice overall, especially if you are in private practice. Please Follow or Subscribe to get new episodes delivered to you as soon as they drop! Visit Jill's company, Health e Practices' website: https://healtheps.com/ Subscribe to our newsletter, Health e Connections: http://21978609.hs-sites.com/newletter-subscriber Want more content? Find sample job descriptions, financial tools, templates and much more: www.MedicalMoneyMattersPodcast.com Purchase your copy of Jill's book here: Physician Heal Thy Financial Self Join our Medical Money Matters Facebook Group here: https://www.facebook.com/groups/3834886643404507/ Original Musical Score by: Craig Addy at https://www.underthepiano.ca/ Visit Craig's website to book your Once in a Lifetime music experience Podcast coaching and development by: Jennifer Furlong, CEO, Communication Twenty-Four Seven https://www.communicationtwentyfourseven.com/

112  Setting Your Chiropractic FeesSetting your fees correctly doesn't require a magic wand or a roll of the dice.  There are very specific and important methods by which you should properly set the fees for your Chiropractic services.    In this episode of the KC CHIROpulse podcast, our hosts explore how to set fees correctly to not only attract new patients but help to retain them for the long term. Kats Consultants CEO, Dr. Michael Perusich, along with our VP of Coaching and Chiropractic industry expert, Dr. Troy Fox, discuss in this episode:Changing your mindset from the old way of setting feesWhy understanding RVU's is important to setting your fee parametersHow your fees often determine if patients will accept your recommendations for maintenanceSetting your fees correctly should help maximize your profitsDrs. Perusich and Fox are highly experienced business advisors, practice owners, and Chiropractic coaches.  From their perspectives as experienced Chiropractic advisors, Michael and Troy explore different and unique ways to keep Chiropractic Physicians on the cutting edge of Chiropractic practice regardless of technique, location, or economic conditions.  Be sure to SUBSCRIBE to the Kats Consultants CHIROPulse Podcast When you are ready we can help. Free Download: The Mid-Year Review Schedule a breakthrough call Attend a Virtual Seminar Join the new subscription program Path to Prosper KC CHIROpulse Podcast. Helping Chiropractors keep their pulse on success. Thanks for listening.

2023 brings a host of changes to medical coding and billing. Dr. Piyush Sheth talks about ICD, CPT, and reimbursement changes including changes to RVU values.

We got two new reviews this week on the podcast, which I was thrilled to see. The first was from, it turns out, Dave Chase from Health Rosetta, who wrote that “with so many people in healthcare practicing ‘innovation theater' and bloviating versus driving real change, it's a breath of fresh air to listen to Relentless Health Value.” Thank you so much for saying that, Dave. We try really hard to get guests who are actually doing great things such as yourself. And then there's another review from mattiw2002, who says, “For anyone trying to stay abreast of developments in the healthcare space, there's none better than … Relentless Health Value.” Thank you so much to the two of you who took the time to write a review—could not appreciate it more. There have been two inbetweenisodes this year where I get deep into the why behind the “why collaborate.” And when I say collaborate, what I mean is anybody in the healthcare industry working together with and for the patients that we're supposed to be serving here. It's creating alignment amongst stakeholders around what's best for the patient. Here is the nutshell version of the two previous shows. First point: Patients fall into one care gap after another. You hear this from any PCP you talk to who's working in a care setting when there's little, if any, collaboration effort on the front end to ensure a non-fragmented patient journey. So then, all these care gaps wind up getting surfaced, which, by the way—let's not forget this—these care gaps were there all along negatively affecting patient outcomes. It's just, in the past, we didn't know about them. But now that we know about them, it becomes the fee-for-service PCPs' job to mop up all the care gaps while the faucet is still running. So, that's the situation analysis, and if we're going to put an end to this, it means that payers have to align with providers and give enough incentive for those providers to create a non-fragmented patient journey (ie, making sure that the care gaps don't happen to begin with). This also means providers need to talk amongst themselves and collaborate. Keep in mind that a multi-morbid Medicare patient sees something like 5 to 13 doctors, on average, depending on what study you look at … 13! If anybody thinks that a patient can see 13 doctors not collaborating with each other and coordinating care and not wind up with some polypharmacy adverse event or materially conflicting advice … I don't know. Call me. I just do not understand how consistent excellence in patient outcomes or patient care even could be achieved. That whole cliché the left hand doesn't know what the right hand is doing? That's a cliché for a reason, and I seriously suspect the entire field of medicine isn't weirdly excluded from it. So, first point: Collaboration/alignment is required amongst healthcare stakeholders for patients to get decent outcomes, especially patients with multiple chronic conditions. Payers gotta pay for the right stuff, and providers have to coordinate care. Otherwise, you wind up with all of the care gaps that PCPs currently working in systems with fragmented patient journeys are seeing. Here's the second point from earlier episodes: Financial toxicity is clinical toxicity. Patients are forgoing care they need and not taking drugs they need because they cannot afford them. This is not speculation. Trilliant Health just released a report that showed this. Healthcare utilization, if you subtract COVID care and behavioral health, might be permanently down. Other reports speculated that by 2030, a leading cause of death might be nonadherence due to cost concerns. Wayne Jenkins, MD, in episode 358, talks about a whole constellation of negative effects when patients can't afford care; and yeah … here we are. Patients cannot afford their care. They cannot afford premiums, deductibles, out-of-pockets. These are insured patients a lot of times we're talking about here. Also, this is not a “Medicaid” problem, as Dan Mendelson put in episode 385. So, go back and listen to the earlier shows for the who and the what and the why of the above and much more context; but nothing I've just said is stuff that I personally would regard as my personal opinion. There is one study after another that bears all this out. There is just one anecdote after another. Fragmented patient care and care that is way more expensive than a patient can afford is going to result in outcomes that are not, let's just say, super. Alright, all of this being said, does then aligning payers and providers, and providers collaborating with each other and coordinating care … if these things are done, do patient outcomes improve? Do care gaps reduce? Are patients more satisfied with their care? Said another way, when physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Why, yes. Yes, it does. Why do I say this? First of all, this very much seems to be the conclusion of CMS. Here's from the Center for Medicare & Medicaid Innovation (CMMI). They released a report updating their strategic vision for implementing value-based care. One of the key new strategies focuses on creating greater care coordination between primary care doctors and specialists. What might be some of the success stories that precipitated the CMMI focusing their strategy on exactly what I've been running around squawking about for one to three years now? The ChenMed Case Study: ChenMed focuses on the most vulnerable patients and dramatically improves access for those patients, which has led to a 30% to 50% reduction in hospitalizations. They published there's been a 20% to 30% reduction of stroke. They've doubled six-month cancer survival rates and, in some cases, reduced heart failure readmissions by 50%, 70%, up to 90%. They see evidence that they are extending lives five or more years. How? By the providers being aligned with the payers and then also making sure that there is very coordinated care going on there. Johns Hopkins has a paper in JAMA that concluded that a care coordination model can be associated with improved outcomes, including substantial cost reduction. I was talking to Larry Bauer from FMEC, the Family Medicine Education Consortium; and he sent me probably a 40-page PDF of really great patient results when care is coordinated and payers are aligned to pay for health. As just one example, Dr. Daniel Hoefer from Sharp HealthCare, they have created what they call their Transitions program. And the idea is by moving aggressive care upstream via community-based palliative medicine, they have proven that the vast majority of people never need to see the inside of a hospital during the last year-ish of their life. The revolving door of hospitalization should be considered an archaic residual of a bygone era, as they put it. Again, this is very well-coordinated care with payer alignment. Do patients actually want this stuff? Before I get into our evidence here, just let me remind you that Kaiser is a payvider with a narrow network and also that Centivo is an innovative TPA (third-party administrator) pulling together narrow networks. On the podcast the other week, Dan Mendelson (EP385) from Morgan Health said that 40% of new employees are choosing lower-premium plans with either Kaiser or Centivo benefit designs. They are choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages. This is what happens when payers and providers are aligned. Nobody gets in the middle there. Heard a similar story from Nick Stefanizzi (EP383) from Northwell Direct. They're doing direct contracting with customers like Whole Foods. Everybody I talk to here is surprised how many employees are electing these kinds of plans. So, yeah … The Nuka System of Care in Alaska (EP312), where I get into this with Doug Eby, MD, MPH, CPE, in great detail. But wow, just wow there. With the Nuka ecosystem, they went from basically a failing mess into the health system that many consider to be the best or one of the best in the country at something like half the price per patient than in mainland US. They have this whole thing where they integrate specialty care into primary care. They have established an agreed-upon referral patterns and also an agreed-upon way to work with specialists that very much involves PCPs talking to specialists so that the whole person, the whole patient can be considered. They structure their whole program around paying for health and getting paid for health. Also, Nuka has a 96% patient satisfaction rate. So again, patients are certainly on board with this. If I was gonna sum up these five examples, I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done. After that, work to collaborate with fellow providers. All of these entities that we just talked about who can brag about their patient outcomes and care quality are doing both of the stuff that we just talked about: aligning and collaborating with payers and other providers. They are also, at the same time, folding three other things into their strategy. And this other stuff is required because you kinda can't align with payers and you can't collaborate unless you're doing these three things at the same time: standardizing best-practice care, getting and using data, and using good technology in conjunction with that data. All of this in the service of this last thing, which is turning transactions into relationships. Human relationships. Relationships with patients. As Rebecca Etz, PhD, and her team at The Larry A. Green Center have shown quite crisply (discussed in episode 295), no relationship with a patient means worse outcomes for patients. End of sentence. But then there's also having relationships with colleagues and relationships with other docs who have patients in common. It is really tough to coordinate care without relationships, and it's also not very fulfilling. Alright, moving on to another question: Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? Well, I can tell you a couple of things. ChenMed has been named to Newsweek's “Most Loved Workplaces” list. Nuka System has a 93% employee satisfaction rating. Considering that elsewhere one out of two family practice docs are burned out, this is pretty striking in contrast. Also, here's another quote from a physician leader about good accountable care where health is being paid for. He said, “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” I'm really sorry I can't remember who said that because it's a great quote and so true. Larry Bauer from FMEC also told me the other day that DPC (Direct Primary Care) conferences have never had a session on burnout. Larry says he tells people if they want to see what 350 happy primary care docs look like, they need to come to a DPC summit. They're happy as clams. Now, while DPC isn't the “be entirely responsible for downstream costs” kind of accountable care, what is going on in DPC is, these docs are accountable to their patients and for the care that they are providing. Here's another anecdote which I think, in sum, adds up to a “yes” if the question is “Do docs really like this stuff?” I had a long conversation with Scott Conard, MD, the other day about his work with clinics in Queens. What I learned was, these clinics, they used to have waiting rooms overflowing with patients who had been waiting the entire day to be seen and just ... it wasn't good for anybody. Fast-forward a few years—high-risk patients get seen fast, and there's time for care coordination. Patients are happy; outcomes are better. But here is why I inferred that the docs are happy in this model: There was a new office manager. New office manager starts trying to go back to the old way, the “normal” way that practices are run. And it was mutiny on the bounty. No way no how were those docs going back. I took that as a pretty solid testimonial if I ever heard one. So, I don't know if anybody has done any sort of global physician satisfaction studies to determine if physicians who are in pay-for-health models where they're collaborating with one another are happier and less burned out than doctors in the current fee-for-service (FFS) environment. But I can tell you that if somebody did do this, there's gonna be one really big confounding factor … and this is what it is: There's a world of difference between a well-functioning accountable care model and a very terrible one. I have had a series of (as I said earlier) pretty heartbreaking, honestly, conversations with PCPs around the country who think value-based care pretty much sucks. For the big why on this, listen to the show with Dan O'Neill (EP359). But in short, in “not quite there yet” value-based care models, one's still in the two canoes messy middle (ie, they've got one foot in the value-based care world and one foot firmly in the FFS world). Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets. There's not really great population health. Nobody's figured out how to defragment the care journey. And then there's the whole measurement industrial complex that gets piled on top of their day. I cannot stress this enough. Alright, so let's just check off our last big question here for the money motivated. This especially comes up when talking with especially specialists, who are doing very well, thank you very much—financially, I mean—in the current FFS status quo. So, let's not avoid the elephant in the room. Is taking on risk, getting paid for value, being accountable to deliver great results, deliver health … is it worth it from a financial standpoint? Alright, let's take a look at this. Here's from show 343 with David Carmouche, MD, when he was at Ochsner. He said, “Anything that we can do to convert the effective reimbursement in the Medicare space to something greater than Medicare fee-for-service rates, we think that this is in our best interest. So, we have gone very heavy into moving as much of our Medicare business into risk as we can. And we will take full capitation under a couple of Medicare advantage contracts.” So, that includes primary care as well as specialist care. Let's talk about One Medical for a moment. Five percent of One Medical members account for 51% of the company's revenue. You know which 5% account for that 51% of revenue? Right, the at-risk ones that are part of the Iora value-based medical group with a capitated model. That is a pretty strong financial endorsement there. There's a whole show with Brian Klepper, PhD (EP335), about why private equity is willing to pay $55,000 per patient in a capitated model. So, some actuaries somewhere think this is a very financially sound way to go. I am not sure if I would die on this hill, but I'd also say there's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow. Everything I've just said, not a secret. Not at all. You see CMS moving in the “making providers accountable” direction. I already mentioned this and what CMMI is up to. But this is very much an overall strategy. Currently, 44% of traditional Medicare beneficiaries with parts A and B are in a care relationship with some accountability for quality and total cost of care. CMS aims to boost that number to 60% by 2024 and 100% by 2030. In sum across the industry, it looks like 19.6% of healthcare payments were risk-based in APMs (Alternative Payment Models) that include upside and downside. This is a couple points higher than in 2020, but it's not like it's skyrocketing. So, that might be a curb to our enthusiasm. However, in 2022 here, looking forward to 2023, you know who besides CMS is going heavy on trying to pay for health and not sick care? I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals. Here's something that Jeff Hogan called out from a McKinsey report: “VBC [value-based care] models that show promise in the employer context include high-performance provider networks with cost- and quality-based metrics, episode-based payments for standardized patient-care journeys … , and risk-based contracts for end-to-end management of high-cost conditions.” You know what all those things have in common that I just rattled off? Only high-performing docs are in network—and this includes specialists. I say all this to say, I don't know, if I were a practitioner of healthcare and I knew that all this data was floating around about my practice patterns and given that doctors that don't perform well as per that data are being excluded from networks … I don't know, just given all of the signs that are pointing in a risk-based direction, learning to take on risk just seems like—I was never a Boy Scout, but the whole “Be prepared” seems pretty sound advice right now, especially given how long it takes to get good at this.   For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here. Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   05:03 When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? 05:46 What is the ChenMed Case Study? 06:26 Can a care coordination model be associated with improved outcomes, including substantial cost reduction? 06:38 Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? 07:29 Do patients actually want this stuff? 07:46 Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? 08:29 What is the Nuka System of Care in Alaska? 09:25 “I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done.” 10:45 Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? 11:16 “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” —Physician leader 13:25 “There's a world of difference between a well-functioning accountable care model and a very terrible one.” 13:59 “Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets.” 14:43 Is taking on risk worth it from a financial standpoint? 16:05 “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” 17:11 “I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals.” 17:54 “Only high-performing docs are in network—and this includes specialists.”   For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here.   Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the ChenMed Case Study? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Can a care coordination model be associated with improved outcomes, including substantial cost reduction? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Do patients actually want this stuff? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the Nuka System of Care in Alaska? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care?” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's a world of difference between a well-functioning accountable care model and a very terrible one.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Is taking on risk worth it from a financial standpoint? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Only high-performing docs are in network—and this includes specialists.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington  

Buying an RV park typically includes a due diligence period and financing contingency. But what do you do when you can't meet the timetable spelled out in the contract? In this RV Park Mastery podcast we're going to review constructive steps to successfully obtaining an extension from the seller if that is necessary. In a perfect world everything would fall into place on the promised dates, but the world is not perfect.

October 21, 2022Mark, Ray, and Scott welcome back special guest Dr. John Lin.  They discuss two questions that came into the Thriving Urology Facebook Group:It is possible to have a billable "pre-operative clinic visit" with an APP before surgery but after the visit where the decision for surgery was made?  The proposed purpose is to make sure clearances and cultures are done prior to their urologic surgery?   I thought this was bundled already and that this type of visit would not be billable encounter? Thanks for your insight! New paradigm for ureteral stent removal. Stent-Removing Snare avoids crossing the sphincter, the most invasive part of the procedure, minimizing discomfort. Reusable, easy to use, avoids a cysto setup, time saving. CPT 50386 with increased RVU's. National av reimbursement $799 (see CMS.gov physician fee tool). I look forward to your posts. Best AUA Stent Removal Coding Article: https://aua.codingtoday.com/restricted/cpt/general/50386/PHE Extension October 15, 2022: https://aspr.hhs.gov/legal/PHE/Pages/covid19-13Oct2022.aspxDr. Lin is the administrator of The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ Urology Advanced Coding and Reimbursement Seminar  - Registration OpenLas Vegas, NV - December 2-3, 2022New Orleans, LA - January 27-28, 2023Register NowCompliance PlansQuestions or need help, please send us an email: info@prsnetwork.comJoin the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com 

Between Hurricane Ian and the Federal Reserve it's easy to get paralyzed by fear when looking at any RV Park deal – or even simply going to the grocery store. But life must go on. In this RV Park Mastery podcast we're going to review decision-making techniques to help reduce your stress and to make better decisions possible on when deals should – or should not – be pursued.

➡️ Become an aesthetic injector WITHOUT wasting time or money: https://intro.aestheticnursesclub.com/masterclassDo you feel as though you're underpaid and overworked in the medical industry?My name is Adam Sewell and welcome to the Medical Entrepreneur podcast! This is where we teach you how to break free from mainstream medicine and carve the career of your dreams.In today's episode, we are going to show you the reality behind pay rates in the mainstream medicine industry.Because the truth is that your money can't buy as much as it used to be able to, and we want to show that you can escape that.But not just that, we want to be able to show you how you can create your dream practice and do the work you love everyday.Make sure to check it out!Key Takeaways:Intro (00:00)This is how the mainstream medicine industry really works (01:25)Here's why pay rates in mainstream medicine make no sense (03:15)What you have to realize (04:48)What are RVU's? (10:37)What you can do to solve this (12:01)Episode wrap-up (14:02)Additional Resources:- Join my challenge here!- Check out my website here!- Sign up for our Aesthetics training here!--Medical Entrepreneur is a podcast dedicated to those who are trying to escape mainstream medicine and start building the healthcare business of their dreams.Subscribe on YouTube or follow us on your favorite podcast platform!

[Durante todo agosto, recuperamos algunos de los episodios más escuchados de la temporada. Este capítulo fue publicado originalmente el 29/09/2021] Seguimos con el ciclo de los "profesionales españoles más creativos en el mundo de los negocios" según la revista Forbes. Hoy nos acompaña Elena Betés, Fundadora del comparador de seguros Rastreator.com. Se acaba de convertir en la directora general de RVU, la división de comparadores de la aseguradora británica Zoopla, después de adquirir por 560 millones de euros la compañía Penguin Portals al Grupo Admiral, que incluye el 100% de Rastreator. Presentan David Tomás, CEO de Cyberclick y autor de “La empresa más feliz del mundo” y “Diario de un millennial”, y Edu Pascual, creador y productor de podcast.

This week we sat down with Dr. David Park, the founding dean of Rocky Vista University to get an update on one of the most exciting developments taking place in Billings right now. Billings Chamber of CommerceJack and Cathy's answers to this week's Rorschach questions: 1. What is a new development in medicine you are excited about?Jack: I think the possibilities for other uses for mRNA vaccines (like Pfizer's Covid-19 shot) are really exciting!Cathy: Increased access to telemedicine and virtual care models in situations that remote medical care is an option.2. What is the best restaurant within 5 minutes of RVU? Jack: Lucky's Ramen NoodlesCathy: Dimond X Beer Co3. What is a career path outside of medicine you think young people should be paying more attention to?Jack: I'll refer back to our episode with Kevin Ploehn and point out that there is a huge pilot shortage right now. If a young person has the disposition to be a pilot, they could do quite well for themselves by going into that field. Cathy: Skilled trade labor positions such as plumbers, electricians, and other skilled trades.

In this episode of Raising The Bar Podcast, Allison talks with Dr. Keith Smith. Dr. Keith Smith is a board-certified anesthesiologist in private practice since 1990. In 1997 he co-founded The Surgery Center of Oklahoma and in 2009 launched a website displaying all-inclusive pricing for various surgical procedures. Canadians, beneficiaries of self-funded insurance plans and cost sharing ministries and uninsured individuals have spent millions of dollars on other things, thanks to this free market approach to medical service delivery. He has made appearances on the Lew Rockwell Show, the Bob Murphy Show, EconTalk with Russ Roberts, the John Stossel Show, CNBC, Huffington Post, The O'Reilly Factor, Capital Account, The Ron Paul Channel, NBC Nightly News, CBS News and has been featured by Reason Magazine's TV division. The New York Times, Time Magazine, ABC news, Forbes and many others have written articles featuring Dr. Smith's revolutionary approach to the pricing of health care and uncompromising free market principles. Are you ready to Raise the Bar? Make sure to take away the notes! Conversation Highlights:[00:17] Who is Keith Smith? [02:25] How did Keith's journey start? [02:33] Why did Keith decide to publish the Pricing? [08:59] It's not only the insurance company but the hospital working with the insurance company to make blacklists.Keith launched his website with all-inclusive pricing.Keith's most humorous conversation about fair pricing? [09:00] How was Allison's experience with Keith? [14:40] Keith's treatment is easy and cost-effective!How does Keith make things simple not just for patients but for surgeons as well? [14:41] Keith hires surgeons on a contract basis! [18:46] "Easy come, easy go."It's always better when doctors work for patients.Physicians need to be paid by those whom they serve.Physicians work for hospitals, not for patients! [20:34] Why is Direct Primary Care a revolution? [23:41] What are the benefits of Direct Primary Care? [23:42] What is the Relative Value Unit(RVU)? [26:52] What are the benefits of RVU? [28:31] Keith's opinion on Pricing Transparency requirements for hospitals. [32:38] What are the pros and cons of price transparency? [32:40] Keith's mentorship and engagement with Medical Students. [35:36] Other than hospital employment, there are many options for medical students.Keith's message to medical students. [35:38] Keith's best piece of advice for consumers and employers! Memorable Quotes:“Doctors make terrible employees.""Doctors are not necessarily making their decisions in the interest of patients but the interest of facilities.""Hospitals can own doctors, but doctors can't own hospitals!" Special Reminder:Thanks for checking out the show. Be sure to subscribe and leave a review.If you have an idea or topic for the show, or maybe you want to be on the display, visit us at https://raisingthebar.live. Reach out to Keith Smith:● LinkedIn: https://www.linkedin.com/in/keith-smith-7a861732/ Resources:● FMMA: https://fmma.org/● Surgery Center of Oklahoma: https://surgerycenterok.com/● Atlas: https://atlasbillingcompany.com/● Benjamin Rush Institute Donation Link: https://benrush.wufoo.com/forms/r5pz5a306b4933/ Connect with Allison:YouTube: AltiqeLinkedIn: Allison De PaoliWebsite: https://altiqe.comPlease email her at clientcare@altiqe.com Available on Apple Podcasts, Spotify, Stitcher, Google Podcasts, and other major podcasting platforms.

In this episode of Raising The Bar Podcast, Allison talks with Keith Smith. Keith is the House Supervisor at Legent Orthopedic and Spine Hospital. Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990.  In 1997 he co-founded The Surgery Center of Oklahoma and in 2009 launched a website displaying all-inclusive pricing for various surgical procedures.  Canadians, beneficiaries of self-funded insurance plans and cost sharing ministries and uninsured individuals have spent millions of dollars on other things, thanks to this free market approach to medical service delivery. He has made appearances on the Lew Rockwell Show, the Bob Murphy Show, EconTalk with Russ Roberts, the John Stossel Show, CNBC, Huffington Post, The O'Reilly Factor, Capital Account, The Ron Paul Channel, NBC Nightly News, CBS News and has been featured by Reason Magazine's TV division.   The New York Times, Time Magazine, ABC news, Forbes and many others have written articles featuring Dr.Smith's revolutionary approach to the pricing of health care and uncompromising free market principles. Are you ready to Raise the Bar? Make sure to take away the notes! Conversation Highlights: [00:17] Who is Keith Smith? [02:25] ●    How did Keith's journey start? [02:33] Why did Keith decide to publish the Pricing? [08:59] ●    It's not only the insurance company but the hospital working with the insurance company to make blacklists. ●    Keith launched his website with all-inclusive pricing. ●    Keith's most humorous conversation about fair pricing? [09:00] How was Allison's experience with Keith? [14:40] ●    Keith's treatment is easy and cost-effective! ●    How does Keith make things simple not just for patients but for surgeons as well? [14:41] Keith hires surgeons on a contract basis! [18:46] ●    "Easy come, easy go." ●    It's always better when doctors work for patients. ●    Physicians need to be paid by those whom they serve. ●    Physicians work for hospitals, not for patients! [20:34] Why is Direct Primary Care a revolution? [23:41] ●    What are the benefits of Direct Primary Care? [23:42] What is the Relative Value Unit(RVU)? [26:52] ●    What are the benefits of RVU? [28:31] Keith's opinion on Pricing Transparency requirements for hospitals. [32:38] ●    What are the pros and cons of price transparency? [32:40] Keith's mentorship and engagement with Medical Students. [35:36] ●    Other than hospital employment, there are many options for medical students. ●    Keith's message to Medical Students [35:38] Keith's best piece of advice for consumers and employers! [39:57] Memorable Quotes: “Doctors make terrible employees." "Doctors are not necessarily making their decision in the interest of patients but the interest of facilities." "Hospitals can own doctors, but doctors can't own hospitals!" Special Reminder: Thanks for checking out the show. Be sure to subscribe and leave a review. If you have an idea or topic for the show, or maybe you want to be on the display, visit us at https://raisingthebar.live/ (https://raisingthebar.live). Reach out to Keith Smith: ●    LinkedIn: https://www.linkedin.com/in/keith-smith-68b916a6 (https://www.linkedin.com/in/keith-smith-68b916a6) Resources: ●     FMMA: https://fmma.org/ (https://fmma.org/) ●     Surgery Center of Oklahoma: https://surgerycenterok.com/ (https://surgerycenterok.com/) ●     Atlas: https://atlasbillingcompany.com/ (https://atlasbillingcompany.com/) ●     Benjamin Rush Institute Donation Link:...

Today we are doing part 2 or the 3 part series with Kathryn Sarnoski. Kathryn is going to be talking about the RVU model. LINKS: www.ContractDiagnostics.com

Cody (3rd-year medical student) describes his experience at RVU.The highlights:- New COMLEX pass/fail test- Outdoor recreation surrounding the campus- A variety of clinical rotation site assignments- How they interface with the Parker, CO campus

May 27, 2022Mark, Scott, and Ray discuss questions that came into the PRS Community Forum.1. Independent historian. For pediatric visits, I'm a little unclear what counts as an independent historian. I see the definition from CMS indicates "an individual (eg, parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patient who is unable to provide a complete or reliable history (eg, due to developmental stage, dementia, or psychosis) or because a confirmatory history is judged to be necessary."Does a parent providing a history count as an independent historian for a baby? I can see an argument for no (i.e. "provides a history in addition" to the patient's history - baby provides no history) but also for yes (baby isn't able to provide history due to developmental stage). Curious your thoughts on this.2. Newborn (post-hospitalization) circumcision consult. Trying to determine how this one is billed. Not talking about the routine circumcisions that happen right after birth (usually done by OB/pediatrics anyways) but rather about the ones referred to pediatric urology because the parents wanted a circumcision but peds / OB didn't think they should do it because of concern for something like penile torsion. - Risk: I presume would be level 4 (minor procedure with risk factors).- Problem: I'm not sure about this one. I presume if something like penile torsion is noted on exam, this would be a level 4 problem (chronic not at treatment goal). What if it turns out the exam is normal? Is it still chronic not at treatment goal because the parents / patient desire circumcision? This seems to be the key question for whether this visit type would be a level 3 or 4. - Data: perhaps irrelevant if problem and risk are 4's, but perhaps a 3 (independent historian) or just a 2 (review of outside records).3. This is a question posed by our ASC.I appealed the insurance denial and they upheld the denial stating “Our review, with medical records, has determined that per published evidence-based coding literature the following diagnosis code(s) is not compatible with the procedure code(s) billed: T19.1XXD and 52310.” They state “the specific code combination listed above was denies based on published evidence-based coding literature. There is a more appropriate diagnosis code for the procedure billed per medical record documentation which states removal of ureteral stent, not a foreign body; please submit corrected claim.”What more-appropriate diagnosis code is there? History was of UPJ stone with hydronephrosis, since resolved on one and ureteral stone, also resolved, on the other. Because the conditions were treated during surgery, the only reason the patient was coming back in was for removal of the ureteral stone and we've always used T19.1XXD w/out issue for that. Other possibilities I'm finding are Z46.6 (Encounter for fitting and adjustment of urinary device) or T83.192D (Other mechanical complication of indwelling ureteral stent, subsequent encounter) but they don't feel appropriate.4. Do you have experience with the code 0421T? I need to come up with RVU's to assign to the Temporary code 0421T. (Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed). I see other health systems with a definitive RVU number. Can you offer guidance on how to assign a RVU to this procedure? ​

This video honors Dr. Ajay Jain, Professor of Pediatrics, Pharmacology, and Physiology at St. Louis University, St. Louis, MO. His journey to nutrition began in medical school where he cared for babies needing parenteral nutrition (PN). While PN sustained them, many had liver injuries that progressed as they stayed on PN and needed liver transplants. This motivated Dr. Jain to focus on novel strategies to mitigate injuries and side effects of PN patients. He credits ASPEN with building his research niche. His first grant was from the ASPEN Rhoads Research Foundation. ASPEN's resources, like Malnutrition Awareness Week, also helped him grow from a clinical perspective. Dr. Jain advises junior faculty to never give up on their ideas. He feels that today's relative value unit (RVU) healthcare model does not give clinicians time to do research. Institutions need to protect and provide clinicians with mentorship, time, and tools to do this important work. Physician Spotlight is a forum for outstanding Senior Leaders, Young Rising Stars, and International Colleagues in the field of nutrition to discuss important topics and ideas that impact patient care. Visit the ASPEN Physician Community at www.nutritioncare.org/physicians The text included in the description of the podcast Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US March 2022

Alex Kirkland and Matt Jensen join Mark to talk about the latest evaluation and management code updates to the Medicare Physician Fee Schedule. The Centers for Medicare and Medicaid Services (CMS) decreased the conversion factor for evaluation and management (E/M) codes for 2022.     Podcast Information Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review! We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.  Please email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsulting   Episode Synopsis CMS increased the RVUs for which they reimburse outpatient E/M services and decreased the conversion factor to remain budget neutral. The conversion factor cuts will affect reimbursement for all services in the fee schedule to increase reimbursement for more cognitive E/M services. Organizations with RVU-based compensation plans need to revalue their wRVU rates to remain economically aligned with the fee schedule, especially if their provider compensation plans tie to wRVU values in the most recent Medicare Physician Fee Schedule. Click to listen to the episode.   Extras 2022 E/M Coding Calculator How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services

Maxillomandibular advancement (MMA) surgery is highly effective in curing moderate to severe obstructive sleep apnea (OSA). But how does that surgery impact a patient's facial profile? Are we inadvertently beating people with an ugly stick in the name of better breathing? On this episode of Dentist Brain Candy, I cover two thought-provoking articles from recent editions of the Journal of Oral and Maxillofacial Surgery, sharing the findings from a study on the impact of MMA surgery for OSA on facial profile esthetics. I also discuss a paper identifying the trends in work relative value units (or RVUs) among oral and maxillofacial surgeons participating in Medicare from 2013 to 2017. Listen in to understand why I find the RVU system so frustrating and learn why the free market is a far better way of determining reimbursement rates for a given dental procedure. Key Takeaways How the physician fee schedule based on relative value units or RVUs came to be Why I find the RVU system incredibly frustrating and offensive Why so few maxillofacial surgeons participate in the Medicare system How a recent study uncovered an increase in productivity of OMSs and a decrease in the number of Medicare patients served by OMSs in the period from 2013 to 2017 Why the free market is a far better way of determining reimbursement rates for a given dental procedure than the RVU system The high success rate of maxillomandibular advancement (MMA) surgery in curing obstructive sleep apnea (OSA) How a recent study found that MMA surgery for OSA does not have a negative impact on facial profile esthetics Why I'm an advocate of building wealth through cashflowing real estate How I earn cashflow from owning a portion of the building my practice occupies Connect with Dr. Bryan McLelland Dentist Brain Candy Dentist Brain Candy on Facebook Dentist Brain Candy on YouTube Dentist Brain Candy Podcast Dentist Brain Candy App Dentist Brain Candy Continuing Education About Dr. Bryan McLelland Dr. Jawbreaker on YouTube Email bryanmclelland@hotmail.com Call (509) 922-2273 Resources Liberty Oral Surgery February Event Nobel Biocare ‘Trends in Work Relative Value Unit Production in Oral and Maxillofacial Surgery' in the Journal of Oral and Maxillofacial Surgery Omnibus Budget Reconciliation Act of 1989 American Medical Association RVS Update Committee ‘Evaluation of Facial Profile Esthetics After Maxillomandibular Advancement Surgery for the Treatment of Obstructive Sleep Apnea' in the Journal of Oral and Maxillofacial Surgery Chris Salazar on DBC S2EP3 Arsenal Capital

Imagine if your employer gave you the choice between paying 20% out of pocket for your surgery/specialist visit/X-ray at the local name brand hospital, and having the same service done at a different location where care quality was higher for $0 out of pocket. For employees of companies that work with David Contorno and E Powered Benefits, this is a reality.50% of Americans get health insurance from their employer, and most employers rely on brokers to give them advice on how to cover healthcare. Unfortunately, their incentivizes are not aligned. The average health insurance broker makes commission, so as the cost of the health plan they sell to an employer goes up, they get paid more. As David Contorno is fond of saying, if you look at our health system today, almost everything that goes wrong is the result of someone or more often everyone involved being better off when care quality goes down, or when price goes up. That's why David decided to change his model.  David's firm. E Powered Benefits,  exclusively provides value based health plan management for companies by sharing up front  fees, never taking commissions, and creating provider relationships that incentivize high quality low cost medical providers.  Their business model has produced average 1 year savings of 40%, as well as substantially reduced cost for employees. These two things are basically unheard of in this space. My conversation with David was eye-opening.  The stereotype of insurance companies is that they love to deny claims. As I learned in speaking to David, that's not exactly the case. The MLR, or medical loss ratio, says that every health insurance company must spend 85% on healthcare costs. 15% is then left for overhead and profit. Therefore, the only way for insurance companies to increase  profits is for costs to be higher. What ultimately ends up happening is that high value care (defined as care that is likely to cure you or treat you with the least intervention possible) ends up being harder to get approved. We also discussed the underutilization of Primary Care, and how when health system employ doctors, often the way they pay them incentivizes low quality, high severity/cost care. RVU's, or relative value units, means doctors are paid on how much value (i.e. revenue) they're helping to generate within the Health System. If you go to a doctor at that health system with a back problem, writing you an opioid script and sending you to a back surgeon for a consult is far more lucrative than sending you for PT outside of the system. We touched on the new hospital transparency law, which theoretically should make it easier to understand Hospital billing. Unfortunately, the law required that hospitals post a machine readable file online, and many have taken advantage of that verbiage to post files that are machine readable but human unreadable. Even worse, some hospitals have put code on their website that prevents it from showing up on Google, which means you have to go to the hospital website and search for a page made intentionally hard to find which is ultimately unreadable by a human.  Finally, we spoke about David's transition from a commissioned broker to an innovator and disruptor. David used to get paid hundreds of thousands of dollars a year from name brand insurance companies for changing employers to their brand away from their competitors, and for resigning existing employers. When he realized this was causing more harm than good, he closed his business, and started a new company with a model where he is paid a flat fee on an exclusive basis with his employer partners, with bonuses for cost savings and better outcomes. 

On this episode we have the incredibly kind and insightful Dr. Randy Cook!✅44 years of practice as a general and vascular surgeon✅Medical Director for wound care and hyperbaric medicine center✅Host of the Rx for Success Podcast✅MD Coaches personal coach for physiciansHe shares: ➡️How medicine  used to be when he didn't ever have a day that he just couldn't wait to go to work because it was so rewarding and fulfilling➡️How medicine changed when he became an employee of the hospital losing control of decision making and forcing him into unsound  territory➡️How physicians have become a commodity--a repository for RVU's➡️His sense of becoming something other than the physician who should always have the patient's best interest in mind and how that is a stressor if you are the kind of person who is motivated to be a healer➡️How he didn't understand that the anxiety that he was feeling and the disappointment that he was facing was a manifestation of stress➡️How he didn't deal with the stressful part of his practice well and how it has been a great teacher➡️How he now uses his insight to coach other physicians looking for guidance and encouragement ➡️How important it is to  have your eyes open when you are feeling hopeless like that. The opportunities are out there. You may not spot them and walk up to them on your own. But just being open to the possibility of seeing things another way can get you redirected ➡️Don't just ever take your eye off the ball. Remember what your purpose is. If you never forget that and can keep your head about  you, you will be ok. But it is so easy to be distracted. Remember what you are here for. Remember what you were thinking when you applied to medical school.  Don't ever forget about that.Earn CME:Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/q7djKu Info for Dr.  Randy Cook:Podcast: https://rxforsuccesspodcast.com/Website: https://mymdcoaches.com/Email: randall.cook@mymdcoaches.com------------------------------------------------------------Info for Dr. Robyn Tiger & StressFreeMD:Register for Rx Inner Peace: A Physician's Guide for Self-Care (25 CME):https://mahec.net/event/65278Check out StressFreeMD:https://www.stressfreemd.net/FREE Stress Relief Strategy Call:https://go.oncehub.com/StressReliefStrategyCall Private physicians-only Facebook group:https://www.facebook.com/groups/thephysiciansselfcarecommunityInstagram:https://www.instagram.com/stressfreemd/LinkedIn: https://www.linkedin.com/in/robyntigermd/Facebook: https://www.facebook.com/robyntigermdTwitter: https://twitter.com/robyntigermdSelf-Care Shop--accredited programs for healthcare and open to everyonehttps://www.stressfreemd.net/selfcareshopPrivate 1:1 Coachinghttps://www.stressfreemd.net/coachingContactinfo@stressfreemd.netPodcast website:https://www.podpage.com/the-stressfreemd-po