This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of April.
You can read more about the series here and the concept of keeping up with innovating in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. As we have done for the past several months we review the latest news on the COVID19 pandemic front. The vaccine roll out appears to be going well but some got the variants are causing challenges especially in Europe and we talk about Vaccine hesitancy, which as Craig points out is as high as 50% in some healthcare workers and how this needs to be addressed.
We review a recent report from ECRI – “Top 10 Patient Safety Concerns 2021” with the number one concern racial health inequity. The good news is the large spotlight shed but the challenge of solving this is not simple and as you will hear the impact has been worsened by the pandemic
Listen to hear Craig and I discuss the new price transparency regulations and the limited effects or impact we are seeing now but the huge change this will bring about as it did in the second car resale industry and real estate.
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
And today as I am every month I’m delighted to be joined by Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners. And as usual, we’ll be talking about news you can use Craig, thanks for joining me today.
Craig Joseph
As always, it’s a pleasure.
Nick van Terheyden
this this month for once, we probably not going to consume everything talking about COVID-19 we probably need to just sort of cover off the highlights maybe there’s been lots of talk about variance. Certainly tremendous talk about vaccination I saw we were reaching some of your 1.5 2 million a day which gets us at the rate. It feels like things are looking up and looking good around the pandemic. What’s your thoughts?
Craig Joseph
Well, I always like to be pessimistic. And that’s why I like hanging around with Yeah. You know, Mr. Fun. No, I agree with you the feeling the vibe is certainly going in the right direction, for sure. yet. We should not get ahead of our skis and we certainly easily could. And there’s a question about if Europe did already I think the variants are a concern. And again, we’re talking about normal mutations that happen very commonly with, with the RNA type viruses and, and sometimes they become more virulent, more able to attack humans. And so, so far knock on wood. That’s mean knocking on wood. We’re pretty good. And the vaccines, like you said, I think last week, we had 3 million on one day, on one day, we got up to 3 million vaccines administered in the United States, which is crazy good. And so that is all great. But we’re gonna we’re running into vaccine hesitancy. And so there are, I read somewhere about half of healthcare workers are vaccinated, or a little less than half at this point, which seems crazy to me. Right. And that can’t be because it’s not available. That is simply because they don’t want it. And, and so that’s, that’s a bit concerning. But otherwise, I am with you, I am I have a I feel good. But I’m trying again, just not to get ahead of ourselves and just make sure that we know we still have, we still have some some place to go. It’s so easy to wear a mask when you’re around other people. And so I think if we can still just remember to try to wear a mask and to stay six feet away from from others or as we quickly pass them in the grocery store. That will go a long way. And of course, we want to get everyone vaccinated with one of the three maybe even in the future for vaccines that are are available in the United States.
Nick van Terheyden
Right. And, you know, to be clear, I think the last time I looked 11, possibly that have been approved worldwide total. And some of them may not ever get approved. They may not be necessary. But the good news from a worldwide perspective, I you know, a couple of comments around vaccine hesitancy I think people confuse vaccine hesitancy with vaccine resistance. I think those two are different. I think people are a little bit concerned, you know, those are possibly possibly, you know, genuine concerns that arise from lack of understanding, you know, concerns over the speed as an example. You know, lots of people have addressed this, but I think it’s important to sort of face that head on I agree with you, the 50% is surprising. And what I’m hoping is that, you know, with increasing numbers, that we’ve got large numbers, imagine 3 million people on a single day, what an incredible piece of data that is, because we’ll know what the side effects are, at least, you know, from an anaphylaxis standpoint, because that’s pretty much on the same day. It’s you know, within short order. So how many anaphylaxis did we get out of that? Well, we know that it’s a very low rate. I’m sure there were probably some, but it remains at the level we expect. And, you know, hopefully, that’s going to continue to sort of add in and reduce that. The other thing that I heard around this is that, that vaccine hesitancy has been sort of attributed to specific groups. And it turns out that that’s not actually the case. In many cases, it’s just lack of access, you know, this inequity in access, which I think, you know, we’ve got to address, but I’m with you 3 million a day. But, you know, let’s not get ahead, the npis. Stay focused, it’s just a short little more of a journey to go. And I think we’re in really good shape. And I can’t believe we’re at this point this quickly, quite frankly. And I know it doesn’t feel that quick, having sat in the matrix for this long, but you know, the good news is, it is and we’re emerging, as By the way, it’s springtime, which is a perfect time to emerge from the matrix, in my view. So great news. Um, let’s move on to some of the other things. And actually, you know, related to that and, you know, inequity. I know you looked at the ecri organization, the quality controls, they were talking about top 10 concerns of patient safety. Tell us what you found, because I think there was some real surprises in there.
Craig Joseph
Well, what was I thought it was quite surprising. Typically, you hear about, you know, diagnostic problems where doctors or ordering problems where doctors order the wrong medication or do the wrong procedure, that kind of thing is a patient safety concern. Their number one concern was racial inequities. And I just think it’s a telling it’s a telling statement on where we’re at that huge segments of our population don’t have the same access. To quality medical care, they don’t have access, you know, just thinking about telehealth and and what we’ve had to do because of the pandemic, or, or, you know, in spite of the pandemic, people who can’t go to the doctor’s office because it was closed, or because it didn’t feel comfortable, you know, could go online and and talk with physicians that way? Well, you can’t do that if you don’t have access to the internet, you can’t do that. If you don’t have the technology that you need in your house in order to, you know, facilitate that kind of connection. And so, you so many things kind of go back to these these inequities, racial inequities in the United States, and you don’t really think about it from at least I didn’t really think about it from a patient safety standpoint, but completely makes sense to me. And, you know, I’m glad we’re talking about it. Certainly, I don’t, I don’t think anyone has the easy quick fix for it. But talking about it, identifying it, acknowledging that it’s there, I think is super important. I’m glad that they’ve, they’ve called it out. They’ve also got other things to like, you know, telehealth not being as secure as it should be, and possibility of someone hearing, you know, or being able to view conversations, those kinds of traditional
Nick van Terheyden
things, that shows up as a patient safety issue from that.
Craig Joseph
Yes. Well, yes. And and, you know, again, there are the the common ones that are still that have always been around for from, you know, patient safety standpoint, you know, improperly identifying someone, you know, if Imagine if I confuse you with another Nic, and you’re not able to give me a history, or a complete history, and I said, Well, here it says that he doesn’t have any allergies, but in fact, I do have out. So those kinds of things are still with us and will always be with us.
Nick van Terheyden
Interesting. I agree with you on the the inaccuracy, I think another one of the and I I’m always hesitant to use the term silver linings and COVID-19. But, you know, it’s amplified that fact, and allowed us to sort of focus and as you point out, start talking about and elevate that to the surface and say, how do we deal with that? What do we do, and, you know, you bring up the things that don’t always occur to me. You know, I had a really interesting experience when I was doing my HIPAA training for the, you know, 5000s time for my vaccine, volunteering for the Medical Corps here in my state. And one of the things was privacy, and you know, we were talking about it, and somebody said, Well, we try to allow for the transmission of that information at the table. And this, you know, multiple tables and people can overhear. So, you know, date of birth name, those are all age, you know, personal or personal identify pH i. So, somebody on the call said, well, gosh, actually, what we do is we write it down and ask them to put the information so they don’t have to say, and I thought, Wow, that’s a great idea. And almost immediately somebody came on and said, well, it’s a great idea, but it has the unintended consequences of precluding people that can’t read or write, you know, so they have health lists, not just health literacy, but literacy challenges. And there’s a troubling number of folks. And suddenly, you’ve created a barrier that you didn’t know. I mean, it’s it’s unintentional. I think that’s the point that I like to get across is, a lot of these actions are not intentional. This is not a deliberate attempt. Sometimes it is I accept that may have been the case. But I think most people start out with the best intentions. And it’s understanding from the perspective of the individual that has a different lens and a different set of experiences that you don’t necessarily understand. And unless you walk in their shoes, how could you possibly so I brought us number of people to sort of look at those issues, I think is the way that we start to address it. But good news now. Moving on price, transparency, hot topic, right?
Craig Joseph
Yeah, actually quite interesting. Within the last, I think month, they went live with a new regulation from the federal government that said that hospitals have to put certain pricing information on their websites make it publicly available and they have to do so in a certain way. And so that files can be you know, looked at and then analyzed so that the information can be consumed by third parties so they can compare apples to Apple’s, and not only were hospitals or our hospitals required to provide that information online to anyone that’s looking. It’s not just their their, you know, cash prices, but they also have to put on there how what kind of deals the insurance companies are getting. So Insurance Company A pays X number of dollars for this procedure and curtain and B pays x plus two times x, whatever it is. And so what was, so that was fascinating, and of course, many hospitals and organizations that represent them, tried to prevent these rules from going into place and gave rationale that it would not be competitive would actually be anti competitive. Be that as it may, none of them worked. And so the rule went into place, and what a couple of of newspapers have put out reports in the last couple of days saying a lot of hospitals, big hospitals are simply either not making the information available, or are making it difficult to find. And the some of the things that they do are, of course, you know, hiding under 14 different clicks, right click here and then click there. And it’s not obvious or or intuitive. Some of many of them have put code to make sure that Google and other bots who which are going through and looking to index won’t index those pages, which means that if you go to your typical search engine and say, you know, show me how hospital x charges, you will not find that page because it has not been indexed, which was I didn’t even know that was a thing. So that I thought that was interesting. Now, again, I was reading the newspaper article, and it said, practically every hospital that they contacted, saying, hey, it looks like you’re not allowing this to be indexed, which means it won’t be found, which means you might be in violation. Within a couple of days. They were Oh, that was a mistake. And, and they fix that problem now. So. But I do, I do think it’s interesting that the the, the fine for not doing making this available is $300 a day, which may seem like a lot to you and me, but to large hospitals, it’s not a big threat. And so really the threat comes from public shaming, and which has been effective. So yeah, that’s going to that information is going to be out there. Now the question is, once it becomes more freely available, and hospitals are kind of getting with the program that they have to do this. Here’s my here’s my question to you. So what? So what the information is out there? What am I? I my question really is? And this is a rhetorical question, I don’t know the answer. What are people supposed to do with that information? Most of the time, and here’s why I asked. Most of the time when my doctor says, You know, I think you need to have an operation. Or I want you to go get an opinion from this doctor, or about this problem. This is the doctor, I suggest you go see, she’s the best around? Well, most of us, as long as that doctor takes our insurance is going to go see that doctor. And if that doctor says I think I want to do this procedure, you’re going to need an operation or a test. And I do it at hospital see that that’s where you’re going to go most of the time. It’s hard for me to imagine many people and I know there are exceptions, but then maybe you disagree. Hey, am I really going to after this doctor said that, you know, I got a referral to this doctor says I need this operation which they can only do at this hospital because that’s where they they do their operations. Am I not going to go there to save some money? Am I going to be able to actually compare apples to apples and understand what the procedure number is? And well, I understand the significance of the fact that it’s not only that procedure, right? So that’s the charge that the hospital might drop, but the surgeon is going to drop a charge, which might be different if I go see a different surgeon.
Nick van Terheyden
Yeah, so I am gonna push but I mean, I understand your position. I’ve heard it You sound a little bit like some of the pushback on Well, what’s the point? We don’t need it, whatever. But there’s a couple of points. So you already mentioned one of the data points that I think is highly valuable, if I’m going in for and let’s pick an emergency procedure that I’ve really got not a lot of choice, potentially. So I’m going in for an appendix e because I’ve got right upper quadrant pain, Bernie sign, you know, CT was positive because I do that. Now that was kind of a shock to me to discover just recently doing the CT for FedEx, but apparently that happens anyway. So I have it, and I’ve got no choice. But if I go look at the charge Master, and I see that they charge insurance company, a 6000, an insurance company B 8000. And, you know, whatever my attitude to that is, well, I don’t care what my insurance company is, if you can do it for that price for this insurance company, that’s a negotiation point. Now, albeit I’ve received the services and you know, my negotiation, but what I found is that negotiation still exists, when you start to fight because people are not keen on some of the the potential bad press that results are some great organizations like clear costs. And, you know, certainly the New York Times, and, you know, folks that sort of try and address this where, you know, there are outrageous charges, and I’ll pick one personal experience, I had a COVID-19 test. Why did I do this? Well, it was coming into the holiday period, I had two family members returning from college who had been in isolation, one actually, you know, very low risk for a variety of reasons and other, you know, really substantially low risk, but through the abundance of caution, we decided that we should all be tested because we were coming together, you know, and we’d be together for an extended period of time. And, you know, the the state says COVID tests of free, well, a $395 bill shows up in my email that has been hounding me now for a month or two. And I’m of the view that that’s not acceptable. And I’m fighting it. And what’s interesting is now suddenly, they’ve gone a little bit quieter, because I pushed back and I provided them with, you know, links. Now all of that requires, and what it does do in my view, is expands the inequity, because that requires having a PC printer, you know, email, all of those things that are very difficult, also being able to put together you know, a substantial case, and, you know, so we do need advocacy for it, but it opens the door. And I’ve got one other additional point that I think is really important, relevant to this. The one of the cleverest pieces of AI that I ever saw was for those ridiculous
user, e eulas. User licensing is a
Nick van Terheyden
license agreement. Thank
you.
Nick van Terheyden
So you click through and it’s 17 pages, you’ve you know, and you’ve given away the rights to your wife, children money, house, the whole thing and you don’t know it. And somebody set up an AI tool that actually went and looked at all these and produced all the summary points that are entirely relevant in you know, like six bullets. And you could run all of these eulas through an AI. And I’m thinking the same thing might happen with the charge Master, even with this inequity, so that you can go do this quickly, and shop around and you know, somebody’s willing to give you a deal. You’ll go for a deal, why would you not, that’s the American way now. Mr. British man would say, Oh, this is ridiculous. Just go to the doctor and do what you tell.
Craig Joseph
That’s very proper of you. Mr. British man? No. And actually, so I was being a little bit argumentative. I would say that your AI, you’re onto the right track. So to me, the WHO CARES is not so much. I think you’re right, that you could use this information to try after the fact especially if you didn’t have a say that that makes sense. But to your point, most people are not going to do that some are. But I think most people aren’t going to realize that they could do that. What I do think, though, is that third parties are going to start being able to really give actionable information, right. So is there going to be an app that I could go to, but with my insurance company or household independent thereof, where they are collecting this information, making it usable, saying, hey, maybe even reaching out to physicians, it looks like you’re operating at hospital a did you realize your patients could pay half for most of the procedures that you do at hospital B and maybe you should ask hospital a why that is. And that
Nick van Terheyden
might be a good RX for hospital charges.
Craig Joseph
Some exactly right, exactly. Something some some third group of third party groups, groups of companies that can take that information, make it helpful and actionable for folks. And then then you got something but right now, I think it’s just a big, ugly mess. Yeah, I agree with you. It’s absolutely more information. it you know, to me, it kind of reminds me of maybe real estate and, and buying cars, you know, back in the day 2030 years ago, you’re totally at at the mercy of the car dealer and the real estate agent because they have access to the pricing and they had access to, right, and now I have that as well as they do. And I remember that
Nick van Terheyden
accessing the Kelley Blue Book was like it was that secret, but it was a physical book two
Craig Joseph
in the multiple listing service MLS, right? How was I to possibly know what how, what houses were for sale, and what their square foot per, per square foot. So once that information is out there granted, but it does take a while for the Zillow to come along and for, you know, other pieces of information so that now these vendors have to really, you know, real estate agents and car dealerships, you know, I have the same amount of information. So the value that they have to provide to me is far greater, and they still provide a service to some extent. But yeah, it does change the power dynamic. And so from that standpoint, 100% think you’re right, but But today, I’m just like, Yeah, I don’t think I could use this information even. And I think I’m pretty skilled,
Nick van Terheyden
you’d be challenged to actually interpret it. Alright, we got a couple of minutes left, I wanted to quickly get to the, you know, the telehealth and, you know, we’re potentially seeing the end of the pandemic, the emergency sort of circumstance, there’s certainly some talk about, well, you know, will we continue to have access and the same opportunity to get telehealth services?
Craig Joseph
Yeah, my hope is that the, the genie is out of the bottle, and it cannot be put back in. But one thing kind of actually taking us back to the beginning and talking about inequities is, it seems to me quite likely that telehealth with video visits will continue in some to some extent, I, it’s so convenient for so many people for so many visits, not for everything, of course, but for many things, you don’t really need to be there and actually be touched by a physician. I want to throw out telephone calls. So today, it’s all the same. So the physician, whether they talk to you on the phone, or whether they look at you over the with a camera, it’s it’s the same chart, actually, whether they see you in the office, it’s all the same. They’re all everyone’s being reimbursed the same amount of money. But there are those again, as we talked about it don’t have the technology. And if we said, well, telephone calls don’t count anymore. And so you’re out, you’ll have to go to the office, then you’re right back to where you started, which is not a good place. And I want to throw out since you brought up a personal experience, I was just talking to a physician yesterday to my physician, one of my physicians yesterday, and it was supposed to be a video visit. And all of a sudden, my phone rings. And it’s the physician saying I can’t figure this out. I’m having some technical problems on my side. So can we just talk over the phone. And that was perfectly acceptable. After I gave him some difficulties, just because I felt that I was in a position to harass him a little bit. You know, my fear is that if you take away the ability to do the telephone calls, things like that, that would have been he would not have been able to just call me, because then that would have been a free call, like that would have been free. And there’s a lot of money.
Not right. Yeah. So
Craig Joseph
yeah, he would have probably rescheduled and it would have been a pain in my butt and a pain in his butt. So yeah, I’m hopeful that we’re able to keep all of these things and as long as we document them well, and folks don’t take advantage and lie and cheat. And by folks, I mean doctors and health systems, then we you know, we can continue to have nice things. And these are nice things and I hope we continue, we can keep them
Nick van Terheyden
100% agree. Well, as usual, we’ve run out of time, unfortunately but just remains for me to thank you for your insights and look forward to catching up next month.
Craig Joseph
Excellent. Thank you for having me.
