Coach JPMD (00:00.174)
Welcome to the Practice Impossible podcast with your host, Coach JPMD. So January 20th, 2024, the Practice Impossible team flew out to South Carolina to participate in the IndieDocs annual winter meeting. IndieDocs is an organization whose mission is to join doctors together to preserve, protect, and promote the independent practice of medicine to ensure that patients in South Carolina have
alternatives and access to high quality and valued doctor driven care. We interviewed several attendees at the meeting from Indie Docs president Marcelo Hockman, who was on our podcast, to South Carolina representative Celeste Davis. All of our attendees or the attendees had one thing in common. They all wanted to ensure that independent doctors have a say in patient care and the future of healthcare in the U .S. I've compiled
This episode, which is a special episode with all the best interviews of the day. And at the end of the episode, I'm going to share some resources that I gathered that will help you learn how you can support the independent doctor movement, whether it be in your city or your state. So here's Dr. Hockman and his opening thoughts on IndieDocs and the independent doctor movement. Well, this is really exciting. Thank you, Dr. Hockman, for having us on at your event.
And this is great to see you again. Yeah. So we saw each other a couple of weeks ago on the podcast and, this is an awesome event. The awesome venue. We're excited. We're looking forward. It's our first time around. So should be a good start. So why Indie docs? Well, independent doctors of South Carolina is a independent, a group of, or a tent of, physicians, regardless of specialty who are intent on.
really bringing doctors and patients back into control of their healthcare. As health systems have gotten bigger and bigger, medicine has gotten more depersonalized for patients and for physicians as well. Physicians are finding themselves in situations that are really kind of antithetical to the way we think and the way we act. So, IndyDocs is going to change the way healthcare delivery is.
Coach JPMD (02:21.934)
seen in South Carolina and we're focused on educating the public, making sure that they start demanding services from independent physicians, which are much more cost effective and more value driven than the big systems, more personalized, and get physicians to start offering some things that were not available here in South Carolina because we've now repealed the Certificate of Need Law.
And finally, to get investment and get, you know, industry to start seeing South Carolina as a great place to do business. That's awesome. And we're sitting right next to or standing right next to the Blue Cross Blue Shield as well. So how did you get an insurance payer to come in and into this event? So I think it's really important, you know, lot of practices are very dependent on the third party payment system. I mean, that's just the reality.
lot of practices are cash only and membership and those types of things. And then there's hybrid groups. But the reality is that Blue Cross is, you know, the major player in South Carolina and we have a great opportunity to work with them to, they have now acknowledged that independent practices are more cost effective, better value.
than the same services provided by outpatient departments of hospitals. So if that's the case, then we ought to be working together to promote independent practices and independent physicians. So they're very interested. I think we're gonna come up with a very innovative way of patients taking back control of their healthcare, whether they're insured or not.
That's awesome. This is a great event and thank you for having this. And thank you. Thank you for being a champion for this for this cause. Because, you know, second season of practice possible is all about independent practices and independent physicians. you are you are the leader in South Carolina in helping physicians. Very intent on making IndyDocs really the organization that is championing the the rights and the practice of independent medicine. So thank you again. Thank you.
Coach JPMD (04:37.294)
South Carolina representative Celeste Davis serves the citizens of the House District 100 and is the first woman to hold that seat. She has a vision for South Carolina and is a strong supporter of independent doctors. representative Davis? Yes. So tell me what brings you to IndieDoc? Well, I'm here to hopefully talk about a few ideas that I have. One being preventative health care.
I see a lot, especially in the people that I associate with, my friends, my sons, I think there's a real need, a real desire for people to start preventing disease and get ahead of it before it rules their life. And so I think there's a real need and a real, I think it's time to talk about preventative healthcare. Also, I'm very interested in artificial intelligence and how that will, I believe, revolutionize
the healthcare industry because doctors gonna have access to so much information. And I really think diagnosis is gonna be easier. That's awesome. So how do you think any docs is gonna play a role in that? I think the voice of IndieDocs and that in the voice of that independent doctor is gonna be very important. So what would be the one thing if you had presidential powers today, you would change in healthcare?
Well, probably if I had presidential powers, one of the biggest things I would change would be the way we provide rural health care. I believe that the way we provide rural health care by building a hospital and then sort of stepping back and waiting for it all to happen, I think that's the wrong way. I think it's an outdated model. I really believe that we should take a more modular approach and bring in health care providers and facilities that meet the needs of that rural community.
Sounds like you have a passion for this. Thank you for coming on the show. Nice to meet you. Marguerite Germain and Sandra Nash Hannigan are two dermatologists that stopped by our booth. Take a listen to their thoughts. So if you don't mind telling us who you are. Yeah, happy to see you. Happy to be here today. Marguerite Germain. I'm a dermatologist from Charleston, South Carolina. I'm Sandra Hannigan, a dermatologist from Charleston, South Carolina.
Coach JPMD (06:54.486)
And so why IndieDocs? Well, you know, it's always good to have a voice and, you know, doctors have to stick together and we have to, you know, let our issues and be known because we want to always do the best we can to serve the public. And sometimes there's things that can be kind of serve against that. So we want to make sure that we get out there and we kind of pull together and we get, we know the information so we can do the best we can do. That's awesome. Why IndieDocs for you?
Well, it's an independent doctors association and we're both independent physicians. So we just have a voice as well as meeting colleagues that are going through the same challenges that we are. It's always good to have people on your side to help problem solve as well. So what do think is the biggest challenge to independent physicians today? Just staying independent. know, it's, there's so many groups that are forming and, saying independence is very difficult.
We don't have a collaborative group of attorneys and business people supporting us like the hospital systems do. We do everything. So when you make everything a big system, it just makes it harder for people to have an independent voice. Awesome. Thank you for stopping by. Thank Dr. Daniel Rosner is a respected auto -laryngologist in South Carolina. He runs a private practice and sits on the board of IndyDocs. So why IndyDocs? Well, first of all,
Can you introduce yourself? Hi, I'm Daniel Rosner. I'm an ear, nose and throat doctor in Myrtle beach and independent practice been independent my entire career since finishing my residency in my 29th year. And interestingly, Marcello was my attending in my residency at MUSC. So we've been friends for years and he approached me one Monday about Indie docs is his, his, his
kind of creation. And I love the concept. I want to see strength amongst private practitioners. I want to see it thrive. And why do you think it's so hard for this one to do what you did 29 years ago? What's for 29 years? Well, you know, I mean, just so many changes. Like when I moved, when I first moved to Myrtle Beach, I don't think there was a single employed physician by the hospital or a private equity organization.
Coach JPMD (09:14.734)
And now, as you see the statistics, it's 70 % are now employed. So the changes are just drastic. So it is, it's, I think it's, it's, there's a lot of external forces make it hard to have a private practice. So I have one question I've been asking a lot of different guests here. And if you had executive powers, you had presidential power, would be the one thing you'd change in healthcare today? Wow. I, I, I do think the one thing is that I wish
There was more transparency between the patient, the doctor in terms of the financial relationship. I think that we all have a good doctor patient relationship from a medical standpoint. But I think that when you have all these third parties involved, I think that it just muddies the water a lot and makes a, I think it creates a lot of animosity.
So I'd like, I'd like, I'd like there to be more of a free market type approach. Thank you. thank you for doing this. Thank you. Dr. Katie Cole, affectionately called the healer's healer. Dr. Cole is an award winning psychiatrist and wellbeing change agent and advocate. She works with healthcare leaders and organizations to reinvigorate their passion for medicine and to help prevent costly burnouts by expanding the wellbeing community.
and helps create a healthier life work balance. So Dr. Katie, Katie Cole. Hi there. Yes, Dr. Katie Cole. Tell me about yourself. Well, I am a psychiatrist by training, osteopathic physician, and I have training in functional integrated medicine. And I've been in hospital leadership for about 20 years. And I recently moved to South Carolina from California and I'm in the process of
really pivoting my career and I'm really passionate about healthcare reform in terms of healthcare wellbeing for all employees and physicians. why IndieDocs? Well, I actually had the pleasure and honor of interviewing Dr. Hockman on my podcast, Hope for Healthcare. And he really is so passionate about what he is doing at the state level to try to impact, you know, independence for physicians and to bring back the doctor patient relationship and to improve quality of care and
Coach JPMD (11:39.182)
access of care along with decreasing costs. So I am really excited to learn more about what he's doing at the state level. I know he helped in a lot of different ways in terms of repealing that. And we're getting called back. But anyway, there's multiple projects that he's been working on that have really impacted.
physician care at the state level. because I really, it's in alignment with what I really want to be doing with my life right now. I want to create a better healthcare system for my colleagues, my patients, and my future colleagues in medical school and residency. So that's why I'm here today. Awesome. And we're going to have you back because I have more questions for you. Thank you so much. Thank you. Matt Wagner is an ACO administrator and describes his experience and why any docs is important to him.
Wagoner? Yes, Wagoner. Yes. And Tony, what do you do? I'm with Palm Beach Accountable Care Organization and I'm the vice president of national growth strategies. So kind of work with helping to expand our ACO into many other states outside of Florida. And why IndieDocs? IndieDocs, we're actually, Palm Beach ACO, actually
owned and operated by independent doctors. So, we partner with independent doctors. So, independent docs that want to maintain their ability to be remain independent, oftentimes need to create additional revenue sources and an MSSP ACO is a great way to do that. They can earn a lot more money with being a part of it, eliminate the need for MIPS and MACRA, which takes a lot of time.
and also really improve the overall quality of care of the patients across the board and kind of remain independent as long as they can. Awesome. So what do you think is the number one thing that is deterrent or is keeping physicians from going independent? From going into... From being independent? I think money's probably got to be part of it. know, primary care docs, as they mentioned in our conference earlier, they...
Coach JPMD (13:34.988)
You know, they're really not paid the best. The money's there. They're the sphere, the tip of the spear when it comes to population health and value based care and that kind of thing. But the money doesn't doesn't often reflect that. So a lot of times practice, you know, you know, there's other practices they go into being a part of a hospital, being employed there. And now they're kind of on an RBU schedule and it's a whole nother whole other thing. So it's kind of hard to break out of that once they're, you know, I would imagine. So you're present. So let's say you're present.
of the United States and what's the first thing you do as a president to fix this broken system we have? my gosh. That's really, really good question. First thing, I'm going to take a minute there. First thing to fix the problem. Man.
Coach JPMD (14:27.246)
I'd say more skin in the game for everyone involved. Patients a lot of times, they're, know, patients, providers, the whole system overall. think we do a lot better if we had more skin in the game. Thank you, Matt. Appreciate you coming on the podcast. We caught up with Lee Gross, who we interviewed in season two, episode three, or our 50th episode. And he has such a wealth of knowledge.
experience in the direct primary care space. Someone I wish the government listened to more. Dr. Gross. Great, great, great talk. Some of which we heard on the podcast. What do you think about this audience and any doctor? I think it's incredibly important for there to be a platform for independent physicians. You could debate about how many doctors now are still independent, 30 percent or whatever, but
It's clearly less than half of the physicians in the country are now independently owned and operated practices. I just heard from my alma mater where I did my residency training just this year, University Hospitals of Cleveland, an inner city based primary care training program in Cleveland, one of the best in the country, just decided to close its primary care practice in the hospital because they said that primary care is no longer a hospital based training specialty. You should only be trained in outpatient. So it's almost as if they're
just giving up on the training of doctors to say the only reason doctors exist now is purely for referrals into the system. And so doctors don't need to be trained in the hospital just to refer patients on to specialists and into the system. A doctor is the same as a nurse practitioner is the same as a physician assistant when your sole role is to refer patients into the system. I agree. Any of them are perfectly capable of seeing a patient and referring them on and triaging them to the right.
specialty. But if you're actually looking for the advanced management of patients with full scope primary care, it is critical for independent doctors to work together, independent primary care, independent specialties for management of the patient. think it's critical for the future of healthcare. And I think it's time for doctors and patients to work together to restore healthcare and bring it back where it belongs between the physician and the patient.
Coach JPMD (16:49.182)
Absolutely. I'm in total agreement. so if you if you had presidential powers, what would be the first thing you did on day one? that's all that's a long list. this is what the main one. Yeah, I mean, I'll just do this because it's low hanging fruit. I have been lobbying for years for health savings accounts to be recognized to be spent for primary direct primary care memberships.
That is something I lobbied at the federal level. It's something that we've taken to the White House and even had a presidential executive order signed to compel the IRS to recognize drug primary care as an eligible expense for health savings accounts. We've met with the secretary of the treasury over the issue and over a dozen Internal Revenue Service lawyers, and yet we still don't have formal recognition from the federal government over the treatment of DPC relationships.
I would do whatever I can within my power to finish that task that I've spent the better part of a decade trying to secure. So I served on the board of an HCA hospital for almost 15 years. I don't think it works within their structure. It's not, it's not their model. They provide excellent care with the system that exists today. I just think the system that exists today is broken and it's too expensive. People can't afford it. We can't afford it. It's a country. We can't afford it.
So I understand why HCA operates the way they do. But in my years, even from a board level position, I was not able to secure price transparency for cash based surgeries. So for example, if I'm an HCA hospital, I'm not picking on HCA, insert any large corporate hospital in here. They're the big boys. They are at the moment. Yes. So if HCA's operating room is booked out for two months,
at full price, full freight, you know, they're going to charge $120 ,000 for a surgery, maybe get paid $50 ,000. Why would they sell that same surgery to somebody else for $18 ,500? Now let's take that same argument to a rural hospital that has massive capacity, they're fully staffing an OR that's sitting with lots of empty slots on the schedule that provides excellent quality. But for them to get one additional case at $18 ,500 is a huge victory for them.
Coach JPMD (19:10.902)
So if you were to find a way to steer some of that low risk elective volume into a rural facility that's just gasping for air, and also working in the arrangement like we did to restructure the employee health program around them utilizing and servicing hospital services to keep them brisk. I think there's a model there to save rural healthcare that I just don't think HCA and corporate medicine is prepared to do because
If HCA were to take that same exact approach to a rural hospital, they would not do that. What they would probably do is close down all the hospital beds, convert it into a freestanding emergency room as a source of referrals into the main facilities, what they would likely do. Thanks for your comments. Dr. Keith Smith was one of my inspirations for the practice impossible season two. He's been practicing some radical methods in cash paying pricing model.
of healthcare. His concepts could radically transform the US healthcare system if implemented at a larger scale. Do you think what he's doing is possible in your area? Take a listen.
And I'll just give you a quick story. Second season. This is my second season. First season was all about managed care. Second season. I what? I've not been on your podcast. Because you are the second person on my list. I just couldn't, I didn't know how to get in touch with you. here I am. So I'd love to be able to get you on the schedule, but you know, I don't know what your timing is, but. I'll give you my email. What does it get us set up? Wonderful. Wonderful. What do you think about IndieDocs?
I think it's more radical than the people in this room even understand. I think I agree. room, God scared shallows. don't care what he says. There, this scares them to death. Blue Cross wants nothing to do with me in Oklahoma and I am one tenth of what they pay the hospital for the same thing. So why do you think they don't get it? Because they make more money by taking a large charge and applying their discount because they skim.
Coach JPMD (21:22.35)
they charge for that discount. That's called claims repricing. And that's a big part of their revenue. And the other thing is the hospitals will tell them, we'll give you a 40 % discount, but our volume or revenue has to be this number. And if you don't meet that trigger, then only get a 20 % discount. Gotcha. So then they shun me because they're not interested in buying more, cheaper and better. They make more money, but it's not
So do you see niches in the country and in areas where this could actually work? Because it works for you and Okla. 37 state chapters of the Free Market Medical Association. is. So it's working. This is like a time capsule. mean, but it's going to happen here now. mean, all the states, if I were going to pick one or two where this would never happen, it would be South Carolina. And it's because of Blue Cross. What about Florida?
No, it's already happening in Florida. That's Lee Gross. Yeah, no, I got Lee Gross, as far as others... are coffee centers that have coffee beans in Florida. No, Florida is much more friendly. South Carolina, North Carolina, Wisconsin, Alaska, they suck. They are really heavy handed. But this is exciting. This is exciting. ground -breaking. Yes. So there you have it, our first road trip.
And in case you were wondering who is on our team helping make this happen, well, it's John Paul Coriotti. He joined our team at the end of last year in 2023, and he brings a wealth of national radio broadcasting experience. And we are in the final stages of planning a weekly episode of Medical Business News of the Week. So stay tuned for more details. It's going to be really exciting. We have some pretty neat things planned.
Take care and be sure to share this episode with your friends and colleagues. Peace out.
