Episode Transcript
Daniel Wrenne: Hey guys, hope you're having a great day. Had a couple of, quick items that I wanted to share briefly before we jump into today's show. first of all, I really appreciate the reviews that we've been, getting from you guys lately on some of the big, podcast libraries. They really mean a lot to me.
they make my day better. They also motivate me to continue doing this. It's a lot of hard work and, just seeing those really motivates me to continue to do that. Also, they are great for increasing exposure and they allow new people to find out about our show, so I really appreciate those. if you haven't, Already left one.
I would really appreciate it if you would take a minute to leave one yourself. The second thing, I'm of course dedicated to continue hosting this podcast. I'm also a planner at RIN Financial Planning. I'm a partner in that firm they're really our main sponsor for this podcast. And ultimately allow us to keep the lights on here.
what's important is they allow us to do that without selling out to a lot of these financial products and services that you often see, being pushed on these financial podcasts and media sources. So this podcast and our planning firm both have a, a similar mission, which is to help physicians use money as a tool to live their best lives.
However, with our planning firm, it's, it's more of a one-to-one model, as opposed to the podcast is, you know, a larger group. And so our team at the planning firm has had the privilege of talking with many of you guys and working with many of you. and we really loved those interactions. So based on this experience, we're gonna be introducing something a little new that I wanted to share with you today.
So we're going to start offering a no-cost triage meeting for finance, for physician listeners that aren't already working with us. the way that this works is you would schedule a 30 minute meeting with one of our great CFPs. it'll be linked in the show notes. And so in this meeting, you're basically gonna be driving the agenda.
Our goal is gonna be to talk through. Whatever you'd like. maybe it's some of your biggest financial questions or maybe you'd like to review your current finances. Either way, our role will be to help you to start to identify the next steps and the urgency of each, and give you suggestions of what those might look like.
Some examples of topics we might cover. maybe you're navigating the home buying decision or maybe. You're thinking about considerations for going into practice or maybe you'd just like a second set of eyes to look over your tax return or your employee benefits or your investment elections. maybe you just want a second set of eyes or a second opinion in general, around your existing advisor.
Those are all great examples of the topics we might cover. So while we're talking about this, I should also point out, If you haven't already worked with our planning firm and we haven't had the privilege of meeting yet, I think it's best to assume that really we're just random people on the internet at this point.
because I guess that's what we kind of are. I'm a random dude talking to you on the internet, which is kind of funny to think about. now I would like to think I know a lot about finance for physicians. I'm confident that I do. but of course everybody's gonna say that. So, it's better if you do your own homework and you consult your own advisors.
same goes for our planning firm. 30 minutes is in no way enough time to get to know you and to fully understand your situation. So at that point, it's just kind of a conversation. and I think it's best going in this to really, make sure and not consider this as advice. it's just not gonna be possible to receive quality advice in a meeting as short as 30 minutes.
or in a podcast there's no way I would know about your situation. So I would be cautious. You know, you, I would not take that approach. Now that doesn't mean we can't add value. Our intent in this meeting is to help you uncover really as much value as possible while also giving you a taste of what it's like to work with one of our great CFPs.
There's not gonna be any obligations associated with this, so you don't have to worry about like, hardcore sales pitches or whatever, follow up, that kind of thing. it could just be as simple as a call and move on. So if you have interest in scheduling one of these, it'll be linked in the show notes, like I mentioned.
make sure when you're scheduling it to indicate that you found us through the Finance for Physicians Podcast so that we know to adjust the agenda. All right, so I'm excited to share my conversation today with Tom Campanella. Tom has worked many years and earned a ton of experience in various areas of healthcare several years ago in response to his.
Anger and frustration in the healthcare system. He decided to begin sharing what he had learned through blogs and white papers and conducting webinars as well as speaking at conferences or seminars. make sure to check out his really popular, LinkedIn articles. I'll link to a few in the show notes, but they're fantastic.
Today I'm gonna be talking with Tom about healthcare economics. So, when you hear this, I'm sure, I'm guessing a few of you're like, what? Why would I. Care about learning healthcare economics. That's like the last thing I wanted to learn. So I think it's, that's a great question. I mean, why in the world would you wanna learn about healthcare, healthcare economics?
So, I wa I wanted to address that first before we jump in. I think we can all agree that the current medical system is, is pretty broken. I think it's extremely expensive for our citizens. I mean, it's, it's, it's well known that it's extremely expensive for our citizens. I think it's like almost 20% of, of gdp and it's, it's, you guys are getting burned out.
Our physicians are, are burning out left and right, are retiring earlier, going to different careers. so if you're in this, in the practice of medicine, you have any interest in helping to solve this problem, which I think you should, if you care about your professional future, you really have to start by educating yourself on how all this stuff works, in particular, the money. Unfortunately, you know, for good or for bad, like inevitably money is at the root of many of these big issues. I'm sure you've heard people say, follow the money. You'll find, you know, the underlying problem.
Hospitals and health, health insurance companies are really ultimately running the system and they're making a ton of money. And they have, they have very little or maybe no incentive to change things. So I wouldn't expect change to happen. The hospitals and insurance companies would be completely happy if physicians just stayed out of healthcare economics completely and just focused on medicine.
gonna reduce the chances of disruption. It's gonna preserve their ability to make profits. it's all good for them. And that's worked okay for a while. but now that the system is really, Having problems. and ultimately physicians are taking the brunt of it. I think something's gotta change.
So in order for this to change, physicians have to become educated and really start to unify and, you know, ideally earn a seat at the table with these other key players. as physicians become more educated on healthcare economics. I think it's gonna empower you guys to start to advocate for positive change, from a really solid foundation.
And I think that's desperately needed in, in order to ch start to change the course of our current system of medicine. So this is a, really complicated topic. Healthcare economics is, but we have a great guest today, that's on hand to help us start to dig into this topic. Tom is especially great about discussing, these complex topics and really boiling them down to understandable nuggets.
So Tom and I discuss, healthcare, economics, some of the basis around what's going on there, what we talk about, some of the biggest problems that are negatively affecting our current healthcare system. We also discuss potential solutions that physicians can be a part of. Things like values-based care or direct care practices, or even physician leadership that can help to, you know, really move the needle on making positive change.
We also discuss how important the primary care physician is in delivering this better version of healthcare. And then Tom gives his takeaway or his take on current, on the current state of, of, the practice of medicine. And I think what's interesting about his take, a lot of what you'll hear us talk about is, you know, may sound, a little bit negative.
I think it's just kind of is what it is. But what's interesting about Tom's take on the future of, medicine is it's very positive. So, Make sure to listen into that. I, I thought it was a very interesting take. So without further ado, let's jump into my conversation with Tom Campanella. Hope you enjoy.
Tom, welcome to the podcast.
Thomas Campanell: Thank you, Daniel. I'm excited about being
Daniel Wrenne: on it. Yeah. So, Tom, you got a lot going on and you've had a lot of great experience and you've been, you've been a professor, you've been, you've helped with the MBA Healthcare Executive program, and I know you still have some associations with Baldwin University, Baldwin Wallace University, and you've got these fantastic LinkedIn articles that cover a lot of different areas of healthcare, which I've been reading, and they're, they're great if, if you guys listen and ahead and checked those out, those are fantastic.
Educational content, I think really anybody in healthcare should, should understand these sorts of topics you're covering. So you, what stuck out to me about you is you have a very somewhat diverse but also focused. Level of experience in healthcare, and you have, and, and, and the, the most impressive thing was how you were able to break down.
And we talked about this when we chatted earlier, how you were able to break down this super uber complicated concept of healthcare economics. And like a, I mean, I think I bet my oldest son who's 10 years old could probably digest the, the majority of the article, which that's a skill in itself. So I'm excited to kind of dig into kind of some of the stuff you're working on and, and talk through, the basics of healthcare economics and hopefully some of you guys listen in.
I mean, this is important stuff you really should know. And I think the more you know about this, it's, it's gonna empower you to, to, to be a better physician and, and make, make good progress in life. So, Tom, thank first of all, thanks for coming on.
Thomas Campanell: Yes. Again, I appreciate the opportunity and thank you
Daniel Wrenne: Daniel.
Yeah. And I know you've you've had a lot of experience and you've worked in a lot of different areas you know, within the healthcare industry. Do you have, I'm curious if you have like a, a favorite, what's been of all the different areas you've worked in, have you enjoyed one particular aspect more than another?
Well, actually,
Thomas Campanell: I've enjoyed is the diversity of it all. I think if I was sort of siloed in just one of those areas because I've had the opportunity to be on the consulting side, the legal side of healthcare, the obviously the teaching, the writing side both. Managing tied in with medical schools as an associate dean being involved with population health, I actually managed 55 multi-specialty physicians.
Then I was on the payer side. And the fun part about it, Daniel, is, is again, I look at it as almost like a puzzle. And as I got into all those diverse areas, I started to see the connections between 'em all. And really when you talked about my publications I really rely a lot on not just the knowledge that I pick up on a daily basis, but on my diverse background and try to apply that.
and finally, as you said, it's an 80 20 rule, people can get overwhelmed with healthcare, but there's some key concepts, as we discussed in the health economics article that really govern it and really allows you to better understand what's happening in the world of healthcare.
Mm-hmm.
Daniel Wrenne: Yeah, and I think understanding that's a, that's a great first step is when you have, you start to develop a better understanding of what's actually going on. Behind the scenes. And that article will link to it in the show notes, health, health Health Economics 1 0 1, I think was the title of it.
But and that article, you really just kind of started with the foundation of like health economics and then some of these problems that are really pretty much have existed I think for a while within healthcare. That, and, and when you start to. Break this down, it really starts to make sense, like why some of these challenges are present.
Maybe we could start out like what, what's in your words? I'd be curious of like kind of a broad scope view of like what prompted you to, to write this sort of article and are your thoughts in, I mean, I, I think it's important for people to be educated on this and. I assume you probably do as well. But like, was it, what's your target ideal reader in, in, in that?
Are you, is it, is this, was this written for physicians in general? I feel like anybody could to read that and digest it and get something out of it, but I'm curious of what prompted you to write it and who was the, the target audience at least in initially writing it?
Thomas Campanell: Well, actually, first of all, I've been doing writing probably for about seven, eight years.
And and the prompting really came back to, and I know it sounds corny, but the altruistic aspect of really as I went through all those diverse sectors of healthcare at one side of it, of me was very Pleased as to what we were able to do to positively impact both individuals healthcare costs, physicians.
And that on the other hand, there was a definitely a level of frustration recognizing, given all the money we spend in this country on healthcare and how much more we can do. So I've really, over the last three, four years, intensely got involved in podcasts, writing, webinars, and that, because in my own little way I'm trying to make a difference.
and what's kind of cool is The readers are very diverse across the whole spectrum, including places like c m s and health policy think tank people and everything. And I'm not naive enough to think that one person, Tom Campanella can make a difference, but maybe, throwing out things and enlightening and maybe some light bulbs going off the people that can really make a difference.
you know, as they say about the village, maybe together we can really focus on what we need to really change this to a real health system instead of, I call it a sick care system.
Daniel Wrenne: Yeah, yeah. So, so the, in the article you talk about some of these big problems and I think really you just broke down like the three big, I mean, within each of these, there's a ton of subsets, but You broke down some of these, these big three problems in healthcare.
I have some level of understanding for these problems being in what, what I do. But the way you broke it down was just ma it just made a lot of sense. So like moral hazard was the first one. And then asymmetric information and then self-interest, that's how you describe each of these. So maybe we could like talk through like what each of those mean.
Because that's why the article is, so, what's so great is you, you broke it down real, real basic, and all of you, as I said, should, should definitely check out the article. But I'd love it if we could talk through each of those three areas and maybe, maybe get like a, a, a basic understanding of what each of those are, and then take it from there.
Thomas Campanell: Well, first of all, and I even do this when I teach Daniel, is I would like to have the viewers as they go through this do their own little role playing because I think it's important as we discuss issues like this as well as others, to put yourself in other people's shoes and see how, what, how that would motivate you one way or another.
And, and in doing that, I think you get a better understanding. So for an example, moral hazard, really moral hazard is a, a term, we use it in health economics and it applies obviously outside of that too. But it really is a change in behavior. And as we relate to health economics, it's basically by the way, in, in the banking side, moral hazard was used a lot in the slight last crisis that we had when the federal government comes in to rescue.
And then a lot of the pundits were saying, you know, aren't we doing moral hazard here? Because, you can screw up from a banking standpoint and good old federal government is there to bail you out. So does that then encourage bad behavior in the future, from that standpoint? Well, in healthcare, for an example, an easy example would be as it relates to you as an individual, and would you think that an individual that had all their.
Health insurance covered would more or less likely overutilize an emergency room for unnecessary services. Somebody's else paying the bill. All of a sudden, you're going there maybe for a sprained ankle or other types of things that clearly could have been done in another setting. And the end result is because somebody else, either the employer or the government, through Medicare and Medicaid, you're utilizing an increasing healthcare costs by in effect taking advantage of the emergency room setting.
On the other hand, that's the whole theory behind copays, deductibles, and that is, you know, I hate to use the term skin in the game, but you know, the idea is to try to put you into a little bit more of a prudent purchaser of healthcare services so that you sort of take a step back. And say, okay, I'm gonna have to pay a little bit.
do I really want to, does it make sense to do this service? Or is it better to wait a little bit, from that standpoint. So ultimately, moral hazard is one of the clauses of over utilization. Just as an aside, the flip side is you don't wanna go in the other direction where all of a sudden you have $10,000 deductibles and in effect, moral hazard becomes a barrier to accessing care.
Where people now all of a sudden, if they have to pay so much out of the pocket, they're not able to use it. So that's an example of moral hazard. Mm-hmm. when you, when you talk about asymmetric information. Mm-hmm. Asymmetric, as you know, is imbalance and healthcare is definitely falls into that category where, especially as it relates to pricing, the costs as well as even quality where you buying a computer, cell phone or anything else.
As you, as a prudent purchaser start evaluating which computer, what car I wanna buy, or whatever. You have prices in front of you. You have reports that you can look at, consumer reports, if it's cars, or even some of those other categories, evaluating both quality and safety and all those things. And you can make a reasonably intelligent decision as to what is right for you in healthcare.
We don't know as we choose between different providers for knee surgeries, gallbladders, or whatever, what the actual cost is that somebody's paying. Either your employer, the government, you may know what your copay might be or everything, but you don't know that total cost figure. So ultimately you may be picking providers that could be two times as expensive as for physician services for an example, or hospital services or somebody going to a hospital based service like for doing orthopedics may wind up being twice as expensive than going to a free-standing physician clinic that provides those same type of services.
And the quality may indeed be the same, but you don't know that. So again, one of the causes of both, not just costs, but you don't know the quality difference really. It's not user-friendly. Now, that's you as an individual. You can imagine the employer who's really paying the bill, either self-insured or that their employees are picking potentially some of the higher price providers that ultimately because they don't have that pricing and quality information accessible to 'em.
And because maybe there's no incentive to, because of moral hazards, somebody else is paying the bill. So those are two concepts that come together. sort of talks to you about both cost side, why we're having escalating healthcare costs, but also in regards to some of the quality issues out there.
And then finally, Good old Adam Smith, if you know from our baseline economics, the old Scottish economist, and the bottom line self-interest and he was saying is really the key to a market system where, you know, ultimately both purchasers and suppliers based on their own self-interest will search for value.
That all sounds great on paper, but somehow it breaks down in the healthcare arena. Some of it is because obviously you don't have pricing, so you know, you can't be, sort of focusing on what the self-interest in purchasing if you don't know pricing. But where the self-interest really comes into is really on the providers side, where we have payment systems that the more you do, the more services you provide.
The more you get paid, and by its very nature, that's inflationary too. So that's why you're seeing a lot of discussion about value-based reimbursement, those types of things. So that's at a very thousand foot level, high level. Mm-hmm. But gives you an indication of when you're talking about why we have escalating healthcare costs why we have inconsistent, quality and everything else.
Those three economic concepts are, not a hundred percent of the reason, but are key factors in those, results.
Daniel Wrenne: Yeah. And it ma it makes sense that if the end patient, user, whatever, didn't really ha, wasn't vested financially. In the choices decisions. And even if they were, they would have a really hard time figuring out what it costs or how it compares quality-wise.
And on top of that, like there's this kind of profit, natural self-interest focus on, more is better and we all have the drive to make more money, and that's always gonna be a driver in the world. It's like those three factors, if you think about it, like think about them separately and then combine 'em together.
It, you can see where it's like collectively creates just this massive cost increase. Cuz like people, the system maybe as a whole or even individuals want to generate more profit and the patients don't care about it ultimately, or don't have the desire. Or even if they did care to some extent, it would be very difficult to kind of.
Do the homework and price shop right, and hold them accountable and measure quality. So it, I mean, it makes a lot of sense that those factors are the biggies and it's, you could see what, how they each one of them individually is an issue, but when they collectively come together, it really just amps it up.
I think a lot of people listening probably recognize those in some form or, or another. if I'm a physician, like what is my role in all of this? Should I, I guess, why should I care about those factors? Why is that important to me?
Thomas Campanell: Well, and again, some of it will bluntly depend on the physician and There may be different reasons depending on the setting that they're in. Mm-hmm. So is, are you talking about a physician that is employed by the hospital?
Daniel Wrenne: Let's go there first. Yeah. Yeah.
Thomas Campanell: Th they're in a position where you're in a position where you're sort of employed. Some people might even call it owned by the hospital.
and you're in a position that your success, the hospital success is dependent upon sort of, a steady stream of income. What I think the physicians in your audience need to recognize, and this is sort of a separate discussion, but it's sort of interrelated, is that as we get. More information available to users, both employers and consumers in regards to price differences as we get more sort of value-based, outcome-based, quality focused information user-friendly, available out there as we find ways to more effectively address either moral hazard or whatever, but getting the employee more involved by providing them incentives to pick value-based providers.
This actually is a potential threat to hospitals, which in turn is a, as I said before, there's both challenges and opportunities as we, as healthcare changes. And the reason why I'm saying that is the one trend that's occurring in healthcare is that the healthcare landscape is changing. And if you're a physician or a hospital person or working on payer side, you see a lot of disruption occurring over the last four or five years.
One of the things that's occurring for an example is that hospitals are becoming admissions are going down overall the trend line, but what's happening is on the inpatient side, but where the increases the patients that are going to the hospital are much more sick. So they have higher risk factors.
So what's and reason why that's occurring? This is back to self-interest. The payer side is really including Medicare and Medicaid is trying to push care to the lowest cost setting that is also safe in that. So there's a major growth in outpatient, so that's where the growth area is outpatient. And as we've seen recently, and it's ramped up under Covid, a big from a low cost setting standpoint, care in the home setting, and that's growing like crazy and you have technology in that.
So now I'm a physician working for a hospital. Now all of a sudden I'm finding that, okay, most of the hospital work that I used to do inpatient is now moving to the outpatient setting. The challenge is that as people become, where are the prices? If the hospital prices are, and in some cases this is definitely true, twice as high as say, a freestanding clinic, physician clinic that provides the same type of, independent clinic that competes against a hospital, then all of a sudden they may wind up losing business.
So the financial viability of the hospital winds up getting challenged. So hospitals are gonna be facing a lot of financial challenges because of all the disruption we talked about, which in turn will impact physicians. It'll create challenges form, but also opportunities. And some physicians may decide that, you know what we're go our specialty orthopedics or whatever, rather than being employed by a hospital system, we're gonna set up our own orthopedic practice and compete against them within the community in that.
So it actually in some ways are going to create more opportunities for physicians. Mm-hmm.
Daniel Wrenne: Yeah, I think, I think it's a, it ties into your career and I mean, this is, this is important stuff and I think the trends are real. And another aspect I think of is like, The patient's financial interest. I think the way that we broke it down, a lot of the ultimate cost be burdens and care or lack of falls on the patient.
Or, indirectly most of the time in the form of higher premiums. like it does eventually, fall back on the patient, which is why, like we talked about, costs have gone up so much, but part of me thinks like what is the responsibility of physicians to think about the economic component for the patients?
Like is there, and I'm just talking generally, I know that's difficult, like. Individual experiences and the system is difficult to work through, but like physicians like overall, I think there probably is some level of responsibility there or interest there in looking out for like the patients, economically speaking.
Right.
Thomas Campanell: I would hope so. And, I actually, going back to my medical school background with the associate Dean of Ohio University's medical school, it was mostly primary care, fa, family medicine. And in some ways we felt that the primary care physician even had that much more ho holistic responsibility for the patient.
When you think about primary care, they always say, you're looking at the, you're not looking at pieces and parts. You're looking at the overall person. And you're not just looking at it from the clinical side, but you're also looking at it from the behavioral health, psychological, those types of things, stress factors that all tie together well, a key facet of that is the economics because, we use terms like social determinants of health or whatever, but the bottom line is, Patients are in a position where we recognize that other factors that impact their health status are nutrition, economic status to be able to transportation and those types of things.
So for an example, as a primary care physician, you need to be, I think, that much more sensitive to making sure that you're getting a bigger picture and trying to make sure that you're providing not just cost effective care for your patients, but as you refer the patient to specialists. That you're referring them to what I call value-based providers, ideally, that and you are actually also playing a role of an advocate.
And I think, to me, maybe I'm naive, but in this case, the primary care doctor as an advocate should be representing the patient, including with the specialists. And if specialists are talking about surgeries or other procedures they should help play a role in sort of helping to educate the patient and helping them sort of better understand their options.
Because there's a trusted relationship, especially long-term wise, between the primary care doc and the patient.
Daniel Wrenne: I think though in reality, at least a lot of the primary care docs I know and, and have worked with they're seems like they're some of the most thinly stretched of all the physicians in, in healthcare and a lot of times extremely stretched thin.
A lot of 'em I know are like, man, I just don't e i I don't even have time to see the one patient that I have in my office right now. Like thoroughly, like I gotta cut it short all the time and then there's someone in the waiting room that's complaining cuz it's been an hour. But, but that's because I got, they got me stacked up like so thick already in my schedule.
And I don't know how you could possibly be proactive in that environment when you're when you're just doing a million visits a day and trying to see the 7 million patients you gotta see I think. That puts you in a position to where you're, even if you have good intentions about like looking out for the patients, like you can only do so much in the time allotted.
And, and when you divide the patient population by the average for 40 hour a week, which is for a lot of 'em, they're working more than 40 hours, probably too many hours. It just doesn't make sense to have enough time per patient. So I could, you know, I've, since I think a lot of that is part partly why a lot of primary care physicians are having frustration and burnout's a big deal and that sort of thing.
And a lot of 'em I know really like what we're saying. I think they feel that responsibility to look out for the patient, but they're just like, s a lot of 'em feel stuck in the system and the system is like,
Thomas Campanell: well, that's why well there's a couple answers to what you're saying. The one answer obviously is we need more primary care.
Yeah. But we're back to the self-interest concept. If you're a medical student with mounting loans, And and lots of expenses overall. And you see medical students that are going into specialties making three times what you're making, from a self-interest standpoint, even though altruistically you wanna be a primary care doc, you know where the incentives are.
This is one of the reasons why, and I know we've talked about this previously I like about direct primary care concept. As it relates to, and there's direct pediatric care and stuff like that, that are out there, that model. And I don't think it'll be the end of it. And I know there's been some criticism of it from different areas, and you've even shared an article with me.
But when you think about that model, it provides the in this case, the primary care physician opportunity to make. Definitely more money. Yeah. More importantly, I think it provides them a more satisfying experience because they're able to spend more time with the patient. They're also in a position where I think they can even be going back to holistic, have that much more an impact on healthcare costs, especially if they're tied in with an employer, with the direct primary care model.
And and then also, they're in a position to be able to have positive impact on referrals and everything else. And it's sort of a, and then if you put the right team together, because I think in primary care it definitely needs to be a team model where it is not just the primary care doctors, but it's the nurse practitioners or PAs, it's the social workers and a, and That type of model financially can be affordable, where you can sort of put all that together and I think there can be different types of models like that, that can make primary care more impactful. Mm-hmm. That doesn't mean that we don't, we still have to find ways and put a lot of political pressure on finding ways to increase.
For an example, the reimbursement fees for primary care docs relative to specialties that is going up, but it needs to go up dramatically. and if you're talking about value-based care, they keep saying what other specialty has is more impactful on overall value-based care than primary care docs.
So they, mm-hmm. As I said in one article, they should move to center stage. The they're really a key player. Mm-hmm.
Daniel Wrenne: Yeah. And going back to the The big three components we talked about at the beginning, direct care practices, if we com, if we look at those from the lens of those three biggies, so like the moral hazard kinda like goes away because, the patient is paying for the service and they know exactly what it is.
It's like as transparent as you can get. Nobody else is, is paying the bill and you have a lot of vesting as a patient. And then the asymmetric information, I mean like it's just right there and there's not, I mean, you don't have, it kind of goes along with the pricing thing. Like you know exactly what the services are that come with it and then the self-interest is always there.
But like, I think the self-interest in that environment, like your incentive as a prac, a physician is to keep patients with you. By adding more value and the patient's interest is in like making sure it's worth the money they're paying. Right. Which I think is a much healthier model for success or for adding value, at least.
Well,
Thomas Campanell: and, and, and in fact the direct, and it's still evolving, but the direct primary care is evolving even further. And one of the evolutions that I really like as I alluded to previously is when you overlay direct primary care on an employer side. So in other words, they establish a collaboration with either multiple employers or maybe one large employer or whatever.
Mm-hmm. And that the employer, instead of the employee, is actually paying the majority of that monthly direct primary care fee type thing with the recognition and reason why the employer is doing it data wise is they recognize that primary care is one of those specialties. I don't wanna say you don't overutilize it, but that, that, that you can't overutilize.
But you know, the idea of getting those checkups and it's like your car or anything else, the oil changes and that. Really in the long run, it pays off. And if this, if you're an employer and you have an employee that's 5, 10, 15 years with you, I mean long term, including productivity, worker's comp and everything, having that primary care trusted relationship.
And then what's nice with the collaboration with the employer side, the employers are obviously very sensitive to costs. So they can then work with the direct primary care docs to set up health benefits overall, that goes beyond the primary. Lousy employees to, you know, more, I call 'em value-based benefit designs that, or centers of excellence and can bring in other parties to provide data and analytic support to the direct primary care practice that allows them to refer to the right providers or centers of excellence in those things so that marriage can be really attractive and it's back to self-interest.
It becomes a win for the patient, a win for the primary care doc, a win for the employer. And depending on how much of this is in a community, really a win for the community. Mm-hmm.
Daniel Wrenne: Yeah, I've, I've talked a lot about direct care on the podcast. if you're listening, you know, I'm a big fan of it and, the reason I like it so much is it's helped solve a lot of these problems that are in healthcare, in the system. They're addressing a lot of these, and I think going back to the big three, we talked about, like, it's such a better, way of addressing those in the interest of the patients and the physician.
Now, of course, in the interest of the hospitals, or the insurance companies, like, they're not gonna be in favor of it because that goes back to self-interest. They're not, they're just, they don't have a interest in that. I mean, I guess they could create a model for that, but there's not that I'm aware of models within those systems.
Thomas Campanell: Well, I think they, they probably will perceive it as a threat. Because for an example, one of the reasons why hospitals acquire, uh, Primary care practices, they wanna have a build-in referral base to their specialists. Yeah. And now all of a sudden, if you have an independent, direct primary care practice, They may not be referring to those hospitals.
It may refer, or it's not some services to that hospital, some to another, some to independent specialty groups. Some may be not, to a centers of excellence in another area. So they're, that's considered a threat. The, the big insurance companies, especially the national ones, aren't necessarily excited about it because, all of a sudden they got a player, they're sort of losing a little bit of leverage with the employer for, especially when it's tied in with the employer side.
They definitely think it is a threat because now all of a sudden the employer has this alliance with this primary care and, and the employer is basically telling the insurance company, this is what you need to do to sort of be the umbrella. For the direct primary care. In other words, provide the benefits around that and insurance.
The big insurance companies like to be calling all the shots. So they're not used to the employer saying, no, no, no. Wait a second, this is what we want. Mm-hmm. So I think, but I think in the end we all benefit because, bottom line is I think it'll benefit hospitals because then hospitals then will have to say, okay, like in any competitive situation in any industry, that if it's considered a threat, we then need to become more value-based.
We need to be able to demonstrate and show our value. Insurance company, we we need to show that too. That's what's great about the competitive markets. We just need to allow them to operate.
Daniel Wrenne: Mm-hmm. Right. We need to earn referrals from direct care physicians. And you said earn
Thomas Campanell: is the key word, right?
That's a great word.
Daniel Wrenne: I know we, we talked about, or I sent you an article about direct care and there was a, it was an article with a little bit of pushback on some of the downsides of that model, and I'm not sure. It was from one of the physician associations. And they highlighted a couple of the, the big downsides of why it's a problem or kind of like discouraging going that, that route and it, it was family physicians that was the association, which I would consider the best candidate for it.
So I just would love it if we could kind of talk through some of these downsides that they threw out. Cuz some of them were a little confusing to me. I think I get so one of the biggest, one biggest ones they, they mentioned is like exacerbating the physician shortage. I get what they're saying there.
Like, if you go into this direct model, you're gonna have a much smaller patient panel. Which means they have to go, your rest of your patients have to go somewhere else, and therefore there's only so many physicians. So it gets exacerbated. I personally don't think that's a reason to not do it, because we have to solve the problem of the care being provided
Thomas Campanell: and you hit it on the head.
And the other part of it too is for an example, what you're really doing, put yourself in the shoes of the the young medical student trying to decide. Do I stay in family medicine or do I switch to a more a specialty that's gonna pay me a lot. Now all of a sudden I hear about direct primary care and the options there, and all of a sudden, you know what, I'm gonna stay in family medicine if this makes sense.
Yes. Otherwise, so you'll wind up losing them to other specialties in that. Right. So the bottom line we do need to address and there's, and it's no silver bullet as it relates to primary care. You know, docs what we need to try to get more of 'em. Now we're trying to do some in regards to nurse practitioners and PAs and expanding their scope, but they again, don't have the training experience as a primary care doc.
But the point is, what you need to do is find what the problem is and address those problems. And if the problem is, maybe we provide loan forgiveness from a government standpoint, if you pick primary care family medicine and you don't have to pay back your medical student loans and maybe mm-hmm.
We as a society feels in the big picture or 50, or, yeah, I know we do some of that already, but, you know, creating that more or finding ways to enhance reimbursement, outside of that
Daniel Wrenne: model, I personally think, I don't care how much money they pay you, if you still, if, if, if receiving that money you still gotta go into a system where you're overworked and underappreciated.
The patients don't really see much value in it, right? And there's too many of them. I think that's not worth all the money in the world if it's gonna make you, dreadful about going to work. And I think that's the problem with primary care is it's become like, I mean, the financial part is a component.
We can't like, ignore that. But like, I think a lot of it too is it's like not, not as desirable versus if you were like truly the quarterback of somebody's financial or health ca healthcare world. Like if you were quarterbacking people's and you had the relationship and the flexibility with your family and it was looked at as like a a desirable profession or subset or specialty I think a lot more people would, would be doing it because, I think the majority of people wanna do that.
I think that's a. Very rewarding position, but I think the system has made it very difficult to do that.
Thomas Campanell: Yeah. And, and that's again, really a validation of, and I'm not saying it's the only model, but a validation of direct primary care, because it does, in that case not only helps their income. Makes I know enough.
Direct primary care. You talk about passionate people. Oh my goodness. Let's go on LinkedIn. I mean, it's crazy. They're all over. Oh yeah. And they just, they, they, they drink to Kool-Aid. I mean, they j and because not, and it's not superficial. They, they see what it's done to them. And a lot of them worked for big hospital systems or others previously, and they felt like they were owned and now all of a sudden they feel they can be impactful.
Mm-hmm. They feel that their skillsets being used, they are, as I said before, the center stage, from that standpoint. And they provide that value. And I think ultimately the result is not just for them, but you know, lower healthcare costs and better quality overall. Mm-hmm. So I think, from that standpoint and to sort of say, well, no, that's too that we're gonna carve that out.
We're not, we don't want that model. I think is ridiculous. And from that standpoint,
Daniel Wrenne: what's with the unregulated insurance? I didn't get that point. They, they brought up in this article that direct primary care, one of the downsides of it is that it's unregulated in insurance. Removing vital patient protection.
Thomas Campanell: Yeah, I think they're, that was over extreme, but they're basically saying you're paying them X amount of dollars and then all of a sudden they don't necessarily, what, if for whatever reason they have, all these patients are taking care of, they're getting the dollars and they're recognizing that they're not able to provide the care for the dollars that they're getting.
And, they're sort, so it's like those insurance companies, one of the reasons why there's capital requirements by Department of Insurance, you don't want them to go under and all of a sudden people wind up not having, they paid X amount of dollars for the year or whatever, and now all of a sudden they're not getting service.
But I, I think that's a straw man. It's not that big, it's not that big of an issue, from that standpoint. So I don't really buy into that at all.
Daniel Wrenne: Yeah, I, I mean, I think that's also too, like lack of faith in the individual too, like the ethical individual. I, I'm much more high on like the physicians calling the shots on like how many patients they see versus like the system, like I am not near as competent in the system of healthcare, like, Calling those shots on, how many people you're seeing and, and that sort of thing.
I don't think that would be a problem. Most people I know that are physicians are very trustworthy and will, do the right thing at the end of the day. And I just thought it was interesting that they. Considered it like an insurance like direct primary care. So, yeah, I, I'm a, I'm a big fan of, of the model.
You mentioned also, before we jump off here, I also wanted to talk a bit about values-based care because I think I'm not as knowledgeable about That as a solution. I know I love direct, direct care as a solution. I think it's a fantastic solution, but values-based care can you gimme quick snippet of, of how you would describe that and how that's potentially a solution to some of these issues?
Thomas Campanell: Well, it's like anything else. Yeah, the devil's into detail. Yeah. So what I call value-based, somebody else may say, well, no, this is value-based. But really value when you think about it in any type of spectrum is a combination of both cost and quality. When you buy a car or whatever you say, that was a value-based purchase because overall the money I paid for it.
Well, it's, it's the same thing with healthcare. I think the difference is value-based is trying one to try to focus more on outcomes. So, saying, okay, we provided all these services and the end result is the person is no better or they say the surgery is successful and you still can't play tennis or anything else if it's orthopedics, is that really value-based?
So that what they're trying to do on one end of it, on the quality end is tie value-based and financial rewards to quality outcomes. Now, like anything else, There's it's not a black and white issue because a lot of times quality outcomes in the patient needs to play an active role in that, their own rehab.
Like say it's a knee surgery or that, and say the person is not walking as well as they should be. Well, maybe they weren't doing the rehab. So you gotta find ways to sort of tie it in. And then the other part of value base is taking a consideration the cost side of the equation. So if it's considered basically a service that's say a commodity, so, it could be MRI or it could be a baseline orthopedic surgery or something like that, where pretty much the way you do it is the same and the quality and the outcome's gonna be the same, but one is, Two times higher price than the other one?
Well, the value-based care or reimbursement would be the one, like anything else, if the outcome's gonna be the same and it's half the price, the value-based real provider, if you wanna put it that way, would be the one that's half the price.
Daniel Wrenne: who is defining value in the value-based system?
Thomas Campanell: Well, that's part of the challenge you have, the payers trying to do it. Medicare is trying to get into that arena, in regards to it. It could be insurance companies doing it. That's part of the challenge that as you go through there, I think in some ways the patient, going back to asymmetric information if the patient has available to them, the pricing differences between all the providers.
They sort of have the information on the cost side, and then the real challenge is, are we able to provide good quality information on the outcomes comparing different providers. So in other words, consumer reports or you're a financial guy. Um mm-hmm. I've used uh, Morningstar. Morningstar. Yeah, Morningstar for years.
and I've, right or wrong, you know, I find it because I'm not necessarily able to deep dive as much and I find it as a, a reasonably good tool. We need to get to that point where you get like five stars, four stars, three stars. Part of the challenge in healthcare is there's so many different players involved in it.
How many times do you see a hospital? I'm the best in heart. No, I'm the best in heart. No, I'm the best. And they all have a different rating system in that. So I think over time we need to sort of centralize a little bit. Is that the government, you know, I don't know.
Daniel Wrenne: I think the challenges like the people ultimately paying are not defining.
What true value is. And also on top of that, the people that are ultimately paying don't even realize that they're ultimately paying. So there's that lack of, I mean, that's where the moral hazard kind of comes in is I don't know how that's a difficult one to solve in the healthcare world. I mean, for the, no, no, that's,
Thomas Campanell: that's where, that's where I think something like direct primary care or some form of that where, we talked earlier about the primary care, if they had available to them, information, both pricing and quality.
And they have the technical skills and the clinical skills to evaluate, and they are objective. They're your advocate. They don't work for somebody else, the big system or whatever, and they're the patient's advocate. That is, I think, a bet it's not perfect, but yeah. You know, the, the individual patient might be just totally overwhelmed, in regards to some of the information that's provided.
Mm-hmm. So to really have a primary care advocate, and it could be the primary care doctor or somebody on their staff that, nurse practitioner or others that plays that type of role. Mm-hmm.
Daniel Wrenne: Yeah, those are all really, really important things to think about as far as solutions.
Those can be like bigger jumps and like the values-based thing might be out of your control. Going into direct care can feel like a really big jump, but I wanted to also talk about maybe some smaller jumps that people can think about. One of the ones I know we talked about is, is leadership and just having a more of a voice in healthcare is a big thing physicians can do, right?
Thomas Campanell: Yeah. One of the articles I wrote was Physicians, we need you to, in effect, take a greater leadership role. Mm-hmm. When you think about from a health policy standpoint or even the health system overall, the, the voices are usually the politicians, the big payers the they call 'em the suits in a lot of the big hospital systems.
Yeah. You know, so the presidents or whatever, and the physicians who really operate in that system are many ways much more knowledgeable about what needs to be fixed, the issues and everything else. And they need to really step up. So it's a combination of them, really stepping up in a lot of areas, including health policy.
We had for an example during the whole affordable Care Act, Obamacare, when there was all the debate going on, there was this big thing about death panels and the, and politicians were saying, these, you can't have things. And it was basically related to one of the programs they wanted to put in is, as it relates to Medicare, is that as soon as you became a Medicare recipient, One of the benefits that you got was sitting down, it was paid for by the government sitting down with your primary care doc, and in effect, coming up with almost like your life plan and, in regards to, especially if you had chronic health issues and that, and, you know, recognizing what role do you wanna have long term for whatever, if you're gonna be living another 5, 10, 20 years into what happens to you, because let's face it, so many times you have that individual that's in a coma and you got their kids saying, this is what my dad will do this for my dad or whatever.
And the dad never had a voice. So basically all that was was you're sitting down, you're talking about, what your preferences are. For an example, I recently sat with my primary care doc, and we talked about things like ventilators, or if you had Alzheimer's, what are your thoughts in that?
And, just getting in there and getting that person. And I actually have my primary care doc in my living will, where my healthcare power of attorney, where my kids need to consult my primary care doc as they talk about end of life issues while bottom line, that was considered the death panel.
And to me, physicians who thought a lot of them ridiculous, should have said, now wait a second, there's nothing wrong. I mean this common sense, we should have that discussions. Individuals need to be involved in their own life issues. And if, you know, and if they have a chronic health issue that we know isn't going to get any better and they have 10 years or whatever, well, you should be able to have those open discussions and you know, and if they bring up issues like, at a certain point, I don't want anything extra given to me.
That's not a death panel. That's somebody's personal wishes. Yeah. And they should have control over their own body. Right. And that's conversation physicians. And I really think if physicians locally, regionally, and nationally, so, so many of 'em didn't like that concept. They liked the idea of. People being in charge of themselves.
If they were a louder voice publicly, I think people would listen. We still, as a non-physician, put physicians on a pedestal. We will listen to you and I would just like to see them, including all their specialties, start working together more to be a bigger voice in healthcare, both regionally, locally, and nationally.
Mm-hmm. That's my 2 cents and I'm gonna stick to it.
Daniel Wrenne: Yeah, I mean that's, that's good that I think historically physicians haven't done a fantastic job of unifying. Right. But I think that's starting to change a little bit. At least I'm hearing like talk of a, a lot more like community and like unified efforts and that sort of thing.
And I think the voice, if you look at like, the collective of all physicians across the country, like that's a massive oh voice. And there's all kinds of power behind that. If it was to get together,
Thomas Campanell: Yeah. And part of the problem is back to self-interest. You have all the different specialties that have their own societies and they focus on their individual specialty from a lobbying or policy standpoint, I'm not saying you don't continue to do that, but there's initiatives that you can go beyond that and break out of your silos and as physicians and societies work together in both locally, regionally, and nationally.
Mm-hmm.
Daniel Wrenne: I know we have to wrap up. I wanted to hit on one last point. I think this is, we'll leave it at a po on a positive note. I think this is very positive note and a, a lot of what we talked about is positive, but this is, I think this is very positive for the future of healthcare. We talked about this a bit, and I know you've written about this is.
A lot of people in medicine are working hard to get out of medicine. There's a lot of burnout and, and people leaving early and, and that sort of stuff. But I know you have a little bit of a different view than a lot of people in terms of like the future of healthcare. And I know your thoughts have, are, are that it's actually one of the best times possible to get into it as a profession, and I would love it if you could kind of explain, where that's coming from.
Thomas Campanell: Well, first of all, I think people, including physicians will say, this is time of disruption. Lots of challenges. You could have the attitude chicken little, oh my God, the sky's falling. This is the worst thing in the world. Or you could say, because of that disruption, now more than ever is the opportunity for change and positive change.
And it's less like an organization. If you work for a big organization and things are really going good and they're making a lot of money, you could be mediocre or really great and you're sort of treated the same. But during challenging times, those ones that can make the difference were the ones, are the ones that are gonna be successful.
So physicians that work for big organizations, physicians that work in their own practice, physicians that are doing particular models in that, they're now more than ever, are gonna have that opportunity to be able. To demonstrate either individually or collectively or within their particular organization, a real positive change and be rewarded for that.
And that's where I think, a lot of the opportunities, bluntly, one could look at this as a negative, but the escalating healthcare costs that everyone's saying, we can't do this anymore. It's going to force a lot of decisions that need to be made. And I think part of the reasons why we have escalating healthcare costs is physicians haven't played enough of a role in being able to provide value-based care and doing what they feel needs to be done now.
I think they're gonna be given more of a forum to do that. So I think the future's bright.
Daniel Wrenne: Yeah, I lo I love your perspective on that and I think that's a a good point. Dan. Tom, I, I really appreciated chatting, chatting with you, having this opportunity. It's been, it's been a fun conversation. There's like so much more we could dig into.
I know we kind of hit on a little, a lot of different concepts from a high, high point, but it's been fun and I appreciate you coming on Daniel.
Thomas Campanell: I appreciate it. And feel free to reach out to me anytime. Definitely. Okay, take care. Bye-Bye.
