Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD

カートのアイテムが多すぎます

ご購入は五十タイトルがカートに入っている場合のみです。

カートに追加できませんでした。

しばらく経ってから再度お試しください。

ウィッシュリストに追加できませんでした。

しばらく経ってから再度お試しください。

ほしい物リストの削除に失敗しました。

しばらく経ってから再度お試しください。

ポッドキャストのフォローに失敗しました

ポッドキャストのフォロー解除に失敗しました

Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD

無料で聴く

ポッドキャストの詳細を見る

このコンテンツについて

Let’s take a second listen to this interview with Dr. Tom Lee that originally aired last summer but listen to it this time within the context first of how primary care can or should reduce ER visits and also downstream specialty spend et cetera, which is one of the through lines that I, along with you lot, have been exploring a lot this past year. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And much of this conversation is about how primary care can survive in these unfavorable times where CMS (Centers for Medicare & Medicaid Services) and commercial carriers complain about the rates that they have to pay consolidated entities with market power, consolidated health systems, but then they actively underpay indie practices. That is very illogical, I’d say, at a fundamental level. It’s not tricky math. Do not force out of business your potential best partners and then wonder why you have so few of them left. Dan O’Neill was talking about this on LinkedIn the other day. So, that is one context to kind of listen to: How does primary care survive? But then also listen to this show in the context of my latest tear, which is this mission versus margin tear. Some of the same themes come up as in the show with, for example, Ben Schwartz, MD, MBA, from last week (EP481). How do you ensure that if you want to achieve scale, and you can only achieve scale when you take professional capital from private equity or VCs (venture capital) or even a consolidated health system with a venture fund or an innovation studio, how do you take their money but not wind up with some board member sitting at the conference room table talking about a mission like, you know, Jeff Bezos’s where he said, “My mission is other people’s margin”? How do you tow that line? Rushika Fernandopulle, MD, talked about this a little bit, too—that you need money to scale but, once you get money, it’s easy for mission to get kicked off the bus. Today I am talking with Tom X. Lee, MD, who has a long history in primary care. He founded One Medical and then also, most recently, Galileo. Dr. Lee also was a founder at Epocrates (tossing that in for context). I wanted to talk with Dr. Lee because so many RHV (Relentless Health Value) listeners are trying to figure out how to sustain primary care as a stand-alone entity when most primary care docs these days are employees of health systems. And that makes sense because these days, the most obvious and most common way to make enough money in primary care is to drive and maximize the dollars from downstream volume of high-priced service lines, which, if you think about it, undermines the entire point of primary care but is also a really good motivation for a consolidated health system to purchase all of the primary care docs in the area. I’m starting to call this the paradox of primary care because when you begin seeing the promise of primary care have to erode if you’re gonna stay in the business of primary care, then yeah, it’s sort of a paradox. Said another way, if you do primary care really well and use evidence-based preventative care to curb the need for excess specialty care (ie, you reduce specialty revenue through primary care), now you’re asking specialty (high-profit health system service lines, that is) to not only make less money but use the remaining money to pay for primary care, which is the entity that is reducing its revenue. So, again, I am hereby coining the term the paradox of primary care to express the conundrum for why a consolidated entity that knows where its bread is buttered is going to do much, if anything, to empower primary care with the technology and the staff and the time, which, if it goes well, is going to cannibalize its own major source of revenue. Meanwhile, if you choose not to participate in this paradox within the context of a consolidated entity, it’s kinda hard to stand up a pure play primary care practice. And I’ve heard this so many times, most recently from Paul Buehrens, MD, who said, he wrote on LinkedIn, “My own primary care clinic lasted independent from 1946-2017, and when costs were rising faster than reimbursement with no alternatives available, we sought out purchase by our hospital, giving up on trying to stay independent. … Consolidation is not driven by bad actors nor by quality nor volume savings, but by the bizarre economics of healthcare as a highly regulated but hardly rational market.” I simply don’t get why knowing as much as we know about the importance of primary care, CMS and others continue to follow RUC (Relative Value Scale Update Committee) guidance on PCP (primary care provider) rates. How much power must be wielded by the AMA (American Medical Association) or the AHA (American Hospital Association) or who knows? I don’t know the half of it, admittedly. Listen to episode ...