Marni Jameson C…: I really saw an opportunity, Keith, to make a difference in a big, meaningful way for our country, because the consolidation in healthcare is just driving us in the wrong direction. I knew it was a David Goliath fight, but that’s kind of why I became a journalist to begin with, so I took it on.
Speaker 2: Welcome to the Growing a Successful Orthopedic Practice podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians. As we break down current issues, affecting the industry and share real stories from guests on their way to growing a successful orthopedic practice. Let’s get started.
Keith Landry: Hello everyone. Welcome to another edition of the Growing a Successful Orthopedic Practice podcast. I’m your host Keith Landry. Today, we’re digging in deeply on staving off the takeover bid, the forced merger to stay independent in 2021. Let me tell you, I’ve got the best guest in America to talk about this. Talk about an expert on this. Marni Jameson Carey is the executive director of the Association of Independent Doctors. Thanks so much for being here today.
Marni Jameson C…: Well, thanks for inviting me, Keith, it’s a pleasure.
Keith Landry: You bet. We’re going to have a great discussion here. By the way, this episode is sponsored by OrthoLive. And let me give our listeners just a little introduction about who you are, what you’ve done, what you’re working on. Marni, you’re the executive director of the Association of Independent Doctors, a national nonprofit designed to support America’s independent doctors, and most importantly stop the trend of healthcare consolidation and thus [inaudible] care costs. To our listeners, Marni was an award-winning journalist. She worked as a senior health reporter for Tribune Media with the L.A. Times and the Orlando Sentinel before taking on her role with Aid in 2014.
Now she’s a past president of a medical marketing firm and author of four books, nationally syndicated columnist and she’s all over the national news from time to time. But really here’s the deal for our folks who are listening. Ms. Carey now serves as the voice of independent doctors who don’t have the time, the resources, or maybe in their case, if they have a small practice, any real clout to speak out against the formidable forces that face them, and that would be including pressures to sell out to a hospital and excessive government regulation. So quite a resume, I thought it was worth reading almost all of it. Thanks so much for being here with us today, Marni.
Marni Jameson C…: Thank you.
Keith Landry: All right. Let’s talk about it. Let’s dig in for our orthopedic physicians and practice managers. Give us some background information about the Association of Independent Doctors, how long they’ve been around and sort of what’s their core mission. What are they focusing on?
Marni Jameson C…: Sure. So Association of Independent Doctors started in 2013. I think it’s important to know that it’s not physician led. I think that can be a plus. It was started by two CPAs and they also have a third founder. Who’s an attorney, a healthcare law attorney, and they were looking around the central Florida area and realizing that as hospitals were requiring independent medical groups, the costs were going up for patients, the quality was going down, the doctors were burning out, taxes were coming up the tax rolls because the institutions were tax exempt and they were pulling these private practices off that were paying taxes and the community was suffering financial harm, folks were losing their jobs, some of these independent practices had these long-term employees who were running the front office and all of a sudden the hospital takes over the staffing and these folks are unemployed.
So just having a lot of negative effects and they represented themselves a bunch of independent practices, so they were really seeing it firsthand. So they got together and they said, “Somebody really should do something about this.” And they looked at each other and said, “Maybe it needs to be us.” At the time I was working as a health reporter at the Orlando Sentinel and they invited me to the charter meeting, which was a hundred doctors showed up and they each paid a thousand dollars to join the association and kick it off. It’s now $500 a year, but at the time it was a thousand and they got some money up and they created this association and I wrote about it for the paper. That story got shared around the country and after that night, over the next 12 months or so, they wound up with a couple of hundred doctors, maybe 225 or so.
Then they asked me out to dinner and I thought they wanted more media, which is why I normally get out of [inaudible] out to dinner. But in fact, they wanted me to run the association and see if I would make a career shift. I really saw an opportunity Keith, to make a difference in a big, meaningful way for our country, because the consolidation in healthcare is jus driving us in the wrong direction. I knew it was a David Goliath fight, but that’s kind of why I became a journalist to begin with. So I took it on and the mission has not changed. I did not start this mission. I inherited the vision of these people I’m really proud to say I work for, Tom Thomas and Carol Zurcher.
They said the first goal is to stop the consolidation of hospitals from buying medical groups. The second one, and we’ll talk about it later on this call I hope is get price transparency out there. So consumers really can be empowered to know the price of care before they get their bill and they can comparison shop and we can get competition in the market. So neutrality is a big deal. The fact that the hospitals were increasing their bargaining power, layering facility fees and charging prices that independent doctors couldn’t possibly afford, or could possibly charge is creating an unlevel playing field. It’s also incentivizing the hospitals to be able to buy up more doctors. So we want to get a level playing field site neutrality out there. We want to work with the FTC to enforce antitrust law. The fifth one was to stop the abuse of the tax exempt status by nonprofit hospitals, so that’s a lot.
Keith Landry: Yeah.
Marni Jameson C…: So stopping consolidation, transparency, site neutrality, antitrust law, tax abuse. Okay. So go. So we get to the-
Keith Landry: A lot to cover here. So tell me Marni, how does the association work with orthopedic physicians and their practice managers? What’s the relationship feel like?
Marni Jameson C…: So it’s not different. We represent all specialties and we have a lot of orthopedists because as a specialty, they tend to be stridently independent. And I love that about them and they really held their ground better than most specialties. But as we know, they’re getting picked off too, and we’re seeing them slowly folding into the big health systems, which we don’t like to see. So one of the things that we’re doing even locally right now is we have as you probably know, some acquisitions in the area and working with one of the last standing bigot orthopedic groups and helping them work with their patients and educating patients, I just don’t think can do enough of this, explaining to patients that why it matters to them. Instead of asking, do you take my insurance? The first question a patient should ask of his specialist or doctor is, are you independent or employed by a hospital or private equity group? Because that is going to change the entire trajectory of your care.
And if you end up in orthopedics with a knee injury and you go to a primary care doctor employed by a hospital, you’re going to get sucked into that whole system. And your arthroscopic knee surgery is going to be $35,000 instead of $7,000. By the time you add in the MRI, the hospital loan and the outpatient surgical center, that’s hospital owned versus going on the independent track, it’s just tons and tons of money. So patients do not know how much they control that and I want to help them learn that.
Keith Landry: All right, we’ll dig into that a little bit more. We’re going to dig into a lot of these very specific things and trends and issues, but overall, the feel for 2021, the broader picture, what are you watching? What do you have your eye on closely? Because we’ve got a new president coming up, what’s on your mind? What are you watching most closely that our listeners should hone in on themselves?
Marni Jameson C…: Well, actively I’m working to continue to push through an effort that I have been working on hard for the last 18 months, and that is healthcare price transparency. This is something that we did gain… We’re bi-partisan. We just want to work with whoever’s in the white house. And we did get some traction with the Trump administration and in price transparency. We got them to sign an executive order. One of our doctors was standing up there with him when he signed it and we helped get the two rules that came as a result of that. HHS has issued two rules, one requiring hospitals to post all their prices and the other in requiring insurers to do the same.
So these two pricing components will work together in an aggregate to help empower patients to see the prices, and I think that’s very, very, very helpful for independent doctors because this house of cards is going to come down very fast once hospitals ans insurers have to rebuild their prices and we get those prices aggregated and patients can shop for the lowest possible price and the best care and the best value care. And that is coming, unless we’re hoping that this administration holds it up, this is a broadly, broadly bipartisan desire in America. Three different surveys show that 90% of Americans want price transparency. The only ones blocking it are the special interests, the hospitals and the insurance companies and we need to make sure those special interests don’t turn the politicians heads any more than they already have.
Keith Landry: Yeah, it’d be interesting to see if that information, if those prices are posted publicly, as they’re supposed to be and somebody can pull that up on their phone while they’re walking down the street, it’ll be hard to put the genie back in the bottle.
Marni Jameson C…: Well, Keith, that’s the hope and the prayer. There are a lot of high-tech companies and innovators out there standing in the wings, waiting for these prices to drop, and the hospitals and insurance companies are constantly saying, “Oh, it’s far too confusing. You’ll never figure it out.” But look, we have Google, we have Amazon, we have Uber. We have Zillow pulling together huge amounts and aggregating huge amounts of data in real time and putting it in our hands. I can tell you the price of your house here in two seconds, right? I can get a driver to the airport in two seconds. I can have a package shipped to my door from New York in half a minute. So we can do this. We cannot buy onto this argument that, Oh, you’ll never get it because we will. And I’ll be able to pick up on phone and say, “Where’s the best place to have a baby or a colonoscopy or my appendix out.” Or, whatever it is and I’ll get it.
The next thing after we get price transparency is outcome transparency, which is harder to measure. But I think patients don’t just want the cheapest care. When you go buy a car, you don’t look for the cheapest car. You want a value, you want the best for your money. But right now we sometimes pay the most and get the worst because we don’t even see outcomes. So all this I think is going to really, really revolutionize healthcare, empower patients and physicians. And a message I liked to get across Keith is, if doctors want what patients want, a lot of doctors get painted into the corner as part of the problem. But as you well know, doctors don’t set their prices.
They get paid what the insurance company says they’re going to get paid and or what the Medicare says they’re going to get paid and you can talk about changing that up a little bit, but they aren’t the problem. They’re trying to fix it too. So they are on patient’s side and I like to remind patients of that. And it’s hard for doctors to say that because it sounds like they’re bragging. Like, “Oh yeah, I’m on your side.” But I can say things doctors can’t because I’m not a physician and doctors complain about their situation and it sort of sounds like whining. But if I complain about their situation, it sounds like I’m advocating. So that’s what I like to do.
Keith Landry: Sounds good. Let’s talk about a topic. You have a lot of passion for our orthopedic physicians and their practice managers. Sometimes they got to make strategic business decisions that can have a major impact on their practice for many years to come. So what would you say to our listeners who run an orthopedic practice about not selling out to a hospital system?
Marni Jameson C…: Well, I think we have to go beyond the administrators, to the doctors themselves and say, don’t give up on what you went to medical school for. Don’t sell out your autonomy. Don’t sell out your principles. Don’t sell out your ethics because the doctors who go to work for these health systems, they are measured on their quotas. They need to admit so many patients. Order so many tests, refer to so many other employed physicians, spend less time with their patients to refer them to another patient, to ratchet up ancillary services and bills. And that doesn’t sit well with a lot of doctors who have a conscience. It’s easy to say, I’ve had it. It’s just too hard. There’s too many regulations. Our compensation keeps getting cut. It’s harder and harder every year. I just want to practice medicine. I’m just going to go let somebody else take care of all that and work for the big institution. I get it.
Especially if you’re coming out of medical school and you have all this debt and they’re going to also help take care of that, I get it. But you’ve got to realize that they are profit driven and they’re going to run you like a cog in a wheel and you didn’t go to 12 years beyond high school to have someone who has four years of college tell you where to make rounds, what [inaudible] device to put in and what gloves to wear. It’s frustrating for doctors who are by nature, intelligent and independent and strong-willed, thank you we like that about you, but the hospitals are putting their thumbs on them and saying, “This is how many patients you need to see. This is how many operations you have to do.”
I have a cardiologist who says, “I cannot control the rate at which my patients get heart disease. My hospital administrator wants me to do so many bypass surgeries.” That’s not how to practice medicine. So if you want to avoid burnout, you want to have control. Hang in there. We’re fixing this problem, but stick to your principles and a sure path to burnout is going to work for the hospital. There are many studies that show that the rate of burnout of hospital employed physicians is far higher than independent doctors.
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Keith Landry: Interesting. All right, well, we’ve just had a year. Talk about something that could lead to burnout. It would be called 2020 in the entire experience. So where can our physicians go to get the support they need, somebody advocating for them to try to prevent that burnout? Because this has been an exhausting year for everyone, frankly.
Marni Jameson C…: Well, I think they need to find some recourse in each other to and enjoy the associations like Association of Independent Doctors, where they’re with a body of like-minded physicians who are in the same boat and have the same ideals and we have message boards that we can put up and say, “Hey, we’re having this problem. Anybody have a solution and share?” Because it’s very isolating sometimes if you’re not in a big group to be in a small practice and be facing all this alone. So to find out there are people not just around you, but all over the country. We’re in 44 States that create this sort of buffer and installation sounding board to help you get through this.
But yeah, it has been quite a year. We’ve had all of our doctors that as far as I know came through. They were shut down with all the elective surgeries and stuff, but they got the PPP financing coming in. They were able to keep their staff, keep their practice, but it was touch and go there. They had their housekeepers stealing their hand sanitizer and masks, and it was a free for all for a while there, but we’re coming out of it and learning how to live with this thing and hopefully we don’t have to deal with it for too much longer.
Keith Landry: I hear you on that. Let’s talk a little bit more about price transparency and the trend in 2021. You’ve been working on this for a long time for a year and a half at least. What do you want our listeners to know about the price transparency and how it could affect them long-term?
Marni Jameson C…: So, first and foremost, we cannot let our foot off the gas. We’ve come this far. As I mentioned, there were two rules that the Health and Human Services, Alex Azar put it into effect. One of them was the hospital rule that said that as of this coming January 2021, hospitals have to post their cash and secret negotiated rates across the board with all of their plans online in an easy to access formula. So we need to make sure that hospitals do that. Hold them accountable. Hospitals have been trying to wiggle around. They’ve been trying to say, “Well, we’ll just put up estimates. We’ll just put up averages. We’ll just put up ranges.” That’s meaningless. So we want the actual real prices in real time. So that rule got challenged in the courts, that is in our court system right now.
The government has so far prevailed. The American Hospital Association and 35 other hospital groups joined forces to sue the government to stop this. They said, they overstepped. This is not right. So far, the federal court has upheld or supported the government and said, actually, the government could do this. You should do this. You’re not going to get out of this. It’s now sitting in the District Courts of Appeal in DC with the appellate court, making another verdict on this. We’ve listened to the hearings. It’s sounding like it’s going to go the consumer’s way, but we’re waiting to see. So meanwhile, the government dropped the second rule. They did that about a month ago where they issued the insurance component of this and said that by January 2022, the insurance companies have to release all their price. So pretty soon we’re going to get the hand and the glove, right? We’re going to get both of them together and we’ll be able to marry the prices and know what exactly our coverage is buying us. And we’ll be able to control the cost of coverage as well as care.
Keith Landry: And Marni, we’re starting to see some independent orthopedic practices post their prices as part of the way they do business. What insights do you want to offer about that trend?
Marni Jameson C…: So if you look, the Oklahoma Surgical Center, they really sort of got this on the news. They’ve been posting their surgical prices for a long time and they’re excellent. In fact, the only time they’ve changed, their prices is to lower them. They are cash only. People come from all over the country to get their surgery there because it’s good quality and they know the price and they’re not going to get surprise bills. So in some cases, they use those prices to get their own hospitals, to come in line and say, “Well, you’re charging me $45,000 for a knee replacement and I can get it done for 7,500 over at the Oklahoma Surgical Center.” I don’t know if those are real numbers, but yeah. And the hospital might say, “Okay, we’ll match that price.”
So I’ve heard some independent orthopedic practices complain about the burden this is to put up their prices. I want to say, look, it’s a little bit of pain and suffering for you, but you are going to come out ahead. You’re going to look very, very good when your prices get up there and the comparison is going to be stark when they see the difference between what you charge them and what the hospitals charge and the competition is going to be good for you. So you might be able to increase your prices a little bit as the hospitals try to get their costs down. So I’m very, very encouraged by seeing these groups already putting up their prices online, patients are going to start to expect it and demand it and I’m thinking we’re on a very good trend. I’ve been telling my doctors to post your prices for a long time, but finally, they’re coming around.
Keith Landry: Marni, would you suggest that they actually incorporate that into part of their marketing plan for 2021?
Marni Jameson C…: Absolutely.
Keith Landry: Do the price transparency and stand on the top of the roof and yell to the world this is what we do?
Marni Jameson C…: I would, and more than that, I think that it’s very sobering and some of them are scared of this, I get it. To put out their cash price because a study out of Vanderbilt came out and said that the cash price is 40% lower than the average insurance plan price for the same service. So what are you paying for? If you have an $8,000 deductible and it’s November, why don’t you just pay the cash price because you’re going to end up saving money? So I think it’s a very good way to go.
Keith Landry: Okay. What are other trends you want to hone us in on for what the association is working on in 2021? I think we’ve covered a lot of ground here, but I want to make sure I don’t miss anything.
Marni Jameson C…: Well, I think it’s really important that doctors, orthopedists and specialists and primary care doctors alike keep the faith. It’s been a rough year and everyone’s tired of it and it’s a really easy time for doctors to our hospitals to be picking off practices that have been struggling and suffering through an era that has been hard on everyone. So I want to just say, just keep the faith, hang in there, be transparent, don’t be part of the problem because right now you’re part of the solution. Independent practice is the way to go. I would also, if you can encourage you to look very seriously at direct pay and direct care and going straight to employers and having contracts with employers where you circumvent the insurance company and go direct to the employer and say, “Okay, for all your orthopedic needs, here we are. And here’s what we would charge you. Let’s just make it a deal across the board and lead them out of it.” That’s working beautifully for many companies and I would encourage more and more practice to go to the employer direct and to the patient direct for cash pay.
Keith Landry: Because now you’re offering employer quality medical care for the employees and you’re saving the money too?
Marni Jameson C…: Yep. Initially, I worked with some companies where they have found their employees think they’re getting short shrift. Oh, what do you mean you want to circumvent the insurance company? They’re the good guys. They’ve been on my side. They’ve helped me out through all this and they think that the employer’s trying to rip them off. So it’s taken a bit of selling to their employees to convince them that no, actually you’re going to get better care and we’re going to all save money and we’ll all be better for this. So there’s a little bit of a PR hurdle up ahead, but it’s all worth it.
Keith Landry: Well, Marni I hope you get some rest during the holidays because you have a very busy 2021 ahead of you and a lot of work to do for regular Americans who need somebody fighting for them.
Marni Jameson C…: Well, I think we have a positive future ahead. Thank you Keith, for your good work too. But I think once patients have prices in hand and they can shop and compare and buy healthcare the way they buy gasoline or cars or flat screens, and be able to compare them side by side and make a choice and know what there [inaudible] is going to be before they get a bill, they couldn’t foresee coming, we are going to bring the price of healthcare down and make it far more accessible. So I’m looking forward to that. Independent doctors are a huge part of that solution.
Keith Landry: All right. That sounds fantastic. Marni, how can folks connect with you and the Association of Independent Doctors if they want to get more information or maybe they want to have you speak to their group or whatever it might be?
Marni Jameson C…: Sure. Well, we’re at www.aid-us.org. Please look in on our website. I’m at firstname.lastname@example.org. And we’d love you to join us if you’re a physician, it’s $500 a year for an annual membership and we need resources and numbers to increase our voice and further our costs.
Keith Landry: All right, Marni Jameson, carrying the executive director of the Association of Independent Doctors. Keep on fighting the good fight and thanks for being here today.
Marni Jameson C…: Thank you so much, Keith. It was a pleasure.
Keith Landry: You bet. It was awesome. And that’s a wrap for this episode of Growing a Successful Orthopedic Practice podcast. I know you picked up some tidbits from this one. We thank you for tuning in, tell your friends and colleagues about what work we’re doing here, and we’ll do it again soon. I’m Keith Landry. We’ll be back at you soon. Thank you.
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