Doctor Specialties That Have Power at Hospital Systems

Certain Doctor Specialties Have Great Power within Hospital Systems Because They Generate High-Margin Patient Volume.
Those Specialties Are: Orthopedics, Neurosurgery Spine, Cardiology and Oncology.
Knee and Hip Surgeries, Spine Surgeries, Cath Lab Procedures, Nuclear Stress Tests and Inpatient Chemo for Commercially Insured Patients Drive ALMOST ALL Hospital Margins.
Value-Based Care is a Betrayal of These Specialties Because the Greater Use of Primary Care Decreases Patient Volume Due to:
1) Greater Use of Physical Therapy
2) Decreased Complex Imaging
3) Decreased ER Visits
4) Increased Cancer Screening with More Early Stage Cancer that Does Not Require Chemo.
Most Hospital Systems Are Unwilling to Betray the High Margin Specialties That Got Them to Where They Are Today... and So Value-Based Care Remains an Enigma.
Sources:
www.beckershospitalreview.com...
www.macpac.gov/wp-content/upl...
Disclaimer: Dr. Bricker if the Chief Medical Officer of Value-Based Care Company First Stop Health.
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[@TFhello-world]

Please never stop making these.

[@ahealthcarez]

Ok 😉 Thank you for watching!

[@nipatel1760]

Some of us are slow learners. I should have known this in medical school and planned accordingly. Thank you for the education on the incentives and realities of the hospital. Please make a video on the implementation of hospital price transparency and how consumers can navigate this to make better decisions. If you somehow got 500K views for your videos, our healthcare cost crisis would be over.

[@ahealthcarez]

Thank you for your suggestion. Appreciate you watching.

[@sandeepbhattarai2317]

That’s why preventive care is so much suppressed in the US health care system. Big players won’t make money with this model of healthcare system.

[@ahealthcarez]

Thank you for your comment.

[@jiezhu8745]

Great video, well said!

[@ahealthcarez]

Thank you for watching and for your feedback.

[@evolving3657]

KZbin University. I truly appreciate your explanations. TY Sir!

[@ahealthcarez]

Thank you for watching!

[@hiyanjun]

This is such an awesome video. This video reminded me of a convo I had w the Chief Strategy Officer at our hospital re: VBC - they said, 'if the "total cost of care" is going down, then somebody is going to make less money. Who is going to be willing to make less money??', which ties in perfectly here. Thank you for helping me connect the dots. A question is, how does Iora Health (now One Medical) or Oak Street, folks who are in VBC, fit into this narrative? Is it b/c they are focused just on Primary Care?

[@ahealthcarez]

Correct. PCPs make more at the expense of specialists seeing less patient volume.

[@gerardhoeltzel4690]

really helpful video to understand this. Thank you!

[@gerardhoeltzel4690]

do you have a video on the economics of urgent care centers? why they are sprouting up everywhere etc.

[@ahealthcarez]

Thank you!!

[@ahealthcarez]

I do not, but it is a good suggestion.

[@railzip]

Yeah I feel their is nothing VBC in the inpatient side. It sits on the ambulatory space. Great presentation doc!

[@ahealthcarez]

Thank you for watching and for your feedback.

[@medaphysicsrepository2639]

Where do pathologists lie on this hierarchy? When I worked in cytogenetics we had ONE MONTH that had slightly less samples than the previous year.. I had 6 MBAs all up my ass trying to make us "more productive" (as if we had ANY control over the amount of samples coming in our lab)... needless to say this video explains that.. thank you Eric!

[@ahealthcarez]

I’m afraid… Low.

[@nena8687]

you are so animated 😂🎉. I'm trying to learn how u.s.a health care runs for my master's program and I'm learning but I'm laughing more with your facial expression and choice of words ❤😂😅. ok I'm watching the video again 🎉!!!

[@ahealthcarez]

Thank you for watching and for your feedback.

[@AdamKMiddleton]

How in the world is this just hitting my email 2.5 months after posting? I have said this to so many but you sum it up in 8:21 seconds!

[@ahealthcarez]

Thank you for watching and for your comment. Appreciate the support.

[@Soriyou3]

Thank you for sharing this insight doctor. Where would general surgery, anesthesiologist, and GI doc fall under this?

[@ahealthcarez]

Great question. General surgery and GI fairly high. Anesthesia lower.

[@14thSun]

The specialists revolt of 2021! Get the Molotov vials ready!

[@ahealthcarez]

Seriously 🙄

[@marcbolan1818]

A perfect reality check as to why value based care gets nodding heads and no action inside hospital systems that are fee for service. Misaligned incentives!

[@ahealthcarez]

Yup. Thank you for watching and for your comment.

[@marcbolan1818]

@@ahealthcarez Waiting for your “real” book on the realities of healthcare in America. You have the chapters based on your videos.

[@bryanh8292]

I mean regarless as more PCPs turn towards becoming Independent Physicians Associations, they are going to have to address it (since PCPs decide who get referred to what). Hospitals risk loosing out on a lot of money. Health systems and insurance companies know we are moving towards VBC and have begun buying large PCP groups. It's just a matter of time!

[@marcbolan1818]

@@bryanh8292" Independent" providers are in their final days. It's far too costly and (regulatory) burdened to exist as an independent.

[@bryanh8292]

@@marcbolan1818 an IPA is not an independent doctor it’s a collective group of pcp doctors primarily used to contain costs from hospitalizations. VBC is at tempting to use this group to reduce the heavy costs incurred by specialty/hospital care! It’s actually heavily expanding atm. But the reality is specialists lose (not a substantial amount imo) in this model but pcp/patients benefit more!

[@dxrulez4]

My understanding with a lot of the cancer screening was that it was actually ineffective. We’ve been doing a lot of screenings but all that has done is increase the amount of treatment, with no, or only a small, decrease in mortality.

[@ahealthcarez]

USPSTF goes by levels of evidence in the data. Pretty straight forward. We’ve stopped checking PSA for prostate cancer screening for that reason.

[@marcbolan1818]

Genomic screening pushed down at the PCP level can allow the PCP and the patient to have very early knowledge and management of the disease before it is identified down stream where it is more costly and there may be less time for proactive therapeutics.

[@KingLe0nidas07]

Where does interventional pain medicine factor into this hierarchy?

[@ahealthcarez]

Good question. Level 2… in the middle.

[@shandsbussey1497]

Assistant to the Regional Manager….

[@pattube]

Here's hoping VBC becomes the dominant paradigm for our health care system! Primarily because VBC seems better for patients in general and we all went into medicine with the priority of helping patients first and foremost. But sadly, given how our health care system is organized around hospitals and the power players noted in your video, "caring for patients" often seems like the last thing we care about. Do you have any prognosis for the future turning into one of VBC? Is it as bleak as I fear or is there genuine hope (e.g. ChenMed)?

[@ahealthcarez]

Thank you for you question. There will be progress, but it will be very slow. Healthcare is typically slow to change.

[@Antrell-wb7qs]

curious to know where neurologists fit on this hiearchy?

[@ahealthcarez]

Middle. Thank you for your question.

[@drkrheum3937]

Where do rheumatologists fall in this if the hospital has 340b funding access and the hospital has an infusion center

[@ahealthcarez]

Generally low. Many rheum not employed by hospitals. Mostly injectable Humira, not infusions. Thank you for watching and for your question.