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Scott Becker - 10 Trends to Watch Today in the Healthcare Space · Becker’s Healthcare Podcast

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  - This is Scott Becker with the Beckers HealthCare
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  - Podcast.
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  - Today, we're gonna talk about 10 health care
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  - trends, and and we'll we'll we'll we'll talk
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  - largely about supply and demand,
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  - payment issues,
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  - payer issues, the triple aim,
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  - artificial intelligence
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  - and technology in in a little bit more,
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  - but we'll try and work through these 10
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  - issues relatively quickly.
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  - First,
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  - we continue to see at the end of
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  - the day,
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  - supply and demand issues is probably the top
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  - issues in health care. There's about a million
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  - doctors in our country compared to about 350,000,000
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  - people.
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  - We do have increased improvement in nurse education,
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  - moving that along in a hurry. We're graduating
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  - about 200,000 nurses a year now,
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  - but we're only starting about 23,000
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  - doctors a year.
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  - We see subspecialty
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  - and specialty issues as a true debacle.
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  - When they look at neurosurgery,
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  - particularly cranial surgery, shorter and shorter on true
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  - brain surgeons,
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  - oncology itself, and some specialties on oncology is
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  - increasingly
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  - really, really challenging.
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  - And some of the other specialties,
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  - we'll just talk quickly about
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  - neurosurgery,
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  - orthopedics, and pain management.
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  - Neurosurgery,
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  - real shortages, particularly cranial surgery,
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  - 250 residency spots a year. Orthopedics,
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  - about 900 residency spots a year. Again, an
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  - aging population of orthopedic surgeons.
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  - And finally, in pain management, about 400 pain
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  - management fellowships a year. And, again,
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  - not as daunting, but pockets of shortage in
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  - different places,
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  - particularly in higher growth and underserved markets.
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  - The the second term we'll talk about is
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  - so much energy is spent talking about the
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  - payment system.
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  - My own view is that whether you're talking
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  - about capitated payments or fee for service on
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  - either side of the table, you've got some
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  - abuse.
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  - But at the end of the day, you
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  - could talk payment system all day long.
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  - But if you don't fix the supply and
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  - demand equation, if we don't improve the supply
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  - of specialists and subspecialists,
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  - no matter what you do on payment system,
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  - you end up with the same wall,
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  - not enough doctors, not enough specialists, and not
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  - enough nurses.
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  - In terms of the great panacea that's value
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  - based care or capitation,
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  - at the end of the day,
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  - there's nothing better or worse about this than
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  - there is about fear for service. If you
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  - look at the the COVID period of time
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  - and medical loss ratios,
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  - the payers all got rich. But for all
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  - the wrong reasons,
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  - procedures weren't going getting done, so the medical
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  - loss ratios had fallen significantly.
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  - But that's not really a win for value
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  - based care or anything of sort.
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  - Third, again, we'll we'll pick on value based
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  - care for one more moment. Value based care
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  - is essentially a managed care euphemism.
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  - Proceduralist,
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  - I think they're doing fee for service care,
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  - very much believe
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  - that they're doing
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  - fee for value, that they're doing a knee
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  - surgery and they're giving value to the patient
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  - for that. And the same thing with somebody
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  - doing brain surgery, the same for somebody with
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  - somebody doing a pain procedure, that this concept
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  - that doing it one way versus another is
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  - not value based care is essentially one of
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  - the great
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  - propagandists
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  - of of our time. It's almost like the
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  - Joseph Goebbels of medicine. This constant value based
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  - care is the panacea.
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  - In our nation,
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  - payers, of course, have immense power,
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  - Huge dollars flows to the top four biggest
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  - United States,
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  - the biggest payers,
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  - UnitedHealthcare,
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  - Aetna, Cigna, Elevent.
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  - Those four are four of the top 20
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  - largest companies in America.
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  - Huge
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  - administrative cost. We spend in our country about
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  - 5,000,000,000,000
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  - in health care. That means literally hundreds of
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  - billions of dollars are flowing through in administrative
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  - cost.
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  - Medical loss ratios have moved from 80% to
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  - 90%.
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  - This has been viewed as a disaster by
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  - the managed care companies. We ought to view
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  - it all as a positive because it means
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  - more money is being spent on health care
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  - than the administrative cost is a is a
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  - ratio.
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  - You know, and and we've ended up in
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  - the situation
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  - where there's massive subsidies, which has led to
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  - massive inflation. But at the end of the
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  - day, because what we've done to health care
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  - cost, we can't sort of get away from
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  - this vicious cycle.
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  - You're in a spot now just to go
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  - to those cost,
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  - premiums in the country,
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  - you know, plus out of pocket medical spending,
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  - you're not about $35,000 to $38,000
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  - a year for a family of four.
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  - The median US household income, not the average,
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  - but the median is about $84,000
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  - a year. And if you got 35,000 to
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  - 38,000 cost against a median of 85,000 a
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  - year, dollars 84,000 a year, those services just
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  - work, just don't work. Half of households earn
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  - more than 84,000 a year, half earn less.
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  - But if your cost is 35 to 38,000
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  - for that half, that's a disaster. So in
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  - this situation where there's massive government subsidies through
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  - the payers,
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  - and to individuals,
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  - we can't get away from it because that
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  - has driven so much inflation. So we're sort
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  - of in this vicious cycle or circle
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  - where we're inflating the health care costs, leading
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  - the higher health care costs, and then we
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  - have to subsidize people more and more to
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  - pay for their health care costs, which leads
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  - to more versions of inflation in health care.
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  - Fourth,
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  - we have more primary care that's going to
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  - physician assistants and nurse practitioners.
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  - This is fortunately or unfortunately an easier substitution
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  - than a lot of PAs and
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  - nurse practitioners for some of the specialties and
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  - subspecialists.
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  - At the end of the day, sort of
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  - the era of primary care that many of
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  - us grew up in, and it's not a
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  - good thing or a bad thing,
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  - that is largely gonna give way to more
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  - transactional primary care through PAs, nurse practitioners, through
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  - urgent cares, all kinds of other ways versus
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  - your regular primary care physician.
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  - The flip side is with some of the
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  - specialties and the subspecialties, it's not so easy
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  - to substitute
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  - in in any resident of a certain age,
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  - know of plenty of people with different types
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  - of cancer
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  - that can't find the right sets the right
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  - specialist at the right time. You know, if
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  - you're in Chicago,
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  - had a nephew with brain cancer, horrendous brain
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  - cancer. You know, there's really a couple serious
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  - cranial brain surgeons
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  - that you could that can have handle the
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  - case.
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  - In oncology,
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  - more and more different types of situations where,
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  - for the life of me, you can't find
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  - the right specialist at the right time. Had
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  - a close friend die the last year and
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  - found that in the subspecialty that he needed,
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  - there's literally about three in the country that
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  - do the melanoma, the eye that he had
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  - that was the place where it showed up.
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  - You know? And and, basically, when when one
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  - was on vacation, you really can't get help
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  - at all. And that's where we're going with
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  - specialist and subspecialist.
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  - And at the end of the day, if
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  - I had my my druthers, I know it's
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  - an unpopular thing to say, we put far
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  - more resources into residencies for specialist and subspecialist.
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  - Fifth, and again, it all goes back to
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  - supply and demand.
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  - You're seeing another level of tearing in health
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  - care. When I say tears, I mean t
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  - I e r, not crying tears, but you're
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  - seeing the evolution of concierge care on one
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  - side, indigent care on the other, and in
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  - between commercial and government.
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  - Used to be things were largely commercial, largely
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  - government, some percentage of indigent. We've moved some
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  - people off the indigent roles. I'm afraid some
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  - of that's going back. But this whole evolution
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  - of concierge care is a direct result of
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  - there not being enough supply. So you've got
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  - people in our area
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  - moving towards concierge in dermatology,
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  - cardiology, primary care of sorts. There are plenty
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  - of places in the country where you just
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  - can't get a primary care physician without paying
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  - accounts to your fee. Just the incredible evolution
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  - of this.
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  - Sixth, we've seen these sort of mass migration
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  - to Medicare Advantage and to Medicaid managed care.
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  - This has been a huge boon to the
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  - huge managed care companies. Again, we mentioned earlier,
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  - four of the largest countries in America
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  - are managed care payers.
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  - Several others are Medicaid
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  - managed care payers.
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  - It's all led to massive health care inflation.
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  - We're spending 500,000,000,000
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  - a year plus on Medicare Advantage.
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  - Of course, Medicare Advantage, like many government programs,
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  - has cost more than expected. It's saved less
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  - than expected. In fact, it's cost more than
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  - traditional Medicare.
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  - It just led to massive insurance companies and
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  - another amount of dollars just going through to
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  - the managed care companies.
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  - When I see the congress
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  - question the managed care executives,
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  - like, like they did a couple months ago,
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  - and they point fingers at them and yell
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  - at them. It's very circular. It's congress has
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  - put through these massive subsidies to the managed
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  - care companies and has led to exactly what
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  - you'd expect. It's very much an unholy alliance.
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  - It's almost laughable when congress is yelling at
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  - the managed care companies. They're really yelling at
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  - the people that that they have funded to
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  - create the problem, and those managed care companies
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  - are doing what congress intended them to do,
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  - which is to say no. We used to
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  - joke
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  - that the key role, and I say this
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  - jokingly, of a chief medical officer at a
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  - managed care firm was to learn how to
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  - say no in several different languages. I say
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  - that jokingly, but there's some truth to it.
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  - Seventh, we're overall moving in the wrong direction
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  - on the triple aim. When we talk about
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  - sort of access,
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  - quality, and cost, it used to be the
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  - thought that you can get two out of
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  - three of these right or one of the
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  - three of the three of these right.
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  - Now we've got costs are through the roof.
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  - Access is really challenging. You have to know
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  - somebody to get the right person,
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  - and quality ultimately goes down if you don't
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  - have enough providers to provide the help that
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  - you need.
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  - Finally, eighth, there are some clear answers to
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  - a lot of this, and we'll talk in
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  - another talk about some of the innovation and
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  - things that are going right.
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  - But DC on both sides of the aisle
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  - is pretty broke in terms of solving problems.
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  - On one hand, they talk about coverage for
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  - all, and most of us believe we should
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  - have coverage for everybody.
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  - But but providing coverage for all
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  - without funding supply, without taking care of the
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  - supply problem is like writing a check you
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  - can't cash. It's this concept of coverage but
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  - not really access.
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  - On the other side, they say things like
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  - get the Medicare out of my get the
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  - government out of my Medicare without realizing that
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  - half of all care is now provided by
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  - government payers. There's sort of no way that
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  - we're getting away from that. We might as
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  - well embrace it.
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  - The ninth thing I'll talk about is
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  - AI. AI is cascading into many different use
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  - cases.
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  - It's not yet moving from two x to
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  - 10 x solutions, but it is providing the
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  - leverage to help things get done
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  - better, a lot of administrative benefits, a lot
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  - of reading and radiology benefits, but not yet
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  - reducing our need for physicians and caregivers. And
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  - I think in the long run, it's going
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  - to be both
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  - technology and people, labor and technology.
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  - The tenth thing I'll talk about today, and
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  - it goes to the supply and demand issue,
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  - is at the end of the day, medical
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  - education in our country needs to be shorter
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  - shortened.
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  - Nurse education, just a few years ago, they
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  - thought couldn't be shortened. Now we're turning out
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  - a tremendous amount of nurses per year and
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  - doing a tremendous job.
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  - Doctors
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  - were doing a horrendous job of turning out
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  - quicker. We produce great doctors, but so do
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  - a lot of other countries to get their
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  - doctors out of medical school by 2223.
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  - We get our doctors out of medical school
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  - by '26 or '27, then they have to
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  - go do a residency. So you've got this
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  - tremendously horrendous situation
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  - where people aren't practicing till '31, '32, '33.
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  - Many are part time by '40.
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  - Other countries have built medical education that's not
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  - as much dependent upon rote memorization.
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  - Our medical education's not been
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  - reformatted since, it was originally developed or not
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  - for a very long time. It was developed
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  - prior to the Internet. It still relies a
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  - ton on rote memorization,
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  - rote work,
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  - and and and reps. Fantastic, but it's gotta
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  - be able to be done shorter. And the
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  - proof of that is so many of the
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  - great doctors in our country come from other
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  - countries where they're educating the physicians a lot
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  - quicker than we are here. In any event,
• 11:50
  - thank you so much for listening to the
• 11:52
  - Becker's health care podcast.
• 11:53
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