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Scott Becker - 8 Issues We Are Watching in Healthcare 2-27-26 · Becker’s Healthcare Podcast

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  This is Scott Becker with the Beckers health
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  care podcast.
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  Today's discussion is
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  eight issues that we're watching in health care,
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  and we'll talk a little bit about
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  the Triple Aim,
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  supply demand challenges,
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  technology,
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  the payers,
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  health systems,
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  you know, a little bit more.
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  And and hopefully people will enjoy this. I
• 0:24
  would encourage you at any time, feel free
• 0:26
  to text Scott Becker,
• 0:28
  (773)
• 0:30
  766-5322.
• 0:33
  One, I'd love to get your comments and
• 0:35
  thoughts,
• 0:36
  sound quality
• 0:37
  thoughts, anything you'd like, whether you agree with
• 0:40
  the substance or not. Second, if you're the
• 0:42
  first person to text Scott Becker
• 0:45
  at (773)
• 0:47
  766-5322,
• 0:49
  we'll send you a one hundred hour Amazon
• 0:51
  gift certificate just as a thank you for
• 0:54
  listening and and for for for jumping in.
• 0:57
  So so here's seven or eight issues that
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  we're watching in health care.
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  First,
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  we talk about the triple aim is trying
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  to lower cost,
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  improve quality, and improve access.
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  It seems like currently that we're moving largely
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  in the wrong direction on all three of
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  these points of the triple
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  aim. Health care inflation
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  is on the rise. I know we're now
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  at more than 30,000 a year for a
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  family of four for insurance through commercial insurers.
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  Where it's about where most families in the
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  country make less than 75 or $80,000 a
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  year. So those are numbers that just don't
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  work.
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  As we run into tremendous shortages of physicians
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  and specialties
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  and subspecialties
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  and across the board,
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  becomes harder and harder to have access that
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  we wanna hear for our population.
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  And then if you can't have access,
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  you can't have quality.
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  And even on the quality side, The United
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  States health system does some things remarkably right
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  and is remarkably challenging,
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  but it's very here to have the kind
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  of quality you wanna have when the bench
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  in many specialties
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  is getting lighter and lighter. So we look
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  at this and say on the triple aim,
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  we're ultimately moving in the wrong direction, and
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  we've gotta figure out a way to fix
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  this. It does strike me as we talk
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  about this that Washington DC
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  on the right and the left is somewhat
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  broken and not focused on solving the real
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  problems,
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  but but focused more on political sloganeering
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  on both sides of the table.
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  Second,
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  we talk often about supply demand,
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  and I often think that supply demand is
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  the fundamental problem in health care.
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  We're at about a million one physicians
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  versus a population of 350,000,000
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  people.
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  We're increasingly running into shortages of specialties
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  in many specialties.
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  You're also in a spot where in subspecialties,
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  and I remember the situation with a very
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  close friend
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  who died of a melanoma of the eye
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  and cancers the last year or so.
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  You know, how once you got past the
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  first two specialists in that particular cancer, there
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  was nobody else left. And whenever one of
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  those doctors was on vacation, and this wasn't
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  at one place, this was in the entire
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  country,
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  he couldn't get help or couldn't get access.
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  The shortage of specialist and subspecialist
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  is becoming
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  incredibly acute,
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  and I think people are starting to see
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  that very much. You need to know somebody
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  to get somebody. You need to know somebody
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  to get to the right specialist,
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  and that's also a horrible thing, the supply
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  and demand challenge for health equity as well.
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  Third, in terms of primary care, where
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  arguably hundreds of thousands of primary care doctors
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  short already. If we really want to have
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  the traditional model where you were seen by
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  a primary care physician and stay with that
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  primary care physician for a lot of your
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  life, that seems to be moving towards an
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  age of the past and being filled in
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  by PAs,
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  nurses, advanced practitioners, and that's okay. That's not
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  a bad thing. But but that's what's happening
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  because we're so short on primary care.
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  Currently, we produce about 25,000
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  doctors a year, about 10,000 to 12,000 doctors
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  retire a year. A huge percentage also go
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  part time,
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  by the time they're 40 to 45 or
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  so. And we and we've got challenges on
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  medical education that we'll talk about that in
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  a second. But at the end of the
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  day, the numbers just don't work. We're producing
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  about twenty, twenty five thousand doctors a year.
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  We're losing about 10 to 12,000 doctors a
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  year. Thank God that we have immigrant doctors
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  to help fill some of those gaps, some
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  of the very best doctors in many of
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  our communities from other countries, and thank God
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  for them.
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  Another thing I'll note, medical education.
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  Medical education of the country was largely developed
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  prior to the Internet.
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  You've still got four years of college, four
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  four years of med school, three to four
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  years of residency,
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  often a fellowship. So doctors aren't getting out
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  till '30, '31, '32. And, again, many are
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  part time by '40, '45, '50.
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  The number just doesn't work, and we have
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  to shorten medical education, get rid a year
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  of med school, get rid of a year
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  of residency.
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  You know, in other countries, they produce doctors
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  that we rely on here that are some
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  of our best doctors. By the time they're
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  '27, 28,
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  we're at thirty, thirty one, 32.
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  And you you contrast that against an aging
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  growing population
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  in more cancers, more heart disease, more everything
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  than ever before.
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  We've gotta figure out a way to manage
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  that. Just as an example,
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  more and more situations where you end up
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  in these discussions.
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  I was on a podcast with a dermatologist.
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  She's the one dermatologist
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  for 500,000
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  people in Northern Minnesota.
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  Similarly, neurology,
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  same problem. Was on a podcast
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  with a neurologist, one neurologist for 500,000 people
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  in Texas. And this is at a in
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  an area of Texas. And this is at
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  a time when, of course, dementia, Alzheimer's, etcetera,
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  is all on the rise. People are aging
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  and and and staying alive longer, but they're
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  they're not not sick.
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  Few other things. Nurse education has improved dramatically
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  the last few years.
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  People may complain about it, but we're getting
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  nurses
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  out of training quicker than before. We're producing
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  about a 175,000
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  to 180,000
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  nurses a year. That's a huge move in
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  the right direction.
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  We talked about this already. The era of
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  the core primary care physician, where you have
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  the same primary care physician for life, maybe
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  very much coming to an end and it's
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  more transactional and filling in the gaps and
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  PAs and everything else. The PAs are largely
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  terrific, so it's not a knock on PAs,
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  but it's a different model that we're moving
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  towards.
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  Finally, ER wait times are another example where
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  we're in supply and demand. Just ten years
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  ago, systems were advertising.
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  They can get in and out of the
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  ER in thirty minutes. Now you're lucky to
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  get in and out two and a half
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  to four hours. It just has changed dramatically
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  over a ten year period because there's no
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  place for patients to go.
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  Third, I'll mention rural health care. Rural health
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  care is in a vicious cycle,
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  lower population,
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  can't attract doctors,
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  systems close down labor and delivery, and it
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  becomes a very much a vicious cycle because
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  you can't get people to come to areas,
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  live in areas if there's not enough health
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  care, and health care professionals won't go there
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  if there's not enough population. So the whole
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  thing has gotten to be a a real
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  challenge in a vicious negative cycle. Russell in
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  a spot where doctors today,
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  other than a generation ago, largely wanna go
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  to the top 30 to 50 metro areas,
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  of physician,
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  and her husband, a physician and his wife,
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  or whoever
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  largely wanna go to the top thirty, fifty
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  metro areas, and that's very different than a
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  generation ago where many went to smaller towns,
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  smaller communities.
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  There's lots of efforts to try and change
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  this, but it but it's very hard.
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  Fourth issue I'll note is the payers continue
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  to have massive power.
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  The government essentially through Medicare and managed care,
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  Medicare and Medicaid
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  has turned over a huge amount of the
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  federal fisc to the major payers.
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  Four of the major payers are amongst the
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  four largest companies in America.
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  That's UnitedHealthcare,
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  CVS Aetna,
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  Elavance,
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  Cigna.
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  You've got a situation where those payers have
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  traumatic power compared to large health systems and
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  practices,
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  and And, also, the entire payer complex has
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  become too complicated for many small practices,
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  and and huge resources are used by it
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  on it by even large health systems and
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  just really a waste of money and time.
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  Medical loss ratios were down to eighty, eighty
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  two percent a few years ago, and the
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  payer industry cheered over this. But it's really
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  a disaster because that means we're spending 18%
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  on an administrative cost as those medical cost
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  ratios have come up to 89%.
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  We're still spending a tremendous amount on administration
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  of health care versus actually delivering health care
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  in in sort of a a debacle.
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  When I talk about the payers
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  and watch the political theater in Washington,
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  you have congressman, congresswoman
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  questioning and berating the insurance executives.
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  But but it it's really very circular because
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  the problem that has developed is largely because
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  the United States federal government has turned over
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  and state governments
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  have turned over so much money to the
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  big payers to to run Medicare Advantage, to
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  run Medicaid managed care plans. And they've done
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  so with the intent
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  that those big payers would would say no,
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  would cut costs because there's no other way
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  to get where you want to get to,
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  which is
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  lower cost without some rationing. I'm I'm not
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  a fan, but this is what's happened. So
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  you've got exactly what the federal government has
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  paid for
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  happening with payers denying care or making pre
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  authorized. It's very hard,
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  and it's really challenging, but it's led to
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  gigantic
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  payers. It's led to the government criticizing the
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  payers,
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  but the government's one has turned over the
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  money to the payers.
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  Fifth, we'll talk about AI and technology. What
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  we're seeing throughout health care is cascading use
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  cases.
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  Great, great movement on the enterprise
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  and on the side of administrative side,
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  moving and making progress on the clinical side,
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  still a long way to go. I'm a
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  big believer that our problems will be solved
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  through a mix of technology and people that
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  we don't wanna fully rely on technology and
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  not put in more residency spots for specialists.
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  I believe that we need both great technology
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  and more residency programs. It can't be one
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  or the other. We'll end up in a
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  horrible situation. Sort of a trust plus verify.
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  Yes. Technology will take us a long way,
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  but we better increase the number of residencies
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  and the number of specialists we have as
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  well to take care of our aging and
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  growing population.
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  The sixth issue I'll talk about is large
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  health systems, large health systems.
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  You're about 60% of health systems have some
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  margin, about 40% don't.
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  By and large,
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  health systems are very busy. They're quite full.
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  People criticize health systems for their business model,
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  but at the end of the day, health
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  systems have huge bricks and mortar. They've got
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  huge labor needs. I don't know a way
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  around that. And and I think health systems
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  are doing a pretty good job of managing
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  with the situation they have. And what has
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  been proven over the years is we very
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  much need our hospitals and health systems, and
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  they're often they're pretty much the backbone of
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  the safety net in our country, so very
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  much needed. The larger doing better.
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  Smaller independent ones are struggling. Rural ones are
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  struggling.
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  What what I say to hospitals talking about
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  strategy is that they need often a clear
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  purpose.
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  Here is what they're gonna be great at,
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  something that they're gonna be great at.
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  The seventh thing I'll talk about is the
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  tiering of health care. So we're going through
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  a period of time where, economically,
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  we're seeing a whole different level of tiering
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  of health care. And and I'll go through
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  this compared to the old days, commercial insurance
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  versus Medicare versus Medicaid versus indigent care.
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  On the commercial side, you had better access,
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  perhaps better quality.
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  On the Medicare side,
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  okay. On the Medicaid side, more challenging. On
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  the injured side, more challenging.
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  Now what you've seen in the commercial side
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  break down into a whole another tier, we've
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  got a concierge tier. So you've got
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  concierge where people are paying access fees for
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  primary care.
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  Recently, a cardiology practice in our area, dermatology
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  practice in our area have added in administrative
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  fees and essentially concierge fees. You gotta pay
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  those to have access to the practice.
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  What this leads to is a whole different
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  level of health equity concerns,
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  tiering of health care concerns that essentially the
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  very wealthy, the top 10% could afford this
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  concierge stuff
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  that the rest of people, commercial, Medicare, Medicaid
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  engine, can have less access.
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  I don't, for one, blame the doctors, specialists,
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  primary care, the duty concierge at all, but
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  it does point to the absolute need for
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  more supply and demand.
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  Those primary care doctors going concierge
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  were overwhelmed under the old system, can make
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  a nice living under a concierge system. I
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  don't blame them one bit. But somehow or
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  another, we've gotta come back to how do
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  we solve this issue of supply and demand.
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  There's not so much incentive to go to
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  concierge
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  and so much lack of access for the
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  rest of us that aren't on concierge.
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  The f eighth point I'll talk about in
• 13:01
  terms of health care, and I'll just mention
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  it shortly. I had a chance to visit
• 13:05
  with a graduate class in health systems management.
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  Brilliant group. Brilliant. Absolutely brilliant.
• 13:12
  And and when they ask for advice on
• 13:14
  what they should look at,
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  what I think about is to really focus
• 13:17
  on what you're seeing, what your common sense
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  shows you.
• 13:21
  If you see
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  a a a three hour wait in the
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  yard,
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  why is that happening? What's the shortage? What's
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  the problem? Why is it happening? If you
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  see in your inpatient services and people can't
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  get access to an an oncologist,
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  why is it happening? What's going on? And
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  and to see what you see and then
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  to advocate for it, and at the same
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  time, of course, do the best job you
• 13:41
  can. It's really based on quality of care,
• 13:45
  quality of service. Probably the best leader in
• 13:47
  the country that I hear constantly talk about
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  the core mission
• 13:51
  is the CEO, Jenny Spizzo, of UCLA
• 13:54
  Health, who constantly talks about it's all about
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  are we doing great quality for our patients,
• 13:59
  great patient care, and we're really taking care
• 14:02
  of patients. And, honestly, coming back to that,
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  but but as a graduate health student,
• 14:07
  you know, a master's in health administration,
• 14:11
  use your view, your your perspective on it.
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  Yours is as important as anybody else's as
• 14:16
  to what's going wrong, what's going right, and
• 14:18
  then advocate for what's needed. I wanna thank
• 14:20
  you as always for listening to the Becker's
• 14:22
  Healthcare podcast. This is Scott Becker,
• 14:24
  publisher, founder of Becker's Healthcare.
• 14:27
  As I said earlier, I'd love your comments
• 14:29
  and love your thoughts. I know I've only
• 14:31
  covered a handful of issues today. I'm at
• 14:33
  (773)
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  766-5322.
• 14:37
  Send me your comments. Send me your thoughts.
• 14:39
  We'll send the first person who does so
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  a one hundred hour Amazon gift card. Thank
• 14:43
  you so much for listening.