Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep54: Medicare cuts and physician challenges with Norman K. "Kip" Beals III, MD

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S1 Ep54: Medicare cuts and physician challenges with Norman K. "Kip" Beals III, MD · Off the Chart: A Business of Medicine Podcast

• Norman K. "Kip" Beals, MD 00:00:00 They're going to cut the prices and the fees that they're providing. then we have to think about how we can do that and have the least impact on our patients and our communities and ourselves. Speaker UU 00:00:15 By the way. Austin Littrell 00:00:22 Welcome to Off the Chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Austin Littrell, in this episode features the conversation between Medical Economics senior editor Richard Payerchin and Dr. Kip Beals III. Dr. Beals joins the show to discuss the evolving landscape of healthcare reimbursement. The two discussed Medicare cuts, financial pressures on medical practices, and strategies to improve efficiency and physician well-being. Richard Payerchin 00:00:58 Hi, Doctor Beals. Norman K. "Kip" Beals, MD 00:01:00 Hey, how are you, Richard? Richard Payerchin 00:01:01 Good. And yourself? Norman K. "Kip" Beals, MD 00:01:02 Good. Thank you. Richard Payerchin 00:01:04 And I'll tell you what. To kind of dive in to our situation in year 2025, I was just to sort of start at the top with CMS. Frankly, I was kind of curious. When you're a physician in practice and, you know, the Medpac meets Congress is in session, there's going to be a cut coming. Richard Payerchin 00:01:22 It's announced by CMS. Do you guys actually get like a letter that says, you know, dear doctor bills Medicare physician reimbursement will be decreasing by 2.83% next year. Or do you read about it in the news or how do you learn about it? Norman K. "Kip" Beals, MD 00:01:36 Yeah, mostly in the news. I never if I've received it, it never made it to underneath my eyes. I think that, you know, most of us recognize that when we look at our payers, the payers of health care, the majority of it in this country is through the government. And so, There's no there's never been a negotiation that occurred from physicians. There are some different groups, like the American Medical Association and others who, are trying to be representatives of their constituents who whoever joins their, you know, organization, and they're trying to have a voice heard to, you know, and I think that most of the decisions are made with, you know, some exposure to the feelings that, you know, are being expressed from physicians in general, or the realities of what the impact that it's going to have. Norman K. "Kip" Beals, MD 00:02:31 But, I think through the whole career of, that I've had, health care reimbursement is something that's mandated from above, you know, from down from above, and we don't really have much to say about it. I think that we do through our organizations to be able to have a voice. And I think that's the way that it's mostly been, you know, delivered. But from my experience, I don't have any direct communication from any of those decisions that I'm aware of. It's usually in the news and it then starts showing up in our, you know, journals and whatnot and commentaries and, and, you know, editorials and whatnot. Richard Payerchin 00:03:12 Okay. Okay, good. And then year 2025 is not an anomaly. This has been going on for, as I understand it, two decades now. And so when when you hear about about this, how do how do physicians react? I mean, is that the question I had was, can you describe your feelings? Is it a sense of frustration, sadness, resignation? Just business as usual at this point? I mean, I don't know. Norman K. "Kip" Beals, MD 00:03:39 You know, it's somewhat business as usual for sure. You know, I you know, I think I probably showed my hand and that when I hear of decisions that are going to be made that I have no power over, then I start thinking really quickly in terms of how are we designed to do what we need to do and how do we rethink how we're doing it? Where are the places where we can make it more efficient, maybe less costly? Is there you know, there's a constant upward spiral, I think, of thought processes in my mind. And the team that I work with, you know, go through when we hear those kinds of things, we expect them. And, we understand that, you know, like you said, we have to embrace what is and if they're going to cut the prices and that there or the, the fees that they're providing, then we have to think about how we can do that and have the, least impact on our patients and our communities and ourselves. Norman K. "Kip" Beals, MD 00:04:44 You know, I read the other day that there's about one out of two physicians are considered burned out now. And that's a pretty powerful statistic. And, You know, for me personally, I'm not sad or surprised or I I'm pretty, pretty realist. And when I hear it, I say, okay, it's time to get to work on the next thing we have to, you know, solve. So that's how I look at it. Richard Payerchin 00:05:13 I see, I see. And with with my dad. One of the things that we well, firstly I don't want to let this go uncommented on because burnout has been something that is in our coverage area and something we take, frankly, very seriously. So, just wanted to throw that out there. And I'm, I'm, I'm hoping that among you and your colleagues, you've been able to kind of avoid those work conditions that that contribute to that. Norman K. "Kip" Beals, MD 00:05:40 I don't think it's I yeah. No, we haven't avoided it. It's, it's I don't think it's it's possible to completely avoid the sort of pressures that individual physicians, you know, are in when they're trying to, you know, make ends meet, anticipate and predict, you know, future movements and skill sets and mastery over certain aspects of what it takes to practice. Norman K. "Kip" Beals, MD 00:06:05 And I think that that, you know, is still causes a great deal of my colleagues and people with even within our system, you know, concerns about how it feels. And, you know, I think the, you know, the heading that we call burnout, I think is, understood by all of us, like yourself and the medic and other people who are in the business. So I think we're not done there. I think that as we redesign and provide the kind of infrastructure, support, decision making tools, maybe, and the efficiencies that allow us to still have the joy and the the passion centered around the care of a, you know, of the human condition. I think we have a ways to still go there. Richard Payerchin 00:06:48 One of the one of the items, the questions that I had actually in And first of all, I'm really glad that, Rhonda Buchholz was willing to make our introduction. And frankly, I relied on the for some of the bullet points about the skill set needed to run a medical office. Richard Payerchin 00:07:08 And I don't I don't have those on screen in front of me. I can get it on screen. But the main gist of that question deals with, frankly, in medical school, how much business training do physicians get to be able to run a medical office? Norman K. "Kip" Beals, MD 00:07:25 Zero. Richard Payerchin 00:07:25 Yeah. Norman K. "Kip" Beals, MD 00:07:26 You know, I think, nowadays we're we're we're we're giving a little bit of, you know, time to it and, you know, to help introduce them and, and show, you know, have have some of the residents. So I think that it's, back when I was there, I, I was, always interested. So I started looking at it very early in my residency, but, it wasn't the norm, and it certainly wasn't a fostered concept with regards to training curriculums and whatnot. Now we have them incorporated into try to, you know, help it. But it's it's, there's a lot of, I think, skill sets that we have to, to train people on. Right? We have to not only allow them the opportunity to understand systems, business, leadership in general, culture, details around coding. Norman K. "Kip" Beals, MD 00:08:18 You know, you know, there's a there's a quite a few things, you know, that, we need to, to be able to pass on. And the curriculums have been expanded to add in that other year to the residency program quite yet. Richard Payerchin 00:08:33 Any one of those people make careers just studying that as a single subject matter in and of itself through, you know, I, my wife's best friend's husband has an MBA and I mean, he that, you know, he's he's a pretty accomplished, a fairly accomplished business leader, I would say. And I work out of our office in Northeast Ohio, so we're actually not that far away from each other. Oh, cool. where I'm going with that is that, you know, he spent a couple of years earning that and, you know, applying the skills. So it's not like stuff you can just pick up overnight. maybe a Segway then into, you know, it's it's January 1st. Hopefully everybody's had a good New Year's January 2nd. You go back into the office and clearly there's been some prep before that day. Richard Payerchin 00:09:19 But you go into the the office on January 2nd, the new year and you need to make a cut. Where do doctors start to look to either increase revenues or cut expenses? Norman K. "Kip" Beals, MD 00:09:32 that's a big question, isn't it? I mean, that's, that's the question of the day. And we're we're all no matter what size of our health system, no matter where we're at in this country, we're we're all, you know, up to our, you know, chin and trying to to to answer that question, I believe that in general, we want to do both. Sometimes it feels like we've already cut ourselves down. We've already done layoffs. We've already done. Let's do. And we're already letting attrition be our friend. And, you know, allowing ourselves to kind of retrofit once we, you know, based on who we have, you know, trying to cross train people, trying to share, we have to what I call intensely collaborate. I think that one of the things that we've done is we've probably spent most of our history and careers being lone, heroic cowboys and cowgirls and probably the, the, the, the word of the day needs to be more like intense collaboration. Norman K. "Kip" Beals, MD 00:10:36 And so that can be with people within the same health system or even neighboring competitors or people who used to be our frenemies are now, you know, people that we need to learn how we can do something together for our communities and both and have it be a win win win rather than, you know, a competition. So I think that, in general, I think physicians we bias probably towards more about growth and about efficiencies. systems wise, what we also recognize is in the new world, we're starting to talk more about things that we never did before, which was we we've got these four locations. Should they be in one location, can't we gain some efficiencies? So there's some, again, design issues that come up quite frequently now. And the solutions of the future for health care. And you know, can we use technology. Can I can tell a health visits can programmatic, systemic or system thinking around how we design, how patients even come into a practice. We collect information. How do we question and query? By using maybe some of these technologies and some of these tools, so that we can then more efficiently analyze what the real issues are, maybe through AI, eventually they'll be allow us to be able to more efficiently come up with answers. Norman K. "Kip" Beals, MD 00:12:04 So we're already leapfrogging from being, well, we better let you know, Mr. Smith know or Mr. Smith know from our front office go so that we can, you know, save money. We're thinking about how can we take care of more of our community, how can we do it with technology? How can we add services that maybe we're not thinking about now? Or are there things that people need that we're not doing? We see a lot of things on, social media and the regular television, like media and whatnot around health care issues. And how many of those are we ignoring that maybe we can be helping our communities. So I think the creative, Innovative thinking, collaboration, intense collaboration in fact and thoughtfulness around what the community is really asking for. And I think teaming with the community closer than ever before, I think is going to be important. So we make sure that we're answering their needs and questions and desires. I think that's where we're going to win. Speaker 4 00:13:10 Say, Keith, this is all well and good, but what if someone is looking for more clinical information? Keith Reynolds 00:13:16 Oh, then they want to check out our sister site, Patient Care online.com, the leading clinical resource for primary care physicians. Keith Reynolds 00:13:23 Again that's patient care online.com. Richard Payerchin 00:13:30 Doctor something you said really caught my ear. And this is a point. Frankly, I probably haven't really thought up or brought up in conversation in the in recent memory. And where I'm going with this is and we all want the Covid 19 pandemic. You know, we all want Covid gone. We want the pandemic behind us and have that in the rearview mirror. One of the lessons, though, that I think came out of the pandemic because and like I said, we I kind of was working as a community journalist at a daily newspaper during that time was that there were businesses that closed, and it was unfortunate and there were people who lost their jobs. But I think a lot of the operators that whether it be in medicine or anywhere that came out of the pandemic, hopefully came out smarter. And just like you said, the main point I'm going with here is leaner. And yeah, if everybody has, you know, I don't know that anybody who has bounced back from the pandemic so well that they have money to burn. Richard Payerchin 00:14:23 And so maybe the mindset, you know, this article really wanted to focus on cutting expenses. But I like your point that physicians offices and many other businesses are already running lean. So yeah. Norman K. "Kip" Beals, MD 00:14:36 You know as you know with the cost of overhead supplies, you know the the pressure that is experienced is still here with regards to staffing. You know, it used to be that, you know, the staffing costs were at one level and they've gone up and they're not going down, you know, they're not going to go back. You know, I think we also recognized the benefit of, a lot of the work that we're doing that we were just talking about about onboarding people, patients, getting histories, being able to supply and provide ideas and health care needs to them, remote patient monitoring that's out there, all those kind of things. We we we found that a lot of this could be done, you know, without them being in an exam room with us. And in fact, it was during a pandemic, in some people's minds, safer and even a preferred methodology we had already instituted at Independence Health, a telehealth, you know, kind of discovery initiative, so that when the pandemic happened, we were kind of poised and ready for, for this. Norman K. "Kip" Beals, MD 00:15:42 So we were fortunate that way. But, I think that, what we're doing now with your point, being taken, which is how do we do this? And instead of looking at it as a compromise, how do we do it better than we did before with what we have? And so I think that that thinking has been required, and it's hard to stay there sometimes because you get disappointed or you do get frustrated or you do get burned out, or it seems like you just have to tick another box. And so how do we design that? So that you're working with a team of people who actually are taking care of the patient? It's not just what has to funnel to me like it's not below me. I always say to mow the lawn, but I don't think you want me to do that. I'm happy to do it. I probably could do as good a job, you know? But, I think that what we have to recognize is that there's probably a way that we can be doing this work better and more efficient. Norman K. "Kip" Beals, MD 00:16:43 So I think that the buy into that is is crescendo. You know, it's it's getting more and more people starting to see that. But we're we're still going through a transition, I think, of reactivating health care. We kind of went through the pandemic. I think we went through some difficult times. We, you know, then we're talking a lot about burnout, a lot about what do we do now? and now we're kind of in this reactivation, I call it phase of of health care, where we're kind of back in the office, back in the hospital, back doing procedures, but not the costs have continued to go up and the reimbursements continue to go down. And how are we going to reconcile that? How do we honor the work and our our how do we honor our industry, our business called health care, recognizing that it's about serving. It's about taking care of our communities. and and how do we put those together? And I think it has to be framed at our meetings, at our business meetings, at our retreats, at our board meetings. Norman K. "Kip" Beals, MD 00:17:48 That's got to be our goal. We have to incorporate those thoughts that you're alluding to. Every time we make a decision, it has to be better. It has to be less costly. It has to be better experience, it has to be more readily available, and it has to have better outcomes. All of that, I think, is what we're looking for, for the future solutions. So I think that if there's something you can say good, that maybe has been switched in the way we think, I think we've activated that part of our brains a lot more for the coming years. Richard Payerchin 00:18:23 I want to, if I may, go back to a point you made a few minutes ago here talking about especially analyzing community needs and then maybe finding, you know, finding a way to provide that service, not just because it's good health for the patients, but it's also, frankly, good business for the practice. I'm just kind of curious. Can you think back just in recent memory? Or maybe not so recent memory? What is what has been a good example of that that you've encountered or maybe one that's been a flop? Norman K. "Kip" Beals, MD 00:18:53 Well, fortunately, you know, because I'm in primary care, you know, we've had long term relationships with thousands of people in this underneath this roof, and we've been able to kind of detect some patterns based on some surveys we've sent out. Norman K. "Kip" Beals, MD 00:19:10 Also just in our querying of, you know, question. And when they sign in, they will sometimes be able to ask them questions. But we also now our hospitals like us or around the country fill out a complete a forms for community needs assessment. And so that helps as well. I've also talked with, some of the local organizations that see some of the people who have difficulty getting healthcare for various reasons and to kind of glean from what they've learned. And one of the, like I live out here again, I said in the rural western Pennsylvania, it's a beautiful place. It's beautiful people. But one of our, main issues is understanding, for example, how do we get people into the office or to go get their mammography? Some of them don't have this transportation, or they have a daughter who's at work and can't take off work to dry it, go home and pick up mom to get her to her specialty. So, you know, we've learned and then been able to find solution to it through grants and even through investments or funding to be able to. Norman K. "Kip" Beals, MD 00:20:25 Or sometimes we just realize it makes sense that we spend the money to solve these. We created a food institute where we started, through our health system, through one of our physicians, Doctor Kathy Sauvage, and she and her team did an awesome job in creating this food institute. And I'll never forget when she said one of the things that, she learned was that when we were trying to provide them with good, healthy foods and then teaching them how to cook them, is that we also had to provide can openers, because some of these households didn't have can openers and the basics of utensils to prepare foods that didn't come in a microwave capable container or whatever. Wow. So we we we got closer to the intimate realities of what people have to deal with and, and what their gaps in, in, you know, their capabilities were. And, you know, we think everybody has a car. We think everybody has a can opener. That's not what's happening where I live in this part of America. Keith Reynolds 00:21:38 Oh, you say you're a practice leader or administrator? We've got just the thing. Our sister site, Physicians Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming. Again, that's physician's practice. Com. Richard Payerchin 00:21:56 From a business perspective. Again, you got the wheels turning for me here, not least because we've had some coverage in the last year, especially with the Physicians Foundation and Social Drivers of Health. And a couple of those factors that you mentioned seemed to kind of jibe with that. And, and I was just kind of curious about clearly it's going to help patient health. Is there a practical and financial benefit to the to the health system, to the hospital, to the practice? Speaker 6 00:22:24 Yeah. Norman K. "Kip" Beals, MD 00:22:25 You know, I, I think that what we know for sure is when we look at some of the sad realities, you know, associated with certain diseases, like for example, when it was Cigarettes and tobacco and lung cancer. You know that we were. Norman K. "Kip" Beals, MD 00:22:40 And we're still fighting an uphill, you know, some days battle against against that. But we've made inroads, haven't we? And what what happens again when we think in terms of the funding that goes into this, which comes out of our tax dollars to provide most of the payment to health systems across this country, if we can put a dent in it and just turn the the, you know, that, move the needle and turn the battleship of disease into a different direction and get less or more efficiently find or be able to discover problems earlier to be able to solve and the side effects. It makes a big impact on the overall cost of health care per individual. So we talk in terms of population. Health is one of the, you know, terms you'll hear talked about oftentimes, I'm sure in your magazine and in our business on the front lines, which is what are the things that we need to do that are going to have better outcomes? Better outcomes are actually less costly in most cases. Norman K. "Kip" Beals, MD 00:23:41 So it does have a positive impact, so that when the government decides they're going to cut us by 2.8%, you know, maybe that'll drive us to find another cure or a better way to do something. Richard Payerchin 00:23:52 I like it, I like it. This is you're like I said, you got the wheels turning for me here because this is like kind of a big picture mindset that I wasn't necessarily expecting in an article like this and trying to do this research. So I but but I like it because like I said, this is something I'm learning and it's given me stuff to think about. Norman K. "Kip" Beals, MD 00:24:10 Well, I think it's, you know, again, one of the joys that, you know, I have working for this for Independent Health System is that they allow us in our dyad leadership to and they foster the input of thinking differently, so that when we are out there trying to look at the world that we're working in and trying to solve. You know, it's not going to come by thinking the way we did when we. Speaker 6 00:24:38 Were. Norman K. "Kip" Beals, MD 00:24:39 Making horseshoes with the blacksmith. You know, that cold cliche. You know, it's, we're we're going to make better solutions, better outcomes. You know, without everybody having to walk down the hallway and wait for me for 20 minutes to come into an exam room, you know, that's still going to be important. Again, I don't want to underpin the importance of having relationships. I think we're humans, and I think that is so critical to good outcomes and understanding each other and understanding the needs of these communities that we have across this country. But I think there's a big opportunities that way, and being able to think differently, I think is enables that creative process to occur. That really is something that's going to solve some of our problems with health care. Richard Payerchin 00:25:26 You know, doctor, I'm keeping an eye on the clock because I got about I got my ten minute warning and I'm down to about 345 and. Okay. I want to respect your time. I'm enjoying our conversation though. So just in our kind of parting minutes here. Richard Payerchin 00:25:37 Yeah. What did. Because we have covered a lot of ground in a short amount of time. What did I not ask about that you want to bring to the table to the conversation? Norman K. "Kip" Beals, MD 00:25:46 You know, I think that, you know, probably the message of making sure that people do look for care through their primary care providers or family practitioners. And I think that that's where cost is oftentimes its most efficient. It's the heart of our our health care providers. It's the, you know, it's the center of and we used to say center of the universe of health care. But we, you know, like to understand that it's really the heart of the care that we provide. It allows people to have oftentimes the most efficient, caring 3D thinking about their health care. So I think that, when we think in terms of health systems and communities. I think that our investment in primary care, and it's not just because I'm a primary care provider, but it's also, I think as a family practitioner, for me, it's it's apparent that we all do our best work when a patient has been seen by their family practitioner and benefits from that three d care and rather than the systems, care that we get from our subspecialists is brilliant. Norman K. "Kip" Beals, MD 00:26:59 These days, what they can do is really oftentimes even to me, on spine. I do think that for the purpose, that's one thing that I probably want to get out there. And I think for us with physicians, the other thing I'd want to to do is, is encourage us to continue to think differently, to be creative, to be innovative, to be innovators, to think in terms of a dyad, to understand that clinical leadership and systems administrative leadership go hand in hand. And the more that we can work together with those with our internal leaderships and our external partners and intensely collaborate with one another, that's when we win. When the patient wins, that's when communities win. Richard Payerchin 00:27:46 I'm just grateful for taking the time. I really did enjoy our talk. Norman K. "Kip" Beals, MD 00:27:48 Yeah, I did too. And yeah. So break a leg. Richard Payerchin 00:27:51 Oh, absolutely. And when you mention about with your sports medicine background, I been having this pain in my knee that I wanted to ask somebody about, but we'll save that for our next conversation. Richard Payerchin 00:28:01 Okay. Your call. Norman K. "Kip" Beals, MD 00:28:01 I'd be happy to give you some advice. Richard Payerchin 00:28:04 All right. I'll tell you. Norman K. "Kip" Beals, MD 00:28:05 What more about that. Can I do other things? Richard Payerchin 00:28:08 You know, just again, thank you and have a great rest of the day. Norman K. "Kip" Beals, MD 00:28:11 You too. Thanks a lot. We really appreciate you letting me have time with you. Richard Payerchin 00:28:14 Oh, not at all. Thank you doctor. All the best. You too. Bye bye. Austin Littrell 00:28:26 Again. That was medical economics senior editor Richard Payerchin and Dr. Kip Beals III. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe on Apple Podcasts or Spotify so you don't miss the next episode. Also, if you'd like the best stories that Medical Economics and Physicians Practice published delivered straight to your email six days of the week, subscribe to our newsletters at MedicalEconomics.com and PhysiciansPractice.com, and be sure to check out Medical Economics Pulse, a quick hitting news podcast that offers concise updates on the most important developments affecting your practice, your bottom line, and the broader health care landscape delivered by the editorial team at Medical Economics. Austin Littrell 00:29:06 Off the chart, a business and medicine podcast is executive produced by Chris Maslin and produced by Keith Reynolds and Austin Littrell. Medical economics Physicians, Practice and Patient Care online are all members of the life sciences family. Thank you.