Presenter: Neal Howard
Guest: Jim Skinner
Guest Bio: Jim Skinner is the founder and president of the Smart Patient Academy, an insurance benefits enrollment and communications company based in Texas. Its sister company, JMS Benefit Solutions, is an insurance brokerage and consulting firm that works with mid-size employer groups, both domestic and foreign owned
Jim Skinner discusses his book “Smart Money, Smart Patient.”
Health Professional Radio
Neal Howard: Hello, you’re listening to Health professional radio; I’m your host Neal Howard. Our guest in studio today is health insurance broker Mr. Jim Skinner. How are you doing today Jim?
Neal Howard: Outstanding. Thanks, Neal.
Jim: Now you are a cancer survivor that’s a great thing, you run marathons, you’re in great health. As an author and well educator now, the new health care reform, it’s impacting patients nationwide, in some instances worldwide. It’s also impacting how physicians treat us. They are already overworked, they’ve got all these compliance issues, they’re seeing sometimes 20-30 patients in a day and we’re seeing our physicians for anywhere from 5 to 10 minutes and that just doesn’t seem adequate when it comes to giving a high level of care, especially when you’re fearful in the first place and possibly intimidated.
As far as healthcare professionals dealing with this new law as well as patients, how is the level of care going to be impacted with this sweeping reform?
Neal: Well there is a huge impact that had a long term consequence and there is a general move through Obamacare and through the Healthcare Reform Act that is designed over time to pay doctors and providers of all types for the outcome versus the procedure.
Jim: Okay, now let me understand …
Neal: So … go ahead.
Jim: Let me first understand, before the Affordable Care Act that was not the case, this is something new?
Neal: Correct, before the Affordable Care Act, doctors were paid on what’s called a fee-for-service basis. I give you … you come in to me with a flu, I do three or four things, I give you an injection. Each procedure and each consultation has what’s called a procedure code associated with it. So there is no prices, there is just codes and these codes translate into reimbursements that the doctor receives from insurance company.
So the theory went that the more procedures the doctor did, the more money he received. That’s the theory behind it. So they said why don’t we change that model, that payment model to doctors and pay the doctors for the outcome they produce instead of the service, the fee-for-service model. And in theory that sounds good but in practice there is some real debate on where that’s going to lead, and I’ll tell you because if you can think of it this way: you know how we have complaints in our education system…
Neal: Where they started talking to teachers … they started teaching, they started testing the kids in schools to make sure they’re learning something and if they didn’t the teacher was penalized; okay? Or the school was financially penalized. So what that drove was teaching to the test. So there is this whole phenomenon of teaching to the test which is now being implemented, the same thought process is being applied into the field of healthcare and the concern is that this process now has people treating to the test not to the actual clinical outcome.
In other words, you can check a box that says this person, I did X, Y and Z on this person but you may feel horrendous, you may not feel like you’ve actually solved any problem. But because the healthcare has now become so formulaic, based on this predetermined procedures it may … the doctor may get paid for a positive outcome that doesn’t ultimately happen. So there is a big debate in the physician community about this whole phenomenon, the debate about whether or not it’s going to happen is kind of over.
It is happening and there is new hospitals that are coming up that are based on this model called Accountable Care Organizations that are called ACOs. And it’s basically a hospital organisation that buys up a lot of doctors’ practices and they become employees of the hospital. And then they have these certain procedures, these certain protocols, if you will, that are designed to create predetermined outcomes so they just test to the predetermined outcomes and as long as your test shows that you’re better, then they get paid.
You may not feel better but that’s the way, that’s the direction and the trend.
Jim: That’s terrifying.
Neal: It’s a fact, it’s happening, and just to bring it to something a little more direct with me personally, I do a little consulting with a new ACO in our area here in Texas, and I had an opportunity to talk to somebody at a high level in the organisation who told me that health care in the future is going to be 95% data driven, 5% intuitive art. That’s quantifying exactly what I just said to you. In other words that’s the epitome of formulated care.
Jim: It seems to me, if I’m understanding you correctly, we’re basically moving away from a doctor actually diagnosing you. You’ll come in with a problem, and basically formulas and algorithms will determine the care that you get and if the outcome doesn’t match the predetermined formula, then how discouraged is the healthcare professional is going to be from a financial standpoint? But more importantly healers as healers it’s almost like their hands are tied even more?
Neal: Right. It’s not a great idea and that’s why a lot of healthcare professionals are not really in favour of this. It creates an incentive. If you can think of it this way: it can create a misguided incentive for a physician community or a hospital to seek out the healthiest patients, right?
Neal: So the people that have the sickest patients are going to get paid the least. I mean, it’s just inherently skewed that way. They’ll tell you that’s it’s not. They’ll tell you that they made allowances for this in the healthcare law, and it’s all based on technology. It’s all based on models of care that are created kind of in a top-down format, from Washington down through Centre for Medicare Services; CMS who reimburses everybody. So yeah, it’s not a great model but that’s a trend that is evolving.
Jim: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. We’ve been talking today with Jim Skinner; a health insurance broker and author of the book Smart Patients Smart Money; The Essential Playbook for the New Healthcare Consumer. Jim decided to write this book after being diagnosed with stage three colon cancer and life threatening brain tumour. He went through a year of chemo and came out on the other side deciding to educate consumers, to educate the other health insurance professionals and healthcare professionals as well in how to navigate this new sweeping healthcare reform in the United States, and still provide a level of care that we all deserve and that we’re all looking for when something happens as far as our health is concerned.
It‘s been great having you here with us today Jim, your book is available on amazon.com, it’s also available at Barnes & Noble and also available at smartpatientacademy.com. Hopefully you’ll come back and spend some more time with us Jim.
Neal: Thank you Neal so much for the opportunity. I appreciate it, and any time, let’s do it again. Thank you.
Jim: Right, transcripts of this program are available at healthprofessionalradio.com.au, and also at hpr.fm.