Dennis Sehgal MD, MBA

🌟 Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and save your place here: https://bit.ly/3MkxxT8

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Instead of paying you and I what we deserve to work in our clinical positions, many programs recruit from overseas. This allows desperate foreign physicians to come to America with a position in place and it allows the hospital administration to keep costs down. Although this seems like a great fix, it's at the expense of both the American physician and the foreign physician... - for example a commensurate salary European physician (lower cost of training and lower opportunity cost of training, lower cost of living in many cases and lower compensation overall) is not the same as that expected by a US trained physician These physicians are then excited to be able to come to the United States with a job in place, but what they don't realize is that they work much harder and usually much more hours with more stress on sicker patients. - remember all those headlines regarding how unhealthy and obese Americans are?... it's actually true. Additionally, because of the board certification process in this country, these foreign physicians most of the time cannot satisfy those requirements without going through retraining in its entirety. Because of this, they can be beholden to the position and facility which recruited them in the first place. - they lose any mobility or negotiating power So instead of actually compensating the existing physicians that are here to do the work we pull in foreigners that might not understand what to expect. They are highly-trained, cheap labor. There are great people all over the world and great physicians and nurses everywhere, but to overlook those that know the work, want to be here, are already here, etc is short-sighted. What are you seeing out there?

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Insurer Micromanagement and prior authorization rationing of #medicareadvantage access, diagnostics and treatments increased patients morbidity and mortality (sickness and death) https://lnkd.in/dDhzmTNA #tripleaim #medicare #publicprivatepartnership

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THIS is money well spent.

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Urticarial Vasculitis Overview Urticarial vasculitis is rare and the causes often go undiagnosed. A Medscape recent overview highlights key features in the diagnosis and management of this rare disorder.

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Are you "for profit?" What does that actually mean, anyway? I think we have a lot of mixed up ideas about money. Is it OK to get paid as a doctor? Should you determine the value of what we offer and insist on getting paid that? If you spend your youth and time and money educating yourself to provide value, should you assign a price to that and ask to get paid? If someone continues to decrease what they pay you for what you have done for a different amount... should you protest? If they make it harder to get the money you were paid for something of value that was agreed to be paid... would you protest? If you provide value and people pay you, then you are "for profit." Are you interested in being "for profit?" If not, what is your financial goal as a doc?

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Reforming or eliminating the RUC/RVU/CPT system is an intriguing idea. Few people like it and even fewer seem to understand it. It pits doctors against one another in what is increasingly a negative sum game (yearly Medicare cuts). Executed properly, fundamentally changing the way we pay for medical care could accelerate the adoption of value-based care and make VBC the reality that never was. Emphasis on "executed properly." Done poorly, such a move could further shift control of medicine away from physicians, lead more doctors to opt out of Medicare, engender more consolidation, and worsen the clinician exodus. Access will suffer and prices will go higher. There are some benefits of the current system. It's more straightforward and less expensive to administer and, for all its faults, a transactional system is easy to understand. Part of the reason VBC has failed is that many programs are too complex and rely on metrics that have dubious clinical relevance. Talk of reforming the system will lead to another round of "pay primary care more and procedure-based specialists less arguments." This is a red herring argument that ignores both the clinical and economic realities of healthcare. The goal should always be to do what's best for the patient -- sometimes that's surgery, sometimes it isn't. That said, there is an argument to be made to shift towards incentivizing proper chronic condition management. After all, hip and knee arthritis and back pain are chronic conditions. They just happen to sometimes lead to surgeries. Instead of creating another zero (or negative) sum game that leads to doctors fighting each other for a shrinking pie, let's create a system that ties together prevention, early intervention, education, evidence-based care, and high value treatments. Maybe it's more of a free market system. Maybe it's a transparent fee schedule with high quality, consumer-focused healthcare businesses built on top. Maybe it's direct care, medical home models, ACOs, or actual IDN/CINs. Whatever it is, building it has to include a willingness to think differently, but smartly, about these issues and involve people that deeply understand them. #medicine #healthcare #healthpolicy #vbc #valuebasedcare #healthcarereform #health

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Fee for service is a burning house and Nevada is in trouble 👨‍⚕️Physicians have watched reimbursement decline year after year over the last two decades. 📉Declining reimbursement has lead to a worsening cycle of underpayment. Between 2001 and 2022 inflation adjusted Medicare reimbursement has declined 24% for physicians across the country. 🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥 At the same time the cost of doing business has risen significantly for physician practices (administrative and facility costs, staff and the electronic health record.) In Nevada, Medmal legislation and reform is increasing costs even further which will make it impossible for some practices to continue doing business. How about Medicaid? Same trend. When we look at Medicaid reimbursement which pays 66% of Medicare, physicians with a large number of Medicaid or 3rd party Medicaid patients are hit the hardest. 🙋‍♂️Who are these physicians? 🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥 Pediatricians and Pediatric Specialists. Yes, doctors and hospitals caring for children are hit the hardest. 🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥 🔥 👶 In Nevada close to 70% of all children are on Medicaid or 3rd party Medicaid 👶 When people ask “why don’t we have pediatric specialists in Nevada?” the answer is dollars 👶 There is little money to support pediatric care in NV Often pediatric specialists, for example pediatric ENT, pediatric anesthesia and pediatric pathology must care for a significant amount of adult patients to offset the losses of caring for children in Nevada. Not only are physicians reimbursed poorly but facilities are as well and this trickles down to a lack of investment in pediatric care. 🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥 So what happens? Kids go out of state for care they should be receiving in state. Physicians and surgeons leave Nevada, frustrated that they’re overworked but collect a fraction of what doctors in neighboring states collect. Physicians who are able open concierge and direct primary care practices which are fantastic for those patients who can afford it but creates a vacuum for patients who can not. And for many pediatric specialists this type of direct primary care is not possible 🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥 🔥 As a pediatric surgeon should I have a membership program in case something happens and your child needs surgery? Or should I have a stripe QR code on my phone and collect money before taking out your child’s appendix if you’re uninsured? Of course not The sad part of this trend is that declining reimbursement and increasing medical malpractice insurance costs strongly affect PATIENT ACCESS Recruitment and retention of talented physicians and surgeons grinds to a halt due to impossibly thin margins 🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥 🔥 What is the answer? Here I’ll be brief Vertically oriented care Physicians as employees Unfortunately, that is the future and I believe that has been the intent all along.

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Family medicine doctor, $300K. GI doctor, $600K. CT Surgeon, $1M. On the grand scheme, these aren't impressive salaries and they certainly aren't that different from each other. For most who earn above the base of an FM doc, it equates to a nicer car, bigger home, a shorter commute, a fancier private school, a few more business class seats, and fancier wines. For the higher earning docs the training is longer, the studying is harder, they get sued more, the procedures are more physically taxing, they spend more time on call, they spend more time babysitting their possessions, and more family and friends likely depends on them for financial support. In the end, their 401Ks, real estate portfolio, saving accounts, and net worths aren't too different. If you go into medicine thinking that you'll make more and accumulate more wealth and your work will be easier as a specialist, you'll likely be disappointed.

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Did you know? The Treat & Reduce Obesity Act is fighting for better coverage! Dr. Sherika Newman, a weight loss champion, equips you with powerful patient advocacy skills. Learn to navigate the system, fight for the care you deserve, and unlock effective communication with healthcare providers. Listen now and empower yourself for weight loss success! https://lnkd.in/e5hNe-rH #WeightLossWarrior #PatientEmpowerment #HealthcareNavigation

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🤩It’s finally here!! 🎥🍿Watch the trailer for the Targeted Pain Treatment documentary- over 2 years in the making! So excited to share this project with the world. Thanks to UT Medical Center, Big Slate Media and the rest of the team for helping make this vision a reality. Link to trailer: https://lnkd.in/e3Qai4Yw Stay tuned to find out where you can watch the entire film! #TargetedPainTreatment #Hope #Trailer #Documentary

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"However, these savings—as much as $50 billion annually1—are unreported and not shown to improve care access for patients without adequate insurance.2,3" ---Well, the financial design is so bad that it has closed over 600 hospitals since DRG and the era of cost cutting. The financial design is the reason for closures and compromises. The 50 billion distributed to hospitals serving vulnerable populations (40 - 50% of US pop) would be some help due to the Era of Cost Cutting 1983 to 2030 or longer. "Per CMS’s budget neutrality principle in the Outpatient Prospective Payment System (OPPS), the $9 billion repayment must be offset by $7.8 billion of cuts to nondrug reimbursements." ---Budget neutrality and regulatory capture prevent any true reform to add support to the hospitals and practices serving most Americans most behind. Once again CMS is not accountable and must be reigned in even if it takes 50 years as it did for physician accountability over the last half of the 19th century and for human subject researchers over the last half of the 20th century. Medicare and Medicaid have failed for 2621 counties (40% of US) most behind and has primary care and basic health access except 1965 to 1978. What about the Belmont Principles and numerous violations? What about protection of vulnerable populations, informed consent (which requires prior study of consequences poorly done by CMS), or beneficent intent - especially with all three lining up consistently against the majority of the nation most behind time after time! Strike 1 for ethical and moral violations - CMS has demonstrated time and again the inability to protect their charges - vulnerable Americans. CMS most fails where there are concentrations of elderly, poor, disabled, and their worst public plans. Strike 2 - CMS has failed to do adequate studies of consequences prior to the implementations of policies since 1983 and including Medicaid Waivers which will steal more from team member support and give more for team members to do - with worst impacts on Community Health Centers with 50% Medicaid and in the most vulnerable populations highest in concentrations of Medicare, Medicaid, and Dual plans. Studies are done more to justify what CMS is doing rather than to protect most Americans most behind from consequences such as their providers rated poorly or penalized just for caring for these populations inherently lower in outcomes and drivers of outcomes (Readmissions, ACO shared savings, Star Ratings, others) Strike 3 - CMS fails for beneficent intent. The intent is cost cutting. CMS harms tens of millions with designs that have killed hundreds of hospitals and countless practices, delivery team members, and local leaders in health and other community areas. We know about some economic and access impacts from these losses, but the full impact and cascades of impacts are never studied. See comments for losses of jobs, income, leadership, and better health insurance

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Why the Medicare physician fee schedule is sheer madness Susan Dentzer, MS ~ HFMA Amid the complexities of U.S. healthcare, there is probably no construct that’s more byzantine than the Medicare Physician Fee Schedule (MPFS) — the program’s elaborate system of paying physicians and other clinicians (including nurse practitioners, physician assistants and clinical psychologists) for more than 10,000 medical services.a In 2022, the schedule drove about $71.2 billion in payments to physicians under Part B of Medicare, and tens of billions of dollars more in clinicians’ Medicare Advantage (MA) payments, many of which are also based on the fee schedule.b Because the schedule is widely emulated by other payers, including employer-provided plans and commercial insurers, it indirectly influences $600 billion annually in private payments as well.c The MPFS is emblematic of so-called administered pricing, in which prices are set by some outside authority, such as the government, rather than arrived at by markets. In the MPFS’s case, the creators of this monstrosity include Congress, federal agencies, academics and, ironically, physicians themselves. And because it is explicitly a fee-for-service (FFS) system, it manifests many of the “pathologies” of this form of payment, as the noted Harvard healthcare economist Joseph P. Newhouse, PhD, wrote in his classic analysis Pricing the priceless: A health care conundrum.d Rarely have the pathologies of the MPFS portended such poor outcomes for the future of U.S. healthcare as they do now. About the MPFS and how it works Read more at: https://lnkd.in/gNDZ3QhT #cms #MPFS #healthcare #Medicare

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Helpful analysis - routine stress testing a year post heart attack is not helpful in predicting risk.

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I recently came across an insightful article on Bloomberg discussing the surge in Nurse Practitioner (NP) jobs and its implications on healthcare. The article raises important questions about the balance between the rapid growth of NP roles and the quality of training and placements. At NPHub, we believe that comprehensive clinical experiences are crucial for developing competent and confident NPs. To all healthcare leaders and NPs: How do you see the role of quality clinical placements in shaping the future of NP practice? What strategies can we implement to ensure our NP students are fully prepared for their critical roles in healthcare? Let's discuss! https://lnkd.in/gmRdNpYq #NursePractitioner #HealthcareLeadership #ClinicalPlacements #NPHub #NurseEducation

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Medical students are reluctant to enter primary care (IM, FM, Peds) because they think the work will be draining and the reimbursement isn't high. No matter what specialty you choose, the pay is quite good. If you can't make it on $250k in family medicine then it's a spending issue, not an income issue. You don't have to work for a Kaiser Permanente or Cleveland Clinic. Those are large commercial jobs where you are expected to be a cog in the wheel. The patients you see aren't your patients and you are considered disposable. You can go into any town and open a small practice and do mix of walk-in, primary care, preventative care, peds, and prenatal care with plenty of customers in a cash-based practice. Setting up your own private practice that is insurance based is also possible but the insurance companies will now be your boss and you'll be a cog in the health insurance wheel.

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The scale of the healthcare 🩺 problem is so great, it’s hard for me to personally comprehend it. ⚠️ I don’t think there is a solution, but I do know the one thing that each of us can do individually, is focus on our own mental and physical health, preventative medicine screening, advocacy for ourselves, and our loved ones, and taking care of ourselves as individuals. I was just thinking 💭 out loud. Dr. Dooreck Also, on behalf of Executive Health Navigation ▫️ ▫️ ▫️ #health #familyoffice #wealthmanagement — — — — — — — — —

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