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A movement founded by doctors, for doctors, dedicated to empowering medical professionals to reclaim control over healthcare decisions and advocating for their fair share of the industry's resources.
00:00:04:00 - 00:00:27:01
Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professional to reclaim control over health care decisions and advocating for their fair share of the industry's resources. Please note the views expressed are those of DocNation and not necessarily those of our Guest or Reference Health centers.
00:00:27:03 - 00:01:02:16
Neil Dougherty
I'm sorry I always get nervous about these introductions here, but, Doctor Brian Rich, thank you for your smiling face joining us here. I know you're a busy man. Just, always been a leader in, interventional pain and spine space, and, and it's been great over the years. Kind of learning, how just exactly how how far that leadership of that space and, of doctors in general is extending to, and, and and the things that you're doing in your free time.
00:01:02:18 - 00:01:25:04
Neil Dougherty
Right. That kind of fighting for physicians. And that's what we do here at DocNation, right? We are trying to learn as much as, about what's going on and trying to help doctors, get a voice. And you are a big voice. I think you are telling us that you are representing doctors on the Hill.
00:01:25:06 - 00:01:26:13
Dr. Brian Rich
00:01:27:12 - 00:01:35:07
Neil Dougherty
Can we start this, conversation by saying what is kind of the update on on the Hill and what, what are you doing right now?
00:01:35:12 - 00:02:02:23
Dr. Brian Rich
Yeah. Where are we going? So, well, first of all, yeah, thanks for that. Before I get too far in, and I will tell you, there's there's a lot of really good doctors out there working with this as well. And, and working on these efforts. I think large in part because the more exposure and, and I think the more, physicians understand really kind of how government works and what's happening, it's created more exposure.
00:02:03:00 - 00:02:19:07
Dr. Brian Rich
And because of that, it's allowed, more physicians to get involved and understand how to get involved. Society as a whole are getting more involved. I think all of them, you know, there for a long time, there's really just one main society that was doing. And now it seems like all of them are are getting involved.
00:02:19:07 - 00:02:43:20
Dr. Brian Rich
And that's really helpful. And I'll tell you why. Because if you go to, if you go to the Capitol and you're standing there and you make them and you pound your hand on the desk, so to speak, really, really, really, really loud. And I'm being very rhetorical here. And you make your point, you walk out and that sort of thing that does not carry near as much weight as if you're in a constant drumbeat.
00:02:43:23 - 00:02:48:10
Dr. Brian Rich
I'm still here. I'm still here. I'm still here. I'm still here. So?
00:02:48:12 - 00:02:51:08
Justin Nabity
So it's not a one and done thing, it requires continuous effort.
00:02:51:14 - 00:03:10:14
Dr. Brian Rich
Absolutely, absolutely. And so you can't you, you know, follow up is the word of the day. And so anything that you do, you have to follow back up and make sure, hey, I'm still here. Every, every, every member of Congress staff, they have staff that you can just kind of keep hammering on and working on.
00:03:10:14 - 00:03:33:22
Dr. Brian Rich
So the creativity of really creating change, especially in Congress, is to, is to keep coming at them in multiple different ways. Now, to answer your question specifically, you know, I got in, I started I was asked to be I think we talked about this. I was asked to be part of, a congresswoman staff as far as, to kind of help her on her medical advisory board and those types of things.
00:03:33:22 - 00:04:03:03
Dr. Brian Rich
And it just start off very innocently, somebody I have known for a long time. And sure, next thing you know, bam, she's on Ways and Means, she's on the House and Energy Subcommittee on Ways and Means, which actually is the controlling oversight. Committee, for HHS and which ultimately is CMS. So every every government agency in the country has some form of oversight somewhere.
00:04:03:05 - 00:04:35:16
Dr. Brian Rich
And, and for us that is Ways and Means, Health and Energy sub, that committee, you know, really started out, you know, a couple, about three years ago, just very slowly from, you know, what's going on in 2474, you know, as far as the, the equalization of Medicare reimbursement for physicians compared to hospitals, as I expected, the bill got introduced in committee.
00:04:35:18 - 00:05:05:17
Dr. Brian Rich
It was, it was and it just kind of stalled there. And any time now, we're in an election year, we're trying to fund a government, you know, those types of things are definitely going to go on the back burner. However, the good part and, and and about this, which is and know short term is kind of like what you guys are doing a donation or what other, societies are doing is that constant drumbeat is is starting to happen.
00:05:05:19 - 00:05:33:11
Dr. Brian Rich
And so, so my, my answer with my suggestion would be keep banging because the more they hear it, the more they know they've got to do something about it. And I can't stress this enough. This is bipartisan. So when you look at, any, any bill or anything that's that's put, that's, that's put out there that’s sent to committee, there's always co-sponsors on both sides of the aisle, which is good.
00:05:33:13 - 00:06:00:15
Dr. Brian Rich
So these are these are all wins. These are things that are wins. The issue we have and this is the real issue, and this is what people are now finally starting to say Medicare cuts or anything, any changes in Medicare or any changes in health care spending has to be deficit neutral. So if something gets added somewhere else, it's going to have to get cut somewhere else, right?
00:06:00:17 - 00:06:07:24
Dr. Brian Rich
And you can see these trends occurring from one administration to the next.
00:06:08:01 - 00:06:08:24
Dr. Brian Rich
Because...
00:06:09:01 - 00:06:21:13
Justin Nabity
Sorry, I'm sorry there up to here. But how is that the case? Because it seems like there are increases being made and they're aren't being equal equivalent cuts other places. So why is it that this area has to be treated that way?
00:06:21:15 - 00:06:38:11
Dr. Brian Rich
Well, the generally speaking the the the the largest, the most vulnerable group in for CMS traditionally has been the physicians because the lobby is just not that strong.
00:06:38:13 - 00:06:38:20
Justin Nabity
Okay.
00:06:38:20 - 00:06:40:03
Dr. Brian Rich
I mean, plain and simple.
00:06:40:05 - 00:06:47:13
Dr. Anthony Giuffrida
Can you can you go into what is the lobby for physicians right now? I mean, I don't even think physicians know if there is a lobby or what they can support.
00:06:47:15 - 00:06:51:05
Dr. Brian Rich
Well, the the lobby that's supposed to be for physicians is the AMA.
00:06:51:07 - 00:06:56:22
Dr. Anthony Giuffrida
Yeah. That that to me, I don't want to make you say it, but that to me has failed us over the last ten, 15 years.
00:06:56:24 - 00:06:59:04
Dr. Brian Rich
Oh, no, I, I'll say it. It has.
00:06:59:06 - 00:07:00:06
Dr. Anthony Giuffrida
Okay.
00:07:00:08 - 00:07:19:18
Dr. Brian Rich
It has. And the problem is, is that the AMA came in, the AMA comes in in negotiations and they've come in in negotiations trying to be conciliatory, that let's work together, so to speak. And the problem is, is the AHA, the hospital association and the, insurance lobby. That's not how that's not how they're operating.
00:07:19:20 - 00:07:28:01
Dr. Brian Rich
You know, if you the insurance lobby in general, you know, they have a fiduciary responsibility to their to their board to make money for their board.
00:07:28:03 - 00:07:31:18
Dr. Anthony Giuffrida
And to their shareholders. I mean they’re a publicly, publicly traded company. Right?
00:07:31:20 - 00:07:42:03
Dr. Brian Rich
Absolutely correct. So what's and the, but that's, but just in generally you're supposed to be deficit neutral.
00:07:42:05 - 00:07:43:00
Justin Nabity
Yeah. That makes sense.
00:07:43:05 - 00:08:09:14
Dr. Brian Rich
And and that's and I mean, as far as getting into the weeds and looking exactly what was added and what was cut, that's just why it's happening. So the. I'll give you a, I'll give you a really good example as it relates to our space: peripheral nerve stimulation. We all know about peripheral nerve stimulation. Peripheral nerve stimulation, you know, for whatever however you're using.
00:08:09:14 - 00:08:17:00
Dr. Brian Rich
That therapy has great success in a lot of areas, you know? I mean, we can all talk about it. Obviously that's used appropriately.
00:08:17:02 - 00:08:17:11
Justin Nabity
Um-hmm.
00:08:17:14 - 00:08:35:06
Dr. Brian Rich
One of the major insurance payers, Humana has decided that they are going to follow the Nordian LCD and out in California and apply that across the country to all Macs, which that's not it's not an NCD, it's an LCD.
00:08:35:08 - 00:08:56:03
Dr. Brian Rich
And what they say in that situation is, is they say that, well, that's Medicare. Well, that's Medicare on the West Coast. And that's the way that well, that's how that works. And so now what they're what's happening is, is when a commercial payer does that and a commercial payer follows that guideline, then CMS tries to jump on that.
00:08:56:05 - 00:09:17:02
Dr. Brian Rich
Then CMS tries to jump on. Well, we're only going to approve these procedures for the same thing. And that's against that. That's against the guidelines of CMS. So you have you you have to have someone literally watching almost every single thing and what they're doing and, and creating a checks and balances. And that is what the AMA is supposed to be doing.
00:09:17:04 - 00:09:22:16
Dr. Anthony Giuffrida
And who are these people making the decisions at CMS? Are they physicians?
00:09:22:18 - 00:09:26:01
Dr. Brian Rich
It's wide variety, but usually.
00:09:26:03 - 00:09:32:20
Justin Nabity
So take that what just shared, if you could, Brian, and translate that to the patient level. Why does the patient care about what you just said?
00:09:32:22 - 00:09:37:24
Dr. Brian Rich
Because an indicated procedure that could benefit them is getting denied, plain and simple.
00:09:38:04 - 00:09:46:02
Justin Nabity
So what the doctor tells the patient this issue that they should have is then being denied by somebody else who's not involved in the patient relationship.
00:09:46:04 - 00:10:03:09
Dr. Brian Rich
I'll make it a lot. I'll make it more plain than that. Yeah. I'm Dr. Giuffrida in my clinic in Florida. I'm sitting here and I'm talking to a patient. I've worked them up. I've done all these things. You know, I may even have, like, one of his fellows standing next to me or something like that. We're talking about what procedure we're going to do that's really going to benefit you.
00:10:03:09 - 00:10:25:05
Dr. Brian Rich
Let's talk about knee pain. Right. So we tried everything. We tried all these options and these things and that. So now we're going to take you to our procedure room. And we're going to do a knee peripheral nerve stimulator trial. This I go into full broad explanation. I get a procedure clearance. I talk about pre-op discussion. I talk about informed consent, benefits risk.
00:10:25:11 - 00:10:44:22
Dr. Brian Rich
I talk about all this stuff. The patient is reading a brochure and everything looks great. And then. And then they go home. They get scheduled. Now we've got to call the patient and said, well, guess what? It's denied. When we didn't even know it was, it should have been denied. And now it is denied. And now the patient's going, well, what the hell is this, doctor know?
00:10:44:24 - 00:11:00:23
Dr. Brian Rich
Why is he talking to me about this procedure that was going to get denied? And of course, he's over there going, wait a minute. He goes, this should be approved. And now we've got to go fight it for two reasons. Number one, because I want the patient to want it. And number two, I don't want the patient thinking I'm crazy, that I'm suggesting a procedure that was never going to get paid.
00:11:01:00 - 00:11:02:10
Justin Nabity
As if you should've known better.
00:11:02:14 - 00:11:03:16
Dr. Brian Rich
Exactly.
00:11:03:18 - 00:11:04:22
Justin Nabity
And apparently you didn’t, so do you really know?
00:11:04:23 - 00:11:08:04
Dr. Brian Rich
That's right. That's real world experience right there.
00:11:08:05 - 00:11:23:16
Dr. Anthony Giuffrida
And for for all the viewers out there. Brian, what percentage of time? I have two questions. What percentage of time do you think you spend talking to the patient about that? Because I, I have to preface with the patient, hey, this might I think this is what you need, but we might not be able to get this approved.
00:11:23:16 - 00:11:36:23
Dr. Anthony Giuffrida
And that's a that's a lengthy conversation. And then what percentage of time do you think you and your staff are spending actually trying to get these approved? I mean, because we're talking about wasted health care dollars a lot in DocNation, to me this is a huge waste and just the time we have to spend.
00:11:37:00 - 00:11:54:09
Dr. Brian Rich
So pre-op discussion, you know, depending on how you're how you're scheduling and stuff like that, typically, you know, as an established as it, you know, if you're scheduling your establishment, visit 15, 20 minutes and you think this is going to be a straightforward pre-op discussion, you can be in there talking to the patient in between 30 to 45 minutes, explaining the procedure to them, trying to first, first.
00:11:54:09 - 00:12:09:16
Dr. Brian Rich
You're trying to get them to understand it, the why you want to do it, why you think it will help them. Then you get into the bad things, the cons of the procedure, and then you talk about the good things, and then you talk about all the things that could be anywhere between a 30 to 45 minute procedure.
00:12:09:18 - 00:12:28:05
Dr. Brian Rich
Patient walks out, schedules the procedure, and then all of a sudden it's denied. It could be weeks of time, it could be weeks of time trying to get it. And that could be that could literally if you have if you have one, let's say you're a let's say you're a smaller, private practice, which that's really where all the attacks are coming, by the way.
00:12:28:05 - 00:12:51:21
Dr. Brian Rich
But let's say you're a smaller private practice, and you have one person that does all your prior auths, or you have one person does all your insurance verification, whatever. That one person could be buried trying to deal with that almost all day long one day, which basically means all the other ones that they should be doing for all your other patients are not getting done because they're sitting here dealing with something that should have already been approved.
00:12:51:23 - 00:12:53:18
Neil Dougherty
00:12:53:20 - 00:12:54:18
Dr. Anthony Giuffrida
Do you think
00:12:54:20 - 00:12:57:02
Dr. Brian Rich
That just bottlenecks your office.
00:12:57:04 - 00:13:07:12
Dr. Anthony Giuffrida
Yeah. In my mind, I think it's a tactic to deter patients and deter physicians for wanting to go down that road and maybe not offer it to the next patient. And that's what I've seen.
00:13:07:14 - 00:13:30:04
Dr. Brian Rich
Well, you're absolutely correct. And I 100% agree the basically it what the way and this and I'll and I'll talk about the next point but the way the way generally insurance companies are operating is they're operating in the sense that the, what they're trying to do is they're trying to wait out, they're trying to sweat you out.
00:13:30:06 - 00:13:30:12
Dr. Anthony Giuffrida
Yeah.
00:13:30:13 - 00:14:07:17
Dr. Brian Rich
And there's actually, supposed to be the next, and I don't, I don't know yet. We're all waiting. There's a couple of, whistleblowers that are coming to testify in front of Congress that are, the prior authorization physicians. Two of them are from Florida that were in interventional pain practices that left their practice. And decided to go work for, I don't know, both of them went to work for Humana, but I know one of them did go work for Humana in the, and is a medical director, and all they do is review claims and on one of them, I've actually talked to him and he straight up said, that's what
00:14:07:17 - 00:14:16:21
Dr. Brian Rich
he said. He said the goal is for them to really just sweat you out. They just keep saying no until you finally just give up or the patient gives up.
00:14:16:23 - 00:14:22:06
Justin Nabity
So they left their practice, they retired their practice or whatever. They transitioned over to go full time.
00:14:22:08 - 00:14:26:08
Dr. Brian Rich
Or yeah, that's a whole nother. Yeah. And that's a whole nother headache.
00:14:26:10 - 00:14:32:16
Justin Nabity
Now they're an insider at the company and they're exposing the really the corruption that exists.
00:14:32:17 - 00:14:33:07
Dr. Brian Rich
That's correct.
00:14:33:08 - 00:14:36:14
Justin Nabity
Doctors can't treat their patients the way they need to be treated.
00:14:36:16 - 00:14:39:00
Justin Nabity
That's insanity!
00:14:39:05 - 00:15:00:18
Dr. Brian Rich
excuse me. Absolutely. And I think the biggest part of it is, is that is, it's just it's just it's they're treating it as a game, and it really is a game in a lot of ways. And again, and when you go back to the reality of that, they have a fiduciary responsibility to their, as doctor said their shareholders, their board, they're they're doing what they think is right.
00:15:00:18 - 00:15:27:11
Dr. Brian Rich
The problem with that just then is this is now a Medicare, and in a lot of ways, is trying to follow some of these crazy guidelines to try to prevent that which that that's a big no no. And so that's a that's the problem. And so and so those are the types of things that are starting to now get exposed, not because one person showed up in Congress and bang their hand on a desk one time.
00:15:27:13 - 00:16:00:21
Dr. Brian Rich
It's been a repetitive thing. And that's why I keep mentioning that this is the way this works is is it's not a one time thing, you know, you know, for it, I mean, and like, for example, I mean, I was talking with somebody a couple of weeks ago and they said, you know, you testified in front of Congress that, actually, yeah, ten times, over the past five years and, and the and the and it's kind of looked at, I mean, I said, but that ten times and testifying in front of Congress, that really kind of equates to really wants because that's how it works.
00:16:00:21 - 00:16:11:21
Dr. Brian Rich
You almost have to do it 20, 30, 40 times before it finally starts moving things. Because it's it's a it's a big bohemoth of a process to try to start moving things.
00:16:11:23 - 00:16:55:03
Neil Dougherty
I want to I want to say this, Brian, because I think, Dr. Rich, you know, this, I, I've represented new technology and new medicine and, maybe, alternatively said that I represent, large investments, private investments and even professional investments in new technology. And when we overlay some of the issues of the insurance denials and these types of things, you kind of look at this window of people that are actually pay... they’re cash pay for their health care, and even sometimes just traditional Medicare are receiving better care.
00:16:55:05 - 00:17:16:07
Dr. Brian Rich
So the best way I can respond to that, I unfortunately, I can't use this, but it's the best saying you can ever say. And now, like, there's some of the Congress members of Congress are starting to use this. I wish I would come up with this. I would have trademarked it. But the just because you have health care insurance doesn't mean you have health care.
00:17:16:09 - 00:17:18:15
Dr. Anthony Giuffrida
I've been saying that. I've been saying that since Obamacare.
00:17:18:21 - 00:17:39:03
Dr. Brian Rich
Yeah. And, and so yeah, that's one of the big issues with that's one of the big issues with ACA is, is they brought all these people in. But when they brought all these people in, they brought them all in with all the Medicare contractors, with all of the, the, the oversight against physicians, and made it just impossible for physicians.
00:17:39:03 - 00:17:53:00
Dr. Brian Rich
They put all the, the burden on physicians. And quite frankly, in in a lot of today's world, if you're a pure cash paid business, the cash pay practice, you're delivering health care more than if you're an insurance practice.
00:17:53:02 - 00:17:54:14
Dr. Anthony Giuffrida
More efficiently, for sure.
00:17:54:16 - 00:18:07:15
Justin Nabity
So those procedures that are getting denied, they're getting denied because insurance is denying it and they're not going to cover it, right. That's the bottom line. And if you're cash pay, then the doctor can provide the patient what the patient wants.
00:18:07:17 - 00:18:23:19
Dr. Brian Rich
So you used to, you know, back it, you know, back in the day when your procedure was denied, right. When you would send in a prior auth your procedure was denied. It was so obvious why it was denied. You didn't do a test. You didn't. You didn't have a diagnosis code. You didn't work this up, you didn't have this.
00:18:23:21 - 00:18:28:13
Dr. Brian Rich
The procedures are getting denied in today's world with perfect notes.
00:18:28:15 - 00:18:51:07
Dr. Anthony Giuffrida
I think that even goes to the peer to peer. Interaction these days. I mean, the peer to peer interaction used to be. Oh, hey, you forgot to put, you know, the MRI attached to this. Can we go over the MRI real quick and if we think it's right, then you’ll get approved the peer to peer for me now, and I don't know if you see the same thing is they will say we just don't approve this no matter what.
00:18:51:09 - 00:19:08:23
Dr. Anthony Giuffrida
That's correct. And I'm saying, why are we doing a peer to peer? This peer to peer is supposed to be a discussion between two physicians about a patient to see if we can do this procedure and the number of times I've heard, heard the “peer”, we’ll use peer in quotes, that works for the insurance company, say they have said this to me directly.
00:19:08:23 - 00:19:13:01
Dr. Anthony Giuffrida
I agree with you. This patient needs this procedure, but we can't approve it...
00:19:13:06 - 00:19:13:11
Dr. Brian Rich
That's right.
00:19:13:11 - 00:19:25:04
Dr. Anthony Giuffrida
...because of someone above them, and to me that we've just destroyed the peer to peer system, and it's more of just like a, a front to appease check the box or they did a peer to peer. It's still denied.
00:19:25:08 - 00:19:58:14
Dr. Brian Rich
So you have to have it. You have to have a peer to peer, companies, commercial payers have to have a peer to peer because it's in their compliance regulation. Now to that point, this that doesn't mean that the peer to peer has to be one that's not tainted like you just described, which is true. I've actually done a peer to peer before, on a patient, where I knew it's probably going to get denied because I knew it happened before and I and I was on the phone, it was, orthopedic spine surgeon, and I pulled the patient on, on a conference call so you can listen to the from the peer.
00:19:58:16 - 00:20:22:24
Dr. Brian Rich
And it was enlightening, you know, and then the peer was just. Look, I understand, I agree with you. I don't want to tell this patient I don't agree with the he needs the procedure. But according to their policy, their policy denies it. That's the biggest issue in a lot of the commercial payers is because there's that the the way a lot of the policies are written is, you know, they have certain guidelines which allows them to deny these things.
00:20:23:01 - 00:20:43:18
Dr. Brian Rich
That and there's nothing you can do about that from a commercial standpoint. But if it's if it's a, if it's the first thing that's going to be reformed are the Advantage plans, that's the top of the list. That's, that's as soon as they can get out of their own way and start actually doing work, you know, which, you know, probably will not be until 25.
00:20:43:20 - 00:20:53:19
Dr. Brian Rich
The first thing that's going to be reformed is going to be the Advantage plans, especially from a prior authorization standpoint, because that's the one that's gotten the biggest drumbeat.
00:20:53:21 - 00:21:09:02
Dr. Anthony Giuffrida
The Advantage plans to me are just totally out of line. I mean, when they were developed, they had to follow Medicare guidelines and I know there was an audit done last year where 80% of claims were not following Medicare guidelines. And then nothing happened from that.
00:21:09:04 - 00:21:10:01
Dr. Brian Rich
That's right. It just went stealth.
00:21:10:01 - 00:21:14:07
Dr. Anthony Giuffrida
Denied claims, 80% of denied claims were not following Medicare guidelines.
00:21:14:09 - 00:21:16:03
Dr. Brian Rich
That's why it just went stale.
00:21:16:05 - 00:21:16:11
Dr. Anthony Giuffrida
Yeah.
00:21:16:11 - 00:21:40:03
Dr. Brian Rich
And and so, that's the problem with, with a lot of, with a lot of the Advantage plans is patients, the patients do the, they do the Advantage plans. And when they do the Advantage plans, they, they do them because they don't want to pay the 20%. But what they don't realize is, is that they're not getting all the Medicare services that they should be getting.
00:21:40:05 - 00:21:59:19
Dr. Brian Rich
Now, there has been some success, some pushback with that, with some of that stuff, with, saying you have to approve this because this is, you know, you have to approve this from a Medicare standpoint. But that's that's going to be the biggest that's probably going to be the biggest overhaul, which is probably going to cause a lot of the Advantage plans to go away.
00:21:59:21 - 00:22:13:07
Neil Dougherty
Is there a way that physicians can shed light or. I don't even know if they can even use social media, but can they put some of these egregious denials out there for the public to see?
00:22:13:09 - 00:22:32:01
Dr. Brian Rich
So, you know, there's two things that I, you know, that I, that I was, you know, you know, and, you know, I used to I used to be a big, you know, cheerleader for certain therapies and certain companies. And I used to teach a lot of different, certain companies and things like that. I still and I still believe in those products.
00:22:32:01 - 00:22:53:08
Dr. Brian Rich
I still believe in everything that everybody does. But what I've learned is, and I know I'm going to roundabout way answer your question, but what I, what I've learned is, is that, you know, the biggest thing that I've learned is, is that don't get on social media and criticize any therapy, regardless of what it is, whether you disagree with it or not.
00:22:53:10 - 00:23:10:14
Dr. Brian Rich
Don't criticize a therapy that has some sense of benefit. In the si joint fusion world. There's been these battles with si joint fusions about certain different techniques and approaches and things like that. And then you had various and so various companies saying, yeah, I see, well, you shouldn't use that because they're kind of fighting for for their therapy.
00:23:10:14 - 00:23:33:13
Dr. Brian Rich
What happens is, is the payers see that and they're like, see, they're look at all these experts. Look at all these peers. Look at all these experts saying that that's not an approved therapy and that's not a good therapy. And they use a lot of those comments that they said were, you know, unsolicited to show that you shouldn't be doing these types of therapies because people saw them on social media.
00:23:33:15 - 00:23:34:15
Justin Nabity
Justifiction, yeah.
00:23:34:17 - 00:24:03:17
Dr. Brian Rich
That's number one. Number two, getting the getting online and and letting people know about how a peer to peer went or how or how something went or how or whatever and how it got denied, you would think would would light the candle right. They it really it really doesn't because of the fact that it doesn't translate down into the patient making a big deal about it to their payer.
00:24:03:19 - 00:24:27:13
Dr. Brian Rich
And until you can until the insurance companies can start to get hurt financially, then they're not they're not going to change. The only thing that they will changes is if somebody goes online and if somebody see if they show somebody saying that this therapy is not effective or that therapy is not, accept that accepted because they'll use that against the physicians and then ultimately use that against the patients.
00:24:27:15 - 00:24:34:04
Dr. Brian Rich
It's got to come down in the form of sanctions. And that's that's what's going to change it. And that's...
00:24:34:04 - 00:24:50:19
Justin Nabity
So you’re saying that if a patient goes and says, hey, I wanted to get some treatment and I couldn't, and this company blocked me, you know, for preventing me from getting better, maybe not even being that specific about the exact procedure, but it just gives puts egg on the face of the company that they have a bad reputation of. They're not.
00:24:50:19 - 00:25:06:06
Dr. Brian Rich
It's the only thing that moves the needle right now with the insurance companies, because then that particular patient can then say, look, you know, I'm not and then I'm going to switch. I'm not going to use this Advantage plan anymore. I'm going to switch away from you or I'm going to move to something else. You're not you're not helping me.
00:25:06:06 - 00:25:09:07
Dr. Brian Rich
Now, that's a small person in a small situation.
00:25:09:12 - 00:25:09:14
Justin Nabity
Sure.
00:25:09:17 - 00:25:29:18
Dr. Brian Rich
it would require a significant amount of people to start doing that for it to really start moving. But awareness to patients or patients becoming more and more and more aware of of what is really going on in the insurance world about what therapies they’re really not getting, is really what's moving the needle right now.
00:25:29:20 - 00:25:58:17
Dr. Brian Rich
So the more as, as physicians or more as what we can do as physicians is, is instruct to the patient, you know, this is why you can't do this. It's not because I don't want to do it. It's because your insurance company won't allow it. And here's the reason why I think this has been such a hard, heavy lift for a while is because I think most patients believe that if their insurance company says it's not medically necessary, then it's not medically necessary.
00:25:58:21 - 00:26:02:17
Dr. Brian Rich
Right? That's so not true.
00:26:02:19 - 00:26:20:15
Dr. Anthony Giuffrida
I think that wheels turning a little bit, though. I think, you know, 3 or 4 years ago when we first started, DocNation physicians were. And obviously we got a bad rap after the Covid. You know, there's a lot of studies that show they don't trust physicians as much, but it's starting to be where patients are realizing, hey, the insurance companies are the bad guys here.
00:26:20:16 - 00:26:21:07
Dr. Brian Rich
That's right.
00:26:21:09 - 00:26:35:04
Dr. Anthony Giuffrida
I mean, the physicians are just trying to help. Hopefully. And I think to your point, the patient is the customer of the insurance company, not the physician. The patient can move the needle way more than a physician can.
00:26:35:05 - 00:27:01:03
Dr. Brian Rich
That's right, that's right. And I mean, it's it's going to require more than one patient to move the needle, right? It's going to require tens of millions of patients to move the needle. But but what can happen in that situation or what happens in these situations is, is that the more patients are informed and the better that they're informed as to what's going on, then that then that's what that's when it's going to start really, truly happening.
00:27:01:05 - 00:27:24:24
Dr. Brian Rich
And I think you're right. You know, it's patients are really starting to understand, you know, my insurance is not that they're against me. You can look you can look at the guidelines for radiofrequency ablation. You know, I mean, I mean, just we used to be able to do multiple levels, great therapy, that sort of thing. Now they've and I tell patients all the time, it's like, you know, they you know, they're expecting me to be perfectly right.
00:27:24:24 - 00:27:29:00
Dr. Brian Rich
And you know, and nailing the area it's really challenging. And it's really difficult.
00:27:29:00 - 00:27:31:08
Dr. Anthony Giuffrida
You know, it doesn't make medical sense either.
00:27:31:11 - 00:27:32:02
Dr. Brian Rich
No.
00:27:32:04 - 00:27:46:20
Dr. Anthony Giuffrida
You know if I do, L4 or 5 and L5S1 I can't go back and do L2, 3 for six months or a year just because it's in the lumbar spine. You know, it's a totally separate joint. It's like saying, if I do a knee injection, I can't do a hip injection for six months.
00:27:46:22 - 00:27:48:15
Dr. Anthony Giuffrida
It makes no sense.
00:27:48:17 - 00:28:12:12
Dr. Brian Rich
Well, the Humana guidelines for PNS, right? You know, they they believe you should I do PNS after somebody has a total so which is yeah, I mean, it was, you know, it that neuralgia cannot occur on its own without post total. And it just goes against all it just, it just does not make any sense whatsoever.
00:28:12:14 - 00:28:34:02
Dr. Brian Rich
The more this stuff gets exposed and the more this gets brought to light and the more this comes to the surface, which is which is what, which is what, you know, I try to do, you know, and I when I talk to, you know, of course, I try to take as many, stories like this from other physicians and other things that, you know, I have enough on my own.
00:28:34:02 - 00:28:44:17
Dr. Brian Rich
But at the same time, it's like the more stories I get from more people that this is. I just I just reflect this when, you know, when we're when we're talking about it, which helps.
00:28:44:19 - 00:28:50:05
Justin Nabity
Dr. Rich, we have so many more questions that we want to ask you, but we'll have to do a part two, part three, part four.
00:28:50:07 - 00:28:55:07
Dr. Anthony Giuffrida
I’d love to get a part two after you come back from testifying in Congress for sure.
00:28:55:09 - 00:29:01:12
Dr. Brian Rich
Yeah. Yeah. I don't know what it's going to be. I mean, I got to get past the, government shutdown fiasco, but I mean.
00:29:01:14 - 00:29:03:20
Dr. Anthony Giuffrida
And then the election and then all that. Yeah. So, yeah.
00:29:03:20 - 00:29:04:16
Dr. Brian Rich
It'll be next year probably.
00:29:04:18 - 00:29:25:10
Justin Nabity
One takeaway I want to offer out there to those that are tuning in is if you have a patient that's having this issue, have that patient contact us, contact DocNation. We can help your patients communicate this issue to get your patient's voice heard, which is ultimately getting you, the physician, your voice, heard as well. So please reach out to us.
00:29:25:10 - 00:29:40:08
Justin Nabity
We'll help you communicate. Get the word out. Get this issue exposed in a way that's professional, that's respectful, but ultimately gets this issue out in the public. So that way more patients can be aware of this. And so thanks so much for your time Dr. Rich.
00:29:40:10 - 00:29:45:06
Dr. Brian Rich
All right. Well, it’s good seeing you guys. Thank you very much.
00:29:45:08 - 00:30:04:20
Justin Nabity
Bye. This has been the DocNation podcast. If you like what you heard be sure to subscribe, rate and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We'd also love to hear your thoughts and any topics you'd like us to cover in future episodes.
00:30:05:01 - 00:30:12:10
Justin Nabity
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