Subscribe
Share
Share
Embed
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 - 00:00:28:01
Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowAarong 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. Aaron, hey, great to have you on the show.
00:00:28:07 - 00:00:45:12
Justin Nabity
I'm excited to catch up with you. It's been a while since we've talked on the DocNation side, and, love to hear what's going on in your world with your business, your practice, and, your perspective on healthcare. Maybe give us some background on, you know, share with those who are listening in a little bit about you.
00:00:45:15 - 00:01:00:15
Reid Lancaster
Hey, I just like to jump in real quick here and say thank you. Aaron, you've been a, a great supporter of DocNation. You were one of our first webinar guests a couple of years ago, and you've been with us through through everything. And and we're just grateful for you and your support for DocNation.
00:01:00:17 - 00:01:21:13
Dr. Aaron Mitchell
Yep. Absolutely. And I'm happy. Happy to jump in with you and and tell you thank you to you. Because without you, we wouldn't be near as successful as we are today. And so the leadership that you guys have given the advice, the contacts that you have, given freely with, with no monetary, financial incentive back to you.
00:01:21:15 - 00:01:39:07
Dr. Aaron Mitchell
From those contacts and third parties have all allowed us to succeed, greatly beyond my wildest dreams. And so, you know, I'm very, very thankful and humbled to, to be on this podcast with you and, to tell you thank you because, I'm happy to support you guys in any way I can.
00:01:39:09 - 00:01:42:03
Justin Nabity
I absolutely appreciate that, Aaron.
00:01:42:05 - 00:02:14:06
Dr. Aaron Mitchell
Yeah. Yeah, absolutely. Well, what's going on right now? Well, I can tell you, I was a previously owned hospital. Family practice doctor six years ago, and, I was, I've been out of residency now for 11. So for the first, six years, 5 to 6 years of me being on a residency, I was owned by a hospital, large hospital system, and they they gave me a two and a half year notice that they did not think that, a clinic system in my area of where I live would be profitable.
00:02:14:08 - 00:02:41:17
Dr. Aaron Mitchell
And so they said, in two and a half years, we're going to enter a contract, and we don't plan to have any more clinics, in your area. So that gave me ammo to, start thinking and planning about creating Mitchell Family medicine. And, we opened it up in, June of 2019. And, since then, we have grown over 500% in the past, five and a half years.
00:02:41:19 - 00:03:03:06
Dr. Aaron Mitchell
So we're really excited about it. We keep adding, to ourselves and taking on, more providers and, and, since then we've also been able to partner with, some other people and open up a small branch of other clinics in our area and, in eastern Arkansas. And so, the laws provide a great, thanks from us.
00:03:03:06 - 00:03:22:15
Dr. Aaron Mitchell
But I have to say that and another plug here for DocNation is when, right when we were ramping up, DocNation came in, and, DocNation was able to, you know, smoothly make this transition with us and help us through all the, the legalities and the possibilities and the contacts to make it even better. So, they're good for that.
00:03:22:15 - 00:03:53:13
Dr. Aaron Mitchell
But, anyway, where we're at right now is we're getting ready to open up two additional locations, and, we're going to open up in the first quarter of 2025. And, continue to expand our services. And right now we're up to 15 providers hired, and, we have space for 20. So we're we're slowly getting to, this, this, ramp up phase and realizing, that primary care can be done and it can be done correctly.
00:03:53:17 - 00:04:13:00
Dr. Aaron Mitchell
It can be done with efficiency. It can be done with a good attitude. It can be done with monetary profit, which a lot of people don't, don't see these days. A lot of hospitals. And we see this cycle come in and they come out over the past 20 years. And it can be done with the profit these days.
00:04:13:00 - 00:04:30:24
Dr. Aaron Mitchell
And so how do you do that? And how do you arrange your clinic system so that it has a great if you if I can chick fil A feel. For each and every patient that that comes in, how do they feel loved and comforted and how does our has our customer service equivalent to awesome patient care.
00:04:31:00 - 00:04:43:00
Dr. Aaron Mitchell
And then a culture where our, employees want to stay or providers want to stay and our patients want to come over and over again. So we're we're very blessed in this regard. And, and that's, that's where we're at today.
00:04:43:02 - 00:04:57:20
Reid Lancaster
That's where I just want to jump in and say they're doing great. And DocNations are part of, almost every facet of what they're doing. They're just, in support. And one thing that we were, we were just in a marketing meeting with them. They got 96 new reviews over the last quarter, unless I'm saying that wrong.
00:04:57:20 - 00:05:15:23
Reid Lancaster
Aaron, 96, New good reviews in the last quarter. So, you know, primary care can be difficult. It can be difficult to get good reviews. And so I'm just proud of you guys and proud of the culture you're building. Aaron, what an experience. It is to be a patient. Underneath your roof.
00:05:16:00 - 00:05:30:23
Dr. Aaron Mitchell
Yeah, yeah, we're excited about it. And hopefully we can continue to give great care. And I know we will. We have great processes in place, great providers. We hire the right people. And, these people are helping us to get where we need to be.
00:05:31:00 - 00:05:53:17
Justin Nabity
So that's encouraging for those that maybe think that primary care is not an option. And or maybe one of the more difficult areas of medicine to be able to do business. But there it hasn't been the easy, right? I mean, there's been some challenging parts of the process. So they talk to you. What are you seeing in terms of what's happening in the healthcare landscape and how that's been challenging for you?
00:05:53:19 - 00:06:19:09
Justin Nabity
And, what are some of the things that you think on a grander scale? The reason why we exist is to not only empower individuals in their practice or their business, but also on a grander scale, like, what do you think? What are some things that you have noticed about the industry as a whole, that if there were some adjustments made, it would impact you and impact your peers?
00:06:19:09 - 00:06:24:04
Justin Nabity
Like what? Share with us. What about this, the difficulty that you've experienced?
00:06:24:06 - 00:06:49:00
Dr. Aaron Mitchell
Certainly. So first off, primary care, we we consider a lot in the medical community as, as, kind of the lower end, if you will, of, of medicine and, but it's the one that has to have some of the most vast knowledge in terms of clinical skills. You got to know from a wide range of ages, pediatric all the way through, geriatric population.
00:06:49:02 - 00:07:06:23
Dr. Aaron Mitchell
And, and then you have to turn around and provide that good care. But when you own a business, it changes things. It changes your perspective. And, and I have a lot of people that still come to me and students, they ask me all the time, they go off, you know, why would you want to do this all the time?
00:07:06:23 - 00:07:34:24
Dr. Aaron Mitchell
And number two is, how do you make a buck? Because it seems like reimbursements are decreasing every year. And it seems like I read a, an article almost every couple of weeks maybe. And, you know, it talks about Medicare reimbursements decreasing again. And we hear another podcast or article about how there's, you know, 20% decreases over the last ten years, 15 years and, and how we haven't had an increase in Medicare, budget in 20 plus years.
00:07:34:24 - 00:07:39:22
Dr. Aaron Mitchell
And so we we keep going. Yeah. How long it's been 24. Wow.
00:07:39:24 - 00:07:52:09
Justin Nabity
Every, every every year for 24 years, it's been nothing but reductions for doctors. But everybody else is seeing a good adjustment. Why are doctors the only ones not getting a bump?
00:07:52:11 - 00:08:11:19
Dr. Aaron Mitchell
Absolutely. And it's time for us to fight a little bit a little bit harder on this. And I appreciate DocNation’s efforts, in these things. And so, where we're at today, though, is, is, especially with Medicare. And I can tell you that right now, our clinic sits at about 53% of, all of our patients are Medicare and Medicare Advantage plans.
00:08:11:21 - 00:08:32:06
Dr. Aaron Mitchell
So of of these things, they make up a substantial part of our revenue every single year. And when I every time I hear that there's going to be a cut or we experience a cut, it is somewhat detrimental. And we have to forecast how much do we see last year and a few, if we know that we're going to be cut 3 to 4%, is that tolerable?
00:08:32:06 - 00:08:56:02
Dr. Aaron Mitchell
And what kind of services do I need to either pick up or scale back on to be able to meet budget for the for the next year? And so forecasting has has become a real deal, thing from year to year. Looking at all of these these cuts though, is it's extremely frustrating. But it also gives us an opportunity to think outside the box.
00:08:56:03 - 00:09:17:24
Dr. Aaron Mitchell
If you are in medicine and especially in primary care these days, I do not see a future for you unless you can jump on the value based care bandwagon. And, that is the number one key to getting every single dollar back out of health care that you can for your office. And, you have to you have to be a part of it.
00:09:17:24 - 00:09:40:15
Dr. Aaron Mitchell
In fact, I've talked to even, people locally here in Memphis, great leaders in the medical community here that say that Medicare is actually the way of the future for big dollars in health care. And so how do you how do you reconcile the two? You have one source telling you it's the future and you have another source telling you, hey, we're getting cut every single year.
00:09:40:17 - 00:09:57:18
Dr. Aaron Mitchell
And so so what do you do and how do you reconcile that? And how do you play the game of value based care to squeeze every dollar out of the health care system that it takes to take care of these patients? And that's where value based care comes in. So although it seems frustrating.
00:09:57:23 - 00:10:24:14
Justin Nabity
And it's not tell us what that is. From your perspective, how would you define that? Because we have patients that are tuning into an organization. Yes, we're focused on helping doctors thrive and to but at the same time, like pick a patient right here because doctors are being respected and valued like they should be. But so what is what is this type of medicine look like?
00:10:24:16 - 00:10:26:05
Justin Nabity
How does it work?
00:10:26:07 - 00:10:50:16
Dr. Aaron Mitchell
Sure. Value based care is was was probably made close to 20, 20 ish years ago and really started ramping up in the President Obama administration. And, over time has evolved. And I believe even, President Trump, when he was in office, tried to abolish parts of this value based care system, but, kind of failed within his first year of presidency.
00:10:50:16 - 00:11:09:05
Dr. Aaron Mitchell
And it's because there's a such a stronghold of the insurances on our government and so that they cannot overwhelm the government. And there's, you know, insider deals and all sorts of things. And we got to break down those barriers. Nevertheless, it's still we're still left with having this value based care. So first of all, just kind of what is it.
00:11:09:07 - 00:11:36:06
Dr. Aaron Mitchell
Number one it's getting rid of fee for service. So right now you go to a doctor, you pay $100. You pay a fee for your service in the future. That is going away. And I think in the next few years we're going to see models that completely eliminate fee for service or bring it down to a at least a level where it's, unachievable to make it in medicine without doing a value based care contract.
00:11:36:08 - 00:12:02:07
Dr. Aaron Mitchell
So what they'll do is they'll take all of these people who are, looking at a fee for service, and they'll say, well, we're going to take your group of people. We're just going to take your Medicare patients, for instance, and we're going to see if you can make them more healthy, because the data shows and, you know, all this is data driven, that the data shows that a healthier Medicare patient is going to save money for the health care system.
00:12:02:09 - 00:12:30:10
Dr. Aaron Mitchell
And, so that is where value is supposed to it. So the burden is shifted. The burden is, shifting now to the provider, to the provider to give value to the patient. And the Medicare system. So there's many reasons why this has to happen. Number one is cost, the cost controls that are there, as we know, the cost of everything is up and up big time.
00:12:30:12 - 00:13:00:04
Dr. Aaron Mitchell
Provider salaries are up, nurse salaries are up, hospital salaries are up, the cost of supplies are up. And it's going crazy. There is no seamlessly, ending budget for Medicare or even these commercial plans that are out there. And so they have to try to control their costs. And this is one way to do it. So instead of sort of focusing on the fee, they instead focus on long term outcomes that provide value for the patient, therefore increasing their health.
00:13:00:06 - 00:13:24:24
Dr. Aaron Mitchell
And by increasing the health, they decrease the need for these health care costs. So that number one is is really just cost. Number two is quality making sure that that our patients are having quality care every single step of the way, reducing rate, reducing admissions into the hospital is just one of those things, reducing e.R visits, getting them out of their chronic disease management.
00:13:24:24 - 00:13:46:00
Dr. Aaron Mitchell
Can we keep their diabetes at a certain level, can keep their blood pressure at a certain level, and, if we can incentivize a doctor to keep good quality of the patient, we know that the health care costs are going to be reduced because we have data that says so. So, you know, if you can make it, you do good, you get money.
00:13:46:00 - 00:14:04:08
Dr. Aaron Mitchell
If you can't make it, you're not going to get any money. So we're not going to create value. But there's a lot of problems with it. Value based care is tough, tough, tough, tough. There's a lot of problems. One of them is just technology. Many, many offices out there. They're not as good as maybe my office.
00:14:04:08 - 00:14:25:12
Dr. Aaron Mitchell
We use a certain EMR system. That's fantastic. It's super technological. They can do a lot of things for us, and it can give those codes out there that help us and assist us with our value based care. But there may be a lot of offices that don't really have that, that capability. And so if you don't have the technology to keep up with it, you're already way behind and you're never going to meet your value based care models.
00:14:25:14 - 00:14:41:16
Dr. Anthony Giuffrida
And I think that's a great point. You're bringing up. And something we do in our office too, is you have to invest. I think a lot of people try to save money. They see the Medicare cuts. They try to save money in their office by cutting overhead. Cutting a lot of these more expensive EMRs that can do more for you.
00:14:41:16 - 00:15:05:16
Dr. Anthony Giuffrida
But I see it as the opposite is you have to invest some money in your practice. And then in the end that will pay dividends. It will pay 2 or 3 x. Then if you're just trying to cut MAs and, you know, see less, have less overhead and see more patients, you have to actually, in my mind have the infrastructure in place with the good EMR, EMR, a good billing specialist, all those kind of things and good people.
00:15:05:16 - 00:15:14:11
Dr. Anthony Giuffrida
So the patients have a good experience, and that investment pays off in dividends in the long run. But a lot of people see it the other way in medicine. I don't know why.
00:15:14:13 - 00:15:33:07
Dr. Aaron Mitchell
Yeah, it's it's definitely frustrating, for some of these especially smaller offices to handle, you know, onesie and twosie, docs or nurse practitioners that are really just trying their hardest to serve their people, they're going to see that their their income will decline year after year after year after year until they're squeezed out of the system or they're forced by.
00:15:33:09 - 00:15:54:21
Dr. Aaron Mitchell
And so, that that's where they're at. But speaking of, you know, just associated costs, that is a barrier to so, the, the cost in general of these EMRs, is just one thing. But in our office, how we, how we, do our cost is we, we actually hire the person to do the work for us and help us and assist us.
00:15:54:21 - 00:16:21:05
Dr. Aaron Mitchell
And so we have someone on our dollar, our cost that we have hired, and we pay them a handsome salary. They usually have a lot of clinical knowledge. They have excellent, you know, computer skills and email skills and, you know, they're able to, you know, look at spreadsheets and make good analytical decisions about where each patient is for each payer at all times in the system.
00:16:21:07 - 00:16:41:02
Dr. Aaron Mitchell
Because it's there's not just one system that handles these things. Medicare is just one. Then you have every Medicare Advantage plan. They're going to have their own system that you've got to work with. They're going to take every commercial patient and Blue Cross, Cigna, United, doesn't matter all of them are going to give you a list of X amount of patients.
00:16:41:02 - 00:17:03:17
Dr. Aaron Mitchell
And they say here you go. You need to control these measures to get all your money. And if you don't you're going to have downside risk and you're going to lose money for your patients. And so, as we go through these, the system of value based care, there is a great, great cost associated with it. To alleviate some of that, we hire it, we hired it, and we train them.
00:17:03:17 - 00:17:25:15
Dr. Aaron Mitchell
Well, in fact, the office of this person is so important in my clinic that the office is right next to mine. And we are in there probably every day. Where we at. Look, as of right now, we are the second the end of the second week of November. Most of these value based care measures and things that we have to meet must be met by December 31st.
00:17:25:17 - 00:17:53:21
Dr. Aaron Mitchell
So it's go time at our office. We are every day like in in the spreadsheets where every day how can we get an inch closer a lot of these things? Well, a lot of these metrics and care gaps and everything, they expect you to meet certain quality criteria. And if you don't meet it, you don't get incentive pay, you don't get bonuses, you don't get money, which then replaces the loss of lack of reimbursement.
00:17:53:23 - 00:18:10:24
Dr. Aaron Mitchell
So we had this lack of reimbursement. We we anticipate through just Medicare alone, not not any other insurance, but just Medicare alone. For instance, our clinic is probably going to lose, based on the new contract next year, somewhere in the neighborhood of, you know, $250,000. Well, at the at the end.
00:18:11:01 - 00:18:12:00
Dr. Anthony Giuffrida
Wait, wait, I gotta stop you there.
00:18:12:02 - 00:18:13:05
Dr. Anthony Giuffrida
How many businesses can.
00:18:13:05 - 00:18:16:05
Dr. Anthony Giuffrida
Just stomach a $250,000 loss.
00:18:16:07 - 00:18:17:08
Dr. Anthony Giuffrida
For doing business?
00:18:17:08 - 00:18:18:07
Dr. Anthony Giuffrida
I mean, it's crazy.
00:18:18:07 - 00:18:20:09
Dr. Anthony Giuffrida
Just that we're so.
00:18:20:11 - 00:18:22:20
Dr. Anthony Giuffrida
Numb to that at this point. And that's every year.
00:18:22:22 - 00:18:24:15
Dr. Anthony Giuffrida
It's year over year.
00:18:24:17 - 00:18:45:04
Justin Nabity
How many businesses don't have the ability to just adjust their pricing as they need to to stay alive. Someone else gets to call the shots for them every single year. And oh, it's a reduction every single year. There's no other industry that I've ever seen before that has to deal with that kind of a a challenge.
00:18:45:06 - 00:18:58:00
Reid Lancaster
Right? So, so so they're not going to get the 250. So there are 250 down. But they have more employees. They've been doing more. They've been doing better. No other business does more.
00:18:58:01 - 00:18:58:24
Justin Nabity
More payroll.
00:18:59:01 - 00:19:09:00
Reid Lancaster
Yeah. More payroll. Yeah. If any business outside of medicine something significant would have to happen for them to lose that amount of money that they were expecting or the year before.
00:19:09:00 - 00:19:26:15
Reid Lancaster
Right. So some of their top salespeople left, you know, something had to have happened. Nope. This is just the overlords saying, yeah, we're we're going to change the goalpost and you have to do this, this and this and, and make things up as they go to make sure their budgets are okay.
00:19:26:17 - 00:19:28:07
Dr. Anthony Giuffrida
I mean, if the price of the Whopper went down.
00:19:28:07 - 00:19:29:10
Dr. Anthony Giuffrida
2% every year, Burger.
00:19:29:10 - 00:19:30:15
Dr. Anthony Giuffrida
King would be bankrupt.
00:19:30:17 - 00:19:32:11
Reid Lancaster
Exactly. And and Anthony, I think it's
00:19:32:11 - 00:19:53:05
Dr. Anthony Giuffrida
The price of lettuce and buns and burgers keep going up and up and up. But that's not, you know, it just. And you know, Doctor Mitchell, you're making a great statement on how to fight against that. But the fact that we're so numb to it and you guys do a great job at that, at keeping your business running, if not even doing better in the system that it's in.
00:19:53:07 - 00:19:59:23
Dr. Anthony Giuffrida
I just I'm so over just laying down all these Medicare cuts. It's just it's out of control.
00:20:00:00 - 00:20:02:19
Dr. Anthony Giuffrida
It's I don't know how any business would run any other business.
00:20:02:19 - 00:20:06:07
Dr. Anthony Giuffrida
In the world that got a 2% cut every year would be bankrupt.
00:20:06:09 - 00:20:25:06
Dr. Aaron Mitchell
Right. So I think we're going to be seeing even more so if, if providers don't jump on the value based care bandwagon, pretty soon we're going to see providers, cutting their the amount of Medicare patients. And that's the fastest growing, insurer right now. So we will see cut after cut after cut of doctors.
00:20:25:08 - 00:20:45:09
Dr. Aaron Mitchell
And next thing you know, the health care system is strained because we don't have providers willing to to take care of these people. And so it's just a cycle that's that's not going to end. So the best thing to do in my mind would be that Congress get together and start making this a, mandatory pay raise with, you know, that equals inflation, at the very minimal.
00:20:45:13 - 00:20:45:22
Reid Lancaster
That's right.
00:20:46:02 - 00:20:49:00
Dr. Aaron Mitchell
At least it would be. That would be the best thing.
00:20:49:03 - 00:21:08:10
Reid Lancaster
And, well, think about the general population. The general population over the last four years got their own income cut by a significant amount due to inflation. And look at the results. I'm not I'm not getting political. But look at the results. What happens when you stick your where did he go...Anthony's bounced? When you stick your hand in everybody in the United States pocket.
00:21:08:15 - 00:21:22:24
Reid Lancaster
That was the number one issue. And it was an overwhelming vote to say, no, we can't afford groceries. We literally can't let this happen anymore. Where is that in medicine? How do we get together and say, no more of this?
00:21:23:01 - 00:21:24:21
Dr. Aaron Mitchell
It doesn't exist.
00:21:24:23 - 00:21:53:17
Justin Nabity
Well, to your point, Aaron, if the if the largest population is going to be on Medicare and needing Medicare services and they can't get it, think about the vision it takes to look out into the future if we make these decisions today, where will that put us in 20, 30, 40, 50 years from now? We have this aging population that's going to be in this group of of needing help with health care, and they're not going to get it.
00:21:53:19 - 00:22:14:23
Justin Nabity
So is that going to be enough of a population to do what Reid’s talking about, which is we've all felt our savings dwindle, our credit card balances go up. All this and that. Is this cohort going to be significant enough to say, we can't keep doing what we're doing because we're trying to take care of our nation?
00:22:15:00 - 00:22:15:10
Dr. Aaron Mitchell
That's right.
00:22:15:10 - 00:22:21:11
Justin Nabity
And the nation is not able to be taken care of because they can't even get in to see a doctor because doctors won’t even see them anymore.
00:22:21:13 - 00:22:41:00
Reid Lancaster
And so and so Aaron already answered the question. He said two things. He said, number one, the government is beholden to the insurance companies. And then he said something about 15 minutes later and he said, well, Congress has got to get together and we got to make decisions in Congress. Well, who's making those decisions for Congress? Big.
00:22:41:00 - 00:22:47:17
Reid Lancaster
The big money insurance companies. So I hate to be doom and gloom, but that's where we're at right now.
00:22:47:19 - 00:23:02:22
Justin Nabity
Well, the good news is to Aaron's experience, in his own words, it's still possible to overcome in the midst of all this, the hope and the courage and the tenacity. I mean, not everyone is like you. I get that, it's.
00:23:02:24 - 00:23:25:16
Dr. Aaron Mitchell
Medicare taking a risk here, by the way, too. They're taking a risk that their data is going to work. All right. And you know that all their data that they've gathered for years, they say we're going to save X amount of dollars if we do value based care, patient outcomes will be better and Medicare will save money.
00:23:25:18 - 00:23:53:18
Dr. Aaron Mitchell
But is that really happening? Maybe a little too early, a little too early to know if it really will? We think it is. But there's nothing out there right now that says, yes, we are saving year after year Medicare X amount of dollars. And so offices are getting held to this standard to provide this care, provide the quality care to sign these contracts no matter what or you're not going to make it.
00:23:53:20 - 00:24:13:01
Dr. Aaron Mitchell
And and so yeah, we, we fit within that model. And, and it is frustrating from day to day. And we try not to let it over ever take our need and our love to still take care of the patient. But it's still something we think about every day. So, we'll see how it goes over the next few years, as if it's sustainable or not.
00:24:13:01 - 00:24:34:09
Dr. Aaron Mitchell
But, we we think we found, every, every dollar. We fight, we fight for every single dollar. And sometimes I don't think it has to be that way. I wish it wasn't that way. But we do. We fight. We fight every day, and we're looking for every care gap. Because you never know. You might miss the care gap by by one denominator.
00:24:34:11 - 00:25:04:22
Dr. Aaron Mitchell
And all of a sudden you're out. Incentive pay of thousands of dollars. And there's there's no turning back because these insurance companies don't care. They want to they want to see that you can perform. Period. And, and that's where we’re at. So we get we even talk more deeply about this that it's now being attached to, not only outcomes of, the patient and it's now being attached to the question of is my doctor is is my provider even good?
00:25:04:24 - 00:25:05:24
Justin Nabity
Really.
00:25:06:01 - 00:25:27:13
Dr. Aaron Mitchell
Yeah. And this is public knowledge, guys. A lot of these, these there are there's something called star ratings if you're not familiar, but if you go to a insurance website, you can look up a doctor and you can see what their star rating is, all right? Their star rating is not whether or not they got a five star review on Google.
00:25:27:15 - 00:25:52:17
Dr. Aaron Mitchell
Yeah, now we love five star reviews. But if you go on a website, you know, let's just choose United. You can look at a provider and see what star level they are. If they're a 1 to 2 star, you know that they're not really pushing hard to meet all the incentives of the value based care contracts. But if they're a 3 or 4 star, you know that they are doing everything they can in their office to, to meet these metrics.
00:25:52:17 - 00:26:00:24
Dr. Aaron Mitchell
And so people can look at the star rating of a doctor and they can know suddenly is that doctor good or not? And it's based all.
00:26:00:24 - 00:26:05:08
Justin Nabity
Are they really good? Are they really good though? Are they really good, or are they good in the insurance companies’ eyes?
00:26:05:10 - 00:26:06:02
Dr. Aaron Mitchell
Tht’s
00:26:06:02 - 00:26:08:21
Reid Lancaster
Good at what? See, but here's my
00:26:08:21 - 00:26:09:14
Justin Nabity
Compliance?
00:26:09:16 - 00:26:34:07
Reid Lancaster
issue. We've been talking to to to Doctor Aaron Mitchell for 30 minutes and 26 minutes of it has been about business like the business operations. And I get it. You spend a lot of time doing that. But you say you have to fight for every single dollar. You're spending more time fighting for dollars, hitting metrics like who, who, who decides if you get a 2 or 3 star or 4 star rating?
00:26:34:09 - 00:26:56:17
Dr. Aaron Mitchell
Absolutely the insurance company. It's not up to a patient. So I may have five stars all day on Google, which is wonderful, I love it, I'm a really nice doctor. He's caring. That's wonderful. You go to the insurance website and say, I missed a couple of care gaps in there. And you know, somebody didn't ever go for the colonoscopy or mammogram because they forgot, I'm on the hook for that.
00:26:56:19 - 00:27:20:24
Dr. Aaron Mitchell
And it shows that I've got a 1.8 out of five, and all of a sudden I am a nobody. That insurance points their finger at you and says, you're not any good. Why would we give you our our premium money? People are paying our premiums, why would we pay you the reimbursements we're going to pay you when you're. Yeah, a 1.8 star versus a 5 star that we could get somewhere else.
00:27:21:01 - 00:27:37:19
Dr. Aaron Mitchell
And so the insurance companies are now starting to direct who is good and who is bad in medicine. And it's been going on definitely the last three years. And so we we follow that pretty closely. We work really hard to improve our, our star ratings, both in the insurance eyes and in the patient eyes. And patients are none the wiser.
00:27:37:19 - 00:27:52:24
Dr. Aaron Mitchell
They have no idea how hard it is in medicine to really look good in insurance eyes and get the reimbursements that we all work hard to receive. It's it's extremely taxing on every practice to go after every single dollar.
00:27:53:01 - 00:28:12:16
Justin Nabity
I'm seeing a video, would that be like I picture Star Wars and the overlords and the insurance companies? And the star rating is like exposing just the dynamic of, yeah, how they're trying to manipulate and control everything. And
00:28:12:16 - 00:28:14:15
Dr. Aaron Mitchell
I'll take you even further.
00:28:14:17 - 00:28:35:20
Dr. Aaron Mitchell
Star ratings are now going to be attached and they are attached. And you're starting to see this to physician employment contracts. You see it all the time. And not only do people physicians get paid by salary and by work related value units, wRVUs, which you are very familiar with. But now we're starting to see performance based and quality based contracts for providers.
00:28:35:22 - 00:28:55:19
Dr. Aaron Mitchell
If you hit these metrics individually, you know, to provide the colonoscopies, the mammograms, the blood pressure, the biopsies and everything, then you're a good provider and we're going to pay you more. And if you don't hit these metrics, which you are responsible for, you're the provider, which you're responsible, then, by golly, I'm sorry, Mr. Provider, you're just not very good.
00:28:55:19 - 00:29:07:20
Dr. Aaron Mitchell
And we're not going to pay you what we think you deserve. And so, you know, the the performance of the provider is being directly attached to their pay. And, you know, that's not what they signed up for in med school.
00:29:07:22 - 00:29:09:00
Justin Nabity
No, no!
00:29:09:06 - 00:29:29:02
Dr. Aaron Mitchell
So it's, it's tough for everybody. It's tough. So you got you got to work on it. You got to be super diligent about it. You got to coach your people. Very taxing. On the administrative overhead and burden to provide quality care. But to train your providers to also train the patient, how to be a good patient.
00:29:29:08 - 00:29:49:06
Dr. Aaron Mitchell
This is this is hard. It's hard when you got to go tell the patient. Look, I love you, sir. Ma'am, these are the certain things that, we need you to do. And your insurance requires you to do. And if you don't do them, I'm going to look bad. Yeah. And so, don't forget. So it's frustrating.
00:29:49:09 - 00:29:50:14
Justin Nabity
Where. Thanks.
00:29:50:16 - 00:30:07:01
Dr. Aaron Mitchell
But we're we're happy to at least, at least go down the journey with all of them and let them know we still love them, give them compassionate care. In the meanwhile, in the background where we're, we're cut throat, we're going after every dollar we can. We we put on a great you know, it's not really a front.
00:30:07:02 - 00:30:15:19
Dr. Aaron Mitchell
It's it's real. We love our patients. But behind the scenes, we are we're killing it in terms of let's get these these metrics matter.
00:30:15:21 - 00:30:31:09
Reid Lancaster
We have a lot of residents and fellows listen to this. And so Aaron, we're just grateful that you are here. And there's a number of people who have asked me some business questions. And so we answer them. But I think it'd be kind of fun to to shoot them your way. So, Aaron, if you're okay with us once in a while.
00:30:31:11 - 00:30:39:07
Reid Lancaster
Yeah. Letting someone pick your brain, it might be different coming from a physician. So thanks so much, man. You have so much knowledge and I appreciate you sharing it with us.
00:30:39:09 - 00:30:40:23
Dr. Aaron Mitchell
Happy to do it. God bless you.
00:30:40:23 - 00:30:43:08
Justin Nabity
Thanks Aaron.
00:30:43:10 - 00:30:44:23
Justin Nabity
Allright, talk with you later.
00:30:45:00 - 00:31:01:20
Justin Nabity
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.
00:31:02:01 - 00:31:09:10
Justin Nabity
Don't forget to follow us on Facebook, Instagram, and LinkedIn for updates, behind the scenes content, and join the conversation. Thanks for listening.