Well, the system's broken, and I think that people all across the country recognize that.
Certainly, I don't accept the idea that in the richest country on Earth,
we should have 47 million people without health insurance
and millions more people who are being bankrupt because of a medical bill.
We're in the money, we're in the money, we've got a lot of what it takes to get along.
We're in the money, the sky is sunny, oh man, depression, you are through, you've done us wrong.
We never see headline about red line today, and when we see the landlord, we can look at God right in the eye.
Rachel, my stepmother, is a nutritional consultant by avocation,
and by vocation, she's my billing manager.
She comes down and does almost all of my billing for me.
Rachel's been helping me with billing for about five years.
Over the years, I've attended a lot of practice management seminars,
Parker, Markson, all these different seminars to teach us how to work in office,
because they don't teach you in school how to run an office.
Chiropractors mostly treat musculoskeletal and neurological problems,
mostly dealing with the spine, but sometimes dealing with the arms, legs, hands, and feet.
Chiropractic has always been considered alternative medicine, but it's becoming much better accepted.
The evidence is growing about the efficacy and the patient satisfaction that chiropractic brings.
Some 60% of the people polled who have tried chiropractic are satisfied.
That's higher than their rating of medical doctors.
I am a physiatrist, and my practice is focusing on pain management.
I help patients in pain anywhere in the body, usually the neck or the low back.
We also help patients with shoulder, elbow, knee, or hip pain, any joint we can address
through pain management or approaches non-operative as opposed to an orthopedic surgeon who does surgery to fix the problem.
My practice focuses on trying to help people non-operatively to improve their pain and to improve their function.
I have been practicing for 11 years now. I have had my own private practice for 8 years.
My practice consists of, obviously, myself. I have an office manager, a front desk secretarial physician,
and I have an administrator, both the front desk and the administrative help is part-time.
The front desk individual strictly answers phones and schedules appointments,
and the administrator, part-time administrator helps with pre-certification for procedures
along with other administrative responsibilities that help the practice flow.
My office manager helps me to see patients and functions as a medical assistant,
but also has responsibility of running the office with me, so she is my only other full-time employee.
I accept most insurances. Certain insurances are prohibitory.
I cannot accept Medicaid just because of the fact that it is not efficacious for me to see a Medicaid patient
with the amount of time that is typically required as they tend to be more complicated patients.
That is why they qualify for Medicaid in the situation of pain management.
Yet, the reimbursement is really not feasible so that you end up not being able to support yourself
if you are going to see these complicated patients with the rates that they are willing to reimburse you.
It literally pennies on the dollar.
Also, in answer to your question as to whether it is getting worse,
there is a looming fear by doctors out there that Medicare is going to be cutting our reimbursement
by up to 30 or more percent, in which case it may be prohibitive to see Medicare patients as well
as no doctor can substantiate or to tolerate a 30% pay cut and still maintain their overhead.
In our practice, what we are finding is that we are spending increasing time dealing with the insurance companies
trying to get pre-certification for procedures.
Our big interaction with insurance companies are trying to get the procedures that we do in the office approved
every time we want to do a procedure. Typically, there needs to be pre-certification from the insurance companies
approving the procedure that we would like to do.
Unfortunately, when we call the insurance companies, they are extremely inefficient.
They have computer programs that you can access online to try and cut the time to get these procedures pre-certed.
Most of the time, they are not working.
You enter a patient's identification numbers into the computer and the program state that the patient cannot be found,
forcing you to call the insurance companies and to spend the time on the phone working through the telephone networking
answering system to get to somebody which takes 15 to 20 minutes in and of itself.
Then you first talk to somebody and they ask you routine questions that take another 15, 20, 30 minutes.
These people on the phone that you are talking to are not qualified.
They are not experienced and all they have to work with are protocols.
So they can't vary very much or they can't stray very much from these protocols.
Based upon their decision, the qualifications of these individuals on the phone are not clear to me.
Based upon their decision, we cannot or cannot do a procedure.
If they deny a procedure, then it goes to the nursing practitioner or the physician for review.
If the physician or the nurse practitioner denies the procedure, they give us the opportunity to appeal the decision.
This takes more time and sometimes they want to speak with us and more often than not on the denials,
they say the physician will do a peer-to-peer review in which case you have to spend time on the phone with them.
And we unfortunately just don't have time to do that for every single situation where a procedure is denied.
It's just not feasible.
In recent years, the insurance companies have usurped a lot of the doctor's prerogatives.
Essentially, the insurance company now dictates care, dictates how many days you'll be in rehab following a surgery,
how many days you'll be in the hospital.
When I want to write a prescription for an MRI, I have to spend time on the phone calling the insurance company,
maybe making several phone calls in the attempt to get this study pre-certified before they will agree to pay for it.
And I have to send them information, facts, they say it's to prevent fraud, but I really think it's to prevent losing money.
Compared with the simple act of writing a prescription that takes perhaps a minute,
these 15, 20, 30 minute phone calls that I have to make, often placed on hold and going from one option to another,
is very time consuming and it really cuts down on the amount of time that I can spend face to face with the patient.
After 1996, I continue to work on health care issues and I've worked in more than 150 legal cases on behalf of patients
and assisted patients in appeals, so I have a wealth of acquired information about the inner workings of the health insurance company.
The one thing that I think in summary my experience, which I've detailed in my written comments,
is that this has never been a more deadly time for patients in terms of insurance practices.
They've become more sophisticated and more expert in achieving the cost cutting and saving goals.
On the rare occasion when I just have no choice where I have to get on the phone and speak to the administrator,
the physician or the nursing practitioner who's overseeing the decision,
then that takes me another 20 to 30 minutes to talk to them.
So obviously I can't do that every day of my working schedule because you have patients to see
and you just don't have time to dedicate to arguing with the insurance companies as to why you need to do this procedure.
It's just not practical.
The insurance companies are trying to cut costs when it comes to procedures and they have patients,
individuals trained on the phone to deny the procedure.
They have certain protocols that they have to follow.
Those protocols are designed to deny procedures and it's absolutely an issue of finances as opposed to the patient's best interest at hand.
That is clearly the motivation of the insurance companies.
Certainly I spend more time trying to collect the money from the insurance companies than I do seeing the patient.
So every year there are new twists and turns, new hoops to jump through.
Every time they think of something it becomes part of the system and gradually all the other insurance companies take up the same thing.
So it gets worse and worse and worse.
It's a constant, just like antibiotics with a bacterium, the bacteria is always mutating to survive the antibiotic.
So the insurance company is always mutating to try to make it more difficult for the doctors to get money from them.
So what ends up happening is what the insurance company, what I believe is what they want you to do is just to drop the case and not do the procedure.
Because they realize that nobody, you don't have the time to argue with them and the patient's not going to really take this up with them.
So they realize what they're doing is trying to make it hard for you so that these procedures are not approved so that they won't be done.
The truth is that for millions of Americans there are layers of corporate bureaucrats standing between them and their doctors, often on matters of life and death.
And those bureaucrats work for the private health insurance industry.
To please Wall Street, private health insurers have to deny medical claims, raise premiums, or both.
Even as the rate of inflation of medical prices has increased, the share of premium dollars spent on medical care has come down to around 83 percent from over 90 percent in the early 1990s.
The state regulatory record and civil litigation dockets are replete with recent findings of wrongful denial and delay of health care by private insurance bureaucrats.
For instance, in 2008, Pacific care, a subsidiary of UnitedHealthcare, paid a $3.5 million fine, $25 million in waived premiums and reimbursement of medical expenses, and restoration of health care to nearly 1,000 patients to resolve violations of California law, including wrongful denial
of 130,000 claims, incorrect payment of claims, failure to acknowledge receipt of claims in a timely manner, and for imposing the hassle of multiple requests for documentation already provided.
We will hear today how the private health insurance bureaucrats have become more sophisticated at denying expensive treatment and more effective at wearing down doctors and patients, conditioning them to choose to pay for the treatment themselves or to go without.
First, I want to ask Mr. Potter about the business profit model of the private insurance industry. What is the business model of the insurance companies? How do they make money?
They make money by avoiding as much risk as possible and often by dumping people who are sick, and they do this through a variety of means. One is delaying or denying care. Another is to rescind policies that we have read about in the news, and it has been the subject of some committee hearings in which people who have been paying their premiums for many years, when they get sick and have high medical bills, the insurance
company will review their original applications and if they find any reason to cancel it, they will, and also purging small businesses.
They are purging small businesses. They deliberately look to see if there are small businesses and mid-sized businesses that are customers whose medical claims are higher than the underwriters expected, and they will jack those rates up.
The premium rates when those customers' accounts come up for renewal, and they will jack them up so high that these businesses have no alternative but to drop their insurance coverage. That is why we have had such a drop in the number of small businesses over the years.
It has declined from 67% in the 90s to just about 38% now.
Well, the regulations that affect physicians practicing today are increasing on a regular basis. When I first started practicing 11 years ago, there weren't nearly as much regulations.
Private individuals may think that physicians are in control of treating patients, but in our reality, the insurance companies set protocols that we have to meet and are regulating how we manage patients.
Their job is again to try and find procedures that they can deny due to whatever reason. So it is very difficult to get your money from the insurance companies for procedures and examinations that you've performed.
It seems to be getting worse. I noticed that my AR is increasing, that's my accounts receivable, and I've been with the same billing company for many years now. So it does seem to be that the insurance companies are holding on to the funds for reimbursement longer than they had in the past.
The truth is that government-run health care has lower prices and much lower administrative costs than private insurance. Government-run insurance negotiates harder bargains with pharmaceutical companies to get lower prices.
It has no multi-million dollar executives, no corporate jets, no dividends to pay, no lobbying expenses, no campaign contributions, no front groups to pay for, and no television advertising.
Private insurers pay for all of these expensive things out of the premium dollars they collect, and these things have nothing to do to improve health care outcomes.
Medicare gives us a reprieve when it comes to pre-certification. You can do a procedure with Medicare without having to get pre-certification.
So if you're looking to do a procedure on a patient to help them with their pain, if you're looking to order an X-ray or an MRI or some diagnostic study, you don't have to get pre-certification for these procedures where you would have to with a private insurance company.
And that does save us a lot of time, energy, and grief.
A state rep from Merrimack, she has the answer. Here's what to do. If you get cancer, just have a bake sale to pay for treatment. Your neighbors will rally 100%.
Let's have a bake sale, bake sale, sell cookies and treats, bake sale, bake sale, life will be so sweet, bake sale, bake sale, the American way, bake sale, bake sale, everything is gonna be okay.
Let's have a yard sale, sell all our stuff, we're having some hard times and it's getting tough to raise enough money to pay all our bills.
Gotta choose between eating or buying these pills.
We had talked in the past about the increased regulation of the insurance companies. I think one of the things that I find very frustrating is the fact that as physicians we have nowhere to voice our concerns, no way to argue or make a significant change in the system.
You can go to the state but the state is not really open to what you have to say as a physician. You can go to the Department of Insurance and Banking and nothing really ever comes of those discussions or those complaints.
So the insurance companies basically set their own standards and it's really not fair to the patient or the physician but we have no way of voicing our concerns or objecting.
And I think that's what I find most frustrating is that I think we as physicians need to organize a little bit more and to voice ourselves to make a difference and that is one of the things that I am looking to try and do.
That's why when you came to me about this documentary I thought it would be a great opportunity to mention this and to voice my issues with the insurance companies so that perhaps in some way as physicians we can organize and take our concerns to the state to make a difference.
Otherwise the way we practice medicine may be drastically changed and our autonomy is in great question in the future. We have to organize and make a difference and I think that would be a key to changing the situation.
A member of the protest group Dr. Kenneth Weinberg spoke to reporters.
I'm an ER physician and every day that I go to work I see the outrage the horrors of what happens to people because they don't have health care. They can't get their prescriptions filled. They can't get follow up. They can't get procedures done. And I've been seeing it for so many years and it's just sickens me.
So we have this fragmented system where the wrong hospitals shut down. They were a great service community hospital and the problem as you were saying is it's now profit, profit, profit.
Companies have to make this quarter on quarter profit to meet Wall Street expectations. If we had a single payer universal health care Medicare for all as it were then what would be happening is everybody would be paying in.
And you'd have a universal insurance pool and all American insurance pool that would be covering everybody. It's been analyzed by the GAO, by the CBO, by the Commonwealth Fund and everybody agrees.
It's economically it makes the most sense. Policy wise it makes the most sense. The only problem has been the power of the corporations.
And that obviously raises the question that was so prominent in 2009 and early 2010, which is do the drug companies and the insurance companies that the health care cartel.
Do they have too firm a grip on this part of an economy, which is their they see their lifeblood for us ever to shake that grip loose.
Well, never say never. We're still fighting the good fight. In fact, we polls have shown mainstream regular polls, Washington Post, CNN, New York Times show 60, 65% of the American people would support single payer Medicare for all.
Recent study academic peer review professional study. Publish showed 59% of American physicians would support it.
We're as tired of the for profit health care insurance companies, the fragmentation, the paperwork, the duplication, people go on insurance, people go off insurance, the churn.
What is it today? I've got 50 different forms. It makes no sense. And no other country in the United States in the world does this except for the United States.
I think it's increasingly difficult, more difficult to run a medical practice and surgical practice today.
The costs of running practices are increasing on a daily basis. And the reimbursement is not increasing.
The reimbursement is not increasing with the rate of inflation or the cost that we are exposed to. It's increasingly more difficult for certain surgeons to practice due to their malpractice rates.
The cost of having malpractice insurance for certain surgeons is astronomical and cost prohibitive.
We cannot afford to run a practice when your malpractice insurance is through the roof and still expect to be profitable.
So I have heard many situations where OBGYNs and other high risk surgical physicians are unable to practice any longer due to the cost of malpractice insurance.
There are other physicians that are not surgeons, that are primary care doctors, that the reimbursement for them is so low that they're forced to essentially run assembly lines and see many, many patients within a day to be able to maintain their costs, to pay for their costs rather.
So it loses its personal touch and it's no longer practicing medicine but it's more running a factory.
So I think a lot of physicians there in primary care are dissuaded from continuing practicing because they just have to see so many patients in a given period of time to make a profit to stay afloat.
So that's very discouraging and I think a lot of physicians don't want to go into medicine thinking that they're going to be placed in that situation.
And so I do see a lot of physicians that are leaving the practice because they can just no longer afford to continue practicing and making a profit to stay in business.
You see that today with physicians that are running boutique practices where they are not accepting insurance any longer and they take a fee, an annual fee for the patient.
And those patients have access to the physician all hours of the day and it's run like a one-on-one private physician's office and the patients have full access to the physician
and the physician is able to spend a little bit more time with the patients because they have additional funding from the patient and they're not dependent upon insurance companies.
And now an exclusive sneak peek of all new episodes of USA's original hit series Royal Pains.
I appreciate your faith in me Frank.
It's Hank.
You were awesome. You got them to sign a retainer.
That's my job. You are running a business here, right?
Yes, exactly.
You may be one of those doctors who's working a frantic pace. You may be worried about the demands on you, your family and your practice.
In this difficult environment, service levels may be slipping and patient satisfaction can be waning.
The majority of primary physicians have to choose between changing their practice standards or just continuing to sink in a downward spiral.
Because the revenue generated in this program is significantly higher per hour than in the traditional practice, your practice income can increase by hundreds of thousands of dollars.
I would ask the executives what kind of health benefits health benefit plans are marketing now to small businesses and to businesses with a high rate of turnover among employees.
If they're honest, they will tell you they're marketing limited benefits or high deductible plans to these businesses.
I would ask Etna and Signa in particular why they are sponsoring the first annual voluntary benefits and limited medical conference in Los Angeles next month.
And I would ask them what voluntary really means.
If they're honest, they will tell you that workers enrolled in voluntary benefit plans pay the full premium as well as high out-of-pocket expenses.
Their employees do not have to pay a dime. Their employers don't have to pay a dime toward their employees' health care benefits.
Many of these plans actually prohibit employers from subsidizing the premiums.
As the organizers of the Los Angeles Conference notes on its website, voluntary benefits and limited medical plans are a multi-billion dollar industry
and one of the fastest growing segments in the health insurance industry.
Welcome to the Employer Health Care Congress.
This year, we are giving you the opportunity to exhibit in an exotic beachfront location in South Florida at one of the largest employee benefits conferences in the country.
We will be at the famous West End Diplomat Beachfront Resort and Spa, one of the only beachfront convention resorts in the country.
When you walk out of the exhibit hall, you'll be looking at the ocean and the famous South Beach in Miami is only a 10-minute ride away.
Exhibiting at the conference provides you an opportunity you just don't get at other events because of the high caliber of decision makers and business leaders we bring in.
And don't forget, we do really exciting and different things to drive traffic to booths.
In Chicago in 2011, we had this amazing Lamborghini $200,000 promotion where attendees would have a bingo card, go around to booths, get stamps from specific exhibitors.
Once they had all the stamps, they had an opportunity to try a six digit code in a safe.
If they won, they would win $200,000 or could take the Lamborghini.
The benefits bingo was actually pretty good.
You have a lot of traffic because of that because everyone wanted the stamp and they wanted to win the Lamborghini.
And I want this little India with perfect healthcare to be translated to other parts.
This is how I'm progressing. This is my vision. This is my strategy.
Dr. Reddy is also gripped by a vision of huge profits, with Apollo Inc becoming the general hospital of the global village.
For the rich of Africa and the Middle East and for healthcare refugees fleeing the high costs of North America, Australia and Britain.
Dr. Reddy believes that Apollo will become a medical mecca.
I'm Patrick Marsec, managing director of Med Retreat and on behalf of our entire company, I'd like to make a promise to you.
When we first envisioned the concept of medical tourism in 2003, we knew it would become a very popular option to US and Canadian healthcare.
And we knew people like you would need an organized way to safely travel overseas to receive their surgery.
Here in the United States, new medications are very costly and other countries are able to contain the cost of medications.
That's a political issue where the big pharmaceutical companies are making large donations to the politicians, which inhibits adequate decisions to control costs for the medications.
Other issues in the cost of, regulating the cost of medicine today is the fact that end of life care is very expensive.
Are we willing to regulate end of life care?
I've had several situations where patients with terminal diseases and short life span, life expectancies of three months continue to get very expensive chemotherapy.
They're in rehabilitative hospitals trying to get rehabilitation.
Is this feasible? Who's going to take care of the costs at the end of life for these procedures that are only going to add a month or two on to a patient's life at a very, very high cost?
Same thing can be said about patients with heart disease and other types of illnesses that are terminal.
So these are difficult decisions that we as a society have to make in order to try and contain the cost of medicine. And those are difficult decisions that individuals need to make.
We're going to hear many emotional peals today. Let me tell you a little bit about my own. I've got the best mother-in-law a man could ever ask for.
She's five years into facing stage three ovarian cancer and she's still fighting it because of a drug called Avastin that's keeping her alive.
Well, if she was a British citizen, she wouldn't have it because they deny this drug to their cancer patients.
We're setting up the identical same bureaucracies they have there here.
We're setting up the identical same bureaucracies they have there here.
We're setting up the identical same bureaucracies they have there here.
I believe that most of the diseases and health diseases that we face today are preventable and our health care costs could be reduced substantially if we try to prevent them.
Heart disease, disease related to smoking and alcohol abuse and diabetes, obesity, metabolic syndrome. All of these things are ravishing our society because we are not taking proper care of ourselves.
I try in my practice to teach my patients how to exercise. Every patient gets an exercise program. We talk about eating properly and we talk about stress management.
These are all things that are involved in a lifestyle modification.
Lifestyle modification is how you change your body's condition to prevent disease in the future.
Every disease is based on inflammation. The things that we do to our body, the way we treat our body, promote inflammation.
If we can educate patients how to take better care of their bodies, we would reduce the risk of inflammation from within and therefore reduce disease prevalence.
It would be advantageous for insurance companies to spend more money on prevention.
Common sense would say that if you can prevent a disease, you're going to contain your costs. However, that is not where the interests of the insurance companies at this time lie.
I think in western medicine the solution is typically to give a pill to treat the problem as opposed to looking at the source of the problem.
If patients were taking better care of themselves, eating better and exercising, they wouldn't need the diabetes medication.
They wouldn't need the medication for cholesterol or hypertension.
The problem therein lies is that physicians don't necessarily have the time to educate.
A physician will say to you, you need to lose weight and to exercise, but they don't have the time to teach an individual how to exercise and how to eat properly.
There's no funding there for a nutritionist or to spend time in teaching a patient how to stretch, what exercises they should be doing.
This is an unfortunate situation because as much as you can recommend it, if you don't teach the individual, give them the tools to know how to do these things, then they're not going to be able to implement these lifestyle modifications.
When my patients come to me and they are in chronic pain, I try to keep an open mind as to what would possibly help them.
Often a patient will come to me having various treatments in the past, so I try to look to what else we can offer someone to help them.
If that is considered alternative treatment, then that is what I'm going to consider.
Chiropractic is a legitimate treatment to helping individuals with pain issues, as is physical therapy and acupuncture.
These are all proven interventions. Some insurance companies cover some of the alternative treatment like acupuncture.
Most of them do cover chiropractic, but there are some other alternative treatments that are not covered.
Well, a lot of times they won't cover acupuncture, they won't cover massage, and they won't cover what we were talking about before if you wanted to have the patient work with somebody, an athletic trainer, or someone that can help them to become more flexible, to resume a better posture, to get stronger.
These things are not typically covered by insurance companies, even though it would be helpful and clearly would help to manage a patient in pain.
So many unemployed individuals with numerous talents and that are very educated, my question that I would pose is why couldn't insurance be non-profit, in which case that the insurance companies are not striving to earn a profit, they're looking to break even,
and you can hire those individuals that are not employed to run a company that is not based on profit, but it's based on providing care for the patients at a reasonable cost.
My spirit makes me know the possibilities are there.
Sharp experience means providing the best healthcare we possibly can for all of our patients.
It means love and caring. Awesome.
Passion. Right there.
Great community.
Awesome healthcare.
Sharp boss.
It's a culture. Sharp experience is a culture, every patient, every time.
Taking care of each other, taking care of patients, and making a difference in the community.
Passion, purpose, and possibility. And that's why I have been here seven years, and I was washing dishes, now I do non-invasive cardiac procedures.
We have come to a defining moment in our nation's history. Tonight, I am thinking about the woman who called into a talk video program that I appeared on last August.
She called in to take issue with a gentleman who had just called in earlier to say that he did not support our efforts to reform the healthcare system because he lacked the insurance he had.
The caller shared her experiences of having been dropped from coverage by an insurance company she thought she lacked, just as she started her second treatment for breast cancer.
She said to the gentleman that maybe he lacked the insurance he had because he had never tried to use it.
With these reforms, dropping people from coverage when they are diagnosed with catastrophic illnesses will no longer be allowed, and denying insurance to children with diabetes and other pre-existing conditions will end immediately.
These reforms will allow children to remain on their parents' insurance policies until their 26th birthday. This bill will immediately begin closing the doughnut hole for prescription medications for seniors, and eliminating burdensome copays or deductibles for their preventive care.
Thank you, Mr. Speaker. I rise today to cast my vote to end abusive insurance company practices and to put doctors in patients in control of their healthcare.
And when I do, I'll cast it for the small business owner in my district whose health insurance premiums shot up more than 100% last year simply because one employee got sick.
I'll cast it for the 135,000 people in my district who don't have healthcare coverage.
And on a personal note, I'll cast it for the 2.5 million breast cancer survivors like me who have a pre-existing condition that make it next to impossible to obtain health insurance.
By the end of this debate, another family will have fallen into bankruptcy because someone had the bad fortune simply to be sick.
More families will have joined them in paying more and more for less and less health coverage.
More businesses will have waited bankruptcy against cutting their workers' care, and their workers will have lost.
I thank all of you for bringing us to this moment. It is great with great humility and with great pride that we tonight will make history for our country and progress for the American people.
Just think we will be joining those who established Social Security, Medicare, and now tonight, healthcare for all Americans.
In doing so, we will honor the vows of our founders, who in the Declaration of Independence said that we are endowed by our creator with certain unalienable rights.
And among these are life, liberty, and the pursuit of happiness.
This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people.
This is an American proposal that honors the traditions of our country.
This is a proposal that honors the traditions of our country.
This is an American proposal that honors the traditions of our country.
This is an American proposal that honors the traditions of our country.
This is an American proposal that honors the traditions of our country.
This is an American proposal that honors the traditions of our country.
This is an American proposal that honors the traditions of our country.
