Відео

Omg your voice and energy is impeccable!!!! I learned so much!!!! Please keep going and helping make the Pharmacy Industry great by keeping us newbies educated!!!! KEEP REACHING FOR OUTTER SPACE!!!!!

if i have a $500 deductible, does that deductible apply to all services and office visits? my preventative care was free of charge so is that the only exemption?

Thanks for all your content Eric! A coworker suggested I watch this video, and then I started going through your PBM playlist. Having worked in healthcare analytics for a couple of years now, your explanations and presentations have been excellent for understanding concepts I didn't quite grasp. Cheers!

Professional scammers

I just watched this (July 2024). I made a living in this space 25 years ago as a data analyst and then about 12 years ago as a business unit director of government programs. I am amazed by how little has changed. As I prepare for a phone screen interview to return to this work (hopefully, the interview goes well), I am verily enjoying several of your videos to re-familiarize myself with the mess of it all. THANK YOU!

You just failed to say, a pharmacist can help you with this. Cause avoiding these all errors is the pharmacists role

I'm working on a process document for a health claim adjudication process and just wanted to say thank you for this. It's incredibly helpful since I'm finding insurance processes difficult/complex/black-holish (sure, that's a word).

I looked up the price for hospital "Observation" for an overnight stay, and it's listed on the hospital's website as being $3,721 for someone with my insurance health plan, but only $204 for the Medicare rate. Since the hospital has made this info public, do you think they'll be obligated to charge me only $408 if i were to write out the magic sentence on the Consent Form in the future? Or is this more for uninsured people?

Good is news that capital is going to turn doctors into cash generating machines with all the rights of McDonald's workers, regardless of legality.

these companies are so evil! thanks for the insight

Unfortunately, MA may have a place in the system as it is today. Many retired folks cannot afford a supplement plan. While MA is challenging, it is far better than the Socialized medicine systems in the UK or Canada where the "First come first served" policy have cost many their lives. I enjoy your videos. Thanks!

Every chance I get, I try to inform people approaching Medicare eligibility age to avoid Medicare Advantage plans- prior authorization + networks is how insurance companies make money off what Medicare pays them. Deny or delay!

Thank you for sharing this wonderful video! No one has ever explained RCM to me this clearly in the 5+ years I have been working in the industry. This is absolutely insightful.

I don’t understand something. How are the US Healthcare costs set artificially low? I understand England and Canada, but aren’t prices in the US negotiated? Or is it that the payers have the negotiating power, so they are setting the prices to their benefit so that the end result is reduced pay for hospitals and providers?

Thank you for your straightforward explanations. I'm beginning to understand healthcare finances after watching your videos.

I am confused. This detail you speak of that is required to support billing - do you mean both with insurance companies and Medicare? I never see this information in a treatment note. Is it someplace else??

What are your thoughts on the recent article the NYT published on PBMS/big 3?

Bravo. Re-introducing competition to unfairly-advantaged-incestuous-government-sponsored-behemoths might bring about fair value in return for good service. Before the 80's-90's when BigGov/OPM became the only risk-venture capital (well actually, taxpayer risk/ VC gain) that made sense, there was the common buyer-meets-seller transaction. Part of that equation entailed 'shame'. If Seller did a poor job, Buyer had recourse. If Buyer didn't pay, Seller had recourse. When Third Party Payment Gatekeepers emerged (evil geniuses who made themselves trillions by harming both Buyers and Sellers of medical care, as a function of corruption of American legislators) the Buyers could say, 'well I paid my insurance, not my job to see if doc got paid' and Sellers were driven to practice defensively (capitulate) or quit the profession. Before ACA, one could purchase a reasonably priced 'catastrophic care' policy for big ticket medical txt's, and pay out of pocket for the routine medical goods and services. HSAs coupled with such catastrophic-care policies made healthcare a reasonable portion of household expenditures at every quintile (when one considers Medicaid). Singapore has a system like this one described, the one America had before people were convinced they need "insurance" more than they needed actual healthcare.

So regardless it is formulary or non formulary drug, one has to pay copay?

I'm surprised you didn't mention short staffing. Short staffing is not a problem to be solved. It is the business model of modern healthcare. It's the most obvious example of how healthcare organizations cut costs to the detriment of patients.

This is amazing. You simplify complex things. As a healthcare consultant and MD I’m so grateful for these videos!!!

As an independent pharmacist owner, thank you Dr. Bricker for making this and other videos that explain the convoluted world of prescription drug pricing. I might add, that the reimbursement that pharmacy’s such as mine receive from PBMs are often just barely enough to cover the overhead costs of dispensing the prescription (i.e. vial/label cost, staffing costs, equipment, etc) in addition to the actual drug acquisition cost. What the general public doesn’t realize is that pharmacies, primarily independents, are being squeezed to death by the one-sided, non-negotiable contracts with the PBMs. Pharmacy’s are stuck between a rock and a hard place in deciding whether or not to take a contract. If they choose not to accept the contract, they may lose in some cases 30% or more of the entire patient population they serve. On the other hand, they may accept a contract that results in them literally losing money on ‘every’ prescription they dispense. Trust me, I scratch my head every day and ask myself how in the heck we got here. I could go on forever, but I’ll get off my dodo box for now.

Thanks for this video, Dr. Bricker! I feel the pain of that med school debt load, burnout even in med school and residency and beyond, government and insurance burdens, etc. For present and future med students who like primary care and hope to end up as an independent physician, would you pick IM or FM (all other things equal, such as don't love but don't hate kids and pregnant women)? Grace and peace to you and yours. 😊

Nice promo for a company run by a CEO who's a CFA and non-physician and their per-diem CMO is the former president of Envision EM, one of the largest CMG run by KKR (Private Equity) who filed Chapter 11 for bankruptcy. This is basically a MSO with a better website. @Eric, the medical community looks up to you for unbiased content and your due diligence.

Thanks Dr. Bricker for another great AHealthcareZ breakdown. If US healthcare has a shot at improving efficiency, quality, and access, its going to be physicians stepping up. Regrettably, the business of healthcare is never taught in medical school ostensibly to firewall the altruistic responsibilities of the Hippocratic Oath from the financing of healthcare delivery. Yet, physicians control 85% of healthcare spend in their daily decisions. For the current power players to retain control and avoid exposure, physicians should expect to be increasingly marginalized, commoditized, and controlled so American can continue to be fleeced. We have more to offer by aligning, incentivizing quality, and advocating for ourselves and our patients. The only way out of this mess is empowered and aligned physician to directly negotiate with the funders of healthcare, and then remain indepedent like their careers depended on it.

I actually disagree with this. The goal of capitalism is consolidation of capital, and what you will end up actually seeing is that United Healthcare will buy up all of the independent doctors, lower quality of care drastically, yet consumers will have little choice except to use United. And, if a new independent physician wants to join the market, United will just refuse to reimburse, because they own the health insurance as well. Then, they will offer the physician a loan to debt trap them, and then force a buyout. Healthcare is one of the greatest examples of the failures of capitalism, yet those who are most knowledgeable about healthcare are often the most indoctrinated by United and others into thinking this is the best possible system. Because, any suggestions to nationalize the vertically integrated healthcare companies will just get accused of being a communist, which automatically shuts down any and all discussion.

Can you do a video discussing why groups actively hire physicians over nurse practitioners for medical clinics, despite paying over 3x as much for the same care of a patient? If I ran a business and could reduce the cost of my service by 2/3 by using a nurse practitioner over a physician, I think I would hire more nurse practitioners and less physicians.

Fee for service is unprofitable for primary care. Is this supporting physicians doing full risk medicare advantage or DPC? If not, this is just fighting against the tides. You can't win against a loss leader.

I wish there was a way for patients to see what doctors in their area are independent. In the (university) town that I live, it seems all the doctors are part of one of the two hospital systems we have. Very frustrating.

Are you paid to endorse Meroka?

Joe The Patient (Informed Consent) I went to obtain an informed consent, And inform the patient what that meant, I spent the next several moments explaining Concepts I'd learned over eight years of training. Now, Patient Joe was frugal, didn't live beyond his means, And was dead-set on keeping his own body free of liens, Joe said fine, he'd be glad to sign, if I told him what the procedure would cost. Then I knew in my heart I was lost. I can go on and on on stents until my face turns cyanotic, Assure him we treat flatlines like they're merely asymptotic, But billing codes and DRGs are topics Gordian-knot-ic. Said I to Joe, I do not know, but if I knew I couldn't say, because third party payers insist it be that way. Joe asks '"how can he give informed consent if he hasn't been informed of price?" And I answered, who knows, but sign it or leave here 'against medical advice '. Patient Joe starts talking lawsuits, then he stops and says "aw shucks. Lets get this done, what do you say, how's cash, five hundred bucks?" I drew on all my experience and training and ethics and...and... (...meet me in the alley out back at nine. Here's cefazolin and some betadine).

Excellent video and ideas 😊

Our medical insurance costs have been skyrocketing because of these doctors abusing the systems with their phantom billings.

Cool org! Found their hackathon as well

Stark Laws made most docs afraid to so much as buy an MRI machine for a neurosurgical practice (for one example): due to fear of prosecution for self-referral. So then, how the heck is this workaround available to incestuous insurance/payvider/PE-owned-vertically integrated medical Amazons? Finally, why hasn't an entrepreneurial workaround emerged to empower and enrich the only necessary component in every single medical transaction (the doc, not the VC Fund Manager)?

Funny how Bickler keeps deleting my comments pointing out why his analysis is nonsense. Maybe it would make more sense to try and actually understand what he is talking about.

Question? What about the IMPORTATION of DRUGS that are being made in CANADA? I'd like to see the IMPORTATION of DRUGS that are being made in CANADA, into the UNITED STATES, this would be a game changer.......

I don't understand why the PBM pays the manufacturer anything. (The example in the video was $400 with a $100 rebate.) The manufacturers sell to wholesalers who sell to pharmacies who sell to patients. What is the PBM paying for?

Question? What are the intentions or the effects of the NEW GUY on the street, AMAZON I'm referencing, could they be trying to get in the Pharmacy game to lower prices? Or are they just going to be a delivery service for the Pharmacy? What about the importation of CANADIAN drugs into the United States? This was a great way of explaining everything. GOLDEN RULE: He who has the MONEY makes the RULES......

Only the US would allow something as ridiculous as PBMs to exist. They are basically profiting from a broken system.

One year, I actually met my high deductible and thought "Super! At last, I can afford some physical therapy for the back pain I've had for years." When I went to the doctor and asked for a order for physical therapy, he replied "I do not consider your financial considerations a therapeutic reason for ordering physical therapy."

I went to a hospital-owned Urgent Care. I did not know they charge a $402 "facility fee" to any high-deductible plan holder for walking in the door, plus charges for services provided. As a high-deductible plan holder, what I want from doctors are clear and accessible price lists.

Love you content sir. One thing, could you please look into adjusting your audio. I have noticed a high pitch ringing noise in several of your videos that is constant which make them difficult to watch sometimes. Aside from the audio issues I love your videos, please continue!

The creator of humira should take it themselves

So this is why our clients call Pharmacy Investigators and Consultants "their bulldog" and other consultants and brokers call us the other name for female dogs. Great job, again, Dr. Bricker. Hopefully, ,more regulatory rules aimed at transparency and litigation like Lewandowski v J&J will expose the incestuous relationship between consultants, brokers and the industry.

Inelastic high margin services paying referral fees or other forms of revenue sharing would make fee for service primary care work just like your examples of airline credit card "partnerships" However, Fee for service primary care doesn't work because of "anti Kickback" statutes .

Agree with the presentation here. To your point, consider the story of Oscar. I was in the room when they approached and were accepted into a large health care exchange. Their very young founder spoke a good (enough) game and they relied heavily on an old school actuary to defend their business model. To Oscar's favor, the exchange decision makers were in a low risk circumstance to accept them. However, Oscar is proving to be a failing organization as they MLRs are very high. Point is that those with more at stake (CFO, VP HR, etc.) in private organizations can (and do) point to examples like Oscar to further their risk aversion.

I think I wouldn't call this "doctor pay", but instead doctor generated revenue, since much of that 'revenue' also goes to paying expenses for private practice owners or in some scenarios to defray costs within a multi-doctor or multi-discipline practice.

This reminds me of internet precursor disrupted in 1980's: Loadlink. Shippe-carrier (truck and train) load-route matching took place in cigar-smoke-filled rooms on chalkboard. Guys in charge at such rooms at Yellow freight, for example, were able to get a trunk full of lobsters or Big Bertha drivers in return for preferential routing. How things never change, eh?

I kept waiting for a confession that this video was satire. Sadly - either the joke is on me or this is the least educated posting I have seen from the good Dr. Published tax rates are not effective tax rates (note when taxes rates were 91%, literally 100-150 people in all of America paid that rate). Corporate profits are not 17% and blaming inflation on corporate actions is a politician's game... not that of a reasoned economist (even the article referenced manipulation of data and states that after monetary interventions corp profits did not flourish and in fact mid-sized firms profits fell after Covid). You will never tax a society to prosperity and nor will you create an efficient/rational healthcare system by pumping it full of more money (don't believe me... look what happened to colleges when their funding became an inflated guaranteed stream.... functionally, a "graduate" today is no longer given a diploma as those pieces of paper are now simply considered by many to be receipts). Lost some faith in Dr. Bricker today.