In this episode of UpMed, Dr. Erica Rowe Urquhart explores the challenges faced by private practice doctors in local communities, highlighting the adversarial role of insurance companies. Through a reflection on increasing patient costs, the concept of the 'other,' and administrative hurdles such as downcoding, prior authorizations, and retrospective audits, Dr. Urquhart reveals how insurance companies avoid paying providers and add to the administrative burden. This episode delves into the complex dynamics of the patient-provider-insurer triangle, examining how insurance practices impact patient care and the sustainability of community healthcare providers.

EPISODE HIGHLIGHTS:

• Identifying the Enemy in Healthcare: The Insurance Company

• Insurance Companies' Strategies Against Providers

• Challenges with Prior Authorization

• Retrospective Audits and Payment Processing Issues

• High Volume Scrutiny and Its Impact

• The Adversarial Role of Insurance Companies

• The Bleak Future of Community Doctors

• Conclusion and Call to Action

In this episode of UpMed, Dr. Erica Rowe Urquhart interviews Dr. Carl Gargiulo, a distinguished physical therapist with a career spanning over four decades. They discuss Dr. Gargiulo's journey from his private practice to his role as Regional Director at Twin Borough Physical Therapy during the onset of the COVID-19 pandemic. The episode explores the differences between private and corporate physical therapy practices, the integration of technology like MedBridge for patient education and adherence, and the challenges posed by limitations of insurance coverage. They also touch on the psychological aspects of patient compliance, the impact of early discharge from hospitals, and the potential future of mobile physical therapy services. Dr. Gargiulo shares his insights on maintaining patient independence and mobility, reflecting on the evolution of the physical therapy profession.

EPISODE HIGHLIGHTS:

• Dr. Gargiulo's discusses his career journey

• Dr. Erica & Dr. Gargiulo discuss Private Practice vs. Corporate Practice

• Dr. Gargiulo explains the evoution of technology in Physical Therapy

• Both Drs discuss Insurance Provision vs Direct Patient Costs

• Dr. Gargiulo explains his vision for the future of Physical Therapy

• Dr. Gargiulo discusses patient psychology when it comes to patient compliance

• Final thoughts and conclusion

Welcome to Season 2 of UPMED: The Journal of Healthcare's Race To The Bottom with your host, Dr. Erica Rowe Urquhart. We kick off Season 2 with a thought-provoking episode. In this episode, your host, Dr. Erica Rowe Urquhart sits down with the incredibly accomplished Dr. Kecia Ford. Dr. Ford is an internist with multiple high-risk clinics in New York. They discuss Dr. Ford's unique journey from biomedical engineering to internal medicine, and delve into the challenges of providing quality healthcare in underserved communities. Learn about the innovative use of wearable medical technology in treating high-risk diabetes patients and the crucial role of public-private partnerships. Dr. Ford shares insightful stories of patient success, highlighting the indispensable value of education, private funding and advocacy in medicine.

EPISODE HIGHLIGHTS:

• Dr. Ford explains her journey into medicine.

• What is a FQHC (Federally Qualified Health Center)?

• Dr. Ford explains how recent technology helps her treat diabetic patients.

• Dr. Ford discusses the population dynamics in the communities surrounding her health center.

• Dr. Erica and Dr. Ford discuss how public/private partnerships help Dr. Ford provide quality care to their patients.

• 3 Challenges FQHC’s Face:

• 1. Environmental Challenges (access to better food sources)

• 2. Patient Financial and Health Challenges

• 3. Insurance Provider Formulary Challenges