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

In this episode, Dr. Erica Urquhart delves into the intricate dynamics of healthcare economics and the role of insurance companies in the industry. She raises concerns about transparency, conflicts of interest, data privacy, and market control within the healthcare system. Dr. Urquhart shares a powerful New York Times article exposing instances where insurance company practices lead to disparities in payments, emphasizing the need for reform in the healthcare payment structure.

EPISOSDE HIGHLIGHTS:

• Dr. Urquhart gives examples of healthcare monetary values.

• Dr. Urquhart explains how the insurance payment system works.

• Dr. Urquhart shares the revelations cited in the New York Times article involving the disparity of the distribution of healthcare payments to healthcare providers.

• Dr. Urquhart shares her three takeaways from the New York Times Article: a. Are we hearing anything about this issue from our legislators? b. Are we seeing more articles giving us the numbers? c. Can we ensure data privacy and security?

• Dr. Urquhart issues a call for change in the insurance payment system.

To continue the conversation, Follow Dr. Erica Rowe Urquhart on her YouTube Channel @ https://www.youtube.com/@theupwardly

Cardiologist, Raashan Williams, MD joins UpMed. In this episode, the interventional cardiologist who trained at Cornell discusses his first impression of the white coat as a toddler in Brooklyn, NY. Dr. Williams has a unique background and perspective on urban healthcare in a diverse environment. He candidly gives us an insider view as he shares his insights on the roles and responsibilities of clinical practitioners.

EPISODE HIGHLIGHTS:

• Dr. Williams explains what drew him to interventional cardiology.

• Dr. Williams and Dr. Urquhart discuss the advantages and disadvantages of private practice.

• Dr. Williams highlights the success he has had in his private practice:

• a. The personality of the practice.

• b. The patient doctor interaction which requires nurturing to be successful.

• Dr. Urquhart and Dr. Williams explain the disconnect between doctors, insurance providers, and patients when it comes to providing quality care.

• It is important to stay focused on what got you into medicine instead of being distracted by what is happening around you.

To continue the conversation, Follow Dr. Erica Rowe Urquhart on her YouTube Channel @ https://www.youtube.com/@theupwardly

This week Dr. Urquhart has a conversation with Dr. Monique King. Monique King MD serves as the anesthesiologist director of a hospital-affiliated outpatient surgery center in Southern California. A graduate of the University of Southern California School of Medicine, Dr. King shares her unique experiences in surgery center management and gives us tremendous perspective on hospital affiliated outpatient management, as she reflects on the need for work-life balance.

EPISODE HIGHLIGHTS:

• Dr. King explains what drew her to the medical field and shares the journey she took in gaining leadership experience working with patients in an outpatient setting.

• Dr. King and Dr. Urquhart discuss the pros and cons of free standing surgical centers vs HOPD’s (Hospital Outpatient Departments).

• Honest and open communication with everyone involved in the care of a patient is very important.

• Dr. Urquhart and Dr. King discuss the importance of time management and how that has affected their practices.

• Dr. Urquhart and Dr. King share the struggles and frustrations they face as women of color in providing quality patient care.

• Dr. King shares her aspirations for the future in her practice.

To continue the conversation, Follow Dr. Erica Rowe Urquhart on her YouTube Channel @ https://www.youtube.com/@theupwardly

Social justice trailblazer, Damali Campbell, MD joins UpMed. A busy obstetrician and gynecologist, she is also an Associate Professor. With a practice in an urban Northern New Jersey environment, she has the opportunity to treat a diverse population of patients that include under served residents of her community as well as regional high risk pregnancies. She is the director of state-wide initiatives where she studies socioeconomic factors that influence maternal health. The focus of our conversation is the personal evolution that is required to maintain a dynamic practice in an academic environment.

EPISODE HIGHLIGHTS:

• Everybody deserves quality care.

• Dr. Campbell discusses the dichotomy of prenatal care in black women.

• Dr. Campbell shares the balance between the administrative side versus the personal side of healthcare.

• Both Drs. discuss how COVID 19 changed the way they practice medicine.

• Dr. Campbell shares the transformations she has seen in over 20 years as a practicing physician.

• Dr. Urquhart and Dr. Campbell discuss the future of AI in the field of medicine.

• Taking time to listen to one another can bring so much healing.

To continue the conversation, Follow Dr. Erica Rowe Urquhart on her YouTube Channel @ https://www.youtube.com/@theupwardly

In this episode, Dr. Erica Urquhart discusses the challenges of toxic work environments in healthcare through the lens of a medical student's experiences and the impact toxic environments have on healthcare providers.

EPISODE HIGHLIGHTS

• Dr. Urquhart defines What is a Toxic Work Environment?

• Dr. Urquhart explains the impact toxic environments have on healthcare professionals.

• Examples of challenges physicians faced during the COVID -19 Pandemic.

• Dr. Urquhart discusses the financial and psychological pressures healthcare providers face.

To continue the conversation, Follow Dr. Erica Rowe Urquhart on her YouTube Channel @ https://www.youtube.com/@theupwardly