What Does the Matrix Represent in Healthcare?
For those of us championing the cause of the Free Market in healthcare, the Matrix represents the overly complicated healthcare system that no one is supposed to know exists. This system wasn’t designed to serve you; the system was designed to frustrate and infuriate you. It’s a system where people make choices for a medical service that really do belong in a movie–like deciding which of their two accidentally severed fingertips to reattach in the Emergency Room without insurance that covers both, suturing their own kneecaps to avoid hospital care, or coming home after an unexpected $39,000 appendix removal only to wind up with even more surprise bills (albeit, with missing CPT codes) that eventually put them into bankruptcy.
This current healthcare system, which is very much alive and well, keeps people from making wiser decisions and choices that, given the chance, would reward them for being responsible, healthy, conscious healthcare consumers, as illustrated in one of our local chapter's quarterly meetings last year. The consumer that shops by proxy instead of accepting whatever fake price the hospital system (enabled by the federal government) offers them, understands how the free healthcare market works. Health care providers that dodge government regulation by opening their own physician practices for more health-care freedom understand that the value of their services is determined by market forces. This “awakening” process is essentially what breaks the healthcare matrix. Using a free market approach to shop and pay for (there’s a distinction) healthcare changes how we purchase healthcare delivery and medical services, which lowers the cost of healthcare to its true cost and fair prices. With fair price controls, healthcare providers can do their jobs, the cost of healthcare lowers, and the entire industry changes with better health outcomes.
The Matrix, Theme of the Free Market Medical Association’s 2021 Annual Conference
Steve Forbes, Dr. Tony Dale, and other dedicated individuals gave presentations focusing not only on the demand side of healthcare, (i.e. lowering the medical costs of prescription drugs and healthcare costs), but the supply side. The keynote speech Steve Forbes delivered at the conference focused on how to safeguard free markets. In his presentation, Mr. Forbes offers a new understanding of how free markets work when there is no interference from Washington politicians and special interest groups.
The Highly Uncompetitive Healthcare Market Failure
"Healthcare is a uniquely uncompetitive market because of the numerous rules and regulations that protect incumbent businesses at the expense of new competition." -PolicyEd There is a market for healthcare, but we need insanely intense competition. That means we need to talk about getting more qualified primary care doctors and doctors-to-be in school. More nurses. More young people who are still deciding on if they want to be in an overworked, underappreciated, overregulated field of medical care, or if they want to go into a free market, explaining what that means to them, screaming at the top of our lungs that insurance and healthcare are not synonymous.
We should focus on new companies and, most certainly, not neglect the lack of doctors we have in this country. When we do these things, a competitive market emerges while we are waiting on changes in policy. However, it’s still important to examine the impact of regulations in the healthcare market and the direct impact of little-to-no, or even poor, entrepreneurship in the market. You can learn more about regulation vs. entrepreneurship in Per Bylund, PhD and Dr. Cristin Dickerson’s presentation on the Matrix of Healthcare Regulation vs Entrepreneurship. (PDF notes)
Small Businesses and Healthcare
Employment-based health insurance leaves a lot of room to focus on stories and case studies that show how employer plans can work in a free market-based system. Dr. Tony Dale, Founder & Chairman of Sedera, and Elaine Parker, President of Job Creators Network Foundation & Chief Communications Officer, explain how to overcome the “bumper sticker health plan” by providing plans that are patient-centric. The goals are to repair and restore the doctor-patient relationship and get bureaucrats out of the exam room to provide choice and affordability. Engaging Company CEO’s To Drive Transformational Change in Healthcare – Tony Dale & Elaine Parker (PDF notes)
Bundled Pricing in the Emergency Room and Maternity Care
Mankind’s greatest hope now lies in us, promoters of the free market in healthcare chasing people down and offering them the red pill they never knew existed. It has been a common misconception that emergency rooms and maternity wards cannot bundle their payments. Yet, in a discussion with Keith Smith, Christion Rice, MD, MBA, and Kylie M. Mayes, they smash the myth explaining how direct care can come to the rescue providing a range of predictable costs and transparency. Publishing prices helps to empower individuals and employers that purchase health insurance to create market pressure and discourage overcharging. Maternity or Emergency Care Can’t Be Bundled, Right? Another Red Pill for You! (PDF notes)
Laws to Improve Access to Care and Affordable Healthcare Coverage With Legislation
David Balat, Director of Right on Healthcare Initiative, Texas Public Policy Foundation, and Jonathan Small, C.P.A., President, Oklahoma Council of Public Affairs gave a legislative update explaining the impact of Medicaid expansion and other updates on the delivery of healthcare for Texans. Among the updates was that the Medicaid Expansion applies to 1-1.5 million people and costs $5 billion. It now extends coverage to able-bodied working adults, crowding out access for the disabled. It also increases the use of emergency rooms for non-emergency care cases. Fewer doctors accept Medicaid, which decreases the quality of patient care. 662K uninsured Texans already have access to Medicaid, but do not use it. See the full presentation here:
Legislative Update – David Balat (PDF notes) video
Our current structure that delivers healthcare services is also responsible for a denial of care, is not price sensitive, and has no interest in operating under a free-market system. When the purchase of health insurance is continuously conflated with the delivery of care and healthcare value, there are unintended consequences. Without care improvement project measures for surgery centers, hospitals, insurance carriers, and checking the outcomes for individual patients, we cannot easily control health-care spending. Doctors are stuck with uncompensated care by central planners with no regard for sound healthcare financing. Regardless of income level, patient outcomes should be favorable, but we've got to escape the Matrix of Healthcare.
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After the Free Market Medical Association's 2021 Annual Conference in Plano, Texas, the local chapter leaders of the San Antonio FMMA were inspired to hold their next quarterly meeting Creating a Free Market Surgery Center in San Antonio, Texas. On October 27, 2021, the chapter gathered together to discuss how to promote affordable, competitive prices for elective surgeries in exchange for a hybrid structure or cash pay from willing consumers. The solution was found in bridging a hybrid surgery center and other cash facilities together with Benefits Advisors or “brokers who get it.”
With about 50 attendees, San Antonio FMMA members (buyers, sellers, vendors, and now facilities with cash pay) came together to hear about facilities that are or aim to operate under a free market model. Chapter Leaders Dr. Roger Moczygemba of Direct Med Clinic and Shankar Poncelet, CEO of Shankx Web Development, introduced the keynote speakers of the evening. Dr. Aamir Ehsan from CorePath Laboratories (accompanied by Executive VP of Business Operations, Curtis Loos), Randy Reynolds and Michelle Patino representing HealthCrest Surgical Partners introduced the new Huebner Ambulatory Surgery Center, and Health Benefits Advisor, Allison De Paoli from Altiqe Consulting helped to tie it all together.
Takeaways From FMMA
Price Transparency and Spearheading a Movement
,San Antonio Free Market Medical Association chapter leaders, Dr. Roger Moczygemba and Shankar Poncelet shared opening remarks before the speakers. Poncelet began by reflecting on how at one point, transparent pricing seemed only theoretical. However, this movement has gained momentum, and it seems more tangible than it did at the beginning. CEO of Shankx Web Development LLC, Poncelet and his marketing team helped make this event possible.
CEO of Shankx Web Development, Poncelet said,"We don't want to destroy medicine. We want to bring back what it originally meant to be. Which is doctors, physicians, surgeons, nurses, pharmacists and anyone else I am forgetting. Give them the chance again to really offer healthcare at an affordable rate and in accessible ways. That is something we can absolutely achieve through American ingenuity, which is truly what FMMA is in my opinion. My role is to get to know all of you and simplify the message a little bit so that the general public can benefit from all this valuable information."
As a very passionate consumer advocate, Dr. Roger Moczygemba is eager to partner with specialists who can help keep consumer costs low while maintaining quality. In 2020, his company saved a single employer over $1.7 million dollars in avoided workers’ compensations claims. By contracting directly with the employer, his clinic was able to cut down unnecessary costs and eliminate the waste by offering direct access to healthcare.
CEO of Direct Med Clinic, Dr. Moczygemba said,"The whole purpose of what we’re doing here is to try to create affordable and accessible healthcare. Which is kind of hard to find these days. But you know when you step back and break it down into individual components...It gets really expensive when we get too many third parties involved. Especially if they get a little too greedy. So if we break it down to the basics that’s what we’re doing here. So we just want to take that to the new level now from doctor, patient, company, clinic to getting more specialists involved...we want this to work and we have some key players here in this room tonight and all of these meetings to make this work."
CorePath Laboratories: Clinical Pathology for Testing, Clinics, and Consultation
Founder, CEO and Medical Director of CorePath, Dr. Ehsan shared insights about pathology labs and their role in the free market system of healthcare. As one of the few laboratories in the world offering cancer cytogenetics (i.e., testing samples of tissue, bone marrow, etc.), molecular genetics, and multicolor flow cytometry (e.g., imaging) in one place, CorePath is unique. The Bone Marrow Clinic, for example, by CorePath Laboratories, not only supplies providers with the kits, equipment, and technicians, but the consultation of their highly-trained, board-certified hematopathologists. This means providers are able to partner with subject matter experts in delivering care to consumers. Understanding that cancer involves time-sensitive reporting, follow-up is critical, and because CorePath provides in-house labs, they are able to deliver results that are timely and accurate. Providing in-house labs is also a key component to maintaining low-costs, passing the savings on to the end consumer without sacrificing quality of care. The lower costs of preferred specialists is due to using a reference lab.
CorePath seeks to discover physicians and providers that are entrepreneurs. They wish to collaborate with universities and the FMMA. Lastly, they are challenging the status quo by saving people thousands of dollars on pathology.
Surgical Procedures With Transparent Pricing: Huebner Ambulatory Surgery Center
Senior VP of HealthCrest surgical partners, Randy Reynolds shared his presentation virtually via Zoom. Reynolds works with the Huebner Ambulatory Surgery Center in San Antonio at an easy to access location. Their surgical facilities have been open since July of 2019 with affordable care and cash pay options for medical bills.
For many consumers, the quality of care begins with accessibility. The larger medical expenses for most Americans are typically a result of hospitalizations, surgeries, emergency room visits, and MRIs. However, Huebner Ambulatory Surgery Center is an outpatient facility that provides elective procedures similar to traditional hospitals but without the high costs and fake prices where cash rates differ drastically from insurance. The facility charges individual patients with competitive, all-inclusive prices with a hybrid form of payment. This means that both private insurance and cash payments are acceptable forms for the health care services rendered.
Surgical facilities do not typically have a price list with affordable prices at an all-inclusive price, but Huebner Surgery Center bundles procedures and prices. Not only are they accessible because of the cost of healthcare, but also because of the location. Working with insurance companies, the surgical center makes sure that transparent pricing is still at the core of their surgical procedures.
Their providers have extensive experience and they have 4 fully equipped operating rooms. Their patients have the ability to stay overnight. They offer a scope of services and cover a full spectrum of 10 different specialties.
Reyolds said,”San Antonio is a large [top 10] city in the country..so there’s a lot of opportunities for cases to be done at a low-cost provider...I think opportunities are endless. We do have an advantage over some of the other surgery centers because we are independent...our contracts aren’t as rich and I think you would find our pricing reasonable. We would work with you to take care of your patients.”
How are you more cost effective and compare to others?
Reynolds said,"We get paid about a third what the hospital systems do on commercial. We get paid 52 cents on the dollar for Medicare. I would say probably any ASC that's hospital affiliated is leveraging their contracts so they're probably getting close to twice as much as we are. As Michelle [Patino] said, we are still making money but we have to run very efficiently and Michelle does a great job with that...we got a staff that loves to work at Huebner ASC and they love to take care of the patients. We have very high patient satisfaction scores. We are very focused on quality. Just because we are the low-cost provider, that doesn't mean that the patient is going to get less quality or care because that's not how we do business."
Raising the Bar: Building a Better Health Plan
Allison De Paoli is a health insurance advisor, health insurance broker, consultant, founder and CEO at Altiqe. As a veteran of the insurance industry, her expertise and knowledge show through being able to help employers budget effectively to save money while also ensuring their employees have access to the care they need. However, just because she’s a veteran of the industry doesn’t mean that she sticks to the status quo. She breaks the mold with her strong focus on transparency and through the way she’s changing the insurance game.
At this meeting, De Paoli discussed how to build a better health plan as an employer and her answer to tackling the modern problems faced by employers and employees alike. One of the biggest problems that she brought up was “The Moral Imperative”, a fitting name for the unnecessary waste and fraud found in our current healthcare system that is benefitting everyone but who it needs to benefit: the everyday consumer. However, De Paoli has the creativity and wisdom to create the solutions necessary to fix these problems. An example of one of her solutions was through utilizing an alternative sourcing partner for your specialty and brand-name medications, which, as De Paoli phrased it, “puts real dollars back in the pockets of your employees”, since these medications come at zero out-of-pocket cost. Read more about Allison here.
De Paoli said,”If we are going to survive, we need to all evolve and adapt. The US healthcare system is coming apart in pieces...so what I do is one thing. I unbundle and rebuild health plans. What we try to do, and sometimes, we build the bridge as we go: Provide solutions that are completely transparent and allow an employer complete control.”
Special Guests Attend Free Market Medical Association Meeting
Some San Antonio FMMA members pose for a group photo. From left to right: Shankar Poncelet, Susan Kaars-Sypesteyn of Nola's Brunch & Beignets, Allison De Paoli of Altiqe Consulting, Constable Kat Brown of Bexar County Precinct #4, Honorable Bexar County Clerk Lucy-Adame Clark, Antréa Ferguson of Shankx Web Development, and Tim Kaufeldt of Laso Health.
Change isn't possible without the assistance of healthcare providers and policy makers. The San Antonio FMMA is building a bridge to policy makers. The special guests who joined the meeting included Constable Katherine Brown of Bexar County Precinct #4 and Honorable Bexar County Clerk Lucy Adame-Clark.
Constable Brown shared that she fought ovarian and breast cancer and how informative the meeting was. She understands very well how costs for cancer treatment can quickly escalate for those who do not have ease of access to healthcare or are not in a single-payer system like the military.
Constable Brown said,"This information that you guys shared with me tonight is very helpful. It’s going to be a contributing factor in terms of the people that I speak to and correspond with.”
San Antonio FMMA in-person meetings and online events were not possible without sponsors. The sponsors include Altiqe Consulting, CorePath Laboratories, Shankx Web Development, and Direct Med Clinic. For more information about sponsoring future events or inquiries, email Shankar Poncelet from Shankx Web Development at email@example.com.
From left to right: Constable Katherine Brown, Antréa Ferguson, Dr. Altamirano of Casa Salud Family Medicine Clinic, Michael Davies, Shankar Poncelet, Susan Kaars-Sepesteyn, Allison de Paoli, Honorable Lucy-Adame Clark, Bexar County Clerk, Tim Kaufeldt, Ansley Partosa, Teresa "Tess" Vardeman, Dr. Aamir Ehsan, Dusadee "Pink" Martin, Sherri Gary-Johnson, Kellie Pickett,
FMMA Member Highlight
The purpose of our member highlights is to shine a spotlight on outstanding individuals who form part of a groundbreaking network as members of the San Antonio Free Market Medical Association. For our December issue, we chose to sit down and chat with Triple Board Certified physician and endocrinology, diabetes, and thyroid specialist, Dr. Arti Thangudu of Complete Medicine.
Dr. Thangudu takes an evidence-based approach to care, focusing on the whole patient, not their disease or symptoms. At her membership-based practice, she offers her patients direct access, frequent coaching, and continuous blood glucose monitoring.
Seeing thousands of patients through her practice and rigorous fellowships, Dr. Thangudu is fully aware of the skyrocketing costs of prescription medications. Her practice is designed to work closely with each patient, ensuring they take only the medications they need. She also advocates for health coaching and focuses on healthy, balanced diets to prevent, treat, and reverse chronic disease, so patients can reduce their medications.
Can you explain the direct care model of operation for your practice and clinic?
With a direct care practice, we're able to do several things that enhance the doctor patient relationship. I don't see as many patients as I used to. It's really hard to have a great relationship with your patients when you're seeing almost 30 individuals a day. In my practice today, I have much fewer patients, they have much longer visits. My initial consultation is 60 minutes, one-on-one, with me and we run like clockwork. With COVID, we've been doing a lot of virtual appointments but my patients always have the option, even before, for virtual visits, phone visits, I call my patients with their labs, I send them their labs in a timely way.
How did you find out about the option to deliver healthcare using this model?
I had heard about concierge medicine for a while there were things I both liked and didn't like about it. Then I heard about Atlas MD, a group out of Wichita that have been doing direct care for a long time. I started learning about it, early in my practice. It just made so much sense to me. The non-transparency in pricing to both doctors and patients is harmful. I would have patients come and see me and they have insurance and their co-pay is $150 or $250. Or their insurance won't cover specialists visits at all...so the access to specialists was limited. I realized, they're paying these large sums of money to see me, with insurance — what if we just let go of the insurance and I could help them in other ways — such as with labs, better service, more treatment options?
Are you operating at capacity?
I do have the chance to take on new patients but I do have to limit myself to only individuals with the specific issues I treat so that I can help them. I am so pro-physician-entrepreneur because it's a dying theme. So many practices are being bought by hospitals. In some ways, that might be beneficial. I do think you have to have vision and drive. If you want to be employed, that's great too because what I do isn't for everybody. But there is a space for this. I didn't think I was going to start my own practice. I just saw so many holes and gaps in the system and, also, holes and gaps in my life. So I didn't feel that there was an employed position that could fill those gaps.
What brought you into the San Antonio Free Market Medical Association?
Through my personal experience as well as that of my patients, I've just been, to be honest, totally disgusted by the lack of transparency in medical care. It makes me feel like, what is this system that we're working in? What I mean by lack of transparency is that when you go to your doctor's office, you have no idea how much you're going to pay until they're done. You also didn't have the option to say yes or no to particular procedures. And then, worse, 3 months later, you get another bill...and then another...and another. People don't know that, hey, my specialist co-pays $60 but I actually spent $1,000 or I have $100 co-pay but I spent $2,000 on labs. I have patients who tell me they're spending $2,000 every 3-6 months on bloodwork. It's not that expensive! The only reason we're facing this is because nobody knows what it should cost.
Where do you see yourself in five years?
I can't say I have a firm plan for where I want to be in five years but I do want to be a voice for this city to use technology and telemedicine. That's part of what I researched during my fellowship and I utilized it a lot. I have spoken to officials here in the city about telemedicine as a way to access healthcare. The majority of people are dealing with chronic, metabolic diseases, especially in lower socioeconomic neighborhoods. Something we could do is have a hub where we provide telemedicine services, even if there's no setup for high-speed internet yet.
About the San Antonio Free Market Medical Association
Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.
The San Antonio FMMA recognizes the three pillars on which the national FMMA was founded by Jay Kempton and Dr. Keith Smith in 2014:
1. Price is not a product.
2. Value is mutually determined and requires transparent pricing and quality.
3. Cash is king, the equality of price is critical.
The FMMA connects buyers and sellers of healthcare, educating and motivating them to work together based upon a mutually beneficial relationship built on the pillars. To learn more, visit https://SanAntonioFMMA.org or contact firstname.lastname@example.org
This member highlight is brought to you by Shankx Web Development and Consulting. For more information, please visit https://www.ShankxWebDev.com