Every November, Medicare proposes physician pay cuts and every December, Congress tries to walk them back. But why? Dr Anthony Paravati and Dr Amar Rewari break down the hidden budget rules forcing specialties to fight over a fixed pie, why the much-celebrated MACRA law of 2015 did nothing to fix it, and how successful health systems are adapting their strategy. This episode is short and sweet but there’s something for everyone. From basic, but often flubbed, must-know facts about the Medicare program to critical insights into payer contracting and service line decisions. Knowledge is power - especially when billions are at stake.

Chapters

00:00 Introduction to Medicare Cuts
03:47 Understanding the RVU and Conversion Factor
09:18 The Impact of Legislation on Physician Payments
14:13 The Role of MACRA and Future Considerations
19:40 The Broader Implications for Patient Care

In this episode, Drs. Amar Rewari and Anthony Paravati discuss the nomination of RFK Jr. as the head of the Department of Health and Human Services. They explore his controversial views on vaccines, public health implications, agricultural policies, and the pharmaceutical industry. The conversation delves into the complexities of chronic disease management, the debate over fluoride in water, and the potential impacts of RFK Jr.'s policies on public trust in science and health.

Chapters

00:00 Introduction
03:24 Early Career and Background on RFK Jr.
04:23 Vaccine Controversies and Scientific Denialism
14:36 Agricultural Policies, Raw milk and Health Implications
17:18 Wellness and Chronic Disease Management
25:29 The Influence of Pharmaceutical Lobbying
27:45 Pharmaceutical Benefit Managers and Drug Pricing
29:31 Fluoride in Water: A Complex Debate
32:25 CPT Codes and the RUC: The Role of the AMA in Healthcare
36:16 Navigating Bureaucracy: Challenges Ahead for RFK Jr.
38:09 Summary

In this week’s episode of the VHV podcast we’ll take a comprehensive look at utilization management (UM) and prior authorization (PA). Utilization management is the healthcare industry term for the various techniques health insurance companies employ to pay for care on their terms, according to their guidelines. Many times, their utilization management approach is in line with what physicians recommend. However, many times it is not. And when it’s not, patients suffer delays in their care and physicians and their staff end up mired in extra work to make sure their patients get the care they have determined is best.

In this timely episode, Dr. Anthony Paravati and Dr. Amar Rewari break down the healthcare implications of a Trump or Harris presidency. From prescription drug pricing and Medicare reforms to Medicaid block grants and the Affordable Care Act, this episode provides a nonpartisan, in-depth analysis of each candidate's position on healthcare. Discover what the future could hold for U.S. healthcare policies, costs, and patient access depending on the election's outcome. This is a can't miss episode before heading to the polls.

Drs. Anthony Paravati and Amar Rewari delve into the complexities of Medicare Advantage, exploring its appeal to seniors, the financial mechanisms behind its low premiums, and the challenges faced by providers. They discuss the demographics of Medicare Advantage enrollees, the revenue structures that sustain these plans, and the implications for healthcare providers. The conversation also highlights the pros and cons of Medicare Advantage for beneficiaries and speculates on the future sustainability of the program amidst tightening margins and regulatory pressures.takeaways

• Medicare Advantage offers lower premiums, appealing to budget-conscious seniors.
• The program is administered by commercial insurance companies, not the government directly.
• Narrow networks in Medicare Advantage can limit provider choices for seniors.
• Seniors with lower incomes are more likely to choose Medicare Advantage.
• Insurance companies benefit from risk adjustment payments for sicker patients.
• Quality bonuses incentivize Medicare Advantage plans to improve care.
• Hospitals face challenges with payment delays and denials from Medicare Advantage plans.
• The popularity of Medicare Advantage is increasing among seniors.
• Tighter margins for Medicare Advantage plans may lead to reduced benefits.
• Future changes in Medicare Advantage will depend on regulatory adjustments and market dynamics.

In this VHH fundamentals episode, we provide a primer on the basics of Traditional Medicare (Parts A, B, and D) and Medicare Advantage (Part C) for physicians and healthcare leaders. We explore key differences in out-of-pocket costs, premiums, and coverage between the two, preparing you for a deeper dive into health policy and healthcare finance on our full podcast episode. Whether you're leading a practice or guiding patient care, understanding the fundamentals of Medicare is essential for navigating today's healthcare landscape. Don't miss this overview to better support your patients and organization! #MedicarePrimer #HealthcareLeaders #MedicareAdvantage #HealthPolicy #HealthcareFinance