Better Late Than Never
Let's Catch Up On A Few Things
The New Lee Health Isn’t Wasting Any Time
For my local followers, let me follow up on the recent Lee Health conversion from a State Chartered Public Hospital system to a private, non-profit hospital entity.
From this months local Medical Staff Newsletter from Lee Health:
Hospital at Home is Now Available at Lee Health
Hospital at Home officially launched at Lee Health on Nov. 20. Through this program, individuals facing specific acute illnesses or exacerbations of chronic conditions can receive high-quality medical attention (at a level previously only available within the hospital) from the comfort of their own home.
Initially, the conditions that qualify for Hospital at Home include chronic obstructive pulmonary disease, congestive heart failure, pneumonia, cellulitis and urinary tract infection requiring hospitalization. The Hospital at Home team is currently treating a set number of patients and these specific conditions, and the program will grow over time.
Apparently the Lee Administration must have the inside word that Medicare has decided to let the hospitals continue with the COVID EMERGENCY virtual hospital payment scheme. From Google AI summary: “Medicare pays the same amount for telehealth services as it would for in-person services. The Medicare coinsurance and deductible usually apply to telehealth services. However, during the COVID-19 Public Health Emergency, Medicare paid for telehealth services in any healthcare facility or in a patient's home”.
It’s a Brave New World. The hospitals aren’t satisfied with being hospitals. They are buying outpatient medical practices and using this disguise to take over the home health care business. Soon our hospitals will be sending their minions into your home while billing as if you had a real hospital bed. What a coup! I wonder if the hospitalists, RN’s, Nurse Practitioners and Physician Assistant work force anticipated being sent on the road for home visits. This announced service explains why Lee Health is going to shutter over 400 hospital beds at Lee Downtown and build only 120 (initial) replacements in their new planned facility.
Meanwhile, Dr. Marconi and I are collaborating with a cool tech company, Validic to beta test harnessing personal health data devices for patient monitoring from home. Soon we will be rolling this out for select patients. We are going to prioritize our higher risk patients and offering it as a value added program for our patient members.
I envision over time that we would be able to offer this for wellness and health optimization. Due to the cost of this service, we can’t afford to provide it to everyone presently. For future planning, it would be helpful for us to know how many of our present patient members would be interested in having us monitor your health data, using a customized health monitoring dashboard. The beauty of this platform is that we aren’t pigeonholed into just a handful of devices. Validic can serve as the data highway for scores of wearable health measurement products. New products will be supported as they develop. This particular market is a work in progress with limitless possibilities.
My vision for the future is that private practice physicians can be your “virtual hospital”. It is a natural extension of us using the available technologies to serve the patients who chose us to take care of them. We will do it and not ask the tax-payers to print excess money to have it happen. Sadly, the majority of the present U.S. physician workforce is not in control of their destiny as corporate employed physicians now comprise 75% of our doctors. Maybe this will change. It is my ultimate hope things will change.
A Bit More Lee Health Information- SHAMELESS SELF-PROMOTION AND DOUBLE STANDARDS
From the same Medical Staff Newsletter this week:
Lee Health Medical Equipment Solutions Respiratory Care Offerings
Lee Health Medical Equipment Solutions is a durable medical equipment, respiratory care and supply company that serves Lee, Charlotte, Collier and Hendry counties. The company, created in 1998, was called Access Medical South and was partially owned by Lee Health. In 2017, Lee Health purchased Access Medical South, and this year, we renamed and rebranded the company to Lee Health Medical Equipment Solutions.
This notice is a beaut. The above quote highlights several points:
It shows you Lee Health’s business model. They wade into the non-hospital businesses by buying a stake with an option to acquire the whole company. Historically they claimed it had to be a majority stake due to their (no longer) State Charter non-profit status. If it is working out, then they take the option of buying the whole enchilada. I surmise that now that they aren’t a government sanctioned monopoly, they now can do deals BELOW 51% majority ownership. I don’t know if my musing is true but over time we will find out. I suspect this was a primary motivation for moving out of the chartered status. More market partners will consider shaking hands IF they can maintain a majority stake in their business.
Hypocrisy at its finest. By law (Pete Stark Regulations), physicians who accept Medicare can not own Durable Medical Equipment companies. We also can not own home health agencies. We can not own ancillary physical or occupational therapy companies and use them for our patients. This is due to rules against self-referrals. Lee Health just informed their medical providers to use their renamed Lee Health Medical Equipment Solutions service for pulmonary equipment orders and services. Apparently for hospital systems, self referring is perfectly fine. Hospitals are blessed with the Medicare’s highest payment for services rendered AND get to bully their way, now front and center, into any of the ancillary health services and physician practice industry. As I said, hypocrisy at its finest. This is all Federal Government sanctioned behavior. Fellow Substack contributor Dutch Rojas does a nice job explaining how Uncle Sam is putting your physicians on the chain and out of their private practices in medicine.
Lee isn’t wasting any time getting on top of the local health care market. This notice is likely an initial announcement of informing us of their other hidden assets (gems) that was kept from the public during their self appointed corporate conversion project. Within days of the county vote to dissolve the public charter, the local press announced their new Orthopedic Surgical and Hospital program. They are now starting their own oncology program as well.
And Like The Ginsu Knives Commercial- That Is Not All Folks!
More new businesses Lee is promoting to its staff include:
Lee Health Musculoskeletal Institute Introduces New Specialty: Primary Care Sports Medicine. Gee whiz- there is now primary care in sports medicine???? Wow. The marketing department is very creative indeed. I guess the orthopedic specialty wants my job. Hmmmm.
Lee Health Home Infusion Launches Specialty Infusion Program and Infusion Suite. Golly gee again. This is a cash business and there are a few non Lee shops open in town. We can’t be having that!!!
Opaque Prescription Drug Market
The 3rd Party Payer Scheme Is Not Helping Medication Prices At The Pharmacy
I have covered this topic in many past posts but a November 27,2024 Wall Street Journal news report shows its readers a recent update from one of my favorite prescription data sites called 46brooklyn. They analyzed the payment market for prescriptions and again demonstrated Medicare part D prescription insurance payers paid wildly different payments for the same generic medications. The spreads are massive. You can read the article (linked above) or look at the 46brooklyn site (linked above) for the details.
The Prescription Benefit Manager, middleman model is an abomination of the well-intentioned original Medicare Part D prescription legislation. The insurance industry weaseled their way into what should have been a direct to consumer prescription drug market and harnessed the cost effective generic prescription drug market into a cash cow for the insurance companies. This scheme is used the same way for the non Medicare insurance industry as well. This payment rigging enterprise also assists the patent drug market in maintaining unrealistic prices for newly invented medications. By gouging the generic buyers, the extra cash flow can help cover the manufacture prices commanded by pharma’s patent protected medication industry. To read in detail (with further supported links/references), check out my past blog.
https://raymondkordonowy.substack.com/p/how-the-system-continues-to-fail-us
The Solution To This Situation Is To Keep Your Prescription Insurance Card In Your Wallet When Buying Generics
When you engage a retail pharmacy or even a mail order pharmacy the game is rigged. They ask you for your insurance card or information. Armed with this, the pharmacist begins to explore the price that will be charged to you, the patient customer. What that will be is totally determined by your insurance contract. The pharmacists computer will spit out a price and your copay to be collected. The system also determines IF it will be covered as well as how many pills/days of prescription will be allowed for the payment exchange. IF the computer states the plan won’t “cover” your prescription, the pharmacist will tell you you can’t have your medication. THAT, BY THE WAY, IS A LIE. Your insurance coverage does not dictate if you can have your medication. They simply can decide if they will facilitate your being charged and partially covered for the prescription written.
If you want to avoid Russian Roulette for your medicine, don’t offer the insurance card. Tell the pharmacist you want to pay the cash price for the prescription. Have them quote the fee and you will quickly learn, it just isn’t a sticker shock, any more than buying a gallon of milk at the counter is.
In our practice we offer in office prescription dispensing. I did this because I was sick and tired of the 3rd party cartel game being played on us. Nearly but not all states in the United States allow physician prescription dispensing. Nearly zero physicians offer this to their patients, having been conditioned to the 3rd party payer model for transactions. IF we did offer this in force and particularly for cash transactions only, you would see the PBM’s crumble like a sand statue on a western sea shore.
Our office fulfilled over 3,500 prescriptions for our patients this year so far. Per pill dose costs vary from 2 cents to under a dollar in most cases. To cover the costs of fulfilling the prescriptions, we charge 12 dollars per prescription. That surcharge pays for the license to dispense, bottles and caps, counting machine, labels and duplicates, special dynamo printers and label ink and staff time. We dispense in 90-100 day lots for convenience and efficiency. Please ask yourself, why would you buy insurance for such predictable budget items for your health care?
Once again, the above story demonstrates, health care is not unaffordable, at least not in a fair and transparent market. My past inquiries confirmed that your primary care physicians cost the insurance company 3 cents of every dollar spent. And we are your medical home! If we keep propping up health insurance companies and insisting on Medicare for All we will only be guaranteed higher costs and more hidden fees.
To show you how having pricing options affects markets, let me share an anecdote that happened this past week. I prescribed a generic medication formally name branded as Librax for a patient plagued with abdominal cramping and irritable bowel symptoms. She is a Florida Medicare patient. The Walgreens pharmacy notified me they wouldn’t fill the medication and that the patient’s insurance required a Prior Authorization form be filled out. We asked them to quote the patient a cash price. They quoted her that 30 days of medication would cost over $500! Learning of this, we went to our wholesale medication warehouse and found out it was $43 for us to procure 30 days of medication (60 pills). My staff called the pharmacy to question the $500 quote informing them what we could get the medication for. Within 24 hours, they called the patient to inform her the medication was covered at zero copay to her. Isn’t that rich folks?!!!???
Honestly dear patients, I vacillate from wanting to take a cheese grater to my scalp to experiencing a deep, perverse gleeful pleasure in exposing this crap to the public at large.
Thinking forward for your patient’s, sweet stuff. 😊 No comment on the evils of Lee Health.