The BRI Blog

Recently I sat down to write a short comment on the recent HHS plan to tackle one aspect of rising pharmaceutical prices. In trying to comprehend this one small piece of our healthcare economy juggernaut, I was impressed yet again by the complexity of moving parts.
Anyone who tells you they know what will happen is lying or deluded.

An uncounted multitude of complex (and frequently contradictory) regulatory and legal requirements attempt to steer the operations of Medicare – which are different from regulations and laws directing Medicaid, which are different from those on private companies. And within private companies, there are different rules for profit and non-profit entities, and for the many subcategories of each. The result is that any one action (such as a change the regulations of one sector) sets off an unpredictable and uncontrollable cascade of reactions and interactions like a gigantic multidirectional, perpetual Rube Goldberg machine. (You can begin to see what I mean by reading this white paper: “Prescription Drug Pricing: An Overview of the Legal, Regulatory and Market Environment.)

So what can we do?

In the ER, when faced with a catastrophic emergency which requires immediate action in the face of limited resources often with inadequate information, the proper response is to get back to fundamentals. Identify and focus on the sickest yet still salvageable by stabilizing vital functions, conveniently referred to as the ABCs: Airway, Breathing, and Circulation.

In medicine, we have rigorously identified those fundamentals (though not without controversy and disagreement). This country is nowhere close to agreement on the fundamentals of economics and healthcare – the clarity of which we desperately need to guide effective change.
What are the primary, inescapable laws of economics to which we must adhere in order to have a healthy, functioning economy? What essential ethical (personal, social and political) principles should guide first our triage, and then our subsequent actions to facilitate a peaceful, prosperous society, and within that framework, medical care?

Until these questions are adequately addressed, any changes made in healthcare policy will be arbitrary, random, and rudderless.

There’s no answer that fits in a brief essay except to call for civil and thoughtful conversations aimed at open and honest inquiry into these most important matters.

THIS is BRI’s mission. Let’s keep inviting others to join us in this most important task.

It is my pleasure to provide an end-of-the-year update on the state of the Benjamin Rush Institute’s chapters. I am thrilled to report that BRI is strong and growing.

Two new chapters have been added this academic year alone, and we have seven chapters actively exploring membership. These developing chapters include one nursing program and two residency programs. Both are new avenues we are hoping to add to the BRI expansion into the medical field.

We have been working closely with our current chapter leaders to learn how to best support their efforts. Having someone dedicated to the growth and sustainment of our chapters now allows us to offer our students additional help in planning their events. We want them to always feel adequately supported as they seek to educate their classmates on free market healthcare alternatives.

Building strong relationships with like-minded organizations is of primary importance to our mission in building chapters. I have been fortunate to meet and speak with many representatives from strong organizations dedicated to free enterprise solutions. Some of those relationships have developed into unique partnerships that are showing exciting opportunities for the students. Our partnership with the Cato Institute is bringing our students to Dallas in just a few weeks for an exclusive student-only summit, Health Reform U., a pre-cursor to Cato’s State Health Policy Summit, and BRI’s annual Leadership Conference will be in conjunction with this year’s FMMA Annual Conference in April. We are thrilled and honored for the future of these outstanding partnerships, and so many more.

The foundation of what we do is building chapters that can hold educational events. Those events range from lectures with policy experts and practitioners to book clubs to debates. We are excited about our new Second Opinion Debates series. Kicking off right at the beginning of the new year with events at Penn State and at the Medical College of Wisconsin, this series of debates will be focusing on both sides of the single-payer healthcare discussion. We will be hosting these debates across the country as part of the events our student chapters will hold on campus. Sharing many of our campus events via social media now – livestreaming events on our Twitter and Facebook pages – allows so much more access for our chapters. A chapter in one part of the country can host a discussion and students at another chapter can watch live! We will expand this functionality more in 2019.

We need your help to keep our mission going. Help me reach out to more students. Help us send more students to more conferences. Directly impact the work Robbie and I do in your state or at your medical school. Sponsor a Second Opinion Series Debate.

I am happy to answer all of your questions, and if you know any students that would like to start a chapter, I would love to speak with them. Please reach out to me directly, 703-835-6118 or [email protected]

Thank you for your support.
~ Rebecca Kiessling, BRI Director of Programs

Health care has emerged as a top issue for voters in the upcoming mid-term election, playing a prominent role in many House, Senate, and gubernatorial races. Many health-related measures are even on ballots in several states. Political ads, highlighting popular provisions in the Affordable Care Act (ACA), including protections for people with pre-existing medical conditions, are a fan-favorite of Democratic candidates.
The Kaiser Family Foundation reviews media coverage and political advertising by candidates during the current election cycle, to explore health care issues being discussed by candidates in key gubernatorial and Senate campaigns across the country. The aim of this review is to assess where health care issues have been a focus of the candidates, not to assess the impact of these issues on voters. – click here! 

Few things in the healthcare market can be as potentially disruptive as retail clinics, and for that reason so much attention is focused on them. A recent survey showed that 91 percent of patients who used a retail clinic reported that they were “satisfied” or “very satisfied” with their visit. With retail clinics being called the healthcare “game-changer”, can DPC compete? Or can retail clinics and DPC live together in harmony?
Read more HERE

My name is Dr. Kristy Hawley, I am a third year surgical resident in the MedStar Health Baltimore program. I have been an active member and participant in Benjamin Rush Institute (BRI) activities since my first year of medical school at The George Washington School of Medicine and Health Sciences. I was recently asked to give some background on how our paper, The Impact of Price Transparency for Surgical Services, recently published in The American Surgeon on price transparency for surgical services came about.

I attended the Free Market Medical Association conference in 2015 as a medical student with the assistance of a BRI scholarship. At this meeting I had the opportunity to tour the Surgery Center of Oklahoma and spend time with Dr. Keith Smith discussing his journey in setting up his very successful and press-worthy surgery center. The unique aspect of the Surgery Center of Oklahoma is that it is completely transparent with its pricing. It was interesting to hear that when trying to determine prices for the operations many of the surgeons actually underestimated their worth. The final list of prices has been quite affordable for patients and the surgeons and anesthesiologists have been quite pleased with their compensation. The Surgery Center of Oklahoma now competes significantly in its local market for surgical patients because it offers transparent pricing, high quality care and high level of patient satisfaction. While I am always a proponent of price transparency, something incredibly unique about this place is that the surgeons, anesthesiologists, and nursing and OR staff seemed very satisfied with their jobs. While they were being fairly compensated, they also had ease with booking cases and were working in a very efficient environment, which allows for more time outside of the OR for outside work or leisu

The leading barrier reported to making prices transparent was discouragement from another practice, hospital, or insurance company.” ~Kristy L. Hawley, MD MPH

The press covered the success of the Surgery Center of Oklahoma in the early 2010s when giving examples of free market solutions versus the Affordable Care Act which was government funded and driven. In 2009 the Surgery Center of Oklahoma posted a list of prices for 112 common surgical procedures online. The premise behind the Surgery Center of Oklahoma is that making prices transparent while also delivering high quality care makes healthcare more affordable to the average American. One article gave the example of an uninsured Florida woman who paid $10,800 for a hysterectomy at the Surgery Center of Oklahoma versus $33,000 quoted by hospitals in Florida. The success of the Surgery Center of Oklahoma inevitably led me to think how useful it would be to share the story of this center beyond stories from the press. After attending the conference in 2015, I connected with Dr. Marty Makary, a pancreatic surgeon at Johns Hopkins who advocates for more transparency in healthcare; and we decided to attempt a survey of surgery centers that have made their surgery prices transparent. We hoped to determine whether or not making prices transparent had an impact on their bottom line and whether or not there were higher levels of patient and physician satisfaction.

While increasing insurance deductibles have prompted some medical centers to initiate transparent pricing, the actual impact of price transparency on surgical volume, revenue, and patient satisfaction is unknown. We found limited information on the barriers to achieving a business model with transparent pricing. Dr. Makary, along with Dr. Ambar Mehta, Tim Xu and Ge Bai from Johns Hopkins, and I worked together to devise a survey that would give some insight into these questions.

We identified ambulatory surgical centers in the Free Market Medical Association database that publicly list prices for surgical services online. Six of eight centers (75%) responded to our data collection inquiry.

• Among five centers that reported their patient volume and revenue after adopting price transparency, patient volume increased by a median of 50 per cent (range 10–200%) at one year.
• Four centers (80%) reported an increase in revenue by a median of 30 per cent (range 4–75%)
• Three centers (60%) experienced an increase in third-party administrator contracts with the average increase being seven new third-party administrator contracts (range 5 2–12 contracts).
• There were three centers (50%) that reported a reduction in their administrative burden, and
• Five centers (83%) reported an increase in patient satisfaction and patient engagement after price transparency.

The leading barrier reported to making prices transparent was discouragement from another practice, hospital, or insurance company. The findings of this preliminary study may help guide medical practices in designing and implementing price transparency strategies.

I share this background on my participation in this recent study to advocate for medical students to get involved in the BRI. The networking opportunities are extremely valuable in terms of finding like-minded individuals who may be interested in topics related to free market medicine and protecting the doctor-patient relationship from overregulation by government interest. My participation in this conference enabled me to make the connection with Dr. Smith and see first-hand a highly functioning outpatient surgical center with transparent pricing. The high level of physician and patient satisfaction at this center is what prompted the idea for the survey. I continue to be interested in the impact of price transparency on lowering costs and increasing quality in patient care and as a surgical resident it will most certainly influence my career as a surgeon.

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In Dr. Fonseca’s talk, From the Trenches: The Fiduciary Responsibility of the Physician to the Patient, he exposes consideration of daily clinical practices that can erode the physician’s fiduciary responsibility in the process of patient care. This includes discussions related to patient care, treatment selection, policies and value frameworks.

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Rafael Fonseca, MD, is the Getz Family Professor of Cancer and a Professor of Medicine. He is a consultant in the Division of Hematology/Oncology at the Mayo Clinic, AZ and Chair of their Department of Medicine. Dr Fonseca earned his MD at Universidad Anahuac, Mexico. He completed a residency in internal medicine at the University of Miami, FL, and a fellowship in hematology and medical oncology at Mayo Graduate School of Medicine, Rochester, MN. He is a clinical investigator for the Damon Runyon Cancer Research Fund.

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