American Healthcare: A View from the Trenches

Featured Physician: Alejandro Badia, MD

Featured Book: Healthcare from the Trenches

Dr. Alejandro Badia is a board-certified Orthopedic Surgeon who studied Physiology at Cornell University and obtained his medical degree from New York University School of Medicine, where he also trained in Orthopedics. He completed a Hand Surgery fellowship at Allegheny General Hospital in Pittsburgh, followed by a trauma fellowship in Freiburg, Germany. In addition to his exceptional medical training, Dr. Badia is a physician entrepreneur and founder of OrthoNOW®, a franchise of orthopedic urgent care facilities. In his book, Healthcare from the Trenches, Dr. Badia offers a very detailed account of the major hurdles faced by physicians today in the current healthcare system. Ultimately, these are problems faced by physicians and patients, as they have a tight and most sacred relationship. Yet neither patients nor physicians are free to be major decision-makers in the complex industry that healthcare has become. Healthcare from the Trenches presents a very detailed account of how and why the healthcare system in the U.S. has come to such a grave state, one in which the decision-making process has been relegated not to the doctor but rather, the health insurance company. Most Americans will be patients at some time and will certainly value Dr. Badia’s insight into the current state of healthcare and his guidance on possible solutions to the current crisis that we all face. This is a position shared by hundreds of thousands of doctors across America and this book provides information that can help doctors and patients to ally in the mission to restore a healthcare system that is efficient and accessible to all of our community.

What are the Major Problems in the U.S. Healthcare System?

myDoqter: Dr. Badia, in your book you mention how the Health Insurance Industry was created in the earlier part of the 20th century to provide financial support for individuals in order to address their major care expenses. This would ensure that the pool of insured consumers would cover the patient in need. But this concept no longer applies. You mention that there is a conflation of “health care” with “health insurance”. The purpose of health insurance should simply be to “collect premiums” and reimburse the costs of care. Most patients are not aware of the real extent to which Insurance Companies control the delivery of the medical care that they receive. Can you explain this relationship in further detail for our readers?

Dr. Badia: Insurance companies are no longer in the business of simply paying for care with the necessary oversight, but rather have injected themselves into nearly every component of the healthcare delivery process. This not only delays and hinders care, but naturally drives up the cost. Essentially, the cure is worse than the disease when discussing health insurance company interference. Due to lack of knowledge, they do not streamline the process and avoid mistakes, but rather place needless obstacles that ultimately drive up cost. The analogy to this is in Chapter 9 where the subsection, “Authorization is a Four-Letter Word” presents the analogy of what the restaurant business would be like if run like our healthcare system. This comparison quickly drives home the point to most readers.

What Challenges Do Healthcare Providers and Physicians Face?

myDoqter: That is a good point: the fact that in many cases Insurance Companies are actually inserting themselves in medical decision-making for doctors and patients, rather than simply paying for care. As you said, they have no medical knowledge to do so and certainly do not have the personal connection with the patient that physicians do. Should patients be made aware about the current crisis we are experiencing in terms of Moral Injury to physicians and the factors that contribute to this? Patients and doctors have a sacred relationship, and in the end, just like doctors hold their patients’ interests and needs as sacred, so too will patients prove to be the strongest advocates for physicians. How can we educate patients about this so that together with their physicians, they can help restore good healthcare?

Dr. Badia: Moral Injury is essentially caused by lack of control of patient care by the actual physician. Patients need to know that the demands of providing care, the long hospital shifts, and the endless hours of study are challenges inherent to the profession, and that physicians spend lifetimes conquering these for the sake of patients. However, doctors are now overburdened by the true factors that contribute to Physician’s Moral Injury. These have to do with the fact that doctors are forced to deliver care in a particular manner, which is restrictive and encumbered.  Many times, doctors are even being denied this ability by the healthcare system and by the endless bureaucracy including over-automation of healthcare via EMR’s (Electronic Medical Records), regulations, and far-reaching oversight. The lack of control over patient care by the actual physician is what causes the process of Moral Injury. This could eventually have a detrimental effect over healthcare in general.

What is Fake News in Medicine?

myDoqter: How can patients deal with “fake news” in medicine, and in which ways do they affect healthcare?

Dr. Badia: Fake news is pervasive due to internet domination of how we get most of our news and knowledge. Clinicians must get more involved in educating the end-user of healthcare: the patient. We can provide patients trustworthy and accurate medical information by posting or writing informative articles in sites like this. Interacting with popular news media is also important in order to reach our communities. Lastly, patient education at the point of service is crucial too, followed by diffusion of that knowledge to the patients’ immediate circle of family and friends.

myDoqter: Indeed, we are hopeful that myDoqter can help deliver health information to patients straight from the mouth of those with the right expertise: physicians! How can physicians and patients work together to regain their decision-making ability in healthcare? What specific initiatives could help patients and doctors to achieve this?

Dr. Badia: Patients must take as much interest in healthcare as they do in other areas of their lives. We see an example in pop culture of what I term the “Kardashian effect”, where patients sometimes care more about strangers’ lives than the immediate impact that patient health education can have in their own lives.  Patients can also approach their health insurance carrier with concerns about their care, and have open conversations about this directly with their doctors.  It is important for the sake of our patients’ health that doctors be the decision-makers of the best medical care for patients, not the insurance company.

How Can We Solve the Healthcare Crisis in America?

myDoqter: Many physicians have recently pivoted to establishing Direct Patient Care (DPC) practices and have encountered great success and overwhelmingly positive reception from patients. A proposed solution to our health care crisis is a hybrid system of DPC with Health Insurance Coverage for Emergencies and Hospitalizations. Do you agree this approach could reduce healthcare costs for patients while dramatically improving quality and access to care?

Dr. Badia: Yes, the concept of a hybrid of Direct Patient Care and Hospitalization Insurance is very attractive because it gives the patient the control and flexibility to focus on more preventative and therapeutic care of their routine medical issues. They can focus their efforts on their relationship with their personal physician, rather than re-directing their hard-earned and precious resources to third parties who decide how their resources would be used. The success of this model could be further optimized in partnership with employers.

How Can We Solve the Cost Crisis in Healthcare? 

myDoqter: What is OrthoNOW® and what are the advantages that this model offers to patients in terms of access and quality of medical care?

Dr. Badia: OrthoNOW® relies on the simple logic that any patient with virtually any Musculoskeletal (MSK) issue should see the right clinician at the right time. It essentially converts MSK care into another division of primary care where seeing a primary care physician for these issues could lead to delayed or even missed diagnoses (much like in Ob-Gyn or Psychiatry). This could also ultimately drive up the cost of care. A walk-in center with full diagnostics, staffed by mid-level specialists under the supervision of a medical doctor, focused ONLY on orthopedic issues, will by definition drive down cost. It will also improve care if connected to the right specialists through digital health applications.

myDoqter: How does OrthoNOW® propose to broadly impact Musculoskeletal care in the U.S. and abroad?

Dr. Badia: OrthoNOW® can achieve this by creating a reproducible model to allow orthopedic surgeons and clinicians, healthcare systems, and even healthcare investors to replicate the model in multiple communities that could all stand to benefit from this radical change in rapid assessment of all Musculoskeletal issues – whether preventive, episodic, or chronic. One key component is to bring this care directly to the employer, which will further streamline care. This will lead to major cost benefits over the current outdated system of incentivizing patients in pain to see a well-meaning primary care clinician first, who may not be focused on this specific area. Information Technology (IT) solutions are also a key component. This includes a clinician communication tool where information and imaging studies can be shared and discussed real-time, regardless of geographical location. Also, patients can access tools such as the ‘On My Way NOW™’ feature of the OrthoNOW® app, where a referral source, family member, or patients themselves can estimate when they will arrive at a particular location. In preparation for the patient’s arrival, the center will already have the x-ray machine set up for that particular evaluation, even allowing internal summons of an Uber car for immediate transport. This can revolutionize acute sports medicine, as well as the management of occupational injuries and most musculoskeletal injuries.

To learn more about Dr. Badia and OrthoNOW®, you can visit: www.OrthoNowCare.com