The FLATLINING Podcast from Fulcrum Strategies
The FLATLINING Podcast from Fulcrum Strategies brings you great healthcare news analysis and discussion each week from industry experts who know their way around politics, economics, and a doctor’s office. Questions about payor issues, Medicaid expansion, or the No Surprises Act? We’ve got you covered. New episodes drop every Wednesday morning.
Episodes
Wednesday Oct 04, 2023
Ep. 66 - What you need to know about Medicare Advantage
Wednesday Oct 04, 2023
Wednesday Oct 04, 2023
As we enter the open enrollment period, there is little doubt that you will be seeing ads for Medicare Advantage ads on TV. Several weeks ago on the Friday Pulse Check Newsletter, Matthew Handley broke down the top plans by tv ads in recent years. Regardless if you are a patient or a provider, there are things you ought to know about Medicare Advantage plans. Can they pay a provider less than Medicare rates? Can a patient use out-of-network benefits? What is the deal with all these promotional ties with grocery stores? Matthew Handley and Ron Howrigon discuss.
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Wednesday Sep 27, 2023
Ep. 65 - Who does medical debt hurt?
Wednesday Sep 27, 2023
Wednesday Sep 27, 2023
This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon discuss recent actions by the Biden Administration to combat medical debt. The White House announced last week that they would be working to bar medical debt from being reported to the major credit bureaus which would then help patient's credit scores. But what happens to physicians and hospitals when consequences are taken away from medical debt? Plus: you'll be suprised to hear that the Biden Administration is taking on action on an issue that most credit agencies have already dealt with.
Matthew and Ron look at these questions:
Why do people go into medical debt?
Aren't there already safety nets to protect patients from medical debt?
What happens if debt doesn't matter?
Who is to blame for medical debt?
Do doctors just charge too much?
Don't the credit agencies already ignore medical debt?
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Find out what Fulcrum Strategies can do for your practice at www.FSDOC.com.
Wednesday Sep 20, 2023
Ep. 64 - NC Medicaid expansion held up by... casinos?
Wednesday Sep 20, 2023
Wednesday Sep 20, 2023
This week on the FLATLINING Podcast from Fulcrum Strategies, CEO Ron Howrigon and Matthew Handley discuss political holdups to Medicaid expansion in North Carolina. The House wants to separate the Medicaid from the state budget and pass it with a casino bill but the state Senate is refusing to agree. So who gets hurt? Is the state ready to handle more patients on Medicaid? Why should you care? Matthew and Ron break it down on the FLATLINING Podcast from Fulcrum Strategies.
Articles mentioned in this program:
House to vote on budget and separate casinos-Medicaid bill this week, top appropriator says - The News and Observer
The fate of North Carolina's Medicaid expansion could be tied to casinos - Becker's Payer Issues
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Wednesday Sep 13, 2023
Ep. 63 - Healthcare News Roundup
Wednesday Sep 13, 2023
Wednesday Sep 13, 2023
This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron break down several healthcare news items that are relevant to the business administration of provider practices. They take a look at these stories:
Cigna, UnitedHealthcare, and BlueCross BlueShield of Michigan claim they have cut prior-authorizations by 20% - Becker's Payer Issues
Affordable Care Act (ACA) compliant plan enrollment reaches record high - Kaiser Family Foundation
Prisma Health and UHC get into a nasty contract negotiation - Becker's Payer Issues
Matthew and Ron discuss whether or not the prior authorization cuts will help patients and their physicians. They also talk about ACA Marketplace plan reimbursement and how the record enrollments will affect provider revenue. And they share some tips on what to do in nasty negotiations.
Follow Matthew and Ron on X. Matthew is @RadioHandley and Ron is @RonHowrigon.
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Wednesday Sep 06, 2023
Ep. 62 - The Battle Over Medicare Coverage: Should all FDA approved drugs be paid for?
Wednesday Sep 06, 2023
Wednesday Sep 06, 2023
Matthew and Ron dive into the debate on whether Medicare should cover every FDA-approved drug, focusing on the case of Aduhelm and Leqembi, two Alzheimer's drugs. Aduhelm was is not covered by Medicare due to limited effectiveness and high cost. The Centers for Medicare and Medicaid Services announced Leqemebi would be in certain circumstances.
Key highlights
FDA approval does not guarantee that a drug should be used by everyone, it only indicates clinical effectiveness and acceptable side effects.
Medicare's decision to deny coverage for certain drugs is based on cost-benefit analysis and clinical effectiveness.
The case of Aduhelm, an Alzheimer's drug, highlights the importance of considering both the clinical value and cost of a drug.
Registries can help ensure that drugs are given to the right patients and monitor potential side effects.
The fragmented system of drug coverage and the need for a more unified approach.
The importance of checks and balances in the healthcare system, including the role of the courts.
The necessity of administrative levels and bureaucracy in healthcare organizations.
The ongoing debate about the size and efficiency of the federal government.
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Wednesday Aug 30, 2023
Ep. 61 - Breaking down the impacts of the TMA 3 ruling
Wednesday Aug 30, 2023
Wednesday Aug 30, 2023
Matthew Handley and Fulcrum Strategies president and CEO Ron Howrigon discuss the recent rulings in the third Texas Medical Association case against the Centers for Medicare and Medicaid Services (CMS), commonly known as TMA 3. Judge Jeremy Kernodle ruled that CMS violated the No Surprises Act by publishing guidelines on the Qualified Payment Amount that contradicted the law in several ways. However, Judge Kernodle ruled against the plaintiffs by deciding that the QPA does not have to be transparent. Matthew and Ron discuss what this means for physicians, hospitals, and the general public.
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Wednesday Aug 23, 2023
Ep. 60 - Public opinions on Wegovy and other weight loss drugs
Wednesday Aug 23, 2023
Wednesday Aug 23, 2023
Matthew Handley and Ron Howrigon discuss the ongoing relevance of COVID, the cost of weight loss drugs in the US, and public opinion on prescription weight loss drugs.
Key highlights
COVID still matters, especially for those at risk
The cost of weight loss drugs in the US compared to other countries
The need for a free market economy in healthcare
Public opinion on prescription weight loss drugs
The potential impact of covering weight loss drugs under insurance
Resources mentioned
Health System Tracker - How do prices of drugs for weight loss in the U.S. compare to peer nations’ prices?
Kaiser Family Foundation - KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs
Facts
COVID can still be severe for at-risk populations
Vaccines can help prevent severe symptoms
The US pays more for weight loss drugs compared to other countries
The prevalence of obesity is high in the US
The cost of covering weight loss drugs for all Americans would be significant
Action steps
Stay informed about the ongoing impact of COVID
Consider the cost of weight loss drugs and explore alternative options
Share your opinion on prescription weight loss drugs
Advocate for healthcare policies that promote a free market economy
Listener challenge:
Reflect on your own opinion about prescription weight loss drugs and consider the potential impact of covering them under insurance.
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Wednesday Aug 16, 2023
Ep. 59 - Remembering Dr. Dan Hurley
Wednesday Aug 16, 2023
Wednesday Aug 16, 2023
We received the news last week that Dr. Dan Hurley, who Matthew interviewed on the FLATLINING Podcast several months ago, had lost his battle with cancer. This week, Fulcrum Strategies president and CEO Ron Howrigon shares how Dr. Hurley's story affected him and continues to motivate him to fight for physicians.
You can listen to our entire interview with Dr. Dan Hurley by clicking here.
Wednesday Aug 09, 2023
Short: Sen. Sanders claims millions can’t access a primary care doctor; is it true?
Wednesday Aug 09, 2023
Wednesday Aug 09, 2023
This week on the FLATLINING Podcast, Matthew and Ron discuss a claim made by Senator Bernie Sanders (I-VT) that millions of Americans cannot access a primary care physician or have to wait months to get an appointment. Are these claims true? If so, what can be done?Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net
Wednesday Aug 02, 2023
Ep. 58 - Two more healthcare proposals to consider
Wednesday Aug 02, 2023
Wednesday Aug 02, 2023
This week on the FLATLINING Podcast, Matthew and Ron talk about Senator Amy Klobuchar’s (D-MN) SMART Prices Act which would speed up the drug price “negotiations” in the Inflation Reduction Act. They also talk about an idea that would eliminate the difference in costs between seeing a doctor at a hospital versus and office.Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.Articles mentioned in this program:Klobuchar, Welch, Colleagues Introduce Legislation to Boost Medicare Prescription Drug Price Negotiation, Lower Costs for Americans - Sen. Amy Klobuchar’s OfficeText of the SMART Prices Act - Congress.govThe SMART Prices Act Deserves a Failing Grade - RealClear HealthFix Medicare Payments - RealClear Health This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net
About Fulcrum Strategies
Fulcrum Strategies is a health care consulting firm specializing in payer contract negotiation and strategic planning for physician practices founded in 2004 by Ron Howrigon, a former managed care executive. After 18 years working for various national payers, Ron became disillusioned with what he saw happening to physicians, particularly their declining reimbursement. In founding Fulcrum, Ron’s goal was to provide medical practices with professional negotiation resources in order to produce better managed care contracts for medical professionals. Almost two decades later, our organization has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.