The Executive: Cristin A. Dickerson, MD

Transcript

[0:00] Flip Radiology on its head typically an Imaging Center plays a radiologist a flat fee to read the study and then bills globally bills for both the interpretation and they scan.
Flip that on its head I paid a flat fee to the Imaging Center for the scan we interpreted the exam and we build globally.

[0:26] Paging dr. cook paging dr. cook dr. Kirk you’re wanted in the OR.

[0:33] Music.

[0:57] Hello everyone and welcome to prescription for Success I’m dr. Randy cook your host for the podcast.
Which is a production of MD coaches providing leadership and Executive coaching for Physicians by physicians to overcome burnout.
Transition your career develop as a leader or whatever your goal might be.
Visit MD coaches on the web at my MD coaches.com because you’re not in this alone.

[1:26] My guest today founded green Imaging for the purpose of providing affordable high quality Imaging services for the uninsured and high-deductible patients in Houston Texas.
Her effort has been wildly successful and currently is available in most US states.

[1:46] To get the details let’s hear dr. Christine Dickerson tell her story.

[1:51] Music.

[1:57] Really excited today to be speaking with dr. Christine Dickerson out in the Houston Texas area who has a fascinating story to tell.

[2:07] And it particularly fascinates me because.
It’s coming from a radiologist who has a really intense interest in.
How we’re going to deal with the ridiculously out of control prices of healthcare So Christine thank you so much for.
Being with us today I’m looking forward to the conversation as I might thanks for having me Randy.
Well I think this is going to be fun as usual I like to begin with the beginnings and that means I’d like to know.

[2:41] When you began to develop an interest in a medical career was that like a Early Childhood thing or did it come later.
It really wasn’t it I was I got a good paying job in high school as an EKG technician and I was only 16 but I friends
friend of my parents was running the department and needed an evening Tech and it was better pay than I could get
doing anything else at that age and so I became an EKG technician and that was really the start
of looking at medicine as a possible career there were so many you know medical Mysteries that the fun part of.
Medicine for me is and that’s why I’m a diagnostic radiologist is solving what’s wrong and pulling all the clues together and coming up with what in this
feel this a diagnosis so you didn’t really have any medical influencers in your family this was something that you discovered.
Quite by Serendipity it sounds like it really was no I’m from a family full of lawyers actually oh my goodness and then an interesting thing happened.
We had a good academic background but after your graduation from Baylor you took a year off to do a research project as a research assistant and.

[4:07] Nuclear medicine how did that come about I did I because I screwed up I was a kid I missed a deadline
on an application for the medical school that I really wanted to go to I had them all stacked in and you know one of those crazy things and so it really ended up being a great year and and also convinced that I
was intent on being a doctor.
Point having you know works that year in actually nuclear medicine so a related field and you know I’ve had the enough experience there that I knew that’s what I wanted to do.

[4:42] Can you think of anything that you learned during that year that really served you later on in your career
I can I loved the long the relationships both of the
Physicians and the staffs of different practices working together and exchanging patients and information and the in this practice there were a lot of
there was a lot of thyroid disease and so these patients came at back year after year for their scans and their takes and those relationships were fascinating and so I really I think I moved from the science and of Health Care to the to the people and of healthcare
yeah as a research assistant and what was the nature of the research that you were involved in.
It was nuclear medicine basically the outcomes of thyroid ablations
and for both cancer and for hyperthyroidism the doctor I was working for Herbert Allen was really a Pioneer a nuclear medicine so it wasn’t I mean it was actually Interventional medicine it was not just Imaging.
Correct yeah I bet that was really fascinating but then you finally got your ducks in a row and 1985 you’re in medical school.
University of Texas in Houston and.

[5:56] What was it like in that first year did you think yeah I really hit it out of the park or did you ever have any second thoughts or.
No I really didn’t and I loved when it really got fun was the third year when we started doing the clinical rotations that’s that was the great part I you know the first two years I think I had a really good basic science background that helped me you know.
Get through those first two years pretty easily the clinical part of it got really fun and then once we got to the electives in the fourth year.
That’s when I discovered first elective I did was radiology and I know that’s what I wanted to do
and did you have a premonition of that or did the Radiology elective just happen accidentally
her it happened accidentally and well I mean it was it was an alternative I had always you know found the diagnostic
piece of medicine to be the fascinating part or the most interesting part and the other
piece of that later I did pathology which is a very similar thought process yeah and I did it isn’t elective yeah and it’s very similar and I probably if I had done it first I might have considered all though
I always see my eyelashes in the microscope so that may not have been okay if it
I got this that could have been a hell yeah might have been a hindrance but we’re probably found a way around it I probably would have figured out how to do it right but anyway I loved the thought process and as far as the you know other Specialties I thought.

[7:24] Nephrology was fascinating
hepatology Rheumatology those were other diagnostic dilemmas that I really enjoyed but that’s pretty good that you that you were able to figure that out
that out early along the way and I’m assuming that you probably took more than the average number of radiology electives
during your last couple of years as I guess most Radiology residents or are sort of required to do you did an internship here
I guess in general medicine and those sorts of things
yes I did a transitional year which is when you’re able to rotate through which I think is awesome for a radiologist because you get the clinical background and
we’re really kind of a doctor’s doctor and so you get the clip you know more of a clinical background in multiple Specialties and subspecialties and so that was a really great year we goes back and forth about whether internship it’s state-by-state and also just the recommendation for whether or not
radiologist should have a clinical year.

[8:27] It tends to go in and out of fashion the latest fashion has been it’s been more important to have a fellowship but then we lose the guys who can just
You Know cover everything and make sure that a practice you know has
emergency coverage so I am a general radiologist although I do have you know
things that I have trained longer and harder and and have much more experience and especially oncology and that was one of the blessings of training in Houston was that I trained at MD Anderson and you know got a very strong background in cancer Imaging
well I know that as a surgeon I’m prejudiced but I have to tell you that my feeling is that.

[9:06] Radiologists who have some experience some substantial experience at bedside care are better at what they do and I’m wondering if you think that I’m right or wrong or it could go either way with that.
I absolutely agree with you and I think that’s how I ended up
doobie I spent most of my career with multi specialty groups with the two large prestigious multi specialty groups here in Houston Diagnostic Clinic of Houston straight out of residency and then Medical Clinic of Houston
adjacent to the Texas Medical Center and and when you got into your residency training did you have the feeling that.
Wow this is about as good as it gets I’m really I’m really right where I want to be or there ever any doubts at all
first day was at MD Anderson in this big reading room we still were on film and you would have had light boxes surrounding this huge room
and by the end of the day I would my eye it’s amazing how much you have to build your eye muscles too
practice Radiology by the end of the day the first month I was just exhausted but I loved it and we had you know probably one of the.

[10:11] You know top three faculties in the country at that point in time so it was very exciting and it was a great start.
I’m really not sure it looking at your CV if you had some particular
leanings and special areas where you would like to concentrate that that occurred to you at all at that point at that point in time Mr I was brand new
people weren’t being trained you know and subspecialties as much as being trained kind of on the new modalities and so I did I became a junior faculty my last year
and helped staff the MRI facility so I really.
That was basically a mini Fellowship but like I said I think my passion has been cancer Imaging of all types including breast Imaging and the other thing that was emerging when I finish residency I actually.

[11:04] Participated in the first stereotactic breast biopsy at MD Anderson LBJ Hospital here which was the county hospital I was the chief resident and so I got
privilege and when I went to Diagnostic Clinic they had just purchased a stereotactic
breast biopsy machine so of course that went to the
the new radiologist and I had a surgeon at their asset surgeon tell me it’s never going to become the gold standard it’s always going to be surgery and pretty soon he became my best referral source
yeah well you know it’s funny I remember those days as well in fact I was just thinking about the early days of
of Mr and my experience was.

[11:49] To see it in two different perspectives I worked at a really busy multi-specialty group in the Tampa Bay area.

[11:56] And we got into on-site Mr right away and then I decided to move back home to Alabama.

[12:05] And when I did the Mr was something that came up and visited on a truck.

[12:13] Every now and then right so you know there were so many
unanswered questions at that time and I think it’s reasonable why people would look at that and say you know if you got to go through all this how is it ever going to become a thing but.

[12:28] It certainly did let’s move you on to what happened next it looks like your first private practical experience was with Diagnostic Clinic of Houston that’s my understanding
that the philosophy of this group
it sounds like it was pretty much like what the name implies and that is it’s all about evaluating and getting to a diagnosis.
And then referring to Specialty as necessary as opposed to having specialist on the site was that about
the size of it we did have a number of specialist but they were medical subspecialists we didn’t have surgical subspecialist we had many surgical subspecialist who were right down the hall and worked with us very closely but if you know having having been prison
president that group in figuring out how to pay people it was always kind of a challenge to to incorporate the surgeons and the medical people in the same practice even that practice very successfully had Radiologists as
as partners that and the philosophy there was and I think it was a great one was that the radiologist would make the best decision about new.
Let me know about the expense of new equipment and the risk of new equipment if they were invested and it was absolutely true and you know that
we very much were part of the.

[13:47] Financial equation and figuring out if new equipment was justified or not and I loved that part of it and I loved working that closely with these doctors we actually sat down to lunch every day together and
discuss patience and I think that’s actually the right idea
yeah and it’s funny that that’s gone away it’s just heartbreaking for me it is heartbreaking now that some of the best aha’s happened in that setting and.
Plus we had the camaraderie we knew each other we knew about each other’s families it was more new talk about a great culture.

[14:22] Monica had a wonderful culture and and so this Evolution into.
The Radiology Group of Houston was that actually associated with diagnostic clinic or was it a totally separate entity
along the way we digitized their couple of stories that happen here number one is that I really went to Diagnostic Clinic of Houston because I never wanted to be.
The business of medicine what a quack.

[14:49] That was my just a bit work out for you and what happened was we had a new business office manager who brought me in this huge.
Box of what we call the Yellow tickets and it was the they were the tickets that the hospital would give us for the work that we did nights and weekends on call and she showed me that most of them did not have enough
information to collect from the
and so that was my nights and weekends away from my kids and family that we were basically giving away and so I thought I might get involved at that point and I ended up two years later bit coming
president of the multi-specialty.

[15:30] In 2005 we were on a mission to become you know one of the early digitized Radiology departments and then free-standing world and So within about a year and a half we were able to accomplish that and at that point in time we had six radiologist but our work
load became that
43 Radiologists and instead of letting go of Partners I decided I would go out and get us some additional contracts there are plenty of imaging centers who could use our
help and so founded Radiology Group of Houston on this side
at what point and how did that evolve into green Imaging we were practicing with multiple the ready Diagnostics Clinic of Houston was ultimately
choir and I don’t even I wasn’t they let they had to let the radiology department go.
Because it was competing with the hospital that somehow
got financially involved with the group and so it was blurry to me because I wasn’t I wasn’t at that point involved and so it was really easy for us we already had this Radiology Group and just continued
you know to practice outside of that so that was really seamless been in 2010 2011 it started becoming clear to me
that in Houston their friends would call and say hey.

[16:49] They want three thousand dollars for this MRI over at the hospital where can I go get an affordable exam and there weren’t good options in fact the large chain of imaging centers had been acquired by a hospital
that and then that was the end Network option and so.
The other problem was that you know the ones that did have self pay rates the self pay rates were all geared toward the Texas Medical Center International visitors you know they were sky-high and so there
wasn’t a good option and so I decided to solve that problem got a pro forma to build an Imaging Center you know
similar to the one we had that a diagnostic and it’s going to be three to four million dollars and I knew I couldn’t
I’ll forget pricing it my prices were going to have to be the same as everybody else’s so at that time a lot of the sharing models the reselling models Travelocity Amazon things like that were emerging
and the Stark laws allow radiologist more latitude than other Physicians for lease
and so since we were reading for multiple imaging centers in Houston that we’re at half capacity I got the idea to try to buy the extra time on their scanners at a discount
flip Radiology on its head typically an Imaging Center plays a radiologist a flat fee to read the study and then bills globally bills for both the interpretation and they scan.

[18:14] Flip that on its head I paid a flat fee to the Imaging Center for the scan.
We interpreted the exam and we build globally and so we built pretty quickly I would say within a couple of years we built a great
Houston and then Texas network of imaging centers using that model so that was really the start of green Imaging
hi I’m Rhonda Crowe founder and CEO Forum D coaches
here on RX for Success we interview a lot of great medical professionals on how they grew their careers how they overcame challenges.
And how they handle day-to-day work I really hope you’re getting a lot of great information.

[18:55] But if you’re looking for an answer to a specific problem management or Administration challenge.
Or if you’re feeling just a bit burnt out like maybe you chose the wrong career.
Well then there’s a faster way to get the help you need now it’s not counseling it’s coaching.
RX for success is produced by MD coaches a team of Physicians who have been where you are I know you’re used to going it alone.
But you don’t have to get the support you need today visit us at my MD coaches.com to schedule your complimentary consultation.

[19:30] Again that’s my MD coaches.com because you’re not in this alone.

[19:39] We’ll get back to our interview in just a moment but right now I want to tell you a little bit about physician Outlook
if you haven’t discovered this remarkable magazine please do so very soon it was created by physicians for Physicians to showcase the intersection between clinical and non-clinical interests whether it’s writing.
Painting cooking politics and dozens of other topics physician Outlook gives a physician perspective
it’s available online and in print it’s really unique among physician lifestyle magazines and like the prescription for Success podcast
physician Outlook amplifies the voice of any physician who has something to say it also engages patients who still believe in physician-led
team-based care and prescription for Success listeners can get 3 months free when you enter our promo code
RX for success and select the monthly option at checkout that’s a really great deal on this stunning publication.

[20:42] And now let’s get back to today’s interview green Imaging.

[20:50] Has quite a large reach nowadays right we do solving the.
The issue of you know multi-state coverage was one that took me a while to
to really wrap my head and hands around and you know the problem is that healthy.
It’s one thing to Market to individual patients to self-pay patients where you really can have the most impact is is health plans and about 50% of the.
Health plans in this country fifty percent of people are covered by a Health Plan actually it’s their employer that is sponsoring that health care plan and so self-funded health care plans are.
You know where the volume is and so if I was really going to grow this National and help the most people possible I needed a way to be in all states because if you have somebody in a health plan they may be located in.

[21:49] Kissimmee Florida but they may have kids you know living with the mom in Montana
and so you really have to have a much wider reach than just one state I couldn’t be HEB and just be in Texas I had to you know to have a national footprint and you know
aside from I don’t want to have to have 50 medical licenses to do that that would that was not attractive that CME would be I think it would take all of my time and so on
we had to figure out a model to work around that so what we do now is where we have a large number of covered lives as we do in Texas Florida Georgia Colorado Louisiana.
We get our licenses and we read those studies where we
don’t have a large number of covered lives we serve more as a traditional Imaging Network
with the difference being that we have peer as radiologist we have peer review access to images and reports so if there’s ever a question of quality we can jump in there and take a look at that and as you know assure that the the proper exam was performed and that the report is accurate and
quality of the exam and so it really creates a huge differentiator for us as compared to any other Imaging Networks.
You got a lot of Sinners out there I’m embarrassed to say course I’ve been report tired for.
Couple of years but I was not aware of the existence of green Imaging and a quick Google search.

[23:16] Showed me today that there is a center less than 20 miles from where I live and I live.

[23:24] Deep in the wilderness of these Talib Amma the central and southern east coast the South and all the way
across to California we’re just starting to get a significant number of covered lives but as far as Arizona then up to Utah now.
Are our that’s our best geographic area.
And now those are obviously the most populous as well and along those lines I was going to ask you if you find some states.
Measurably more difficult than others or is it a huge stumbling block or are most all the same.

[24:03] Huge Market variability Boston 90% of the Imaging is performed at in the Mass General system or at Boston Children’s and there’s very little outpatient
Independent Imaging performed there and you know so what is there they do
typically replicate the Mass General protocols which are long and so it’s more time on this machine and they exams cost more
I would also say that Texas and Florida are very competitive markets and the direct Contracting world you know while they are Hospital dominant maybe the hospital domination has lead to
Physicians breaking off and Arden.
You know staying independent but what we’re hearing in the self-edit healthcare plans is that Texas and Florida are great markets for that you know for whatever reason
you know we’ve been pushed in the free market Medical Association here in Texas and really trying to get the word out to doctors that they have this option to not be beholden to the insurance companies and Hospital Systems sounds like a great idea to me
and then the question that I suspect a lot of our audience.
Is asking is what makes green Imaging green.

[25:21] They’re a couple of things that make green Imaging green number one is the money that we save and we’re able to save a greater than that they can’t get greener than that
we save individuals and health plans about sixty percent as compared to the typical price in a hospital system or in a self-funded health care plan and some exams we you know what.
For 20 percent of the cost of the same exam in a hospital and then the other is the fact that we do not open new brick-and-mortar instead we use existing resources and you know use the under
tapped time on the table and you know the interesting thing that happened to us early on as you know usually radiologist sits in a
at least at that point in time now it’s mostly teleradiology but at that point in time they sat in a dark office and you know just read what was handed to them
we started bringing you know patients to the imaging centers and they all wanted us to be there Radiologists and so you know that kind of.

[26:19] Impeded our growth to you know in the scheduling and concierge business early on
I think it’s going to be a great opportunity for us again you know at our core really is a Radiology Group
and what’s happening in the industry right now is all the mergers and Acquisitions you know these imaging centers were at 50% capacity for three months and twenty twenty still everybody’s at about 80% of typical capacity costs or.
Dramatically higher and lots of re schedules and cancellations and so a lot of the imaging centers have there
Reyes and Simon mad and Acumen have been acquiring centers and their other companies as well and then also in the radiologist space there are emerging.
Radiology they call themselves supergroups North Carolina there’s one that’s 1400 radiologist and what they do is they aggregate
they quote unquote good old contracts they look at you know 40 Radiology groups contracts and they find the best one and they start billing under that contract as a large group
and that’s really driving up
the cost of Imaging so what we saw in a recent and set of Blue Cross Blue Shield claims data was that the percentage of the total Imaging spend that was professional fees prior to the pandemic was about 22 percent
and in this last set of Blue Cross Blue Shield data it was 45% and the facility fee isn’t going down so that’s just being added to you know to the Top Line.

[27:49] You make a point that one important component of getting this underway is.
Educating employers why is that and what does it mean you know that’s the perception is that people want to Blue Cross Blue Shield or signor at a card in their pocket what they don’t realize and
this is there’s a great case study about this there is a school
and Central Florida school district Osceola County where in 2019 the employee wage increase was completely wiped out by the increase in there Cigna premium
not only that these employees had a four thousand dollar deductible and then a 50 percent coinsurance up to a six thousand dollar maximum out of pocket
so basically they were paying 20% of their income for a health plan they couldn’t afford to use and so the teachers union went to the school board and said Something’s Gotta Give
and so they looked at what was going on and actually the near site Clinic was in a hospital system where we know the cost of care is five times greater typically than that with an independent physician Lee and yeah and so they District implemented they still had signal.

[29:01] You know in place they couldn’t do anything about that for another year.
But they put they move to the near site Clinic to the rosin Health Center and that’s a great story in and of itself and they put green and at zero out of pocket so that the employees had access to this not just a clinic it’s a true Health Center
and then they also put green Imaging in at zero out-of-pocket to ensure that they could get the
Imaging exams they needed and we saved in the first year we had estimated 1.3 million in savings
we actually saved the district and its employees 1.5 million in 2020 despite the pandemic and it’s 2.5 million this year so.
What employers have this idea that people want to Blue Cross Blue Shield card what they want is.

[29:50] Affordable high-quality care and there are so many ways to achieve that even with the Blue Cross Blue Shield.
Card on the pocket I have a friend who owns urgent cares here and you know she these nurses want to what we call a Bucca
you know Blue Cross Blue Shield United sick that neck card but she pulls everything she can and we did this at Diagnostic Clinic as well
pulled everything week she can out with direct contracts so that they never touch that Blue Cross Blue Shield plan and our premium stay low and so her employees come to Green Imaging are you astounded as I am that
in spite of the fact that Blue Cross Blue Shield is really not doing anybody any favors for the most part they are looked upon as the gold standards to.
It really is and you know as somebody I think it’s Keith Smith that put it really well you know when everybody every doctor you know is it is I’m not almost every doctor we know is in network with Blue Cross Blue Shield what’s special about that.
You know what are their quality measures what what what are they doing you know what kind of fiduciary do they do the are they providing so it’s really pretty fascinating.
They certainly have complete lock on the system in the state of Alabama where I live and.

[31:07] You’re absolutely right nobody seems to be asking the right questions but we’re getting closer because of people like you and that gives me some.
Room for enthusiasm you’re really getting Way Beyond radiology and into the nuts and bolts of.
Where the money comes from and again I find this to be remarkably unusual for.
Radiologist but in the blogs and pieces that you’ve written.

[31:36] One of the things that impressed me is you have a three simple solution.
Hi Expose and number one in that list is primary care is the foundation you want to talk about that a little bit.

[31:47] I really do you know 90% of care in this country can be performed by a good primary care physician
and it’s really fascinating that we have people who hurt their knee and the first thing they do is go to an orthopedist.

[32:03] And the great opportunity for four primary care is that right now it’s on an unsustainable model.
The fee-for-service model you know that doctor too
let’s make a living to pay off their student loans you know has to see 20-something patients in a day and that does not end
and they spend over fifty percent of their time recording that information in an EMR and in the electronic medical records so it doesn’t it
doesn’t make sense but if we can capture more at the primary care level and pay the primary care doctor fairly we achieve tremendous savings and.

[32:47] You know one of the things that we love it green Imaging is that were easier to use in the traditional system and that’s what everybody says about direct primary care or the.
Subscription-based Primary Care is that Health Care becomes so much easier not only is this Primary Care.

[33:02] Taking great care of them of their kids frequently if there’s a specialist referral that’s needed and it’s a Telehealth that drug primary care doctor is on
the conference call with the patient and The Specialist and rittany and I’m not relying on a consult I receive a month later.
But really discussing the patient and the way we used to over lunch pigs and
yeah and so the other thing that they do is they serve as a sherpa through the health system so that redundant testing isn’t performed if somebody really does need to go to the emergency room to rule out appendicitis
the DPC doctor can share with the ER doctor you know what the labs were today what the ultrasound showed what you know.
The clinical information leading up to the ER visit and avoid redundant testing and also you know provide frequently a much more insightful history than the patient might be able to relate when the patients in pain or.

[34:01] Absolutely and then the the second component of that of your three Simple Solutions and this is the part that just absolutely.
Astounds me the most and that’s the price transparency or lack thereof where did that come from.

[34:19] You know there was an interesting article that came out in the raise it Radiology business journal’s today about why why price transparency is failing and you know one of them is the specialist that bill
let’s do split billing and so about 70% of Imaging in this country
is build split build where the facility bills for the scan itself and the radiologist spilled IT professional fee and.
Interestingly a lot of the specialist don’t want to play along and you know provide flat fees for the hospital so that the hospital could provide it bundle charge
not that the hospital’s want to play along with transparency but it’s one of the reasons being cited the other thing that I think is so hard for Hospital transparency is actually
you know part of the problem is not just the cost of the study part of the problem is the redundancy of care you know where
a patient might have a you know CT scanners and outpatient then two days later it’s repeating of the same exam.
With no change in symptoms is repeated in the hospital because they don’t have the record of the prior so many things are wasted and.
You know in those just add to the cost so even if you can look up that I’m going to have a cholecystectomy and I’m a gallbladder out and this is how much it’s going to cost
if you you know had an anesthesia reaction and this and this you’re not going to be able to.

[35:47] Many of the expenses that happen down the line and so you know that is one of the things when we get to bundled pricing where actually you know the risk is being written into that bundled price you know that that is a solution but right now the hospitals
and the insurance companies have no incentive to release these rights that they’ve negotiated their making record profits and
you know they can whatever the penalty is it’s it’s a slap on the wrist right now for not complying with the transparency and even the ones who.
Comply do it in very
interesting ways they will only release probably a lot of them will you have to submit an inquiry and they will only submit pricing to the
him or herself you know not to a third party
you know so so a DP C doctor can’t go shop on behalf of the patient you know there are a lot of interesting strategies that there.
Taking their where in fact I think you know there are a few I know that the Krista system
here in Houston we’ve been able to my husband went in and we were on a defined benefit health care plan and so the first surgery he had kidney stones and ended up with one procedure right before Christmas and the other of course January 2nd
what they did octuple the first one he was billed out at 40 now.

[37:11] 30,000 and we were able to negotiate it down to 10,000 and the second one we went in and.
It was planned went in and negotiate have negotiated a cash right got it for 5,000 and it was built out at 40,000.

[37:27] So you know some of them are starting to work with patients and I think
I think that will we will start seeing more and more of that the health sharing Ministries are really catching on especially cetera that is.
You know encourages patients to go out and be basically self-pay patients and then they get reimbursed by the health plan and so I think we’re going to see more and more negotiation like that we’re going to
not see the tree the hospital’s themselves being transparent for quite a while.

[38:00] If you can give us a simple explanation for.

[38:05] Why lack of transparency is so terribly important to the hospitals because it’s protecting.

[38:12] Their way of life the hospital’s I last I saw I think it’s eight administrators
per doctor in a hospital system they’re very heavily and they did there are lots of regulations they have to comply with.
I will say that it is they are highly regulated there’s lots they have to do and they have to stay safe and they do complex things and they do a myriad of exams I understand that piece of it but still the administrative burden is
very very expensive and they get paid a lot more than the doctors do is the other kind of do dirty Secret in there yeah.
I practiced for 44 years and in that period of time the number of administrative personnel.
Increased by thirty two hundred percent I still can’t understand what the justification for that is and then I think you just gave it to me.
It’s just part of the subterfuge right.

[39:17] And at that sort of leads me into my next question one of the things that you’ve written about a lot in your blogs and that’s the middlemen you want to give us a little
expose on just exactly who the middlemen are and who they represent and why they are truly I think the worst of the bad guys.
Yeah I mean that they occur all all throughout Healthcare and and I always want to throw in unnecessary middlemen because there’s some middle men who are serving a great purpose and I would say that’s you know.

[39:51] Medical management has a kind of its kind of a dirty word and imaging because they’ve thrown off that’s at us and Ott’s do nothing to change utilization they just slow down the process and.
Add more friction to the Imaging process but medical management done properly
can redirect patients to higher quality lower cost
sights and aim deadbolt who’s a nurse founded aim and she does just that she gets patients to you know.

[40:27] Five you know.
It their rankings of surgeons and she tries to get him to the top five or ten percent you know in for that surgery that’s performed and and it’s amazing how when you show.
Patient see now that here’s your doctor at 43% here’s this doctor in the same practice that’s it you know 92% how easy it is to redirect so you know there are people doing good.

[40:54] Middleman work there are also people who are doing you know pbms up the cost of and Pharmacy benefit solutions that what that.
Benefit management manager yeah.
Those are middleman who nobody you know are just shoveling around are trading are I think and they’re just there
serving no good purpose except to drive up cost that would be an example of that I think another really is that we don’t talk about much but not for profit
it’s Hospital Systems my dressing room looks out over the Texas Medical Center and I look out there and I look at all this
quote unquote not-for-profit hospitals sitting there on the most expensive real estate in Houston using our resources are trains and buses and Roads and.
Fridges and.

[41:46] You know and not giving back to the community since the Affordable Care Act came into existence the percentage of
charity care that hospitals quote-unquote giveaway has dropped from likes.
Seven to thirteen percent to now it’s about three percent so they’re actually doing even less yes and you know in Houston at least they’ve become REITs real estate
fans basically because they’re buying up all the Suburban land Building these big buildings that are half empty these doctors go out there you know one day a week to see patients in the suburbs and really there you know enriching their.
Folio with this expensive land and you know I.

[42:28] That’s one of the ones that I find the most bothersome and yet they get so many advantages as compared to for profits and how you know how they get to operate.

[42:38] Yeah they really do and that’s been a great puzzlement to me because one of the as you’ve already mentioned one of the justifications for giving them the tax breaks.
Is that they’re supposed to that that’s supposed to offset their disadvantage and when you look at them it’s very difficult to see exactly.

[42:59] Where their disadvantages actually are because they look like they’re doing very well.
You want to talk a little bit about what it is about the terribly flawed system that we have that makes predatory pricing so easy so possible.
It’s the complexity of the way coding and billing.
Are performed and so it is very important to have some standardized way to describe what occurs in a medical encounter.

[43:35] For example a chest x-ray.
You know weight it is very logical that we have a code for two views of the chest as compared to a code for for views of the chest the time in the room they
Radiologists time all of those things have to be factored into what spayed and so the AMA actually owns the rights to the.
CPT codes between the ones that we use to code what happened in the medical encounter and the ICD-10 which are how we code what the patient’s symptoms and findings are
and those are used ubiquitously throughout the system
well is there is a lot of lack of let me see maybe intentional complexity for example.
There is a code for bilateral hip x-rays but there’s not a code for bilateral elbow x-rays or bilateral shoulder x-rays there is no logic to the way this is put together which makes the complexity for.
Everybody who’s doing labor in this market too.

[44:40] Everybody has to look things up all the time and figure things out and ask questions you know that’s adding to the cost of Labor and but the other thing is it makes it really hard for somebody to really understand what’s going on.
In the claims data so in Texas we have a law where employers over a certain size have.

[45:00] Can’t imagine that employers have a smaller size wouldn’t have access to their claims data they don’t but if you’re a big enough employer you can have access to your claims data
when the Buca plan send these across to the
whoever it is you know the employer himself the benefits advisor you know somebody who’s doing analytics for them they send it on over in a mush it makes it
it’s nonsensical it’s frequently missing some of the modifiers some of the fields that you need to analyze it but when you are persistent and you get a large volume of claims data
it’s still complex– to know what’s going on in that system and I will tell you that I actually had a.
TPA a third party administrator who processes claims for a Health Plan send out a comparison quote-unquote comparison of Aetna.
Pricing compared to green imaging’s and what they did
they showed that we were about the same as which is not true and what they did was they just took the CPT code and they averaged it by the you know number of exams that were performed instead of what you have to do with.

[46:11] Imaging because 70% of those exams are split build you have to look at the modifier and you have to break out the professional fees and the technical fees add them together and then them
then divide them by the number of the exams performed it’s so if the analytics are not done
properly you get false information and even people who are supposed to be experts in this like at EPA doesn’t always know.
Understand the complexity of what they’re doing so it’s really I think it’s intentionally broken which which just continues to
make all those administrators necessary yeah I hate to.
Even think that the system was created specifically for the purpose of making it difficult for people to understand it so that you could take advantage of them maybe it wasn’t personal sfil.
But it certainly has
worked out that way I would agree with you I have a hard time thinking people were scheming and the back room but it is certainly served to their benefit yeah.
If you are a non-medical person but you are a consumer of health care which.

[47:17] You know everybody is there is a tendency to think that.
It’s the insurance companies that are absolutely to blame for everything because they charge these enormous premiums and when you go to get care you find out that
sometimes more than half of what happened to you isn’t covered.
And so it’s easy to think that the insurance companies are truly the bad guy and I suspect that there is a significant amount of Badness to them.
But are they the real issue or they the real problem no I think it’s perfect it’s pervasive throughout the system but I think a lot of it is.
Just the complexity and Marshall Allen who’s a was a pro public
writer and is now with Health and Human Services interestingly published a book last this year.

[48:08] I’m called never pay the first bill and I always joke with him and say it should never be paid the first bill unless it’s green Imaging.
But we are in the book but he gives strategies for how to become a better consumer and I think it’s really tough for people to become a good consumer but what he does is he explains
why and how things are broken and how you can combat that
and I think the more we do this as individuals we take back our own Healthcare you know whether it’s a Buca plan on the exchange whether it’s a health sharing Ministry actually you know we’ve my husband and I have been guinea pigs we’ve tried all kinds of health care plans and we’re now on cetera which is a you know a health sharing.

[48:50] Plan and and we find it to be truly wonderful it’s very freeing to really not have to worry about any of the bureaucracy of healthcare we go in as self-pay people and if we’re done.
Made a certain threshold we’re going to have that expense shared with the whole group but it’s really.
It’s refreshing and but Marshall really gives you the kind of strategies you need
to take back health care how to you know how to find good care how to find care that’s you know even if you’re somebody who really doesn’t qualify you really needs the high-risk pool of an Affordable Care Act plan that doesn’t mean that you.
Need to be ball and chain getting Healthcare from that plan.
Yeah the hard part for an assurance for me is there are so many surprises and what you thought was covered that isn’t covered.
Right and then the other thing is the way things could price you know how are you supposed to know.
The kind of insurance that you need it’s bound to be agonizing for most consumers certainly is for me.

[50:02] And certainly you know that that’s where subscription-based Primary Care even if you are paying for a traditional health care plan that’s where subscription-based Primary Care.
Can really save you money you know get get you good RX that you know some of the dpc’s can self-prescribed you know can do the
actually fill prescriptions in some states you know they will get you to a four if you’re not going to reach your deductible they will get you to Affordable self-pay Specialists and labs and you know everything you need
can usually happen under your deductible if you’re on a high-deductible health care plan
well dr. Christine Dickerson this has been a very enlightening conversation and I appreciate more than you know your willingness to sit down and share your time with us.
We are at the point
that I enjoy the most in my program and that’s what I just get out of the way and let you speak to us from your heart so I’m going to close my mic and
dr. Christine Dickerson will give us her personal prescriptions for Success okay my my prescription.

[51:09] Is number one to stay flexible and be ready to Pivot my career has taken as you heard today me down many paths I still am ready to Pivot
if something you know changes Health Care in this country whether it
would be you know Universal coverage whatever it is I’m already thinking of ways that I could pivot and and be flexible and absorb that so I think you know although we all do need to to create you know
our future in our mind and know where we want to head I think.

[51:44] If you are two married to that you stand the chance of missing out on some really great opportunities and so I
number one would be just be flexible and number two
is persistence and you know there have been several times in my career where and and we didn’t really touch on this one but I actually lost my partner in green Imaging a 42 year old radiologist didn’t wake up one Saturday morning
and so there have been times on this 10-year path with green Imaging that you know I was
the pandemic really you know we were at 50% capacity for three months I you know had 20 employees there have been times when I wasn’t sure
you know that this was going to happen and make it and
persistence I think waking up the next day and saying okay what can I do to make this better and you know how am I going to keep this going so that we can take care of more patients more affordably has really been that answer so just stick with it
whatever you know if you believe in something stick with it you can find creative ways to make things work and you’ll find
people along the way who helped you do that so those are really my that’s my RX for success.

[53:02] Well there certainly is a lot of wisdom there and we are indebted to you for
spending some time with us and sharing that before we go I want to give you an opportunity to.
Advertise a little bit so if you’d like to tell our audience where they can find you and what you represent we are ready to hear it.

[53:21] Absolutely actually my email address is dr. Dickerson at Green Imaging dotnet drd I ckers 0n at Green Imaging dotnet
happy to help you you know launch on your path to becoming a better Healthcare consumer or a physician who you know wants to take a different path and start looking at Direct.
Those are all things that I really love mentoring and our.
Website is www.greenapple.co.nz net if you ever have an Imaging order you can actually just take a snapshot of it.
I have your order and text it to and it’s a secure messaging system mess text it to seven one three five two four ninety one ninety and that will start the referral process and you’ll.
Either whichever you prefer receive a text back or a phone call back and we’ll get you scheduled.

[54:14] So thank you so much for having me Randy well dr. Christine Dickerson thank you so much for being here it’s been a great pleasure and.

[54:22] Music.

[54:28] Thank you so much for listening with us today remember you can get more information about our guests as well as hear them face my rapid fire questions at our patreon site.

[54:38] And while you’re there you can also subscribe to the podcast give us a rating and hopefully offer suggestions on what you’d like to hear in a future episodes.

[54:49] Thanks very much to Ryan Jones who composed and performs our theme music.

[54:54] That’s all we have for now so please be sure to fill your prescription for success with my neck.

[55:00] Music.