Join us as we welcome Dr. Michael King, Chief Medical Officer of Upperline Health, for an in-depth exploration of upcoming Medicare reimbursement & critical Medicare changes.
Dr. King brings his extensive expertise in healthcare administration and policy to break down:
- The most significant changes coming to Medicare physician reimbursement
- How these changes will affect different medical specialties
- Strategic approaches for healthcare providers to adapt to the new landscape
- Potential impacts on patient care and access
- The broader implications for the future of healthcare delivery
As Chief Medical Officer of Upperline Health, Dr. King offers unique insights from both clinical and administrative perspectives, making this conversation particularly valuable for understanding the practical implications of these policy changes.
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Guest Biography
Dr. Michael King
Dr. Michael King is the Chief Medical Officer of Upperline health, a lower extremity comprehensive care and value-based healthcare company in Nashville, TN.
He is a past president of the American Podiatric Medical Association and the Massachusetts Podiatric medical society. He was the podiatric advisor to the AMA CPT editorial panel for 10 years and deeply involved in health policy and practice.
Mike is board certified by the American board of foot and ankle surgery in forefoot and rearfoot surgery and is a fellow in the American College of foot and ankle surgeons. Mike lectures frequently, and has for years on coding, documentation, compliance and now, value-based healthcare initiatives. He maintained a limb salvage practice in Massachusetts for 30 years before joining Upperline as its CMO
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Show Notes from this episode
- Introduction and Background of Dr. Michael King 0:00
- Dr. Barrett introduces Dr. Michael King, highlighting his role as Chief Medical Officer of Upper Line Health and his expertise in billing and coding.
- Dr. King shares his background, mentioning his 30-year career in private practice and his transition to Upper Line Health.
- Dr. King discusses the vision of Upper Line Health’s CEO, David Thorpe, and the company’s mission to evolve healthcare delivery.
- Dr. King explains the concept of ACOs (Accountable Care Organizations) and Upper Line Health’s specialty-based ACO, which focuses on value-based healthcare.
- Upper Line Health’s Mission and ACO Program 3:20
- Dr. King elaborates on Upper Line Health’s ACO program, which manages between 30,000 to 50,000 Medicare lives.
- He describes how Upper Line Health acts as an insurance company, managing patient care from stem to stern.
- Dr. King emphasizes the importance of early intervention in healthcare, using examples like offloading diabetic patients to prevent ulcers.
- He highlights the success of Upper Line Health’s ACO, with medical loss ratios well below 90%, indicating significant cost savings.
- Challenges in Healthcare Reimbursement and Value-Based Care 16:39
- Dr. Barrett and Dr. King discuss the rising costs of healthcare and the inadequacy of insurance premiums compared to past coverage.
- Dr. King explains the inefficiencies in the current reimbursement system, where hospital and facility expenditures are high.
- They discuss the potential of value-based care to address these inefficiencies by focusing on early intervention and prevention.
- Dr. King shares examples of how Upper Line Health’s ACO program is proving the effectiveness of value-based care.
- Medicare’s Future and the Role of ACOs 16:55
- Dr. King outlines Medicare’s plan to eliminate fee-for-service reimbursement by 2030 and transition to a value-based system.
- He explains the potential challenges and benefits of this transition, including the need for providers to adapt to new payment models.
- Dr. King discusses the role of ACOs in managing patient care and the importance of recognizing and addressing co-morbidities early.
- He expresses optimism about the potential of ACOs to improve healthcare outcomes if implemented effectively.
- Criticisms of Medicare Advantage Plans 17:13
- Dr. Barrett and Dr. King discuss the limitations of Medicare Advantage plans, which are often criticized for reduced coverage and increased bureaucracy.
- Dr. King explains the design of Medicare Advantage plans to privatize Medicare and the challenges in managing care effectively.
- They discuss the potential for ACOs to provide a better alternative to Medicare Advantage plans by focusing on evidence-based care and early intervention.
- Dr. King emphasizes the need for a system that rewards providers for managing disease effectively and not just for coding and billing.
- The Future of Healthcare and Provider Shortages 46:25
- Dr. Barrett and Dr. King discuss the potential shortages of healthcare providers in the future due to the high cost and stress of medical education and practice.
- They highlight the importance of recognizing the value of podiatric physicians and their role in providing comprehensive care.
- Dr. King shares his concerns about the sustainability of the current healthcare system and the need for innovative solutions.
- They discuss the potential for ACOs to address these challenges by providing a more sustainable and effective model of care.
- Conclusion and Final Thoughts 48:29
- Dr. Barrett and Dr. King reflect on the importance of understanding and supporting the role of podiatric physicians in healthcare.
- Dr. King expresses his hope that the healthcare system will eventually recognize the value of early intervention and evidence-based care.
- They discuss the potential for ACOs to revolutionize healthcare and provide a more sustainable and effective model of care.
- Dr. Barrett thanks Dr. King for his insights and contributions to the conversation, emphasizing the importance of continued innovation and collaboration in healthcare.
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