Is the U.S. healthcare system failing to prioritize what truly matters? Join us in an eye-opening discussion with Thomas Campanella from Baldwin Wallace University, as we dissect the multifaceted challenges facing the primary care sector. With a staggering 40-year experience in healthcare, Tom sheds light on the dire shortage of primary care physicians and the frustrating economic dynamics that undervalue this essential field. Despite the U.S. spending nearly 20% of its GDP on healthcare, only a small fraction goes to primary care, a discrepancy that Tom believes is starting to gain overdue recognition through innovative collaborations and a push for quicker changes.
We dive into the complex economic and political landscape that hinders primary care, revealing how vested interests and profit-driven motives perpetuate a system focused more on treating illness rather than preventing it. As we navigate through the intricacies of value-based care, Tom highlights the growing impact on primary care provider compensation, especially for family medicine practitioners. By understanding the broader context—payer systems, hospital operations, and policies—we underscore the need for tailored solutions to address primary care issues in both urban and rural settings.
The conversation also ventures into the transformative role of technology in healthcare, particularly in bridging gaps in rural areas. From the rise of telehealth accelerated by COVID-19 to the efforts of retailers like Walmart and Walgreens in making healthcare accessible, we explore a range of innovative solutions. We also discuss the challenges specific to rural healthcare, such as limited broadband access, and the importance of collaborative community efforts. Wrapping up with insights on federal support and successful models of rural healthcare, this episode offers a comprehensive look at the future possibilities in primary care.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron Higgins (00:02):
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take our summer break toprepare for Season 5, we are
revisiting some of our mostimpactful episodes.
In this Season 4 episode, TomCapanella from Baldwin-Wallace
University joined us to discussthe critical issues facing
primary care.
With over 40 years inhealthcare, Tom addresses the
(00:25):
shortage of primary carephysicians and the economic
challenges that undervalue thisessential field.
Despite the US spending nearly20% of its GDP on healthcare,
primary care remains underfunded, a gap that's beginning to see
overdue recognition throughinnovative approaches.
Tom explores how value-basedcare is affecting primary care
(00:45):
compensation and the broadereconomic and political factors
at play.
He also highlights the role oftechnology and telehealth in
improving access, especially inrural areas, and discusses the
efforts of retailers likeWalmart and Walgreens to expand
healthcare access.
If you enjoyed this episode,please rate and share our
podcast in your favorite podcastapp.
(01:06):
It really helps the show.
Thank you for tuning in.
Let's dive back into our vitalconversation with Tom Capanella.
Jason Crosby (01:16):
Welcome to everybody and thanks for joining
us.
Tom Campanella (01:19):
Thank you and I really enjoy the company that I
will be having over the next,you know, half hour or so.
Aaron Higgins (01:28):
Yeah, we are really excited to have you here,
Tom.
I know Mike cleared hisschedule specifically to join us
, so it's kind of a treat wehave Mike on here with us as
well.
Mike Scribner (01:39):
Absolutely Looking forward to the
discussion.
I really like the kind of thehigh-level philosophical parts
of it, so let's get going.
Jason Crosby (01:46):
Sounds great.
So, tom, you've especially inthe academia award you've
covered so many different topics.
You've studied, you've got datacome from all direction that
we've.
We've read and particularlyyou've done a lot recently in
the primary care space and youknow we obviously work a lot of
primary care physicians.
We thought we'd thought we'dstart there and just really want
to hear your thoughts andthings you've come across
(02:09):
regarding various primary careshortages, the other challenges
and trends you're seeing.
You know here we are halfwaythrough 2024.
So get our audience up to speedwhat you've been seeing and
things that you see coming onthe horizon on the primary care
space.
Tom Campanella (02:24):
Thank you, jason , but I want to start off just
briefly.
While I've been in academia forthe last 20-some years, in
total I really have 40 years'worth of experience in health
care in all sectors.
So both the payer side also asan associate dean of a medical
(02:46):
school osteopathic which wasprimarily focused on family
medicine and was situated inrural Appalachia, ohio, down in
Southeast Ohio I was on thepayer side as a VP of healthcare
finance for Blue Cross Plan wason the payer side as a VP of
(03:07):
healthcare finance for BlueCross Plan, healthcare attorney,
healthcare consultant,economist, a little bit of
everything.
So what I try to do in all mywritings, podcasts, and that a
lot of it is obviously based onwhat's happening in the current
world, but a lot of it is basedon my own personal experience
over the last 40 years fromdifferent perspectives, and that
(03:28):
really really dovetails intothe subject of family medicine
Because, as I said, as theassociate dean of Ohio
University's osteopathic medicalschool, which primarily focused
on family medicine in fact thiswas the late 90s we produced
more family medicine physiciansthan any other medical school in
(03:51):
the country from a percentagestandpoint, but it was also in a
rural area I gained both anappreciation of the value and
the importance of familymedicine and primary care, but
also the challenges in ruralAmerica, which I know we're
going to be talking about later.
The bottom line when you talkabout family medicine, when push
(04:14):
comes to shove, it is probablyone of the most ironic and maybe
frustrating and challengingsubjects because, as everyone
knows, we spend more on healthcare than any other country in
the world on close to 20% of ourgross domestic product and the
specialty that is focused onkeeping people healthy.
(04:38):
We approximately spend about 7%of our health care spend on
family medicine and primary care.
So we really have it backwardsand really that's the reason why
, when we talk about health care, we really have a sick care
system that really treats peopleand most of our dollars are
(05:00):
focused on after somebody issick, has a health issue, and
that, rather than preemptivelyfocusing on trying to keep them
healthy, which is the ultimatefocus of primary care and family
medicine.
Mike Scribner (05:16):
Have you seen that start to shift recently?
It kind of feels like in ourworld.
We're a little bit late to thegame in this section of the
country, but nonetheless it doesfeel like that the boat is
beginning to turn.
What is your experience?
Tom Campanella (05:33):
Yes, I definitely see it moving in what
I would call the rightdirection, but at the same time,
it needs to be done in a muchmore accelerated way.
I think what's happening is andwe know this and this is a
(06:08):
subject in itself analyticalcompanies and that to sort of
partner hire, come up withcreative collaborations with
family medicine and primary care, which is then creating more
opportunities for familymedicine and primary care and
hopefully is incenting themedical students to go in that
(06:32):
direction, which really shouldbe the long-term goal.
But I've had the opportunity toI speak on a number of
different topics, differentaudiences, but one of the most
interesting is I actually speakto medical students and family
medicine residency programs indifferent parts of the country
(06:55):
and I'm starting to see a littlebit more steam, a little bit
more hope.
But we still got to pay them somuch more money than with the.
You know the value that theycan and are providing versus
what we pay them, versus otherspecialties, is really, you know
(07:16):
, basically a crime.
And then the other thing is theburden we put on primary care
physicians ultimately is causinga lot of burnout.
So at one end we're starting toget more in, but the other big
challenge, Mike, is we have alot of physicians that are in
family medicine, primary care,that are in their 60s and
(07:39):
they'll be retiring, so wereally got to ramp it up.
You know we talk about WorldWar II analogies, especially
with D-Day and that, and wereally need a Marshall Plan, as
they did in Germany andeverything else for primary care
, and you know from a countrystandpoint.
So that's where I'm at, sowe're going in the right
(08:00):
direction, but it needs to beaccelerated big time we're going
in the right direction, but itneeds to be accelerated big time
.
Aaron Higgins (08:10):
So, Tom, kind of going back to the point you
raised about needing to be moreproactive versus reactive in the
sort of care that we're giving,that seems to me to be more of
a cultural problem rather thanone that we can throw dollars at
.
How do you think we couldovercome that?
Tom Campanella (08:21):
Well, it's really a couple things, aaron is
.
You know, the culture aspect is, bluntly, we have to change the
mindset in the US to getindividuals much more engaged in
their own health, Because, whenwe compare ourselves to other
countries, one of the reasonswhy we may not have the best
(08:45):
outcomes is bad lifestyles andother types of things, and we
need to get them more engaged intheir health.
That's where, again, I reallythink having family medicine and
primary care much more robustmuch more robust, including with
(09:08):
their staff and usingtechnology in that can be a way
to educate and engage thepatient in their own care much
more than it is today and maybefrom a family standpoint
especially when you're talkingabout seniors and others getting
them much more involved in thatindividual's care or, you know,
getting on top of them ofwhatever's needed.
But there is a lot of thatgoing.
(09:29):
The other part of it is, let'sface it, when we talk about 20%
of our gross domestic productbeing spent on healthcare, we
may perceive that as a cost, buta lot of stakeholders are
looking at that as revenue andprofit, so they make a lot of
money on our current sick caresystem.
(09:50):
That bluntly devalues primarycare.
So part of the challenge we have, even in Washington DC, is
politically, is that a lot ofthese players are in effect.
You won't see them out in thepublic, but behind the scenes,
these lobbyists and everythingelse are protecting their little
(10:12):
piece of the pie really bigpiece of the pie, to the
detriment of primary care.
So that's when you say whycan't we do more?
This is so obvious.
I mean, you could put a bunchof high school students together
and they can come to theconclusion of what needs to be
done.
But you know, as you know, thename of the game is follow the
dollars, and there's a lot ofdollars being spent on.
(10:35):
You know, once a person is sickand I hate to say it, it sounds
terrible, but that's an issueculturally- it sounds terrible,
but that's an issue culturally,from a societal standpoint, we
need to address.
Mike Scribner (10:51):
It does seem like , at least to a small degree,
that as the value-basedcomponent has become a bit
larger, that that's driven upprimary care providers' salaries
to a certain degree.
Like I feel, like I'm sensingin our market that if you wanted
to recruit primary care to arural market five years ago,
(11:15):
even 10 years ago, for surethey're going to be employed by
the local hospital because theycan't make it on their own
individually and with somemovement of value-based care,
somewhat successful versions ofit out there, it's driven up the
compensation for primary careto a certain degree.
Are you seeing that nationallyand is there any sort of
(11:37):
leverageable part of that thatcan be replicated?
That is a larger solution thanjust market by market.
Tom Campanella (11:45):
Well, first of all, I am seeing that nationally
, mike, and it's back to what welearned in school supply and
demand, and right now we havethat limited supply of primary
care docs.
But there is a recognition in avalue-based world that we're
(12:05):
trying to transition to, withmultiple stakeholders including
for-profit and non-profit.
Getting involved is, as you getmore players, bluntly, the
family medicine physician hasmore leverage.
They do have options and, asyou know, in the non-healthcare
world, when you have options,options and as you know in the
(12:27):
non-healthcare world, when youhave options, you know you're in
a position where you have theability maybe to control and
demand higher compensation, abetter quality of life, that
type of thing.
So I definitely see that comingand it is starting to come in
different areas of the countryto different degrees.
You know, not just regionally,but urban, rural and everything
else.
There's obviously a lot ofother factors.
(12:49):
You can't look at it.
You know.
Analogy that we talked aboutearlier, mike, really applies to
family medicine as well asother subjects in healthcare.
I look at it like a piece of apuzzle.
You can focus on one piece, sayfamily medicine shortage, what
can be done?
But if you just isolate just onthat piece and your knowledge
(13:14):
base is just focused on thatpiece, you're never going to
really understand the challengesbut, more importantly, find the
answers.
You got to look at all thoseother pieces that sort of come
together.
So you got to have a betterunderstanding of what's
happening in the payer world,the hospital world, overall
state and national health policy, the different types of payment
(13:36):
methodologies, what's happeningin for-profit.
So you have to have thatappreciation.
But just like a puzzle, once youhave that grasp of that, you're
in a better position to bothlocally and regionally and
nationally.
Going back to your pilotprograms and that, to put pieces
together and say, hey, I thinkwe found a solution if we put
(13:58):
this piece together with thatpiece and everything else, with
these stakeholders state orwhatever else involved in it,
getting the payer side, whateverit happens to be, but each
region, including urban, rural,region of the state or whatever
is not necessarily have the samesolution.
What makes sense in Montana maynot make sense in New York City
(14:22):
.
Obviously we went through thiswith COVID and everything else.
You know you just can't have across-the-board thing.
You know there's issues goingon in each region so there
really needs to be almost like aground-up approach to a
national approach, but aground-up approach to address
some of the challenges in familymedicine and primary care.
Aaron Higgins (14:44):
Let's take a quick break.
We'll be back in just a moment.
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Jason Crosby (15:21):
Tom, you mentioned a couple of things.
I'd like to follow up on One.
In terms of the provider base,you've got the aging population
that you mentioned before, andthen the younger group that's
coming up and maybe not fillingthat gap number-wise or pay-wise
.
Then you also mentionedtechnology.
Aaron and I have talked about afew different topics that kind
of maybe fits in that vein interms of provider gaps that
(15:45):
exist, right, and from theprovider side, you've got
utilization, perhaps ofmid-levels that haven't been
utilized as much as they could.
Or, in particular last year,we've talked a lot about
retailers, right, whether it'sthe Walmart, walgreens, dollar
General, even that at least area little bit more in the
accessibility space thananything else.
(16:05):
Then, on the IT, you've gottelehealth that really took off
from COVID and of course, ai.
That's really been a hot topic.
I'm curious I know I just threwa few different kind of things
at you there but those items,whether it's the provider side,
like mid-levels, or the IT side,like telehealth, how they may
(16:26):
be of some benefit to this gapthat exists over these coming
years, or maybe what you'reseeing nationally that maybe
those can provide a relief tothat gap.
Tom Campanella (16:36):
Well, I definitely think, just like it
would in other areas, theeffective use of technology can
allow things to become moreefficient, to be able to do
things in a sort of more focusedand productive way.
Let's talk about telehealth,for an example.
You know telehealth has been,you know, was really starting to
(16:59):
ramp up prior to COVID.
Obviously, covid accelerated itbig time.
I actually wrote an article, ablog, back in 2018, which was
obviously two years before COVIDreally hit about.
I called it care in the homesetting the new frontier of
health care, and I saw thattrend, which now everyone's
(17:23):
talking about hospitals at homeor whatever.
But I wrote what I thought wasa reasonably good analytical
reason, going back to the piecesof the puzzle, how the
different factors that resultedin maybe care in the home
setting playing a key part.
Ultimately, just as an asideand that will fit into this
(17:44):
discussion is that you know, Iknew the payer side both the
government and commercial andemployers were, and self-insured
employers were trying to drivehealthcare costs, especially
because escalating to the lowestcost setting.
But it needed to be a safesetting.
And the number two thing is Ialso recognized that what was
(18:09):
happening in the hospital world,which also results in why we
have a lot of competitors isthis trend again has been
occurring for a number of yearsprior to COVID is inpatient
admissions across the board havebeen going down throughout the
country on the hospital side.
But what's happening is theones that are going into the
(18:33):
hospital have more high-riskfactors.
So in many ways in hospitals,especially in major urban areas,
are almost becoming like giantICUs, intensive care units,
because it's really focused onthe high risk.
Where are these patients thengoing?
Well, they're going to theoutpatient world, which we've
(18:53):
been seeing that for a number ofyears, but that's accelerating.
And, by the way, this is achallenge for a hospital because
on the inpatient side, when youthink about it, how many
competitors do they have?
You know just a few otherhospitals, but on the outpatient
side, you know you could haveniche players, big players,
whatever it is, regional,national players.
(19:15):
But then, when you think aboutthe lowest cost setting, I was
thinking God, care in the homesetting.
But to do that it's a chickenand egg phenomena.
You can't have care in the homesetting from a safety
standpoint unless you have to beable to provide it.
You need technology, you needmedical device and everything to
(19:37):
both provide it, to bothmonitor it, diagnose it and
everything in that home setting.
But where the chicken and eggcomes in, think about it.
If you're a technology company,if you're into virtual care, if
you happen to be a medicaldevice company, you're not in it
because you know I hate to sayit altruistically you're there
(19:59):
to make money, you have researchand invest in it.
So the only way you're going topay for it is if you know
there's a long-term trend thatpayers are going to pay for it.
So that's where the synergycomes in.
The chicken and the egg.
Payers are saying we want todrive it to the lowest cost
setting and we're willing, butit's got to be safe.
And then, at the same time,medical device technology,
(20:22):
including telehealth, is sayingwe're willing to do this and
invest in it to make ituser-friendly, but we got to
have a long-term revenue sourcefor it.
So you got that synergyoccurring.
So telehealth what's so greatabout that is not only is it the
ability to be able to do itwithin a home setting, for an
(20:43):
example, but also which wereally haven't done enough of.
You know we talked aboutpatient engagement and those
types of things between visitsto better engage that patient,
plus their family members, intowhatever health issues chronic
(21:13):
health issues that are havingcan be a great vehicle to be
able to, you know, sort of finda way to keep people healthy and
everything else.
So there is a lot of thatadvancement.
Where the challenge is is one ofthe you know topics that you
know I find really important isrural health care, which you're
very familiar with and you knowwhen you talk about broadband
(21:36):
and other areas, that's whereyou have a potential opportunity
with telehealth.
But, depending on the rural area, you may not have access to it
or the people may not be able toafford.
You know the technology costsor whatever it happens to be, or
they may not have.
You know they may have issuesjust being able to grasp.
(22:00):
You know the ability to be ableto use you know technology in a
more effective way, so you gotto also be able to address that.
The good news there is andaside is just last year there
were billions of dollars setaside for a broadband expansion
throughout the country, with themajor focus being in rural
(22:21):
arenas.
So there is a recognition.
So hopefully that will allowthat vehicle to become even more
important and I definitelythink nurse practitioners, pas,
you know all these other onescan be a great vehicle to help
complement the primary carefamily medicine physician in
(22:42):
those environments.
Mike Scribner (22:52):
I get that.
My next question is going to,admittedly, come across from a
very biased we represent nothingbut providers point of view.
However, in that wholediscussion that you were just
having, what I find is one ofthe issues that we always run
into is that the business casefrom the perspective of the
local provider in the ruralmarket is tough to get in
telehealth because of the lackof payer support for it and in a
lot of ways, we sense that thepayers are less creative, maybe
(23:19):
less less incentive.
I don't know what the answer isto to to fully support that,
that that tenant that we'regoing to move into the lowest
cost setting, and it becomesmore of a barrier than anything.
Again, I see we see world, theworld, from a very, very small
lens, but what's yourperspective around that?
(23:40):
Have you sensed that?
Or is that?
Is that our payers across thecountry more receptive and more
supportive and facilitating thatdeeper in other places?
Tom Campanella (23:51):
Well, I think, mike, like anything else, it's
hard to make across-the-boardgeneralization because it
depends on the payer, it dependson the region, those types of
things.
I see them being, at leastverbally and this is always a
challenge what you say and whatyou do and verbally supporting
(24:13):
expansion of telehealth.
You know, verbally supportingany initiative that addresses
social determinants of health,those types of things.
The question is, are they whatthey are?
(24:34):
You know, even through federaland state legislation and rules
and policy, there's reallyputting more pressure on them to
get more involved in thingslike telehealth, addressing
social determinants.
You know, really finding waysto sort of address whatever
(24:55):
barriers there are to providebetter health care.
You know from that standpoint.
You know they always say ittakes a village or whatever.
But you know if you're talkingabout rural areas and you're
talking about smaller providers,you cannot.
You know we do business plansand everything else in the
(25:16):
academic world, as you said, ifyou really did a dollar and
cents return on investment typesituation with some of these
rural hospitals for example, youknow you're just not getting
that return on investmentbecause you don't have enough
people.
You know the specialties andthat.
Can you keep an ER open whenyou only have X number of people
(25:38):
, how do you handle and pay forspecialists or others, if you
know if there's travel issuesand that?
So that's where it really doeshave to be.
That's why I mentioned thingslike Marshall Plan, not just for
family medicine, but eventhings like rural health care.
That's where you know you gotto get employers involved, you
(26:00):
got to get the governmentinvolved at state level and the
federal level.
There definitely needs to beadditional compensation.
What I didn't like, bluntly, is,for an example, the COVID part
and I know there's a lot ofissues politically and I'm not
going to go into that.
But when it came down to givingmoney out to different players
(26:24):
after COVID hit and there wasmoney given to hospitals, for an
example, but a big share ofthat money went to the big major
hospital systems in the bigurban areas and from my
standpoint, they shouldn't havegotten it.
You know they have the abilityto survive through that thing.
(26:47):
What was not done is theyshould have been narrowly
focused on those small hospitals, those rural hospitals.
That's where the money was.
Covid hit the rural areas morethan urban areas, and I'm not
saying that there wasn'tchallenges in the inner city
because of COVID, but the pointis we should have been directing
(27:09):
it to there.
Problem is, the small ruralhospitals don't have the
political lobbying force, evenwith the American Hospital
Association, than the big urbancenters.
So that's part of the challengethat you have there and so it
really needs to be coming fromdifferent sources.
Employers, especiallyself-insured employers, are key,
(27:31):
but where the challenge is, asyou guys also know, is that one
of the challenges, includingafter COVID, there's been an
erosion of employmentopportunities in rural areas,
which is one of the reasons whywe have so many challenges there
.
So it's not like we can say okay, employers, you know you need
to help subsidize thistelehealth, or you know you need
(27:56):
to financially support thatrural hospital, you know the
small hospital and that A lot ofthem are leaving, and that's
where I think you know, evenwith the big urban hospitals, I
think there should be some formof I'm not a big believer in tax
, but the bottom line they needto help support.
(28:18):
We're part of the United Statesand we need to address it and I
don't care if you live in anurban area or whatever, or a
major player in urban, includingan employer or whatever.
(28:40):
There needs to be some form offinancial support for providers
in our rural parts of thecountry, and I grew up in the
inner city of Cleveland, so it'snot like I'm a small town,
rural guy and I don't care aboutit.
But the bottom line I saw and Icontinue to see in my talks and
(29:03):
in my visits in rural America,it's not just healthcare, it's a
quality of life issue.
Aaron Higgins (29:09):
Instead of the Marshall Plan, we need the
Capanella Plan for tackling this.
Tom Campanella (29:15):
Yeah, hey, actually, you know it's funny.
You know, way back when in my20s I was a Cleveland City
Councilman and I quicklydiscovered that even though I
was altruistic, passionate andeverything else, it was the
political side was not me, youknow I, you know, I played a lot
(29:38):
of sports and I had so manytimes people coming up to me in
politics you got to play ball,or I knew I was not meant for
politics when I was starting totell my mother and she would ask
for help and I'd say, well,what's in it for me?
So I'd rather, when I write andpublish or speak I never know,
(29:59):
am I doing it from aneducational standpoint or a
venting standpoint?
Because it really isfrustrating to see this country
and what we spend on health careand to have some of the
discrepancies as we talk about.
So, on a personal basis, I'm 74and I don't plan on giving up
(30:22):
and I plan on, you know, Godwilling being involved in one
way or another in health careadvocacy and policy, on things
like family medicine and ruralhealthcare for hopefully, many,
many years.
Aaron Higgins (30:35):
We'll be right back.
Ami Patel (30:38):
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Mike Scribner (31:08):
So, all government help and Marshall
Plan, campanella plan aside,what successful models?
Are you seeing?
Rural health care where theyare?
You know local providers, localhealth systems, whatever have
stepped up and are you knowtaking innovative approaches?
What are those things?
What does the right directionlook like from a rural
(31:29):
provider's world?
Now, forget the Calvary runningin to help.
What are they doing themselves?
Tom Campanella (31:35):
Well, first of all, as they always say, god
says you got to help yourselffirst.
So, in other words, it reallythe community needs to be
involved and they need to be acatalyst for a lot of this.
And you know just as an asidefor a lot of this, and you know
just as an aside.
Again back to personalexperience, back in the 90s in
Southeast Ohio nine counties youtalk about a very rural area,
(32:04):
some of the poorest areas, notonly in the state but in the
country I got elected.
Besides the role of associatedean and doing population health
, I was over a collaborative ofdifferent stakeholders that were
working together to address thetype of issues we're talking
about in that region of thecountry.
So, for an example, in my roleI was in a position where I had
(32:29):
access to health care, mobilehealth care clinics.
Back in the 90s they actuallyreported under me as part of the
medical school role.
So we were out there in thecommunities, but we also worked
with the Department of Health,jobs and Family Services, the
local hospital, the differenttypes of the school system,
(32:49):
because health care starts, youknow, in grade school, you know
in different ways and webasically said you know, we are
all back to the puzzle, play acertain role within this region,
but we're doing it in silos.
We need to work together.
We need to actually puttogether a collaborative to work
(33:09):
together, and then we looked atgetting funding from Robert
Wood Johnson to help out.
You know, from that standpoint,you know the state and
everything else, we wereaddressing issues like licensed
schools.
You know which was a majorcause of absenteeism, for an
example, but we had to come atit from a different direction,
(33:30):
for an example, but we had tocome at it from different
direction.
Where I'm laying that foundationis I saw the potential back in
the 90s and what I'm starting tosee in different parts of the
country and I don't have themall in front of me, but you
could actually Google to findout but, like in the state of
Washington, for example, andothers, they have collaboratives
that are working.
A similar type of perspectivewhere you get local players
(33:53):
taking ownership and that wouldinclude the employer side too,
obviously and the local hospitalworking together, finding ways
to do things in a much moreefficient way, but identifying
and prioritizing the majorissues and then coming at it
together.
You can imagine if it's acollaborative you have
politically and everything else.
(34:14):
Also more leverage with thelocal politicians, but also
within the state capitol, andthen hopefully finding ways to
be able to get the congressmenand senators involved in doing
things, so that, I think, issort of the ground-up approach
in it.
You've got to have leaders inthe community taking ownership,
(34:36):
not just recognizing that wejust can't have our hand out.
The good news is I always foundincluding my own experience
people from small communitiesdon't have the attitude of
looking for handouts.
I think most of them, from whatmy experience was that they
(34:56):
really, if anything, had issueswith that and wanted to take
things on their own.
So I think there is thatmotivation they may need and
we're starting to see this.
The federal government isworking and they have planning
grants for an example, which Ithink is great.
So, for an example, you mayhave a community in Georgia or
(35:16):
wherever and they're wanting todo this, but there's
infrastructure issues ortechnology or how do we get
these players to work bettertogether?
There are federal grantsavailable that might be able to
help with some of the backroomstuff to allow this
collaboration, you know, so thatwhen you're working on a family
(35:37):
, say, you know you got to worryabout HIPAA, you know in or
something like that, butmultiple agencies are involved
in it it might even be with thesame family or that there should
be a linkage of information anddata to have more of a
comprehensive approach.
(35:58):
So I think the collaborativeapproach, with assistance from
the state and federal governmentand others, is, I think is an
effective way to be able to havethat ground-up approach.
Aaron Higgins (36:12):
So you're talking about changes to HIPAA
potentially as a part of this,and I agree with you.
I've been the HIPAA wonk formost of the organizations I've
worked for in the last 20 yearsand it's both a barrier and a
protector.
So I guess maybe expand on thata little bit.
(36:33):
I'd be curious to hear how youwould see that sort of change
play out, because I think you'reright, it's one of those things
that's potentially hinderingcare.
Tom Campanella (36:44):
Well, I remember I was teaching a class I was in
health economics when the HIPAAlaws came out and one of the
problems we have is like apendulum.
You know we have an issue andwe go all the way to one
direction or all the way to theother direction instead of
finding the right direction.
It's almost like we work off of, you know, polls.
(37:05):
You know it's a political arena, let's face it.
You know it's a political arena, let's face it.
So you know, the whole idea ofHIPAA obviously is protecting
the individual's privacy from ahealth care standpoint.
On the other hand, inprotecting that, it ultimately
is an inhibitor of communicationbetween providers, between
(37:34):
providers.
Covid was a perfect examplewhere in communities urban and
rural, for an example you mayhave people that had multiple
health issues, seeing multipledifferent providers, including
mental health providers, andthey may also be in a position
where they're going to localcommunity health centers or
whatever.
And then we're trying toaddress initiatives and identify
(37:55):
these people and determinewhat's best we can do both
individually and as a group.
But if the players can'tcommunicate with each other
because HIPAA is a barrier, thenthat's where it gets really
challenging.
But it can't be administrativeburdensome, but some type of
release on a more general basisthat allows for this type of
(38:19):
communication and education.
From that standpoint, and whileat one end maybe it should be
individual, on the other handthat could be really bogged down
.
There just needs to be thatfine line and I think if you got
the right people in the roomthat understand the issues,
solutions can be done.
It's just a matter of justbringing them up to the table.
(38:41):
You know, from that standpoint,I'd be curious.
Jason Crosby (38:44):
you've touched on both kind of a cultural mindset
and rural community, but alsosome legislative action that
could be taken.
You know we've had REH hererecently Rural Emergency
Hospital Hopefully I got thatacronym right.
That's taken effect but we'veseen a slow adoption of that for
various reasons.
340b, what swing bed program,having that thing, and of course
(39:10):
those are big hindrances to arural hospital being able to
take that on.
Do you feel such legislation isone, a big piece of the puzzle
you were just talking about, andtwo, removing those little
pieces like 340B may justfurther adopt such a model that
would be acceptable to thecommunities in those rural
hospital settings.
Tom Campanella (39:29):
Well, first of all, this goes back to my
argument before in regards tothe COVID quote bailouts to the
hospitals, for an example, whereit should have been going to
the small hospitals or ruralhospitals and a big chunk of it
went to the very profitablemajor urban hospitals.
Well, it's the same thing with340B.
(39:51):
I mean, the whole theory behindthat was, you know, to be in a
position to be able to target,you know, individuals and
hospitals that are providingcare to, in effect, the people
that really need it, the poorerpeople, the uninsured, those
types of things, the people thatreally need it, the poorer
people, the uninsured, thosetypes of things.
(40:13):
And next thing, you know everyhospital in the world is getting
a chunk of 340B and thenthey're upcharging it and
everything else that should benarrowly focused on certain
hospitals, especially small,urban, rural hospitals.
You know, from that standpoint,and that's an example of
redirecting resources for theright reason, you know from that
standpoint, and that's anexample of redirecting resources
for the right reason.
(40:33):
You know from that standpoint.
So, and then the whole idea ofemergency hospitals, and you
know, ultimately focusing onthat, as well as you know, the
effective use of differentfor-profit players that are out
there Walmart's been inhealthcare Now I don't know
what's going on with thembecause they were in, then
(40:55):
they're out, who knows?
But you mentioned Dollar Generalfor an example.
Dollar General actually has Iknow they experimented in
Tennessee mobile health vans inwhich they were putting on their
sites and others to be able toaddress it and hopefully go out
(41:16):
to the communities too.
And I know Dollar General isall over the place in rural
America and there may need to bemore involvement with players
like that there to be able toaddress it.
In regards to the differentmodels, like anything else, it's
not one size fits all.
(41:39):
I mean, there's pros and consand the devil's in the detail in
regards to some of the optionsthat they're throwing out there,
including the emergency typehospital settings, type hospital
settings and that, and I'mstill in the process of
evaluating some of these things,so I'm not in a position to
really get that specific.
Aaron Higgins (41:58):
Thank you for joining us today, boy.
We just it feels like we justbarely scratched the surface.
We would love to have you back.
I think there's a whole lotmore to talk about and be able
to pick your brain some more,and I guess I'll speak on behalf
of Jason and Mike.
We really enjoyed today'sconversation, so thank you for
joining us.
Tom Campanella (42:19):
Thank you and I really enjoyed this and, as you
can tell, I'm not short of wordsbut hopefully they're impactful
.
But feel free to reach out tome on multiple topics.
I enjoy talking about it andyou know, and hopefully we can
continue this relationship.
Aaron Higgins (42:39):
Yeah, and where can our audience find you if
they want to reach out?
Tom Campanella (42:44):
Probably the easiest.
Well, first of all, definitelyreach out on LinkedIn under
Thomas or Tom Campanella, andthat's where all my publications
are posted, actually includingpodcasts.
Hopefully we can work it outwhere this podcast I can post it
(43:07):
, on health care recap, which Ihopefully will have the links
from this podcast to send it toabout 8,000, 9,000 people too.
And so that is the one way.
The other way is, you know,strictly by email.
It's real simple TCAMP, t-c-a-mas in Mary, p as in Paul, and B
(43:28):
as in boy W as in Wallyedu.
So that's my email addresstcamp at B-W dot edu.
Aaron Higgins (43:36):
Okay, all righty.
Well, thank you for tuning intoday and we look forward to
having you back.
Tom Campanella (43:42):
Okay, thanks, guys, appreciate it.
Aaron Higgins (43:47):
This has been an episode of Beyond the
Stethoscope Vital Conversationswith SHP.
If you enjoyed this podcast,please be sure to rate and share
it with your friends.
It sure helps the show.
Jason Crosby (43:58):
Production and editing by Nala Weed.
Social media by Jeremy Miller.
Aaron Higgins (44:03):
And our co-hosts are me, aaron C Higgins and
Jason Crosby.
Our show producers are MikeScribner and John Crew.
Jason Crosby (44:11):
Thank you for listening and we'll see you next
time.
Aaron and I like to always savethe best question and the
hardest question for last.
Oh thanks, yeah, yeah, butgiven where you're located, I
think I already know the answer.
It's a popular recent debatewho really is the GOAT?
Is it LeBron or Georgia?
(44:32):
Or write and vote.
Tom Campanella (44:37):
Oh, I'll tell you, yeah, it's a matter of
perspective.
Obviously, from a Clevelandstandpoint, it's also a matter
of perspective.
We had one perspective ofLeBron in 2016 when we won and
another one when he moved toMiami.
So that perspective changes alot too.
(44:57):
And I have to admit Jordan,being a Cavs fan in the 90s, we
had an unbelievable team duringthat period with Mark Price and
Doherty and Nance and those guys, but that Jordan you know so
many times prevented us fromgoing.
(45:18):
And just a quick story, by theway, I was actually in Chicago
at a sports bar in the 90s whenwe lost to Chicago, when the
shot they keep talking about,and you know, and I was in a bar
and I was giving all theChicago fans a hard time because
(45:42):
we beat the Bulls six timesduring the regular season.
And then the shot comes alongand everybody forgets those six
games.
If I hear that word, the shotone more time or the drive or
the fumble or whatever.
Mike Scribner (45:59):
come on, guys.
We all know he pushed off,though it was an offensive foul.
What are we doing?
What are we doing.
Yeah right, tell me about it.
Call the foul ref.
Aaron Higgins (46:07):
Oh Tom, it was hard to be a Cleveland fan
period during the 90s.
All the heartbreak, all theheartbreak.
Jason Crosby (46:15):
I love that you brought up the fumble.
That's great yeah don't gothere.
Tom Campanella (46:19):
I brought it up, so who am?
Aaron Higgins (46:21):
I.
Tom Campanella (46:22):
Mea culpa.
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take our summer break toprepare for Season 5, we are
revisiting some of our mostimpactful episodes.
In this Season 4 episode, TomCapanella from Baldwin-Wallace
University joined us to discussthe critical issues facing
primary care.
With over 40 years inhealthcare, Tom addresses the
(00:25):
shortage of primary carephysicians and the economic
challenges that undervalue thisessential field.
Despite the US spending nearly20% of its GDP on healthcare,
primary care remains underfunded, a gap that's beginning to see
overdue recognition throughinnovative approaches.
Tom explores how value-basedcare is affecting primary care
(00:45):
compensation and the broadereconomic and political factors
at play.
He also highlights the role oftechnology and telehealth in
improving access, especially inrural areas, and discusses the
efforts of retailers likeWalmart and Walgreens to expand
healthcare access.
If you enjoyed this episode,please rate and share our
podcast in your favorite podcastapp.
(01:06):
It really helps the show.
Thank you for tuning in.
Let's dive back into our vitalconversation with Tom Capanella.
Jason Crosby (01:16):
Welcome to everybody and thanks for joining
us.
Tom Campanella (01:19):
Thank you and I really enjoy the company that I
will be having over the next,you know, half hour or so.
Aaron Higgins (01:28):
Yeah, we are really excited to have you here,
Tom.
I know Mike cleared hisschedule specifically to join us
, so it's kind of a treat wehave Mike on here with us as
well.
Mike Scribner (01:39):
Absolutely Looking forward to the
discussion.
I really like the kind of thehigh-level philosophical parts
of it, so let's get going.
Jason Crosby (01:46):
Sounds great.
So, tom, you've especially inthe academia award you've
covered so many different topics.
You've studied, you've got datacome from all direction that
we've.
We've read and particularlyyou've done a lot recently in
the primary care space and youknow we obviously work a lot of
primary care physicians.
We thought we'd thought we'dstart there and just really want
to hear your thoughts andthings you've come across
(02:09):
regarding various primary careshortages, the other challenges
and trends you're seeing.
You know here we are halfwaythrough 2024.
So get our audience up to speedwhat you've been seeing and
things that you see coming onthe horizon on the primary care
space.
Tom Campanella (02:24):
Thank you, jason , but I want to start off just
briefly.
While I've been in academia forthe last 20-some years, in
total I really have 40 years'worth of experience in health
care in all sectors.
So both the payer side also asan associate dean of a medical
(02:46):
school osteopathic which wasprimarily focused on family
medicine and was situated inrural Appalachia, ohio, down in
Southeast Ohio I was on thepayer side as a VP of healthcare
finance for Blue Cross Plan wason the payer side as a VP of
(03:07):
healthcare finance for BlueCross Plan, healthcare attorney,
healthcare consultant,economist, a little bit of
everything.
So what I try to do in all mywritings, podcasts, and that a
lot of it is obviously based onwhat's happening in the current
world, but a lot of it is basedon my own personal experience
over the last 40 years fromdifferent perspectives, and that
(03:28):
really really dovetails intothe subject of family medicine
Because, as I said, as theassociate dean of Ohio
University's osteopathic medicalschool, which primarily focused
on family medicine in fact thiswas the late 90s we produced
more family medicine physiciansthan any other medical school in
(03:51):
the country from a percentagestandpoint, but it was also in a
rural area I gained both anappreciation of the value and
the importance of familymedicine and primary care, but
also the challenges in ruralAmerica, which I know we're
going to be talking about later.
The bottom line when you talkabout family medicine, when push
(04:14):
comes to shove, it is probablyone of the most ironic and maybe
frustrating and challengingsubjects because, as everyone
knows, we spend more on healthcare than any other country in
the world on close to 20% of ourgross domestic product and the
specialty that is focused onkeeping people healthy.
(04:38):
We approximately spend about 7%of our health care spend on
family medicine and primary care.
So we really have it backwardsand really that's the reason why
, when we talk about health care, we really have a sick care
system that really treats peopleand most of our dollars are
(05:00):
focused on after somebody issick, has a health issue, and
that, rather than preemptivelyfocusing on trying to keep them
healthy, which is the ultimatefocus of primary care and family
medicine.
Mike Scribner (05:16):
Have you seen that start to shift recently?
It kind of feels like in ourworld.
We're a little bit late to thegame in this section of the
country, but nonetheless it doesfeel like that the boat is
beginning to turn.
What is your experience?
Tom Campanella (05:33):
Yes, I definitely see it moving in what
I would call the rightdirection, but at the same time,
it needs to be done in a muchmore accelerated way.
I think what's happening is andwe know this and this is a
(06:08):
subject in itself analyticalcompanies and that to sort of
partner hire, come up withcreative collaborations with
family medicine and primary care, which is then creating more
opportunities for familymedicine and primary care and
hopefully is incenting themedical students to go in that
(06:32):
direction, which really shouldbe the long-term goal.
But I've had the opportunity toI speak on a number of
different topics, differentaudiences, but one of the most
interesting is I actually speakto medical students and family
medicine residency programs indifferent parts of the country
(06:55):
and I'm starting to see a littlebit more steam, a little bit
more hope.
But we still got to pay them somuch more money than with the.
You know the value that theycan and are providing versus
what we pay them, versus otherspecialties, is really, you know
(07:16):
, basically a crime.
And then the other thing is theburden we put on primary care
physicians ultimately is causinga lot of burnout.
So at one end we're starting toget more in, but the other big
challenge, Mike, is we have alot of physicians that are in
family medicine, primary care,that are in their 60s and
(07:39):
they'll be retiring, so wereally got to ramp it up.
You know we talk about WorldWar II analogies, especially
with D-Day and that, and wereally need a Marshall Plan, as
they did in Germany andeverything else for primary care
, and you know from a countrystandpoint.
So that's where I'm at, sowe're going in the right
(08:00):
direction, but it needs to beaccelerated big time we're going
in the right direction, but itneeds to be accelerated big time
.
Aaron Higgins (08:10):
So, Tom, kind of going back to the point you
raised about needing to be moreproactive versus reactive in the
sort of care that we're giving,that seems to me to be more of
a cultural problem rather thanone that we can throw dollars at
.
How do you think we couldovercome that?
Tom Campanella (08:21):
Well, it's really a couple things, aaron is
.
You know, the culture aspect is, bluntly, we have to change the
mindset in the US to getindividuals much more engaged in
their own health, Because, whenwe compare ourselves to other
countries, one of the reasonswhy we may not have the best
(08:45):
outcomes is bad lifestyles andother types of things, and we
need to get them more engaged intheir health.
That's where, again, I reallythink having family medicine and
primary care much more robustmuch more robust, including with
(09:08):
their staff and usingtechnology in that can be a way
to educate and engage thepatient in their own care much
more than it is today and maybefrom a family standpoint
especially when you're talkingabout seniors and others getting
them much more involved in thatindividual's care or, you know,
getting on top of them ofwhatever's needed.
But there is a lot of thatgoing.
(09:29):
The other part of it is, let'sface it, when we talk about 20%
of our gross domestic productbeing spent on healthcare, we
may perceive that as a cost, buta lot of stakeholders are
looking at that as revenue andprofit, so they make a lot of
money on our current sick caresystem.
(09:50):
That bluntly devalues primarycare.
So part of the challenge we have, even in Washington DC, is
politically, is that a lot ofthese players are in effect.
You won't see them out in thepublic, but behind the scenes,
these lobbyists and everythingelse are protecting their little
(10:12):
piece of the pie really bigpiece of the pie, to the
detriment of primary care.
So that's when you say whycan't we do more?
This is so obvious.
I mean, you could put a bunchof high school students together
and they can come to theconclusion of what needs to be
done.
But you know, as you know, thename of the game is follow the
dollars, and there's a lot ofdollars being spent on.
(10:35):
You know, once a person is sickand I hate to say it, it sounds
terrible, but that's an issueculturally- it sounds terrible,
but that's an issue culturally,from a societal standpoint, we
need to address.
Mike Scribner (10:51):
It does seem like , at least to a small degree,
that as the value-basedcomponent has become a bit
larger, that that's driven upprimary care providers' salaries
to a certain degree.
Like I feel, like I'm sensingin our market that if you wanted
to recruit primary care to arural market five years ago,
(11:15):
even 10 years ago, for surethey're going to be employed by
the local hospital because theycan't make it on their own
individually and with somemovement of value-based care,
somewhat successful versions ofit out there, it's driven up the
compensation for primary careto a certain degree.
Are you seeing that nationallyand is there any sort of
(11:37):
leverageable part of that thatcan be replicated?
That is a larger solution thanjust market by market.
Tom Campanella (11:45):
Well, first of all, I am seeing that nationally
, mike, and it's back to what welearned in school supply and
demand, and right now we havethat limited supply of primary
care docs.
But there is a recognition in avalue-based world that we're
(12:05):
trying to transition to, withmultiple stakeholders including
for-profit and non-profit.
Getting involved is, as you getmore players, bluntly, the
family medicine physician hasmore leverage.
They do have options and, asyou know, in the non-healthcare
world, when you have options,options and as you know in the
(12:27):
non-healthcare world, when youhave options, you know you're in
a position where you have theability maybe to control and
demand higher compensation, abetter quality of life, that
type of thing.
So I definitely see that comingand it is starting to come in
different areas of the countryto different degrees.
You know, not just regionally,but urban, rural and everything
else.
There's obviously a lot ofother factors.
(12:49):
You can't look at it.
You know.
Analogy that we talked aboutearlier, mike, really applies to
family medicine as well asother subjects in healthcare.
I look at it like a piece of apuzzle.
You can focus on one piece, sayfamily medicine shortage, what
can be done?
But if you just isolate just onthat piece and your knowledge
(13:14):
base is just focused on thatpiece, you're never going to
really understand the challengesbut, more importantly, find the
answers.
You got to look at all thoseother pieces that sort of come
together.
So you got to have a betterunderstanding of what's
happening in the payer world,the hospital world, overall
state and national health policy, the different types of payment
(13:36):
methodologies, what's happeningin for-profit.
So you have to have thatappreciation.
But just like a puzzle, once youhave that grasp of that, you're
in a better position to bothlocally and regionally and
nationally.
Going back to your pilotprograms and that, to put pieces
together and say, hey, I thinkwe found a solution if we put
(13:58):
this piece together with thatpiece and everything else, with
these stakeholders state orwhatever else involved in it,
getting the payer side, whateverit happens to be, but each
region, including urban, rural,region of the state or whatever
is not necessarily have the samesolution.
What makes sense in Montana maynot make sense in New York City
(14:22):
.
Obviously we went through thiswith COVID and everything else.
You know you just can't have across-the-board thing.
You know there's issues goingon in each region so there
really needs to be almost like aground-up approach to a
national approach, but aground-up approach to address
some of the challenges in familymedicine and primary care.
Aaron Higgins (14:44):
Let's take a quick break.
We'll be back in just a moment.
Julia DiGiacomo (14:49):
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Jason Crosby (15:21):
Tom, you mentioned a couple of things.
I'd like to follow up on One.
In terms of the provider base,you've got the aging population
that you mentioned before, andthen the younger group that's
coming up and maybe not fillingthat gap number-wise or pay-wise
.
Then you also mentionedtechnology.
Aaron and I have talked about afew different topics that kind
of maybe fits in that vein interms of provider gaps that
(15:45):
exist, right, and from theprovider side, you've got
utilization, perhaps ofmid-levels that haven't been
utilized as much as they could.
Or, in particular last year,we've talked a lot about
retailers, right, whether it'sthe Walmart, walgreens, dollar
General, even that at least area little bit more in the
accessibility space thananything else.
(16:05):
Then, on the IT, you've gottelehealth that really took off
from COVID and of course, ai.
That's really been a hot topic.
I'm curious I know I just threwa few different kind of things
at you there but those items,whether it's the provider side,
like mid-levels, or the IT side,like telehealth, how they may
(16:26):
be of some benefit to this gapthat exists over these coming
years, or maybe what you'reseeing nationally that maybe
those can provide a relief tothat gap.
Tom Campanella (16:36):
Well, I definitely think, just like it
would in other areas, theeffective use of technology can
allow things to become moreefficient, to be able to do
things in a sort of more focusedand productive way.
Let's talk about telehealth,for an example.
You know telehealth has been,you know, was really starting to
(16:59):
ramp up prior to COVID.
Obviously, covid accelerated itbig time.
I actually wrote an article, ablog, back in 2018, which was
obviously two years before COVIDreally hit about.
I called it care in the homesetting the new frontier of
health care, and I saw thattrend, which now everyone's
(17:23):
talking about hospitals at homeor whatever.
But I wrote what I thought wasa reasonably good analytical
reason, going back to the piecesof the puzzle, how the
different factors that resultedin maybe care in the home
setting playing a key part.
Ultimately, just as an asideand that will fit into this
(17:44):
discussion is that you know, Iknew the payer side both the
government and commercial andemployers were, and self-insured
employers were trying to drivehealthcare costs, especially
because escalating to the lowestcost setting.
But it needed to be a safesetting.
And the number two thing is Ialso recognized that what was
(18:09):
happening in the hospital world,which also results in why we
have a lot of competitors isthis trend again has been
occurring for a number of yearsprior to COVID is inpatient
admissions across the board havebeen going down throughout the
country on the hospital side.
But what's happening is theones that are going into the
(18:33):
hospital have more high-riskfactors.
So in many ways in hospitals,especially in major urban areas,
are almost becoming like giantICUs, intensive care units,
because it's really focused onthe high risk.
Where are these patients thengoing?
Well, they're going to theoutpatient world, which we've
(18:53):
been seeing that for a number ofyears, but that's accelerating.
And, by the way, this is achallenge for a hospital because
on the inpatient side, when youthink about it, how many
competitors do they have?
You know just a few otherhospitals, but on the outpatient
side, you know you could haveniche players, big players,
whatever it is, regional,national players.
(19:15):
But then, when you think aboutthe lowest cost setting, I was
thinking God, care in the homesetting.
But to do that it's a chickenand egg phenomena.
You can't have care in the homesetting from a safety
standpoint unless you have to beable to provide it.
You need technology, you needmedical device and everything to
(19:37):
both provide it, to bothmonitor it, diagnose it and
everything in that home setting.
But where the chicken and eggcomes in, think about it.
If you're a technology company,if you're into virtual care, if
you happen to be a medicaldevice company, you're not in it
because you know I hate to sayit altruistically you're there
(19:59):
to make money, you have researchand invest in it.
So the only way you're going topay for it is if you know
there's a long-term trend thatpayers are going to pay for it.
So that's where the synergycomes in.
The chicken and the egg.
Payers are saying we want todrive it to the lowest cost
setting and we're willing, butit's got to be safe.
And then, at the same time,medical device technology,
(20:22):
including telehealth, is sayingwe're willing to do this and
invest in it to make ituser-friendly, but we got to
have a long-term revenue sourcefor it.
So you got that synergyoccurring.
So telehealth what's so greatabout that is not only is it the
ability to be able to do itwithin a home setting, for an
(20:43):
example, but also which wereally haven't done enough of.
You know we talked aboutpatient engagement and those
types of things between visitsto better engage that patient,
plus their family members, intowhatever health issues chronic
(21:13):
health issues that are havingcan be a great vehicle to be
able to, you know, sort of finda way to keep people healthy and
everything else.
So there is a lot of thatadvancement.
Where the challenge is is one ofthe you know topics that you
know I find really important isrural health care, which you're
very familiar with and you knowwhen you talk about broadband
(21:36):
and other areas, that's whereyou have a potential opportunity
with telehealth.
But, depending on the rural area, you may not have access to it
or the people may not be able toafford.
You know the technology costsor whatever it happens to be, or
they may not have.
You know they may have issuesjust being able to grasp.
(22:00):
You know the ability to be ableto use you know technology in a
more effective way, so you gotto also be able to address that.
The good news there is andaside is just last year there
were billions of dollars setaside for a broadband expansion
throughout the country, with themajor focus being in rural
(22:21):
arenas.
So there is a recognition.
So hopefully that will allowthat vehicle to become even more
important and I definitelythink nurse practitioners, pas,
you know all these other onescan be a great vehicle to help
complement the primary carefamily medicine physician in
(22:42):
those environments.
Mike Scribner (22:52):
I get that.
My next question is going to,admittedly, come across from a
very biased we represent nothingbut providers point of view.
However, in that wholediscussion that you were just
having, what I find is one ofthe issues that we always run
into is that the business casefrom the perspective of the
local provider in the ruralmarket is tough to get in
telehealth because of the lackof payer support for it and in a
lot of ways, we sense that thepayers are less creative, maybe
(23:19):
less less incentive.
I don't know what the answer isto to to fully support that,
that that tenant that we'regoing to move into the lowest
cost setting, and it becomesmore of a barrier than anything.
Again, I see we see world, theworld, from a very, very small
lens, but what's yourperspective around that?
(23:40):
Have you sensed that?
Or is that?
Is that our payers across thecountry more receptive and more
supportive and facilitating thatdeeper in other places?
Tom Campanella (23:51):
Well, I think, mike, like anything else, it's
hard to make across-the-boardgeneralization because it
depends on the payer, it dependson the region, those types of
things.
I see them being, at leastverbally and this is always a
challenge what you say and whatyou do and verbally supporting
(24:13):
expansion of telehealth.
You know, verbally supportingany initiative that addresses
social determinants of health,those types of things.
The question is, are they whatthey are?
(24:34):
You know, even through federaland state legislation and rules
and policy, there's reallyputting more pressure on them to
get more involved in thingslike telehealth, addressing
social determinants.
You know, really finding waysto sort of address whatever
(24:55):
barriers there are to providebetter health care.
You know from that standpoint.
You know they always say ittakes a village or whatever.
But you know if you're talkingabout rural areas and you're
talking about smaller providers,you cannot.
You know we do business plansand everything else in the
(25:16):
academic world, as you said, ifyou really did a dollar and
cents return on investment typesituation with some of these
rural hospitals for example, youknow you're just not getting
that return on investmentbecause you don't have enough
people.
You know the specialties andthat.
Can you keep an ER open whenyou only have X number of people
(25:38):
, how do you handle and pay forspecialists or others, if you
know if there's travel issuesand that?
So that's where it really doeshave to be.
That's why I mentioned thingslike Marshall Plan, not just for
family medicine, but eventhings like rural health care.
That's where you know you gotto get employers involved, you
(26:00):
got to get the governmentinvolved at state level and the
federal level.
There definitely needs to beadditional compensation.
What I didn't like, bluntly, is,for an example, the COVID part
and I know there's a lot ofissues politically and I'm not
going to go into that.
But when it came down to givingmoney out to different players
(26:24):
after COVID hit and there wasmoney given to hospitals, for an
example, but a big share ofthat money went to the big major
hospital systems in the bigurban areas and from my
standpoint, they shouldn't havegotten it.
You know they have the abilityto survive through that thing.
(26:47):
What was not done is theyshould have been narrowly
focused on those small hospitals, those rural hospitals.
That's where the money was.
Covid hit the rural areas morethan urban areas, and I'm not
saying that there wasn'tchallenges in the inner city
because of COVID, but the pointis we should have been directing
(27:09):
it to there.
Problem is, the small ruralhospitals don't have the
political lobbying force, evenwith the American Hospital
Association, than the big urbancenters.
So that's part of the challengethat you have there and so it
really needs to be coming fromdifferent sources.
Employers, especiallyself-insured employers, are key,
(27:31):
but where the challenge is, asyou guys also know, is that one
of the challenges, includingafter COVID, there's been an
erosion of employmentopportunities in rural areas,
which is one of the reasons whywe have so many challenges there
.
So it's not like we can say okay, employers, you know you need
to help subsidize thistelehealth, or you know you need
(27:56):
to financially support thatrural hospital, you know the
small hospital and that A lot ofthem are leaving, and that's
where I think you know, evenwith the big urban hospitals, I
think there should be some formof I'm not a big believer in tax
, but the bottom line they needto help support.
(28:18):
We're part of the United Statesand we need to address it and I
don't care if you live in anurban area or whatever, or a
major player in urban, includingan employer or whatever.
(28:40):
There needs to be some form offinancial support for providers
in our rural parts of thecountry, and I grew up in the
inner city of Cleveland, so it'snot like I'm a small town,
rural guy and I don't care aboutit.
But the bottom line I saw and Icontinue to see in my talks and
(29:03):
in my visits in rural America,it's not just healthcare, it's a
quality of life issue.
Aaron Higgins (29:09):
Instead of the Marshall Plan, we need the
Capanella Plan for tackling this.
Tom Campanella (29:15):
Yeah, hey, actually, you know it's funny.
You know, way back when in my20s I was a Cleveland City
Councilman and I quicklydiscovered that even though I
was altruistic, passionate andeverything else, it was the
political side was not me, youknow I, you know, I played a lot
(29:38):
of sports and I had so manytimes people coming up to me in
politics you got to play ball,or I knew I was not meant for
politics when I was starting totell my mother and she would ask
for help and I'd say, well,what's in it for me?
So I'd rather, when I write andpublish or speak I never know,
(29:59):
am I doing it from aneducational standpoint or a
venting standpoint?
Because it really isfrustrating to see this country
and what we spend on health careand to have some of the
discrepancies as we talk about.
So, on a personal basis, I'm 74and I don't plan on giving up
(30:22):
and I plan on, you know, Godwilling being involved in one
way or another in health careadvocacy and policy, on things
like family medicine and ruralhealthcare for hopefully, many,
many years.
Aaron Higgins (30:35):
We'll be right back.
Ami Patel (30:38):
IPAs Independent Physician Associations unite
independent providers, creatinga collective voice in an
evolving healthcare landscape.
By joining forces, theynegotiate better rates and fair
contracts.
Shp manages comprehensive IPAservices, from contracting to
practice enhancement andeducation for our members.
Visit shplccom for details.
Mike Scribner (31:08):
So, all government help and Marshall
Plan, campanella plan aside,what successful models?
Are you seeing?
Rural health care where theyare?
You know local providers, localhealth systems, whatever have
stepped up and are you knowtaking innovative approaches?
What are those things?
What does the right directionlook like from a rural
(31:29):
provider's world?
Now, forget the Calvary runningin to help.
What are they doing themselves?
Tom Campanella (31:35):
Well, first of all, as they always say, god
says you got to help yourselffirst.
So, in other words, it reallythe community needs to be
involved and they need to be acatalyst for a lot of this.
And you know just as an asidefor a lot of this, and you know
just as an aside.
Again back to personalexperience, back in the 90s in
Southeast Ohio nine counties youtalk about a very rural area,
(32:04):
some of the poorest areas, notonly in the state but in the
country I got elected.
Besides the role of associatedean and doing population health
, I was over a collaborative ofdifferent stakeholders that were
working together to address thetype of issues we're talking
about in that region of thecountry.
So, for an example, in my roleI was in a position where I had
(32:29):
access to health care, mobilehealth care clinics.
Back in the 90s they actuallyreported under me as part of the
medical school role.
So we were out there in thecommunities, but we also worked
with the Department of Health,jobs and Family Services, the
local hospital, the differenttypes of the school system,
(32:49):
because health care starts, youknow, in grade school, you know
in different ways and webasically said you know, we are
all back to the puzzle, play acertain role within this region,
but we're doing it in silos.
We need to work together.
We need to actually puttogether a collaborative to work
(33:09):
together, and then we looked atgetting funding from Robert
Wood Johnson to help out.
You know, from that standpoint,you know the state and
everything else, we wereaddressing issues like licensed
schools.
You know which was a majorcause of absenteeism, for an
example, but we had to come atit from a different direction,
(33:30):
for an example, but we had tocome at it from different
direction.
Where I'm laying that foundationis I saw the potential back in
the 90s and what I'm starting tosee in different parts of the
country and I don't have themall in front of me, but you
could actually Google to findout but, like in the state of
Washington, for example, andothers, they have collaboratives
that are working.
A similar type of perspectivewhere you get local players
(33:53):
taking ownership and that wouldinclude the employer side too,
obviously and the local hospitalworking together, finding ways
to do things in a much moreefficient way, but identifying
and prioritizing the majorissues and then coming at it
together.
You can imagine if it's acollaborative you have
politically and everything else.
(34:14):
Also more leverage with thelocal politicians, but also
within the state capitol, andthen hopefully finding ways to
be able to get the congressmenand senators involved in doing
things, so that, I think, issort of the ground-up approach
in it.
You've got to have leaders inthe community taking ownership,
(34:36):
not just recognizing that wejust can't have our hand out.
The good news is I always foundincluding my own experience
people from small communitiesdon't have the attitude of
looking for handouts.
I think most of them, from whatmy experience was that they
(34:56):
really, if anything, had issueswith that and wanted to take
things on their own.
So I think there is thatmotivation they may need and
we're starting to see this.
The federal government isworking and they have planning
grants for an example, which Ithink is great.
So, for an example, you mayhave a community in Georgia or
(35:16):
wherever and they're wanting todo this, but there's
infrastructure issues ortechnology or how do we get
these players to work bettertogether?
There are federal grantsavailable that might be able to
help with some of the backroomstuff to allow this
collaboration, you know, so thatwhen you're working on a family
(35:37):
, say, you know you got to worryabout HIPAA, you know in or
something like that, butmultiple agencies are involved
in it it might even be with thesame family or that there should
be a linkage of information anddata to have more of a
comprehensive approach.
(35:58):
So I think the collaborativeapproach, with assistance from
the state and federal governmentand others, is, I think is an
effective way to be able to havethat ground-up approach.
Aaron Higgins (36:12):
So you're talking about changes to HIPAA
potentially as a part of this,and I agree with you.
I've been the HIPAA wonk formost of the organizations I've
worked for in the last 20 yearsand it's both a barrier and a
protector.
So I guess maybe expand on thata little bit.
(36:33):
I'd be curious to hear how youwould see that sort of change
play out, because I think you'reright, it's one of those things
that's potentially hinderingcare.
Tom Campanella (36:44):
Well, I remember I was teaching a class I was in
health economics when the HIPAAlaws came out and one of the
problems we have is like apendulum.
You know we have an issue andwe go all the way to one
direction or all the way to theother direction instead of
finding the right direction.
It's almost like we work off of, you know, polls.
(37:05):
You know it's a political arena, let's face it.
You know it's a political arena, let's face it.
So you know, the whole idea ofHIPAA obviously is protecting
the individual's privacy from ahealth care standpoint.
On the other hand, inprotecting that, it ultimately
is an inhibitor of communicationbetween providers, between
(37:34):
providers.
Covid was a perfect examplewhere in communities urban and
rural, for an example you mayhave people that had multiple
health issues, seeing multipledifferent providers, including
mental health providers, andthey may also be in a position
where they're going to localcommunity health centers or
whatever.
And then we're trying toaddress initiatives and identify
(37:55):
these people and determinewhat's best we can do both
individually and as a group.
But if the players can'tcommunicate with each other
because HIPAA is a barrier, thenthat's where it gets really
challenging.
But it can't be administrativeburdensome, but some type of
release on a more general basisthat allows for this type of
(38:19):
communication and education.
From that standpoint, and whileat one end maybe it should be
individual, on the other handthat could be really bogged down
.
There just needs to be thatfine line and I think if you got
the right people in the roomthat understand the issues,
solutions can be done.
It's just a matter of justbringing them up to the table.
(38:41):
You know, from that standpoint,I'd be curious.
Jason Crosby (38:44):
you've touched on both kind of a cultural mindset
and rural community, but alsosome legislative action that
could be taken.
You know we've had REH hererecently Rural Emergency
Hospital Hopefully I got thatacronym right.
That's taken effect but we'veseen a slow adoption of that for
various reasons.
340b, what swing bed program,having that thing, and of course
(39:10):
those are big hindrances to arural hospital being able to
take that on.
Do you feel such legislation isone, a big piece of the puzzle
you were just talking about, andtwo, removing those little
pieces like 340B may justfurther adopt such a model that
would be acceptable to thecommunities in those rural
hospital settings.
Tom Campanella (39:29):
Well, first of all, this goes back to my
argument before in regards tothe COVID quote bailouts to the
hospitals, for an example, whereit should have been going to
the small hospitals or ruralhospitals and a big chunk of it
went to the very profitablemajor urban hospitals.
Well, it's the same thing with340B.
(39:51):
I mean, the whole theory behindthat was, you know, to be in a
position to be able to target,you know, individuals and
hospitals that are providingcare to, in effect, the people
that really need it, the poorerpeople, the uninsured, those
types of things, the people thatreally need it, the poorer
people, the uninsured, thosetypes of things.
(40:13):
And next thing, you know everyhospital in the world is getting
a chunk of 340B and thenthey're upcharging it and
everything else that should benarrowly focused on certain
hospitals, especially small,urban, rural hospitals.
You know, from that standpoint,and that's an example of
redirecting resources for theright reason, you know from that
standpoint, and that's anexample of redirecting resources
for the right reason.
(40:33):
You know from that standpoint.
So, and then the whole idea ofemergency hospitals, and you
know, ultimately focusing onthat, as well as you know, the
effective use of differentfor-profit players that are out
there Walmart's been inhealthcare Now I don't know
what's going on with thembecause they were in, then
(40:55):
they're out, who knows?
But you mentioned Dollar Generalfor an example.
Dollar General actually has Iknow they experimented in
Tennessee mobile health vans inwhich they were putting on their
sites and others to be able toaddress it and hopefully go out
(41:16):
to the communities too.
And I know Dollar General isall over the place in rural
America and there may need to bemore involvement with players
like that there to be able toaddress it.
In regards to the differentmodels, like anything else, it's
not one size fits all.
(41:39):
I mean, there's pros and consand the devil's in the detail in
regards to some of the optionsthat they're throwing out there,
including the emergency typehospital settings, type hospital
settings and that, and I'mstill in the process of
evaluating some of these things,so I'm not in a position to
really get that specific.
Aaron Higgins (41:58):
Thank you for joining us today, boy.
We just it feels like we justbarely scratched the surface.
We would love to have you back.
I think there's a whole lotmore to talk about and be able
to pick your brain some more,and I guess I'll speak on behalf
of Jason and Mike.
We really enjoyed today'sconversation, so thank you for
joining us.
Tom Campanella (42:19):
Thank you and I really enjoyed this and, as you
can tell, I'm not short of wordsbut hopefully they're impactful
.
But feel free to reach out tome on multiple topics.
I enjoy talking about it andyou know, and hopefully we can
continue this relationship.
Aaron Higgins (42:39):
Yeah, and where can our audience find you if
they want to reach out?
Tom Campanella (42:44):
Probably the easiest.
Well, first of all, definitelyreach out on LinkedIn under
Thomas or Tom Campanella, andthat's where all my publications
are posted, actually includingpodcasts.
Hopefully we can work it outwhere this podcast I can post it
(43:07):
, on health care recap, which Ihopefully will have the links
from this podcast to send it toabout 8,000, 9,000 people too.
And so that is the one way.
The other way is, you know,strictly by email.
It's real simple TCAMP, t-c-a-mas in Mary, p as in Paul, and B
(43:28):
as in boy W as in Wallyedu.
So that's my email addresstcamp at B-W dot edu.
Aaron Higgins (43:36):
Okay, all righty.
Well, thank you for tuning intoday and we look forward to
having you back.
Tom Campanella (43:42):
Okay, thanks, guys, appreciate it.
Aaron Higgins (43:47):
This has been an episode of Beyond the
Stethoscope Vital Conversationswith SHP.
If you enjoyed this podcast,please be sure to rate and share
it with your friends.
It sure helps the show.
Jason Crosby (43:58):
Production and editing by Nala Weed.
Social media by Jeremy Miller.
Aaron Higgins (44:03):
And our co-hosts are me, aaron C Higgins and
Jason Crosby.
Our show producers are MikeScribner and John Crew.
Jason Crosby (44:11):
Thank you for listening and we'll see you next
time.
Aaron and I like to always savethe best question and the
hardest question for last.
Oh thanks, yeah, yeah, butgiven where you're located, I
think I already know the answer.
It's a popular recent debatewho really is the GOAT?
Is it LeBron or Georgia?
(44:32):
Or write and vote.
Tom Campanella (44:37):
Oh, I'll tell you, yeah, it's a matter of
perspective.
Obviously, from a Clevelandstandpoint, it's also a matter
of perspective.
We had one perspective ofLeBron in 2016 when we won and
another one when he moved toMiami.
So that perspective changes alot too.
(44:57):
And I have to admit Jordan,being a Cavs fan in the 90s, we
had an unbelievable team duringthat period with Mark Price and
Doherty and Nance and those guys, but that Jordan you know so
many times prevented us fromgoing.
(45:18):
And just a quick story, by theway, I was actually in Chicago
at a sports bar in the 90s whenwe lost to Chicago, when the
shot they keep talking about,and you know, and I was in a bar
and I was giving all theChicago fans a hard time because
(45:42):
we beat the Bulls six timesduring the regular season.
And then the shot comes alongand everybody forgets those six
games.
If I hear that word, the shotone more time or the drive or
the fumble or whatever.
Mike Scribner (45:59):
come on, guys.
We all know he pushed off,though it was an offensive foul.
What are we doing?
What are we doing.
Yeah right, tell me about it.
Call the foul ref.
Aaron Higgins (46:07):
Oh Tom, it was hard to be a Cleveland fan
period during the 90s.
All the heartbreak, all theheartbreak.
Jason Crosby (46:15):
I love that you brought up the fumble.
That's great yeah don't gothere.
Tom Campanella (46:19):
I brought it up, so who am?
Aaron Higgins (46:21):
I.
Tom Campanella (46:22):
Mea culpa.
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