Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Family nurse practitioner Bettina Reed discusses her article, “The hidden crisis in health care: How corporate greed is destroying patient care.” Drawing from four decades of experience across hospitals, private practices, FQHCs, hospice, and corporate medicine, Bettina shares a powerful account of how the health care system has been dismantled by corporate interests. She details how profit-driven practices—ranging from insurance denials and billing pressures to rising drug costs and privatization—have harmed patients, pushed out providers, and contributed to burnout and workplace violence. Bettina offers insight into alternative models of care and urges the public to reclaim health care from those who exploit it for gain.

Our presenting sponsor is Microsoft Dragon Copilot.

Want to streamline your clinical documentation and take advantage of customizations that put you in control? What about the ability to surface information right at the point of care or automate tasks with just a click? Now, you can.

Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Offering an extensible AI workspace and a single, integrated platform, Dragon Copilot can help you unlock new levels of efficiency. Plus, it’s backed by a proven track record and decades of clinical expertise and it’s part of Microsoft Cloud for Healthcare–and it’s built on a foundation of trust.

Ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Bettina Reed. She’s a family nurse practitioner. And today’s KevinMD article is “The hidden crisis in health care, how corporate greed is destroying patient care.” Betina, welcome to the show.

Bettina Reed: Thank you for having me, Kevin.

Kevin Pho: Alright, so just briefly share your story and then talk about your KevinMD article. For those who didn’t get a chance to read it.

Bettina Reed: OK, so I’m a family nurse practitioner, and I’ve been in the medical field pretty much my whole life, as my father was a family physician practicing in rural America. I worked in many different areas. I work in hospitals. I’ve worked in primary care most of my career. I’ve done federally qualified health centers, and I now work in corporate health and also work hospice on the side. I really am very passionate about patient care. I’m a strong patient advocate, and I’m also a strong advocate for just health care in general because I was raised to see that as a relationship between the patient and the provider. It’s very precious, and it’s an honor to be able to take care of people when they invite you into their lives.

So I really, really have seen so many changes over the years. My 33 years since I’ve been licensed really have shown that we’ve gotten a lot more corporatization of health care, a lot of big health insurance since. We’ve gotten prior authorizations, we’ve gotten copays, we’ve gotten referrals, we’ve gotten things we never used to have. We simply used to have an office where a patient came in or wanted to see the doctor, and they paid a 45-dollar visit and saw the doctor, and the doctor wrote what they thought they needed. The patient went home, then they would file their 45-dollar visit with their own private health insurance, and they would get paid. Mm-hmm. That’s the way it used to be, and it was still that way when I started practicing.

The reason I wrote this article was triggered a little bit because my daughter had just graduated, and she’s an RN working now in an ER, a busy ER, a trauma level one trauma center here in Richmond. There was so much violence in February against health care providers across the United States, and, you know, we were talking about it. It was just so tragic: patients lashing out against those people who were there to care for them—the ICU in Pennsylvania, the nurse in Florida, a poor doctor who was stabbed in the chest and had to be med-flighted out. I mean, it’s just tragic what has happened, but we are the face of what people see when they come in for their care, and they don’t understand this complex system—it really is. When you’re a medical professional, you know what goes on behind the doors, but patients don’t see that. Yeah. So we all know it’s broken, and they think it’s our problem that we’ve kind of done this to them.

Kevin Pho: So you’ve been practicing for 30 plus years. Tell us about some of the corporate influences that you’re seeing that really interfere with what’s really the core of medicine—that relationship between clinician and patient.

Bettina Reed: Right. So I’m very strong in that patient-provider relationship. Over the years, you know, when Blue Cross suddenly went for profit, we started having to justify our decisions to somebody way up there who has no idea what we’re doing in a room with a patient, then explain it and send records and try. We had to become fighters for getting medications and fighters for getting tests. Yeah. And fighters for getting appointments against someone who really wasn’t even in health care and didn’t understand anything about this provider-patient relationship.

So when the corporatization started coming in, I was always working in private practice then. I started seeing a lot of changes, because my father was also a family physician, and, you know, we talked about the billing changes and the new expenses that came in and how you couldn’t negotiate with insurances because everything suddenly became like, you charge 45 dollars for a visit, they’d reimburse 17. You’d send out someone for an MRI, and it’d be like 4,200 dollars, but if they cash paid, it’d be 1,800. You know, that sort of thing.

Then I started asking a lot of questions—why is it this way? Why has this game kind of become what it is? You start learning about the HAC Reduction Act and all the hospitals not paying for, or having reduced payments for, any infections or complications that patients get in the hospital. I found that out when I had to send a patient for x-rays, and he called me a couple weeks later and said, “You know, I got a 3,000-dollar bill. Why is that?” I told him, “Don’t worry about it, I’m sure it was a mistake.” I called the hospital: “You probably billed him for a CT.” And they said, “No, actually they passed this law. Now we have to foot the bill for all this inpatient care, so we’ve had to turn around and raise all these prices out here just to try to break even.” And it made me look and start researching, and sure enough, that’s kind of what happened.

As time goes on, everyone out there practicing medicine knows the struggle of trying to get medications for their patients. One year we got a letter that said 75 percent of your medications are gonna require a prior auth. And I sat there with a prior auth for a medication on the Walmart four-dollar list. You start researching and learning, and you start wondering, where is all this money going? Because now we have people paying monthly premiums that are going up every single month. They’re paying deductibles, which means you really don’t have health insurance until you’ve met your deductible. Then it kicks in, and normally that’s that 80–20 thing. Yeah. So where is all this money going, you know? It really is going into a very for-profit system, where up top they’re making 20, 30 million a year salaries and lobbying in the government with millions and millions—hundreds of millions—of dollars that I researched. JAMA put that out because they researched it, and it goes directly into our senators’ and congressmen’s campaigns and pet projects. So they’re not gonna pass legislation to regulate an industry that they’re making money from.

It ends up putting providers and doctors and nurse practitioners—all of us—in a very, very smothered role, where we have the knowledge and the expertise, and we are in the room with the patient, and we’re the ones with the skin in the game doing things. But we really don’t actually have the final say.

Kevin Pho: And how does that make you feel as a clinician when you’re in the exam room talking to a patient and realize sometimes you have to justify your decisions? You have to go through the whole pre-authorization for both medications and ordering tests. How does it make you feel as a clinician taking care of a patient, knowing that there are layers of bureaucracy that separate both of you?

Bettina Reed: I’m a very easy-to-get-along-with person, but honestly, it makes me think that they think I’m stupid up there, that I have to justify all the stuff I’ve learned to them when I’m the clinician. It makes me feel like they think we have no knowledge at all. And I’ve many times—I quit a job once simply because they told me I couldn’t send in my patient’s Zoloft, and it was on a Friday. I was at a federally qualified health center, so they received federally qualified money, so we had a lot of boxes to click, lots of rules to follow. But I sent in her Zoloft—I was gonna see her in a couple weeks—and I got a call from our pharmacy director, and he said, “Betina, you can’t send in Zoloft for her.” I thought, “That makes no sense. Why not?” He said, “Because there’s a government rule that you have to have seen them in 12 months in order to send in the script.” I told him, “You know, no problem. I’m seeing her in two weeks. She was coming in last month, but her son got sick, so they swapped appointments. It’s covered.” And he said, “No, no, we’re gonna discipline. You cannot do it. It’s a law.” And I told him, “You know what, I’m doing it anyway because I’m the one caring for this patient, and that’s patient care, and you do what you have to do, and I’ll do what I have to do. But I really don’t work for a little government guy up there.”

So I feel like that really good patient relationship with their provider has just been sullied by people who really aren’t in health care, and I don’t feel like they should have a say in it, to be honest.

Kevin Pho: So what are some ways that you push back? You told your story about the Zoloft, where this happens across the country so often, every single day. How can clinicians push back about some of that bureaucracy? Because it’s overtaking almost every part of what we do every day.

Bettina Reed: It really is, and that’s where—I mean, clinicians are frustrated. We spend so much time on all of our administrative tasks, and personally, I just won’t do stupid stuff. That’s where my line is. If it affects my patient care, I’ll just tell them, “I’m just not gonna do it. You write me up, you put it in my little file, whatever you want, but my patient care is gonna continue.” Now, I know a lot of people can’t do that, but I feel like we have the power. This is our field. We have the knowledge. This is where we shine. We care for these patients. We come into medicine in a service capacity, with compassion and love and care. I mean, we should make money at it too, because it’s what we do, and we sacrifice a lot of time and education to get there—especially a lot of physicians who spend decades of their life. Mm-hmm. You should make that money, but to have to then answer to other people and click all those boxes…I understand there’s some thought process to it, to justify, but it really ends up degrading that doctor-patient relationship so that you spend more time worried about, “Hey, did I click those HEDIS measures so that management’s not gonna come snag me at the next meeting?” It really degrades that time spent where you could actually use your knowledge to care for a patient.

Kevin Pho: You mentioned earlier that as difficult as it is for clinicians, patients in our health care system often have it worse, and sometimes they’re very frustrated with what’s going on and often blame the clinician or health care professional that’s in the room with them. They’re certainly not aware of the surrounding rules and the environment that we have to practice in. What are some ways that we can educate patients, or what are some things patients can do to improve the structure of a health care system?

Bettina Reed: I think that’s really tricky because I’m a strong believer in general good health, preventive medicine, healthy food, and I think that should be a basis. Our American food is pretty horrible out there, so I think that needs to be cleaned up. But when you work with patients and you realize they’re very frustrated, I think you need to take a deep breath and realize that this is a financial burden for them, but they’re also scared, they’re unsure—this is not their world. Yeah. You know, they might be losing somebody, and we have to take a big step back, a big breath, and explain and say, “We are here advocating for you. If we can’t do something, it’s not because we don’t want to, it’s because the insurance maybe isn’t gonna allow us, but we will try something else.” Or, “We’ll…” I think taking a few moments with the patient to explain, “Listen, I’m on your side. I’m part of your team. We’re gonna try to do this because that’s why I’m here. Now we gotta do all the red-tape stuff because unfortunately they hold all the power and strings, but I’m on your team.” I think if we really work with patients to help them understand that, “Hey, this is a you-and-me relationship, and we just have to deal with them somehow on the side because they are there,” that would really foster a lot of improvement in patient perception.

Kevin Pho: You mentioned earlier about some tragic cases of workplace violence, right? So talk more about that and what we can do to help prevent future episodes and maybe deescalate some of the conditions that potentially can lead to violence in the health care workplace.

Bettina Reed: That’s a big question, Kevin. That’s a big one because I think the system right now… I’m not seeing a good way that that’s actually gonna get better. I really am not, because I think patients truly feel very, very frustrated. This is a financial burden; this is a health burden to them. And I feel our providers—all of them, everyone from the techs watching the monitors, to the nurses, to the PAs, the NPs, the physicians, the radiologists, everyone, the anesthesiologists—I think everyone up here is all burned out trying to do what we’re trained to do in a system that really doesn’t support letting us be free to actually take care of the patient. Mm-hmm. So I don’t see that the violence, honestly, is gonna get much better because that is such a big problem. Patients need someone to lash out at, and we are the person right there in front of them. Yeah. They don’t understand the complications of this corporate bureaucracy and all the money that’s being made off of their illnesses. They don’t understand that it’s really complex, so they’re gonna take it out on us.

Until things change up here—and there is some movement, they’re trying to work with getting rid of some of the pharmacy benefit managers and all that, because that’s just… that’s crazy. I mean, everyone has stories to tell, but yeah, you know, the cost and the price transparency have to come back into medicine. You shouldn’t have different prices and costs for everything, where patients don’t know the cost, we don’t know the cost—it increases frustration across the board. I don’t see this getting better until people up top get out of our field, just back up, and actually start saying, “You know what, y’all are the experts. Y’all really actually maybe know what you’re doing, and we need to start seeking your opinion and your consult in order to help improve our system,” because it is so precious and so fragile and so important that it just shouldn’t be treated so callously.

Kevin Pho: We’re talking to Bettina Reed. She’s a family nurse practitioner. Today’s KevinMD article is “The hidden crisis in health care, how corporate greed is destroying patient care.” Betina, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Bettina Reed: I think my take-home messages are probably simply, you know, have compassion for your patients. Actually take a moment, look away from your computer, and listen to them—ask what their story is—because people feel unheard. We feel unheard. And support your colleagues. Sometimes there’s a lot of banter because everyone is so stressed and overworked and tired. Really just support each other and back each other up. And don’t be afraid to talk to management. If there’s a problem, tell them it’s a problem. If the insurance is being stupid, call them up. Say, “Listen, you know what? You don’t have a doctor there to see this patient. I’m the one seeing them. You at some point have to listen to me because this is my field. This is what I do. It’s not what you do; it’s what I do.” So I think really just get your confidence back and start advocating more for our patients and ourselves. I think that’s important because sometimes we’re so tired. We just wanna glide along and go home and get some family time, you know?

Kevin Pho: Betina, thank you so much for sharing your perspective and insight.

Bettina Reed: Thank you, Kevin.