Venkatesh Ramnath
speaker
47 appearances
1 recordings
1 series
first heard Mar 2025
last heard Mar 2025
Venkatesh Ramnath’s voice in public audio — every appearance, attributed to the second.
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I could take a stab at it. I'm not a health policy wonk, but I am a physician that has to deal with Medicare all the time. So Medicare, in sort of general terms, is a type of health insurance that is provided by the federal government. It is almost exclusively for individuals above the age of 65, as it dates back to the 1960s with Lyndon Johnson's Great Society program.
coverage for any individuals above that age such that all their medical services or products you know whatever they need for their health care is actually covered by the government this is the federal government now the interesting thing about medicare is that there are different parts to it there's part a which is primarily for some essential services and includes hospital care but
There's Part B, which includes whatever physicians' fees go into that health care. And then there's Part D, which relates to pharmaceutical prices, so your drug costs. It's not comprehensive in the sense that there's always something more that individuals need, but Medicare... for all intents and purposes, is the sort of standard, and it should cover most of an individual's needs.
Now, that said, the commercial payers, that is the other insurance companies that are not federally government-sponsored, take their lead from Medicare. So a lot of the different payment rates
or coverages and services, they all look to what the centers of Medicare and Medicaid services dictate as far as what is an acceptable reimbursement rate, what are the rules around what should be covered and what should not. So that's why Medicare is such an important entity for the United States.
Let me add to that. So, you know, telemedicine has been around for a very long time, at least technically speaking, right? I mean, you can go back to the 1970s, even when you talk about the intensive care unit, which is where the sickest people in the hospital are. There are studies that come out of the 1970s.
However, ever since people have had iPhones and been on Airbnb and everything else since 2007, that inflection point actually had a wave of opportunity that washed right into medicine. And as Kaveh is saying, we have such a fragmented healthcare system
that has folks living in rural areas, suburban areas, and urban areas, all of whom are at the mercy of what specialists may be there contracted at any given time for any given specialty. Now, telemedicine, as it's gotten more and more popular, has kind of leveled the playing field. I mean, you can be in...
rural place like where I'm sitting right now on the U.S.-Mexico border, or you can be in New York City, one of the densest populations, but you might not have access to specialty expertise without telemedicine. With telemedicine, you can now have access. And I've seen patients love it. You can deal with the sickest of the sick, like I said, intensive care units.
But you can also have outpatient experiences. And we've seen a number of different commercial opportunities that have leveraged that. But the point is that as we're hearing on this, it's become sort of a standard operating procedure for how we deliver health care. And if you just pull the rug out from that, there can be some unintended consequences to that that are not insignificant.
Yeah. So basically, the sort of this convoluted way that we pay for services is it looks to one standard, even though some may argue, how did that standard come about? But regardless of that, Medicare is the central authority that basically tells everyone this is what we should be doing and this is how much we should be paying for it.
Now, the commercial insurers can decide to exceed that if they wish. If they, say, have an employer whose employees they want to have a special contract with, that's fine. That's not restricted. But the bottom of what is considered a reimbursable amount is really set by Medicare. And so they move the bottom. And so if you drop the bottom,
you can pretty much well assured in this, you know, in a capitalist, you know, sort of mentality that the costs should go down, right? I mean, why should you pay more for something that you don't need to, right? And we see that every year, okay? Every year there's new technology, but the slightly older technology, which is, again, covered by Medicare, they move those reimbursements down.
So whether it's a sleep study, you know, for someone with obstructive sleep apnea or difficulty sleeping at night, or it's some ophthalmology technology, or it's some ultrasound machine, it doesn't really matter what it is. Medicare is always trying to minimize costs, which is understandable. They want to make it cost effective, but they are setting the lead. So everyone will follow what they do.
That's kind of the way that our system is sort of set up.
I do want to add something here, and I do want to be careful about the term, because telemedicine and telehealth are not only sort of a catch-all, but they're sort of used interchangeably, right? And just like anything, you have to be specific about the term. So I think what we're talking about on this podcast is telemedicine in terms of a two-way audiovisual technology.
interface where you can have a direct face-to-face consultation or interaction with a practicing practitioner. Usually that's going to be a physician, but it may be a nurse practitioner or other physician extender, we call them. But just to be clear, telemedicine also extends to
other types of devices like wearables, those things that they're either, you know, trackers that you can wear as your Fitbit or a sleep device, you know, that you can wear around. Those kinds of things are kind of put into the telemedicine bucket and And it's not clear to me, at least, how that is going to change.
I think April 1st is when the face-to-face coverage from a professional fee standpoint, that is slated to end because they did liberalize it during the COVID pandemic. And it's been extended, I think, another year around that. And that will definitely change the dynamic here. But it's not clear how much of it extends to other types of remote physiologic monitoring services and products.
Yeah, it's a tough time, certainly. And coming out of the pandemic, this is not what really anybody expected. But the stresses have been mounting for quite a while, right? Healthcare professionals are seeing and feeling more stress at work, whether it's the demands of the job, meaning that there are fewer resources to spend on a heightened number of patients with increasingly complex diseases.
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