Jesse Pines - perhaps the leading health services researcher in emergency medicine - speaks with The Shift Report about the complexities of our health insurance system, the effects of the No Surprises Act, and why boarding is still a problem.
Follow his work with USACS at https://www.usacs.com/about-us/academics/usacs-research-group, read his columns in Forbes and look for his upcoming book "Quality Measurement in Healthcare."
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Summary
Til Jolly and Jesse Pines discussed various topics during Podcast #24, including Jesse’s career journey, the complexities of the U.S. healthcare financing system, and the No Surprises Act. They also explored hospital boarding practices and potential healthcare system changes.
Jesse shared his career trajectory, starting from his time at Penn, internships with Senator Joe Lieberman and the White House, and medical studies at Georgetown. His interest in the business of medicine led him to pursue an MD/MBA program. Despite the economic downturn in 2001, he continued practicing emergency medicine due to his passion for the work.
The discussion on healthcare financing highlighted the disparities in payment rates between private and public insurance and the resulting challenges for physician practices. Jesse emphasized how these dynamics impact emergency physicians, who are obligated to provide care regardless of payment.
The No Surprises Act was examined for its role in eliminating unexpected out-of-network medical bills, while also shifting negotiation power toward insurance companies. Jesse noted the act’s success in preventing large patient bills but pointed out its challenges for physician groups.
Hospital boarding, a profit-driven strategy where emergency departments handle less profitable patients, was also discussed. Jesse and Til explored how elective surgeries and patient flow patterns contribute to this issue and proposed potential remedies, such as reallocating RVUs or government intervention.
They concluded by discussing possible healthcare reforms under the new administration, including shifting focus from acute to chronic diseases and regulating processed foods. Jesse outlined his upcoming projects, including a Forbes column, a book on healthcare quality measurement, and further research with the USACS group.

Episode: https://emcentric.podbean.com/e/24-jesse-pines-demystifying-the-world-of-health-insurance-and-how-it-affects-how-we-work/

Podcast: https://emcentric.podbean.com