Intro (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams Health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:24):
And good morning, everyone. Welcome to another edition of Health Law Talk here at Chehardy Sherman Williams. Conrad Meyer, Rory Bellina, your leading healthcare lawyers who pioneering everything healthcare. Right. Rory,

Rory Bellina (00:36):
That’s a good description, very good description.

Conrad Meyer (00:39):
And today in the studio, we have a wonderful guest. We have Dr. Jamie Kuo.

Dr. Jamie Kuo (00:45):
Hello. Thank you for having me.

Conrad Meyer (00:47):
That’s great. We’re happy to have you. And, and I gotta tell you, it’s, it’s, it’s fun because for our listeners out there, I taught Jamie in law school,

Dr. Jamie Kuo (00:57):
Well, not law school, Remember the

Conrad Meyer (00:59):
Masters? Oh, the masters in

Dr. Jamie Kuo (00:59):
Healthcare. I want misrepresent

Conrad Meyer (01:00):
Myself. Yes, that’s correct. So, so, so forgive me. Yes. But she was in, she was in our health law class. And, and, and Jamie has wonderfully decided to come on the show today. I mean, really got some good stuff going on, Jamie. How, how are you doing? What’s going on in your world?

Dr. Jamie Kuo (01:14):
I’m doing well. I’m super busy like everybody else in the world. I’ve I’m still getting my master’s degree. And, and the reason why you think that I’m in law school is because the master’s program is in the Loyola Law School. Right. So I’m still doing that right now. I’m taking six hours this semester. I’m still working full time. I’m an ER doctor, and I’m doing a lot of my advocacy, which is what we’re gonna talk about today.

Conrad Meyer (01:39):
That’s great. So, so what, let’s talk about that ER doctor. I mean, you know, that’s, that’s a big deal. I mean, you know, my wife’s an ER physician, so I know how terribly tough and stressful it is. What, what is that like? I mean, what, how long you’ve been doing that? Where are you, you know, if you’re comfortable saying that, what, Tell me about that role in, in, in terms of your professional career. Yeah.

Dr. Jamie Kuo (01:58):
Oh, exactly. For sure. so I graduated from LSU Medical School in oh seven, and Hurricane Katrina happened during my third year. So my husband and I said, Oh, let’s go away for a few years. Let’s, let’s go have some fun. So we did residency in Charleston, South Carolina.

Conrad Meyer (02:13):
Nice.

Dr. Jamie Kuo (02:14):
And honestly, we probably would’ve stayed there, but my husband became disabled, so we moved home about six year. He got sick about a year after his he started working. So we wanted to be closer to family. So we moved back. And I’ve been working in the community since 2013. So I’ve been practicing, you know, for about, what is that, 15 years?

Conrad Meyer (02:35):
That’s a, that’s a, that’s a long time. Yeah.

Dr. Jamie Kuo (02:37):
You know, and it does, it is a long time. And you know, you were asking what’s er, like, you know, we, er doctors see acute unscheduled care patients. Right, Right. So patients that are having acute problems and they don’t have an appointment with the doctor, so they come to the er. Right, Right. And then of course, we see the patients that are sick and literally dying. Right. Absolutely.

(02:59):
And it’s hard. But, you know I feel like my career has prepared me for what I’m doing right now, because as an ER doctor, I literally all day am advocating for patients. Whether it’s a homeless patient that needs to go to a shelter, we help set that up for some homeless patients, whether it’s a person who has an opiate addiction and they need to go to, they want to go to rehabilitation or recovery. We can help them set them up. and then, you know, just the, the patients, the 25% of the patients that we admit to the hospital, we’ve got to advocate to their consultants and their physicians that they get admitted to. So, you know, all day long I’m talking to people, I’ve learned how to talk to all different kinds of people. Right. Like, I take care of CEOs and,

Conrad Meyer (03:49):
And that’s a gift. I mean, that’s a real gift to do that. I mean, being able to talk to everybody. I mean, you really have to have a patience, I would think. Right. I mean, it’s hard to, it’s hard to do sometimes. It

Dr. Jamie Kuo (04:00):
Is. And you know what’s interesting? When I was a little younger and more egotistical, I was probably a little more stubborn and hardheaded and probably had a harder time uhhuh. But as I’ve gotten older, I’ve just realized that if I just keep the focus on the patient when I’m at work, I don’t lose, you know, like whether I’m, you know, fighting for something for them in the community or even, you know, arguing with a doctor about what the appropriate care is. Right. I shouldn’t say arguing, but, you know, spirited conversation, I guess you know, if I keep the, if I keep the focus on the patient, right, We all win. As long as we’re doing what’s best for them. That’s just what I’ve learned to do.

Rory Bellina (04:36):
You know, I was just talking with Conrad before the show when we were prepping. I think you’re the first er doc that we’ve had on the show. We’ve had a lot of doctors. So just wanna spend a few minutes, not a lot of time. Cause we could spend a whole episode on, on could, what the past two years have been like for you. What was it like? Oh, that’s a good question. Moving out of that. I know, I promise. Give me a two minute answer on this so that we could pivot off. We,

Conrad Meyer (04:57):
We could, we could literally do a whole episode on that. Sure.

Rory Bellina (05:01):
Probably.

Dr. Jamie Kuo (05:03):
so the, it was personally hard for me because my husband is disabled, He’s immunocompromised and he’s on oxygen. So I’m one of those doctors who literally in, I don’t wanna sound funny about this, but I, I don’t, I’m not an anxious person, but that was one of the first times in my life and my career where I was like, I was literally at work and my, my partners were having to talk me down cuz I was so nervous. Mm-hmm. because we, you know, we have a child. We have a 12 year old. So there were all these, you know, and at the beginning, so many healthy people were dying. Right. It was so virulent and so deadly. That one, I was worried I was gonna catch it and I was gonna die. Another thing was that I was worried about was I was gonna catch it and bring it home to my husband and he was gonna die. And then we were gonna orphan my son. I actually was one of those doctors that moved outta my house.

Rory Bellina (05:51):
Oh

Dr. Jamie Kuo (05:52):
Wow. Okay. For a few months. Yeah. Okay. And I had some really nice friends who donated their Airbnbs to me or some kind condo that Oh yes. People really came out and helped me. And then you know, we just kind of went wild, you know, buying supplies. Even my brother, my brother, my, my, my family is from Lafayette and we do industrial insulating. Not me, but my family does. Okay. And so my brother has all these industrial accounts and he started buying those, you know, those coveralls that would cover the whole head. And he bought a bunch of those for us and donated to them. And we got all these masks and I was on, I was so active on social media, which I actually usually am not mm-hmm. , but just posting every day. Like, everybody, you gotta do this and you gotta do, come donate your masks to us, blah, blah, blah. And then, you know, taking care of the patients was pretty frightening, you know, cuz they’re looking at you and they were literally looking at me like you are right now. But their oxygen levels are in the forties, which is,

Conrad Meyer (06:49):
That’s not good. Oh

Dr. Jamie Kuo (06:50):
No. I mean, your oxygen levels should be between 93 to a hundred percent. Right. They were in the forties. And so when we would have to put the breeding tubes, cuz remember there was a whole fear of the ventilator shortage, right? Yeah. Right. We were ventilating everybody. you, you had to do your procedure so fast and you had to be so confident in it mm-hmm. to to do it that I had a, I had sweat going to my back numerous times. Wow. but, you know, I was lucky. I I, I don’t work at some of the bigger hospitals that were just crazy out the wa u patients in the hallway. we were a little more controlled in my hospital, so we had all the supplies that we needed, so That’s

Conrad Meyer (07:30):
Good. Yeah. Yeah. I mean, I don’t remember, you know, my wife came home and, and I don’t like talking too much about my wife, but, but she’s great. We had a whole sterile technique. Like, in other words, when she got in the garage, immediately take off all the clothes. There was the garbage bag waiting. She put it in the garbage bag. Mm-hmm. walked up immediately, went into the washer immediately went into the shower. I mean, it was a whole thing for, I mean, and we did that for, gosh, almost a year. I mean, a and I can remember that. And we, and I mean, I went to, I went and bought toilet paper. I mean, I had toilet paper and paper towels and I mean, I mean, people thought I was crazy hoarder. Absolutely. You know? Absolutely.

Dr. Jamie Kuo (08:12):
we did the same thing. I, I would get undressed on my, on, you know, my back porch and everything and you know, now C’S not gone. Yes. It’s less virulent, but it’s still deadly for my family. Right, right. it that I still, ma y’all saw me. Y’all came in. I still mask. Sure. Oh my gosh. You know, I feel like everybody is, I can’t breathe either in it, you know, I don’t like wearing it either, but, but I hope

Conrad Meyer (08:35):
You don’t feel bad cuz we’re not wearing mask. Cause I

Dr. Jamie Kuo (08:37):
Hope No, y’all are sitting far enough away from me. Okay.

Rory Bellina (08:39):
Okay.

Conrad Meyer (08:40):
Good. Okay. Good. Good.

Rory Bellina (08:41):
Yeah. So how have things been, I guess let’s segue into your practice now. How have things have things, I know there’s normal’s not the right phrase, but are, are things going back to more of your pre covid practice? Yes. Okay, good. It

Dr. Jamie Kuo (08:53):
Is. Yeah. Good. And, and you know, we, we definitely see all the spikes in covid and everything as they come. We recently had one and where there was always a few patients in the ER that had it. But I haven’t seen anybody in respiratory or failure failure Recently. one of my partners said she felt like she saw original strain not too long ago. Oh wow. Where like, like I was, I was describing like the patient that’s sitting there looking at you, but their levels are in the 40%. so Yeah. No, it’s feeling it’s pretty normal.

Conrad Meyer (09:24):
So how, how, how did, let me pivot back. Okay. The journey to law school . How, I mean, I mean, most doctors I know, I’m sorry. Not law school. The masters in, in law. I get that messed up. Isn’t that Roy’s looking at me with four eyes, like Conrad, he didn’t go to law school.

Dr. Jamie Kuo (09:40):
I will correct you every time. Cause

Conrad Meyer (09:42):
I know you’ll represent. I know you’ll never, but, So how did, I mean the masters in law, in health law, tell, tell me how that came to be and where, where the desire to go for that. Yeah. Come

Dr. Jamie Kuo (09:53):
From. I actually love telling this story and it’ll actually come full circle for y’all because when I was in my first semester mm-hmm. , you told us about I was taking health all one. Right. And you told us about this. Oh, you didn’t know about this podcast. We had this podcast we’ve been doing. So I started listening to it. Well, I think y’all’s third podcast was about house Bill 4 95. It’s 2021 House Bill 4 95 introduced by Barry Ivy. And it was a scope of practice bill.

Conrad Meyer (10:19):
Oh, I remember. I remember this. I remember this one.

Dr. Jamie Kuo (10:20):
Yeah. Yeah. I think it was your third. So it was very interesting. Literally the day that you told me about the podcast, that was the podcast that was released that day. . So in, that’s honestly, I like it. House Bill 4 95 is what really started my journey with all of this advocacy. So you know, in the healthcare arena, we have mm-hmm. a lot of people that take care of patients. Right. We have physicians, nurse practitioners, PAs, we have pharmacists in the hospital, we have physical therapists, social workers, You know, there’s, there’s a lot of different people. So what,

Conrad Meyer (10:55):
Yeah, I, I wanna tell about this 4 95. Can you wanna give a quick, quick little for the listeners who didn’t listen to that podcast, What, what is that Bill? Why did that trigger the interest? Right.

Dr. Jamie Kuo (11:07):
So 4 95 was asking for independent practice for nurse practitioners after a certain amount of time. The

Conrad Meyer (11:14):
Mid levels, correct? Yes. Okay. Your aps.

Dr. Jamie Kuo (11:17):
Yeah. so we actually, I call them non-physician practitioners. I think that that’s a more accepted terminology because that’s actually what the federal government refers to as nurse practitioners and PAs.

Conrad Meyer (11:27):
Is they non-physician practitioner.

Dr. Jamie Kuo (11:29):
They’re non non-physician practitioner. Got it. Okay. So we think that’s our, that’s our accepted terminology. Got it. That right. Okay. mid levels. cuz I have a lot of friends that are nurse practitioner and PAs. Right. Eight levels they feel is a little derogatory towards them. So I really try not to use that word.

Conrad Meyer (11:41):
Okay. I, I did not know that. Good to know. Yeah.

Dr. Jamie Kuo (11:43):
Good. We, we used to back in day and I even slipped because I used that word.

Conrad Meyer (11:47):
I thought a PPP was the one, like a, you know, advanced practice provider. That was sort of what we were told. But anyway, that’s,

Dr. Jamie Kuo (11:53):
That’s just kind of a, a word that hospitals have made up. But I feel like every hospital, the hospitals around here definitely say a P Right. Okay. one of the big hospitals. Okay.

Conrad Meyer (12:03):
We have a lot of word salad in health healthcare.

Dr. Jamie Kuo (12:05):
We surely do. But the, the terminology that is accepted by CMS is non-physician practitioner. Got

Conrad Meyer (12:10):
It. Okay. Good to know. Good

Dr. Jamie Kuo (12:11):
To know. Okay. So the, the bill was asking for independent practice and you know, I’ve been practicing for 15 years and at that time I’d been practicing for 13 years. I’ve worked with a lot of nurse practitioners. Right. I’ve worked with a lot of physician assistants and I, physician assistant. See, I need to, you gotta make sure with the terminology, cuz that is also derogatory. If you call them physician’s assistant, they’re not a physician’s assistant. They’re physician assistants. Have y’all, have y’all made that?

Conrad Meyer (12:39):
I have not heard that. It’s just I’ve heard physician extenders. I’ve heard of mid-levels now, the non-physician practitioner. Yeah, I’ve heard of all that, but I’ve not heard of that.

Dr. Jamie Kuo (12:47):
Well, I try to be sensitive because some of the topics that I focus on are not personal and they’re not, I’m not trying to be derogatory. Sure. So I just try to be respectful about how I talk about

Conrad Meyer (12:59):
It. I totally agree. Very diplomatic.

Dr. Jamie Kuo (13:02):
Yeah. So Right, because this is not personal. No. Right. How I feel is not personal. My focus is the patient. So the, the bill was asking for independent practice for and for nurse practitioners. Mm-hmm. . And, you know, I kind of looked back and said, Gosh, I don’t think this is safe. Right. And this bill, it had always been kind of floating around. I had even been hearing about nurse practitioners and PAs and this, you know, Kuote unKuote, they’re gonna take your jobs and all that, you know kind of negative talking points. But I had always had of ignored it. I wasn’t really paying attention. I, my, my, my head was in my books. I was just working, keeping my head down. But, you know, when I saw this bill, I said, I don’t think this is safe. And I’m gonna tell y’all why.

(13:45):
Mm-hmm. , I’ve worked side by side with a lot of nurse practitioners and PAs. I have trained a lot of nurse practitioner and PAs, whether they’re freshly outta graduation or mid-career and making a change. I have been a recipient of the care of nurse practitioners and PAs both me and my husband. So me as a direct patient, but also as a caregiver. and then now I I’ll work for the federal government. So now I work with them in a capacity where they already have independent practice. so I said, Look, I really feel like I know a lot about this and I don’t think it’s safe. I do feel like nurse practitioners and physicians assistants have a role in healthcare, but I feel like they need to be supervised. So, you know, I was watching House Bill 4 95 and it, it did ended up it ended up dying in the Senate. It

Conrad Meyer (14:46):
Did. Right? Yeah. It did make it,

Dr. Jamie Kuo (14:48):
But what what sparked all this advocacy was I started watching every single committee hearing meeting and I was blown away. . I was blown away at what?

Rory Bellina (14:59):
So you watched those hearing meetings, watched them. I watch,

Conrad Meyer (15:01):
They’re very boring. The debates. Oh my gosh. Wow.

Dr. Jamie Kuo (15:04):
They’re very boring. Whether it was health and welfare. I and I, and, and then through that you start going, Oh, I’m interested in this bill I’m in, interested in. So you start watching all the committees and then you kind of know how they all operate. And then I would watch the floor debates. Right. And the way I felt was, gosh, these legislators, well first, first before I said that I love state level politics because I really feel like our state educate. They, they live in their districts. You know, they don’t live in DC They, so they truly care. Right, Right, right. And I felt like I, I just realized that they don’t really understand a lot of the bills that they’re passing or not passing. Right. Right. Because I would agree with that. Some of them, if you look at health and welfare committing, some of them are lawyers, Right. Some of them are, some of, you know, some of them are, well,

Conrad Meyer (15:48):
Their backgrounds aren’t in he care, they’re

Dr. Jamie Kuo (15:50):
Not healthcare. So they don’t truly understand how these bills affect patients at the bedside.

Rory Bellina (15:55):
And you have a lot of career politicians in Baton Rouge that you have been there for so long that they don’t really understand or, or know.

Conrad Meyer (16:02):
You know. And even at the hearings though, Rory, I mean, cuz you got different interest groups, you know, pitching mm-hmm. Right. Whatever the, the bill is on the, on the, on the table. Right. At the committee level. So you might have a hospital or a, at the the State Medical Society or whatever, whatever lobbying group is pitching these guys, you know, the, the, the, the the legislators. So Yeah. You know, I agree with I see. I’ve seen it. It was, It’s

Dr. Jamie Kuo (16:24):
Terrifying. Yeah. So by the end of that session, I said, Oh my goodness. Right. It was like, patience, need an advocate and it’s gonna be me. So, but I felt, and I felt like I have time. Like I’m the ER doctor, I do a lot of shift work. So I have just like, some day, like this week I have Monday, Tuesday, Wednesday, and Thursday off because I’m working this weekend, you know, so I have time to do this kind of outreach. My specialty has taught me how to be an advocate. So it kind of comes naturally to me now. Mm-hmm. , you know, being able to talk to people and advocate for the patients.

Conrad Meyer (16:53):
I can see that in you.

Dr. Jamie Kuo (16:54):
Thank you. And, and, but then I said, Well, I wanna go to law school. So I started researching law school and honestly with the disabled husband and, and the son and the full-time job, I really couldn’t. But Loyola had this masters in healthcare, admin, healthcare, and masters in health fund administration. And I said, I’m gonna do that. It’s, it’s a master’s program. It’s 30 hours and I’m still gonna be to really focus on the classes that will help me. And it’s been amazing. It’s been absolutely amazing.

Conrad Meyer (17:22):
And we were the first class, I mean, were we the first class? Yes. So, so I have to ask, and I’m, and I, and you’re in front of me now, . Did you like the class? Did we do a good job? Oh, I loved it. I loved

Dr. Jamie Kuo (17:32):
It. You know, it was a little chaotic because, you know, Bo taught on Mondays in Utah. On Wednesdays. Yeah. So you would have to switch your brain, you know. But at the end, everything really came together and it was great. Oh, I use, actually, you know what I’m a member of the American College of Emergency Physicians. Yes. And this past year I was a counselor where, you know, you go to the, and you go and you make rules for the society and everything. Yes. Okay. I actually introduced a resolution to ask them to support to ba basically give legal advice to new graduates on contract negotiations. That’s

Conrad Meyer (18:11):
Great. Yeah. That’s really good. Yeah. That was really good. That’s really good. It

Dr. Jamie Kuo (18:14):
Didn’t get, and it was, that really stems from you. Cuz when I was in your class going, I’ve never hired a lawyer for any of my contracts. I got really lucky. Yeah, sure. You know, that I didn’t get trapped anywhere. Right. But it was after taking your class that I said, you know, we need more presentations. Physicians are, you know, we got the tunnel vision. We’re way too into our books. We’re not paying attention to anything. Physicians are notoriously bad about money. Notoriously bad.

Conrad Meyer (18:35):
Very true. we, we can agree to that, right, Roy? Yeah, I hear that.

Rory Bellina (18:39):
I’m kind’s got personal experience from his wife, I’m sure.

Conrad Meyer (18:42):
Yeah. No, I, my wife,

Dr. Jamie Kuo (18:43):
No, no. She’s, she knows. She’s on,

Conrad Meyer (18:45):
On, she’s on ball. You know. so wait, so, so, so that, that was a very good experience for you. And now, so taking that experience, what have you done to further the advocacy? Where, where are you now? What’s going on

Dr. Jamie Kuo (18:59):
Now? Yep. So we ended up for, so there’s, I’m not the only physician who feels this way. Okay. Right. A lot of physicians woke up that year and we said, Gosh, we really need to advocate for the patients. So three of us, interesting enough, three, we ended three er doctors. I guess we just have more time during the week. You know, it started a non-profit, it’s called Louisiana Physicians for Patients. And we decided we’re just gonna advocate for the patients. You know, so we raised money, We, and literally I’m talking about cold calling my friends and just going down like, Hey, I’m starting this group. We’re gonna hire a lobbyist. And you know, we, you know, I’ll go on a little tangent right there. Our, I love our lobbyists. Right. I think lobbyists have a very negative reputation in general. I

Rory Bellina (19:45):
Agree with that.

Dr. Jamie Kuo (19:45):
But, you know, I can’t live at the capital Right. In contact every single one of them. And if you really, I spent at least one day a week at the capital this past week doing the physician of the day and also just going to meet with my legislators and everything. And if you meet the lobbies, they’re wonderful. They’re nice. They’re just doing a job. They’re just, they’re just spreading your message for you cuz you’re at work, you know? Right. So

Rory Bellina (20:07):
What’s the overall message of the nonprofit?

Dr. Jamie Kuo (20:09):
Yeah, so we, patients first. Okay. Patient safety. That is the main thing. So we started the non-profit, we started that in February. We raised money to hire a lobbyist. And what we’ve been doing is we’re trying to educate the legislators. So the, the goal has not changed. Right. So that’s, that’s how I originally felt was I needed to educate the legislators. So what we’ve been doing is we’ve just been meeting with as many of them as possible. Okay. whether it’s bringing them to lunch and, you know, I I, I even brought all my stuff today to show y’all y’all weren’t interested, but, you know, we kind of showed them the data of why they should or should not be voting a certain way. Okay. And all the data that we bring is very patient focused. Okay. so we talk about like, quality, cost, outcomes mortality.

Rory Bellina (20:59):
So are you having to do this every time a bill is introduced? Yes. Where you get a, you get a, a draft of that first bill when it’s read and then you say, Okay, we’re good with this one. We want to tackle this one, We hate this one. Let’s, is that kind of what the process of the non-profit is?

Dr. Jamie Kuo (21:14):
It is, yes. And, you know, we’re so small we, and we don’t even really have a membership yet. Sure. we’re not completely organized cuz we’re brand new. We just started, you know, what, eight months ago. but yet that’s what we did. When the bills all got registered at some time in March, we had to zoom together and said, Okay, these are the bills of interests that affect medical care. You know, let’s, we’re gonna either support these or oppose other ones. Yeah. Mm-hmm.

Conrad Meyer (21:38):
So lemme ask you this. So I, I know that the state medical society has its own lobbyists mm-hmm. , have they reached out to you? Have you interacted with LSMs?

Dr. Jamie Kuo (21:46):
Yeah. So part of my goal is to unite all physicians across the state. Mm-hmm. . And not every physician is a member of LSMs. Agree. Yeah. So I, I joined LSMs, I joined the American Medical Association. I joined asap. I joined, I ended up joining every group cuz I said, Right. If we, you know, we’ve, again, this is probably the, I’m saying this, doctors are not paying attention. Like, they’re like this. I’m literally on my phone finding doctors in Lake Charles, finding doctors in Alexandria, finding doctors in the country you know, in whatever rural area and saying, Hey, this is the message. This is what’s going on. And they’re like, What? We had no idea. Or Yeah. Or, or they say, Oh yeah, we know, we know we’re on it. And then you know, but yeah. So I am in touch with LSMs. I actually spoke to the lobbyist yesterday and we, we updated. Wow. You know, I’ve been very clear. I’m not competing with anybody. Right. Right. Like, if I want to work for the patient, I’ve got to work with everybody for the patient. Right. Right, right. so if, you know, if L SMS wants me to, we have this Facebook group with physicians. It’s called Louisiana Physicians for Patients, but it’s only physicians in the group. And if L SMS wants us to publish something, we publish it for them. Okay.

Rory Bellina (22:55):
That’s great. Can you walk the listeners through a process of, you gave an example on the house bill from last year, but what’s a process look like if something comes out that you decide collectively you don’t like, or you think you need to go edge? Educate everyone in Baton Rouge about.

Dr. Jamie Kuo (23:10):
Okay. So I’ll talk about the, there were two nurse practitioner bills. One was introduced in the Senate and one was introduced in the house. Neither one removed. Neither one got moved at all. Sure. Like they weren’t even presented in committee. Okay. There was a physician assistant bill, and I’ll go into detail about that one. Everything that we did. And then there was also a pharmacy bill where they were wanting to diagnose No, no, actually that was the one thing they didn’t ask to do. They were wanted to prescribe medicine order labs. they basically wanted to practice medicine. Okay. and leave one step out, which we didn’t support. Okay. that one died in committee two. Got it. Okay. It got, it got discussed a few times, but it also died. Okay. So the physician, the PA bill, Right. The PA bills have the PAs have a lobby in Louisiana.

(23:59):
It’s, it’s Lapa, Louisiana Association for PAs. I’m I’m pretty sure that’s what he stands for. So they they want to practice independently and as part of their OTP strategy, optimal team practice. Okay. With optimal team practice, they have four strategic pillars. And one of them is to have independent practice. Okay. Okay. So what we do is we kind of, obviously we read the bill and we see what they’re asking for. And right now, PAs need supervision. Mm-hmm. nurse practitioners need collaboration. PAs need supervision. When they’re supervised what happens is the physician that they have their, you know, for lack of a better word, their contract, well actually I think it is a contract. It is. Okay. Mm-hmm. , when they go over their contract, the physician that they work with. So let’s say Ortho, cuz I know y’all had an orthopedist here who was talking about a mid-level one time. do you remember that? He was

Conrad Meyer (24:58):
I think I do. Yeah. , I think I do. I, If it wasn’t to your podcast, See I tell you, she’s, you know, I’m trying to remember. Jamie is really on it. I mean, Wow.

Dr. Jamie Kuo (25:10):
anyways, so I think he was from Colorado or something. Oh,

Conrad Meyer (25:13):
He was Colorado State. I do know what you’re talking about. Okay.

Dr. Jamie Kuo (25:15):
So PAs, I mean, orthopedists love to have a PA because they do first assist and they’ll go,

Conrad Meyer (25:19):
It was the one on a physician contracting. And it was the one I did an ortho contract form. And that’s what he was Yes, exactly. Yes.

Dr. Jamie Kuo (25:24):
And that was actually one of my inspirations too for asking for a contract help with the, My National Society. But anyway, so they like to use PAs because they can first assist them and the, or, or they can do, they can start consults for them. You know, for example I had a spinal tumor when I was a resident. And right now I still follow up in town every few years. And when I go, I will see the physician assistant and then they get all my history and then they go speak to the doctor. They go present it to the doctor the neurosurgeon. And then they make their decision and the PA comes back and talks to me. But I, but then the physician, the physician also comes into the room. So

Conrad Meyer (26:04):
It’s more efficient. It allows you to see more patients. Exactly. Exactly.

Dr. Jamie Kuo (26:07):
And you keep the quality there because the physicians still

Conrad Meyer (26:09):
See it has oversight. Okay.

Dr. Jamie Kuo (26:11):
Yes. Okay. So so I’m sorry I go into so many tangents. so we look at the bill, we kind of, we, we see what they’re asking for. Well, our concern this year was the, the optimal team practice. Right. They were at the strategic pillars. One of them is to get the independent practice. Well, what, what their lobby, I felt did not reveal was there is an alliance in the PA world called the Physician Assistant Education Alliance. And they wrote a white paper in 2017 talking about optimal team practice. And they said, Okay, we agree with three out of four pillars that y’all suggest. And one of them was, you know, one of the pillars was pay parody. We agree with that. One of them is the PAs wanting their own licensing board instead of being under the bme mm-hmm. . and they said, Okay, we support that.

(27:02):
Another one was promoting team practice. I’m not really sure what the details of that was, but they said, Yes, we agree with that. Right. The one thing that they said, the fourth pillar, which was asking for unsupervised practice they disagreed with, and they went through all the education and they said, PA schools do not prepare PAs for independent practice. We oppose this. And so this was written back in 2017. They were saying, you know, we don’t prepare them for that. The, the way that the PA body was built or the education was built was that they go under supervision. Like that’s the whole point of the specialty. Right, right, right. they were like, if we want to have independent practice, we would have to extend their we would have to make their education longer. We would have to completely revise all these PA schools in the nation.

(27:51):
I don’t think y’all realize, I don’t, they said they did not think that they, the real, the national bodies realized the unintended consequences of this. and, and to me, the, what’s the national associate, I think it’s called the, the national pa, the lobby. to me they ignored it. And they’re, they’re still pushing it. They still passion. So pushing it. Okay. They still put it as their resolution. So what I did, cuz you’re, you know, your question. You probably forgot your question cause I’m talking so long. But what I did was, hey, you know, they’re asking for this, but their, their own education alliance doesn’t approve of this. Okay. So I take it

Conrad Meyer (28:28):
You did that at the committee level. So you went to the committee and said, Hey guys, ladies, y’all need to see this, this white paper. I mean, did you sort of bring that to them? Mean, how did you advocate to I guess, kill the bill?

Conrad Meyer (28:42):
If it was killed, I can’t, Was it killed in committee or was it, I don’t even, I dunno if it made it to the

Dr. Jamie Kuo (28:46):
Floor, it died on the Senate floor.

Conrad Meyer (28:47):
Okay. Okay. So how did you, were you able to get that white paper out to people so they could see that?

Dr. Jamie Kuo (28:53):
not at the time. I’m doing it now.

Conrad Meyer (28:55):
Got it. I’m

Dr. Jamie Kuo (28:56):
Doing it now. i, in the,

Conrad Meyer (28:58):
I know the board’s position, I mean, I’ve talked to, to people. I mean, I can’t speak for the board, but I know that, that they would very much prefer to have PAs under their umbrella.

Dr. Jamie Kuo (29:09):
Yeah. Well look, if you’re practicing medicine, you should be under a medical board. Right. And that’s how I feel about physician’s assistants, PAs. And that’s how I feel about nurse practitioners. If you are practicing medicine, you need to be under the medical board.

Rory Bellina (29:20):
So what kind of below back, or I guess, and have you had any negative responses maybe from the PAs or the nps?

Conrad Meyer (29:28):
You know, that’s my next, I’m waiting to hear like what, like where’s the pushback or the rubber meets the road? What, what, what, what’s, what’s been that? like

Rory Bellina (29:35):
Nasty Facebook messages. Yeah. Right. or they did to get docs.

Dr. Jamie Kuo (29:39):
Okay. So I do not like to put stuff on my social Facebook. So I, cuz there’s face, I think social media is so dangerous and that’s why I stay very data focused. Sure. I’m like, if you, if you have the data and you focus on the patient, like I said, you can’t lose. Right. Right. So and I’ll just speak and I’ll speak to the nurse practitioners and the PAs. When the PA bill came out, I actually texted a, like eight PAs that I know. I said, Hey, do you support this? Six outta eight of them said no. Wow. They were like, We don’t know. Wow. And they were like, But you know, everyone fears retaliation. Sure. Cause a lot of, a lot of physicians won’t even speak out. Physicians that like oppose Sure. The unsupervised practice. They, they’re like, Oh, I’m afraid my, my, my job’s gonna get mad at me. Or I’m afraid Right. I’m gonna upset this person at work or something. Everyone’s afraid to offend everybody. but what I’ve done is like, you know, my ego is not as important as patient safety. Right. You’re gonna be a patient, you’re gonna be a patient. I’m gonna be a patient. We’re all gonna be patient all and we’re all going to be affected by this. So as I feel, as long as I keep my focus on that, then what people have to complain about is, is irrelevant.

Conrad Meyer (30:41):
But also, Jamie, I mean, I think this too though. I mean, should, shouldn’t we be able to have a conversation about this anyway? Yeah. And I do, you know, without having hurt feelings, I mean, shouldn’t we be able to all sit around what, whatever the topic is, shouldn’t be able to talk about it?

Dr. Jamie Kuo (30:53):
exactly. And , there’s one nurse practitioner that she and I have talked about this several time and we have, you know, spirited debates about it cuz she wants, you know, she wants the unsupervised practice and she

Conrad Meyer (31:04):
Can always go to fqhc. She can always go to there and the federal cuz there’s not, there are no supervised practices there. Yeah. But I get what you’re saying. Yeah.

Dr. Jamie Kuo (31:11):
And you know, I I I just told her, it’s not personal. This is not about you. Right. And this is not about me. Right. You know, this is about this and I I don’t agree with it and I somebody needs to speak out, you know? Yes. Okay. So, and it’s gonna be me.

Conrad Meyer (31:24):
Okay. I like that. Yeah. And why wouldn’t it be you ? I mean, why would, so, so let me ask you this. So you eight months into it did you ever think you were gonna do this?

Dr. Jamie Kuo (31:35):
No. No way. I, I, I can’t believe I just look, I had a revelation. I just, like, I woke, I was literally watching one of the committee hearings going, Oh my gosh. Oh my God. Like literally pacing back. I was like, I’ve got to do something about this. Right. I was, I’m starting a Facebook group. That was my first thing. I’m going and, and literally I just went down. I added every single doctor that I I knew to it. And so

Conrad Meyer (31:59):
Lemme ask you

Dr. Jamie Kuo (31:59):
This. I took off from there.

Conrad Meyer (32:00):
How big’s the group now? How many members do you

Dr. Jamie Kuo (32:03):
Have? We have about 700 members. Oh

Conrad Meyer (32:05):
My, Wow. Wow.

Dr. Jamie Kuo (32:06):
So not, we don’t have 700 members of the, like the, the non-profit

Conrad Meyer (32:11):
And the Facebook group.

Dr. Jamie Kuo (32:12):
You have 700? Yeah. I actually, we actually haven’t started the membership drive yet because we’re still filing right now. Sure. And building the website and everything. And, and I do everything myself. Like I, I’d spend a, a lot of money out of my own pocket,

Conrad Meyer (32:25):
You know, You know who she reminds me of? Dr. Hoyt. Yeah. Yeah. That’s true. I, you, you another guest on the show. Another guest on the show. I mean, the drive, the passion. Yeah. I mean, I mean, you just a go-getter. ,

Dr. Jamie Kuo (32:39):
I’m stubborn, I’m a little stubborn.

Conrad Meyer (32:41):
. No, I mean, I, I think you’re passionate about what you like it sound, I mean, I can hear it in your voice. I mean, Rory, I can see it. We can see it in your, in your emotion. And, and I think this is a great thing. I mean, who, who knew a year ago that, you know, sitting here today, you’re gonna have a non-profit. That you’re being a patient advocate. you went to, you got getting your masters. I mean, I mean that’s just so, it’s very interesting.

Dr. Jamie Kuo (33:04):
Yeah. It and it’s fun, you know, And one actually a few legislators actually complimented us and said, you know, we really like hearing from y’all because y’all are focused on the patient. Y’all, y’all, we, when we talked to y’all, y’all, it’s not about you. It’s not about my industry

Conrad Meyer (33:21):
Or, or the physicians. It’s about the, the people.

Rory Bellina (33:23):
Yeah. I’m sure they get so much from the insurance side and the, and the reimbursement side and the big lobbyists that come in for fighting for whatever it’s gonna be for Blue Cross or whoever it is. Mm-hmm. . So coming for a patient perspective, I’m sure they don’t get a lot of that.

Dr. Jamie Kuo (33:37):
Yeah. Because when they, they, when they ask me, actually, I had a conversation with one of, I was, I was in the hallway at the Capitol and he goes, So what do you do? I said, he was like, Where do you work? And I said, Oh, I work for the federal system. And he goes, Wait, but y’all are, they already have unsupervised practice in the federal system. I was like, Yeah, I know. He was like, So why are you doing this? I was like, cuz I’m doing it for the patient. Like I get nothing out of this. Right, right, right. You know, And, and, and that is something that I’m constantly battling. And you probably remember this from from class, but I’m constantly defending physicians because it’s so easy to vilify physicians and act like they’re trying to protect their wallet. Right. And trying to, you know, our egos are so big or something. Right. Really. Come on. Do you think a neurosurgeon needs to have his ego stroked the neurosurgeon? That’s true. Let me tell you something. The neurosurgeons are some of our biggest supporters.

Conrad Meyer (34:27):
Let me tell you. We, we represent, I mean, I represent several neurosurgeons and I could say right now they, they, they need no stroking.

Dr. Jamie Kuo (34:33):
They need no stroking. And their, their jobs are not threatened by unsupervised practice. You know, why are they, why are they supporting us? Because they care about the patient. Right. Right. Because that’s, I

Conrad Meyer (34:43):
Think, I think you have a lot. Don’t you think you have a lot of doctors who generally, when you get down to the, to the marrow in their bones, that’s how they really feel.

Dr. Jamie Kuo (34:50):
Oh, absolutely. And the, the problem is, we all go into medicine with that very altruistic, I wanna help people attitude. Right. And then you get into it and it’s easy to forget and get lost in all the drama of the date, the paperwork, the never ending clicking the insurance, the prior authorization. I mean, there’s just so much that just drags you down. We call it moral injury. Right. that it, it, it’s hard to remember, you know, why you did this. Sure. But I know on my hardest days at work, I’ll turn to nurses and go, We had a great day. And they’re like, Oh, you’re crazy. And I’m like, No, we save lives today. Right. Like, that’s, don’t forget, that’s why we’re doing this. Like we, we got killed and retired and we fill out a, we clicked a thousand times, you know, but we saved a bunch of lives today. Yeah. So, and that’s why we all went into it. So people get reminded of that. For sure.

Conrad Meyer (35:38):
So where, where the Louisiana physicians for patients right now, currently it’s, you’re looking at legislation mm-hmm. , do you see this expanding into other areas maybe with even medical legal partnerships, things like that, that, that, that not only help patients from the legislative standpoint, but in other ways? Oh,

Dr. Jamie Kuo (35:57):
Absolutely. And we already, we, we do, you know, I’ve been talking mainly about scope of practice this whole time. And you know, let me go back. I said I do everything myself. I don’t exactly do everything myself. We do have a core group of people and we have, I have advocacy partners that we, we go to launches together. I’m just talking about like doing the paperwork and building the website. One of our partners do the website. So I don’t, I don’t want, if they’re listening to this, I don’t wanna completely take their credit away. I just mean that we’re,

Conrad Meyer (36:19):
It, it’s a team effort.

Dr. Jamie Kuo (36:20):
It’s a team effort. I just mean that we don’t have an executive director. Like we’re just, it’s

Conrad Meyer (36:24):
Just well have you grass. I would think that you’re the executive director. I would think

Dr. Jamie Kuo (36:28):
So. I guess so. yeah. No, but we already

Conrad Meyer (36:31):
You have a board?

Dr. Jamie Kuo (36:32):
We not yet because Okay. Kind of. So one of my partners is the president, another one is the treasurer. So for a non-profit, you really only need two officers. But my partner who’s doing the paperwork now, now just messaged me like two days and ago. So, Hey, do you wanna be the vice president? I was like, Sure. You know, . There

Conrad Meyer (36:48):
You go. See she’s have

Dr. Jamie Kuo (36:50):
A title. but yeah, so we’ve already expanded out. We, we do give opinions on non-competes. we gave opinions like, cuz there were, I think there were two bills this past year. They didn’t move. They stayed in the

Conrad Meyer (37:02):
Sure. Yeah. We talked, That was another podcast on that one. That’s right.

Dr. Jamie Kuo (37:06):
we, something that we would like to do is we’d actually like to introduce some proactive bills, some protective bills. Mm-hmm. , one of them is a transparency. So a lot of, not a lot of clinic. There are some clinics out there. Well they’ll, they’ll do like a bait and switch. so you make an appointment and you think you’re seeing, you know, Dr. Con Red Meyer. Right. And when you get there, you’re not seeing Dr. Con Redd me. You’re seeing they’re a nurse practitioner or they’re Right. So it’s a bait and switch. And then the, you know, and then there are some nurse practitioners who are introducing themselves as doctor in the clinical setting. and it doesn’t always get clarified that they’re not

Conrad Meyer (37:45):
Physician. That’s, to me, that’s the biggest frustrating thing. Mm-hmm. , I think for patients is the, is is is how you, you know, who’s addressing Yeah. And what terminology they’re using. What are they they showing the patients. Yeah,

Dr. Jamie Kuo (37:55):
Exactly. So there is the American,

Conrad Meyer (37:57):
The patients don’t know. Jay’s they

Dr. Jamie Kuo (37:59):
Don’t know and Right. So that’s what we’re here for. We’re here to try to educate them and try to protect them by passing this proactive legislation. So we’re gonna try to practice pass it or introduce it this year, but it’s a fiscal year, so I don’t know what’s gonna happen with that. Right. But it’s transparency in healthcare. It’s saying like, this is who’s working today, This is their credential. and then

Conrad Meyer (38:18):
Interesting. Mm-hmm. , I think that, I think that would clear up confusion for, because you know, patients, they just don’t know. Yeah. They see a white coat, they see a badge. Yeah. And if some nurse practitioner or physician assistant says, I’m Dr. So-and-so, which in my mind I, I, you know, I think the board might even have, I don’t, I thought there was issues about you can’t say what, or you can’t say you can’t hold yourself out to the public.

Dr. Jamie Kuo (38:43):
that is a truth in advertising. and that was law. Cuz I had, I know the person who went in,

Conrad Meyer (38:49):
I don’t, I don’t know the law exactly, but I thought there was some rule against, you can’t hold yourself out as a physician if you’re not licensed in the state to practice medicine.

Dr. Jamie Kuo (38:58):
Oh really? Yeah. If you’re not

Conrad Meyer (39:00):
Licensed. Is that right Roy? Am I correct on

Rory Bellina (39:02):
That? You can’t hold yourself Absolutely.

Conrad Meyer (39:04):
If you’re, you cannot hold yourself out to

Rory Bellina (39:06):
Be a physician. If you’re not licensed in the

Conrad Meyer (39:08):
Physician. Yeah. You’re violating the Medical Practice act. Absolutely. very interesting. So, so you got the transparency. No, that being proposed right now, I mean, is that already written on in committee or are we, are we, I don’t wanna get ahead of yourself and I wanna leak.

Dr. Jamie Kuo (39:22):
No, no, no. I have a bare bones bill cuz a few states have already have already passed this. I

Conrad Meyer (39:28):
Got it. Okay. So and that’s even greater. Yeah.

Dr. Jamie Kuo (39:29):
We have model legislation. Yeah,

Rory Bellina (39:31):
That’s that’s great. Perfect.

Conrad Meyer (39:32):
Yeah.

Dr. Jamie Kuo (39:33):
And we would love to introduce a patient bill of rights so that the patients know what their rights are. Okay. You know, so there’s one, there’s one

Conrad Meyer (39:44):
Medicaid these’s our national, there’s a nursing home Bill of Rights in Louisiana. I know that, but there’s no patient Bill of Rights in Louisiana. Mm-hmm. . Wow. Okay.

Rory Bellina (39:52):
And what would that look like?

Dr. Jamie Kuo (39:53):
It would it would, the patient would, so if they wanna see a physician, they can see a physician. Okay. So that would be part of their bill of rights. Like you have a right to see a physician if you wanna see a physician. Okay. especially if somebody pulled like a bait and switch on you. Right. Sure. you have a I’m blanking on it now. I can pull up paperwork

Conrad Meyer (40:14):
That’s, we’re not gonna hold you to everything in the bill, but I mean, I think that that’s a so, so this is, this is the second bill. So transparency is one and a patient bill of rights. Yeah. I think you’d have a lot of, I think you had a lot of support if you, if the, if there was commonsensical patient focused Exactly. Patient safety. Yeah. Things like that, I think, I think you would get a lot of support because it’s almost, it’s a no brainer how it’s a no brainer.

Dr. Jamie Kuo (40:38):
Right. That’s how I feel. But y’all know how it is at the capital.

Conrad Meyer (40:41):
Of course. Things

Rory Bellina (40:42):
That

Dr. Jamie Kuo (40:42):
You

Rory Bellina (40:42):
Think would be, you’re have a lot of big hospital systems fighting you. Wow.

Conrad Meyer (40:46):
Wow. Why do we need that on

Rory Bellina (40:47):
That? We don’t need that. Right. So where do you see this in, in five years of everything’s That’s a great question. The way that you, you want it to go? You, you mentioned membership, so you wanna do some sort of, I guess, paid membership to help fund these things with physicians paying in? Yeah,

Dr. Jamie Kuo (41:01):
I mean just, it, it, the, and it’s just to incre honestly, it’s, we need money for a lobbyist. Sure. Because I can, although I was able to go pretty much every week this past year, I’m only one person. Sure.

Conrad Meyer (41:10):
Yeah. You

Dr. Jamie Kuo (41:10):
Know and you know, l SMS is there every day. They do a great job. but right now I feel like I’m flying by the seat of my pants. So I really don’t have a five year strategy. Okay. we’re still growing. We’re still talking and, and planning. Like we’re, you know, right now we’re talking about the American, the Louisiana chapter of asap American College of Emergency Physicians. We have been brainstorming on how to raise money. So we’re talking about maybe trying to plan a CME conference Okay. So that we can, because you know, it’s, it’s a big problem actually in the ER world is in the rural areas, like you might not always see a physician. Sure. You might just see a nurse practitioner and, you know, do you want to have some sort of a tractor accident and you know, not have a board certified emergency physician that

Rory Bellina (41:57):
Happened to, not me over the summer happened to my, my son over the summer. Not a tractor accident, but same thing. Rural went to a hospital Saturday night. Your typical, what you would expect of an ER in a rural town on

Conrad Meyer (42:08):
Saturday night, if they’re really an er, they could be just a GP or a PCP or family medicine, I mean, was the right

Rory Bellina (42:15):
Er, this was the ER that the paramedics recommended and it was a nurse practitioner, knock on wood. Wow. Everything was great. He did a great job. but it, you know, had to do had to do a CT scan and radiology and all that. Would I have felt better with an MD or a do there? Yeah, probably. But you know, that’s, that’s what we were faced with. So

Dr. Jamie Kuo (42:36):
Interesting. Yeah. And look, I mean, I I, I can’t say it enough. It, it’s not that I think nurse practitioners and PAs are not good enough to practice. Sure. I just, they need supervision. The physician needs to be there for the times that they’re, the whatever the patient at presenting with is beyond their level of education.

Rory Bellina (42:53):
And I think you’re gonna see there’s so many different angle sets cuz from the hospital’s angle is that in this hospital, they could make them as an independent contractor so they can bill themselves and they’re probably having to pay them much less than an MD or a do mm-hmm. , you know they want to do it because they want to capture more fees and not have to be under, underneath the supervision. So I think there’s a lot of different people that either want this to happen or don’t want it to happen. Probably the patients don’t. But I think hospitals are probably

Conrad Meyer (43:22):
Okay with it. I think, I think hospitals, Well, I mean, think about this though. If you think about, you know, incident two billing, right? I mean, if they, they want, I would think they will want to have more mid, you know, more, or, or, or Right.

Rory Bellina (43:36):
That’s what I’m saying. If I’m a

Conrad Meyer (43:37):
Hospital, so I can, I can capture that incident too at a full hundred percent and it’s all being done by the a

Rory Bellina (43:43):
Yeah. If I’m, if I’m a hospital and I need to staff an er, I would rather staff it with an A

Conrad Meyer (43:49):
Than a Cause I’m paying less, but I’m still capturing the full the full. Correct.

Dr. Jamie Kuo (43:55):
So okay. So

Conrad Meyer (43:58):
That was a lot of legal jargon, but that’s, that’s, that’s, you

Dr. Jamie Kuo (44:01):
Know. No, no, I hear everything you’re saying. I actually agree with you. So the, and, and that is what is happening. So, but that’s like the tip of the iceberg, right? So the, the people in the business office are saying, All right, we’re gonna hire and this is happening with private equity, which I think private equity is the root of all evil. Like when they move, when they move into the hospital, systems costs go up and quality goes down. It is proven. I mean, I have a bunch of data to back that up. Okay. So, but what they’re doing is they, they’re saying that they can, they’re taking advantage of the nurse practitioners real look. Right? They’re right. They’re saying they’re paying them less to do the same type of work.

Rory Bellina (44:37):
They’re not putting ’em in their network. So they’re billing the patient out of network.

Dr. Jamie Kuo (44:41):
Oh really? I didn’t

Conrad Meyer (44:42):
Know that. Yeah. Oh yeah. That’s a common, that’s

Rory Bellina (44:44):
The big scheme in ERs is that you have them as an independent contractor. They bill out of network. So the hospital gets to build their fee.

Conrad Meyer (44:52):
But wait, that, that’s gonna end though with Come on. It happened this year. Oh yeah. The new legislation,

Rory Bellina (44:57):
It ended January 1st where they, we have to take your, Was

Conrad Meyer (45:00):
That the Kim’s a No, it was Come on. What was that? You know, I’m talking about Oh,

Rory Bellina (45:04):
The acronym for it now. I, Oh,

Conrad Meyer (45:05):
It’s killing me. it’s sort of January 1st. You’re correct. It was a transparency. The it’s like a, the billing and they can’t, You’re in network. You gotta stick to network fee. You can’t, Right. Yeah.

Rory Bellina (45:15):
It’s for emergency

Dr. Jamie Kuo (45:16):
Services, like no surprise billing. That’s

Conrad Meyer (45:18):
What Oh, okay. The no surprise, the no surprise, no surprise. Thanks Jamie coming to the rescue. Yeah.

Dr. Jamie Kuo (45:22):
Well, we, we advocate for that last year in DC

Rory Bellina (45:24):
That just started.

Conrad Meyer (45:25):
That just started. So all that, that mess is that’s, that’s supposed is gonna tie it up. Correct. You know.

Dr. Jamie Kuo (45:30):
Yeah. So there’s a, there’s a study out of Hattiesburg, There’s the Hattiesburg clinic that they finally showed us the data that physicians all knew was true, but we just didn’t have the data to back it up. Uhhuh. And they finally published the data for us. So Hattiesburg Clinic is a clinic in Hattiesburg, Mississippi, and, you know, they’re cousins. So healthcare is very similar. Right. But they are an accountable care organization, which means that they see they’re funded by Medicare, right? Sure. And they need to keep quality up and costs down. Correct. And if they meet their goals, then they get, then they get their Get a bump. They get a bump. Okay. Okay. So Hattiesburg clinic is, I, I don’t need to look it up, but they, they have a, however many clinics, however many doctors, and they were doing an analysis because they have a business to run.

(46:16):
Right. Like, let’s, we, we gotta, let’s, let’s do an analysis and see who needs help and who doesn’t. Well, what they found when they did their analysis was the lowest performers were the nurse practitioners in the PAs. And to that point, and I’m sure there, I’m sure there were a few doctors. Right. Okay. So they found that the nurse practitioners and the PAs, and they had their own patient panels by the way, meaning like, they would see their own patients. Wow. Wow. They had this, they had this contracted physician, but the physician wasn’t seeing them. Well, you know, the ceo, he’s done a few interviews, a few like podcasts and stuff like that. Right. Where they were under the assumption that the quality would be good and the cost would be good. So that’s why they hired them. They were, they were,

Conrad Meyer (46:58):
But they gave them their own panels.

Dr. Jamie Kuo (47:00):
They gave ’em their own patient panels. Yes. So when they did the analysis, and this is 10 years of information, they found that the nurse practitioners and the PA panels independent run panels lower in eight outta 10 quality metrics. And if you care about money, Right. The nurse practitioners and the PAs cost Medicare $43 per member per month for the effective patient. So when you, you calculate that out, right? It doesn’t sound like a lot, right? Oh, it’s only, only $43. $10 million a year. And this is just for uncomplicated patients. And

Conrad Meyer (47:36):
Why is that? Why do you think it costs many patient? Well, they must have that large panels and they must have had a, a tremendous amount of patients. And at that dollar rate, you know, annual, Well, they,

Dr. Jamie Kuo (47:45):
They, they order more consults. They order more

Conrad Meyer (47:47):
Tests. I got some more tests. Guess but wait, is it’s capitated? Is it capitated or is it No, no. So it’s fee for service. Mm-hmm.

Dr. Jamie Kuo (47:54):
. Oh, I don’t know if it’s fee for service, but I know it’s my

Conrad Meyer (47:56):
Capitated. Cause when you say $43 per member per month, I’m thinking in my, my brain, that’s a capitated payment. No, but

Dr. Jamie Kuo (48:02):
It’s not. They were, they were billing out to Medicare costing Medicare $43. Wow. Per member per month. Interesting. This was just for simple patients. This simple.

Conrad Meyer (48:10):
Oh, I see. Above, above that. I got it. Above that. Exactly. Okay. They were out, They outlier.

Dr. Jamie Kuo (48:14):
Yeah. Because they were, they, and, and this is what their data showed, you know, they consult more even the consultants. Interesting. Were referring to other consultants. Okay. More in, in the independent panel, you know, non-physician practitioners.

Conrad Meyer (48:27):
So,

Dr. Jamie Kuo (48:28):
So what they did was, after they did that analysis starting in 21 or TW maybe this year they took away all of their independent panels and all the panels need to be overseen by a physician now.

Conrad Meyer (48:42):
Interesting.

Dr. Jamie Kuo (48:42):
And, and look, they were very, they were like, Look, they, they said the same thing else that we value our nurse practitioners. We value as our, our PAs. they just need to be supervised now. That’s what’s best for the patient. and they said, they said the NPPs at their clinics, like they had six months to prepare for it. They took it very well. They weren’t offended. Right. Because you can’t argue with the data. Right.

(49:04):
Interesting. It’s Medicare data. Right. It’s right. so they said it went very well and you know, we, we did have the, the nurse practitioner lobby and the PA lobby kind of try to brush it away. They actually did that in committee. And I was actually very upset with it cuz I felt like they misrepresented the study. but they, they, they tried to blow it up and I’m like, you know, if you, if you read the study, it’s only five pages, you know, it’s very clear, Right. that patients need physician like care.

Conrad Meyer (49:30):
Yeah. I mean, I think I mean all the physicians I talk to, I guess , they’re self-interested some would say, would say the same thing. Like there, there needs to be oversight. Yeah. So that’s a very interesting concept. So, so let me ask you this. So now you, you know, you haven’t got a full year in I would, I mean, I think we’re gonna have to have you back cuz I would love to see follow up. Oh, I, without a doubt. Yeah. You know, especially if some interesting bill comes out that you guys think that that your, your organization feels like it needs to be talked about. I would love to have you on so that we could talk through it. Yeah. I

Dr. Jamie Kuo (50:07):
Would love that. Yeah. And like, gosh, you know, we’ve only been here for eight months and sometimes I feel like, ah, you know, Sure. Like I said, I’m flying by this, you know, I’m pissed. But when I really go back and list what we’ve done for people, like we had a lunch with the black caucus. I had a, I organized a listening session with one of the senators and one of the reps to speak to rural health physicians because it’s always about rural health. It’s always the, the talking point for the nurse practitioners is access to care. Right. Right, right. which is not true. It’s not true. I, and I keep telling people it’s an unfulfilled promise. Like every state, 27 states have passed unsupervised care. and not one of them has improved their rural, their role access

Conrad Meyer (50:46):
To care. You mean the market penetration in terms of Got it. Yes. That’s interesting. So they use access as a goal for independence, but it’s really a far a

Dr. Jamie Kuo (50:54):
Farce. It’s a farce. Interesting. Yeah. Yeah. I can show you the maps. It’s and you can do the comparisons. It does not change. That’s

Conrad Meyer (51:00):
Pretty amazing. That

Dr. Jamie Kuo (51:01):
Is data driven. That is data driven. You

Conrad Meyer (51:03):
Can’t, data doesn’t lie.

Dr. Jamie Kuo (51:04):
And then, you know, like, you know, one of the, one of the senators on the health who she introduces a lot of the bills, you know, she’ll point out that the VA right. Has art. Well, they do it, They haven’t had any problems but you know, there was the, I wanna say independent practice or unsupervised practice for them was pr you know, was passed.

(51:26):
Okay. I don’t remember what year it was. Maybe it was 2016. Okay. Right. Well in 2014 there was a quality group that looked at all the data for nurse practitioners and their quality and they asked like very specific questions about outcomes and everything and Right. they, I wanna say they started off with like 900 studies and then when they whittled it down, only eight studies applied. Right. Cuz you’re gonna hear the nurse practitioners say, we have all this data. Here’s all this data that supports our calls. Right. Well, only eight, they were only able to use eight of the articles and then eight of the articles, all eight either were like low to moderate to really know what, I’m sorry I’m blanking. All the word. like the quality of the study. Sure. They were low quality studies. Right. So they said, even though we’re gonna tell you what these studies show, it’s low quality data, so you can’t even really make a decision on it. Well guess what? The VA passed independent practice two years later. Anyways,

Conrad Meyer (52:24):
It’s no, no joy. Well, yeah, so I mean, I mean we talked a lot about it today. Yeah. the focus on oversight for nurse practitioners, physician assistants non-physician providers. Mm-hmm. . what other, and we talked a little bit about transparency mm-hmm. , are there any other topics that your organization, the Louisiana Physicians for Patients is, is looking at? and, and, and it’s not, I’m just curious if, if it’s, if there’s any other things that, that are on your radar right now Right. For your organization that, that you wanna bring up?

Dr. Jamie Kuo (53:02):
no. everything that we comments on is very, like, said it for a a dozen. It is very, very, very patient focused. So we did comment on a few like vaccine bills where we felt like it would be detrimental for the patient. So there was one bill it was they were asking for pharmacists to be able to give vaccines to people of all ages. Okay. Like right now you have to be a certain age to, to get vaccine in a pharmacy mm-hmm. . And we actually oppose that. And it was very mixed that the medical community was very mixed about that. Mm-hmm. , but we oppose it cuz I personally know people who like Children’s Hospital, I think this is Great Children’s Hospital has a shot bus to make getting vaccines more available. Sure. more like they’ll go park in, you know, the Walmart parking lot and like, come get your shots.

(53:49):
Right. Sure. I think that’s great. But I personally know some people who don’t go see their primary care physicians because, so they don’t get their wellness checks. Right. Got it. And preventive healthcare is what prevents, you know, medical problems. And that’s where a lot of medical problems are found. So if you go every year and you just go get your shot and you don’t see your physician and they don’t hear that murmur or see that medical problem that you don’t, then we felt like it was a danger to patients. So we actually oppose that. So, so, no. So as a, as a broad broadly, no, there’s no specific topic. we kind of just like, we kind of address them as they come.

Conrad Meyer (54:24):
Gotcha. Gotcha. Yeah. We’re gonna let me ask you this, Jamie. So if, if someone wants to go to, I know you haven’t built it yet, you’re saying you’re building the website, do you have a domain a a a domain name or, or website address that’s gonna be coming out yet as if you do? I think it would be really, it would be very interesting. And if you don’t, if you don’t, we can always get that to you later. That’s fine. We can post it on the on the link to the podcast. Yeah, we could do that too. Oh, that’d great. That’d be great. You know it’s Louisiana. It is. It’s HTTP Louisiana Physicians for Patients dot

(54:56):
Www dot Louisiana Physicians for Patients.

Dr. Jamie Kuo (54:58):
It’s not www, it’s not, it’s just the http

Conrad Meyer (55:02):
Colon slash slash Louisiana physicians for patients.com. Yeah. Got it.

Dr. Jamie Kuo (55:08):
Okay. or.org or something. Shame on me. We’ll

Conrad Meyer (55:11):
Get it’s, I’m, it’s okay. Well, you know what, we’ll get it from you, but I wanna be able to, the listeners, if you want to go to the website and look at what your organization is doing for patients, I think that would be something that, that would be of interest, you know. Thank you. Well, Jamie, Rory, any final thoughts for Dr. Kuo? No, I think we should definitely have you back maybe when Yes. When some bills come out in session and we’d love to hear, I want Jamie on as a regular here. I mean, she looking would natural

Conrad Meyer (55:38):
I Would love to hear that. Well, we wanna thank you very much for coming down today. It’s been a pleasure seeing you. I I really, I really enjoyed this. This was really fun. and I’m so happy for you. I mean, this is, you know, I’ve, like, I’ve watched you in the classroom and now I’m seeing this. It’s like I’m very proud. I’m very proud of Thank you so much and thanks for having me. Great. We’ll look forward to next time. Well everyone, thank you very much for another episode of Health Law Talk and we’ll post this up pretty soon. I hope Rory and I will get this done and we look forward to the next episode. Everyone have a great week. Enjoy.

Intro (56:12):
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