Know Your Vital Signs

0:00Welcome back to the disruptive podcast with Scott Middleton. My name is Jamie and we're here with Scott right now. He's in a public square. I'm not sure we're going to find out where he is because this is we we never know. I mean, some days it's Georgia, some days it's South Carolina. You just never know where the man is. You're like Carmen San Diego back in the old cartoon. So Scott, how are you doing, buddy? I'm doing great. I'm doing great. Beautiful beautiful weather. Really interesting too. I got you know, there's been this like old-like symptoms going around on the muckets allergy or whatever, but I have been taking you know, of course, more pet tides and I really haven't had any allergies. I usually have a lot of Simon allergy. I've not had them all year, but anyway, I went to New York this week, which was really exciting for not to go to the US open, but I went up to meet with the guys from clinic to do a lot of our software stuff for the CCM collection

1:03and other things that I'm going to talk about on the holiday. And then I started feeling bad like my allergies, my nose was running, everything was really bad. So I was starting to look at my pet tides. What could I take? Now, I know my clinical pharmacists are going to jump on this one today. So I found that KPV, which is a peptide I had been taking, actually acts as a natural histamine. And so I just added a little bit more KPV to it and then with my regular stuff like I believe in C, you know, can help prevent it if you get started on soon enough. And within 48 hours, I'm back to normal. Wow. That's great. It completely, and it didn't slow me down. So, you know, I think a part of, you know, people who are constantly getting sick is because there's something unhealthy in their lifestyle and they're diet. And listen, I've been there. I know exactly what it's like. But if you clean all that up, I'm telling you, you will not have those illnesses and sicknesses. Yeah. And then even when you do get sick, it'll heal way faster.

2:05Right. Yeah. And that's really the key. So I just get exposed to something because some stuff and things all around. And I was able to sit back from that with, you know, relatively short period of time. Yeah. Yeah. Unless you fly private, it's, you're in there with a bunch of germs. Yeah. You know, I'm all about getting exposure though. I think the more germs you're exposed to better communities you build up in your system says, but let's get started today. So, Brody sent me this quote and I just thought I got to start with this and I probably add more stuff to it, but he sent me this. I don't know where he got it. To the picture of this, it says, if your doctor prescribes you medicine without first asking you about your diet, you said, you're sleep, your exercise routines, your water consumption, whether you have any structural issues and the stress in your life. And I would add to say if they don't know your vital

3:06signs on a regular basis, then you don't have a doctor. You have a drug dealer. So I will tell you how important it is for us to know information about our patient if we're going to take care of them properly. Yeah. And I think what medicine has become is doctors have become basically sales people for pharmaceutical companies. And we got to figure out how to stop that. So when you go to your doctor and the reason you go to your doctor is to make sure everything is okay. And so we have got to find opportunities to get our doctors and nurse practitioners in front of patients quicker than we currently do. So I have the opportunity to go to New York this week and meet with the guys from clinic. In clinic does a lot of our CCM remote patient monitoring.

4:08They're really a software company more than anything, but they help to integrate all of our data back in. One of the things that they do is when you go in with your remote patient monitoring equipment and you take your blood pressure and all that, it rolls in through clinic. It goes through clinic and you have a clinic app that you can download on your phone and that information will upload right into our EMR and that way your provider has when they do look at your chart, they'll be able to see multiple days. Right. So what clinic is now doing for us is that everything was related to an individual patient. Now they have basically vital signs on a pole where we can hand that to one of our nursing homes and put them on each wing and they'll be able to go down the hall. We'll add a scale to it. Blood pressure, pulse ox, we can do spherometer and what I found out today was extremely important is height because how you capture your BHA. So here's an interesting stat. Our wellness team went through all of our patients on our ACO, which remember we only

5:15have 5000 patients on our ACO, we have about 40,000 total patients. So they went through those patients and they looked to see who would qualify under the new regulations for weight loss GLP. So these are non-biotic people. So they were able to pull 700 and 50 patients to you with qualify just out of that 5000. So 20% for a qualify. And out of those 750 patients, we only can calculate a BHA on 11. Because we don't have their height. All you need is height and weight. And because we didn't have their height. So I suggest them now that all of that hold that we have that has your scale and your blood pressure and pulse ox, and all that. We're going to add to be able to measure people's height. And by measuring their height, we can do it in their weight. We can do their BHA and they can now qualify for the GLG.

6:21So 750. Now, extrapolate that with our whole 40,000 patient population. We have about 40, 500 to 5000 patients who are going to qualify for this new program to get a GLP. So we've got to get on that. So our wellness vision is going to be working on that. Get anything information is important. And I'm telling you, we still don't do that. So for example, if we know from studies that if we were doing blood pressure on all of our patients, three to four times a week, that we could predict 50% of the heart attacks and probably 50% of the hospitalizations related to those natural. Because we could catch that earlier on. That is our job. That is what your health is all about is predicting what's going to happen to a patient and then trying to prevent it from ever happening. That's how we're going to save our health care system in the United States. So how do you do that? You cannot do that without the information.

7:24So one of the programs that we're rolling out we've talked about is we now are going to be able to contract with our nursing homes and assisted living and pay them for things they do with managing the care of our patients, their management. One of those will be looking at vital signs. Guys, we have to have the vital signs. And the vital signs need to be connected to doing something about it. So I've asked Clinty if they could correlate that if a provider puts here is the, here's what I'm expecting with this patient. Here's what I'm expecting. Blood pressure to be there, weight to be and if things are fluctuating with that information, I want that Clinty screen when they go to log in with their vital signs. I want it to start flashing red if it's off. And so they can contact the provider immediately. If we were contacting providers immediately, as we see vital signs changing, we can present

8:27millions and millions of dollars of unnecessary charges. Just like I've shared before, my dad went to the hospital, had a little seizure is what they thought he really just had pain from an abscess too. But he goes to the hospital and within an hour, they had already built $8,000 to Medicare for unnecessary tasks. So now here's the bad part. He is one of our humanit patients. So he now has spent, as he was hospitalized for two days, he now has spent Medicare's been paid out over $40,000 to other people, not to not save your health, but other people. And that's going to throw us over the cap for him and your health will have to pay money back on his behalf because he was sent out to the hospital. Wow. Could we have prevented that? Yes. Had he been getting his vital signs checked three times a week, they would have shown some elevation in something going on due to the pain. And we would have said, hey, we need to push

9:31this surgery up or give him something for pain until he has that surgery. Yeah. Particularly sacred. Yeah. Scott, do you think these providers that are, you know, giving these tests, knowing that, hey, yeah, I probably don't need this, but do you think they have in mind a healthcare organization like your health, like saying, oh, you know what? This is, this person is part of an accountable care organization. I better be careful. Do you think they care? No, I know. Absolutely not. Absolutely not even if it's in their own system. Like when I was at the conference couple of weeks ago on the bundle payment, the cardiovascular surgeon, I ask in particular, yes. So you have a patient that comes in to the emergency room and it looks like they need to have a need replacement because their risk score is zero because they haven't been to a primary care provider. Would you push off the surgery at any point in time, given them other medications, get them through in order to prevent this over expenditure or to make sure you get

10:37the risk or higher. And he said, no, I'm just, I'm a surgeon. He said, I cut on people. That's what I do. And I got a patient in front of me. And I have pretty much the standards of, yes, I'm just going to go ahead and do it. Yeah. I don't care about the money. And that was where was interesting is that the your surgeons didn't care that they were putting in a $30,000 pick or a $5,000 hit. And one of them even admitted that he liked the cheaper one better but he always used the other one. Wow. And then my question is, why does he like it better? Well, you know, he likes it better because he likes it. It's easier for him to do in surgery. He doesn't know whether this is a better knee for the long term for his patients or nor does he care. Yeah. If he gets his money and he moves along. So exactly. And that's what I've kind of told our folks. Our providers, like one of the, uh, Brooke was talking today on one of our calls and she said, um, I really,

11:39you know, providers aren't doing follow through or something on a particular, um, uh, thing she was talking about. And I said, oh, that's not their job. That's what matters job to diagnosed and prescribed and to coach and teach their patients and that kind of thing. But I said, the, the, the quality, the qualifiers to get somebody in front of the patient are really up to the rest of us. And in particular, our nursing staff who should be identifying the patient who are need. So we have roughly 40 directors of population health. And, and we rolled out GLP ones in July. It was rolled out and everybody in our company was aware that Medicare is now going to pay for just for weight loss, not diabetes. And yet we don't have BMI's on the 750 people we've. Yeah. So we got a lot. Yeah. Yeah. How could you not have BMI? I mean, you need to have obviously, well, and this isn't for every person that has diabetes, but most people with diabetes

12:41struggle with weight. I mean, that's just obvious. So why wouldn't you have the GMI and know where you're at? And more than these people struggling with weight have diabetes. So, you know, it just, it has that to more data. You have the better decision you can make. Exactly. So the data is data is important. My goal is to have vital signs on all of our patients three times a week within the, by the end of the year. And my, my question is, how are we going to do that? We, we at one point incentivize our community health workers paying care. Now, obviously, I mean, I don't know if we didn't roll it out well or what, but how do you get that stuff to get the vital sign so that we can make and make in the appropriate decision? We, we had, um, what one of the question is, you know, it's always how often you need to see a patient, you know, and those numbers are, I don't even know how you're going to determine it, but you need that you need to be looking at, we know that the more often we see our patients based on their

13:46risk score and the higher the risk score, the more times we see them, we're going to keep them out of the hospital and they're going to spend less money. But then the real question is, well, what's prompting those visits? And like I, on the wellness call this morning, I had, I said, so you guys will implant pellets or somebody to replace their hormones and follow up with them in 30 days. The recommendation by bio tea has been, do it in six weeks. I said, you're seriously going to alter somebody's hormones and start changing those immediately in their body and you're not going to follow up. Well, we tell them to call us. Oh, yeah. How many times have you just said, maybe out of college, do you have you ever said, maybe I should call the doc or somebody else around you said, maybe you should call your doctor and then you don't. It will happen more often than we not. So we have to have triggering points. It says to living nursing homes, this is easy. We put our vital signs on a pole. We take that around three times a week to every single patient.

14:46We log that if there's a, if there's something off, we call the provider. We have an appointment. We will make and say, we will save, save dollars for the Medicare system and prevent a lot of things. So getting the data, labs is another thing. How many times are we not running labs that right now? If I looked at it, our patients should have labs every 90 days. It should be an automatic order that goes in on behalf of your patients. The providers can go in and set that up with a new patient that I want to have labs every 90 days. Yeah. I mean, how many things would be caught if a provider just, I mean, I know people, younger people too, that their lab count was off. Like there was something in their lab that they found out. Oh, they had cancer. And they caught it early just because of a lab value. I mean, you're talking about major stuff that if you

15:47just have those labs, things get caught. Right. So that's what my push for is going to be this year is vital science and we're going to set up standards and we've got to work around the providers. Like I've heard some people say, well, the providers are supposed to be ordering the labs. Well, no, we should be determining based on the health condition of the patients statistically. How often we want to run the labs and those should be in the now, yes, the physician or the provider has to order the labs, but they can sign off on the standards. We have what we can, what we call standard orders and we can set up standards within our company. Our providers agree to practice within the scope of that and when those things happen. And that's what we have not done. I don't know what the resistance is about that, but I'll talk to Teresa about that with our quality measures. But to me, I think we can justify at least on most of our patients.

16:54Well, I'll be all of them because even you think about the healthier younger people who are on our wellness program. And if they're doing test off room or hormones or GLPs, we should be doing their labs quarterly anyway. So why wouldn't we just establish it? You're going to be part of our practice. You're going to have your labs when we do expect you to go like vital funds three times a week. If you're going to be in our practice, yeah, that's a standard. You're in our expectations. Yeah, the patients got to have some stake in this. If they don't, you know, with exercising and all that, I mean, if you're going to, and I know, I know it's tough to make somebody do it, but compliance is part of the patients. It's not just a provider's job to be compliant. It's got to be the patient as well. And I think people wanted, I think, I think of a provider encourages the patient right? I think a lot of people will do that for their provider if they really like their provider. Well, you also have to encourage it. So one of the things that I had started a few weeks

17:59a few months ago was to make sure that all of our employees who are on their health insurance. Now, it's not that I don't care about the rest of them, but guys, we're paying for your health care. It's coming out of our pocket. So we, I mean, it's not like there's this mystical insurance company that pays for it. Ultimately, the employer pays all of the cost of your health care because if they're either self-insured like we are, or they are paying a company so much money to be insured. If a health insurance company is not making money on an employment period, they will cancel your policy. So they have to make a profit out of that. And generally, they won't 10 to 15%. So we self-insure our hours. We pay it out of the pocket and we say that 10 to 15% as profit for our organization. And a lot of that goes back to, you know, bonuses and incentives for our employees. So you've got to, but we've got to be responsible. So I asked that out to say, every patient, every person who comes on board and our health insurance will be

19:01assigned to one of our providers or they can pick. I mean, it's not like you have to say, but we will make sure. But what I didn't think is that we have to assure that those patients are being seen. So we have employees right now who hasn't seen the doctor in a year or two years, three years. And guys, that's ridiculous. And the reason is, we don't feel accountable. We're going to go in. Well, that's their problems. No, ma'am, when that person ends up with a million dollars worth of health care falls, it becomes all of our problems because it comes out of our profit margins. And if we don't have profits, we don't operate. We're taking money out of the hands of our patients and out of our staff when we're having to spend it at the hospital for other people out there. So we want it to be there for the things that need to be done, but we've got to get better at that. And so driving our patients, whether they're employees or they're outside of it, we have to drive

20:04them to see their provider and then making sure and we do that by collecting the data. Yeah. And it's got how easy is it because I want employees to hear this. How easy is it for them to schedule an appointment with their provider? Oh, yeah, it's pretty easy because you can text the emails. But here's the other thing. But let's just say I put an oral that says, all right, I'm going to give you a discount on your employee health insurance provided you give me vital signs three times a week. And if you don't, then you're you're I'm going to, you know, otherwise, you know, get like, let's say you pay, I don't know how much you pay $100 of paycheck right now. I can give you a 10% discount if you do vital signs and you do your blood work every quarter, but every quarter I'm going to look and if you haven't had your blood work done and you haven't had your your vital signs on average of three times a week. Now you could do it seven times one week and none the next and you'd still have to average it, right? Right. But I could look at that. That probably is what we're going to have to go to to push people to set standards. And that's what we

21:11don't do. Most people only know their blood pressure for when they go to their doctor and they may only go to the doctor once a year. You know what your blood pressure is and what it should be. Yeah. So yes, it is ours. It is our responsibility to find that out. I think we have generously staffed our team to be able to do these things. You know, you have a care grid with 2000 risk points. So that means it could be 2000 very healthy people or it could be 600 very six people. Yeah. And you have that nurse that director of population help to be going through everybody's charts. Hey, this person needs to think of cardiology. This person needs to see the endocrinologist. We're not waiting around for a referral from a nurse practitioner. We're going to say this person needs to see our cardiac partner. This person needs to see our wellness department. And we can educate those that the rest of the team has to watch. But that's what that DPH role it's about. Then they send those referrals or they make the

22:15referrals basically the DPH. Thanks for that information to your executive director of clinical services. It is assures that the care teams schedule those patients and facilitate those visits. But maybe if I just started penalizing that's maybe the next step we could also penalize the care teams if you don't average vital signs three times a week. So what would that do for your home patients? You had a gruesome patient. I think you'd be Johnny on the spot to make sure these guys are capturing their vital signs. And then we can do a study to see how well that reduced costs overall. Right. Yeah. Absolutely. So guys, this is where we're moving. We're moving into wellness. We're continuing to push this pro activity. But the pro activity means we've got to get vital signs. We got to get labs. And we can't be waiting around for quote emergency labs. So I think that's just crazy. You should have scheduled them long before when you're down to this wire.

23:17We can prevent most of these illnesses. I prevented getting sick this week. One because I stay very healthy. I eat right. I take my peptides. Right. So my body is strong. But when I was exposed to something that several people I've talked to a friend of mine who had been sick for weeks with this little whatever virus it was because it got into their lungs. It got into to their chest. And they started having coughing and hacking things out there. And if they had they could have prevented that. But when you do get sick, then you look at what other things can I do right away to get over this thing quickly. And then you bounce back. And that's how we keep people healthy. So guys, keeping people healthy is the important part. And right now, here's my thing. If you if you've seen my new teams picture that my daughter or lawyer wants me to take down because I'm on the back of the T-Rex charging forward. You know, with that, that's my charge right now is vital signs

24:19in lab work. So if your patients aren't getting those, I'm going to be calling you out on it because it's the best way to keep people healthy out of the hospital and safe. Yeah, absolutely 100%. That's great. Yeah. And it's so easy. I mean, you've got anytime I've gotten vitals in the past, it's they've come to the house for me. You know, or if I was, you know, near, you know, clinic, I would go to clinic. Yeah, if you're an employee, there's no, there's no excuse. Well, especially because we've told everybody on the wellness is required, the program is required to have remote patient monitoring and use it. I don't think they are. And so somewhere in our offices, people are coming in and we're not hanging on the remote patient monitoring. So I'm and I'm telling you, I'm not really good at it right now either because I'm traveling a lot. And it's hard to put that. I can't get the scale in the car. Right. So I'll use a scale at home, but I do take my pulse off always because it looks in my backpack. If I could figure out a better way

25:25to do my, my heart, my, my blood pressure with a smaller device that would help, but I'm telling you, that's still probably average. Maybe one for week. And so if I play three times a week, let's go for it. And let's, I'll try it and see if it's doable. If it is, then we're going to push everybody in that direction. Right. So guys get ready for it. Got to have the information to make good decisions, right? That's right. Absolutely. Scott, is there anything else? Anything, what's your final word today? What's what, what, what do you want? I know you want people to collect the data. You want people to get their blood pressure, you know, and you want employees to make sure they're seeing their provider, not just getting their vitals, all that stuff, you know, but and, and, and for you, and this is, this is my question. Scott, I know it's not just about finances for you. Like that's, you know, I know that's a, that's a big thing, you know, because you're, you're a responsible

26:26business owner and, and you want to have a profit, because you want your employees to have a profit too. You want, you know, that's why, that's why there's reward in all that stuff. But for you, it's, it's about health too. You want to see people succeed in their health and talk about that a little bit to people. So they understand your heart behind all this. Yes. Thank you. I appreciate that. I was asked yesterday by somebody. They said, what is your end goal? And, and I said, well, my end goal is to see that our model to prove that the model that we have is going to work and is going to be beneficial to saving people's lives. And also, just saving the Medicare system that I'm afraid, you know, they're getting ready to start bumping up our Medicare rates because, and so security rates, because we're in aging population and we're losing money as the government. And so we're going to start paying for all that. And I said, so, and I think I have to think back and said, no, no, no, no, I mean like what's your kind of exit

27:30strategy? And like are you here for a year or two years or 10 years? And I said, well, I'm here for it for the for the long haul. I said, yes, the reality is I'm 67 years old. In all reality, in 10 years, I probably will be slowing down, but Warren Buffett just retired at 94. And so he wasn't great shade. And you've seen Warren Buffett. No. No. No. Terrible. You know, so I mean, he's kind of like Trump. You know, the reason he and Trump, I think, have done so well from their health standpoint is to be their age and still active in business is because they didn't drink. You know, think about somebody who doesn't drink and who takes care of themselves. I mean, I probably go to 90s pretty easily, but but but the reality is, I'm trying to prove a method. And I'm trying to prove the process so that we can improve people's lives. Yeah. Because at the end of the day, I'm still going to go back to I'm the United

28:31Methodist Minister. I got into my career because I wanted to save soul. And what and saving a soul means that people need to be in order to be productive human beings and to follow what God wants us to do. We have to take care of ourselves. And scripture is very clear. You know, that our bodies are the temple of God. We should treat them like that. So we should be we should be treating our bodies like we would treat our God. Yeah. And we don't. And so it's an abomination. When you have I'm sorry, the fat guy up there preaching to you. And and the problem is there are internal and an expert old thing that calls us not to be like you you didn't probably eat any different than I did as a teenager. And yet you were always overweight. Yeah. And and I was. So there are environmental factors that are inherent in what I would call sin in this world. Right. Yeah. You know, and sin comes in a lot of forms. And it's not necessarily individual,

29:36but other things that project on us. We have the ability now though with this knowledge we have to start correcting those things by the use of the heads of the pods replacing our hormones. You know, doing other things to make ourselves healthier. So if you are obese and you're sitting in the pulpit, preaching a sermon today and you are working on that in terms of now I have the opportunity. Let me use my intelligence and my health in order to get better. Right. That's what we want because none of us are perfect. Right. We're always going on a profession. And so that I will tell you that's my motivation and goal. It's not about money. Yes, I am accountable for the finance that's that's organized. And if we do not profit, then we can continue to move. And we actually have to have big profit margins. If we don't, we won't have investors to help us grow.

30:36And that's what we recently did by merging in with this other organization. I gave up 20% of our company to to private equity investors who now have helped us leverage the leverage finances for us to grow this organization. We have to be profitable. So I need people to understand you look down if we don't make right now just to cover our debt payment. We have to have a million two in in profit basically to cover the debt payment. And then we have to show profit if we want to get further investors to help us down the right. But I convinced the model works. Yeah, you know, see the patient collect it like the data. See the patient's often and we can make the huge difference in the world. Yeah. So that's the end of my sermon. There we go. There you have it. Scott, thanks so much. Travel safe. Thanks, Jamie. Enjoy your weekend. Yeah, it should be interesting information that I learned. I got to go to the conference next week. So I'm in the

31:39right now. So you'll have a great weekend. Great day. Thanks, Jamie. Bye-bye. Somewhere in the American healthcare system right now, there is a patient headed towards a crisis that was completely preventable. The data that could have stopped it exists. It was just never collected. That's not a technology problem. That's a decision problem. If your doctor prescribes you medicine without knowing your vital signs on a regular basis, you don't have a doctor. That's not a knock on physicians at all. I think doctors are amazing. They're unbelievable at their job. But that's an indictment of a system that never gave them the time, the tools, and the incentive to do anything different. So here's your challenge this week. Know your numbers, blood pressure, weight, resting heart rate, whatever you have to access, check it. Not once in a year, not an annual physical, but a regular enough that you actually notice a change. So you could see something that you'd notice something's different here because the shift from

32:43reactive to proactive doesn't start with a healthcare system. It starts with you deciding your data matters. And we have to be our own... We have to do these things for ourselves. It's not just our healthcare provider's responsibility. We have to take care of ourselves as well. We play an important part of our healthcare. Not saying don't listen to your providers. I mean, that's not absolutely not what I'm saying. I'm saying we have to also play a part and play our role. Thanks so much for listening to the Disruptive Podcast. We will see you next time. Go have a great week. We'll see you next time. Bye bye.