Dr. Briskin was invited by the Council’s leadership to join the council due to his life-long commitment to improving the lives of patient and doctors. He currently serves as the only internist from Florida on the Council.

 

“There are certain things that make the practice of medicine very difficult for physicians right now,” says Dr. Briskin. “A lot of that is due to government overreach. They want to bring down the cost of healthcare, but are imposing certain things that eat up the physician’s time.”

 

The National Physicians Council for Healthcare Policy was founded in 2014 under the leadership of Drs. Marcy Zwelling of California and John Gill of Washington, DC, under the auspices of Congressman Pete Sessions. It consults with and advises members of Congress on various healthcare issues, such as the new Medicare Access and CHIP Reauthorization Act (MACRA) implementation as well as private-sector modifications/alternatives to the Affordable Care Act (ACA).

 

Dr. Briskin was invited to join because of his experience working behind the scenes on healthcare reform over the past 25 years.

 

“It was very inspirational to be sitting in a congressional hall with 60 doctors and several members of Congress,” he says. “It was incredibly empowering to be a part of a group of healthcare leaders from all parts of the United States. Most of the 50 states were represented with people trying to find solutions for patients and physicians to make the healthcare system better.”

 

Dr. Briskin has not seen many new original ideas from Congress which would ultimately affect the total cost and quality of healthcare. There are various financing mechanisms, he notes, such as block grants to the states, high risk pools, selling insurance across state lines.

 

“But the devil is in the details and there are problems with virtually everything I’ve heard, other than HSAs, Direct Patient Contracting with physicians, Medical Homes, which have definite merit,” adds Dr. Briskin, who founded the first concierge-style medical practice in Palm Beach County in 2000, one year before the arrival of MDVIP.

 

He adds, “I have yet to witness any meaningful, comprehensive reform proposals coming out from major medical organizations, including the FMA or the AMA. The original ideas, in my opinion, stem from the innovators in healthcare. Every idea I hear is centered on tax credits—giving credits so people can buy their own health insurance. But I have not seen any plan that would influence the price of the health insurance. Nothing makes it more affordable. Our mission is to try to come up with suggestions for Congress. It’s a process.”

 

While the Council believes that the current healthcare system capably delivers the highest quality of care in the world, they also stress that the highest quality care is not accessible or affordable to all Americans. They believe that any reforms must focus on patient-centric care that is adequately funded, offers individual choice and direction.

 

“Basically, if you’re rich, you can get the best care in the world,” says Dr. Briskin. “The problems is for 80% of the population for whom the high cost of healthcare is an issue. The best care may not be accessible to you, especially for the lower and middle classes in our country.”

 

One idea that Dr. Briskin sees as a valuable addition to traditional health insurance is the Healthcare Sharing Ministries Medishare program. Through these plans, faith-based organizations collect monthly dues and then distributes the money to subscribers who have medical bills to pay.

 

Dr. Briskin and his wife and four children recently enrolled in Liberty Healthshares, and saved about 75% over his prior BlueCross/BlueShield policy. The only real problem, according to Dr. Briskin, is that these plans are not guaranteed issues and pre-existing conditioning are grandfathered in over several years.

 

“Still, for about 80% of the population, I feel this is a great alternative to taking charge of your health at a reasonable cost,” he says. “One of the answers to healthcare is to partner with the faith community.”

 

Dr. Briskin proposed a similar idea to this at the National Meeting of the American Public Health Association in New York City in 1996.

 

“Every community has churches, synagogues and mosques with a volunteerism program,” he says. “They have an ethical and moral responsibility to take care of their congregants and make them better. That is not an ethic that for-profit insurance companies have. They may tell you that they are there to make people better but there’s a big difference between the faith community and for-profit insurance companies in terms of their idealism and values.”

 

Dr. Briskin believes something similar to the Healthcare Sharing Ministries could save billions of dollars and provide more affordable care to up to 85% of the population.

 

“These are people who are basically well but are currently paying exorbitant premiums or choosing to self-insure,” he says.

 

Another idea that he is championing is to increase the primary care base and correcting the inverse ratio of primary care doctors to specialists in the United States.

 

“One of the reasons that healthcare is so expensive is that the United States has an inverted ratio of primary care physicians to specialists,” Dr. Briskin says. “You have to change the role of the primary care doctor. You have to give them more time to solve the problems of the sickest 15% of the population who make up 85% of healthcare costs. Right now, a primary care doctor only has about two minutes direct contact with a patient, regardless of the number of complex problems the patient may be asking you to evaluate. He or she will refer a patient with complex issues to various specialists. That gets expensive.”

 

He adds that every Westernized nation covers their entire populations and has the exact opposite ratio of primary care physicians to specialists and does it for much, much less money.

 

“In the U.S., we have a 2 to 1 ratio of specialists to primary care physicians. Other countries have a 2 to 1 ratio of primary care physicians to specialists,” says Dr. Briskin. “In addition, most other westernized nations have nearly 100% coverage of their population and spending on healthcare is no more than 11% of their GDP. In this country, we have 89% covered, but with many who are under-insured, and spending is over 18% of our GDP. Even many with insurance still have no access to care, due to exorbitantly high deductibles.”

 

Dr. Briskin would favor a plan that would increase the primary care base and allow more compensations for primary care physicians who will have more responsibilities to cost-effectively treat patients and achieve quality outcomes, such as lower hospitalization rates, all patients on any needed medications based on their conditions, based on national guidelines.

 

“We also need to give them more time with patients and compensate them to actually solve problems themselves and getting them to refer less,” he says. “That is one caveat to what I think should be done.”

 

In addition to finding alternatives to replace the ACA, MACRA is a key issue for the Council. According to the Centers for Medicare & Medicaid Service, MACRA “provides that solo and small practices may join ‘virtual groups’ and combine their … reporting” under Medicare’s Merit-Based Incentive Payment System (MIPS). Providers are nervous about taking on the risk of MIPS, and prefer a model that provides incremental steps towards taking risk.

 

“MACRA is really something that is burdensome to all physicians,” notes Dr. Briskin. “However, in rural areas, patients don’t have any options. They need their rural doctor—their primary care family doctor. But the resources that these practices have to pay for all of these requirements is so onerous that it’s driving rural doctors out of practice.”

 

The Council believes that MACRA should ultimately be abandoned for the good of the physicians and the patients, who could pay for their own care directly, through a free market system.

 

“Ideas like HSAs paid for by tax credits based on need, direct relationships between patients and doctors, high-deductible insurance plans for catastrophic, unexpected medical needs, and Healthcare Sharing Ministries are all great ideas for most of the population,” says Dr. Briskin.