Episode 9: Saving the Independent Provider

Marni Jameson Carey the president of Power to the Patients, a national nonprofit dedicated to helping Americans realize their right to know health-care prices up front, and to making sure hospitals follow the law to show all their prices. She was previously the executive director of the Association of Independent Doctors, a national, nonprofit, nonpartisan trade association based in Winter Park, Florida, working to stop health-care consolidation and lower health-care costs. An award-winning journalist, Carey worked as senior health reporter for Tribune Media, writing for the Los Angeles Times and the Orlando Sentinel. She is also past president of a medical marketing firm, author of four books, a nationally syndicated columnist, and frequent TV guest and speaker.

Curt Kubiak: Hello and welcome to this edition of NOVO Live – The Podcast. I’m Curt Kubiak, CEO and leader of NOVO Health. And we bring to you, every session, different perspectives of the health care delivery system. Providers, employers, patients – different ways of understanding how it is we can make the healthcare system more accessible, more affordable. And I’m pleased today to have a wonderful guest with me: Marni Jameson, Carey. I’m so glad that we could connect, and I could get your perspective on this topic of health care. But before we go there, I know that each of us has a story prior, you know, to where we are. And it’s helpful for I think our audience to understand that we are ourselves, you know, humans, right, that we’re, we’ve got a life outside of health care, we’ve got families that we’re managing all the other issues that you know, the rest of us are dealing with, in addition to this health care topic that is so passionate for both of us. Could you just give us an introduction and help our audience understand who you are, your history, Marnie? Please? 

Marni Jameson Carey: Oh, gosh, well, I’m trying to bring it full circle. I’m a wife and writer, and syndicated columnist and health care advocate and a mother of five children with a blended family. And they’re off in the world doing wonderful things. So, I’m most proud of that. I came to health care out of journalism school, my first job out of journalism school was to work in a hospital. And that was in California. And the doctors came forward, approached me and asked me if I would help them with their marketing. And so, I did that, on the side at night, on my own time, and the hospital administrators told me that was a conflict of interest. I was 22 years old and had to look that up. And I realized that they were kind of nuts that I was trying to help their doctors get more patients into their hospital on my time. And they had an issue with that. So, I quit. And I started my own PR firm. I didn’t know it, I didn’t want to say I was unemployed. So, I said I was freelancing. But next thing I knew, in three months, I needed a secretary. And off I went started a PR firm in the San Fernando Valley. And I ended up representing most of the big major medical centers in the Southland. And this agency kind of ran me more than I ran it, but it was a ball. And then I started having a family. And when I was nine months pregnant with my second child, I thought this might be a little too much and sold the business. And as soon as I did, I had the LA Times, which had been familiar with me, because I was working with them to try to get stories pitched, asked me if I was clean and sober, meaning that I was no longer in PR and if that were true, if I could start writing for them. So, I became a freelance health reporter for the LA Times and did that for a number of years. Until, fast forward to 2014. And my kids are off to college, or one is in high school, and one is off to college, and I wanted to get into the newsroom and took a job at the Orlando Sentinel as their health reporter. And that’s what got me into Florida. And here I am. And I was tapped eight years ago by the founders of the nonprofit, the Association of Independent Doctors, which I’m sure we’ll talk about to lead the effort of trying to help America’s doctors become independent, which would help improve, among other things, the affordability and accessibility of health care, which I know is a topic that’s near and dear to your heart. So that’s how I got here. 

Curt Kubiak: Wonderful introduction, Marnie. And thank you for giving us a little bit of your history and understanding that you’ve got all these other roles, you know, that you’re trying to fulfil. I can say that, from my perspective, once I got involved in this health care space, and realized how many improvements were required, and the price point that we were headed toward, understanding that I’ve got three boys myself, you’ve got your five kids and your family, right, in order for us to keep this accessible and affordable for them, right? For us, probably not so impactful where we are. But certainly, for that next generation. We need to do something now to make certain that we’re setting the stage for them to be able to enjoy, you know, access to what I believe is life’s most important feature, which is, you know, a healthy lifestyle. Oh, how do you feel about that?  

Marni Jameson Carey: When we think about the fact that even one out of every $5 that your kids earn out there in the working world, and we earn goes to pay for health care whether we see a doctor or not. It’s pretty mind numbing to realize how much of our income is going towards something that we don’t directly benefit from. All Americans pay for all health care. I think that’s the big message to get across that people go “oh, well, that doesn’t affect me, or I’ve got insurance.” It doesn’t matter you pay for it by not getting a pay raise because your employer’s having to pay more, your employer’s premiums are going up the cost of them when you go to a restaurant, you’re paying more, because they have to cover their interest, there are people staying in horrible dead end jobs, because they need to make sure their kids go to the doctor, it is crippling what has happened. It just doesn’t have to be that way. If we can get rid of the greed and the abuse, I’m very passionate about it. And it can be done. And there’s a way to do it. But we just need to get some big selfish interests out of the way. 

Curt Kubiak: I can appreciate what you’re saying. And then I think, for our audience to understand that, you know, the dollars and how they’re spent really could be turned back to them. And if you become a better consumer of health care if you’re educated about where you spend your dollars, and, you know, not necessarily where your primary health care physician, who is affiliated with a health system is asking you to go but rather, where you think is best for you. Can you talk about that? How do we as individuals, you know, trying to get by with our jobs, and then we get thrust into the healthcare system? Because something happens to us, and we’ve got to buy? How is it that we can become educated on what our options are? And what does it mean to purchase healthcare from an independent physician, as opposed to a health system? And why should I care? 

Marni Jameson Carey: Yes, there are a lot of a lot of questions in that question. So, I think that starting with, I don’t think most consumers realize the difference that they will get in care and cost if they go to an independent doctor, versus one that is employed by a health system or private equity group. And I think fundamentally, patients think, well, I want to know, if this doctor accepts my insurance, you want to know if this doctor accepts my insurance, or this private equity group accepts my insurance? And that’s not the question. The question has to be, are you independent or employed by a hospital system, and once you get that figured out, then you start going to go to independent doctor. And here’s why. Independent doctors don’t get ratcheted into a spiraling cost center that the health systems impose on these doctors. I’ll give you an example. If you go out and play tennis this weekend, and you wrench your knee, and you go to an independent doctor, and he your primary care doctor is going to refer you to probably an independent, that is a non-hospital employed. orthopedic surgeon, you worked in the orthopedic industry. And that doctor is going to send you to a free standing, one hopes imaging center, and then you’re going to go to get outpatient surgery because you tore your ACL or whatever it happened to you at an outpatient surgical center that’s not owned by the hospital, the total trajectory, I don’t know, plus or minus maybe $7,500. Okay, you go take that same trajectory, and you go to an employee primary care doctor who must refer to another hospital employee doctor. So, he’s going to send you to a hospital-employed orthopedic surgeon, which is going to change you have a hospital ohms MRI, which is right there, the difference between 530 $500, then outpatient surgical center and your total bill is $35,000. Same procedure, same procedure, so multiply that by all the patients that are going the wrong direction. And you see where the ripple effect and the multiplier, that compounding effect of not going to an independent doctor will cost not just you, but society as a whole. So, it’s very important that the first question patients ask is, are you independent? Or are you employed by the hospital and don’t say, I don’t care because I have insurance, because many people have high deductible plans, and it does matter to you. So that has been a big point of education, we can talk to you about the next big thing is we’re working really hard to get price transparency in this market, because that is the game changer. So, I’m excited to talk about that. But I’m not sure I fully answered your question.  

Curt Kubiak: I think you necessarily did answer and, and so when I think about the ways that we are trying to make healthcare more affordable, we’re not trying to reduce the quality of health care, we’re not trying to reduce the consumption of health care. We’re just trying to make it more accessible and affordable by the location that you have those procedures done and the physicians that work at those look at those locations. So again, to keep it very simple. I’m a simple guy. You know, you don’t want to pay for things that you don’t care much about which are very expensive facilities, and expensive administrators that manage those facilities, right? So how do we steer those dollars to the clinicians, right to the doctors and their staffs, right, that are treating you so that you know that you’re getting the best possible care and the price savings isn’t coming because we’re using lower quality implants or we’re using lower quality procedures. But it’s because you’re not having to pay the elevated price points for some of these facilities and some of the administrators that are making a lot of money and not adding value to you individually, when you’re you look at that individual, you know, healthcare service you’re trying to buy, does that make sense? 

Marni Jameson Carey: You bring up a really great point, nobody wants the cheapest health care, it’s not very reassuring to say, oh, the least expensive guy is going to replace my knee. That’s really not what we’re trying to do here. And there is an association between cost and quality. That really is not true in health care. I think that’s what it’s not the difference between buying an inexpensive car and a Ferrari, it’s not like that the more you pay, the better the better car you get. It’s highly dependent on what they’re burying in and what they’ve negotiated into those fees. And sometimes the best doctors are independent, they didn’t have to succumb to the hospitals, pressure to join them. And they’ve been able to be able to stand up to the pressures of persuasion and been able to stay independent, because they’re excellent. And so, I just think really, that’s the facility fee is a real thing. They hospitals, once they employ a doctor, they have to professional fee, plus they layer in this facility fee, which they say they need to add, and it can create up to 10 times the price. They say, to leave the lights on 24/7 to operate our infrastructure, I don’t want to pay for that. I don’t want to pay for that at all. And I don’t want to pay for all the suits above the doctors who telling them how to do rounds. And you’re not necessarily getting the best quote. I had an orthopedic surgeon saying “I don’t want it administrator telling me what implant I need to use the what medical device which I know is crummy because they’re getting a volume discount, or what gloves they want me to use, because I want to use the nice gloves and they want me to use cheap gloves that are going to break and cause an infection and $100,000 insurance claim that’s going to go against me against my malpractice insurance. I don’t want any part of that.” So the doctors want the freedom and the autonomy to choose the devices they want to use, the gloves they want to use, the facilities they want to use, how many procedures they do a week, the hospitals trying to grind as many procedures as possible out of these doctors and independent doctors and say, You know what, I want to spend time with my wife and kids, I’m going to go to sleep at night. So, they can structure their own time and not be grounded into some quota that they have to meet if they want to get their next contract. And that’s how it works in hospital healthcare systems. Doctors who are employed are often miserable. And you don’t want a miserable doctor working on you, do you? 

Curt Kubiak: Not at all? Yeah, you’re giving I think our audience a peek inside, you know, some of the details that we don’t think about when we’re deciding where to have our procedures done or what physician to see or where to see them. And you brought an interesting point about with regard to price transparency. And it takes me back to when I was first buying health care, working for a manufacturing company back in the early 90s. And I was asked to shop for healthcare, they said, you know, you spend more time buying a car than you do paying for your health insurance, I think you need to take more time and really figure out where it is you want to spend your dollars. But back in the early 90s, we didn’t even, you know, early 2000s, we didn’t even understand where the what the prices were. So, if I wanted to be a good consumer, it was very difficult because the system wasn’t set up for me to be able to see what is the best quality? What are the price points, so that I could, you know, make that informed decision. So, can you tell me a little bit about this price, transparency, movement and what it means to the industry overall? 

Marni Jameson Carey: Well, it means a huge revolutionary change that would bring healthcare into the realm of the affordable and the accessible. And we are moving the ball down the field. Kurt, it’s not been easy. There have been headwinds against us. But when you think about any other thing, you buy airline tickets, gasoline, flat screen televisions, groceries, you know the price before you buy it, and you get to the checkout, and you and you pay it, and there’s just no question. It’s clear. You wouldn’t get on an airplane from Washington, DC to California and say how much Oh, we don’t know. We’ll let you know when you get off the plane. Then we’ll give you a bill for $40,000. And the next plane next year is going to the same place for $400. What you wouldn’t do that, but we somehow accept this and healthcare. It’s ridiculous. It is the biggest shell game going and we need to take that opacity away from the hospitals and insurance companies and they’re in this together. They have been very successful at arguing though if prices just too complicated. Don’t worry, your pretty little head consumer. We’ll do all the bargaining for you. We’ll get you the best price. It doesn’t happen. We are paying far too much for health care because of the opacity and the lack of trends. Apparently So do you know about Cynthia Fisher, she’s a form to a force of nature, and brilliant businesswoman. And she has been fighting for a couple years now a few years straight to get price transparency in the market. She’s worked with both administrations, this is a bipartisan issue. We’ve seen several surveys that show 90% of Americans on both sides of the aisle want to know the price of health care before they get it. Simple as that, and we got a law passed that went into effect January one, you wouldn’t know it. But the hospitals are supposed to post all their prices online, for the 300 most common shoppable services, everything from getting your tonsils out to getting a hip replaced. And you should be able to go to the hospital, the hospital and compare the price, not only the cash price, but based on your insurance plan. We’ll give you a whopping Guess how many hospitals are complying with this rule? I ask you? 

Curt Kubiak: I would guess very few, right? Because it’s not to their advantage to take to participate in this type of an activity. So, my feeling is probably less than 10%. 

Marni Jameson Carey: That’s exactly right. The last survey that came out the best survey in July was 94.6% were not complying. So very few are and they’ve just and the government is probably to blame because they’re not putting any enforcement behind it. Now this is getting a little bit better. And this is what I mean, we’re moving the ball down the field, but it’s taking a lot of a lot of effort. So, they were you originally this whole year, the price has been $300 a day, which is a whopping $109,000 a year, which is change on the bar for these hospitals are making many millions more at our expense by charged keeping prices in the dark. So, we’ll pay the fine. Ignore the rule. And the rule wasn’t the fines and even kicked in until CMS Centers for Medicare services sent a letter first, they had to send a letter warning the hospital saying hey, you’re not in compliance. If you don’t fix this in 90 days, then we’re going to issue a fine well guess how many letters have gone out? 330. That’s it. And of all the hospitals we have what is it five or 6000 hospitals in this country 300 have gotten letters saying you’re not complying and then they have 90 days to get in compliance, and then they’ll get a wrist slap of $300. This is not going to be enforced enforcement. So, we pushed and pushed, and we got it a little bit better. Starting this January 1, the hospitals now the fine is up to $5,500 a day, if you’re over 30 beds, it goes up by beds, and then it tops out just over $2 million a year, which starts to be real money. But when you’re in an $11 billion institution, it’s pretty much not a big deal, you probably you’re still going to keep your prices in the dark, but it’s a little better. So, we’re working slowly on getting the hospitals to comply to getting government to enforce the rule and hold the feet to the fire and make these hospitals show their prices. And we also have one more rule going into effect. As of right now, we’re hopeful that on July 1, there’s a companion rule, that is the transparency and coverage rule. And that would require insurance companies to do just what we’ve asked hospitals to do cough up their prices. That way their finger pointing has to stop if the hospital says oh, we will charge this if you have Blue Cross plan such and so Blue Cross will have to put up the same amount. And we need to make sure these numbers marry. So, there’s not any finger pointing. And that’s they’ve been working really hard. As you know, the hospital challenged the rules in court and lost twice. And the insurance companies have challenged their role and they got postponed six months. So, we’re hoping there’s no more diluting the rule or delaying the rule. So, all the prices can be out. And I’ll tell you, I’m sure you have another question. But I’ll tell you how it’s all going to magically happen if things go well, and what that’s going to mean for American consumers because we’re getting very close. 

Curt Kubiak: You’ve explained, you know, the complexity of the health system that is there unnecessarily. So, there is no other industry as complex as they can be. Whether they are internet based companies, banking based companies, automotive companies, they all have found a way to be transparent about their price points. And we have the ability as consumers to decide how to buy their product or service. And so, it’s very difficult for me to understand how groups can claim that, you know, medical systems are more complex or not comparable to some of these other organizations that are, in my mind equally complex in terms of their services, but also, you know, in terms of their size, you know, very very difficult to manage these things, but they’ve somehow found a way. Those that are most adept at it have gained are Trust and have earned our dollars. And, again, I think for the most part, we’re okay with that we understand that groups are going to make a profit on the services that they provide on the on the products that we buy. So long as it is a willing decision on both parties part. 

Marni Jameson Carey: Yeah, and it’s, it’s going to shake out what I’m looking forward to the day. So if, as we get compliance, which is slow and slow and coming, the hospitals are supposed to post their prices in two ways, in a way that you can hop on and shop, how much will it cost, my wife has to have a C section. And if I go to this hospital with this insurance when you find out before you go, and then they also have to put machine readable prices. And this is where the beauty lies. When the machine readable prices are available data aggregators, the equivalent of Expedia, or Google or Amazon or Uber, can gather up the health data and put a special app on your phone that says, Oh, if I go to hospital X, it’s going to cost this, if I go to hospital Y it’ll cost this, you get to know and it’ll be on an app, it’ll be user friendly. And you’ll buy your health care services, the way you buy airline tickets. You compare United to American to Delta, and you go, Oh, this is the best deal, or this is the best time this is most convenient. This has the fewest stops whenever you get to have that transparency. So when that machine readable file is in place. So there are data aggregators waiting in the wings for this, this information to come through because the hospitals are saying, “Oh, it’s too complicated, don’t leave it to them to create the app that’s going to make it easy for you to shop, they’re not going to do that.” In fact, they’ve dropped in software with deliberate, deliberately obfuscating their information, the Wall Street Journal did an expose a and found that the hospitals were pretending to post their prices, but then dropped in code that made it inaccessible, even for the smartest data analysts to get to you. So they’re not complying and they’re not being helpful, and they’re not being cooperative. But eventually, you know, in their argument, one of their arguments is, and I think this could be good for the hospitals if they would just come along. But well, the only people that will benefit is our competition, the hospital and CFOs say, you know, why would I show my prices only my competitors are going to benefit? Well, that’s like saying your two grocery stores across town can’t see what the other ones charging for milk. What that’s ridiculous. It’s not a state secret. It shouldn’t be you should be able to have competitive pricing, and have people be able to look around and say, Oh, what is your quality? What is your price and make a value decision, like you would on anything else. So I’m hopeful that that the cloud will pass and then the enforcement will kick in. And the government will do what they need to do to give Americans what they want. And we will see prices come tumbling down. And I have said for a long time, Curt, when the Affordable Care Act went into effect. And I was I was a health reporter. And all the all the information that came to me was how many people will lose coverage or gain coverage when the Affordable Care Act goes into effect. And the and the insurance companies and the hospitals were brilliant at moving the public perception away from the issue of cost to the issue of coverage. So cost here’s the dirty little secret cost ceases to be for coverage ceases to be a problem in the face of affordable care. When the costs come down to where they should be, coverage takes care of itself. Because care is affordable, and so is insurance. So that was just so mind blowing to know how brilliantly they turned our attention to this whole thing about covered lives, and they did not want to talk about cost. And guess what? Premiums have gone skyrocketing since the Affordable Care Act passed and so of health care costs, so it did nothing to make costs affordable, but it did a little bit for coverage, we can get so much better. 

Curt Kubiak: So, I’m going to take our conversation and tip it just slightly to the physician side. So, we’ve talked a lot about how this is going to benefit the consumers and you know, the challenges that we’re facing today, but how things might change as we go forward, with better access to the prices. So how does this work out then for the physician that’s just entering their career and wanting to you know, decide, do I join a group of independent physicians, or do I join a health system? And what do you project could be an argument for one of these young physicians entering the market, in making this decision that you can put your time, your effort, your energy behind an independent organization, because they will have your best interest in mind? How do you envision that playing out? 

Marni Jameson Carey: This is a personal question as well. I have two daughters who are about to enter the medical profession, not MDs – one is becoming a vet and one’s going into neuro psychology – and I have been hearing first-hand especially, in veterinary medicine, the private equity persuasions that are coming at my daughter to be employed by them, and to move into that market versus the independent practices. And she knows where I stand, and she knows what I think. But man is it when you’re coming out of medical school and you have all that debt, and they’re dangling all this money at you. And I’m like, but there are some little magic words like productivity. So, she’d get a base pay and then productivity, which is how many procedures she does on these animals. And the more she does, the higher she gets paid. That’s a disincentive. I had a dentist he was a member of AID who said, you know, he was getting a persuaded to go to work for a private equity firm there, and he was working for them. And they were saying he wasn’t putting in enough crowns a month. And he said, I cannot control the rate at which my patients get tooth decay. Now it’s either necessary or it’s not. But doctors who are dis-incented do the wrong thing. You know, they start to get into this gray area of Oh, the patient really doesn’t need this. But well, it wouldn’t be a bad idea if it made my boss happy. And inadvertently, the allegiance they have developed with their patient shifts to their employer, and they’re working to please their employer and not please the patient. And that’s not good for anybody. And you know what, at the end of the day, I really think it eats that doctor souls, because they did not go to medical school to do tests they don’t need to order, to do procedures they don’t need to do and it makes them feel compromised, and they are being compromised. So, I guess that was a major soul search and say, you know, I know you’re getting them out with all that detail. But if you want to be your own, and you want to call the shots, and you want to practice medicine, the way you went to medical school for your best bet is to go into independent practice. 

Curt Kubiak: You’ve described some interesting aspects of that these folks have to make decisions based on right as they’re entering the market. And as you say, it is far easier right to choose a solution where you feel like you’ve got a steady paycheck, and you’ve got some recognizable income. And again, you’re up against a significant amount of debt coming out of school, I can appreciate those pressures. The common feeling is that you may not earn as much as an independent position as you would as an employed physician. My experience is different than that, and in the right environment, you can actually earn more in terms of salary because you can control better the facility fee, the administrative fee, some of the diagnostics and ancillaries. Can you comment on that maybe your experience with the ID physicians that you worked with and how they viewed their practices, as compared to the employed clinicians in the spaces that they worked. 

Marni Jameson Carey: I think it’s heavily specialty dependent. And some have a harder time steering clear of acquisition. But the studies I have seen PAI physicians Advocacy Institute, they do an annual report on physician salaries, and they do a survey, and it’s pretty neck and neck, the independent doctors and the employed physicians at the end of the day, it’s pretty neck and neck now. You know, on the one hand, you’ve got the hospitals taking care of all your business and letting you focus on medicine. And that’s their big play. But that comes with strings attached. And so, I guess you know, if you want to be in control of the whole thing, from your staffing to your hours to your you know, your Billings and all of that, I think I think independence is still going to be your better answer. If you just cannot abide the business aspect and you do not want to hire an employee and feel responsible for taking that that onus on, then maybe you do go to work for the hospital. I think it’s I just think it’s you’re going to sell your soul. The doctor attrition rate, the suicide rate among physicians is very high, it’s horribly high. And the satisfaction rate among independent doctors is measurably higher than those who work for someone else. So, the other example I was going to give you is the neuro psychology, for example my daughter’s teetering between going into private practice and going into hospital-based neuropsychology. And the hospital-based one has better research, better network of folks to lean on and sometimes more interesting cases because it’s an academic based research center. But the independent one, where she worked for a summer, she gets to run around marketing, see her own clients have a lot better relationship with them and they’re not just… The one neuropsychologist in that hospital setting only did two kinds of tests. Every single day she did the same thing because she was a cog in a wheel, oh, you do these two tests, you just get really good at it, we’ll take care of everything else. And my daughter’s that I will be bored as heck. The other one gets variety, she gets to get to have more time with the with the customer, she gets to design our office space, she gets to have, you know, the full, full example. And she said she’s much happier. And also, she can have a family and have balance of life. So, she’s seeing this really upfront she shadowing these people, and she’s, I’m channeling a little bit, but I’m trying to stay out of it. You know, it’s like, it’s interesting to see it in play. 

Curt Kubiak: Your perspective is excellent, not only with the profession, but also within your family. And again, as we started the conversation, you know, this is really about, you know, you and me as fellow Americans trying to, you know, live out the best possible life that we know how but attacking this health care thing as part of who we are and what we do. I understand too that you’ve now changed your role once again, and you’re now working with a new organization. Can you tell me a little bit about that? And what are they aiming to do and give me a feel for what the next chapter is for you, Marnie? 

Marni Jameson Carey: Well, thanks for asking Curt. As you know, I associate some independent doctors is a wonderful cause. And we weren’t, we ran hard at it for I was there for seven years, that organization existed for eight. And it’s really about getting the independent doctors to be, you know, supportive and recognized as a way to go and healthcare. And one of our missions, there are five missions, but one of the big ones was transparency and health care. And we talked a little bit about it. But if prices were transparent, Americans would see oh my gosh, if I go to this doctor, it’s such a better deal than if I go to this one, right. And so, the hospitals would lose their incentive for buying independent doctors because they wouldn’t be able to make the profit because they’d have to get competitive, they’d have to bring their price down. It would fix a lot. So, I’m not really giving up on the cause. But I did get a little exacerbated by the doctors who really weren’t supporting aid in the numbers that I needed them to, to grow and to have the voice that I wanted. So frankly, and sadly, for lack of physician support, we closed it. We shut it down in December, and I was up for grabs for about a day and a half. I was having great plans to take French lessons and, and painting classes and bone up on my tennis. But that didn’t happen because as I mentioned before, Cynthia Fisher, who’s a wonderful champion for patients, and for price transparency, started an organization called Patients’ Rights Advocates and has been moving mountains on Capitol Hill. And at one point I testified before the Senate and a couple of cases, actually, and her team kind of knew who I was, as this doctor spokesperson. She had a second organization called Power to the Patients, which is getting the population much more aware of price transparency and their right to know prices. And she needed someone to run it. And somebody said, “Well, why not Marni?” So, I got a phone call and said, would you be president of Power to the Patient. So, I was honored. And of course, I stepped right up. And it’s a huge, a huge honor. And it’s very important to America, and probably more important than my getting better at tennis, which I probably never would be good at anyway. So, she’s handling Capitol Hill, and the big picture. And I’m trying to work on getting the grassroots folks to get a handle on what their rights are. And I hope together, we can put the pressure on our administration to do what they promised to do, and to do what’s right for all Americans, and check in same time next year and see if we did it, Curt. 

Curt Kubiak: I am excited, Marni. And it was excellent spending some time with you today to learn a little bit about what you’ve been up to most recently, but also just the breadth of work that you’ve been a part of over the over a career. And I really want to thank you for the work that you’ve done. Because again, you’ve got so many other responsibilities in addition to the professional work that you do. And I think for our audience to understand that they too can be part of the solution. And you know, follow in the footsteps of folks like you and others that are advocating for, you know, the rights of patients, but also independent physicians to be able to coexist in communities and support their neighbors and their employer partners and those organizations as well. So, I’m looking forward to checking in with you again at the end of the year and finding out how things have come along positively we’re going to see some great changes. But your perspective has been very welcome. Thanks for spending some time with me today. 

Marni Jameson Carey: Well, thank you for having me. It was my pleasure. 

Curt Kubiak: And that’ll wrap up another edition of NOVO Live – The Podcast. I want to thank you again for joining us and we’ll see you next time. And until then, let’s keep the conversation going.