Healthcare Facts You Should Know!

In February Drs. Greg & Chaminie Wheeler hosted a Physician's Advocate Party. In addition to wonderful presentations, networking, and fellowship, the doctors played a Healthcare Trivia Game. Read the questions and answers below and see how informed you really are!

In 2023, the US federal budget was $6.2 trillion in spending and $4.5 trillion in revenue resulting in a deficit of $1.7 trillion. Of that federal budget, in 2023, how much did the US spend on healthcare?  

A. 4.9 trillion  

B. 4.5 trillion  

C. 3.1 trillion  

D. 2.7 trillion  

Answer:

A) $4.9 trillion, or $14,570 per capita. 

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Why is the vertical integration of healthcare concerning patients and physicians? 

A) It increases patient choice by providing more options for care  

B) It lowers administrative burdens for independent physicians  

C) It consolidates insurance companies, hospitals, and pharmacy benefit managers under a single  control, reducing competition  

D) It ensures fair pricing acr.ezoltross all healthcare services 

Answer:  

C) It consolidates insurance companies, hospitals, and pharmacy benefit managers under a single  control, reducing competition 

Explanation:  

Vertical integration limits competition by allowing large networks to control all aspects of  healthcare, from pricing to referrals, leaving independent physicians at a disadvantage and  reducing patient choice. 

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How does vertical integration of healthcare and physician employment contribute to increasing  healthcare costs? 

A) Large healthcare corporations acquire physician practices, allowing them to charge higher  facility fees for the same services.  

B) Consolidated health systems reduce competition, leading to higher prices for medical services  and fewer choices for patients.  

C) Employed physicians are often pressured to order more tests and procedures to maximize  revenue for the hospital system.  

D) Companies like Optum (a subsidiary of UnitedHealth Group), the largest employer of  physicians in the U.S., use data-driven tactics to prioritize profitability over patient affordability.  E) All of the above. 

Answer:  

E) All of the above.

Explanation:  

Vertical integration in healthcare—where hospitals, insurers, and physician groups merge— reduces competition, inflates service costs, and limits patient choice. When physicians become  hospital-employed or work for corporate entities like Optum, services previously billed at lower  rates in independent clinics become significantly more expensive due to facility fees and higher  negotiated reimbursement rates. Additionally, corporate-driven incentives lead to increased  testing, procedures, and referrals within the system, driving up overall healthcare spending. 

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Number of physicians employed in US in 2014 (Source: "Survey of America's Physicians: Practice Patterns and Perspectives")  

A. 72%  

B. 65%  

C. 58%  

D. 53% 

Correct Answer:  

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In 2024, what percentage of physicians in the United States were employed? (Source: Physicians Advocacy Institute (PAI) and Avalere Health) 

Number of physicians employed in US in 2024  

A. 84.%  

B. 78%  

C. 71%  

D. 65%  

Correct Answer:  

B) 78% ____________________________________________________________________________  

As of 2024, which organization ranked #4 among the 9,020 lobbying groups in Congress,  according to OpenSecrets? 

A) American Hospital Association  

B) Pharmaceutical Research & Manufacturers of America  

C) National Association of Realtors  

D) U.S. Chamber of Commerce 

Correct Answer:  

A) American Hospital Association r.ezolt

Explanation:  

A) The American Hospital Association ranked #4 in lobbying influence, advocating for hospital  funding, healthcare regulations, and policies that impact medical institutions nationwide. ___________________________________________________________________________

How does the American Hospital Association (AHA) contribute to increasing the cost of  healthcare? 

A) By lobbying for higher Medicare and Medicaid reimbursement rates, leading to increased  government and insurance spending.  

B) By promoting hospital mergers and acquisitions, reducing competition and driving up service  prices.  

C) By supporting facility fees, making outpatient services more expensive compared to  independent physician practices.  

D) By opposing price transparency laws, preventing patients from knowing costs upfront.  E) All of the above. 

Correct Answer:  

E) All of the above. 

Explanation:  

The AHA increases healthcare costs through lobbying for higher reimbursement rates, supporting  hospital consolidation, allowing excessive facility fees, increasing administrative complexity,  and blocking price transparency laws. These factors collectively contribute to rising medical  expenses for patients, insurers, and the federal government. ____________________________________________________________________________

What is one major impact of hospital networks remaining tax-exempt as "non-profits"? 

A) They must offer free healthcare to all patients  

B) They are not required to disclose profits publicly  

C) They can amass significant financial surpluses while still receiving tax exemptions  D) They are unable to advertise their services 

Answer:  

C) They can amass signifir.ezoltcant financial surpluses while still receiving tax exemptions 

Explanation:  

Many hospital networks operate as de facto for-profit entities while benefiting from tax-exempt  non-profit status. They use financial surpluses to expand, acquire private practices, and market  services, reducing competition and driving up costs. __________________________________________________________________________

In a procedure oriented private practice, typically what percentage of patients are medicare/medicaid?  

A. 93%  

B. 85%  

C. 76%  

D. 64%  ____________________________________________________________________________

In a procedure oriented private practice, typically what percentage of patients of revenue is medicare/medicaid?  

A. 70%  

B. 40%  

C. 30%  

D. 10%  

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In one private procedure oriented practice (personal example from PA), where the physician  tracked financial records, what percentage of patients were on private insurance or self-pay, and  how much revenue did they contribute? 

A) 7% of patients, 90% of revenue  

B) 10% of patients, 70% of revenue  

C) 20% of patients, 50% of revenue  

D) 50% of patients, 50% of revenue 

Correct Answer:  

A) 7% of patients, 90% of revenue 

Explanation:  

In this real-world example, only 7% of patients had private insurance or paid out-of-pocket, yet  they accounted for 90%of the revenue collected. Meanwhile, 93% of patients were on Medicare  or Medicaid, contributing only 10% of the revenue. This highlights the financial disparity in  reimbursement rates between private insurance/cash payments and government programs. ___________________________________________________________________________

How much higher were Medicare payments per year for services billed for hospital-employed  physicians compared to independent physicians for the exact same service provided? 

A) $50,000  

B) $85,000  

C) $114,000  

D) $150,000 

Correct Answer:  

C) $114,000

Explanation:  

Medicare payments for services billed by hospital outpatient facilities were, on average,  $114,000 higher per physician per year compared to services billed by independent practices,  primarily due to additional facility fees. _________________________________________________________________________

So why are we here —>  

Why is the independent physician movement considered best for patients in terms of quality of  care? 

A) Independent physicians have more flexibility to make patient-centered decisions without  corporate or insurance interference.  

B) Patients receive more personalized, continuity-driven care due to longer appointment times  and stronger doctor-patient relationships.  

C) Independent physicians often have lower overhead costs, which can lead to more affordable  care options for patients.  

D) All of the above. 

Correct Answer:  

D) All of the above. 

Explanation:  

The independent physician movement allows doctors to prioritize patient needs over corporate  interests. Independent physicians can provide longer appointment times, build stronger patient doctor relationships, and make clinical decisions without third-party interference. Additionally,  

they have lower overhead costs, which helps in keeping healthcare more affordable. These  factors combined contribute to better quality of care, patient satisfaction, and health outcomes. _________________________________________________________________________

Why is the independent physician movement considered best for decreasing the cost of  healthcare? 

A) Independent physicians have lower administrative overhead by avoiding costly bureaucratic  requirements from hospital systems and insurers.  

B) Direct Primary Care (DPC) and independent practices often eliminate middlemen, reducing  unnecessary costs for patients.  

C) Independent physicians can negotiate fairer pricing for services, labs, and medications,  passing the savings on to patients.  

D) All of the above. 

Correct Answer:  

D) All of the above.

Explanation:  

Independent physicians reduce administrative overhead by avoiding excessive hospital system  bureaucracy, eliminate middlemen through models like Direct Primary Care (DPC), and  negotiate lower prices for services, labs, and medications. Without corporate or insurance-driven  cost inflation, independent physicians can provide transparent, cost-effective care, helping to  decrease overall healthcare expenses for patients. 

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What is the ONE factor that would immediately reduce overall U.S. healthcare  expenditures by reversing the ratio of independent to employed physicians (from 22%  independent to 78% independent)? Of course there are many others too:) 

A) Independent physicians generate higher profits for insurance companies  

B) Independent physicians reduce Medicare spending by eliminating unnecessary facility fees

C) Hospital-employed physicians are paid lower salaries than independent physicians  

D) Independent physicians receive more government funding than hospital-employed physicians

Correct Answer:  

B) Independent physicians reduce Medicare spending by eliminating unnecessary facility fees. 

Explanation:  

Shifting more physicians to independent practice could reduce federal healthcare costs by  eliminating facility fees and other inflated costs associated with hospital-employed physicians,  leading to improved operational efficiency and lower Medicare spending. __________________________________________________________________________

What is one of the primary goals of expanding Health Savings Accounts (HSAs)? 

A) To eliminate all health insurance companies  

B) To provide Americans with greater autonomy in managing their healthcare dollars  C) To require all Americans to use direct primary care (DPC)  

D) To increase government control over healthcare spending 

Answer:  

B) To provide Americans with greater autonomy in managing their healthcare dollars 

Explanation:  

Expanding HSAs allows individuals to save and spend pre-tax dollars on healthcare expenses,  giving them greater flexibility and choice in selecting healthcare providers and services. This  reform reduces reliance on third-party payers and fosters a competitive free market that can  lower healthcare costs. __________________________________________________________________________

How do expanded HSAs strengthen the independent physician movement?

A) By forcing hospitals to refer all patients to independent physicians  

B) By allowing patients to spend their healthcare dollars directly on independent physicians and  direct primary care  

C) By eliminating all large hospital networks  

D) By making health insurance companies manage HSAs 

Answer:  

B) By allowing patients to spend their healthcare dollars directly on independent physicians and  direct primary care 

Explanation:  

When patients control their healthcare funds, they can choose independent physicians and direct  primary care (DPC) models instead of being funneled into hospital-owned networks. This  reduces administrative overhead and prevents large hospitals from monopolizing patient care. ___________________________________________________________________________

Which of the following bills proposes raising HSA contribution limits to $10,800 for individuals  and $29,500 for families? 

A) HSA Modernization Act of 2023 (H.R.5687)  

B) Healthcare Freedom Act (H.R. 5842)  

C) Personalized Care Act (H.R. 5810)  

D) Health Savings Act of 2023 (S.1158) 

Answer:  

C) Personalized Care Act (H.R. 5810) 

Explanation:  

Representative Chip Roy’s Personalized Care Act proposes raising HSA contribution limits  significantly and allowing HSA contributions regardless of insurance plan type, broadening  access and financial flexibility for individuals and families. _______________________________________________________________________

Which of the following statements is true about Health Savings Accounts (HSAs) and their role  in healthcare cost reduction? 

A) HSAs encourage cost-conscious decision-making, which puts downward pressure on  healthcare prices  

B) HSAs eliminate all healthcare costs for individuals  

C) HSAs increase dependence on large hospital networks  

D) HSAs force individuals to rely solely on insurance for healthcare payments 

Answer:  

A) HSAs encourage cost-conscious decision-making, which puts downward pressure on  healthcare prices

Explanation:  

HSAs allow individuals to shop for competitive pricing, make informed healthcare decisions,  and avoid unnecessary procedures, helping to control and reduce overall healthcare costs through  free-market mechanisms.