Medicare for All Rounds Single Payer Advocacy in the Clinical Setting - Introduce ourselves Ask people in the room who is a resident/attending/medical student/allied health/premed Linda Liu MS4 Shirlene Obuobi MS4

You are a single payer advocate. Case Scenario Your patient is a 64 y/o woman admitted to cardiology for a MI. You are preparing to discharge her and want to set up PCP and Cardiology follow up appointments for her. You have called to set up appointments at 3 institutions in the area—including your own—only to be told that they do not accept your patient’s insurance and that she will have to go to County. You are a single payer advocate. How would you discuss this patient’s barrier to care with your team? Ask to group: How do you discuss this patient’s barrier to care with your team? - As a Medical student? - As a Resident? - As an Attending?

Goals of Advocacy on the Wards Bring awareness to how single payer can address barriers to healthcare access seen in daily patient care Promote greater discussion of inadequacies of current healthcare model What more compelling reasons to show why we need universal health insurance than seeing patients who face health access barriers As healthcare professionals, most of our time is spent in clinical contexts. Bring awareness Should take advantage of opps to spark conversation amongst a colleagues, identify potential single payer advocates in your institution and build a community

Sparking Single Payer Discussions As a Medical Student Don’t be afraid! Ask questions in real time (en route to patient rooms, in workrooms, during procedures) Don’t be afraid to talk about insurance and access! Take advantage of lulls during rounds (en route to patient rooms!), in the workroom, during procedures to spark conversation about single payer! Ask questions in real time as a segue to spark conversation (see sample questions on slide) “On the fly” learning points- When you encounter a barrier, use the opportunity to talk about other healthcare systems that handle this better “I’ve heard that in Canada, there’s no such thing as being in or out of network, and so patients can see anybody.”

Sparking Single Payer Discussions As a Medical Student Don’t be afraid! Ask questions in real time (en route to patient rooms, in workrooms, during procedures) “This patient doesn’t have insurance. How will they pay for all of these tests?” “How does a patient know what is or isn’t covered by their insurance?” Don’t be afraid to talk about insurance and access! Take advantage of lulls during rounds (en route to patient rooms!), in the workroom, during procedures to spark conversation about single payer! Ask questions in real time as a segue to spark conversation Example: “ “On the fly” learning points- When you encounter a barrier, use the opportunity to talk about other healthcare systems that handle this better “I’ve heard that in Canada, there’s no such thing as being in or out of network, and so patients can see anybody.”

Sparking Single Payer Discussions As a Medical Student Don’t be afraid! Ask questions in real time (en route to patient rooms, in workrooms, during procedures) Give on-the-fly learning points Don’t be afraid to talk about insurance and access! Take advantage of lulls during rounds (en route to patient rooms!), in the workroom, during procedures to spark conversation about single payer! Ask questions in real time as a segue to spark conversation Example: “ “On the fly” learning points- When you encounter a barrier, use the opportunity to talk about other healthcare systems that handle this better “I’ve heard that in Canada, there’s no such thing as being in or out of network, and so patients can see anybody.”

Sparking Single Payer Discussions As a Medical Student Don’t be afraid! Ask questions in real time (en route to patient rooms, in workrooms, during procedures) Give on-the-fly learning points E.g. when encountering difficulties with getting patients follow up: “I’ve heard in Canada that there’s no such thing as ‘being in or out of network’ and so patients can see any provider” Don’t be afraid to talk about insurance and access! Take advantage of lulls during rounds (en route to patient rooms!), in the workroom, during procedures to spark conversation about single payer! Ask questions in real time as a segue to spark conversation Example: “ “On the fly” learning points- When you encounter a barrier, use the opportunity to talk about other healthcare systems that handle this better “I’ve heard that in Canada, there’s no such thing as being in or out of network, and so patients can see anybody.”

Sparking Single Payer Discussions As a Resident / Fellow / Attending Post-rounding teaching activity Identify recently discharged patients from your list who had insurance-related barriers to care Post-rounding teaching   Discussion of patients from last call cycle with team Which barriers to care did you encounter that were related to insurance coverage What did you do to try to overcome those barriers? Were you able to? What concerns do you have about your patient’s ability to follow up/ their long term care? Short spiel about single payer healthcare and how such a system would circumvent or improve such barriers

Sparking Single Payer Discussions Patient Barrier to Care? What was it? RW HP HG LL DT CC Post-rounding teaching   Discussion of patients from last call cycle with team Which barriers to care did you encounter that were related to insurance coverage What did you do to try to overcome those barriers? Were you able to? What concerns do you have about your patient’s ability to follow up/ their long term care? Short spiel about single payer healthcare and how such a system would circumvent or improve such barriers

Sparking Single Payer Discussions Patient Barrier to Care? What was it? RW Y HP N HG LL DT CC Post-rounding teaching   Discussion of patients from last call cycle with team Which barriers to care did you encounter that were related to insurance coverage What did you do to try to overcome those barriers? Were you able to? What concerns do you have about your patient’s ability to follow up/ their long term care? Short spiel about single payer healthcare and how such a system would circumvent or improve such barriers

Sparking Single Payer Discussions Patient Barrier to Care? What was it? RW Y HP N HG LL DT CC Post-rounding teaching   Discussion of patients from last call cycle with team Which barriers to care did you encounter that were related to insurance coverage What did you do to try to overcome those barriers? Were you able to? What concerns do you have about your patient’s ability to follow up/ their long term care? Short spiel about single payer healthcare and how such a system would circumvent or improve such barriers

Sparking Single Payer Discussions Patient Barrier to Care? What was it? RW Y Presented with late complications due to patient’s concerns about high deductible HP N HG LL Patient’s insurance not taken at our institution DT CC Insurance would not pay first line medication Post-rounding teaching   Discussion of patients from last call cycle with team Which barriers to care did you encounter that were related to insurance coverage What did you do to try to overcome those barriers? Were you able to? What concerns do you have about your patient’s ability to follow up/ their long term care? Short spiel about single payer healthcare and how such a system would circumvent or improve such barriers

Sparking Single Payer Discussions As a Resident / Fellow / Attending Post-rounding teaching activity Identify recently discharged patients from your list who had insurance-related barriers to care Ask your team: Which barriers to care did you encounter were related to insurance coverage? What did the team do to try to overcome those barriers? Were you able to? What concerns do you have about your patient’s ability to follow up/ their long term care? Follow up the activity with single payer discussion

Case Practice 1. A 26 year old man arrives in the ED after severing the tip of his finger in a car door. He is unsure of his insurance coverage. His finger is washed and dressed in the ED, but given his insurance status, he cannot follow up at your hospital for the procedure to close the wound. 2. You're in clinic, and an attending complains about how much time she spends on paperwork. 3. An uninsured 45 year old woman who is medically ready for discharge is kept in the hospital for three additional days to complete her full course of IV antibiotics because she cannot receive home nursing follow-up. Your team laments the high cost of her continued hospitalization. 4. You are a medical student in clinic when one of the patients, who has been following with your attending for fifteen years, states that this is his last visit and that he would like to have “all of [his] loose ends tied up.” He reveals that his insurance would be changing in 30 days and he no longer be able to follow at this clinic.