Curbside HealthCast

How to Fix Primary Care: Pay for Outcomes, Not Appointments

Primary care feels broken: rushed appointments, long waits, endless forms, and a printout you can’t read. But what if the real problem isn’t your doctor… It's how we pay for care?  In this episode of Curbside Health Cast, Dr. Brady Steineck explains physician compensation and why fee-for-service healthcare turns primary care into a visit factory. When the payment model rewards office visits, we get more visits, more clicks, more checkboxes, and less actual health. If you’ve ever wondered why doctors seem hurried, why prevention gets ignored, or why messaging your clinic still turns into “schedule an appointment,” this is the missing piece. We dig into value-based care, capitated payment, per-member-per-month funding, and how shared savings models can reward prevention and better outcomes.  This conversation is for patients who want better access, clinicians who feel trapped on the treadmill, and healthcare leaders and payers who want real healthcare reform. Because if we pay for visits, we get visits, but if we pay for health, we can finally build a system designed for proactive care, chronic disease control, and real relationships. Highlights: → You’ll learn the 3 forces that keep primary care stuck: why the visit becomes the unit of business, how fee-for-service squeezes time out of care, and why prevention gets treated like an afterthought.  → You’ll also hear a simple explanation of capitation and why per-member-per-month primary care funding can support proactive outreach, team-based care, and better access without forcing every problem into an office visit.  → Dr. Steineck breaks down shared savings and full-risk contracting models, and why quality metrics, patient experience, and outcome guardrails matter so this becomes the right care, not less care.  → Finally, you’ll get a practical call-to-action whether you’re a payer, healthcare executive, clinician, or patient, so you can spot (and support) a system that’s built to keep people well. Learn more about your ad choices. Visit megaphone.fm/adchoices [https://megaphone.fm/adchoices]

Palliative Care vs Hospice: The Difference That Changes Everything

Most people say they want to spend their final days at home, comfortable, surrounded by family, and cared for with dignity. But in real life, many patients with serious illnesses still end up in crisis mode: ER visits, repeat hospitalizations, ICU stays, and decisions made under stress.  In this episode of the Curbside Health Cast, host Dr. Brady Steineck sits down with Dr. Carrie Hyde, a physician and Chief Medical Officer for a national palliative care organization, to explain what families and clinicians often misunderstand: palliative care is not hospice, and it’s not “giving up.” Palliative care can be used alongside treatment for cancer, heart failure, COPD, kidney disease, and more, focusing on symptom management, goals of care, caregiver support, and quality of life. Hospice is a specific benefit typically used in the last months of life when the focus shifts to comfort.  If you’ve ever wondered when to involve palliative care, how to avoid unwanted hospital trips, or how to talk about end-of-life planning without taking away hope, this conversation gives you a clear, practical roadmap. Highlights: → You’ll hear the clearest breakdown of palliative care vs hospice, including why “all hospice is palliative care, but not all palliative care is hospice.”  → Dr. Hyde explains what actually happens when supportive care starts earlier: better symptom control, clearer goals-of-care conversations, less caregiver burnout, and fewer crisis-driven 911 calls.  → You’ll learn how to reframe “I’m a fighter” into a values-based plan that still protects hope while matching care to what matters most.  → Finally, you’ll see how community-based, high-touch palliative care (including 24/7 access and proactive home support) helps patients stay where they want to be, and how earlier hospice enrollment can improve quality of life for both patients and families. https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a4. [https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a4.htm] htm [https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a4.htm]https://allianceforcareathome.org/wp-content/uploads/2024/09/Facts-Figures-2024_FINAL.pdf?utm_source=chatgpt.com [https://allianceforcareathome.org/wp-content/uploads/2024/09/Facts-Figures-2024_FINAL.pdf?utm_source=chatgpt.com] https://www.kff.org/medicare/medicare-spending-at-the-end-of-life/ [https://www.kff.org/medicare/medicare-spending-at-the-end-of-life/] Learn more about your ad choices. Visit megaphone.fm/adchoices [https://megaphone.fm/adchoices]

Can Personality Tests Reduce ADHD Medication?

What if your pediatrician wasn’t just treating symptoms, but truly in your corner? In this episode of the Curbside Health Cast, Dr. Brady Steineck sits down with Dr. Shelley Senders, a pediatrician who has spent 37 years building one of the most innovative independent pediatric practices in the country. From integrating behavioral health directly into primary care, to using personality testing to reduce unnecessary ADHD medication, to enrolling 173 adolescents in the Pfizer COVID vaccine trial, this conversation explores what patient-centered care really looks like in modern healthcare. If you’re a parent frustrated by fragmented mental health services, a provider overwhelmed by today’s healthcare system, or someone who believes medicine should feel more human, this episode is for you. Discover how one independent practice built a 19,000-square-foot pediatric “treehouse” clinic, embedded therapists and play therapy rooms, conducts clinical trials, and still prioritizes relationships first. This is healthcare reimagined. Highlights: → You’ll learn how integrating behavioral health into primary care reduces fragmentation and improves patient outcomes, and why the traditional split between psychiatry and pediatrics often fails families.  → You’ll also discover how using Myers-Briggs personality testing in pediatric evaluations can reduce ADHD misdiagnosis and potentially lower stimulant prescriptions by identifying personality mismatches between students and teachers. → Plus, hear the behind-the-scenes story of participating in over 300 clinical trials, including major vaccine studies, and how a small independent practice can literally change the world. Learn more about your ad choices. Visit megaphone.fm/adchoices [https://megaphone.fm/adchoices]

Patients Don’t Want “The Portal” They Want a Human

Have you ever called a medical office with something that felt urgent… and got treated like an inconvenience?  In today’s episode, we talk about why modern healthcare can feel cold, why patients hear a quiet “no” through portal messages, policies, and rushed triage, and how good clinicians get trained into emotional distance without even realizing it. This is not a rant about bad people. It’s a breakdown of a healthcare system that rewards speed, punishes humanity, and turns real care into compliance, documentation, and workflows.  If you’re a physician, nurse practitioner, PA, nurse, medical assistant, triage staff, or healthcare leader, this episode is your reminder that the messiness isn’t a glitch in the job, it IS the job. Because illness isn’t tidy. Fear isn’t tidy. And patients don’t just need answers, they need reassurance, curiosity, and a clinician who doesn’t flinch when the story doesn’t fit the template. We’ll unpack how “work-life balance” can quietly become a shield, how reflexive gatekeeping erodes trust, and what it looks like to draw boundaries without building walls.  The core message: the mess is medicine, and reclaiming small human moments can change everything. Highlights: → Why patients feel rejected even when nobody “said no” → The 3 forces creating distance in healthcare (compliance, inconvenience, avoidance) → How triage and portals can become gatekeeping (and how to fix the tone) → 3 practical practices: see the person, replace “no” with curiosity, set boundaries without walls → How burnout changes behavior, and how to stay compassionate without self-sacrifice → What healthcare leaders must change (metrics, documentation burden, relational outcomes. #healthcare #burnout #patientcare #medicine #leadership Learn more about your ad choices. Visit megaphone.fm/adchoices [https://megaphone.fm/adchoices]

85% of Visits Don’t Need the Office: So Why Are We Still Doing This? with Dr. Rodney Ison

Healthcare is becoming financially unsustainable, and fee-for-service is a huge reason why. In this episode, Dr. Rodney Ison breaks down what value-based care actually requires and how to build a patient-centered model that works in the real world. If you’re one foot in value and one foot in fee-for-service, this is your wake-up call. Highlights: → Why fee-for-service pushes “widgets,” not outcomes → The “True North” move: defining patient-centered care as the operating system → What changes when you pay for outcomes instead of visits → How remote monitoring + messaging can deliver “care anywhere” → The real barrier to transformation: fear (and how to move through it) → How to build a culture of change clinicians actually buy into → How to catch up faster by learning from people who already made the mistakes Learn more about your ad choices. Visit megaphone.fm/adchoices [https://megaphone.fm/adchoices]