Welcome to MedCast, the podcast from MedChi, the Maryland State Medical Society. In episode eight, Dr. Stephen Rockower speaks with Dr. Benjamin Lowentriit, a Urologist in Baltimore County about his background, his work with MedChi, and the issues that drive his advocacy. Then, stick around for a peek at Dr. Lowentritt’s COVID-19 watchlist.
You'll find it all right here, on MedCast.
Be sure to tune in next time for our discussion with Dr. Clarence Lam, Maryland State Senator!
Dr. Stephen Rockower (00:16):
Welcome to MedCast, the podcast from MedChi, the Maryland State Medical Society. Each week, we'll be doing a deep dive into medicine and taking an insider's view on issues facing Maryland's physicians and patients, and healthcare more broadly. I'm your host, Dr. Stephen Rockower. Today, my guest is Dr. Benjamin Lowentritt, a urologist in Baltimore County. Welcome Dr. Lowentritt.
Dr. Benjamin Lowentritt (00:41):
Thank you very much for having me.
Dr. Stephen Rockower (00:43):
I'm so glad that we can be doing this. This has been a long time coming. And I'm enjoying doing these things and I think you'll enjoy it too.
Dr. Benjamin Lowentritt (00:52):
No, I know, it's been great.
Dr. Stephen Rockower (00:53):
Let's start with a couple of biographical kind of stuff. Tell me things about where you grew up, where you went to medical school and college, how you did your training, and how you wound up in Baltimore County.
Dr. Benjamin Lowentritt (01:07):
No, I'm happy to. I grew up just outside of New Orleans, Louisiana and lived there. I'm an only child, and my parents still live there. So I still have a big piece of New Orleans in my heart and go back frequently. And I went to college at Harvard and then to Baylor College of Medicine in Houston. And then did my urology training at the University of Maryland in Baltimore. There during my time in residency I met my wife, and that's why I'm in Maryland still. I did do a one year fellowship in robotic and minimally invasive urologic surgery at Tulane. So I was back home for a year, but have been in practice since 2006 with Chesapeake Urology in Baltimore City and Baltimore County.
Dr. Stephen Rockower (02:08):
What was your connection with Baltimore before you came to Maryland, anything?
Dr. Benjamin Lowentritt (02:13):
No, it was the urology match and fate. So I didn't really have any Maryland connections before I came here.
Dr. Stephen Rockower (02:21):
Okay. Well, we're glad that you made it here.
Dr. Benjamin Lowentritt (02:23):
Dr. Stephen Rockower (02:25):
So tell me some about how you got involved in MedChi and got into leadership.
Dr. Benjamin Lowentritt (02:30):
Yeah, even in medical school I was, well shoot, even in college my major was in the history of medicine, essentially. I was very interested in the late 19th century medicine in America, which was really where a lot of organized medicine started. So even the history of the beginning of organization around medicine, both in localities and education, and then in actual organized medicine with the AMA and other organizations. So I had this interest. And then in medical school, I did get involved with the Texas Medical Association as a student, and was a delegate co-leader for the TMA at that point. So I had this interest and it just had grown over time.
And I can't remember the year exactly, I want to say it was 2008, a friend and a mentor of my wife's, Dr. John Thompson, was the president of Baltimore City Medical Society and invited us to a function. And I got to meet a lot of people and it kind of stuck. And I started becoming active with Baltimore City Medical Society and was fortunate enough to serve as the president in 2013, '14. And have since been involved on the MedChi board, and then more recently also with the legislative council, and then most recently a speaker. After I started to get involved with the Baltimore City Medical Society, I was also very fortunate to have a great mentor in MedChi because my father-in-law, Joseph Snyder, is a former president of MedChi and still involved. He was very helpful in helping me understand the roles of MedChi and how I could participate. It was always great to be able to sit next to him at meetings and work together with him. So I've come through it both from an organic place and also married into it, and am very happy to be part of the MedChi family.
Dr. Stephen Rockower (04:39):
And Dr. Snyder was one of my mentors as well. Surprised he never got you to move to Montgomery County.
Dr. Benjamin Lowentritt (04:47):
Not for lack of trying.
Dr. Stephen Rockower (04:49):
Yes. Well, let's talk about the legislative council for a little bit. Some of our listeners may not know really what goes on there, tell me how resolutions get through the legislative council and where they go from there.
Dr. Benjamin Lowentritt (05:07):
It's really one of the key functions of MedChi and our mission, is the work we do in Annapolis, all year round, but especially during the session from January through part of April. We have a wonderful team that works with us on the lobbying side, our representation. And we have a very well refined system where any bill that's being proposed, any resolution that's coming through the State House that has really any regard to one of our three main groups or three main foci in our advocacy efforts. We have a public health group, an insurance group that deals with a lot of the finances, et cetera, around healthcare, and then what we call boards and commissions, which is a bit of a catchall, but tends to get issues around scope of practice and other types of regulatory control over medicine.
And so we have three subcommittees within the legislative council that discuss any related potential bills that are coming through the legislature once they're filed. And those groups meet every weekend, usually on an early morning, on a Sunday, or midday or late in the day. And then on Monday evenings throughout the session, so usually eight or nine consecutive weeks through the early part when the bills are being presented, we discuss this as a group. When I was first starting this, we did this in person still at MedChi in Baltimore City. And we would all drive there on Mondays and discuss the bills.
Dr. Stephen Rockower (07:00):
Yes, I remember that well.
Dr. Benjamin Lowentritt (07:02):
What's interesting is in 2019 there were a series of snowstorms that all hit on Mondays and Monday afternoons. So we had to adjust on the fly and I'm pretty sure that you, Dr. Rockower, were part of the communications group that had brought this unknown product to us called Zoom.
Dr. Stephen Rockower (07:24):
Dr. Benjamin Lowentritt (07:24):
And so we started doing Zoom meetings for the legislative council actually in 2019, which really prepared us well for when the world shut down a year later. So we found that actually it's been a wonderful thing for this group in particular because it does allow people that want to have a say, maybe just on a couple of relevant bills, to be a part and join the discussion at the legislative council, but also really has allowed them to hear some of the other issues that frankly may be going on if they stay on. So we've actually had a lot more engagement, a lot more involvement, which I think has been a very strong positive for the organization to hear different voices.
Dr. Stephen Rockower (08:09):
Yes, as you know, I've been part of the legislative council myself for many years. You don't remember the days, or maybe you do.
Dr. Benjamin Lowentritt (08:15):
Dr. Stephen Rockower (08:16):
When before even the bills were on the web, where they would messenger out a big stack of paper of all the bills that were to be discussed over the weekend. That was a real pain in the-
Dr. Benjamin Lowentritt (08:31):
Oh, that I did miss.
Dr. Stephen Rockower (08:32):
Yeah, that was a long time ago. Yes, well, you're not missing any of that. So how do the bills from MedChi become bills, and how we advocate certain things? And then we'll see how it goes from there.
Dr. Benjamin Lowentritt (08:53):
Pretty much all of the time when we get the bills they've been scheduled for some sort of hearing. There's already a committee in Annapolis or a subcommittee, usually in Annapolis, that's planning to hear a bill. And what we are asking of ourselves as MedChi is, do we want to take a stance on this bill? Do we want to advocate for it, against it, or essentially make no opinion and take no position, if it's something that we feel for one reason or other we just don't want to stand in front of? So generally those are the choices that we're being asked to make. Do we support, do we take no position, or do we oppose? There are some times where we say we generally support something, but we'd like to see a few changes. So we might support with some suggested amendments.
And then once again, we have our advocacy team and our partners in Steve Wise, and Danna Kauffman, and Pam Kasemeyer, so the group that we have that takes that message and works on the lobbying side. But also we really in general, part of what the function of the legislative council is when we do have passionate voices, we're able to draw on those people to then go testify. Because the most powerful testimony that we can deliver is from ourselves and our colleagues. Our lobbyists are wonderful, but they'll even admit that it's much, much stronger when they have a physician at their side advocating for something that MedChi has an opinion on. We are able to draw from our discussions at the legislative council.
And it's essentially a purely democratic approach. We listen to everybody. Everyone has a chance to have their voice heard. It is required that you be a member of MedChi and a member of the legislative council to vote, but we don't have an exclusive membership. We just ask for people to declare at the beginning of a session that they want to be a member of the legislative council and essentially they can be. So everyone's welcome to contribute even if they're not a member of the legislative council if they're a member of MedChi. And frankly we allow non-members to come in and just encourage them to then become members.
Dr. Stephen Rockower (11:16):
Dr. Benjamin Lowentritt (11:19):
It's an open forum for discussion. It is then a democratic vote. And we take that then to Annapolis and to the subcommittee level, to the committee level if necessary, and on both the House of Delegates and the Senate side.
Dr. Stephen Rockower (11:35):
Have you done testifying yourself?
Dr. Benjamin Lowentritt (11:37):
I have. I actually didn't this year, but I several years was doing it in person, and then in 2021 did some remote testimony. It's really a great experience. What you got to remind yourself of is that we're all just people, including the legislators and including the processes made up of people. To have your voice heard in Maryland, I think, is actually really, really practically available. And that's why I really enjoy state advocacy efforts because you can have your voice heard and you can get out there, meet your delegates, meet delegates from around the state, and quickly get to know the people and have them get to know you, and have an effective voice.
Dr. Stephen Rockower (12:28):
Absolutely. As you always heard me say, it's always helpful to be talking to the delegates outside of session so they know who you are and where you come from. And even if you're not talking about medical issues, if you talk about the traffic light that's needed or with some of the schools in your neighborhood, then when you come back to them with medical issues they know you and trust you.
Dr. Benjamin Lowentritt (12:52):
It's a great point. And I think there's this thought that says that the only thing that speaks to legislators is money. And listen, I won't say that doesn't help, but the truth is just showing up gets you so much credit. Showing up and showing that you care because the only people they hear from are the people that care enough to show up. And I think if you're showing up, like you said, for the other issues, if we then as MedChi need to call on people, it's very helpful for the house of medicine to have well connected physicians that are working with us to be able to draw on those relationships and get our points across. Because in the end, we're just trying to reason with other people.
Dr. Stephen Rockower (13:36):
Absolutely. So you've been the chair of the council. Did you change anything or did you approach it differently than some of the previous chairs?
Dr. Benjamin Lowentritt (13:46):
Well, it's funny because I think the chairs that I watched growing up through the system, of course, were yourself, Dr. Pushkin, and a couple of others. And the interaction and having the co-chairs was really great. I've both been the sole chair and had co-chairs for the past, I think, five years that I've been involved. I do think it's really nice when you have a co-chair. I do think that the entire Zoom transition did force me a little bit or allow me, depending on what I might be truthful, to be a little bit more directed in controlling some of the discussion because when you're in person, there's more ability to gauge the room and there's some crosstalk, but you can bring it out. In the Zoom world, you really have to be organized and somewhat, not dictatorial, but somewhat certainly consistent in trying to get people to state their opinions in the time allowed and then allow for everyone to vote. Because it is technologically, you can't have two people speaking at once, right? You have to stay organized.
So I found myself being a little bit more controlling, for lack of a better word, of just trying to keep us on the tracks. But with that said, no, in the end, I think as I said before, it really allowed for more participation, which was great. And I think that it still was very efficient because we weren't dealing with people eating meals and catching up and dealing with traffic and everything. We were able to start on time and be efficient, and then spend the time discussing the issues at hand.
Dr. Stephen Rockower (15:41):
What have been some of the most memorable discussions you've had?
Dr. Benjamin Lowentritt (15:45):
Well, I think the big discussions where there tends to be unanimity, oftentimes there's not much discussion at the legislative council, right? So big scope issues and tort reform and some of those things, which are very powerful and very meaningful for the society, oftentimes don't have a whole lot of discussion. I think what was interesting during my time is a lot of the marijuana bills came through, and there was a healthy amount of discussion on people getting used to the idea of how that might be entering in as far as the medical use of marijuana. What was interesting is, and I think there were certainly some minority of people that just wanted it to stay illegal, but I think a large part of the voice that was sometimes speaking in opposition to the medical marijuana discussion was, why are we making this medical?
As you know, the medical data, especially when this first was coming along, was fairly limited. It was sort like, and it's interesting kind of nuance here, but to be able to say, we were happy with it being legal, but don't make me the policeman, the broker for it. And I think what was really interesting is we did then get a group within MedChi that rose up that really helped with not just leading us through some of the discussions, but then I think helped with, really did help with forming some of the regulations that led to a responsible way to make this "medical marijuana" and keep that way, where it was not putting physicians in a too awkward of a place to essentially be brokers for other type uses of marijuana. So I think it was a really interesting discussion that evolved over time in how different people approached it. And I thought it was a very healthy discussion and helpful.
Dr. Stephen Rockower (17:57):
Okay, let's take a break now for a few minutes. We're speaking with Dr. Benjamin Lowentritt, a urologist from Baltimore City and Baltimore County.
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Welcome back to MedCast, the podcast from MedChi, the Maryland State Medical Society. We're continuing our discussion with Dr. Benjamin Lowentritt as he discusses the legislative council and things that happen legislatively. So we were discussing the legislative council, and one of the things that grew out of that was the Care First Working Group. Tell us about that.
Dr. Benjamin Lowentritt (19:33):
So in the 2020 legislative session, really on the eve of the legislative session, the advocacy team from Care First, which is the Blue Cross Blue Shield provider for Maryland and the DC and Northern Virginia areas, the biggest private payer and really the dominant private payer in Maryland, presented a bill to the House of Delegates to allow for double sided risk, upside and downside risk arrangements to be created between a private insurer and a physician or physician group.
Dr. Stephen Rockower (20:14):
Okay, explain that a little bit what you mean by upside and downside risk.
Dr. Benjamin Lowentritt (20:18):
Right. So what we talk a lot about value based care, this concept of creating contracts and ways to pay for medicine that aren't just about volume of care, but have some degree of value or other sets of goals that are included in it. And one of the interesting things about Maryland, and we could talk for hours about this separately, is Maryland is already kind of under a global value based care system through Medicare in the all payer system that's regulated by the HSCRC, called the Medicare waiver, which its current manifestation is the global budget for hospitals. So in some respects while the rest of the country has had some other experiments with ways to institute value based care, Maryland has been actually excluded because many of those efforts could potentially come in conflict with the waiver and therefore haven't been applicable. So there have been some nationwide value based care arrangements that we were actually excluded from. Not all of them have been successful, but it in some ways was restrictive, in a way.
There are existing legislation that allowed for some of the federal plans to work through the HSCRC to institute some risk sharing. So this is the idea that if we're able to institute a practice or a type of care that saves money to the system, that a group that is instituting that new type of care could share in some of the savings. And if it's purely upside, which says, "Hey, we're going to institute better home care for our diabetic patients so that they have less episodes where they have to go to the emergency room, and therefore we save money for the system." If we can show that for the patients we take care of we saved a lot of money that we could share in some of that savings from the insurance providers.
What has happened in some respects is that in order to really even more motivate care transformation, so new ways to innovate and try to care for patients beyond a traditional fee for service, there are some instances where providers may want to enter into arrangement that definitely has upside, right, that's sort of the incentive to do it from a financial standpoint, but also has some downside, which theoretically allows the insurer to put more at risk and theoretically have more upside, but also some downside. So if you don't make your marks, if you don't so show savings, then potentially your payments may be reduced. And those can be created in all different types of ways. Maryland was in a unique situation that because of the restrictions that the waiver provided, we had to get a legislative fix if people wanted to do this. And I say we, it really wasn't we. It was the insurance companies that were interested in doing this because in the rest of the country they are doing this.
The opportunity for us at MedChi was because there was this hurdle of needing a legislative fix, we were actually able to negotiate and consider and propose regulations that frankly don't exist in any other state in the country. So it's a little bit more like the wild, wild West in most states where there's very little regulation of the contract between a private payer and say a private group or even a hospital group or the like. Because it has to be disclosed, it has to follow certain guidelines, but the contracts themselves can be written in all different types of ways. The bottom line is in 2020, they proposed something, frankly without giving us much time to make any comment or propose anything in that short term. We actually advocated against the bill in its initial construct with a goal to engage because Care First is a large player in the state and we certainly wanted to try to work with them.
And out of that, the committee chairs that were seeing this basically said, we want y'all to do a working group and said that we want MedChi to sit down with Care First and with the Maryland Hospital Association to try to work out a way to make this a more palatable arrangement to all parties.
Dr. Stephen Rockower (25:24):
And, okay, go ahead.
Dr. Benjamin Lowentritt (25:26):
So that was the 2021 session. And then we essentially got together every two weeks for nine months, starting in the spring of 2021, and worked through a list of probably 15, 20 different key points that all the different parties really put forward. And I was fortunate enough to serve along with David Safferman, a radiologist also who's from Baltimore County, and with Gene Ransom, our executive, and Danna Kauffman, our lobbyist, was present at pretty much all of those meetings at 7:30 in the morning on Tuesdays to get our points discussed and to come to something that we thought we could live with.
In addition, we were having regular meetings with a broader group of MedChi members who had expressed an interest. So we had, probably every one or two months, we had an update for that group so that we could hear concerns and give updates. And through that we were able to get some really key concessions in the final legislation, including capping what the loss could be, what the downside risk could be at 10%. It included some requirements for transparency. It requires a number of different contractual requirements that, frankly, for many people they wouldn't necessarily know to even ask for. When you're getting presented by your largest private payer, it's easy to feel overwhelmed and maybe just say yes. So we were able to put in some legislation to protect those that want to participate.
And almost as importantly, we created a number of boundaries to protect those people that were choosing not to participate. So we don't want this to become mandatory that if you don't participate in this risk group that you somehow have no way to even maintain your regular fee for service arrangements. So I think it was a very successful effort. There certainly was compromise on all sides, but it was a great exercise in what these kinds of efforts can yield. And as it turned out, the bill essentially went through just as we all agreed by the end without any significant resistance in the 2022 session.
Dr. Stephen Rockower (28:06):
Great. And when does it go into effect?
Dr. Benjamin Lowentritt (28:09):
So I believe, that's a great question. I believe it's October 1st, but I'm not a 100% sure. Most of the bills that we agree to go into effect October 1st. I think realistically because contracts are being negotiated all the time, it would be later this year.
Dr. Stephen Rockower (28:25):
Right. And speaking about private physician groups, what about physicians that are employed by hospitals? Do they get to participate in any of this or just through their hospital contract?
Dr. Benjamin Lowentritt (28:42):
Well, there are two answers to that question. There were already some ways that hospital employed groups could participate in different aspects of value based care because of previous regulations and legislation around the Medicare waiver, because those really focus on hospital setting environments. So there were some doctors that could already participate in certain aspects of this. But no, for the most part for those that are employed, they may not be negotiating their own arrangements, but absolutely that's why the Maryland Hospital Association was a vocal part of this is that they employ a large number of physicians in the state. They are able to participate in the same way in contracting.
I do think though, and it is always a point for those of us that are employed by a healthcare entity, that you need to understand how your work is being compensated and how that may impact how your compensation eventually is, right? Because, for instance, if you're in a pure RVU based model, but you're being heavily incentivized to do different kinds of work that may not generate the same types of relative value units, then you need to make sure that you're having that discussion with your employer. Because it really is we're in that phase where sometimes, and it's still going to be a minority of what we do, but more and more is going to be in these kind of alternate framework compensation setups. You want to understand how it impacts you. I think it could be different from every employer.
Dr. Stephen Rockower (30:38):
And I think it's important to point out that MedChi was negotiating on behalf of all physicians of the state, whether they're in private practice or employed. And so everybody wins with this, whether they're members or not. So we would actually prefer that they be members, but we're working for them anyway.
Dr. Benjamin Lowentritt (31:00):
No, it's absolutely the right point. And that working group that we had through MedChi had representation of many different specialties, many different work environments. We really did try to include the voices for as many people as possible. And essentially, as you said, whoever shows up was heard. We can't help those that we don't hear from. So it's a very good point.
Dr. Stephen Rockower (31:29):
Okay, so let's change gears a little bit. What would you be doing if you were not a physician?
Dr. Benjamin Lowentritt (31:35):
Yeah, I think, well, if I could, I'd probably be trying to be a chef. That's my dream if I won the lottery, would practice medicine some and start a small restaurant. That's practical. I love to cook and that would be a real treat.
Dr. Stephen Rockower (31:57):
[inaudible 00:31:57] you can get together with Pushkin and ...
Dr. Benjamin Lowentritt (32:00):
Yes, yes. Well, he lives a great life.
Dr. Stephen Rockower (32:04):
Yeah. Okay, I'm sorry. Go ahead.
Dr. Benjamin Lowentritt (32:08):
No, I do ... it's funny, at one point I was even approached about would I consider working in the political side and running for office. And I don't think I would do that, but I do enjoy helping those that are doing that work on projects. So maybe I would work in some degree in a political fashion. I don't know. But I don't know, I'm glad I don't have to answer that question because I really enjoy medicine.
Dr. Stephen Rockower (32:44):
What's the best advice that you've ever gotten?
Dr. Benjamin Lowentritt (32:46):
Ooh, that's a tough one. Yeah, my father has repeatedly told me, and it's somewhat trite, but has always said, "Continue to stay grounded in your core." Don't forget who you are, essentially, in everything that we do. Because I've been very fortunate to have great opportunities like working in these environments and help lead different groups, and it's easy to go down a path where you're not staying true to your values. So I do regularly try to ground myself and make sure that whatever I'm doing is consistent with my core values. It's a true intentional exercise to do that regularly because it is interesting when you find yourself kind of veering off course.
Dr. Stephen Rockower (33:53):
Yes, I understand. Are you reading or watching anything regularly now?
Dr. Benjamin Lowentritt (33:59):
Yeah. So I during COVID watched all of Breaking Bad and then watched all of Better Call Sal. So I'm now on the last three episodes now. So I'm heavily engaged in that. Yeah, I'm not reading anything interesting right now. When I'm fortunate enough to relax and read it's not high art, for sure. And then with my kids, because I have an eight year old and 11 year old, it's funny, for some reason they've gotten into Star Trek. So we're watching every different Star Trek show, which there are so many of now.
Dr. Stephen Rockower (34:42):
Dr. Benjamin Lowentritt (34:43):
And trying to catch one or two episodes a week here, there with them to have something we can watch together. And that's fun for me. I enjoy it a lot.
Dr. Stephen Rockower (34:56):
And it's interesting, with the recent death of Nichelle Nichols, who was Lieutenant Uhura, she was a real groundbreaker in the television scene.
Dr. Benjamin Lowentritt (35:10):
And it's funny, we haven't gone to the original series yet because I don't know how they would react to that given just the visuals they're used to. But Uhura, there've been two or three other people playing that role in different shows. It's still fun to watch, but I did talk about that with them yesterday.
Dr. Stephen Rockower (35:29):
Okay. And let's end with this one, what advice would you give to your younger self?
Dr. Benjamin Lowentritt (35:38):
I do think ... I'm going to take a moment on that one.
Dr. Stephen Rockower (35:45):
Dr. Benjamin Lowentritt (35:50):
I think I would tell myself to go for it earlier. I think it took me a while to get my feet on the ground with some degree of confidence in really just going for it more for certain opportunities that were out there. I've been very fortunate that I've had many opportunities, but I look back and I wonder, geez, well, what if, a few times, and I definitely held back. I think that I would go to a couple of specific times probably early on in college and just say go for it more. I had a little bit of a shock going from a big fish in a small pond to a small fish in a small pond and didn't react as well as I would want. And I think I would go to myself then and say, "You know what, just go for it, fight through it. You know you can do this." And I would've wanted to end up exactly where I am, but I'm just curious what those experiences would've been.
Dr. Stephen Rockower (37:02):
Okay, well that's wonderful. Well, I want to thank Dr. Benjamin Lowentritt, who has been our guest on MedCast, the podcast from MedChi, the Maryland State Medical Society. Tune in next time as we continue our conversations with the leaders of medicine in Maryland to discuss the issues facing physicians and our patients. For all of us here at MedChi, I'm Dr. Stephen Rockower, thank you and goodbye.