Delaware Health Care Reality

Episode 25: The Truth About Corticosteroid Injections: Myths, Science, and Solutions

Think you know everything about corticosteroid injections? Think again. Join host Nicholas O. Biasotto, DO and renowned Orthopaedic surgeon Michael J. Axe, MD as they bust long-standing myths, break down the science, and reveal what’s really happening inside the joint. From the truth about cartilage damage and steroid limits to the surprising effects on diabetic patients—not all injections are created equal. Wet joint vs. dry joint, Bupivacaine vs. Lidocaine, inflammation research, and why physical therapy must follow—don’t miss this eye-opening episode!

Episode 24: Inside MedNet: Delaware’s Trusted Network for Independent Practices

Join host Nicholas O. Biasotto, DO for an insightful conversation with Michael J. Bradley, DO, Past President of the AMA State Medical Society and the Medical Society of Delaware, and Lori Ann Rhoads, CMPE, Director of Health System Innovation at MSD. 
They discuss Medical Network Management Services of Delaware, LLC (MedNet)—a subsidiary of the Medical Society of Delaware, a physician-owned and led organization supporting over 1,300 clinicians across Delaware. Since 1996, MedNet has helped independent practices thrive in a changing health care landscape, offering:
Higher reimbursements through fee-for-service contracts
Support for value-based care, quality metrics, and care coordination
Credentialing and insurance issue resolution
Shared savings programs—with over $3 million returned to primary care
We explore MedNet’s collaboration with the Delaware Health Information Network (DHIN), efforts to close care gaps and improve outcomes. Tune in to learn whether there’s been any real progress with Primary Care Reform in Delaware.
Why MedNet? Because it's trusted, physician-led, and built for the future of independent practice in Delaware. Let’s get into it!

Episode 23: The Broken Health Care System

In this powerful three-part podcast special, host Nicholas O. Biasotto, DO, takes listeners on a deep dive into the systemic flaws crippling American health care. From the vanishing number of primary care physicians and the mounting burdens that push them out, to the complex—and often opaque—ways hospitals and insurance companies generate revenue, this episode pulls back the curtain on a system in crisis.
Dr. Biasotto unpacks the forces behind physician burnout, the hospital profit machine, and how insurance companies are impacting both patients and physicians. With real-world examples, emerging legislative efforts, and potential paths forward, this is a must-listen for anyone who has ever felt frustrated or confused by our health care system.
If this conversation resonates with you, share your thoughts and stories with us at healthcare.reality@medsocdel.org.

Episode 22: Beyond the Silos: Why Physicians Are Unionizing for Change

Join host Nicholas O. Biasotto, DO, with two special guests from ChristianaCare: Bryan Haimes, MD, MPH, Internal Medicine Hospitalist and Pediatrician and Amber Higgins, MD, Emergency Medicine and Obstetrics and Gynecology physician: Together they played a pivotal role in forming the first and largest private attending, multi-specialty physicians union in the country.
In this episode, we explore what led to this historic move — from overcrowded emergency rooms and long wait times for inpatient beds to top-down decision-making that left physicians feeling unheard. We’ll also touch on the American Medical Association’s stance on unionization.
What does collective bargaining look like in medicine? What happens when negotiations stall? You’ll learn about key terms like “Bad Faith Bargaining” and the “Union Security Clause”, and how unionization is being used as a strategy to unify physician voices and advocate for change. — ultimately aimed at improving the physician workforce and delivering better patient care.  This is an eye-opening conversation you won’t want to miss.  Let’s get into it!

Episode 21: LET'S GET REAL ABOUT POTS (Postural Orthostatic Tachycardia Syndrome)

Joining host Nicholas O. Biasotto, DO is special guest Ronald L. Lewis, DO, FACC, FACOI a Board-Certified Cardiologist, at ChristianaCare. We’re diving deep into a complex and often misunderstood condition affecting millions of Americans: Postural Orthostatic Tachycardia Syndrome, or POTS - a complex condition that affects 1 in 500 Americans, primarily women, and often goes undiagnosed.
What you’ll learn:
Is POTS a heart issue—or something else?
Can autoimmune diseases trigger it?
What symptoms should raise red flags?
What must be ruled out first?
Available treatments?
Dr. Lewis explains how autonomic dysfunction drives symptoms like rapid heart rate, breathing difficulties, and regulation issues—and what patients and clinicians need to know.
A clear, compelling look at a misunderstood syndrome—only on Delaware Health Care Reality.

Episode 20: The Future is Here: Regenerative Medicine & PRP Therapy

Join host Nicholas Biasotto, DO and special guest Joseph Straight, MD, Director of Primary Care Sports Medicine, First State Orthopaedics, and Medical Society of Delaware Past President, as they dive into the cutting-edge world of Regenerative Medicine, focusing on the powerful potential of Platelet-Rich Plasma (PRP) Therapy. From healing wounds and easing chronic pain to rejuvenating skin and restoring hair, PRP is transforming care across fields—including veterinary medicine. Already embraced around the globe, this innovative treatment is gaining momentum in the U.S. Hear why Dr. Straight says: “It’s the future.”

Episode 19: The Real Issues in Health Care!

In this episode, host Nicholas O. Biasotto, DO, and Mark B. Thompson, MHSA, Executive Director, Medical Society of Delaware, sit down to discuss the incredible momentum of the podcast and preview what’s ahead, including deep dives into POTS Syndrome and Regenerative Medicine—topics shaping the future of patient care.
Beyond the podcast, today’s conversation tackles some of the biggest issues in health care:
🔹 Prior-Authorization and its role in delaying critical patient care
🔹 Primary Care Reform Efforts and what it means for physicians and patients
🔹 Unionization & Collective Bargaining in health care
🔹 The rising cost of care in the U.S. and why Delaware is at the center of the conversation
Join us for a thought-provoking discussion on the forces driving health care challenges—and what’s being done to address them.

Episode 18 - Medical Aid in Dying: Insights From Both Sides of the Stethoscope

What does it mean to make compassionate, informed choices at the end of life? In this powerful episode of Delaware Health Care Reality, host Nicholas Biasotto, Do, welcomes two distinguished guests to explore one of the most complex and emotional health care topics. Joining the conversation are Robert Varipapa, MD, specializing in Neurology and Sleep Medicine, advocating in favor, and Michael Vest, MD, Associate Professor of Medicine, Sidney Kimmel Medical College, specializing in Critical Care Medicine, presenting concerns against legalization.  They explore end-of-life decisions, patient autonomy, and Delaware's proposed legislation that could make it the 12th state to legalize this option.
Examine key considerations such as palliative care, hospice support, and mental health resources. Hear insights on data from Oregon's long-standing Medical Aid in Dying law, where patients have reported choosing this option due to concerns like the cost of medical care and feeling like a burden on loved ones.  What safeguards exist to prevent a "slippery slope" from impacting vulnerable populations?
Tune in for an insightful discussion on patient rights, physician roles, and the ethical questions that shape this deeply personal and evolving topic.

Episode 17: Navigating Senior Care: It Takes a Village!

Nursing homes are expensive, and in-home care isn’t always affordable. So how can families help their loved ones age in place? Join host Nicholas Biasotto, DO who sits down with Frank DeMarinis, founder of Senior Advisors of Delaware, LLC. With decades of experience in nursing homes and assisted living, Frank and his team are on a mission to help seniors stay at home through valuable services offered, available resources and nonprofit support. Tune in to learn about Miller Trusts, Conditional Medicaid, Health Care Proxies, and what federal and state programs might be available to help. Because when it comes to senior care, it takes a village!

Episode 16: Shaping the Future of Medicine

Join host Nicholas Biasotto, DO, for an insightful conversation with Bhavin Dave, MD, the 179th President of the Medical Society of Delaware. Dr. Dave, a Board-Certified specialist in Internal Medicine and Gastroenterology, shares his forward-thinking vision for the future of medicine and health care. From ensuring cost-effective care and addressing the environmental impacts on medicine to the transformative role of artificial intelligence and legislative changes shaping the field, this episode dives deep into the pressing issues of today. Explore his perspectives on primary care reform, cost standardization for testing, prior-authorization challenges, and the potential of a one-party payer system to revolutionize health care delivery. Don’t miss this engaging discussion packed with thought-provoking ideas and actionable insights!