Doctor≠Provider

Dedicated to helping all Physicians fix this mess. And yes, I'm a real MD in private practice. My views are those shared by healers, not providers.

[Ed Gaines @EdGainesIII]

@RepGregMurphy thank you for your outstanding representation of the physician community during your terms in Congress and we wish you all the best in your next endeavors.

The physician advocacy and supporting community will continue to advance your H.R. 4710, The No Surprises Act Enforcement Act, along with your bi-partisan co-sponsors.

https://t.co/wSUR62QArl

[Dutch Rojas @DutchRojas]

Hospitals received an increase for the 29th year in a row while reimbursements for independent physicians has gone down for nearly 20 years.

Hospitals have used the additional payments, not to help their communities, but rather to buy more independent practices.

Then they lobby, successfully, as cash strapped and financially weak facilities.

When will the ruse end?

[Adam Nessim, MD @adam_nessim]

Doctors are about to take a 20% pay cut for doing a procedure the same day they see the patient. They get penalized for helping the patient on the spot.

[Mark Cuban @mcuban]

Forgot to add the moral to the story. If you are the CEO of a self insured employer of any size, REQUIRE , that BEFORE any denial of care by your Third Party Administrator that could negatively impact the health of an employee or their family member, they must report it to the CEO or their designee, to approve or disapprove.

I get that some employers use denials to save money. I'm willing to bet they would rather spend money than answer to a grieving family or the media sitting in their office.

[Mark Cuban @mcuban]

Here is crazy that pretty much every F500 CEO is complicit in

1. They self insure - good thing
2. They hire a third party administrator that is owned by a Too Big To Care insurance company. - Really Bad
3. They allow that TPA to deny care determined by the doctors that the TPA selected to be in network - Horrifically bad
4. They don’t tell the CEOs about the denied care , when it’s their money and ultimately their decision as to whether they should pay for care - more horrific
5. Employees and their families get sicker while the denial is appealed. Again, when the ceo has no clue. Even if the cost to help the patient could a small amount. - insane

Big self insured companies do dumb shit that makes the cost of care in this country far higher than it should be.

It’s not their core competency and they often listen to consultants whose interests are not aligned with theirs.

[Dutch Rojas @DutchRojas]

Physicians keep paying specialty association dues. Apparently, losing requires a subscription.

Hospital ownership? Gutted. Stark and anti-kickback restrictions? Alive and well. Certificate of Need laws? A handful of individual physicians get to spend their own money fighting for permission to compete.

CMS pays a premium to send patients to the most expensive buildings in town while treating the physician’s professional fee like a clerical error it intends to correct downward.

And when Washington comes for physician ownership in ASCs, I’m sure we’ll get another beautifully formatted statement expressing profound concern.

For decades, physicians have funded executive directors, boards, committees, lobbying teams, and annual trips to Washington. Meanwhile, they’ve lost income, ownership, and autonomy.

Then comes the victory lap: We “mitigated some of the more significant concerns.”

Congratulations. They wanted both kidneys. You negotiated one.

At some point, the people collecting dues need to explain why the people paying them keep losing ground. Access to lawmakers is lovely. A photograph with a senator must be thrilling. Neither pays the overhead.

Imagine a surgeon explaining that the operation failed for the twentieth consecutive year, but the relationships in the operating room have never been stronger.

Please renew your membership.

And here come the “to be fair…” comments.

We are at war.
We are losing big time.

[Texas Medical Association @texmed]

TMA President Bradford Holland, MD, congratulates Texas' newly elected leaders. He extends a hand of partnership on behalf of physicians from every corner of the state, who stand ready to work together to tackle the enormous health care challenges facing medicine.

[Tony Lane 🇺🇸 @TonyLaneNV]

“We’re out of time.” Those may be some of the last words heard from the cockpit of the private jet that plunged into a Florida neighborhood Sunday.

Audio circulating online appears to capture the pilots of the Learjet 60 talking with air traffic control before the crash in Greenacres, Palm Beach County. The FAA says nine people were on board, flying from Austin, Texas, to the Bahamas. Instead of a vacation, the jet dropped from cruising altitude almost straight down and exploded into a mobile home park just before 1 p.m. Reports say none of the nine survived. Nine families woke up expecting a trip to paradise, and tonight they’re getting the worst call of their lives. The NTSB is now trying to figure out what went so wrong, so fast.

What do you think could cause a jet to fall out of the sky that quickly?

[Bradford Holland MD MBA FACS @DrBradHolland]

What should be a great treatise against facility fees, and for site-neutral payments is derailed by a terrible headline. “Doctors offices” are not to be blamed, but the hospital systems are. Unfortunately, there are so few health reporters these days, they often miss the forrest for all the trees (and reporters don’t get to write the headline). Independent physicians are immune from this phenomenon that purely happens in health systems. @juliezweil

[Adam Bruggeman, MD @DrBruggeman]

Follow up from today’s post

I looked into the group whose video ad is running in the Root post, and what I found is concerning.

The ad is titled "EXPOSED: Double Billing." Its disclaimer reads "Paid for by Patients for Safe and Affordable Health Insurance."

It is a limited liability company. The only place its legal name appears is the website's privacy policy. There is no named executive director, no board, no staff, no spokesperson, and no press release.

Its listed address is 712 H Street NE, Suite 1403, in Washington, DC. That address belongs to a FedEx and UPS shipping store. "Suite 1403" is a mailbox.

Its website launched in January 2025. The files behind it are hosted on a WordPress network that also hosts campaign pages for Republican candidates. Most of its pages were written by an account called "Web Ops," not by anyone at the group. This isn't a patient organization that hired a web designer. It's a political vendor's product with a patient-sounding name on the front.
In 18 months, its campaigns have covered oncology drug vials, out-of-network doctors, upcoding, hospital facility fees, a state-specific attack on a hospital system in Indiana, and now modifier 25. Every single one targets a doctor or a hospital. Not one targets an insurer. Not one mentions prior authorization, claim denials, or the profits of the companies that sit between patients and their care.

Look at who it lets speak. Its "facts" page cites AHIP, the insurance industry's trade association. Its billing campaign is built on a Blue Cross Blue Shield Association report. Its surprise-billing pages repeat the insurer line that arbitration costs too much and doctors win too often. The op-eds it promotes are written by a former Florida Blue executive, a former chief medical officer of Regence Blue Cross, and a former chief medical officer of AmeriHealth Caritas. Not one practicing physician. Not one patient.

A group that says it speaks for patients, has no patients, no leaders, and no address, and only ever points in one direction is suspicious at best.

Notice the timing. The comment period closed September 14. More than 150 medical organizations told CMS to withdraw this proposal. CMS tried the same cut in 2019 and pulled it. The final rule is due within weeks. Nine influencers and a video ad showed up in exactly that window, with the same talking points, thanking the administration for a rule it hasn't finalized yet. That is a pressure campaign not a public awareness campaign.

Why would an insurer care about a Medicare rule? Commercial plans already fight physicians over modifier 25 claims. Physicians push back because Medicare, the benchmark, pays in full. If CMS cuts it, every commercial contract in the country follows, and the cut stops being something a doctor can appeal. The savings won’t ever go to seniors. They will go to the plans and their shareholders.

Who funds this and why are we hearing from a mailbox instead of a person?

If you want to argue that Medicare should pay less for same-day services, make that argument. Put your name on it. Publish your data. Tell us who you work for. Defend it in the comment period and in the open.

What you shouldn't do is fund a video from a mailbox, pay nine accounts to run the same script, and call it a grassroots movement.

Patients do deserve transparency. That starts with knowing who is talking to them.

[Bradford Holland MD MBA FACS @DrBradHolland]

No reasonable person would ever conclude that any doctor visit which could accomplish two things on the same day should be unnecessarily split into 2 separate visits in the name of efficiency and monetary savings. @CMSGov needs to keep the 25-modifier. And we need to find out who’s behind this very odd PR campaign of misinformation. @DrOz

[Bradford Holland MD MBA FACS @DrBradHolland]

Attention Plumbers—you have been over-billing if you charge for the house call/consult/diagnostic work up and parts order, AND if you charge for the repair. And you should (by law) not do all that on the same day!

Apparently that’s not allowed in medicine (but it sure is allowed in the plumbing world—as it should be).

Billing for the consult and assessment and taking everything into account before doing the procedure should be paid separately from the procedure and should be paid at 100%— even if done the same day.

Whoever says otherwise is selling snake oil (or they are a comedian trying to be funny).

[Bradford Holland MD MBA FACS @DrBradHolland]

This is probably the most misguided and erroneous tweet I’ve seen in 2026.

Ending the 25-modifier will be a great INEFFICIENCY for patients and physicians (and patient families who have to takeoff to bring grandma into the doctor) and will not save money, there’s absolutely no data or even a suggestion that it will.

If @DrOz lets this change go through, I believe it will be one of the most demoralizing policy change
we’ve seen hit healthcare in the last 15 years.

We need to keep the 25-modifier and CMS needs to reject that proposed 2027 change.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Chef opens a restaurant. People really like it. He books out reservations for 3 months.

But now people are upset there’s a 3 month wait to go to the restaurant.

Then, the government decides to put price caps at how much he can charge customers. He still needs to pay overhead and staff and ingredients, though.

So he decides he needs to serve more customers to cover his costs. So he shortens the allowable time for meals. Of course, now the customers aren’t happy about having to rush through their meals. Many of them insist on eating at a leisurely pace, or they send their food back because they didn’t like it, or they show up late for their reservation and insist on being seated anyway.

Meanwhile, the chef is trying to keep up. He feels bad he can’t put the same attention into each meal he did before. But if he doesn’t serve enough people in a day, he will have to close down (or sell to the large restaurant conglomerate down the street).

Oh, and the government also decides that he now needs to do two hours of computer work for every hour he spends cooking. They force him to use a terrible, but expensive, computer system, too, not the one he wanted. So he needs to serve even more customers to cover those costs as well.

The customers are rightly upset. They’re waiting longer and getting less personalized service. The chef is also upset that he’s spending more on overhead but delivering worse meals.

Nobody is happy here.

[Heath Veuleman @HeathVeuleman]

Your bill specifically excludes the largest employer of physicians: not-for-profits hospitals and health systems.

[Adam Bruggeman, MD @DrBruggeman]

The problem:

1) Hospitals (and first insurers) were allowed to massively consolidate

2) Consolidation never led to the promised/projected efficiencies and lower costs. The opposite occurred

3) Doctors avoided consolidation until late, leading insurers and the government to dramatically reduce payments driving them to consolidate underneath the protected insurers and hospitals

The result:

Costs are up and access is dropping. Insurance is not healthcare and may not be worth more than the paper it is written on for most insured patients.

[Bradford Holland MD MBA FACS @DrBradHolland]

Please @SenBillCassidy I implore you to make a last stand for your physician colleagues and for every rural patient who has to drive a long ways for physician appointments—do not allow the proposed changes to the 25-modifier to take effect. This is life and death for so many practices. Please.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Imagine a chef employed at a restaurant that charges $100 for a hamburger.

One day he gets sick of his institution ripping off customers, so he goes across the street and opens a shop with $5 hamburgers.

Now the hamburger loving people are better off. Competition drives down prices and increases quality.

The original restaurant, angry over the lost business, gets a law passed that bans chefs from owning restaurants.

Everyone would recognize this as a corrupt, protectionist law.

And yet, in healthcare, with skyrocketing costs, we still outlaw physician owned hospitals.

[Eric Topol @EricTopol]

The 3 reasons why AI won't reduce clinician jobs:
—Jevon's paradox (more efficiency, more use)
—"Lump of labor" fallacy (the type of work changes)
—Tasks ≠ Skills
@NEJM @DhruvKhullar
https://t.co/vSWgGlmbYS

[Texas Medical Association @texmed]

In a component of the proposed 2027 Medicare physician fee schedule Texas physicians are decrying as particularly disturbing from a patient care standpoint, the Centers for Medicare & Medicaid Services (CMS) proposes to slash doctors' payment when they bill an office/outpatient evaluation and management (E/M) service using Modifier 25 on the same day as certain global procedures. TMA President Bradford W. Holland, MD, explains how this cut represents a double whammy for patients' access to care and physician practice viability.