Ananth Eleswarapu

Spine surgeon and lifelong learner.

[Ananth Eleswarapu @ananthe2]

@Davembmd I hear this argument frequently made against standardization but how much variation is true innovation? Most is just sloppiness, greediness, lack of belief in EBM etc.

A truly experimental procedure should be done under an IRB and have the results tracked and published.

[Ananth Eleswarapu @ananthe2]

@joshuapliu I think subscription-based models will look obvious in retrospect. DPC just the tip of the iceberg.

[Ananth Eleswarapu @ananthe2]

@LocasaleLab This is also obviously false in surgery. There are individual surgeons in each subspecialty that can cure disabilities, save lives etc that no one else can. Market does not yet have a way to reward this but it is among the most valuable skills on earth.

[Ananth Eleswarapu @ananthe2]

@SebastianCaliri Is there opposition to these legislation changes? Or just slowness of our legislative system?

[Ananth Eleswarapu @ananthe2]

@seanluomdphd @SurgeryCenterOK What do you mean by sue more? Who would they sue?

[Ananth Eleswarapu @ananthe2]

@SurgeryCenterOK A lot of jobs nowadays are employed non-academic. All of the downsides of private practice - pressure to be "productive", need to build your own referrals - with none of the autonomy or financial upside. And no meaningful research or teaching on involvement.

[Ananth Eleswarapu @ananthe2]

@nikillinit What qualifies something as integrative though? If it is well supported by evidence it just becomes normal medical care

[Ananth Eleswarapu @ananthe2]

@SethBorman @KelseyTuoc @ZachWritesStuff Yes patients can pay cash but most wouldn't want to for a covered service if they've already paid insurance premiums. Many imaging facilities will not schedule without auth as well.

[Ananth Eleswarapu @ananthe2]

@KelseyTuoc @ZachWritesStuff Most patients in the United States have to wait to get an MRI though. Insurance companies usually require a 6 week exercise program prior to MRI. And when that's completed and documented you then need to apply for prior auth. 9 weeks would be typical here.

[Ananth Eleswarapu @ananthe2]

@jasonryanmd We should teach logic, statistics and the interpretation of clinical literature

[Ananth Eleswarapu @ananthe2]

@DrDiGiorgio Don't they make higher margins on non-insurance products? Maybe insurance is a loss leader for things like PBM, data analytics products, utilization review services etc

[Ananth Eleswarapu @ananthe2]

@nikillinit Why price setting?

[Ananth Eleswarapu @ananthe2]

@mcuban @BradSpellberg How do you know this to be true? There are reasons a hospital would accept Medicaid even at a negative contribution margin.

[Ananth Eleswarapu @ananthe2]

@SebastianCaliri Couldn't agree more.

[Ananth Eleswarapu @ananthe2]

@dvasishtha I actually don't see why your PCP couldn't fix this for you.

A big problem is that the EMR is built as a structured database which may not be necessary anymore now that we have LLMs that can understand unstructured text.

[Ananth Eleswarapu @ananthe2]

@dvasishtha There is no significant liability in correcting an error in the chart. There could even be liability in leaving it there, if a patient received a suboptimal antibiotic for an infection due to an allergy history everyone knew was false...

[Ananth Eleswarapu @ananthe2]

@f3nring @s0ymalia @MostlyMonkey As far as how many people start surgical residencies and then end up doing something else, I've never seen official statistics but anecdotally I'd say its more than people think. Maybe half the gen surg residents from my intern year ended up doing something else.

[Ananth Eleswarapu @ananthe2]

@f3nring @s0ymalia @MostlyMonkey I'm not an expert in law but I don't think stepping off the partnership track is necessarily failing out. A lot of people leave to do lucrative rewarding things elsewhere (like being in house counsel at a tech company)...

[Ananth Eleswarapu @ananthe2]

@s0ymalia @MostlyMonkey Its hard to get a second job though without a good reference from your first.

Ironically the people who leave and do something else often end up happier and richer than most surgeons.

[Ananth Eleswarapu @ananthe2]

@s0ymalia @MostlyMonkey This may be true for non-surgical specialties. Its definitely not true for surgery. I know several people that were politely advised to stop operating by colleagues. I suppose if you completely lack self awareness you could try moving to another town and starting over...