not the real Chris Stanton

i do EP and other things. recovering mayo IM, CV, EP fellow. don’t take my advice. Sioux Falls EP.

[not the real Chris Stanton @cmstanton75]

Trying to get to sleep at a reasonable hour when sun doesn’t set until 11pm

[Ali Carine, DO @Dr_Ali_Carine]

There is a lot of detail here, but let me Summarize it this way; in 1997, they decided to “balance the budget” into the future on the backs of physicians by FREEZING our reimbursement. Not any other Medicare cost, only physician reimbursement. So according to the law passed, we are frozen in 1997 unless some emergency “doctor fix” happens on a regular cycle. And congress has decided this is acceptable. Now….they want to tell patients to come back on a second day everytime we need to do a procedure because a visit and a procedure can’t be done on the same day. Patients pay attention, as you walk the halls of the beautiful hospital and wonder why you are so dissatisfied with the care the physician team provides, remember who is getting paid well and who is not. Think back to pre-1997, when I applied to med school. The brightest minds applied, it was very hard to be accepted. If you talk to college kids, they know…….the brightest minds are in engineering or science fields….but not medicine. We all suffer when our physicians are paid poorly.

[Dutch Rojas @DutchRojas]

HHS has roughly 72,000 employees today.

My efficiency plan:

Step 1: Fire them all.

Step 2: Hire back the 5% you immediately miss.

Congratulations, you’ve just found the org chart.

[Heath Veuleman @HeathVeuleman]

Chris is most likely correct - hospitals will cut clinical services long before administrative bloat. Data shows it and AHA/FAH have warned everyone for years. @CMS can inoculate this by 1) capping admin spend via cost report allowables and 2) requiring any clinical cuts to be exceeded 1.5× by admin reductions vs. the prior cost report. Target the real waste.

Of course, if you are enraged that (mostly) not-for-profit hospitals are extorting you while spending billions of dollars a year in stadium naming rights, private jets, outrageous executive compensation, then you’re not alone.

They will - 100% - limit your care before they will reduce the obscene administrative spend.

[not the real Chris Stanton @cmstanton75]

@AnasNomanMD Wash your hands brother

[not the real Chris Stanton @cmstanton75]

@coleleiter Truly shocking as I thought FIFA was totally legitimate

[George Tolis @georgetolisjr]

The number of senior surgeons who feel that their leaders are substandard doctors and their societies serve self promotion rather than advancement of the field is staggering. What is even more scary is their fear of professional retaliation should they make their thoughts public.

[Ben Dreyfuss @bendreyfuss]

All these people are like “wow fifa letting the American player play means the whole thing is corrupt”

Well, sure, obviously the whole thing is corrupt. Congratulations, detective.

[not the real Chris Stanton @cmstanton75]

@clintonyates Too impossible to be a coincidence!

[Dutch Rojas @DutchRojas]

We had affordable catastrophic coverage until Democrats outlawed it!

Before 2010 a $150 plan would protect you from cancer, a car wreck, or financial ruin.

I have this feeling that every single American would have been happy with $150 a month catastrophic premium.

[Noah Kaufman, MD @noahkaufmanmd]

These are not small community hospitals trying to survive on 3% margins in a county with no obstetrics, no ICU, no surgeon, and a payer mix that is mostly Medicare/Medicaid.

They are:

tax-exempt nonprofit systems

with billion-dollar revenue

large endowments/investment portfolios in many cases

major lobbying capacity

elite legal/compliance departments

pricing power against insurers

340B arbitrage potential

massive executive compensation structures

regional acquisition machines

And then they can still claim “rural” status for certain Medicare purposes.

That is the pathology of American healthcare in miniature: a rule ostensibly designed to protect fragile access gets optimized by the entities with the most lawyers.

The best critique is not “they broke the law.” It is worse than that:

They appear to be using the law exactly as written, which reveals how corrupted and gameable the law has become.

The Health Affairs/Johns Hopkins findings are damning: urban hospitals with dual urban/rural Medicare status went from 3 in 2017 to 425 in 2023, with about three-quarters being nonprofits, and the top examples include NewYork-Presbyterian, Cleveland Clinic, AdventHealth Orlando, UCSF, and Cedars-Sinai.

And HealthLeaders reported that in 2023, these dual-classified urban hospitals accounted for 61% of all beds in Medicare-designated rural hospitals. That is insane from a policy-design standpoint.

[Dutch Rojas @DutchRojas]

In 2010, one sentence in the Affordable Care Act made it illegal for doctors to build new hospitals.

Not regulated.
Banned.
Out of Medicare entirely.
No sunset, no review.

300+ physician-owned hospitals existed before the ban.

Of the ones that died, a third were bought by the same systems that wrote the ban.

They called it patient protection.
Tell me again who got protected.

[National Board of Physicians and Surgeons @InfoNbpas]

As conversations around physician burnout and certification reform continue to grow, this podcast discussion from last year remains just as relevant today.

Karen Schatten, Associate Director of NBPAS, shares perspectives on continuous board certification, physician advocacy, and reducing unnecessary administrative burden in medicine.

🎧 Listen here: https://t.co/Ksho3cWzdn

[Westby Fisher, MD @doctorwes]

Just look at the trajectory of their earnings on their latest tax filing and be prepared to puke.

[Westby Fisher, MD @doctorwes]

I will never support an org that promotes self interest over US docs and their patients. Those that work for these orgs are sycophants of our broken health care system and suck the soul out of the profession of medicine. MOC discriminates against younger, vulnerable docs. End MOC

[Dutch Rojas @DutchRojas]

State Attorneys General have started suing hospital systems for anti-competitive behavior.

Indiana sued a system last year for blocking patients from accessing independent imaging.

North Carolina is investigating exclusive contracting practices.

Texas is reviewing 340B abuse.

The AHA's legal strategy assumed federal capture was permanent. It overlooked the states.

The cartel cracks at the state level first.
It always does.

[Dutch Rojas @DutchRojas]

Physician-owned hospitals are banned unless they were grandfathered under Section 6001 of the ACA.

Even the grandfathered ones are largely handcuffed from expansion.

People say, "Doctors can still build without Medicare or Medicaid."

Fine.

In a market dominated by Medicare and Medicaid, that is like telling a restaurant it can open as long as it refuses most customers.

CMS helped freeze supply.

Then everyone acts confused about prices.

Create real-time pricing.
Let supply respond.
Let physicians own facilities.
Let buyers see the market.

That is called price discovery.
Healthcare might try it someday.

[Dutch Rojas @DutchRojas]

Physician-owned hospitals are “conflicts of interest.”

Health systems employing every primary care doctor in a zip code is “integrated care.”

Amazing branding department.

[Dutch Rojas @DutchRojas]

Congress banned new physician-owned hospitals to protect patients from lower infection rates, lower prices, better outcomes, and doctors who answer the phone.

[not the real Chris Stanton @cmstanton75]

Maybe make it worth it

[Congressman Greg Murphy, M.D. @RepGregMurphy]

Unless our Medical Schools do a better job of screening admission candidates, we won’t have any Doctors. If you don’t want to practice FULL time for at least 20-25 years, pick another profession.

[Dutch Rojas @DutchRojas]

The public is trained to hear “hospital closing” and assume virtue.

Poor patients.
Bad reimbursement.
Heroic administrators.
Cruel politicians.

Sometimes true.
Often incomplete.

The harder truth is that the majority of hospitals are fragile because they have no real financial architecture, no coherent strategy, no physician alignment, and no one inside the building who knows how to run it.

That is fixable.
But not by pretending every failing institution is well-run.