Sera

Doctor of Internal Medicine. Private practice.

[Tyler Olson, EA @olsonplanner]

While all the doctors debate the merits of making the unpaid med students work overnight shifts, the admins work 9 to 5 and make more money than the pediatricians.

[Dutch Rojas @DutchRojas]

For years, physicians have stood by while CMS and the health system lobby crippled private practice.

But now that RFK Jr. is making noise about healthcare, suddenly some of you have opinions?

Where was this outrage during the last five HHS secretaries who bent over backward for corporate medicine?

Stop the simpleton complaints and start using RFK Jr. to push real policy change.

1. End the Moratorium on Physician-Owned Hospitals.

Health systems lobbied CMS to block competition by banning POH expansion.

It was never about “patient safety”, it was always about protecting their health system monopoly-grift.

If RFK Jr. wants to fight corruption, get him to attack this head-on.

2. Cut Facility Fees & Increase Physician Payments.

Health systems get paid multiples more for the same procedures.

This scam is driving up costs, bankrupting independent physicians, and padding their profits.

Push RFK Jr. to end the facility fee loophole and shift payments back to physicians.

Physicians must stop playing defense and start setting the agenda.

If RFK Jr. is serious about fighting healthcare corruption, make him prove it.

The biggest threat to the success of physicians isn’t him—it’s the cartel of health systems and insurers rigging the game.

Start working with him.
Use him as a weapon against CMS.

Or keep complaining while health systems and carriers keep winning.

#healthcare

@waysandmeans
@GOPDoctors
@SecKennedy
@cmsgov

[Alex Balekian, MD @AlexBalekian]

How do you define abject failure?

In-N-Out Burgers, a quintessentially Californian institution that is still family-owned, is relocating its corporate offices to Tennessee.

There are no In-N-Out locations in Tennessee.

This move was not driven by a desire to be close to the brick and mortar stores. The original (and soon to be downsized) corporate headquarters are in Baldwin Park, one mile away from the first In-N-Out.

This move was instead forced by the anti-business climate created by far-left progressive politicians who espouse socialist mediocrity over entrepreneurial ingenuity.

Wake up, moderate Democrats. You need to wrest the pendulum from your far-left comrades, and you cannot do it without outside help.

And pay attention, moderate Republicans. The Golden State is up for grabs again, and we cannot let the socially-conservative wing of the party commandeer the messaging from the fiscally-conservative wing.

Keep the messaging simple:
Focus on public safety.
Stay out of my bank account.
Stay out of my personal decisions.

@CAGOP @GOPLosAngeles @CorrinRankin

[Dutch Rojas @DutchRojas]

I asked ChatGPT:

If I were the devil and wanted to systematically destroy independent medical practice, how would you do it?

ChatGPT:

I would take a multi-pronged approach that slowly erodes physicians’ autonomy, financial viability, and ability to compete.

Here’s the blueprint:

1. Regulatory Capture & Bureaucratic Strangulation

•Certificate of Need (CON) Laws: Ensure that new physician-owned facilities—surgical centers, hospitals, imaging centers—are nearly impossible to open by requiring government permission, which will conveniently favor large hospital systems.

•Site-of-Service Payment Disparities: Manipulate CMS and insurance payment structures so that hospitals receive 3-5x the reimbursement for the same service that independent physicians provide, making it financially untenable for them to stay independent.

•Increased Administrative Burdens: Require excessive documentation (MIPS, MACRA, prior authorizations, etc.) that siphons time away from patient care and makes it impossible for small practices to function without selling out to larger entities.

2. Insurance & Payer Monopoly Control

•Eliminate Fee-for-Service: Force physicians into risk-based contracting where they assume financial liability for patient outcomes while insurance companies collect premiums with zero risk.
•Narrow Networks: Make it difficult for independent physicians to get into insurance networks, while ensuring hospital-employed physicians are always covered.

•Ban Direct Contracting & Cash Pay: Push for regulations that prohibit physicians from opting out of Medicare/Medicaid and limit their ability to offer cash pricing or direct employer contracting.

3. Debt & Financial Manipulation

•Medical School Debt Trap: Ensure new physicians graduate with $300K+ in debt, making them dependent on high-paying hospital jobs.

•Reimbursement Cuts & Inflation: Keep physician reimbursement stagnant while inflation erodes their real income. Meanwhile, keep hospital and insurance executive salaries skyrocketing.

•Malpractice & Compliance Costs: Drive up liability insurance and compliance costs, making independent practice too expensive to sustain.

4. Big Tech & EMR Entrapment

•Force EMR Adoption with High Costs: Ensure all practices must adopt bloated, expensive EMRs that are cumbersome and designed for bureaucratic billing rather than patient care.

•Restrict Data Ownership: Ensure hospital systems and insurance companies control patient data so that independent physicians are at a disadvantage in managing population health or transitioning between systems.

5. Cultural Warfare & Public Perception Manipulation

•Demonize Private Practice: Run a media campaign suggesting that private practice physicians are “greedy” while hospital-employed doctors are “team players” who put patients first.

•Use Burnout as a Weapon: Overwork and overburden physicians while portraying burnout as an individual failure rather than a systemic problem caused by monopolization and bureaucracy.

•Encourage Mid-Level Creep: Expand scope of practice for non-physician practitioners (NPs, PAs) while cutting physician reimbursement, making them cheaper alternatives and devaluing medical training.

6. Legal & Legislative Warfare

•Strengthen Stark & Anti-Kickback Laws: Make it illegal for independent physicians to band together to compete with health systems while exempting hospitals and insurers from the same restrictions.

•Ban Physician-Owned Hospitals: Ensure hospitals are owned only by corporate entities, which can then consolidate power and eliminate competition.

•No Surprises Act Weaponization: Craft laws that appear patient-friendly but actually benefit insurers by shifting financial power away from independent physicians and toward insurance companies.

7. Corporate Takeover & Consolidation

•Private Equity Buyouts: Encourage venture capitalists and PE firms to buy up independent practices, squeeze profits for a few years, and then dump them into hospital systems or insurers.

•Encourage Hospital Employment: Make hospital employment seem like the only viable option by cutting physician reimbursement in private practice while increasing it for hospital-employed doctors.

•Create Dependence on Large Systems: Ensure that independent practices can’t survive without being a part of hospital networks, whether for referrals, technology, or payer negotiations.

The Endgame

Within a generation, independent practice would be a relic of the past. Physicians would be reduced to shift workers for hospital systems, insurers, and private equity-backed MSOs, stripped of autonomy, forced to comply with bureaucratic nonsense, and unable to directly serve patients or compete in a fair market.

The good news?
Physicians can fight back. Price transparency, direct contracting, captive insurance, coalitions, and independent alliances are all weapons to counteract this systematic destruction. But they must act before the devil’s plan is fully realized.

[Sera @docsera]

@RepGregMurphy @GmOrr9000 Doctors are tired of this system. We can no longer practice medicine. We have to dance around insurance”exclusions” PBMs, HMO rules. This is why people no longer want this job.

[Sera @docsera]

@RepGregMurphy @GmOrr9000 How about you MANDATE insurance companies pay doctors properly? Adjust pay to inflation and cost of living? Surely they charge patients more each year in premiums. MANDATE less red tape. Remove prior authorizations for commercial insurance like Medicare.

[John Mannisi MD 🇺🇸🇮🇹���️‍🩹🏃 @JMannisi]

@RepGregMurphy @GmOrr9000 What are you talking about. Many medical students graduate with $500,000 of student debt! You have abandoned your profession which you apparently now loath. Physicians have been corporatized. Restore private practice. That is your challenge.

[🕊MaeSun @MaeSunMD]

@RepGregMurphy @GmOrr9000 Does the federal government pay med school tuition or just sell loans to vulnerable med students at astronomical rates and then sell that debt to "loan servicers?" Help me understand because I always thought it was me that had to pay back my medical school loans.

[Humane Healthcare for All @LighthouseDPC]

We don’t have a Physician Shortage. We have a Physician TIME Shortage. Obamacare forced Doctors to use EMRs instead of paper charts GREATLY decreasing efficiency. Now over 50% of Physician’s TIME is spent on Administrative tasks, what used to be done by Health Insurance Companies. Physicians didn’t sacrifice 7 years of their lives to be secretaries for your health insurance company. You pay for this with shorter visits and longer wait times. #healthcare #business #corrupt #fraud

[Adam Bruggeman, MD @DrBruggeman]

These are the words of a former Cigna employee. This is criminal. Literally criminal.

[Ken Klippenstein @kenklippenstein]

Luigi Mangione Judge Married to Former Healthcare Executive
https://t.co/Oas7SVxHQb

[Third_Eye_Prophet @Third_i_Prophet]

A media blitz has been going on to demonize Doctor salaries. It's obviously funded by the Healthcare-Pharma Complex, to deflect blame onto Doctors for high Healthcare costs.

It is the worst kind of gaslighting against doctors, because the exact opposite situation is true.

First, doctor pay is 6-9% of all Healthcare costs, so even if they worked for free, it would hardly put a dent in Healthcare spending.

Second, many young doctors may not realize this, but Congress froze Medicare payments to doctors in 1997, and real salary adjusted for inflation decreased 80% since then!

Medicare work-RVU payment-
2000: $36.69
2024: $33.29
Inflation since 2000: 70%

Meanwhile, hospital payments and insurance premiums have OUTPACED INFLATION since 2000. That is where the problem lies.

People will argue that doctors are paid more in the US, but so is every other profession- law, finance, tech, nursing, etc.

Average nurse salary-
USA: $82,750
Germany: $33,000

Also, the US has fewer doctors per capita than Europe, resulting in more office visits and procedures per doctor.

And US doctors have on average $227,000 in debt compared to none in Europe. If you just invested that money in the S&P at it's historical return of 10.26% for 45 years, adjusting for inflation, you get $22.97 Million. That is the opportunity cost of becoming a doctor in America.

Anyone blaming doctor pay, which is down 80% the past 25 years, for our high healthcare costs, needs to read this thread and face the facts.

[Sera @docsera]

@ks_94 @DrPlantel Amen

[Vidu Yarlagadda, MD 🇺🇸 @VKwhy]

@txsalth2o Meanwhile, this…

[Third_Eye_Prophet @Third_i_Prophet]

@txsalth2o https://t.co/QNlP2TR9nL

This thread shows how absurd it is to demonize doctor pay as a cause of increasing healthcare costs.

Medicare work-RVU payments-
2000: $36.69
2024: $33.29

And inflation since then is 70%!

[Sera @docsera]

@ks_94 @DrPlantel Oh most definitely. I live that way myself. Lift weights, prioritize protein, sleep. Lifestyle first always. The thing is, most people (patients) want a quick fix. I can preach lifestyle all day long, but I can’t hold their hands to the gym, to the dinner table, and to sleep.

[Ken Klippenstein @kenklippenstein]

"There's no value in engaging with the media," United Health CEO tells employees in internal video leaked to me.

Watch the full video here: https://t.co/ySDtxk6gN6

[Ken Klippenstein @kenklippenstein]

United CEO Andrew Witty gave an address to the company today (video leaked to me). Some highlights:
- "we guard against the pressures that exist for unsafe care or for unnecessary care."
- "There are very few people in the history of the US healthcare industry who had a bigger positive effect on American healthcare than Brian [Thompson]."
- "the health system needs a company like United Health Group, and it needs people like Brian within it."

[Justin Whang 🐙 @JustinWhang]

“Unnecessary care”

United wouldn’t approve my mother for the medicine her doctor said she needed until she first tried this other medicine. As a result, one day she went temporarily blind on the way home.

[EmilyMedvec @EmilyMedvec]

VIDEO: United Health CEO Decries "Aggressive" Media Coverage in Leaked Recording, by @kenklippenstein https://t.co/lPx1QjiUjL