DrMattDaggett

Ortho specializing in sports, knee and shoulder. CEO of Sano H&C, Sano Specialty Care. Passionate about changing this broken healthcare system.

[IndependentDocX @DocLibertarian]

Medicare pays about $256 for a lumbar epidural in a doctor’s office and about $741 for the same shot in a hospital. Same doctor, same needle. The incentive is for hospitals to buy practices. Patients and taxpayers eat the markup.

[AOSSM Journals @aossmjournals]

Attachment sparing hamstring autograft leads to earlier ligamentization in ACL reconstruction. #sportsinjurycenter #AJSM
https://t.co/UEST2MsGRO

[Real Doc Speaks @realdocspeaks]

When you look at this graph, it is impossible to miss that the costs of Hospital Services is about 3X inflation and is higher than ANY other service.

You don't need a Economics degree from Harvard to realize we desparately need more competition in the hospital market.

Physician owned hospitals can provide that competition, if Section 6001 of the ACA is eliminated.

There is no excuse for the prohibition of physician owned hospitals!! @HeathVeuleman @DutchRojas @HEALTHCOSTtruth @ahahospitals @BKRBusinessMin @mcuban @AtlasMD @DrLGarl

[Alex Shteynshlyuger MD @DrAlexUrology]

The question of course is who incurs the costs and who derives benefits.

Insurance plans managed to externalize costs and impose them on physicians while pocketing savings.

We call this “perverse incentives” in Economics

@DrJBhattacharya @econliberties @DrBruggeman @DrOzCMS @RepGregMurphy

[AOSSM Journals @aossmjournals]

Synovial fluid inflammatory phenotypes at the time of ACLR with concomitant meniscal injury predict baseline symptom severity and long-term recovery patterns highlighting the potential for personalized biologic treatment strategies. @nyulangoneortho
https://t.co/M8QDYEKwLf

[New York Magazine @NYMag]

‘Travel sports,’ a term that has come to encompass all sorts of private teams, leagues, and clubs, used to be for the truly exceptional young athlete. Now, they’re for anyone willing to pay — an expensive, exhausting commitment that has become popular not necessarily because millions of parents want them for their children but because it can feel like there’s no other choice. Rec programs are underfunded and struggle to compete with for-profit leagues for prime field, rink, and court times. And the level of play is diluted, often very early, as travel teams are incentivized to enroll children at young ages.

Around 5 million children in the U.S. now compete on travel teams. Parents find themselves trapped. They know the benefits of sports and want that for their children, yet giving it to them often means buying into a sports ecosystem that’s inherently flawed. As the pay-to-play model increasingly takes hold, so does the idea that kids should start competing at younger and younger ages, risking their sense of self along with their shoulders and ACLs.

“I never want my kids to look back and say I didn’t do everything I could to help them live their dreams,” a mother of three soccer players said. She’s hired professional photographers to take action shots for her 12- and 13-year-olds’ Instagram accounts — the platform has become a recruiting tool — and they’ve both asked her to pay for personal trainers.

“I think the word isn’t ‘specialize’; you are ‘professionalizing’ your kid early. You are exposing them to everything professionals have to deal with — I’m talking injury, time, schedule, everything,” said John Van Benschoten, a former MLB player and travel-baseball coach.

It makes one ask: All this for what? And for whom? Read Caitlin Moscatello’s cover story on how travel leagues have made youth sports more expensive, hypercompetitive, and all-consuming — and the investors who are making a killing: https://t.co/zHcKsPYfeC

[Nicholas Fabiano, MD @NTFabiano]

Exercise works for bipolar depression.

A pilot trial found an 82% response rate.

Movement needs to be treated as medicine.

[AOSSM Journals @aossmjournals]

Does FIFA 11+ work?
Yes—but only if you do it consistently.
This AJSM systematic review found that higher adherence to the FIFA 11+ program was associated with greater reductions in injury risk.
#SportsMed #OrthoTwitter #Soccer
https://t.co/Ka9PUowtdC

[DrMattDaggett @DrDaggett]

@nytimes Bad idea…..

[DrMattDaggett @DrDaggett]

@kcrehabguy I’ve got a couple patients now fully released. I’m cautiously optimistic about it. So much better and faster quad control post surgery then traditional quad

[DrMattDaggett @DrDaggett]

With our ASCs we negotiate for the best possible pricing amongst different implant vendors. While total hips can range in cost substantially, the implant costs in my opinion are not as big of the issue as where the surgery is performed. There is no reason a hip replacement at a hospital should cost double (or more) than the cost of doing it at a surgery center.

[Nicholas Fabiano, MD @NTFabiano]

Exercise works for depression.

92% of clinicians get zero training on how to recommend it.

If this were medication, it would be malpractice.

[Anish Koka, MD @anish_koka]

"If you're a physician reading this, take a Valium before the next paragraph. The budget neutrality constraint that governs the PFS — where every dollar increase in one service must be offset by a dollar decrease somewhere else — applies only to the physician fee schedule. It does not apply to Medicare spending as a whole. Congress can and does appropriate additional money for hospitals, for MA plans, for drug coverage, for post-acute care — all outside the zero-sum straitjacket that governs physician payment."

[DrMattDaggett @DrDaggett]

@drroddymcgee @mcuban 10 :(

[DrMattDaggett @DrDaggett]

@PhilPlisky @medbridge Really enjoyed the conversation Phil!

[Amy Faith Ho, MD MPH @amyfaithho]

To add to the sordid tale of healthcare and private equity, check out this oxymoron:

Private Equity + Nonprofit.

Seems antithetical to one another, but here we are.

Rather than buy a nonprofit hospital outright, PE buys the control, leaves the nonprofit shell (and tax benefit) standing, and calls ot joint venture. It's an acquisition without triggering the regulation of acquisitions.

Fast facts from @PEstakeholder's killer new report on it:
~500 healthcare facilities now operate as nonprofit-PE joint ventures.

-These avoid State AGs and the FTC regulations because they either don't have traditional asset sales or nonprofit conversions (State AGs) or are individually each too small for FTC review

-Besides slashing patient care and heightening profits, there's some other usual financial hacks like the sale-leaseback of hospital real estate. Cash out now, generate a payout that can fund a dividend, pay rent forever.

-The IRS rules governing all of this were written in 1998 and 2004 — well before PE poured $1 trillion into U.S. healthcare

[DrMattDaggett @DrDaggett]

The challenge is this is becoming more and more scarce as independent practice is dying as the professional fee world is nearly impossible to navigate these days, which has led to a drop to 12-18% of docs remaining independent.

The reality, almost all the entities that employ the other 82-88% have no desire or need to do direct contracting…in fact, quite the opposite.

[DrMattDaggett @DrDaggett]

To your point, this model is often way better financially for both patient and provider. In these arrangements there is reduced or eliminated costs for patients.

For our docs, the professional fee is substantially higher as well, as we can reset internally the ridiculous dichotomy of professional vs facility fee.

Further, we can realign incentives internally by tying physician reimbursement to net promoter score, as the ultimate outcome is an optimal patient experience+safety. This then creates an appropriately incentivized network that fines alignment with, in my opinion, the two most important stakeholders in healthcare. 1: patients. 2: doctors.