Andrew Yang, MD | Hand Surgeon

Board-certified orthopedic surgeon. Solo private-practice hand surgeon (NJ/NY). Breaking down physician pay, Medicare, insurers & policy. Not medical advice.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

https://t.co/IjBaXuESPw

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@brian_blase @HammondOnHealth @washingtonpost Solo docs don't get market negotiations. We get a fee schedule. Cap awards at an insurer-set rate and that sheet becomes the ceiling. Keep patient protections. Audit bad actors. Don't hand insurers the pen.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@CharlesLutzMD That ban is the double standard. Doctors can't open new physician-owned hospitals that bill Medicare. Insurers buy practices and surgery centers and call it integration.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@crappiedoc Same market here. Hospital-owned groups nearby means I get the fee sheet. No real negotiation. About 80% of Medicare.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

I can't raise my fees. Insurers won't negotiate.

So I cut costs. VAs at $4/hr. Billing at 3.75%. A used mini C-arm. $3,000 in-office WALANT.

Still 45 to 55 patients a day, weekends off. Wrote up exactly how I run lean as a solo hand surgeon.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@wendellpotter Another thing the ads skip: an Advantage plan can approve your surgery, then decide afterward it wasn't necessary and pay less. There's a bipartisan bill to stop that, H.R. 10394.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@PatientAction Patients shouldn't have to ask. Insurers should publish their denial rates.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DrSeanWheeler Ha. The AI is calmer than any of us after a peer-to-peer. A doctor outside your specialty shouldn't be the one picking your procedure.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@rational_doc @anish_koka Hard, not impossible. I opened with a bank loan after 3 years employed. Keep overhead low and you build in your own margin.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Residents: 5 years out, 2 years owning my own practice. Office 4 days, OR 1 day, most weekends off.

You've been told private practice is dead. It isn't.
What's stopping you?

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@Ds_9981 No company. I hired them directly on https://t.co/qwgJJVhNUK and interviewed them over Zoom. You still have to train them like any other employee.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DrSuneelDhand Hospitals keep the food cheap and unhealthy to save money. Ironic for a place that's supposed to make you healthy.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@BostonGlobe My med school debt was $300,000, and it's much higher for students now. Debt like that is why most residents take the first hospital job they're offered when they finish.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DutchRojas Nobody taught me business in training. I learned it after I opened. Overhead was the first number I had to learn. In the age of AI, it's easy to learn.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Medicare gives hospitals an inflation update every year. Doctors don't get one.

Then everyone wonders why practices sell.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@sethmhardy @WillyRontgen Agree. Keep doctor pay flat long enough and selling to the hospital starts to look like the only option.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@robolivermd Real people, not AI. Two full-time remote assistants in the Philippines. They answer the office phone, schedule patients, and handle email.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@charliebilello Premiums didn't fall for any patient I see. What fell is what doctors get paid after inflation.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@anish_koka Plans get paid more when they code patients sicker. When I code exactly what my op note says, I get a denial to fight. Same program, different rules.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@itsmigdady @DutchRojas We could if we all stayed independent. Once we're all employed, we lose that leverage and get told it's none of our business.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Employed surgeons get told "your collections don't cover your salary."

Then why does the hospital keep recruiting you?

Your cases fill their OR. That facility fee just never shows up on your line.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@Maryfields32861 Prior auth hits small practices hardest. Big systems pay full-time staff just to fight insurers.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Insurers won't negotiate with a solo doc. Hospitals keep buying the practices that could compete with them.

This isn't a free market. It's a monopoly.

The one job I want government doing: break up the monopolies.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@andoverdoc Good to hear one came to the table. A shortage in their network is real leverage. Without it you get the sheet.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Solo docs don't negotiate. We get a fee schedule.

Make the median the out-of-network cap and it becomes the ceiling. Then it drifts down.

I've never had a real rate negotiation. Just a take-it-or-leave-it sheet.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

If doctors out of network rates are limited to median in network rates, that leads to downward pressure on doctor pay. If you can’t negotiate any higher than the median rate, the insurance company will never offer anything more than that. So you see a slow decline in doctor pay. This isn’t a hypothetical, CA did this and @EdGainesIII can show the receipts.

@LorenAdler would say that declining doctor payments aren’t a bad thing in themselves. I agree we shouldn’t assume that high doctor pay is a good thing in itself. I’d be nothing but a cartel mouthpiece if that was the case.

However, declining doctor pay does lead to fewer independent doctors. There is overhead, and if you can’t pay your bills, your practice either closes or gets acquired. As proof, I offer the previous 20 years of declining independent physician practice.

While declining reimbursement isn’t the only cause, it’s a big one. Medicare rates are 30% lower than they were 20 years ago. Most practices cant keep the lights on with medicare rates, anymore. So they rely on private insurance.

Take away a fair arbitration process and you’ll see more practices bought out by large hospital systems.

And that vertical integration drives up prices. So on net you end up with an even more expensive system.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@RojaGarimella Hand rates aren't great either. Medicare pays me about $423 for a carpal tunnel release. That includes 90 days of care after surgery. I make it work with low overhead and in-office procedures.