Habib Rasoully

Psychiatry Resident Physician

[John Asghar @JahangirAsgha10]

Today’s misinformation, brought to you by another insurance lackey.

Let’s blame the arbitrators…

The whole “they’re making too much money” argument is stupid.

Arbitration fees are fixed and published. The arbitrator doesn’t get a cut of the award or send the case to arbitration.

Cases get there because the parties failed to reach a negotiated agreement. Insurers can’t refuse to negotiate, submit lowball offers, and then act shocked when disputes go to arbitration.

If insurers want fewer arbitration fees, they should start negotiating. Blaming the arbitrator’s profit margin is a distraction.

They just want government price controls on everyone but themselves.

[Anil Makam @AnilMakam]

Too much training. Learn the skills on the job. A 2 year pay cut and delay in starting a career is not worth it IMO

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

There numerous different regulations that need to be changed for AI to replace doctors. If you know about the pace of regulatory change, thinking replacement will come in 5-10 years is insane.

American helath law regulates a chain of actions performed by a named, licensed, enrolled, privileged, insured and sanctionable human being.

All 50 states & DC have their own medical licensure regulations. Each one of those would need modification to allow autonomous AI to evaluate and treat patients.

States would also need to revise laws around informed consent, scope of practice, who may issue orders to nurses and other allied health staff, continuity of care obligations... just to name a few.

Then, of course, there's Medicare. To actually get paid for providing care to a Medicare beneficiary, The Social Security Act defines “physicians’ services” as professional services performed by physicians and defines a physician principally as a doctor of medicine or osteopathy legally authorized by a state. There is no benefit category for clinical services furnished by AI.

Of course, if AI is going to provide care and bill CMS, you'd need a whole new fee schedule, since the physician fee schedule's rules around work, time, intensity, and practice expense are not applicable to AI.

Additionally, AI can't even order anything for Medicare beneficiaries unless more laws are updated. Current Medicare rules require many services to be ordered by an eligible physician or professional, and claims must identify that person by legal name and individual NPI. Organizational NPIs cannot currently be used as the ordering or certifying professional.

And AI would need to get a DEA controlled substances authority...

Oh wait there's more.

Medicare hospital regulations are saturated with references to physicians, medical staffs, and individual humans. You'd need to change conditions of participation for hospitals, ASCs, SNFs, home-health agencies, hospices, dialysis clinics....

EMTALA mentions physicians. Joint Commission credentialing mentions physicians. Numerous state and federal programs require "individuals" authorized under state law to be involved in everything from mammography to blood banking to sports clearance to nuclear medicine. Many governmental bodies require human physicians for things like FMLA, workers' compensation, organ-donation documentation, communicable-disease reporting, child abuse reporting, capacity assessments, psychiatric holds, birth/death certification...

All those laws would need to be updated.

And then there's the liability. Each state is going to work out how to handle harm done by autonomous systems.

All this still hasn't touched on the language in HIPAA, or any of the issues around privacy, civil rights, patient protection laws, fraud, or the entire regulatory structure surrounding the commercial insurance market.

We are probably talking about thousands of legal and regulatory changes before AI has the authority to take over what doctors do. I think doctors are safe until roughly the next ice age.

[Glenn Greenwald @ggreenwald]

This is getting so extreme that one day, it might even be that American politicians feel like they need to make pilgrimage to Israel and put on a yarmulke and kiss a wall, and then go back to the US and visit synagogues and AIPAC conferences to praise Israel. Could you imagine?

[Paul Graham @paulg]

Meron Rappaport in +972 Magazine:

[Paul Graham @paulg]

If you didn't speak out against *both* woke censorship and Trump's attempts to suppress criticism of Israel at universities, you're not a genuine free speech advocate. You're just a partisan hack who pretends to care about free speech when it suits you.

[Bruno Maçães @MacaesBruno]

Anyone who will spend the day talking about Ukraine and ignoring Israel’s announcement that it will resume and accelerate the genocide cannot and should not be taken seriously

[Bruno Maçães @MacaesBruno]

Look forward to seeing Vance shout at Netanyahu that he has to be grateful and stop begging for money

[Dr. Omar Suleiman @omarsuleiman]

Remember when Trump was pulling out Netanyahu’s chair for him at the White House? Trump asked Zelensky to leave the White House after this exchange. Ask yourself: why do some get this ”America First” treatment while Israel gets the blank checks and red carpet? Who is dependent on whom?

[Dr. Omar Suleiman @omarsuleiman]

Dear @elonmusk,

when one of your Teslas kills someone while self driving or explodes on fire and the media charges your vehicles as unsafe, you point out sampling bias, share all kinds of statistics, and allege that the media is either accidentally or deliberately misrepresenting statistics to promote a vindictive agenda.

Yet, for the past week, you have blown every conceivable dog whistle of Islamophobia, by highlighting a select group of (horrifying) incidents supposedly in the name of Islam. Your barrage of tweets aimed at Islam have been as dangerous as they are dishonest about a faith practiced by over 2 billion people.

If you don’t know you are doing this and genuinely want clarification, I and many others easily accessible to you are willing to have a conversation. If this is deliberate smear campaign, then you are indeed every bit the hypocrite you once condemned.

[Glenn Greenwald @ggreenwald]

Here, @TheoVon speculates Congress finally had the votes to shut down TikTok because the platform allowed too much Israel criticism.

No need to speculate: the bill's GOP sponsors said explicitly that this was what led Congressional Dems and the WH to finally support the bill.

[Mouin Rabbani @MouinRabbani]

It seems "Alles klar" is German for "Allahu Akbar"

[Owen Jones @owenjonesjourno]

How do we know Elon Musk isn’t doing taqiyya? What about Donald Trump? What if I am? Maybe your cat is at it.

From now on just presume everyone is dabbling in a bit of taqiyya just to be sure

[Alonso Gurmendi @Alonso_GD]

The attacker says one thing in this video: “alles klar” (“understood”) Far away from the camera, in responde to police instructions. Everything else is said near the camera, by bystanders and by the Police. But it doesn’t matter anymore. Amidst 14 years of anti-Islam tweets, they found one thing they could manipulate. And they have the full force of the biggest propaganda operation “social media” in the planet behind them

[Ahmed Fouad Alkhatib @afalkhatib]

This Tweet is deliberate & purposeful disinformation. In the screenshot reply, the Magdeburg attack suspect was responding to a pro-Hamas person on Twitter & sarcastically told that person that Hamas should be brought to Gaza & to this person's home so they could "taste it" - likely a reference to dealing with the consequences of living under the Islamist terror of Hamas. The attacker was overtly "pro-Israel" and believed that Gaza, the West Bank, and Lebanon should be annexed by Israel as part of a "one state solution" according to him. It has been wild to see bigots, agents of chaos, and fascists work overtime trying desperately to make this a case of Jihadi terror when available evidence suggests it wasn't. Terrorism is evil and horrendous, even when it doesn't fit your anti-Palestinian, anti-Muslim narratives.

[Dutch Rojas @DutchRojas]

Blaming physicians as ‘overpaid’ is not only misguided but also a blatant misunderstanding of reality.

Physician compensation has decreased in real terms over the years, even as their workloads and administrative burdens have skyrocketed.

Meanwhile, journalists and reporters, like Vox guy below, rarely go after the real culprits—insurance companies and health systems—because that’s where their bread is buttered.

Advertising revenue from these entities keeps their publications afloat, so instead of holding the true power players accountable, they target doctors.

It’s easier, it’s sensational, and it deflects attention from the inefficiencies and price gouging that make healthcare unaffordable.

Physicians aren’t the problem—they’re the ones keeping the system from collapsing entirely.

#healthcare

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

With this story, it’s worth discussing how doctors get paid in Medicare.

Lengthy explainer here:

@RobertKennedyJr has mentioned reforming the American Medical Association’s (AMA) role in Medicare. To understand this, we need to explore how the AMA currently influences how doctors are paid.

When the government purchases goods or services, it typically defines what it’s buying—a “unit of service”—and negotiates a price. For example, if the military buys a tank, it specifies the requirements and solicits bids from manufacturers. Paying doctors, however, is a very different process.

In Medicare, the government defines physician services using Current Procedural Terminology (CPT) codes—for example, a spinal fusion or a patient consultation. But rather than negotiating prices in the marketplace, Medicare relies on a committee to assign a value to each service. This committee, called the Relative Value Scale Update Committee (RUC), evaluates each service’s complexity, time, and resource requirements and assigns it a value expressed in Relative Value Units (RVUs). Medicare then uses these RVUs, along with a conversion factor, to determine how much doctors are paid.

Here’s where the AMA comes in: the AMA controls both the CPT code system and the RUC.

What makes this process unique is that, unlike most goods or services purchased by the government—where prices are set by competitive markets—the value of physician services is centrally planned by the RUC. And because the AMA controls the RUC, it effectively oversees the system that defines and values physician work for Medicare.

To be clear, the issue isn’t just that the AMA controls the RUC. The broader issue is that RVUs are valued through a centralized planning process at all. While physicians should have a say in defining and valuing their work, the system would benefit from incorporating more market forces and reducing the reliance on centralized decision-making.

It’s also important to note that doctors—whether in the AMA or not—can’t simply “pay themselves” whatever they want. Once the RUC determines RVUs for various services, Medicare applies a budget-neutral formula. This means that if more RVUs are billed across the system, the amount paid per RVU decreases. Doctors see this in practice as the conversion factor is reduced every year.

Ultimately, the RUC’s recommendations are submitted to the Centers for Medicare and Medicaid Services (CMS), which makes the final decision on whether to adopt them. However, CMS accepts the majority of these recommendations, making the RUC—and by extension, the AMA—a key player in determining how healthcare dollars are distributed and how doctors are paid.

There’s not enough information regarding the plan to cut the RUC out of the process for an analysis on the benefits and Tradeoffs. If it just involves moving the process into CMS, it’s unlikely to have much benefit. Substituting CMS administrators for a physician run committee is likely to have many adverse unintended consequences.

I’ll be watching this closely as it unfolds.

@anish_koka @mass_marion @drdanchoi @MayaBabuMD

[Mouin Rabbani @MouinRabbani]

I have consistently stated that the International Criminal Court would never issue an arrest warrant for an Israeli official. I am delighted to have been proven wrong. Almost as delighted as I am by watching Western leaders and politicians take a break from preaching human rights, the rule of law, etc. to the rest of us, to experience a collective thermonuclear meltdown about these developments.
I am particularly amused by the attacks on Karim Khan. I fully agree he should never have been elected ICC Prosecutor. The catch: the only reason he was elected to this office was because of incessant lobbying on his behalf by not only his government, Great Britain, but particularly by two states that are not ICC members: the United States and Israel. They promoted him to protect their interests, he did his very best, but Israel's conduct and an effective campaign to pressure him to fulfil the duties of his office ultimately left him with no alternative.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Doctors, don’t ever let a hospital claim they are losing money on your salary.

If you’re employed and they are just comparing professional fee collections to your paycheck, they’re trying to trick you.

You generate far more revenue than your professional fees. There’s the DRGs for all the hospitalizations. There’s the facility fees for outpatient services. There’s the downstream revenue of every lab test, imaging and PT order. There’s the revenue they generate by having you cover call, allowing them to be a trauma center or stroke center or cardiac center.

Doctors have the leverage. They need us. And once we reverse the ban on physician owned hospitals, we won’t need them.

@DutchRojas @anish_koka @cscla

[Bryan Carmody @jbcarmody]

Aw jeez, not this again.

According to this consultant, hospitals now *lose* an average of $304,312 per physician per year.

🤦🏻

Guess it’s time for another thread on Budgetary Gerrymandering.