Landon

Orthopedic Surgery Resident 🦴🪚• Interested in adult recon • MO➡️ WV➡️OH • Alumni @WVSOM, @WashU, @SLU_Official

[Landon @LandoReading]

I’m going to be an orthopedic surgeon! 🦴 🛠🪚

I cannot believe my long time dream of becoming an orthopedic surgeon is finally becoming a reality.

#orthotwitter #orthomatch #clevelandclinic
#medtwitter #Match2022 #MatchDay2022 #WVSOMMatch2022

[Matthew Deren, MD @DrMattDeren]

Join us in Cleveland for the Third Annual #ROCKS2026 @CciMeetings

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

It’s time to follow this thread up with one on how hospitals get paid.

This is an even lengthier explainer, as the system is much more complex (and open to exploitation).

Those wishing to cut waste and inefficiency take note:

While physician services are defined by CPT and reimbursed via RVUs determined by the RUC, hospitals have many more revenue streams.

The cornerstone for inpatient payments is the Diagnosis-Related Groups (DRGs).

These are defined by @CMSGov. Each patient is assigned a DRG based on their principal diagnosis, with adjustments for procedures performed and any secondary diagnoses.

Payments increase if Complications and Comorbidities (CCs) or Major CCs (MCCs) are present. These too are defined by CMS.

The entire hospital stay is paid under the DRG, so hospitals are incentivized to minimize costs per stay—sometimes at the expense of longer-term patient outcomes.

Ever feel like the hospital was rushing to get a patient discharged? This is why.

Hospitals also make money through their outpatient departments, which include outpatient surgery centers and hospital-affiliated clinics.

Payments here are governed by the Hospital Outpatient Prospective Payment System (HOPPS), defined by CMS.

Unlike DRGs (per-stay payments), HOPPS is per-service, which incentivizes high volumes.

Another major distinction between the physician fee schedule and HOPPS is the addition of facility fees for the exact same service.

A standalone physician clinic is paid based solely on the CPT/RVU system.
A hospital-owned clinic performing the same service can bill via HOPPS + a lucrative facility fee.
This creates a huge financial incentive for hospitals to acquire outpatient practices. It gives the hospital a huge financial advantage over the independent physician practice.

In addition to service-based payments (DRGs and HOPPS), hospitals have several other revenue streams:

340B Program: Hospitals buy discounted drugs intended for low-income patients but resell them at higher rates to private insurers, pocketing the profits. Again, something that is unavailable for independent physician practices.
Disproportionate Share Hospital (DSH) Payments: Additional funds for treating large numbers of Medicaid or uninsured patients.
Certification Subsidies: Hospitals receive payments or subsidies for being certified as trauma centers, stroke centers, or STEMI (heart-attack) centers.

At the end of the day, all these revenue streams rely heavily on coding and metrics.

For example, hospitals invest in administrative staff to ensure every CC and MCC is captured in physician notes—leading to constant emails and harassment for coding “updates.”

This administrative focus ensures hospitals thrive not by providing high-quality, efficient care but by employing armies of administrators to maximize payments from DRGs, HOPPS, 340B, DSH, and other streams.

The entire system is defined by CMS, with little input from organized medicine.

While the AMA’s role in physician payment raises concerns, hospitals have perfected the art of gaming Medicare.

Their unchecked growth has profound implications for costs, access, and competition in healthcare.

As we discuss reforming physician payments, we cannot ignore how hospitals’ financial incentives distort the broader system.

If @RobertKennedyJr, @elonmusk, @VivekGRamaswamy and @DOGE are serious about tackling waste and inefficiency in healthcare, these overly complex and exploitative systems must be reformed.

@anish_koka @DutchRojas @mass_marion @p_m_robinson @EconTalker @mungowitz @doc_gero @drdanchoi

[Landon @LandoReading]

@stoolpresidente Come to the Cleveland clinic!

[NFL @NFL]

Everybody needs to listen to this speech from Tom Brady 🗣️ (via @Patriots)

[Landon @LandoReading]

Thank you! @nspiuzzi @IPasqualiniMD

[Landon @LandoReading]

Check out this interesting case I was involved in!

[Nicolas S. Piuzzi, MD @nspiuzzi]

Challenging case ➡️ Multidisciplinary approach
@jbjs @IPasqualiniMD @CleClinicArthGp

[Landon @LandoReading]

@GOhansen330 Congrats man, welcome to the family! Can’t wait for you to start.

[Dave Portnoy @stoolpresidente]

The Browns are putting the worst beat down on the Texans I've ever seen in the history of the NFL.

[Cleveland Clinic Adult Recon & Research (CCARR) @CleClinicArthGp]

Get to know our adult recon fellowship staff! Full video in the link and good luck to this year’s applicants #orthotwitter

https://t.co/eOkhuY511K

[Landon @LandoReading]

@orthobullets 4

[Landon @LandoReading]

@orthobullets 2

[PGA/LIV Hot Takes @PGALIVHotTakes]

The LIV players taking the $$$ and coming back to the PGA Tour

[Landon @LandoReading]

@DrCasteelEM @olsonplanner You’re spot on!

[Landon @LandoReading]

@olsonplanner @Ortho_Jake Good question. IMO the short answer is no. I think for some such as this PD that wrote this believes DO’s are less superior and possibly doesn’t think DO’s deserve competitive seats. Maybe they are less familiar with DO’s. Honestly not sure.

[Landon @LandoReading]

@Ortho_Jake @olsonplanner I couldn’t believe it. Wrote a letter how awesome he was but those 2 sentences in there and ranked him low because of it. Pretty bad.

[Landon @LandoReading]

@olsonplanner osteopathic medical school. His chances of matching would be in the upper 1/3 if he was an allopathic applicant.” But ended up ranking him lower 1/3 strictly bc he was DO applicant. Even mentioned how hard he worked, well liked, and great USMLE scores.

[Landon @LandoReading]

@olsonplanner This is very common unfortunately. Being on the other side of interviews this season was eye opening. The PD for a state university in MO wrote a standardized PD letter for a student. He stated “I think the biggest challenge for him in an allopathic program is that he is in

[Landon @LandoReading]

@ashtonsamos Unfortunately this is extremely common in the field of orthopedics. Most allopathic programs won’t even entertain a DO unless heavy connections to that program. Even if high USMLE scores and overall competitive applicant.

[Yelena Bogdan, MD, FACS, FAAOS @InvictaOrtho]

How posterior starting point causes extension deformity in distal femur. My residents asked me to explain how I think of start point deformities in general; this is what I showed them. I treat the fragment that is away from start point (on other side of fracture) as “stationary.”

[Landon @LandoReading]

@orthobullets 5