Leon Adelman

Emergency Physician | Co-Founder @ Ivy Clinicians | Creator of Emergency Medicine Workforce Newsletter

[Loren Adler @LorenAdler]

Today we published a new @BrookingsInst databook on the No Surprises Act’s (NSA) arbitration (IDR) process

The main takeaway?

Prices emerging from IDR in 2024 remained FAR above the in-network commercial prices that prevailed before the law.

We'll update annually.

[CORD @CORD_EM]

Thank you for your feedback on the proposed ACGME changes. We recognize the impact on EM training and hear concerns about the four-year format. Read CORD’s response here: https://t.co/Fq5HG3U7N4

[Leon Adelman @LeonAdelman]

@ddayen @moetkacik @moetkacik is the best!!!

[Adam Bruggeman, MD @DrBruggeman]

New estimate out from MedPAC shows an estimated $84B will be spent by patients on Medicare Advantage over traditional Medicare. Since inception, Medicare Advantage has NEVER saved money over traditional Medicare and has cost $687B to taxpayers. @DOGE and @elonmusk probably should take a look.

When the CBO scores cost savings or actual costs, they do it on a 10-year outlook. That means that closing the Medicare Advantage loophole for favorable selection and upcoding could add $840B in savings to be used elsewhere.

Several have estimated that fixing the physician fee schedule (which MedPAC also recommends) would cost around $100B. That leaves an additional $740B to be used to reduce the deficit or in other projects.

@RepGregMurphy

[Congressman Raul Ruiz, M.D. @RepRaulRuizMD]

I am excited to launch the Doctors Caucus that will fight for quality, affordable health care for American families. As doctors we understand the pain and suffering that people endure for not having access to care.

We will work to ensure that every American has the health care they need.

I am excited to join @RepBera, @RepHerbConaway, @RepDexterOR, @KellyMorrisonMN, @RepKimSchrier in launching this caucus.

[CIR/SEIU @cirseiu]

CIR has landed in Minnesota for the first time and it’s big news…

Check out this week’s headlines.

“Hennepin Healthcare resident physicians file for union recognition”

Via @ Minnesota Reformer

https://t.co/n6po8jt6Vd

[Dr. Glaucomflecken @DGlaucomflecken]

Every professional organization in medicine should denounce the involvement of private equity in healthcare. They should send a clear message to their young physician members that PE is bad for hospitals, private practices, and patients.

They won’t do it, but they should.

[Ed Gaines @EdGainesIII]

This bill is hardly a “clean CR” per Politico, yet POTUS is calling for shared sacrifice & patience until Sept. ‘25. The physicians & advocacy community has been patient & promises were made. GOP funding patch boosts defense & deportations, cuts others. https://t.co/qFyxarxjJU

[ACEP Members @ACEPNation]

A Well Workplace prioritizes personal & professional health & well-being on the job. Do you know an organization that positively impacts the wellbeing of their healthcare workers? To nominate a Well Workplace institution, visit the link in our bio! 🔗

https://t.co/xOgJ3V0uHi

[John Arnold @johnarnold]

This is A+ philanthropy:
Find a field neglected by other funders (nursing ed) that has broad benefits (economic mobility & health outcomes), identify the constraint (shortage of faculty and lab space), do strong due diligence, fund it at scale, and give while living.

[Leon Adelman @LeonAdelman]

@EdGainesIII @DOGE @OIGatHHS @WSJ @Aetna @EdGainesIII - I appreciate your optimism about #doge. Unfortunately, seems more likely that the T admin will reward big insurers & pharma while decreasing funding for acute hospital care. https://t.co/eTkE9Ou1on

[EMcentric @emcentricusa]

🎙️The Shift Report: Where Emergency Medicine Meets Music
Listen to Dr. Ian Warrington share how blending music with medicine helps him thrive in the ED. From COVID-19 to clinical shifts, his story shows the healing power of artistic passion. https://t.co/uv6MlQGHZe

[Jessica Riedl 🧀 🇺🇦 @JessicaBRiedl]

“Why aren’t you cheering Trump & DOGE? I thought you wanted spending and deficit cuts!"

Because I’ve been doing this for 25 years and can’t be tricked by gimmicky nonsense. Trump’s first term added $8 trillion in enacted spending hikes and tax cuts to the deficit - half of which was unrelated to the pandemic. This time around, Trump has proposed roughly $8 trillion more in tax cuts and spending hikes over the decade. And right now, a GOP Congress is preparing to abandon most reconciliation cuts and instead add $325 billion this year in new spending. We’re headed towards $4 trillion deficits within a decade.

So, no, I don’t get excited when DOGE cancels $1 billion in govt contracts. Or saves $3 billion in federal workforce reductions out of a $7,000 billion budget. Not when Trump and Congress are also preparing to add $800 billion more annually in proposed new tax cuts and spending.

And no, the huge savings are not coming. Even (unrealistically) eliminating 20% of the federal workforce would save $60 billion, and overhauling federal systems to sharply reduce payment errors may save perhaps $80 billion (and is probably unlikely too). For all of DOGE’s bluster, administrative and executive reforms would at best save 1-2% of federal spending and offset only a small fraction of Trump’s red ink agenda.

That leaves trying to unilaterally impound spending such as USAID—which is wildly illegal—or actually going to Congress to pare back spending the constitutional way. But Trump has already taken Social Security, Medicare, defense, veterans, border (and interest) off the table, which is 2/3 of all spending and is driving deficits. And the GOP Congress seems ready to give up on cutting the remaining one-third of spending. Want to cut spending and the deficit? How about they stop passing budget-busting bills. Don’t brag about your coupon-clipping frugality at the same time you are buying a $250,000 Ferrari. I’m not going to cheer Trump and DOGE for adding “only” $750 billion to deficits instead of $800 billion. We’re still going backwards.

I’ve spent decades studying the federal budget. I know that $7 trillion(!) behemoth inside and out – where the money really goes, and where the savings opportunities lie. So I can also detect bullshitters who talk tough about trillion-dollar spending cuts without doing their homework. It’s the ones who claim most spending goes to undefined “waste,” federal salaries, immigrants, foreigners, Ukraine, or non-working welfare recipients. It’s the ones who claim we can easily balance the budget or cut $1 trillion without specifying exactly what line-items to cut. Or that we can return to 2019 spending levels for each program, which means a 20% inflationary cut, defaulting on the federal debt, and kicking off every senior who has since retired into Social Security and Medicare. It’s all hot air and empty bluster. Tough talk without following through on anything substantive. Just wait until you see the final deficit numbers in October.

And this is why GOP movements to cut spending always fail. They make absurdly ambitious promises without doing their homework, understanding where the money goes, and specifying real plans to fix it. You can’t significantly cut the deficit just by cutting waste, firing bureaucrats, and defunding immigrants and foreigners. There are no easy short cuts. You have to stop cutting taxes and then address Social Security, Medicare, defense, and a lot of other popular programs. Wake me when the GOP goes there.

So, no, I will not get excited about a couple billion in DOGE savings on one hand while Trump pushes Congress to add $8 trillion over the decade in tax cuts and spending with the other hand. I’m not that gullible.

[Pat_Garofalo @Pat_Garofalo]

A bill to ban non-competes for physicians passed the Indiana state Senate yesterday by a vote of 47-2.

Bipartisan disgust at the power of Big Medicine is a real thing.

https://t.co/mEKB0s5QOs

[Amy Faith Ho, MD MPH @amyfaithho]

Few things:

1. The federal government is largely not funding our tuition. It’s why medical students have $200k of student debt on average. We already “refund” it in that we pay it back…with interest…🤨

2. 15 years of full time practice is around age 45 for most medical students. That covers nearly all child bearing years…for a field that has a demanding work schedule (weekends, call, nights) which is both physically and mentally demanding plus doesn’t sync with traditional childcare solutions, a culture of almost no parental leave and certainly no paid parental leave, and Match(s) that force you to new locations that may make childcare/family support difficult/impossible…

Congressman’s proposal is so ignorant to how physician families function (I myself came off clinical full time when I had my first baby, as did many many many of my physician mom friends), I just can’t…

[Amy Faith Ho, MD MPH @amyfaithho]

I don’t believe the “40% of med students don’t plan to practice” stat…but even if I did, here’s some more relevant stats.

- the government has cut RVU reimbursement year over year, while inflation has only increased…in the past few years alone we took a double digit pay cut because of government @MedicareGov reimbursement when adjusted for inflation

- private equity has taken over healthcare, fairly unchecked. This results in bad patient care, unstable healthcare markets and poor working conditions for physicians…

-healthcare administrators have grown 3800% versus physician #s growing 200% since the 70s. This represents declining physician autonomy and an overwhelming administrative burden…much of which is created by government programs like CMS “Quality Measures” which are less about care quality and more about gamesmanship and documentation burden

- insurance companies have a chokehold on the finances of healthcare…and their lobby dollars fund the congressmen who help keep them in power and allow them to continue to squeeze physicians and patients both

How ‘bout you work on some of those issues, Congressman…and get back to the med students after you do?

[CoffeeBlackMD @CoffeeBlackMD]

Employed physicians do need to unionize.

I kind of hate that, but it’s like chemotherapy for cancer. No one is excited about all of it.

Physician employment looked good (enough) on paper when all of those guys who built the huge private practice system and networks in this country sold to big hospital systems, instead of selling to the young guns coming out of training.

To be a bit fair the young guns coming out of training already had big loans, no money, and usually no experience or knowledge of running a business. The “docs are bad at business” meme was cranked on hard. Which isn’t true, even if some really were. (“A problem” is docs are smarter than average by mere virtue of having to be to get to where they are and once they understand VERY BASIC business concepts, they are quite good at business. Too good.) And these young guns saw immediate, median “market rate” 6 figure yearly incomes on day one without the stress of starting a new practice or the few years work as an associate before being able to buy in as partner to a practice.

So you can see how this happened pretty easily. But with most physicians now being employed the “leverage” that was still available in work and compensation discussions when this wasn’t the case is disappearing, quickly.

The only recourse left will be collective bargaining as a huge group of employed physicians. Thus a union. Which comes with all the negatives of a union as well. But the positives arguably hugely outweigh the negative.

Hopefully the unionization will happen in parallel with a new resurgence in new independent and private practices.

[Steven Rattner @SteveRattner]

In his farewell address, Biden warned: "an oligarchy is taking shape in America of extreme wealth, power and influence".

Indeed, workers have been getting a smaller share of national earnings, especially since the turn of the century.

[Healthcare AI Guy @HealthcareAIGuy]

The future according to Mayo Clinic

Mayo Clinic's investments show how AI is transforming the hospital

[Martin Tobias (Pre-Seed VC) @MartinGTobias]

I have invested in over 250 pre-seed startups, mostly in B2B software. The most successful ones have had some distribution tricks to quickly get their first happy customers.

Here are the Best (and worst) distribution wedges I have seen for Pre-Seed software startups.