Matthew E. Tick, DO

Gastroenterologist interested in IBD, endoscopy, EBM, technology, innovation, and QI. Views mine & not medical advice. Meliorist. Alum - @GW_Gastro @GWIMRES

[Dimitrios Tsatiris MD @DrDimitrios]

Hospitals spent more than $7.8 billion on management consulting services from 2009 to 2023.

The money spent did not improve operations, financial performance or, most importantly, quality of patient care.

The U.S healthcare system is inefficient, fragmented and detached from what matters most.

Putting the patient first.

https://t.co/UNwPWxe5t2

[Matthew E. Tick, DO @mtick27]

@HeartOTXHeartMD @RichDuszak Good ‘ol American regulatory capture

[Matthew E. Tick, DO @mtick27]

@DrBloodandGuts @OvescoEndoscopy Does the Megacap need the mega scope (therapeutic gastroscope) or will it fit on the end of the GIF-190’s?

[Matthew E. Tick, DO @mtick27]

@nickmmark Is it the honor system to report income or is any substantiating documentation required? I hear there’s an academic peds nephro who makes $3M per year and works 32 hr work weeks and has 12 weeks PTO. It’s real, I saw it online!!

[Matthew E. Tick, DO @mtick27]

@EndoCollabcom NET - small, < 10 mm, would inject to lift and snare it off

[Matthew E. Tick, DO @mtick27]

@PLooserMD @Humana Why does it take public shaping of @Humana to at least attempt to get them to do the right thing? Shameful.

[Matthew E. Tick, DO @mtick27]

@SalaryDr First jobs are that - first jobs - try negotiating non compete. Also if there’s a sign on bonus and you leave before X yrs negotiate to pay back a prorated portion (sign on bonus / number of months of first term) - only pay back the portion for which you’re leaving early

[Matthew E. Tick, DO @mtick27]

@nikillinit Doctor - have a doctoral degree
Physician - Practices medicine

Does that work?

[Matthew E. Tick, DO @mtick27]

@realdocspeaks Curious why eliminating restrictive covenants/non-competes didn’t make your list? That could allow employed physicians the opportunity to re-align and join the ranks of independent physicians

[Matthew E. Tick, DO @mtick27]

@drkeithsiau Seems like an answer in search of a question.

Can’t imagine much utility for this - how many EGD’s are you doing where you aren’t taking biopsies? Also cost - if something doesn’t look quite right on here then you’re going to EGD with Bx and now that’s 2 procedures instead of 1

[Matthew E. Tick, DO @mtick27]

@DutchRojas Nonprofit is a tax status, not a mission statement

[Matthew E. Tick, DO @mtick27]

@DrNikhilMD Sucralfate can sometimes be helpful in stubborn esophageal ulcers to provide some mucosal coverage

[Gastroenterology @AGA_Gastro]

🌟Hot off the press! Our newest special issue introduces an enhanced global conceptualization of disorders of gut–brain interaction from the Rome Foundation.

📖Browse the issue here: https://t.co/lNmQChnbyE

#GutBrainAxis #Neurogastroenterology #DGBI

[Matthew E. Tick, DO @mtick27]

@spartywrx Don’t forget that those big law partners are just that - equity partners - who own their law firm and work product while physicians are mostly barred from ownership of hospitals

[Matthew E. Tick, DO @mtick27]

@DrNeilStone I think she meant to post that on 4/1 for April Fool’s — what a 🤡

[Matthew E. Tick, DO @mtick27]

@AOAforDOs I’m curious what percent of DO’s who match into a primary care field end up going into fellowship training and become specialists?

[Matthew E. Tick, DO @mtick27]

@ginorthshore @DCharabaty @DouglasAdlerMD @DrBloodandGuts @EBGIdoc @stevenbollipo @UmaMahadevanIBD @HealthyLivingGI @drkeithsiau @AGA_Gastro @AmCollegeGastro @ASGEendoscopy @gastroendonews Thanks for this thoughtful piece

[Kevin Pho, M.D. @kevinmd]

Hospitals are putting hard caps on physician compensation, sometimes as low as the 75th percentile, and calling it fraud and abuse protection.

Think about what that means. If earning above the 90th percentile is inherently suspicious, then 10 percent of every physician in every specialty must be breaking the law. At the 75th percentile, 25 percent of all physicians are apparently committing fraud. That logic falls apart the moment you say it out loud.

Health law attorney Dennis Hursh has been reviewing these clauses for years, and he says they are showing up in the majority of physician employment contracts now. Some contracts say compensation "may be reviewed" if it exceeds the threshold. Others are blunt: under no circumstances will your total compensation exceed this number.

So if you are the most productive physician in your specialty in the entire country, your pay is frozen. Every dollar you produce above that cap flows to the institution. And as Hursh puts it, the CEO's bonus is not capped.

It gets worse. Most hospitals are not giving physicians clear, timely productivity data. You might be told you produced 9,500 WRVUs, but without access to the actual benchmarks, you have no idea whether you are approaching the cap. You are flying blind while working at a pace that funds someone else's compensation growth.

There is also a downstream effect that hurts the entire profession. Compensation surveys from MGMA and SullivanCotter use reported salary and productivity data. When the highest producers have their pay artificially suppressed, it pulls benchmark numbers down for every physician in that specialty the following year. The cap does not just limit one doctor. It compresses pay across the board.

Hursh says physicians need to review contracts for this language, demand regular and transparent productivity reports, and push for independent third-party compensation reviews when they are producing at the top of their field. The hospital should not be the one deciding whether the cap is justified.

The physicians most hurt by this are exactly the ones hospitals cannot afford to lose.

Listen to the full conversation on The Podcast by KevinMD. Link in the replies.

Have you seen this cap in your own contract? #ThePodcastbyKevinMD

[Matthew E. Tick, DO @mtick27]

@fakeJohnStocco It’s only April…