SnotDoc

Ear, Nose and Throat surgeon specializing in minimally invasive in-office sinus solutions. Ideas discussed here are just mine as I call it like I see it.

[SnotDoc @PowellENT]

Great synopsis of how Government regulations have driven up healthcare costs and hospitals have found loopholes and paths to make more profit while patient costs go up.

https://t.co/bEu6pdyBnU

[SnotDoc @PowellENT]

Haugh returning to Florida; NCAA loss 'lit a fire' - via @ESPN App https://t.co/gCr9INVjZ6

[Sun Devil Beach VB @SunDevilBeachVB]

Welcome to Tempe, McKenna Flaherty! 🔱

McKenna is a senior transfer from Florida State!

#SandDevils /// #ForksUp

[Josh Hawley @HawleyMO]

You can’t argue with the return on Nancy Pelosi’s time in Congress.

She outperformed the S&P 500 by more than double in 2024

Time to pass my PELOSI Act and ban congressional stock trading
https://t.co/aJk0MPaWPP

[Ron DeSantis @RonDeSantis]

I agree — let student loans be dischargeable in bankruptcy and make the universities liable for the default.

[SnotDoc @PowellENT]

Coincidence?

[Nancy Pelosi Stock Tracker ♟ @pelositracker]

This again is why we track the politicians ✍️

Back in January, Rep. Brad Knott (R) bought ~$30K of CompoSecure $CMPO

We flagged it as "notable" for three reasons

1. First time a Politician ever bought $CMPO
2. Only had a market cap of $1.2B
3. His brother sits on the board

Well congrats to those who got in bc since his first buy, the stock is +54%

[SnotDoc @PowellENT]

Well the line in the sand has been made

[Dutch Rojas @DutchRojas]

Top 5 Physician Takeaways from the CMS 2026 Analysis:

1. “The Writing is on the Wall for Independent Practice”

The 0.5% payment differential between APM and non-APM physicians, combined with the 2.5% efficiency cuts, makes it mathematically clear that CMS is systematically making independence financially unsustainable. Physicians see this as confirmation that the regulatory environment is designed to force consolidation.

2. “Hospital-Based Work is No Longer Viable for Independent Docs”

The 8-9% cuts to facility-based care for internal medicine, family practice, and nurse practitioners mean independent physicians can no longer afford to do hospital rounds, SNF visits, or facility-based procedures. This forces a choice: abandon these services or join a hospital system that can absorb the losses.

3. “2027 Will Be the Real Crisis Year”

While 2026 has temporary relief from the 2.5% increase, physicians understand this expires December 31, 2026. Combined with returning PAYGO cuts and sequestration, 2027 could bring devastating payment reductions that will trigger a wave of practice sales and closures.

4. “APM Participation is Becoming Mandatory, Not Optional”

The two-tier payment system makes it clear that physicians who don’t participate in Advanced Alternative Payment Models will be systematically penalized. However, most independent practices lack the infrastructure and patient volume to qualify for these programs, creating a catch-22.

5. “Traditional Practice Models Need Immediate Strategic Pivots”

Physicians recognize they need alternative strategies beyond the traditional “sell to hospital vs. sell to private equity” options. This includes exploring MSOs, physician coalitions, direct-pay models, or other collaborative arrangements that can provide scale while preserving autonomy.

The overarching physician reaction would likely be: “This confirms what we’ve been feeling, the system is rigged against independence, and we need to act now before 2027 makes the decision for us.”

Big decisions to be made.
Fight or fold.
Which one will it be?

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

I love when smug healthcare policy wonks throw out that old “Medicare and Medicaid only have 2–5% administrative costs” line, as if it’s gospel truth and not a completely misleading stat from a 2011 Health Affairs article.

Let’s unpack this nonsense because it violates basic economic logic.

In what world does a centrally planned, government-run bureaucracy more efficient than a private competitive market? True efficiency requires price signals, profit/loss, and competition. This is econ 101. Medicare/Medicaid lack all of these things.

So lets think more about that 2-5% figure that keeps getting thrown about. You know what it's based on?

CMS's administrative budget.

That's it.

It leaves out the following:
- Physician time on documentation for CPT compliance, ICD coding, and submitting claims.
-Physician compliance with MIPS quality metrics
-Hospital staff requirements for submitting claims, auditing charts for maximum DRG capture, coding queries, quality metrics, star ratings, bundled payment compliance, readmission tracking, etc
- The entire RUC/CPT process which involves four annual meetings a year with hundreds of doctors.
- Licensing fees for CPT
- EMR and meaningful use mandates
- CMMI demo projects

And, last, but most importantly, most of Medicare and Medicaid are now administered by private insurance.

So to claim that Medicare/Medicaid has lower administrative cost than private insurance assumes that these private insurers somehow operate MORE efficiently when taking capitated payments from the government. Not only is this a ridiculous notion, the insurance companies also need to comply with the various regulations, such as quality metric reporting, star-ratings, MLR reporting and the hundreds of other compliance regulations needed to get capitated government payments.

So when people keep saying popping up and saying "well AKSHUALLY it's way more efficient to just have the government run the program."

Remind them it only appears efficient because CMS makes everyone else do the work.

[Dutch Rojas @DutchRojas]

Oh no. RFK Jr. did something crazy.

He fired seventeen members of the Advisory Committee on Immunization Practices.

And everyone in the pharmacy bought lost their minds.

Like he canceled vaccines.
No. He just canceled them.

These people are acting like he just burned down the CDC.
He didn’t.
He just told seventeen lifelong bureaucrats, “Hey, maybe you shouldn’t be on the panel recommending vaccine schedules while you’re funded by the companies that make them.”

And now it’s like Apocalypse Now in the group chats at Brown and Harvard. “THIS IS AN ATTACK ON SCIENCE.”

No, Susan. It’s an attack on your Marriott points from attending 35 junket conferences per year while pretending your job is “science advisor.”

You ever seen who sits on these committees? Watch the videos on X!

It’s not your small-town pediatrician.
It’s professional grant-chasers.
It’s deans of public health programs whose universities rake in billions from NIH and pharma-adjacent contracts.

These people don’t run clinics.
They run PowerPoints.
They know more about indirect cost recovery than they do about children’s immune systems.

RFK Jr. shows up and goes, “Maybe a panel that controls national vaccine policy shouldn’t be 90% made up of people with NIH addiction and pharma side hustles.”

And they act like he’s banning penicillin.

“BUT WHAT ABOUT THE EXPERTISE!?”

What expertise?
The expertise to build a career pretending to be neutral while taking funding from Pfizer, Moderna, the Gates Foundation, and three alphabet soup think tanks in DC?

Come on.
This wasn’t a committee.
It was the VIP lounge for the academic cartel.

They thought they had diplomatic immunity. RFK Jr. walked in like a substitute teacher with a flamethrower and said, “Hey—class dismissed.”

And now all the usual suspects are weeping into their NPR tote bags:
“Oh, this is dangerous… we’re losing trust in the system!”

Buddy, the trust is already gone.
You just finally met someone who doesn’t need your approval to tell the truth.

You want to talk about dangerous?
How about locking parents out of medical decisions, pushing one-size-fits-all mandates, and then calling anyone who disagrees a fascist?

How about crafting public health policy at invitation-only Aspen retreats with corporate sponsors and calling it “evidence-based medicine”?

RFK didn’t break the system.
He just exposed that it’s already broken and funded by the people who benefit most from keeping it that way.

So now the grifters are furious. The academic elites!
The conference invites are drying up.
No more free dinners at The Capital Grille with the Glaxo reps.

Just angry Slack channels and sad LinkedIn updates that say:
“Former ACIP member. Advocate for evidence-based policy. Open to work.”

[SnotDoc @PowellENT]

Maybe why UHC is in free fall 🤷🏻‍♂️🙏🏼

[Real Doc Speaks @realdocspeaks]

This EO gets rid of the PBMs according to @realRFKJr.

Calling out the PBMs by name sends a compelling message!

I am all in favor of getting rid of the PBMs and keeping the independent pharmacies!

[Mark Cuban @mcuban]

Charlie , you aren't close. Drug prices are too damn high. But the big culprit isn't the brand manufacturers, it's the big middlemen. Namely PBMs. They work so hard to distort pricing the first lines in their contracts with everyone is "you can't disclose any of this "

How bad are they , have you ever seen them disclose a net price list ?

For your company Charlie, ask your PBM for a list of claims and the price paid for each med.

Let us know if you can get them

This EO has a real shot. And big pharma isn't innocent. But it's the PBMs that have screwed things up

Separate formularies from jem and make them disclose all claims to employers and manufacturers and we may be able to get brand meds cheaper than many countries

[Congressman Greg Murphy, M.D. @RepGregMurphy]

Going after high drug costs means going after PBM’s owned by insurance companies. THEY are the real cause of high drug prices.

[Dutch Rojas @DutchRojas]

Blue Cross Blue Shield of Michigan made $36.3 billion last year.

Did you know Blue Cross Blue Shield of Michigan is a NON PROFIT?

Their CEO walked with $15.7 million.

Charity grants to clinics?
$914,000.

Let’s talk about the nonprofit lie in healthcare.

A thread...🧵

[SnotDoc @PowellENT]

@nickmmark https://t.co/XnkPbAAhaw

Rare but not alone. Peter Attia did this as well. Same reasons.

[Dr. Glaucomflecken @DGlaucomflecken]

New law: Every time you say physicians just push pills and don't care about their patient's health, you have to do 8 hours of state-mandated shadowing of a family physician.

[SnotDoc @PowellENT]

@MdBreathe Yes

[SnotDoc @PowellENT]

Corruption?

[Wall Street Apes @WallStreetApes]

American surgeon records herself doing a “peer to peer” call with UnitedHealthcare trying to get a patients surgery approved

- UnitedHealthcare refuses to give any of their doctors names who makes decisions
- The doctor doesn’t specialize in surgery that’s being requested
- She asks for the determination paperwork of how UnitedHealthcare determined the patient shouldn’t get the surgery, UnitedHealthcare won’t provide that information
- UnitedHealthcare tells the surgeon to do an “internal appeal” but won’t provide any details on their determination

So to recap: UnitedHealthcare denies patients, their surgeon calls and can’t get a name, a specialty, or any details whatsoever regarding the denial

This is the state of American Healthcare

[SnotDoc @PowellENT]

Has to stop

[Ed Gaines @EdGainesIII]

Remarkable that @UHC will not allow their internal physician to give their name, their specialty and/or provide the data & basis for their denial decision. This is what the health plans do & then we all have to appeal. 1/3 of claims are denied, a substantial portion of those denials are not followed up on and then go straight to the plans’ bottom line.

[SnotDoc @PowellENT]

@NUCLRGOLF Tempo tempo tempo

[Florida Gators Men’s Basketball @GatorsMBK]

YOUR 2025 NATIONAL CHAMPIONS.