Tom Biuso MD,MBA

Physician Executive and Hospitalist, Associate Clinical Professor of Medicine University of Arizona. Tweets are my own

[Dutch Rojas @DutchRojas]

I love 340B.

As a nonprofit hospital administrator, I consider it one of the great miracles of American healthcare.

It started as a program to help poor patients get access to medicine.

Beautiful.

Then we found the spread.
I buy the drug at the 340B discount.
I bill the commercial plan at the regular rate.

I keep the difference.

The patient gets the deductible.
The employer gets the renewal increase.

The manufacturer gets blamed.
I get a new tower.

That is called mission.

And the best part?
I don’t have to pass the savings to the patient.
I don’t have to pass the savings to the employer.
I don’t have to lower premiums.

I don’t have to prove the vulnerable patient ever saw a dime.

I just say “access” three times, put “community benefit” in the annual report, and everyone nods like I’m running a soup kitchen with oncology margins.

Then came dual classification.
Urban hospital?

No problem.
I’m rural now.

Yes, my hospital is in Manhattan.
Yes, my campus sits on billions of real estate.
Yes, my lobby looks like a Four Seasons.

But on paper?

Country doctor.
Dusty road.
Single stoplight.
Maybe a cow.

That’s the business model.
Rural when I want the subsidy.
Urban when I want the commercial rates.

Nonprofit when I want the tax exemption.
Monopoly when I negotiate with employers.
Charity when Congress asks questions.

Private equity when I buy physician practices.
Wall Street when BlackRock underwrites my bonds.

Mission when the reporter calls.

This is why I love 340B.

Manufacturer must provide the discount.
Employers pays full freight.
Patients pays out of pocket.

I keeps the arbitrage. Then I build a cancer tower and call it hope. Do I pass the 340B discount to the self-funded employer?

No.

Do I pass it to the fully insured commercial plan?
Absolutely not.

Do I use it to make healthcare cheaper?
Please.

I’m a nonprofit hospital administrator.
Not a threat to my own margin.

In 2024, 340B purchases hit $81.4 billion.

That’s scale.
I call it stewardship.
And I serve vulnerable populations.

Use the correct language.
Now excuse me.

I have to explain why my nonprofit hospital needs another tax exemption, another rate increase, another physician acquisition, another rural designation, and another debt issuance.

The poor are counting on me.
I love the US taxpayer…

[Tom Biuso MD,MBA @tbiuso1]

@DrBruggeman If you look at where CMS is going - site neutrality, ACO participation, data driven Part B changes, prospective primary care payment, MEI linked reform is pro physician and moves us away from failed RBRVS patchwork over years @anish_koka.

[Tom Biuso MD,MBA @tbiuso1]

Scaling and optimizing Hospital at Home #HaH has clinical, regulatory and operational challenges but could have quite an impact on healthcare ecosystem especially in value based arrangement
https://t.co/W8KEfuYTQk

[Tom Biuso MD,MBA @tbiuso1]

@HEALTHCOSTtruth @statesdj Where is legislation at in this #340B scam?

[Tom Biuso MD,MBA @tbiuso1]

@jwhite_health And the ownership @jwhite is also cross markets. At the same time the number of health system claiming nonprofit status has skyrocketed over the least few years. Payers in the commercial world are still reimbursing at percent billed charges to large consolidated systems.

[Tom Biuso MD,MBA @tbiuso1]

@DrugChannels @statesdj @DrDiGiorgio And one more @DrDiGiorgio An echo with employed health system cardiologist much more expensive than in independent office or how about MRI at hospital compared to outside hospital setting. Not a direct tax to patient but we all pay because of these outrageous reimbursements

[Tom Biuso MD,MBA @tbiuso1]

@mcuban Most hospitals use the ratio of charges to cost which is full of distortions. The best health systems use TDABC and the CFO knows that a Dual patient admission, for example, can cost 40x more, than a commercial patient. You can’t direct contract if you don’t know your costs.

[Tom Biuso MD,MBA @tbiuso1]

@JudiciaryGOP @boback Both MLB and the Match are monopsonies - single buyer of labor with antitrust exemption. Residents have debt from medical school and work long hours for small wages. Meanwhile college athletes make millions (NIL).

[Tom Biuso MD,MBA @tbiuso1]

@anish_koka GME expansion in the academic world does not necessarily pay off in workforce retention or quality even when the level of support is above the residency cap. GME incentives are perverse much like the rest of healthcare

[Tom Biuso MD,MBA @tbiuso1]

@ashishkjha @BostonGlobe It’s both. Look at Dartmouth atlas. Also you are using charges. It is more complicated than what you wrote

[Tom Biuso MD,MBA @tbiuso1]

@DutchRojas Reference?

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

My thoughts for reform here:

https://t.co/ayp1WWjhW6

[Tom Biuso MD,MBA @tbiuso1]

@BojanRadojici10 plz share

[Tom Biuso MD,MBA @tbiuso1]

https://t.co/2mTEVLrGD4
This recently published study backs up what we already knew. Length of stay in the hospital is prolonged by Medicare Advantage Plans vs. FFS Medicare. Good discussion in the conclusions

[Tom Biuso MD,MBA @tbiuso1]

https://t.co/u9nwhM6pGw

Azelastine nasal spray may prevent Covid infection in a prophylactic setting

[Tom Biuso MD,MBA @tbiuso1]

https://t.co/j9XXJNwc1N

Covid mRNA vaccine sensitizes tumors to immune checkpoint blockade and survival significantly better in melanoma and NSCLC patients.
Prior research also shows how the gut microbiome plays a crucial role in how the immune system responds to ICB therapy

[Tom Biuso MD,MBA @tbiuso1]

https://t.co/KrV9zWgQXu

This is very powerful and can be revolutionary. It is price transparency with respect to a hospital bill from the patient’s perspective.

[Tom Biuso MD,MBA @tbiuso1]

@creatorschmidt excellent

[Tom Biuso MD,MBA @tbiuso1]

@GrantHesser Skeptical at best. And how did they measure depression by claiming 50% less. Smoke and mirrors.

[Tom Biuso MD,MBA @tbiuso1]

https://t.co/SDBx6Y9FTo
Frank discussion from payers and those on revenue cycle management side on the huge divide between payers and physicians