Mike Tchou

Pediatrician | hospitalist | improving value and reducing healthcare costs | data & science | #QILIFE | equity | environment & climate | #dadjokes | he/him

[The Lincoln Project @ProjectLincoln]

Blaming Democrats for a shutdown when you control the House, Senate, and the White House only proves you can't govern.

[Mike Tchou @TchouMd]

@SocietyHospMed @PHMConf Will Rainbow Mickey make a return appearance? #PHM25

[Society of Hospital Medicine @SocietyHospMed]

Who’s ready for #PHM25?! 🙋 Join us this Thursday, July 24th to kick things off in Anaheim, CA! See why your peds hospitalist peers attend @PHMConf. ⤵️
https://t.co/Gv4WgWt7WY

[PHM Conference @PHMConf]

Have you downloaded the conference app yet?

Download the SHMConnect app

Open the app and select the event PHM 2025

Confirm your selection by clicking the "Select This Event" button

Unlock the PHM 2025 event with the passcode sent to your email when you registered!

#PHM25

[Jon Lovett @jonlovett]

I know we're having fun, but imagine how much MORE fun it would be to live in a functioning democracy where two fragile billionaires crashing out didn't impact, say, rural hospital closures.

[Deborah Greenhouse @greenhousemd]

As we all share in the political comedy playing out today, I'd like to take a serious moment to remind everyone in South Carolina that @AnnieAndrewsMD is running for US Senate.
And she actually truly wants to help people in South Carolina.

[Dr. Annie Andrews @AnnieAndrewsMD]

I'm Dr. Annie Andrews. I’m a pediatrician, not a politician. But either way I know how to handle people who are full of sh*t.

Today I am announcing my campaign for US Senate to replace Lindsey Graham. RT if you're with me.

[Judgmental Jim @Judgmental_Jim]

It’s Colorado rapids tradition to risk dying of hyperthermia to watch the first game of the year

Nuff said

[Pete Buttigieg @PeteButtigieg]

Incompetence in Washington puts every American at risk, no matter how you voted. No one should be happy that the DOGE team - the same folks who randomly published classified U.S. security information online today - wants access to your bank account & Social Security numbers.

[Dr. Annie Andrews @AnnieAndrewsMD]

People who spend their careers writing NIH grants are the literal opposite of grifters.

It is a soul-sucking, brutal process.

The scientists don’t get rich when they get funded. Their salary doesn’t change.

They do it for science. For patients.

You know, to make 🇺🇸healthy.

[Joe Thomas, MD, FHM @DocWithBowtie]

Never forget that when Michelle Obama tried to increase access to healthy foods in school lunches, she got crucified by Republican politicians for government overreach, but when RFK Jr talks about changing additives without any impact except to make food more $$$, he’s heralded.

[Mike Tchou @TchouMd]

@DocWithBowtie Congratulations!!!

[Sean Casten @SeanCasten]

To all those saying "shouldn't we root out government inefficiency? What's wrong with DOGE?" a quick background on Constitutional law and why the WAY it is being violated exposes the true motives of the criminals:

[Jay Giri @jaygirimd]

🧵 Many “hot takes” about the reduction of @NIH indirect grant costs to 15%.

Let’s lay out the facts about the university grant management process & accounting. And then use this to project likely short and longer term impacts of the policy.

[Adam Grant @AdamMGrant]

A reliable way to boost cognitive functioning: Go to the gym.

383 studies: Exercise improves attention, memory, and information processing. It’s true across age groups and different types of workouts.

Physical activity is good for the mind. Moving sharpens thinking.

[Jesse Ferguson @JesseFFerguson]

Musk, Trump and the GOP are getting results.

Hope they're proud.

[Democratic Wins Media @DemocraticWins]

BREAKING: In a stunning moment, Congressman Steven Horsford just demolished Donald Trump and Elon Musk for increasing the prices of eggs, groceries, and toys while dismembering the United States Government. The Democratic resistance is growing.

[Spencer Beswick @spencerbeswick]

Howard Zinn: "To be hopeful in bad times is not just foolishly romantic. It is based on the fact that human history is a history not only of cruelty, but also of compassion, sacrifice, courage, kindness. 1/4

[John Asghar @JahangirAsgha10]

My favorite term to describe healthcare in the US…DISECONOMIES OF SCALE

This occurs when an organization grows so large that the cost per unit of production increases, rather than decreases, due to inefficiencies.

This concept contrasts with economies of scale, where increased size reduces costs through efficiencies like bulk purchasing or shared resources.

Diseconomies of Scale in Healthcare

In the context of healthcare, as corporations consolidate (e.g., hospital systems merging, private equity buying practices), they often aim to achieve economies of scale by pooling resources, reducing redundancies, and increasing purchasing power. However, this consolidation can lead to diseconomies of scale due to several factors:
1.Administrative Complexity: Larger organizations require more layers of management, which can slow decision-making and increase bureaucratic costs.
2.Loss of Personalized Care: As healthcare systems grow, they may focus on standardized processes, potentially compromising individualized patient care and reducing patient satisfaction.
3.Reduced Provider Autonomy: Consolidation often means tighter control over how providers practice, leading to dissatisfaction, burnout, and inefficiencies as healthcare professionals navigate additional layers of oversight.
4.Inefficiency from Overcentralization: Large organizations may centralize decision-making to the point that it disconnects leadership from the unique needs of local facilities or patient populations.
5.Increased Pricing Without Improved Quality: Consolidated entities may wield monopolistic pricing power, driving up costs for patients and payers without necessarily improving care quality or access.

Government Intervention and Diseconomies of Scale

Government policies can exacerbate or mitigate the effects of diseconomies of scale in healthcare consolidation:
1.Exacerbation Through Policy:
•Regulatory Burdens: Increased regulatory requirements (e.g., reporting, compliance with payment reforms) may disproportionately impact larger organizations, which face more complexity in implementation.
•Fee-For-Service vs. Value-Based Care: Transitioning to value-based care may demand significant investments in infrastructure (e.g., IT, analytics), which larger systems struggle to implement efficiently across diverse sites.

healthcare consolidation seeks to leverage economies of scale. However, it often leads to diseconomies due to administrative inefficiencies, loss of patient-centered care, and monopolistic behavior.