Don Peterson

Founder Founder IVX Health, EoY, #60 Inc500.

[Dutch Rojas @DutchRojas]

The trajectory is set.

If nothing changes:

1.Fewer physician-owned practices
2.Higher healthcare costs
3.Weaker innovation
4.Declining access in underserved areas

This is all basic arithmetic.

When you subsidize consolidation,
you get consolidation.

When you penalize independence,
you lose independence.

When you eliminate competition,
prices rise.

Every policy that protects health system margins accelerates this cascade.

340B doesn’t lower drug costs for patients.
Tax exemptions don’t fund charity care.
GME dollars don’t train more physicians.

They fund expansion.
They fund acquisition.
They fund the elimination of alternatives.

The road ahead isn’t uncertain.
It’s inevitable, unless the policy changes.

More like this at The Rojas Report,
where I track how healthcare finance actually works.

[Dutch Rojas @DutchRojas]

In 2010, 80% of physicians owned their practice.
In 2024, less than 20% do.

Where did they go?

They got bought by “nonprofit” hospital systems.

Here’s the playbook:

1) Hospital identifies successful independent practice

2) Hospital offers to “partner” (buy)

3) Physician sells, becomes employee

4) Hospital raises prices 145% for the same services. Thanks @cmsgov

Competition eliminated

The physician gets a salary and a boss.
The patient gets higher bills.
The hospital gets market control.

This is called “vertical integration” in business school.

In healthcare, it’s called Monday.

The Dutch Line:
Every time a nonprofit hospital buys a physician practice, competition dies, and health insurance rise.

They call it “expanding access.”

I call it what it is: consolidation dressed in scrubs.

The hospital called it a partnership.
The physician called it bullshit.
The patient received a 40% premium increase.

Only one of them was surprised.

[Don Peterson @whatscorrect]

The game isn’t overbilling or wrongful denials—it’s that neither side has to commit to anything until weeks after care is delivered. Fines assume you can referee a game where both teams wrote the rulebook. You can’t enforce your way out of a system designed for ambiguity. You have to change the architecture: real-time prospective payment commitment, not retrospective adjudication. Break the information asymmetry, not just the companies.

[Don Peterson @whatscorrect]

@mcuban What’s the point of giving money to patients if no one can tell them at the point of care what it’s going to cost them? If they’re paying the whole thing w/o insurance, sure. If not, no one knows the OOP. No one.

[Don Peterson @whatscorrect]

@DutchRojas While you can’t buy a gas stove in CA w/o the climate folks up your butt, you can monopolize an entire market and no one says a word.

[Don Peterson @whatscorrect]

@GeBaiDC @PBS @NewsHour I ran a multimillion dollar provider organization and we didn’t set any charges, we worked off insurers’ fee schedules. Gross margins were around 15% on accrual basis and maybe 11-12% on a cash basis. Are you suggesting I’ll cut margins even further? No thx.

[Don Peterson @whatscorrect]

@SenRandPaul @POTUS Great policy, Senator. But impossible on todays payer-controlled claims adjudication system. Until all claims are fully processed no way to tell pts what their OOP will be. I've got a fix. https://t.co/aOREMM8LxO

[Don Peterson @whatscorrect]

Good start. Now modernize the payment infrastructure those plans run on. Real-time adjudication. No prior auth. Transparent pricing. That’s when cross-state competition actually works. https://t.co/CNtcYqij8p

[Rand Paul @RandPaul]

“Sen. Rand Paul (R–Ky.) proposes better legislation that expands Americans' access to HSAs and to group health plans offered by all sorts of organizations across state lines.”

https://t.co/JnIMPXSuMS

[Don Peterson @whatscorrect]

You’re dissecting the frog that’s eating America. Of all of the stakeholders in healthcare, hospitals, physicians, patients, employers, and taxpayers, only one stakeholder seems content…insurers. I’m building a new OS for healthcare that will democratize and dismantle this oligarchy. Pray that we do…otherwise, we’ll be dependent on politicians $700M deep in campaign contributions and lobbying.

[Dr. Roger Marshall @RogerMarshallMD]

Insurance companies can be just as bad as the Grinch — my plan cuts the red tape between doctors and insurers and puts patients first.

[Don Peterson @whatscorrect]

@mcuban Right ideas Mark: transparency, affordable prices. The big question is how? What options are there? When? What about https://t.co/CNtcYqhLiR? Healthcare needs a new OS.

[Don Peterson @whatscorrect]

This one doesn’t get enough attention. Community Health Centers are essential infrastructure in communities that would otherwise have nothing. Good to see it in the plan.

[Dr. Roger Marshall @RogerMarshallMD]

There’s no place like home for the holidays — and getting quality healthcare close to home shouldn’t be hard. That’s why investing in community health centers matters for families in every corner of America.

[Dr. Roger Marshall @RogerMarshallMD]

Today I’m introducing The Marshall Plan — a real fix to our broken healthcare system. Republicans are ready to deliver results.

My plan delivers:
✅ Fraud prevention
✅ Price transparency
✅ Lower costs through competition
✅ High-risk reinsurance pools
✅ A 1-year ACA subsidy bridge, then money directly to patients through an HSA

Let’s make healthcare affordable again — for patients, not bureaucrats.

[Don Peterson @whatscorrect]

You assume insurers care how patients pay their out of pocket costs. They don’t care if you have an HSA or you borrow the money from Aunt Mary. More HSA money won’t change payer attitudes. It won’t change provider attitudes either. Aside from a small copay, providers can’t collect from the pt at the time of service all that they might owe bc the claim has not been adjudicated. But as soon as it is, here comes your surprise bill!

[Don Peterson @whatscorrect]

Great question, Mark, and a great idea if providers actually set their own prices…but they don’t. Payers do. The system is the problem. Waste is egregious. $.15 - $.30 of every premium dollar goes to prior auth, claims processing, denial and appeals management. Change the system, change the behavior.

[Don Peterson @whatscorrect]

@mcuban SG’s ministry of health also sets all of the prices. One price from one payer. Providers compete on service and quality. Gov owns all the hospitals. Simple for a city state of a less than a 5 million people. Can it work at scale?

[Don Peterson @whatscorrect]

I’m trying Mark. I’m happy to walk you through how we would eliminate prior auth, code and assemble claims in near real time and initiate payment to the provider in seconds rather than weeks or months. The current system sucks. But until we adopt better, faster payment rails and fraud detection, we’re just throwing point solutions at a huge systemic problem.

[Don Peterson @whatscorrect]

I understand you want to fix it. But the system suffers from antiquated tech that serves only big payers, not patients or providers. The admin waste is egregious. 30-60 day rev cycles are draining private practitioners. Patients pay the price. Modernizing the system would help. https://t.co/m0sdcwGBKT

[Don Peterson @whatscorrect]

The nonprofit tax arbitrage you’re exposing is real—but it’s a symptom, not the root cause. When payment infrastructure requires 60-90 day float, only organizations with municipal bond access can survive. Real-time payment infrastructure eliminates the capital advantage that enables consolidation. The policy fight you’re waging gets easier when the economic moat disappears

[Don Peterson @whatscorrect]

@DutchRojas And how do you propose disrupting it? I’m working on it and would be happy share. https://t.co/7OEHK841hN.