Neurosurgery and Health Policy. Views my own. Co-Host: @DRsLoungePod Author: https://nitter.cf/t.co/yCG1hZyvF9
San Francisco, CA
Joined January 2013
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Anthony DiGiorgio, DO, MHA retweeted
Imagine trying to reduce healthcare costs and outlawing any constraints on healthcare consumption and keeping those ideas in your head simultaneously.
Anthony DiGiorgio, DO, MHA retweeted
Being a conservative sucks because many of us are trying to do what's best for humanity and we are considered worse than hitler by performative leftists who act morally superior when their convictions come entirely from whatever is trending.
Anthony DiGiorgio, DO, MHA retweeted
So I’ve talked about it before on here but now we’ve implemented ‘our’ vision for DPC contracting at our practice. Now before everybody flames me on our price let me explain 1/
🤖 Made with AI
Just remember, @SenSchumer says these hospitals will have a seat at the table while any doctor who asks for payments from patients is vilified.
Few understand just how often American hospitals sue their patients.
In Virginia alone, hospitals and other medical providers sued patients 1.15M times from 2010 to 2024. That's more than 1 in 4 debt collection suits in the state!
More than half of these lawsuits were brought by nonprofit hospitals (yes, the tax-exempt ones).
And hospitals received court orders to garnish their own workers' wages 4,100 times.
Not great!
Reminder that ACA subsidies go to insurance companies. If you like subsidizing insurance companies, that’s fine.
However, there’s a strong argument to be made for putting that $ in people’s pockets and letting them choose how to spend it.
Hospital admin: “here’s an email Friday afternoon with a really urgent coding query you must complete right now!”
Doctor: “this isn’t my patient. Please re route”
Admin: “auto reply; I am out of the office and won’t see your email until I return”
Anthony DiGiorgio, DO, MHA retweeted
I'd personally rather have expensive access than cheap scarcity.
This is what happens when you eliminate the private market for healthcare.
A 13 year old needs to wait 9 months for an mri while in pain.
Yes, the “cover” everyone but they don’t provide access.
Centralized price setting simply doesn't work. Hayek eloquently showed this decades ago, yet we still rely on price setting for how we run US healthcare.
Imagine we paid for food this way. The department of agriculture sets a code for "hamburger" and assigns a price. "Hotdog" "popcorn" "steak" & "glass of red wine" also all recieve codes and fixed prices.
Those prices don't reflect how much people actually want those types of food.
If there's a local shortage of beef, there's no way for the prices paid for beef-based codes adjusts in response. So nobody offers those products any more. The menu only has chicken and rice now.
If steak is in high demand, yet the code for steak doesn't pay enough for restaurants to make money off of selling steak, then there will be no steak for hungry patrons. They're not allowed to raise the price of steak to meet the increased demand or the increased cost of beef.
It also allows for gaming the codes. Some chef comes up with a chunk of meat-type substance that technically meets the defintion of the "steak" code, and all of a sudden he gets paid at the filet mignon rate. Furthermore, a steak from the best chef in the world is sold for the same price as a tough piece of meat from your local bargain chain.
There's no way for restaurants to make more money with higher quality, or for providing an in-demand service. So they make up for it on volume. You only get five minutes at your table. You must book months in advance. If you want dessert, you need a separate reservation.
A key role of dynamic prices is that they help relieve shortages.
Want to know why it takes so long to get an appointment with some doctors? This is why. Prices are set, so independent doctors can't charge more when costs or demand goes up. They can't be used as a signal for new doctors to open up clinics or new firms to invest in infrastructure.
In fact, Medicare payment rates to doctors are about 50% lower than they were in the 1990s. That's a major reason independent clinics are shutting down and being bought by health systems. The payments go down while the costs of running a practice continue to go up.
We need prices in healthcare. It's the moral and ethical thing to do.
CMS just released the new PFS and OPPS rates.
Pretty much every doctor I know is upset about the rates they'll receive.
I'm still aghast that we think central planning and price setting is the way to go.
church.substack.com/p/we-kno…
Medicare for all means doctors get a 2% pay cut every year.
It's annual paycut season for doctors, brought to us by @CMSGov…
And, drumroll…it's a cut. Again.
-2.31% for most of the house of medicine in 2027 on the RVU conversion factor (to $32.63/RVU).
Adjusted for inflation, that's:
A one-year 4.7% decrease,
A 10-year cut of 32.6%,
A 20-year cut of 46%.
Yikes.
Thanks, @RobertKennedyJr.
😬😬😬
Anthony DiGiorgio, DO, MHA retweeted
A new bill, H.R. 10924, opens Medicare to everyone and keeps employer plans on paper.
The fine print: all-payer rate setting. Employer plans and Medicare Advantage would pay doctors at Medicare for America rates.
That is not a choice. That is one fee schedule for every plan.
Commercial rates are the only room a solo practice has above the Medicare floor. Cap them there and the floor becomes the ceiling.
Site-neutral payment in the same bill is fine. Same service, same price, office or hospital outpatient. Keep that. Drop the all-payer Medicare rate cap.
Doctors, residents, med students: email your House member and both senators this week.
Speaking about the costs of childbirth with @nikillinit
The Doctor's Lounge - Mr. Nikhil Krishnan nitter.cf/i/broadcasts/1OGwbnXLz…
The Doctor's Lounge - Mr. Nikhil Krishnan nitter.cf/i/broadcasts/1OGwbnXLz…
I agree with this.
Medicare is insanely complicated. I’ve learned to be pretty darn good at neurosurgery. Learning US healthcare policy is about 100x more difficult.
There's plenty to dislike about insurance companies. But they are not responsible for high insurance premiums. Attacking them just shows economic illiteracy.
Look at @zackcooperYale's work out of Yale. Insurance premiums directly track with healthcare spending.
Want lower insurance premiums? Remove the incentives for large healthcare systems to consolidate and raise prices. That's the #1 driver of your high insurance premiums.
Also contributing: you're being forced to buy a package of services you don't necessarily need. The "essential benefits" include things that most Americans would probably forego if given the choice, especially if it were to drive down their price.
It would be like if the government mandated that auto insurance cover oil changes, tire rotations, and a tank of gas twice a month. Auto insurance premiums would be sky high.
If we are going to have rational conversations about healthcare reform, we have to move beyond the simplistic "insurance companies are bad" pandering.
Key word from headline: enraging.
This is fantastic reporting on the dramatic surge in premiums facing ACA enrollees.
Democrats need to wake up and 1) attack the insurers and 2) articulate a serious plan for a rational universal health care system.
seattletimes.com/business/en…
Cooper's work here for anyone interested: jamanetwork.com/journals/jam…
Anthony DiGiorgio, DO, MHA retweeted
If you don't like private equity in healthcare, then find the actual part of the process where they are wielding force/coercion, or the place where they are actually privatizing benefits while socializing costs, and fix *that*. The real problem might be in, say, bankruptcy law. Or maybe they're somehow abusing the institution of limited liability. Get some legal experts to look at that with an objective eye. But don't just "crack down on private equity" because it's easy to make profit-seeking business people into villains.
Anthony DiGiorgio, DO, MHA retweeted
It’s a Medicare For All plan:
“Establish all-payer rate setting, requiring providers to accept Medicare for America rates from employer plans and Medicare Advantage plans, while increasing payments for primary care and mental health services by at least 30 percent and guaranteeing hospitals in underserved areas get the support they need.”
Here’s a new universal health care proposal from @rosadelauro. Love the all-payer rate setting. delauro.house.gov/media-cent…
