Anthony DiGiorgio, DO, MHA

The actual take is that providers have been being underpaid (punished) for being more interested in the patient than the code. Hard to call it inflation when it's just AI helping providers get paid accurately for the first time. Hospital price inflation is the primary driver of healthcare inflation. Not AI helping physicians document accurately.

Actually no because over half of seniors choose Medicare Advantage plans because the cost of government operated Medicare costs too much. Private companies are winning over 55% of the market from $0 premiums & caps on out of pocket. Medicare often requires Medigap.

@MohammedAlo I gave you about 8 things Medicare does to make life worse for doctors, feel free to push back wherever you'd like.

@DrDiGiorgio Happy to get into this. What specifically would you push back on, or what can I clarify? Glad to walk through the evidence with you.

Ro I deal with Medicare every day. Private insurance, free of Medicare’s copious rules and regulations, is far preferable. Ask any doctor who dropped Medicare. Their compliance costs decreased 90%.

@MohammedAlo And Medicare forces you to use CPT coding rules, NCCI edits, MACs, claim scrubbers, submit quality metrics, prohibit you from charging cash prices, force you to follow Stark regulations, prohibit you from owning a hospital...

@DrDiGiorgio I think you have it backwards. Medicare pays immediately, within 30 days, and you almost never need to do prior auths. It's the commercial insurances that never pay, pay after 90 days, and require prior auths.

@SebastianCaliri Well the bird is also a 340B CE so it can generate spread on the financial arbitrage of part B medications...

@DrDiGiorgio Yes with the important caveat that the drinking bird is sold by an LGBTQ+ firm and somehow involves Ilhan Omar becoming very rich

Medicare uses a 1979 COBOL-based mainframe system for processing payments. It isn’t really capable of assessing medical necessity before paying claims, which is partly why there is so much fraud, waste, and abuse. So Medicare is definitely better for criminal fraudsters. Ro should feel free to clarify that he meant “better” for committing fraud, not taxpayers or beneficiaries. Thankfully this administration is investing in overhauling this crucial system, which processes ~1.5% of GDP.

@fuqekgs you got this

My picture at the testing center right before one of the biggest exams of my life

@alohacowboysol Yeah who doesn’t want a potential felony held over you for each bill you drop

@DrDiGiorgio Not to mention that billing disputes with medicare can end in massive clawbacks or felony charges…

@ChasingNewLife @RoKhanna Excellent perspective

@DrDiGiorgio @RoKhanna, I opened a non-medicare hospital that was still accredited by CIHQ. I can concur with this from a hospital perspective as well.

@SBlake2000 @pgipe Because there’s no residual claimant and no price signals. Any hospital or physician who meets conditions of participation gets to bill the system.

@pgipe @DrDiGiorgio Yes. I suppose I am just wondering what the mindset was that said, oh, Medicare needs all these extra regulations that had not occurred to the private insurers.

@BDubati You have no idea what it’s like rounding on patients, doing surgery, and running a clinic when you’re getting pinged every 30 seconds. The chats are intrusive and the “just fyi” text is marked with the same urgency that the “patient is literally dying” text is.

@DrDiGiorgio You lose the argument by getting personal.

Imagine if every passenger on an airplane had a direct line to the pilot. That’s what medicine has become. We have embraced frictionless communication and that not a good thing. With things like Epic Chat, every member of the healthcare team has immediate access to the physician. Now there’s a constant stream of minor questions. It’s discouraged people from thinking critically. “Just ask the doctor,” has replaced any sort of clinical reasoning. When I was a resident, we had an answering service. Anyone who wanted to reach the doctor needed to go through a third party. This provided triage and accountability. If we were getting called in the middle of the night for stool softener orders, there was a record of that. A little friction in communication is a good thing.

@BDubati How many patients have you taken care of?

@DrDiGiorgio The relationship between a pilot and the passengers is not in any way analogous to the relationship between a doctor and his patients. Pilots are not individually flying passengers out. Pilots never even know the names of their passengers. The analogy does not work at any level

@CanesDavid @txsportsdoc @RojaGarimella @WellPrept

The native memory in codex or claude is… just ok. It remembers what it remembers about you, your jobs, your projects, your home etc I had it create and maintain an obsidian vault. You get back what you put in (it takes a lot of work logging everything) But once you do it becomes a wonderful partner. Creatively for knowledge work… keeps track of all my to do’s. Best part is I can use any harness. So long as I point it to this vault, it knows everything I need it to know about every important domain in my life. Only rule: no PHI in there.

paid $500 in Claude overages last week. worth every penny. a friend in medicine recently told me they saw no reason to sign up because “why would i pay for AI?” the chasm is here.

@BDubati Like I said, you wouldn’t want the passengers and flight attendants messaging the pilot every 30 seconds all flight.

@DrDiGiorgio Chat platforms are asynchronous, just like email. People might send messages to you, you don't have to read or respond immediately except for those marked Urgent by sender. Chat has democratized (small-d) access and is universal now, all fields and professions.

@CanesDavid @txsportsdoc @RojaGarimella @WellPrept How did you set that up? I’ve been struggling getting one to work with codex.

@txsportsdoc @RojaGarimella Running @WellPrept is the main thing. But it has become a central hub for coordinating my entire life. Like the most knowledgeable personal assistant who never forgets.

@SBlake2000 About 800 pages of federally mandated regulations.

@DrDiGiorgio Yes. But what is it about Medicare that makes it so much more burdensome than private insurance?

@BDubati Not patients. Epic chat with no filter. Do you like if your doctor is interrupted every 30 seconds while they’re trying to talk to you?

@DrDiGiorgio I'm very sympathetic to the travails of physicians in modern medicine. But, this is not a good look "Waah, people want to talk to me" is a bad look for a doctor. First thought that comes to mind "God complex" Pilot analogy is ridiculous. Doctors aren't treating patients in bulk

@THEdylanhansel You didn’t answer this one. And how is it clearly motivated? I admitted I didn’t know his motivation. You seem so sure of it. Are you a mind reader?

@DrDiGiorgio I answered your question. You didn’t ask another one 😂😂 But it doesn’t surprise me that you sidestepped it It’s clearly motivated lmfao

Anyone defending the losers who wrote on the pride hats is an absolute loser. They were permitted to, and could have, simply worn normal hats But know, they wanted to act out and specifically spit on the faces of a marginalized group So much for “love thy neighbor”

@THEdylanhansel I don’t know why it’s the first time but that alone is not enough of a reason to think it’s motivated by hate especially given the verse in question. Now answer my question.

@DrDiGiorgio Generally sure. I have one tattooed on me. But in this context it’s different Now it’s your turn to answer my question