Jeremie Perry

Iran Coverage The headlines abound: Iran Regime doing well, in control Trump under pressure to end war Khomeini son just as tough as Father US responsible for missile on school One headline after another essentially featuring Iranian propaganda as the news. Where are the headlines: 50 Iranian ships sunk Iranian military assets destroyed Leadership tries to put on good showing despite internal chaos Khomeini appointment creates hereditary theocracy War plan progress unprecedented The press is a drumbeat of negativity favoring the Iran regime. It’s puzzling at this point how any success is buried. The reality is likely the regime is being pummeled on all sides and has no ability to provide for its people. Maybe it can put on a good show for another week or two but its leadership is under immense pressure. But that’s not what the American public is getting from mainstream media.

Leadership should be judged on facts and service. @szaafran has dedicated his career to patient care and upholding the mission of the Texas Medical Board. The reporting confirms there is no evidence of wrongdoing, the title of the article draws attention, but ultimately to a non story by @DallasExpress. Texas patients deserve strong physician leadership, and Dr. Zaafran’s record reflects exactly that. @texmed @TSAPhysicians @ASAGrassroots @ASALifeline dallasexpress.com/state/texas-me…

@EdithaTogo @DrDiGiorgio @SchillerLeanne Its called a medical loss ratio. Congress in their lack if wisdom said insurance companies can only make a 15% profit on their total premiums. But if they overpay for everything and then pass it on in premiums 15% of 1 Billion is 10x what 15% of 100 Million is.

@DrDiGiorgio @SchillerLeanne Why are the insurers agreeing to pay that? Are they prohibited from negotiating? Australia prohibits private hospitals and insurers from negotiating the price of medical services. Not sure why. But it's chips compared with that- health.gov.au/our-work/reduc….

Skeptics claim no hospital would charge $18k for a $500 MRI, yet @SchillerLeanne here brought the receipts. Of course, these aren't real numbers. They're artificially inflated so the hospital can claim it's giving the insurance company a "deal" when it charges less than that. But as a patient, your copay is likely on the full amount. Many patients would pay less than their copay if they just go down the street to an independent imaging center. The same goes for every doctor's visit, lab, or procedure.

@DavidIAuerbach @DrBruggeman 3x medicare = 0.8x network rates in some cases so if network rates decline to where this bill puts them (medicare as the limitation) you would be creating a license threatening penalty for physicians who bill even 1x current network rates.

@DrBruggeman The QPA may be below in network rates by 10-15%. So why does a cap at 300% of the QPA seem unreasonable to you? If all rates were paid that high then you’re almost tripling health insurance premiums which are currently $30k/yr.

BCBS Arizona is sneaking in a new Arizona bill (H.B. 2211) after losing a significant number of federal IDR arbitrations under the No Surprises Act. The bill would make it “unprofessional conduct” (and subject to licensing board discipline) for a physician to offer more than 3X the Qualifying Payment Amount (QPA) or 3X Medicare in federal arbitration. Think about that for a minute… Congress deliberately rejected fixed payment caps when drafting the bipartisan No Surprises Act. Instead, lawmakers created independent arbitration so neutral decision-makers could weigh all relevant factors and determine fair payment case by case. H.B. 2211 attempts to override that framework at the state level by capping arbitration offers and threatening physicians’ licenses for fully participating in a federally established process. The QPA itself has repeatedly been shown to understate true median in-network rates. Capping offers at 3X a benchmark that may already be significantly depressed effectively allows insurers to dictate rates while penalizing physicians who challenge them. Tomorrow, @IndeMedAction will submit formal opposition ahead of the House Appropriations hearing. As of tonight’s registration, there are 2 in favor — both BCBS representatives — and 137 opposed — including frontline physicians, nurses, CRNAs, and major Arizona physician organizations This doesn’t fix a broken system. It undermines one that is working for patients. Stay tuned for our full statement tomorrow.

@RasmusJarlov @BillAckman Yeah - a bunch of Democrats said this before the 2016 and 2024 elections. Never say never.

@BillAckman Greenland is not for sale and never will be. Not a single member of parlament wants to sell. It is never ever going to happen.

The United States is about to grow by 22%. The biggest real estate deal ever.

Same goes for all male mammals

@ScottAdamsSays RIP @ScottAdamsSays

A Final Message From Scott Adams

Testimonial Tuesday: “We have roughly 50,000 anesthesiologists in America. If only 20% of them (10,000) would just pick up one legislator as their friend, we would easily beat the billionaire-financed lobbyists.” – H.A. Tillmann Hein, MD, PhD, FASA

@AnthemBCBS, a/k/a @ElevanceHealth or whatever they call themselves this week, has responded to the AHA letter in opposition to Anthem's announcement in Nov. 2025 that beginning 1/1/26 that it "may" reduce hospital reimbursements by -10% for each hospital based group who is out of network (OON) or will become OON. The AHA and Federation letter is here: aha.org/lettercomment/… In classic Anthem fashion, it is blaming physicians for in essence refusing their low ball offers & unfair/illegal claim adjudication practices, going OON and filing IDRs. Facts are stubborn things. CMS data shows that the plans are losing 85-90+% of the IDRs which means they are paying the clinicians and for the adjudicator's fee in "baseball arbitration." If you were playing sports and losing 90% of the games, wouldn't you say that the system is rigged? Anthem claims that for certain categories the IDR awards are 9X of the initial payment. Is there a suggestion here that if they paid fair in network rates that the volume of IDRs would decline + that clinicians want to be in network at fair rates--better for all concerned? Not to Anthem--introspection is not their jam. A warning to the physician and supporting advocacy community: Anthem and other plans including the BCBS Association and AHIP are building the narrative that the IDR process has to be substantially reformed or eliminated entirely or else the consumers will pay for the additional costs. Of course, not a word about their billions in profits which would have been multiples of those profits if the law had been written as they advocated for it--benchmarking to Medicare or other rates determined solely by the health plans with no IDR process (the House Energy and Commerce bill in 2019). @drdanchoi @DrBruggeman @mass_marion @PPA_USA @ahahospitals @DrAlexUrology @AmerMedicalAssn @RadiologyACR @ACEPAdvocacy

'He has a point, but he's too blunt.' From the start, a key tactic of the gender identitarians has been linguistic prescription, and it's proved shockingly successful. Trans activists' shibboleths and euphemisms have been allowed to penetrate the upper echelons of our culture with devastating consequences to freedom of speech and belief. Huge swathes of liberal media, the arts, academia and publishing have thrown themselves with gusto into the defence of a quasi-religious belief causing provable real world harm, and in their arrogance they've been outraged when people they assumed were part of their In Group have refused to march meekly along in lock step. Time and again, I've seen and heard well-educated people who consider themselves critical thinkers and bold truth-tellers squirm when put on the spot. 'Well, yes, maybe there's something in what you're saying, but it's hateful/provocative/rude not to use the approved language/pretend people can literally change sex/keep drawing attention to medical malpractice or opportunistic sexual predators. Why can't you be nice? Why won't you pretend? We thought you were one of us! Don't you realise we have sophisticated new words and phrases these days that obviate the necessity of thinking any of this through?' As the vibe shifts, and a lot of people in the elite professions start trying to reposition themselves, the obvious place to start is, 'it's not that I couldn't see your point, but did you have to say it that way?' We dissenters were supposed to find a way of questioning the chemical castration of children while calling it 'gender affirming care.' We were meant to defend the rights of vulnerable women while also using female pronouns for male rapists. We should have found a way to discuss fairness for women and girls in sport, while pretending that the ineradicable physical advantage men have over women doesn't exist. Either a man can be a woman, or he can't. Either women deserve rights, or they don't. Either there's a provable medical benefit to transitioning children, or there isn't. Either you're on the side of a totalitarian ideology that seeks to impose falsehoods on society through the threat of ostracisation, shaming and violence, or you're not. The alternative to being 'blunt' - using accurate, factual language to describe what was going on - was to surrender freedom of speech and espouse ideological jargon that obfuscated the issues and the harms caused. We've always needed blunt people, but we need them most of all when being asked to bow down to a naked emperor.

The TSA is thrilled to win the Alabama Cup this year for our chapters contributions to the ASAPAC!

So many of us felt the absence of Dr. George Williams at #TXAnes25 this past week/weekend. Though he is no longer with us, his presence and impact are still felt by so many in the anesthesiology community. Wearing a bow tie in his honor is just one way to keep his memory alive. We will forever miss his smiling face and perfectly placed bow tie. Our thoughts are with his family, friends & all who knew him during this difficult time.

New: @JayHardaway, a former Abilene city councilman and once-staffer for @RepArrington & @RepStanLambert, has filed a CTA to run in #HD71. Lambert announced this morning he will not seek re-election next year. #txlege

I'll be attending the amazing TSA Annual Meeting. Let me know if you're planning to attend so that we can say Hi! 👋 Or register now and join me at the event! whova.com/portal/registr… #TXAnes25 - via #Whova event app whova.com/portal/registr…

It’s an incredible honor to be the chair of the @TSAPhysicians Education Committee. We have a fantastic CME lineup with amazing speakers from all across Texas. I hope you consider attending the 2025 meeting at the @JWSanAntonio! @CRCook1978 @ZachJonesForTX

Camille, Vivian and I are now reunited with Caroline and Juliana who were evacuated from Camp Mystic. The last day has brought unimaginable grief to many families and we mourn with them as well as holding out hope for survivors. We want to thank the first responders who have come from far and wide to save lives. The TX Division of Emergency Management has been incredible and the White House, DHS, FEMA, DPS and local officials have all been responsive and helpful. Please join us today as we pray for miracles.

Genius move by United…. We already have a hard time getting anesthesia coverage for surgeries. By placing further downward pressure on anesthesiologists we risk losing even more coverage. What does that mean? Less surgery for patients who need it, but more money for shareholders of UHC.

🚨🚨🚨 So @AHIPCoverage @txhealthplans @UHC Slashes Anesthesia Payment at the Expense of Patients w/ Complex Preexisting conditions, These include senior adults, women with complex pregnancies, minority patients & critically ill children. @UnitedHealthGrp is flexing with the leverage they have gained from the #NoSurpisesAct @UHCprovider has issued a sweeping policy change that eliminates payment for ASA Physical Status modifiers—key indicators of patient medical complexity. Effective Oct. 1, @askUHC will also cut 15% from anesthesia services performed by CRNAs using QZ modifier. 📉 Physical Status Modifiers (P3–P5) are vital to documenting & compensating for patients with serious or life-threatening conditions. UHC’s move to zero out these adjustments devalues critical care for the sickest patients. 🧾 This isn’t reform—it’s rationing care to increase profits. 🚫 This policy: •Hurts patients with preexisting conditions •Undermines anesthesiology workforce stability •Forces cost-cutting at the bedside, not in UHC boardroom where the cuts belong. 📢 Defend patients. Demand reversal of this policy from: @askUHC @UHCprovider @UnitedHealthGrp @AHIPCoverage @txhealthplans @UHC 🔗 Learn More: asahq.org/standards-and-… @RobertKennedyJr @DrOz @realDonaldTrump 👀 ⬇️ @RepRaulRuizMD @DrKimSchrier @RepHerbConaway @herbconaway @MaxineDexterMD @Morrison4MN @RepBera @RepMMM @RepMarkGreen @RepGregMurphy @RepRonnyJackson @RepJohnJoyce @RepNealDunn @RepAndyHarrisMD @RichforGA @RepDesJarlais @SenJohnBarrasso @SenBillCassidy @RogerMarshallMD @DrRandPaul @MikeKennedyUT @BobOnderMO @GOPDoctors @RepRaulRuizMD @DrKimSchrier @RepHerbConaway @MaxineDexterMD @Morrison4MN @RepBera uhcprovider.com/content/dam/pr…

@dogeai_gov @repdavidscott @RepGregMurphy @SecVetAffairs This means relying exclusively on mid level practitioners will increase inefficiency and add expense to the system. That will drive delays.

There is no shortage of Anesthesiologists in the VA system. If anything their presence improves efficiency in the system. Multiple studies demonstrate less utilization of un-necessary lab tests and radiographic studies when physicians direct care. Efficiency requires expertise.

We know that removing VA physicians during anesthesia care strips away a critical layer of medical expertise—particularly during high-risk or emergency procedures.   @RepGregMurphy & I were joined by 80+ Members in calling @SecVetAffairs to protect VA anesthesia care standards.⤵️