Brandon Beal

397 posts

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Brandon Beal

Brandon Beal

@BrandonBealMD

Growing a Derm Biz | Offices in STL & JAX | Inc. 5000 Mohs Surgeon | Facial Plastic & Reconstructive Surgeon Building & Learning as we Go!

St. Louis, MO Katılım Mayıs 2024
155 Takip Edilen117 Takipçiler
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I practice in Troy, MO - a rural town outside of St Louis. Im the only dermatologist in town. Medicare’s Physician Fee Schedule (should be called the outpatient fee scheduled) In real (inflation-adjusted) terms, has decreased 33% since 2001… Paradoxically, patients are paying more, not less, and healthcare costs keep rising … even as physician payment declines. Doctors represent 6% of healthcare costs; nurses 6% … so a patient would still owe 88% of their bill if all the doctors and nurses worked for free … …. healthcare costs have outpaced inflation … why? Because Washington has systematically rigged the system to support large hospitals … 75% of independent doctors office have closed since 2008. A major driver is “site-of-service” payment inequity. When the same outpatient service is provided in a hospital outpatient department (HOPD) instead of an independent physician office, Medicare and beneficiaries can be charged roughly double (or more). As physicians are acquired and services shift into HOPDs, taxpayers and patients spend more for the same care. Federal policy also amplifies this imbalance. Our practice accepts Missouri Medicaid… yet we are excluded from Disproportionate Share Hospital (DSH) payments … yet the hospitals benefit from this program while doctors offices caring for patients with Medicaid are excluded! Hospitals receive substantial subsidies and special payment streams, including 340B revenue, DSH payments & GME payments that independent doctors offices are systematically excluded from. And what happens to the cost of healthcare??? …. It keeps rising and we wonder why? Because we’ve drained the reimbursement of the most cost effective affordable care and What can congress do? 1. Index physician reimburse to inflation just like hospitals reimburse is and facility fees are … rename physician reimbursement to “Outpatient Reimbursement” 2. Site neutral payments - same payment for the same work. Quit paying hospitals 200% more for the same care and wondering why costs keep increasing 3. Allow doctors offices to participate in all programs hospitals can at a prorate share: DSH, 340b, GME This would actually reduce healthcare costs while return doctors to rural communities. You Can Do It!
Josh Hawley@HawleyMO

Rural hospitals are absolutely vital. Just in Missouri, about 40% of the hospitals are rural hospitals. 20% of rural hospitals are at risk of closing SOON. That represents THOUSANDS of people and we can’t let that happen

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I practice in Troy, MO - a rural town outside of St Louis. Im the only dermatologist in town. Medicare’s Physician Fee Schedule (should be called the outpatient fee scheduled) In real (inflation-adjusted) terms, has decreased 33% since 2001… Paradoxically, patients are paying more, not less, and healthcare costs keep rising … even as physician payment declines. Doctors represent 6% of healthcare costs; nurses 6% … so a patient would still owe 88% of their bill if all the doctors and nurses worked for free … …. healthcare costs have outpaced inflation … why? Because Washington has systematically rigged the system to support large hospitals … 75% of independent doctors office have closed since 2008. A major driver is “site-of-service” payment inequity. When the same outpatient service is provided in a hospital outpatient department (HOPD) instead of an independent physician office, Medicare and beneficiaries can be charged roughly double (or more). As physicians are acquired and services shift into HOPDs, taxpayers and patients spend more for the same care. Federal policy also amplifies this imbalance. Our practice accepts Missouri Medicaid… yet we are excluded from Disproportionate Share Hospital (DSH) payments … yet the hospitals benefit from this program while doctors offices caring for patients with Medicaid are excluded! Hospitals receive substantial subsidies and special payment streams, including 340B revenue, DSH payments & GME payments that independent doctors offices are systematically excluded from. And what happens to the cost of healthcare??? …. It keeps rising and we wonder why? Because we’ve drained the reimbursement of the most cost effective affordable care and What can congress do? 1. Index physician reimburse to inflation just like hospitals reimburse is and facility fees are … rename physician reimbursement to “Outpatient Reimbursement” 2. Site neutral payments - same payment for the same work. Quit paying hospitals 200% more for the same care and wondering why costs keep increasing 3. Allow doctors offices to participate in all programs hospitals can at a prorate share: DSH, 340b, GME This would actually reduce healthcare costs while return doctors to rural communities. You Can Do It!
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Josh Hawley
Josh Hawley@HawleyMO·
Rural hospitals are absolutely vital. Just in Missouri, about 40% of the hospitals are rural hospitals. 20% of rural hospitals are at risk of closing SOON. That represents THOUSANDS of people and we can’t let that happen
Josh Hawley tweet media
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Dutch Rojas
Dutch Rojas@DutchRojas·
The IRS test for tax exemption is “community benefit.” Median nonprofit hospital spends 2.3% of revenue on charity care. For-profit competitors spend 3.8%.
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This involved a U.S. soldier who allegedly took advantage of his position to profit off of a righteous military operation. Thank you to our agents, Intel teams, and great partners @TheJusticeDept who protected our war fighters. Investigation ongoing.
Bill Melugin@BillMelugin_

BREAKING: DOJ announces it has arrested a US Special Forces soldier who took part in the raid that captured Venezuelan dictator Nicolas Maduro after the soldier allegedly pocketed $400,000 by betting more than $30,000 on Maduro’s removal on Polymarket. Name: GANNON KEN VAN DYKE

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The Redistricting War has been a national disaster. I will be sponsoring legislation to end partisan gerrymandering by having congressional districts drawn by independent commissions in every state.
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@WallStreetApes Explained so well - this is wild & crazy it’s allowed! How is this not monopolistic behavior?
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This literally blew my mind There is a healthcare law called ‘The Medical Loss Ratio Rule’ This law says any money you pay in healthcare premiums, the insurance company must spent 80% on your healthcare If they don’t, they’re supposed to refund you Yes, this is real Insurance companies found a loophole. They bought the doctors, the pharmacy benefits managers, the pharmacies and the clinics Now, they skyrocket prices on everything from doctors visits, tests and prescriptions so that your 80% is spent But it’s not really spent, they’re just paying themselves inflated prices so it actually doesn’t cost them anything. They just pocket all the money and never have to refund premiums This provision is written in the Affordable Care Act, called the 80/20 rule 80% must be spent on care or refunded, 20% can be profit for the insurance company We are being robbed blind
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You know that healthcare interests are not aligned when an AI tool that allows doctors to see more patients (and look and listen to them instead of at their screen) and more accurately communicate what happened at that visit leads to higher physician compensation…… and is seen as a problem by insurers. statnews.com/2026/04/08/are…
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@CAgovernor These cities in these states with high murder rates are run by democrats!
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Governor Gavin Newsom
Governor Gavin Newsom@CAgovernor·
Missouri's murder rate is 73% HIGHER than California's. No amount of right-wing spinning can change reality: our state is investing in prevention, enforcement, and is holding criminals accountable. Fix your own failed policies before lecturing us.
Senator Eric Schmitt@SenEricSchmitt

California is covering for criminals. Not punishing them. Not stopping them. Covering for them. The paper trail is bloodier and far worse than you could even imagine.🧵

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@SchmittNYC Why even live or work in NYC?
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Ken Griffin paid a 5.3-million dollar mansion tax for the privilege of buying his home. Mamdani says that’s unfair… because it’s not enough. Truly amazing.
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Peter Magyar is a good example that being right-wing should not mean being pro-Russia.
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@BrentAWilliams2 Depends on where you went… where I went, St Louis University, it was very difficult. You get out what you put in … I put in a lot.
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@DavidPiotrowski Seems like a lawsuit could help California find its way on this one
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Why does LA provide a free lawyer to a tenant but not to a landlord? A tenant stops paying rent and gets a free lawyer to fight an eviction. A landlord doesn't receive his rent and needs to file an eviction out of his own funds. Does this sound fair and equitable to you?
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@PeterMoskos What if the man on the scooter hit a pedestrian and killed them? We don’t know what the final outcome would have been. But the judges rulings were certainly not congruent nor reasonable nor fair nor just.
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I'm not saying the sergeant shouldn't do time. I do not think a cop trying to do a job should get more time for accidentally and tragically (and negligently and predictably) killing a man than somebody who sets out to beat a homeless man to death with his bare hands.
John D. Macari Jr. 🇺🇸🗽@JohnDMacari

As bad as NYC’s District Attorney’s are, they are no where near as radical as NY Judges are. Many judges like Police managers are also Politically appointed. Elections matter. The two rulings below are from the same judge, 2 very different sentences.

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Brandon Beal
Brandon Beal@BrandonBealMD·
@KevinRobertsTX This is a reasonable minimum wage. What % of the population make less than that in Va?
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Jobs will decrease and prices will increase for Virginians. It’s the same outcome every time in every state that does this. Governor Spanberger seems to be in a race to the bottom with her already historically low approval rating.
Governor Abigail Spanberger@GovernorVA

🚨BREAKING: I just signed legislation to raise Virginia's minimum wage to $15 per hour. We are putting more money in the pockets of the Virginians who power our economy — and charting a brighter, more affordable future for families who call the Commonwealth home.

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Brandon Beal
Brandon Beal@BrandonBealMD·
So true … yes got you here … No’s will set you free!
Dimitrios Tsatiris MD@DrDimitrios

Why is setting boundaries so hard for physicians? The culture of medicine has trained you to be obedient. Any rejection of authority during medical school or residency can jeopardize your career. Obedience may help you survive medical training. However, it will be your downfall as an attending. Be prepared to set boundaries against a system that profits from your productivity.

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AI is a tool … shovels 🪏 are tools, backhoes are tools … tools help us dig ditches faster and better than someone holding a spoon. These tools replaced the worst ditch diggers, but we still have people digging ditches and we need them and are grateful for them! The same with call center representatives. We use AI to answer our phone and it’s better than the bottom 25% of call center reps … but guess what. .. we still need and are super grateful for our call center team. We just hired two more humans despite having AI answer 100% of all incoming calls. Doctors are no different… AI will make the good ones better and replace the ones that are not good at their job. The internet created more jobs and companies than it eliminated and AI will do the same. The internet was scary for some and disruptive … some legacy retail stores are still trying to figure it out … other are thriving and small businesses have found new markets and opportunities to sell their products.
Suneel Dhand MD@DrSuneelDhand

The medical specialties most likely to be replaced by AI next few years: 1. Primary care doctors 2. Radiologists 3. Dermatologists 4. Psychiatrists 5. Ophthalmologists Least likely: Surgeons (although it’s still on the horizon) Did I miss any?

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AI replaced the bottom 40% of call center reps … the top 30-50% all have jobs and companies are thankful for their work. AI eliminates jobs for people who are bad at them … it’s better than the bottom 25% Of personal trainer who might create programs that injure their clients, but it’s not better than the top 25% of personal trainers and the top 25% will use AI to make their programs better and clients healthier.
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Not a single doctor will be replaced by AI. Radiologists don’t just look at images - they make real-time decisions. In a USG-guided FNAC, reaching the gallbladder fundus while the patient is breathing, coughing, moving… you constantly adjust needle direction. A skilled radiologist does this in 5–10 minutes. Now imagine AI robots: scan > upload > LLM/SLM > interpret > command (Repeat cycle if patient inhale deeply/cough). By the time it processes everything, it can easily take an hour for the same task and the clinical situation would have already changed. And in an Indian setup with 50 patients waiting, this isn’t just inefficient - it’s impossible. I have so many reasons. Dermatology looks easy until you actually practice it. Everything overlaps. Diagnosis often needs histopathology, Wood’s lamp, and clinical correlation. The “steroid + antifungal fixes everything” idea is nonsense. Even urticaria has multiple variants. And are we seriously going to scan entire bodies of women and send that data to external servers to diagnose conditions which an experienced dermatologist takes barely 1 min ? What about privacy and data leaks? Psychiatry is not data - it’s human behavior, tone, emotion, context. That branch actually needs human EQ! Ophthalmology - retinal surgery is among the most delicate procedures in medicine. A tiny error means permanent blindness. You can’t hand that over to autonomous systems. Primary care doctors manage everything - multiple diseases, public health programs, rural realities. They are the backbone of Indian healthcare. Don't fear about AI, outperform it! And learn to show middle fingers when LLM companies come to take patient data to teach their machines.
Suneel Dhand MD@DrSuneelDhand

The medical specialties most likely to be replaced by AI next few years: 1. Primary care doctors 2. Radiologists 3. Dermatologists 4. Psychiatrists 5. Ophthalmologists Least likely: Surgeons (although it’s still on the horizon) Did I miss any?

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Three things are happening in your reply, and none of them are engagement with the argument. First, the label. ‘Communist.’ This is a containment technique. You attach a political label to a structural observation so that anyone reading it filters it through ideology instead of economics. My post says nothing about redistribution, collective ownership, or state control. It describes a transfer of professional infrastructure from physicians to policy intermediaries and nonprofit hospital systems. That’s an accounting statement. I am an accountant. Second, the false equivalence. ‘You could claim the same thing for any other profession.’ No. You couldn’t. No other profession had its entire training pipeline, facility ownership model, insurance design authority, and fee structure systematically transferred to a concentrated set of third parties over five decades. Lawyers still own law firms. Accountants still own accounting firms. Physicians, in the majority, no longer own the means of delivering care. That’s not a talking point. That’s a market structure. Third, the inversion. ‘We have allowed doctors to do too much of this.’ This is the move that tells me you’re not engaging in good faith. You took an argument about physician disempowerment and flipped it into an argument about physician greed, without citing a single structural mechanism. The post lists eight domains of lost control. You addressed zero of them. The monopoly you’re worried about already exists. It’s just not held by physicians. It’s held by tax-exempt systems with $300B+ in combined reserves, lobbying budgets that dwarf the AMA’s, and regional market concentration that would trigger antitrust review in any other industry. You didn’t argue with the post. You argued with a version of it that was easier to dismiss…
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Retarded communist garbage, you could claim the same thing for any other profession. Forming a monopoly on medical services that would allow physicians to extract maximal rent is not the standard. We have allowed doctors to do too much of this, in fact.
Dutch Rojas@DutchRojas

Physicians, in aggregate, are not compensated commensurately with the value they create. The deeper issue is not clinical skill or effort. It is coordination. As a profession, physicians have rarely acted with collective intent to secure what is structurally theirs. Over time, key domains were ceded, quietly and incrementally, to a small set of policy actors and intermediaries in Washington. Hospital ownership. Graduate medical education funding. Academic training pathways. Insurance design and control. Employee benefits infrastructure. Employer-based clinics. Professional fee structures. Core healthcare software and data systems. These were not lost in a single moment. They were transferred, piece by piece, without a unified response. There was no sustained counterweight. No organized resistance. While control shifted outward, physicians remained fragmented, often directing their energy toward one another rather than toward the structures reshaping their profession. The consequences are visible. Patients bear the cost. Outcomes lag. The system grows more complex and less accountable. There are exceptions. A minority of physicians do engage, organize, and push back, and when they do, they are formidable. Supporting them is both necessary, worthwhile, and a joy! But at the level of the whole, the profession has not operated as a coordinated economic or political force. In that vacuum, others have stepped in to define the terms.

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California's unsheltered homelessness was on the rise in the years before I took office as governor. Just last year, it DROPPED 9%. Thanks to our ongoing work, California is bucking the nationwide increase in homeless rates through urgency, compassion, and local accountability.
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