Brandon Hirsch

@anish_koka @DrDiGiorgio And unfortunately paradigm also extends to healthcare services, no bueno for patients

Not only was everyone mandated to buy health insurance , all ACA plans were mandated to cover “essential health benefits”. Like Patrick , I thought that made a lot of sense, but it turns out that forcing insurance companies to cover prescription drugs (as one example) massively inflates the cost of drugs purchased through insurance. It creates the nightmarish PBM discount racket. Employers/consumers don’t actually get real discounts , they get fleeced via premiums. Don’t have to believe me — just ask @mcuban — not only will patients get a better price right now if paying directly, it massively pushes the price of drugs down even for patients with prescription drug plans. That’s the glp1 story over the last 5 years. Prices have continued to come down even after the compounders were eventually shut down.

@DrKateEndocrine @IndeMedAction Wow

Refer to the doctor best for the patient no mater what group or practice they work for! What a novel idea. Take care of the patient!!!

Are you trapped by a broken health system? Feel powerless against the machine? The man got you down? Look at @mcuban - he took on Big Pharma, Walmart & Amazon with Cost Plus Drugs. He’s winning. Look at @ryancohen - battling Wall Street shorts & bloated consultants at GameStop. Winning. Look at @marcuslemonis - grabbed a hollowed-out Bed Bath & Beyond and is fighting the professional management class. Winning. Winners win. Quitters quit. And the flat-front complainers who bitch about everything and never do anything? They’ll never even try. Don’t be a flat-front Ken doll. Carpe.

@noahkaufmanmd @KaufCare @real_doc_speaks Very cool, very applicable to spine care and acute spine pain I’m sure that’s built in there

Should I go to the ER? Our updated @kaufcare app will help triage you! Education only of course… This and many more great updates on our big update! Huge thanks to @real_doc_speaks for great feedback and advice for these incorporated improvements! apps.apple.com/us/app/kaufcar…

@noahkaufmanmd Genius

Direct Care get together in Denver! Just starting now. The direct care community is amazing here. Meeting a ton of people we will be able to refer to for the stuff we’re not good at!

We really have a bifurcated healthcare financing system in the US. We have Medicare/Medicaid and Employer-Sponsored healthcare. We can’t really do a lot with laws or regulations - that’s a very slow process and, to be brutally honest, the deck is stacked against you by lobbyists and special interests. Who could change healthcare on a dime? Employers. If employers would re-think healthcare, you could get more services, better outcomes, and higher productivity - all at lower costs. Am I a healthcare warlock? I’ve been called a lot worse. But it’s honestly just removing the superfluous parasites which hide as intermediaries between the buyer and the seller. And this isn’t rocket science and it’s so easily done. If you’re a self-insured employer and you want to change the game - you have all the power today.

@HeathVeuleman @ryancohen @mcuban Nice Heath, who leads the pack in direct surgical care for MSK and Spine for employers right now? What should independent docs who want to be in this space be looking to do to get involved? Seems it requires scale and comprehensive capability to be relevant to large employers.

Look @ryancohen you should hire me to do healthcare for GME and eBay. I could use DPC, DSC, direct contracting - with physician-led enterprises - and Cost Plus Drugs (@mcuban) to drive your healthcare costs way down. Mercer (2025 National Survey): Average total cost of employer-sponsored health insurance = $17,496 per employee (~$1,458/month). Employers expect ~6.7% increase in 2026 → >$18,500/year. eBay has ~12,000 employees. GME has ~4,000 employees. We can turn your expense into an asset, spin this off into its own enterprise in 24-36 months, and make money by actually saving corporations money. Thank you for your attention to this matter! **(I’ll do it for half cash, half stock)**

Doctors are starting to realize something: we cannot keep waiting for institutions to fix healthcare for us. The people closest to patients see the failures of the system every single day. There is a growing recognition that physicians have a responsibility….to directly advocate for a better healthcare system overall. Physicians have relied on organizations and associations to advocate for too long. It’s time to own this advocacy as personally as we own our medical decision making. This is a generational moment in healthcare.

"In the years since, hospital consolidation has accelerated, an increasing share of physicians has been absorbed into large hospital systems, and hospital prices have skyrocketed, far outpacing inflation. The competition that POHs were providing was effectively shut down. Policymakers should lift the ACA restrictions on POHs to increase competition and lower hospital prices." Great look at the issue by @Paragon_Inst.

@HeathVeuleman Are people falling for it or do they just have no other choice due to the crushing corporate power imbalance in the U.S.?

When someone starts talking about “value” and “experience” - that’s code for: paying more and getting less while being treated like an inconvenience. Stop falling for the sophistry.

@DutchRojas Would sign up if you were in business in CA! Lmk!

A behavioral observation worth sitting with. If you ask a hundred independent business owners whether they would cooperate with their direct competitors to lower a shared cost, the answer is almost universally no. If you ask the same hundred whether they would cooperate with their non-competing peers in the same town, on a category that does not touch their differentiation, the answer is again no, but for a different reason. The first no is strategic. The second no is unexamined. This matters because almost everything that bleeds an independent business is a Category Two cost. HR. Payroll. Property insurance. Cyber. Benefits. Compliance. The categories where pooling is fully legal, fully sensible, and would change the cost structure within a renewal cycle. They are not refused on principle. They are refused on inertia. “This is the way we do it” is doing more economic damage to American small enterprise than any policy environment has managed in fifty years. The competitors most independents are afraid of are not the ones across the street. They are the consolidators who pooled all of this a generation ago and now write the checks.

@CanesDavid @Gabe__MD @robgraymd All LLM products I use have explicit instructions never ever to use “Its not this-its that”, colon pivots, and em-dash sentences.

@CanesDavid @Gabe__MD @robgraymd The ubiquity of this AI writing style drives me up the wall and i hope it ends soon. I dont understand how people tolerate these ridiculously repetitive and inauthentic sentence structures, let alone attach their name to them online.

This is one of the most useful productivity unlocks with AI that I've experienced since I first learned about chatGPT. If you don't know what this is... you're falling behind.

@DutchRojas @DrDiGiorgio Need @DutchRojas on the SMISS @ForSpine keynote @TUMI4L4N !

Presented to the distinguished members of CSNS today. This included the dangers of bad accounting. At large physicians were trained to treat the business of medicine as a necessary evil. Health systems, insurers, and private equity treated it as the whole game. That is why they accumulated the assets, the contracts, the leverage, the infrastructure, and eventually the control. The answer is not for physicians to become less clinical. The answer is for physicians to stop letting other people design the economics around their work. The future of independent medicine will belong to the physicians who understand a simple idea: All expenses are not costs. Structured correctly, they are the purchase price of freedom. Time to make physician-led medicine the rational choice for physicians again! @councilsns

@anish_koka @DrDiGiorgio I was actually going to join CMA, may have to rethink that with this tomfoolery

Chickens for Chick filet would like a word

Now here is an example of a physician that promotes patient first, physician-led care. The man is a fantastic family man, friend, and fierce advocate for patients. Nice work @DrDiGiorgio

Cmon man

Urgent cares are often a “race to the bottom” with variable care from less experienced or trained providers. They often send cases to the ER that they cannot handle. There’s room for a new category that is the best of both worlds: an Advanced Urgent Care, staffed with trained and experienced ER docs. Transparent prices, ER level care for many complex problems, but no hospital hassles/wait or extreme prices. It is a better way. Now there is: 1. DPC (Direct Primary Care) 2. DSC (Direct Surgical Care) 3. DAC (Direct Acute Care) These 3 branches of independent physician care can now replace 95% of systemic care without insurance at transparent market prices. 80% of patients are direct pay anyway because they never meet absurd deductibles. Time to reinvent care in America. Check out denverhealthconsortium.com and others to find independent practices that are fair and compassionate near you.

@noahkaufmanmd @anish_koka @DRsLoungePod @DISCmd centers similar premise

@anish_koka @DRsLoungePod @BrandonHirschMD

Chairman of Neurosurgery Elad Levy talks to us @DRsLoungePod about where the idea to build the only ambulatory neurosurgery center in the US came from. They now do 3000 cases/year. And everyone's home in time for dinner with the kids. 🔥 Full episode on Spotify.

@realEstateTrent @robgraymd Any thoughts on why some suffer from SMS and others don’t? Any ideas on how one can cure themselves of SMS?

I call it Spilled Milk Syndrome. The people who suffer from it live difficult, stressful lives, no matter how well things may otherwise be going for them. They freak out when their iPhone screen cracks. Their flight gets delayed an hour, and it makes them crazy. Their uber driver cancels last minute, and they yell at their screen. Their printer runs out of paper when they’re running late and need that important document - and their heart races like crazy. Their blood boils when their latte’s too hot. Or their new shoes get stained the first time they wear them. Or the babysitter’s running 10 minutes behind. Life’s little annoying moments shock them every time. They are the spilled milk moments that fill all of our lives - and they’re routine no matter who you are or even how wealthy you may be. The people who expect these moments and take them in stride have an incredible gift. When a business deal falls apart, they try to save it - and they move on to the next when they realize they can’t. When the baby starts crying again at 3am, they can choose to be frustrated and to feel sorry for themselves because they had a long day and need the sleep - or they can choose to not to let it get them down. How you handle those countless moments is simply up to you. They are going to keep happening no matter what - and you can choose to take them in stride, not let them set you back, and to look forward. Or you can choose to waste much of your life angry and frustrated, “crying over spilled milk.” It’s perhaps the most important life choice you can make.