CryptopaedicSurgeon 🦴💀🦴

@northwoods1980 Parents aren’t comforted by the literature and like to see an image.

If all of this is true, why am I still reading serial follow up X-rays on buckle fractures day in and day out from ortho?

@TKopelman I appreciate our own category 😅

Own occupation disability insurance can be a life saver But especially so for: - doctors - surgeons - dentists - ortho Or anyone who would lose their income if their body did not work like it does right now

@randymcohn @drericksonspine Would never get in today. It’s been a great run.

Annual orthopaedic surgery match rate post.... ERAS has 1953 people applying in ortho NRMP has 1652 This likey means 301 people dual applied and matched in something other than ortho. 963 residency spots available (up from 899 a few years ago) 963 people matched today. Congratulations!! However, that's slightly less than 50% of those who originally applied. Looking at just the 1652 who didn't dual apply and matched in something else (NRMP data): Overall 963/1652=58.3% MD senior 765/1129=67.8% DO senior 121/283=42.8% US IMG 5/36=13.9% Non US IMG 5/22=22.7% MD grad 53 DO grad 14 Don't have n for grads. But 182 applicants left over from above numbers. So combined match rate 36.8% for those reapplying Every orthopaedic surgeon sees this and is thankful for our careers. Huge congrats for everyone who matched today. For those that didn't I hope this data helps you decide your next path.

@smithhmackenzie I can get down and hold it, but getting back up is a challenge!

If you sit all day and your hips feel tight, this is non-negotiable: It's a deep squat hold. Feet slightly wider than shoulders, toes turned out. Lower down as deep as you can. Hold 30–90 seconds at a time. Do it daily and your hips, knees, and low back will thank you.

@marklewismd @DrAkhilX Do you see the fundus?? Uhhh, yeah, sure. 😀

That day in med school we all got ophthalmoscopes, then realized we didn’t know how to use them

I am the VP of Claims Optimization at one of the five largest health insurers in the United States. I do not practice medicine. I have never practiced medicine. I have an MBA from Wharton and a background in supply chain logistics. Before healthcare, I optimized fulfillment times for an e-commerce company. The transition was seamless. In e-commerce, the product is a package. In healthcare, the product is a claim. Both are routed, processed, and occasionally denied. The denial rate for packages was 0.3%. The denial rate for claims is 34%. The margins are better in healthcare. The algorithm is called nH Predict. We did not name it. The vendor named it. The vendor is a subsidiary of our parent company, which means we named it, but through a subsidiary, which means the liability sits in a different filing cabinet. nH Predict processes a claim in 1.2 seconds. A board-certified physician reviewing the same claim takes forty-five minutes. We replaced the forty-five minutes. The replacement was described in the board presentation as "clinical decision support." It supports the decision to deny. My team processes 1.4 million claims per quarter. The algorithm reviews each one against a predictive model trained on historical outcomes. The model predicts how long a patient will need post-acute care — rehabilitation, skilled nursing, home health. Then it recommends a coverage duration. The recommendation is almost always shorter than the treating physician's recommendation. The physician sees the patient. The algorithm sees the data. We trust the data. The data is cheaper. Here is what I am not supposed to tell you. We know the reversal rate. We have always known the reversal rate. When a patient appeals a denial, 90% of denials are reversed. Ninety percent. This means nine out of ten times, the algorithm was wrong. Not arguably wrong. Not borderline wrong. Reversed-on-appeal wrong. The appeal is reviewed by a human physician. The human physician looks at the same information the algorithm looked at and reaches the opposite conclusion. This has been happening for three years. We have not recalibrated the algorithm. Recalibration would increase the approval rate. An increased approval rate would decrease the margin. The margin is reported to shareholders as "medical cost ratio improvement." Nobody asks what the words mean. The business model is the gap between denial and appeal. Sixty-three percent of patients do not appeal. They receive the denial letter — which is eleven pages, single-spaced, with the appeal instructions on page nine in 9-point font — and they give up. They pay out of pocket. They skip the rehabilitation. They go home early. Some of them fall. Some of them are readmitted. The readmission is a new claim. The new claim is processed by nH Predict. The 37% who appeal wait an average of 43 days for a decision. Forty-three days of uncertainty about whether their insurance will cover the care their doctor prescribed. During those 43 days, many of them have already been discharged. The appeal is retroactive. The care is not. I have a dashboard. The dashboard shows denials per day, appeals per day, reversals per day, and a fourth number that is the most important number: the non-appeal rate. The non-appeal rate is 63%. I report this number weekly. It has never been described as a problem. It has been described as "patient engagement efficiency." When the non-appeal rate rises, I am congratulated. When it falls, I am asked what happened. The class action lawsuit uses the phrase "bad faith." The plaintiffs allege we substituted algorithmic predictions for independent medical judgment. This is accurate. The substitution saves $2.1 billion annually. The lawsuit seeks $1.3 billion. Even if we lose, the math works. Three years of $2.1 billion is $6.3 billion. Minus $1.3 billion is $5 billion. The settlement will include the phrase "without admitting wrongdoing." The settlement always includes that phrase. I am the Vice President of Claims Optimization. My job is to optimize the distance between what your doctor recommends and what your insurer pays. The distance is the product. I have been optimizing it for three years. The algorithm gets faster. The appeals process gets longer. The font on page nine gets smaller. The margin gets wider. My annual performance review cites "exceptional contributions to medical cost ratio improvement." The review does not mention the 90% reversal rate. The review does not mention the 63% non-appeal rate. The review does not mention the patients. The algorithm does not practice medicine. I want to be clear about that. It predicts. It denies. It profits. The prediction, the denial, and the profit are three separate functions. The separation is important. For legal purposes.

@johnarnold @Noahpinion Get rid of all the bullshit gap year to get into med school too

AI should allow med schools to rethink whether 4 years is still necessary for med school. If students can focus more on clinical practice and less on memorizing the Krebs cycle and molecular bio, many programs could eliminate a year, reducing both costs and physician shortages.

@AdamFerrellNFL This xray has been going around since I was an intern. 🤣

Maxx Crosby's MRI shows significant knee damage.

@chrispapst What percent of city students take the SAT?

NEW RECORD LOW: Despite record HIGH funding, SAT scores in Baltimore Schools have hit record LOWS. This year, taxpayers will give the district ~$1.9 billion (Full results go back to '17). '17: 910 '18: 916 '19: 887 '20: 892 '21: 977 '22: 875 '23: 866 '24: 867 '25: 856

@sweatystartup If you are not absorbing from pill form, make sure to take with fatty foods. Vitamin D is fat soluble.

Use liposomal vitamin D. Pills and drops don’t work.

@txsportsdoc Of course not. Why would they want 18 when they identify as 26.2? Next will be an iron man finisher medal for someone who can’t swim.

So now we are lowering the standards for LA Marathoners and get a medal if they quit early. Will we now see “18” stickers on cars now?😂

@BrentAWilliams2 Correct. Thats why we are the smartest.

This is true. ORTHO turfs everything that isn’t ORTHO to the appropriate specialty, instead of pretending that they know everything.

@cenkuygur Congrats. One of the dumbest posts I have read.

I criticized Iran’s Supreme Leader Ali Khamenei a thousand times. He was oppressing his own people and preventing democracy. But there’s one thing you can’t take away from him, he died on his own two feet, instead of kneeling to Israel. That took courage. He didn’t bow.

@DocDifferently Raise your rates. I doubled my rate several years ago, and thought at most I would lose half my business, work less, and make the same. NOT ONE client even questioned my rate hike and have only continued to get busier.

I’ve been an expert witness for 5 years and I’ve never seen the inside of a court room, been deposed, or met a lawyer in person. My experience has essentially been remote chart review and writing expert reports. I charge $600/hr for my pediatric expertise.

@DrNiravPandya Great job!

This is a very complex surgery

@DrJesseMorse Job well done for bad injury. There is a proximal fibular fracture at the neck, but doesn’t require surgical treatment.

Lindsey Vonn shares her actual X-rays post 6+ surgeries!!! Looks like a severe proximal tibia fracture. Tibial plateau fracture + Metaphyseal/Tibial Shaft fracture Appears that fibula is intact. Unclear if the femur was involved. Based on initial photos, I wouldn’t be surprised if there was an open wound and possible fasciotomy due to compartment syndrome. LONG rehab journey ahead but nothing she hasn’t done probably 5 times already. Mind you eventually she will (likely) have to have her ACL reconstructed. Good luck girl!

@MaryBowdenMD You are incredible. Have followed your case closely. 💪🏻

Grateful to my attorneys Steve Mitby & Michael Barnhart. When I tapped out financially, they would not let me go pro se and represented me pro bono. They defended me against the 3 other cases TMB brought against me and have helped many others doctors fight the board.

@Mr_Derivatives Doctors offices can’t survive without them

Off topic: One thing that still surprises me that exists today and still hasn’t gone way of pagers and typewriters is the….. Fax machine. Like why is it still a thing? Go away to obsolete technology heaven already. Or I am just a hater?

@sweatystartup This is the only correct take on moving (and ladders!). Orthopaedic approved advice

Friends don’t ask friends to help them move. We aren’t in college anymore. Get out your wallets and hire movers, losers.

@DiplomatSchukow @RealSpitfire Why reply when you know nothing. External fixators are commonly used in US, Europe, and non third world countries.

External fixators? As an orthopedic surgery tech and combat surgical tech, external fixated are for third world countries when the wounds are still too bad due internal permanent fixation. There are intermedullary rods and plating system that should have been used. I feel so bad for Lkndsey. God hesr our prayers for her safety healing

Lindsey Vonn posted a pic from her hospital bed after her THIRD surgery to repair her broken leg. That is a ton of external fixators!🤯