Doctor Money Matters
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US nonprofit hospitals spent $7.8 billion on management consultants from 2009 to 2023, but contracts were not associated with meaningful changes in finance, operations, or quality of care. 🧵 ja.ma/4d46zfq
We have numbers. Big bump to plain films at the expense of body CT and neuro CT/MRI as well as a general devaluing of ED work. On the breast side, a huge cut to screeners for a smaller increase for diagnostics. For IR, no delta. GI fluoro still isn’t fair. benwhite.com/radiology/rp-t…
If someone at RP wants to share their methodology and some concrete TBWU-RVU numbers, I'd love to share. RP is the single biggest employer of rads in the country, so what they do matters and impacts the whole field. In the meantime, some broad thoughts: benwhite.com/radiology/rad-…
Seen a lot of conversation about how predatory the American medical system is. So I will weigh in. I ended up going to the ER about 2 weeks ago for crippling pain. Turned out to be a ruptured ovarian cyst. I was there for MAYBE 4 hours. My bill? $13,500 dollars. Because I'm uninsured (by choice, that shit is a SCAM), the hospital dropped my bill down to $8,100 and some change as an "uninsured" discount. For starters, $13,500 for a 4 hour hospital visit is insane as it is. But the fact the hospital can wipe $5,000 off the bill "just because" should show you how utterly fucked this system is. And to be clear - $8,000 is still an absolutely insane sum of money when all these people did was scan my stomach and give me some pain killers. On my itemized bill, my CT scan was 7k. The iodine they used was $900. Just being in the ER room alone was $2,500. We phoned the hospital to haggle. They dropped the price by $20. Normal people can't survive this shit. I do okay and $8,000 is still an INSANE chunk of money out of my savings. Anyone who argues this isn't a disgusting, predatory system is crazy. And it is even crazier that Americans accept this. And for those of you who argue this is the free market, I need you to be quiet. There can never be a true free market here when government and insurance have their creepy little fingers in this pie. People shouldn't go bankrupt trying to pay medical bills. This has to change.
@mcuban The Heart and Vascular hospital my Dad goes to has a lobby that rivals the fanciest of hotels, huge glass atrium, crystal chandeliers, a grand piano, etc. Every time I think about the expense of that infuriates me .
Hospitals are putting hard caps on physician compensation, sometimes as low as the 75th percentile, and calling it fraud and abuse protection. Think about what that means. If earning above the 90th percentile is inherently suspicious, then 10 percent of every physician in every specialty must be breaking the law. At the 75th percentile, 25 percent of all physicians are apparently committing fraud. That logic falls apart the moment you say it out loud. Health law attorney Dennis Hursh has been reviewing these clauses for years, and he says they are showing up in the majority of physician employment contracts now. Some contracts say compensation "may be reviewed" if it exceeds the threshold. Others are blunt: under no circumstances will your total compensation exceed this number. So if you are the most productive physician in your specialty in the entire country, your pay is frozen. Every dollar you produce above that cap flows to the institution. And as Hursh puts it, the CEO's bonus is not capped. It gets worse. Most hospitals are not giving physicians clear, timely productivity data. You might be told you produced 9,500 WRVUs, but without access to the actual benchmarks, you have no idea whether you are approaching the cap. You are flying blind while working at a pace that funds someone else's compensation growth. There is also a downstream effect that hurts the entire profession. Compensation surveys from MGMA and SullivanCotter use reported salary and productivity data. When the highest producers have their pay artificially suppressed, it pulls benchmark numbers down for every physician in that specialty the following year. The cap does not just limit one doctor. It compresses pay across the board. Hursh says physicians need to review contracts for this language, demand regular and transparent productivity reports, and push for independent third-party compensation reviews when they are producing at the top of their field. The hospital should not be the one deciding whether the cap is justified. The physicians most hurt by this are exactly the ones hospitals cannot afford to lose. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Have you seen this cap in your own contract? #ThePodcastbyKevinMD
@real_doc_speaks @SurgeryCenterOK There are plenty of doctors that run hospitals. What are their relative results ?
@mcuban @annbauerwriter True, Mark. We physicians complain constantly about consultants and their cost when we ALREADY know what needs to be done.
More than 400 hospitals across the U.S. are at high risk of closing or cutting services because of the Medicaid cuts in President Trump’s “big, beautiful bill,” according to an analysis from the progressive watchdog group Public Citizen. nbcnews.com/health/health-…
Exactly right. Problem is too many radiologists sold out or let themselves get taken over by hospitals like little bitches. After that good luck standing up for yourselves. But if you’re independent and own your shit you can deny services, modify services in logical ways like what you’re alluding to here.
