Humane Healthcare for All

@sonodoc99 You don’t understand. MDs are employees yet are not payed hourly but on production. Yet corporate medicine overhead is 75% meaning the MD gets 25% of what insurance pays them. Everyone you mentioned gets paid hourly unless they are company owners. I own my practice. I keep 75%.

@DrBruggeman Leave. The Free Market is waiting for you. No one is coming to help you.

CMS just dropped the CY 2027 Physician Fee Schedule proposed rule. At 1,592 pages, it is one of the most consequential rulemakings in years for independent physician practices, and almost none of the headlines are capturing what is actually at stake. The long and short of it is that Congress let the 2.5% conversion factor fix expire, so non-APM physicians are looking at a -1.68% cut on January 1. That alone would hurt. Buried in this rule are structural changes that compound the damage in ways that will outlast any year-end patch. This week I am walking through what matters most for independent practices: Tuesday: The conversion factor cut and what Congress has to do about it before year-end. Wednesday: The proposal to slash payment 50% when you bill an E/M and a procedure on the same day, and why we beat this back in 2019 and can do it again. Plus, the new JAMA data showing how much uncompensated post-op work physicians are already doing that CMS is not counting. Thursday: The two biggest structural threats buried deeper in the rule. A complete overhaul of how practice expense RVUs are calculated, and a comment solicitation that could let CMS define "employed" vs. "independent" in ways that devastate facility-based independent practices in 2028. Friday: Fix It Friday. Specific comment asks and legislative actions with real deadlines. Comment deadline: September 14, 2026. You have eight weeks. Let's make them count.

In English, they pay Doctors with RVU Coupons, not money. Then Doctors have to turn in the RVU Coupons to your Health Insurance and exchange them for money. CMS, the government, cuts the value of the RVU Coupons every year. So much so that since 1992 Doctors have had a 56% pay cut. RVU Coupon value is cut every year for the past 34 years. And every year Doctors act surprised. I bet you thought Doctors were smart.

@DrBruggeman Of course you’re speaking a foreign language to average American citizens whose lives are impacted every day by seriously messed up healthcare policies. If physicians could translate that to American English, maybe the People could get on board and help/support the needed changes

@DutchRojas perfect.

HHS has roughly 72,000 employees today. My efficiency plan: Step 1: Fire them all. Step 2: Hire back the 5% you immediately miss. Congratulations, you’ve just found the org chart.

@DutchRojas RVU Coupons have been cut every year since 1992, 34 years. The AMA whole heartedly supports Doctors getting paid with RVU Coupons. Do you really think Congress gives 2 craps what Doctors say?

The lesson beneath it all: independence survives when physicians own the practice, own the assets, control patient access, diversify revenue, and build political power equal to that of the institutions trying to buy them. Everything short of that is negotiating the terms of the sale. File the comment by September 14. The docket is open at regulations.gov/docket/CMS-202…, file code CMS-1848-P. Not because one comment bends a number. Because a comment carries weight when the physicians behind it are funded, organized, and voting. That machine is not built in the week a rule drops. Then build the institution that gives the next comment weight.

@doxcost @Dividend__Doc @Markroot14 CT - abdominal/Pelvic CT, etc. It's like a 3 dimentional X Ray.

@LighthouseDPC @Dividend__Doc @Markroot14 I don’t claim to be a doctor. What is a CTS? Who sells it?

What are you spending your Health Insurance money on? 7.3% goes to your Doctor.

@Tamara39224 Looks like it's run by idiots too.

@LighthouseDPC Baystate is our only trauma unit. Baystate Medical has been a cluster f for 25 yrs. It’s filthy, people lined up in the halls b/c no room in ED, urine flowing in the ED hall b/c people are urinating on them no one will help to the toilet. ED waits 10 hr

Hospitals are now having to get a 2nd job to make ends meet. The wealth you're paying your Health Insurance company isn't going to the people giving you Health Care. Many of us have been saying this for a while. The house of cards is collapsing. Doctors are already getting 2nd job due to pay cuts. Call it a "side hustle" or whatever you want to make yourself feel better. You wouldn't want to work when you get home if you didn't have to. Look at this article and see what these Hospital CEOs are saying. Put what they say in English. It's great! 1. CEO of UTMB Health - Computers/AI will replace your Doctor. They can pay them less and they don't get burned out. win-win for administrators. But you can't sue an AI. 2. CEO of Baystate Health - We live in Massachusetts. Everyone is leaving the state and everyone staying is old. 70% of patients are Medicare and Medicaid, worst paying of all Health Insurance and growing. Baystate is screwed. "we view a future of alternative revenue streams with an interconnected ecosystem of providers, our integrated health plan, independent health plans and the state government using shared technology (including AI) and unified, holistic care plans to manage member health and total cost of care proactively, efficiently and effectively." WTF does this even mean? I have never seen an MBA come up with a self supporting healthcare network or business model. Baystate will be continually sucking off the government tit and have their hands in taxpayer pockets. 3. Senior Vice President and CFO of LMH Health - He says they are the "sole community hospital". No competition. They can name their prices. They are going to open a "Specialty Pharmacy". Think Taxpayer Subsidized EXPENSIVE medications. The will expand "our retail footprint" and "corporate health services in our service area". Since they can name their price they got the city by the taint. LMH is also a 501c Taxpayer Subsidized "Nonprofit". We pay their taxes. I'm sure the locals are thrilled LMH is going to buy more property they will not pay property taxes on and price gouge the locals. 4. President of University of Nebraska System - My favorite. He's just going to continue to screw the Doctors. Their pay is getting cut. You think there's a raise or decrease hours in a doctor's future in this hospital? #Hospital beckershospitalreview.com/ceo-cfo-speake…

@GmOrr9000 You absolutely can calculate your hourly rate if you know your desired salary and overhead.

@LighthouseDPC Direct care will not work with Ophthalmology.

He’s looking for excuses not to leave the system. He’s given 2 reasons not to open his own Direct Specialty Care or Direct Primary Care practice. 1. A Doctor is too old - I left the system at 55 6 mo before Covid. I’m doing great. 2. A Doctor is too Young - A young couple here started a Direct Primary Care practice right out of residency. They have since hired another Doctor AND had 2 children. All while paying off 2 Medical School loans. Neither of his arguments is correct. We prove him wrong every day. He’s trying to justify his fear of leaving the system. I understand. I was afraid too. If you’re going to stay in the system accept your yearly pay cut and be content. No one is coming to your rescue. If you’ve had enough message me. Take your freedom back. No one is going to give it to you. #Hospital #CORRUPT #Fraud #scam

@fourto5 Direct Primary Care and Direct Specialty Care is emerging rapidly. We need the eliminate the laws preventing us.

For every economic problem a solution exists. Rural regions used to pay for med school for a local teen, if he promised to come home and practiced locally for a number of years. Modern day: local investors/residents backing/patronizing a local direct-pay practice. Next: problem: disparate buyers and sellers of a product have no efficient way to meet and transact directly. Enter Priceline, Uber, Airbnb. Modify and upgrade by way of an open-source options exchange, with licensed Med-pros selling options to purchase described services for cash. Buyers/potential patients would pay appropriately small premiums directly to Med-pro sellers. Voila. Cut out middlemen. (Start by creating simplified, plain-English CPT coding of <300 choices).

@Knoxteaparty @Dividend__Doc Especially when they don’t see the cost at time of purchase and they don’t have to pay it directly

@LighthouseDPC @Dividend__Doc Yes, that's Obamacare's medical loss ratio's perverse message to insurers: Spend more, keep more. But there's also a perverse motivation for patients to consume, since in a pool, everyone else pays most of your bill. But everyone else has the same incentive, so it spirals costs.

@doxcost @Dividend__Doc @Markroot14 When I buy $4000 CTS instead of $400 CT’s, I would imagine they make very little money.

@LighthouseDPC @Dividend__Doc @Markroot14 75% of Americans do not have health insurance, so MLR does not apply. You forgot state premium tax…about 2-2.5%. SG&A about 9-10% This is why the conglomerates are downstream in the pharma business, buying physicians et al. Insurance makes very little money.

@doxcost @Dividend__Doc @Markroot14 Why is it smart to own a Health Insurance company when the “margins” are so low?

@LighthouseDPC @Dividend__Doc @Markroot14 Insurance is very little of what the conglomerates do and less from where they profit. @LighthouseDPC may recall that it was the president who wrote the law and jammed it through the lame duck session of Congress before it flipped or the law never would have passed.

@doxcost @Dividend__Doc @Markroot14 Where does most of the profit come from?

@doxcost @Dividend__Doc @Markroot14 Which President? The law of unintended consequences always supersedes.

You’re looking for excuses not to leave the system. You’ve given 2 reasons not to open your own Direct Specialty Care or Direct Primary Care practice. 1. A Doctor is too old - I left the system at 55 6 mo before Covid. I’m doing great. 2. A Doctor is too Young - A young couple here started a Direct Primary Care practice right out of residency. They have since hired another Doctor AND had 2 children. All while paying off 2 Medical School loans. Neither of your arguments is correct. You’re trying to justify your fear of leaving the system. If you’re going to stay in the system accept your yearly pay cut and be content. No one is coming to your rescue.

@LighthouseDPC @SurgeryCenterOK I agree. But the young docs have loans to pay off and families to feed. It’s a bad situation. They won’t enjoy/love their profession as much as older docs like me cuz of the lack of independence

Doctors are ignorant. They are like toddlers playing with a jack-in-the-box who are surprised every time jack pops out. Doctors are surprised and outraged every year when their RVU Coupon(Doctors are paid in Coupons, not money) value is cut. Doctors have receive a pay cut EVERY YEAR for the past 36 years.😂 1 RVU Coupon in 1992 = $31.00; adjusted for inflation 1 RVU Coupon(1992) = $71.00. 1 RVU(2025) = $33.00. That's more than a 56% pay cut. Take your lumps or do something about it. Those of us in Direct Primary Care and Direct Specialty Care took our freedom back. No one gave it to us. Send me a message if you have any questions. #HealthInsurance #Hospital #Congress #Corruption #Fraud

@ssdhall 92.7%

And 73% goes to people that do not do the healing

@MichaelK634 @DRsLoungePod I’m opted out of Medicare. I can’t support my Family as a Family physician getting paid with Medicare. It’s over.

@LighthouseDPC @DRsLoungePod Everyone thinks Dr. Oz and this current administration is only making things worse but what if that's the point? What if they are intentionally imploding Medicare and encouraging doctors to leave and start a new system

A colleague four years out of fellowship, highly trained, in demand — and ready to quit. Not because of the pay. Because of the autonomy he doesn't have.

@MichaelK634 @DRsLoungePod Medicare is imploding without them. Has been for decades. It’s done.

The cost is astronomical. Healthcare purchased through Health Insurance costs 18% the Economy. $1 of every $6 you spend every day. Healthcare purchased through Health Insurance costs more than Food, Energy and Military Spending COMBINED! It’s costing jobs and infrastructure. It’s costing our kids future.

Insurance companies have net margins of 5-6%. compared to other industries this small. the real issue is everything cost so much. get rid of insurance profit we still have a problem. it's the prices stupid. Insurers just passing those costs on via premiums. healthaffairs.org/doi/10.1377/hl…

The cost is astronomical. Healthcare purchased through Health Insurance costs 18% the Economy. $1 of every $6 you spend every day. Healthcare purchased through Health Insurance costs more than Food, Energy and Military Spending COMBINED! It’s costing jobs and infrastructure. It’s costing our kids future.

@Dividend__Doc @LighthouseDPC The prices are high bc of insurance. Which makes insurance go up. Insurance removes the normal constraints on price; when no one's spending their own money, no one cares what their thing costs, but tries to push it on everyone else. That's why the US system is costly.