Neil Floch MD

@DutchRojas I am a physician and a surgeon to my patients. The only entity that I am a “provider” for is my family.

Modern US healthcare defined

The difference between GLP-1ra medications and bariatric surgery: when stopped the GLP-1ra benefits go away, the bariatric surgery benefits are long lasting and fade slowly over years and decades.

This isn’t about failure❤️ Obesity is a medical condition. For teens, Metabolic Bariatric Surgery can be safe & effective: supports growth, leads to lasting weight loss, improves diabetes, BP, sleep, energy & confidence. Lifelong care & family support are essential #IFSO

🔬 Metabolic & Bariatric Surgery Webinar Join us to explore the latest advances in metabolic and bariatric surgery. 📅 March 30, 9:00 AM (Eastern Time) 👉 Please click here to register: oaepublish.com/webinars/ais.4… We warmly welcome everyone to join and actively participate!

There is no medication There is no surgery There is no treatment ….that has zero risk or side effects. Every alteration of the human body has risks and consequences. We, as physicians and scientists must weigh the risks and benefits. The benefits of treaty obesity with both metabolic bariatric surgery and GLP-ra medications far outweigh the risks.

The women improvising their GLP-1 doses — without a doctor apple.news/AsIFI0eGWTD6r6…

The solution for those who do not lose weight on 2.4 mg of Wegovy….

Everyone wants me to rip on TrumpRx. Reality is, it’s saving patients money on IVF and a few other drugs. A lot of money. IMO, anything that saves patients money is a win. And they truly do have some great people that are making smart moves. You just don’t know their names. Chris Klomp. Mark Atalla, Abe Sutton and so many more. When you talk to them, and see the work they put in, it’s obvious they are focused on trying to do the right thing for patients. Don’t forget they didn’t give the insurance industry a price increase they wanted, and those stock prices got crushed. TrumpRx is just getting started. @costplusdrugs is just getting started.

No association of pancreatitis and GLP-1ra medications

Oh come on… On self-referral “conflict of interest”: The Stark Law already governs physician self-referral. POH physicians must publicly disclose their ownership interest to every referred patient. Now… what do hospital controlled doctors disclose?? Nothing. They have zero disclosure obligation when they refer patients to the same corporate system that signs their paycheck. They are systematically incentivized to use higher-cost outpatient hospital settings rather than independent facilities. A 2020 Journal of General Internal Medicine analysis of Texas BCBS claims found hospital-owned physician practices generated 5.8% higher annual spending, 13% higher imaging costs, and 21.7% higher outpatient facility costs than independent practices, driven entirely by utilization and site-of-service billing. If the concern is financial conflicts driving utilization, the data points to hospital consolidation, not physician ownership. On the “data is clear” claim about cherry-picking: The data is actually clear in the opposite direction. The 2015 BMJ study examined 219 POHs and 1,967 non-POHs across 95 hospital referral regions and found Medicare patient proportions were statistically identical with 47.1% at POHs versus 47.2% at non-POHs. Medicaid proportions were 14.9% versus 15.4%. Minority patient proportions were similarly equivalent. The 2024 Physicians Advocacy Institute analysis of 20 high-cost DRGs found no evidence of cherry-picking after controlling for patient age, race, and health status. At the same time they found POHs delivered care at 8-15% lower Medicare cost per episode. The 2023 JAMA Network Open study found POHs had 17.5% lower commercial negotiated prices and 46.7% lower cash prices in the same geographic markets. The “cherry-picking” narrative collapses under peer-reviewed scrutiny. On rural hospital harm: The FAH report this argument relies on was commissioned by the Federation of American Hospitals and the American Hospital Association. It is a modeled simulation based on hypothetical scenarios, not observed real-world outcomes. The legislation in question (H.R. 2191) specifically requires a 35-mile separation between a new POH and any existing rural hospital, which is a provision designed precisely to avoid the competitive overlap this model assumes. More importantly, 152 rural hospitals have closed since 2010 (when the POH ban took effect). The ban did not protect rural access. It accelerated consolidation, reduced competition, and drove up costs. Markets with POHs have 16.7% lower concentration scores than markets without them. The real threat to rural hospitals is a Medicare reimbursement structure that already produces -11.8% Medicare margins for sole community hospitals. Fixing that requires payment reform, not protecting incumbent hospital systems from physician-led competition. What’s perhaps not discussed enough is that nearly every procedure performed in hospitals today is subject to utilization review (prior authorization). If someone is looking over the claim to make sure it is indicated and medically necessary, all of these arguments go away anyway. It doesn’t matter if the physician takes the procedures to their own facility, particularly if the physician hospital provides the same or better quality and the same or lower price. The ACA Section 6001 ban on physician ownership was legislative horse-trading, so let’s not pretend to take some high road that this is about protecting patients. Fifteen years later, consolidation has accelerated, patient choices have narrowed, and the organizations lobbying hardest to keep the ban are the ones profiting most from it.

It was an honor to testify in front of the @HouseCommerce subcommittee on health regarding healthcare affordability. We discussed consolidation and the demise of independent physician practice. My solutions include: Repeal section 6001 of the ACA which banned physician owned hospitals Reform Stark law Implement site neutral payments Reform 340B Use FMAP to encourage states to be pro-competition (repeal CON, eliminate non competes)

@MichaelMindrum Amazing- awesome city

@NeilFlochMD I was just in Barcelona! Beautiful country

I am on my first vacation that is longer than 6 days. It has been 26 years since I was away any longer… nuts. …still took care of 4 patients and their issues today while in Spain. 🇪🇸

Thank you for advocating on behalf of physicians!

@DutchRojas A physician is one of the most sacred professions. One that is under-appreciated until needed.

@DutchRojas I am a physician and a surgeon to my patients. The only entity that I am a “provider” for is my family.

A physician who read 60,000 pages of medical literature, completed 15,000 hours of supervised training, and carries $1 million in malpractice liability is called a “provider…..”

Phase 2 results from @StructureTx for #aleniglipron put @novonordisk and @EliLillyandCo on notice. They will not have the obesity market for oral GLP-1s all to themselves for long. conscienhealth.org/2026/03/17/an-…