Steven Maximus

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

A panel of specialists—including Jason T. Lee, Steven Maximus, Gustavo Oderich, Benjamin W. Starnes, Carlos Timaran, Kak Khee Yeung, and Javairiah Fatima—reviews the growing array of endovascular solutions available for complex abdominal aortic disease. evtoday.com/articles/2026-…

This is a really bad thing. These jobs in healthcare aren’t nurses or doctors. They’re middle managers, billing specialists, and people whose sole job is to extract the maximum amount of government dollars for large hospital systems. They don’t make care better. In fact, they make it much worse. They harass the frontline workers, physicians and nurses, driving them to early exits from clinical medicine. They consider patients nothing more than widgets. Worst of all, they make your cost of healthcare higher. They are so parasitic that they consume all non-healthcare jobs. Employers can’t hire more workers and companies can’t expand because these parasites just destroy wealth. This trend is a bigger threat to America than anything else.

In a review of a technical innovation aimed at improving outcomes in patients with chronic aortic dissection, Drs. Steven Maximus and Gustavo Oderich describe the role of septotomy using electrosurgical techniques to enlarge the true lumen. evtoday.com/articles/2026-…

It was an honor to discuss Complex Endovascular Aortic Procedures With Dr. Rogers. youtu.be/myUxe5gRA70?si… via @YouTube

Congrats to Hannah Oden-Brunson for excellent presentation @SCVS1969 on #fbevar #taaa Textbook Outcomes. Low mortality (1.3%) among 609 consecutive patients. Opportunities for improvement are prolonged length of stay (24%) and major adverse events. Stay Tuned to new contributions from #MarcusVITALlab @AorticC @AortaEd @GustavoOderich @JCoselli_MD @BCM_Surgery @farkomd @Texas_Heart @ThinkAorta @THINK_AORTA @UK_Aorta @AndresSchanzer @AWBeckMD @CarlosTimaran @VascularNews @BCM_Surgery @bcmhouston @UTHealthHouston @MethodistHosp @MayoClinicSurg @MayoClinic @BCMHouston_News #FenestratedBranchAorticRepair #GrandRounds #AorticSurgery #VascularSurgery #EndovascularRepair #AorticAneurysm #EVAR #TEVAR #MinimallyInvasiveSurgery #VascularHealth #AorticDissection #StentGrafts #MedicalInnovation #MarfansSyndrome #Medicine #Vascularnews

If you're thinking about healthcare spending in the US, one fact worth noting About 9% of healthcare spending goes to physician compensation Another 9% goes to nurses Yes, doctors and nurses get paid more in the US than they do in other countries and yes, a small proportion of physicians really do get paid a lot But I've never thought we're going to solve our healthcare spending by going after physician and nursing salaries Not enough there -- and slashing physician or nursing compensation would be a great way to demoralize the core of the US healthcare workforce

Doctors in large centers don't realize what a life-changer fast operating room turnover times are. For those that don't know, the turnover time in OR's varies widely between hospitals. That's the time it takes to clean the room and set up for the next case. In efficient hospitals, especially those that are physician owned, it can be as quick as 20 minutes. In large academic hospitals, it can push 4 or even 5 hours. Think of the difference that makes for quality of life, patient care, and revenue. A doctor who has a large waitlist of patients might be at the hospital until 8pm and still only get two surgeries done because the turnover time is so long. That same doctor could get 3 or 4 surgeries done in a more efficient hospital, getting home in time to have dinner with his family. A physician owned hospital would never tolerate a 4 hour turnover time. That's money being lit on fire. Yet hospitals tolerate this all the time because they don't face competition. There's no incentive to run efficient. So the patients have to wait longer for their surgery, the doctors get frustrated, and everybody loses.

This happens all the time. People want to talk about wasted money in healthcare; hospital transfers are a likely a large part of it. I probably accept at least one patient a week who doesn’t have the problem that was claimed. I’ve had patients transferred via helicopter from other states who had “blockages” of their arteries or other problems, that turned out to be chronic, asymptomatic and didn’t warrant treatment, or the outside radiologist was flat out wrong. All could be avoided if we could look at the imaging prior to transfer, but other ER’s and hospitals won’t do it. There’s no efficient way to share images between different hospitals and there are many times we end up accepting the patient, evaluating them, and sending them home. All could have been avoided by being able to look at the scan myself. The health care system can’t even figure out an efficient way to image share in 2026. But sure, AI is going to take everyone’s job in 2 years.

I once had a brain trauma patient transferred into our ER from an outside facility. It was a small brain bleed, but even a small bleed can be life threatening if it grows. Repeat CTs are essential to ensure it’s not growing. The patient didn’t arrive with imaging from the transferring hospital. They simply neglected to send them. We called and asked them to upload the images to an online portal (HIPAA compliant, widely used). They refused. We asked them if they could put the images on to a CD or flash drive and send it over. They refused. The only way they would release the images is if our hospital sent a courier with a records release form to their hospital to pick up a CD. The amount of time that would take made the images meaningless. So we just repeated the CT to get a new baseline. Stuff like this happens every day.

Maybe we should hire even more administrators to help fix the problem of administrating more administrators.

Private equity firms bought 500 hospitals. Death rates in their emergency rooms went up 13%. They fired 12% of the staff. Then they paid themselves billions in dividends. A Harvard study just confirmed what doctors already knew: people are dying so investors can hit quarterly targets. Exactly what happens. A PE firm buys a hospital using debt. The debt gets placed on the hospital's balance sheet, not the firm's. Now the hospital owes hundreds of millions it never borrowed. To service that debt, the hospital cuts costs. Costs mean nurses. The numbers from the Harvard/University of Chicago study are horrifying. After PE acquisition, emergency department salary spending dropped 18.2%. ICU salary spending dropped 15.9%. Hospital-wide employees were cut 11.6%. Emergency department deaths rose 13%, seven additional deaths per 10,000 visits. A separate study found patients undergoing surgery at PE-acquired hospitals had 17% higher odds of dying within 90 days. Steward Health Care, owned by Cerberus Capital, filed bankruptcy with $9 billion in debt after closing hospitals across Massachusetts. The CEO lived on a $40 million yacht while emergency rooms went dark. Eight hospitals serving 2 million people nearly disappeared because a PE fund extracted more cash than the system could survive. The private equity industry has poured over $1 trillion into healthcare. They operate a quarter of ERs nationwide. This isn't going away. The investing angle nobody talks about. Non-PE hospital operators like HCA Healthcare (HCA) and Tenet (THC) are the direct beneficiaries. Every time a PE hospital closes or deteriorates, patients flow to the nearest competitor. HCA has returned 1,200% since 2011. Patient volume from PE closures is a structural tailwind nobody's pricing in. Medical staffing firms (AMN Healthcare, Cross Country) charge premium rates specifically because PE hospitals cut staff. The staffing shortage IS the business model for these companies. The disruption play: outpatient surgical centers (SCA Health, now part of UnitedHealth) are pulling profitable procedures out of hospitals entirely. PE-owned hospitals lose their highest-margin surgeries to outpatient, and the death spiral accelerates. Pull up tradevision and monitor healthcare M&A alerts, hospital closure filings, and patient volume migration data. When a PE-owned hospital announces "restructuring," the patient volume shift to competitors like HCA starts within 30 days. That 30-day window is when the competitor's earnings revisions haven't updated yet. Free to try. (a private equity firm bought your local hospital. borrowed $500 million in the hospital's name. fired 12% of the nurses. emergency room deaths rose 13%. then they paid themselves dividends. nobody went to prison. they're currently buying another hospital.)

It’s 2026. I can stream a movie on my phone with zero lag. Cars drive themselves. AI bots argue with each other on the internet. And yet the only way to compare a patient’s prior MRI to a new one is to send a courier two hours away to pick up a CD-ROM from another hospital.

For years, Dr. Gustavo Oderich and Dr. Steven Maximus have worked side by side, combining their expertise in vascular and aortic surgery to achieve remarkable outcomes for patients facing some of the most complex conditions. Their collaboration continues here at @bcmhouston where innovation meets experience. Together, they lead one of the most advanced aortic surgery programs in the region. We’re proud to have this powerful team in Houston, setting new standards in aortic care and shaping the future of vascular surgery. #BaylorCollegeofMedicine #AorticSurgery #VascularSurgery #HoustonMedicine #HeartAndVascular #SurgicalExcellence #BaylorSurgeons #ComplexAorticRepair @GustavoOderich @VascularMaximus

Dear @VascularSVS tell us if we are are wrong and why! @@SUNDAYtrial @EarnestTrial #IMPROVE-AD

"The best interest of the patient is the only interest to be considered." -William Mayo, M.D. Founder, @MayoClinic

Let’s go Knicks!!

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The moment the Knicks clinched their first ECF trip in 25 years. Absolute cinema

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The Garden ERUPTS off the OG triple ‼️ 🗣️ New York up by 41 🤯