Arvind Cavale
6.1K posts
@endodocPA
Clinical Endocrinologist/Researcher, Educator, Small Business Owner, Taxpayer, Job Creator, Entrepreneur, Healer, Problem-solver
@mcuban Because reimbursement is often set below cost. Medicare—especially Medicaid—pay fixed rates that frequently don’t cover staffing, infrastructure, and 24/7 care. Hospitals can’t refuse those patients so the gap gets made up elsewhere.
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-…
The most effective regulatory capture doesn't look like corruption. It looks like an advisory committee. HHS and CMS Announce Members of the Healthcare Advisory Committee to Improve Patient Care and Modernize the U.S. Healthcare System. 18 members. Who Is NOT at the Table •Independent physicians •Physician-owned hospital operators •Rural hospital administrators (non-system) •Patient advocacy organizations •Healthcare antitrust experts •Medical school debt/workforce experts •Uninsured or underinsured patient representatives •Direct primary care physicians •Emergency medicine independent groups •Physicians who have testified against hospital consolidation The incumbents do not need to lobby if they're writing the policy. hac.rojasreport.com If we are missing anything, please let us know. If we are incorrect about any data, let us know. This goes especially for @DataRepublican, the queen of insights. It took a 30-minute conversation with the team, and here are the results.
@doctorwes @Allison_Dupont @jaygirimd @InfoNbpas many hospitals will affirm that they accept @InfoNbpas but others, like some major payers that @InfoNbpas has advertised as "accepting" and "recognizing" nbpas will not affirm this. and their credentialing systems will reject you, as I am now, unfortunately, experiencing.
The fake narrative is that there are not enough people among the U.S. domestic population that can be doctors. Make US medical education a $400,000 , minimum of 11 year post high school journey that discriminates based on race (guess which ones) and yes.. you may have a problem. We also don’t have a physician shortage problem when we create a new cardiology fellowship yearly for some problem that affects 0.01% of the population. And please understand residency slots exist in many places to .. yes.. provide cheap labor to community hospitals who get paid ~ 2x by the U.S. taxpayer for each spot. Many of these residencies are essentially large feeder programs for hospitalists.. another specialty that didn’t really exist when I started training.
I do not believe in accidents. The system does not need physicians to be wrong. While physicians argue about vaccines, APPs, RVUs, and IMGs, the architecture dismantling their profession operates without a single opponent in the room. Section 6001 sits untouched. CON laws protect incumbent monopolies in 35 states. Site-neutral payment dies in committee every session. Professional fees have been cut significantly over the last 20 years. The Ways and Means contribution tables get filed and forgotten. Energy and Commerce collected their cash. Meanwhile the health system have built a captive architecture around commercial insurance. The employed physicians generate commercial revenue that subsidizes the system. The system tells the physician they are a cost center. The physician believes it. The physician does not see the facility fee attached to every service they deliver. The physician does not see the commercial rate differential between the hospital outpatient department and what they would collect in independent practice. The physician sees only their salary and the number their administrator shows them. No hospital ownership and now the lobby is moving to ban ASCs entirely in select markets. Of course this is the last structural alternative to hospital employment for proceduralists who still want independence. Divided physicians are manageable physicians. United physicians are an existential threat to a $275 billion subsidy apparatus. Every distraction contains a genuine grievance. That is precisely what makes the distraction effective. You cannot dismiss a legitimate argument. You can only be consumed by it while the architecture calcifies around you. The hospital and insurance lobby does not need physicians defeated. It needs them occupied. As far as I can tell, it’s working…
If the large hospitals can replace American trained doctors with foreign trained,sponsored by hospitals, they can control their practice of medicine. Many states now don’t require passing USMLE or completion of a US residency. It’s a manufactured shortage. It’s also exploiting these foreign doctors. Americans need to be informed. When you go into a hospital, many of the Hospitalists are from this pool.
