jason hemming

Eagles receive: 1st round pick in 2027 4th round pick in 2027 Kayshon Boutte Patriots receive: AJ Brown Let’s get it done on June 1st, Howie.

@DrHarryDOesHep @yuvalpatelMD Yes an intern year with not credit that will need to be repeated. Pretty exploitative by the program

@yuvalpatelMD @jhemming Neurosurgery to me is like GI: super competitive, more qualified applicants than slots. What is a research year and getting 4 or even 14 more publications going to tell you about a candidate and how they will do? This person finished “the equivalency” of an intern year.

This can’t be real…..

After much reflection, I have decided to resign from my position as Director of the National Counterterrorism Center, effective today. I cannot in good conscience support the ongoing war in Iran. Iran posed no imminent threat to our nation, and it is clear that we started this war due to pressure from Israel and its powerful American lobby. It has been an honor serving under @POTUS and @DNIGabbard and leading the professionals at NCTC. May God bless America.

Saturday Night Live occasionally makes me laugh. Welcome to MAHAspital. Where emergencies are treated with beef tallow and raw eggs.

@JakePearson303 There’s more money in slinging propriety supplements than any medications. I have never once made a dime off of a prescription.

There's a reason your doctor never mentioned Berberine. It can't be patented, so there's no profit in it. For 3,500 years, this natural compound has been torching fat and optimizing hormones. They buried it. I'm bringing it back. Here's the truth: 1… twitter.com/i/web/status/1…

@CharlesLutzMD Hospitals / health systems can choose the $ per RVU they credit physicians for their work. If CMS is proposing a cut in rvu the we should be demanding an increase in $ per rvu. Know your worth!

Agree with you but think a better strategy is to reclaim the ownership of the medical profession that we have given away over the past 25 years, in large part because we don’t have united advocacy in Washington. The wRVU coupon that CMS provides is essentially the same as it was 25 years ago and adjusted for inflation is a fraction of what it was. Yet the hospital makes a increasing yearly amount on our labor. In my humble opinion our societies need a different strategy. @DutchRojas @DrDiGiorgio @anish_koka @realdocspeaks @GeBaiDC

@drkeithsiau Small 1 yr open label study in patients in remission on 5ASA. Interesting indeed. But doesn’t make appy a valid treatment option for UC yet

Did you know that appendicectomy is a valid treatment in ulcerative colitis? This is what you need to know about the recent ACCURE trial ✂️

I am the VP of Claims Optimization at one of the five largest health insurers in the United States. I do not practice medicine. I have never practiced medicine. I have an MBA from Wharton and a background in supply chain logistics. Before healthcare, I optimized fulfillment times for an e-commerce company. The transition was seamless. In e-commerce, the product is a package. In healthcare, the product is a claim. Both are routed, processed, and occasionally denied. The denial rate for packages was 0.3%. The denial rate for claims is 34%. The margins are better in healthcare. The algorithm is called nH Predict. We did not name it. The vendor named it. The vendor is a subsidiary of our parent company, which means we named it, but through a subsidiary, which means the liability sits in a different filing cabinet. nH Predict processes a claim in 1.2 seconds. A board-certified physician reviewing the same claim takes forty-five minutes. We replaced the forty-five minutes. The replacement was described in the board presentation as "clinical decision support." It supports the decision to deny. My team processes 1.4 million claims per quarter. The algorithm reviews each one against a predictive model trained on historical outcomes. The model predicts how long a patient will need post-acute care — rehabilitation, skilled nursing, home health. Then it recommends a coverage duration. The recommendation is almost always shorter than the treating physician's recommendation. The physician sees the patient. The algorithm sees the data. We trust the data. The data is cheaper. Here is what I am not supposed to tell you. We know the reversal rate. We have always known the reversal rate. When a patient appeals a denial, 90% of denials are reversed. Ninety percent. This means nine out of ten times, the algorithm was wrong. Not arguably wrong. Not borderline wrong. Reversed-on-appeal wrong. The appeal is reviewed by a human physician. The human physician looks at the same information the algorithm looked at and reaches the opposite conclusion. This has been happening for three years. We have not recalibrated the algorithm. Recalibration would increase the approval rate. An increased approval rate would decrease the margin. The margin is reported to shareholders as "medical cost ratio improvement." Nobody asks what the words mean. The business model is the gap between denial and appeal. Sixty-three percent of patients do not appeal. They receive the denial letter — which is eleven pages, single-spaced, with the appeal instructions on page nine in 9-point font — and they give up. They pay out of pocket. They skip the rehabilitation. They go home early. Some of them fall. Some of them are readmitted. The readmission is a new claim. The new claim is processed by nH Predict. The 37% who appeal wait an average of 43 days for a decision. Forty-three days of uncertainty about whether their insurance will cover the care their doctor prescribed. During those 43 days, many of them have already been discharged. The appeal is retroactive. The care is not. I have a dashboard. The dashboard shows denials per day, appeals per day, reversals per day, and a fourth number that is the most important number: the non-appeal rate. The non-appeal rate is 63%. I report this number weekly. It has never been described as a problem. It has been described as "patient engagement efficiency." When the non-appeal rate rises, I am congratulated. When it falls, I am asked what happened. The class action lawsuit uses the phrase "bad faith." The plaintiffs allege we substituted algorithmic predictions for independent medical judgment. This is accurate. The substitution saves $2.1 billion annually. The lawsuit seeks $1.3 billion. Even if we lose, the math works. Three years of $2.1 billion is $6.3 billion. Minus $1.3 billion is $5 billion. The settlement will include the phrase "without admitting wrongdoing." The settlement always includes that phrase. I am the Vice President of Claims Optimization. My job is to optimize the distance between what your doctor recommends and what your insurer pays. The distance is the product. I have been optimizing it for three years. The algorithm gets faster. The appeals process gets longer. The font on page nine gets smaller. The margin gets wider. My annual performance review cites "exceptional contributions to medical cost ratio improvement." The review does not mention the 90% reversal rate. The review does not mention the 63% non-appeal rate. The review does not mention the patients. The algorithm does not practice medicine. I want to be clear about that. It predicts. It denies. It profits. The prediction, the denial, and the profit are three separate functions. The separation is important. For legal purposes.

After the Iraq Invasion, George W. Bush stopped playing golf He said he didn’t want “some mom whose son may have recently died to see the commander-in-chief playing golf” abc.net.au/news/2008-05-1…

@DougRus24467683 @growingwisdom My roses get decimated by rabbits any advice?

@growingwisdom Rabbits beat mine up this winter....

One of the very first things I do is cut back the roses and feed them. Snow still on the ground.

@DrDiGiorgio @Sensible__Med I’m most confused that they need 4 chiefs…..

An internal medicine colleague of mine once told me that their chief resident refused to have more than 8 patients on their service because any more would be unsafe. Another got written up for asking a med student what their thought process was for coming up with a diagnosis. Another was reprimanded for criticizing an intern in front of the team instead of privately.

@dr_ericberg If “Dr” Eric actually went to medial school and was taught proper physiology he wouldn’t be posting such nonsense

Drinking just water in the morning, when blood volume is lowest, may dilute electrolytes and increase dehydration. Adding a pinch of sea salt can help retain water in the bloodstream and improve how you feel.

@DrDatta_AIIMS @SebastianCaliri Also curious what the rate of incorrectly recommending emergency care

In real world conversations, GPT-5.4 correctly recommends immediate care in emergency cases more than 99% of the time. May we know the reference of this highly irresponsible statement? AI evangelist and researcher here. Please don’t spread misinformation. Looks cool but it isn’t!

Remember the paper saying ChatGPT Health undertriaged 52% of medical queries? Turns out the study methodology was massively flawed. In real world conversations, GPT-5.4 correctly recommends immediate care in emergency cases more than 99% of the time. Healthcare AI isn't perfect and there are open questions about how to evaluate LLM-based tools. But always worth remembering that there are groups that have an incentive to produce a sensational, AI-skeptical headline by cloaking suspect science in academic authority.

@SebastianCaliri The key is not sending every “red flag” to the EDD the key is knowing which ones don’t have to.

@liverazzi @Deutschland_M10 @drkeithsiau It’s also not uncommon to find a cecal polyp along the icv ad ones trying to intubate TI

@Deutschland_M10 @drkeithsiau Agreed that yield is low, but if the only time you try to intubate through the IC valve is in a highly inflamed ileum, well…may take more than 56 seconds !

🤔 Should we be doing routine terminal ileal intubation during colorectal cancer screening colonoscopy? 🔦 💡 No, according to the results of a newly published meta-analysis 👇

@Deutschland_M10 @drkeithsiau The goal is to not really to find pathology. The goal is to get proficient in intubating the TI so when it comes to the synpatomatic patient you’re not failing. So should I not be intubating the pylorus to examine duod in patient with GERD?

@drkeithsiau Agreed. In asymptomatic screening patients the yield is extremely low. Ileal intubation probably makes more sense when there is suspicion for IBD, unexplained diarrhea or inflammatory changes.

@JustinBonomo They literally r*ped, sodomised a innocent Palestinian man and he needed surgery to his rectum after. It's all on camera!!! The lawyer who leaked the security video was arrested.

This the shit I be talking about

Some of the frivolous September purchases made under Secretary Pete Hegseth’s stewardship include a $98,329 Steinway & Sons grand piano for the Air Force chief of staff’s home, $5.3 million for Apple devices such as the new iPad, and an astronomical amount of shellfish, including $2 million for Alaskan king crab and $6.9 million worth of lobster tail. (Lobster tail is apparently a favorite of Hegseth’s Pentagon—the department spent more than $7.4 million total on the luxury item in March, May, June, and October.) In other pricey food purchases, the government decided to drop $15.1 million for ribeye steak (again, just in September), $124,000 for ice cream machines, and $139,224 on 272 orders of doughnuts.