
John Stetson
214 posts

John Stetson
@jstets212
Husband. Father. Fund Manager @sunsetbaycap.com. Stoner’s Pizza Joint @joint_stoner CEO/Owner. @PolarityTE CEO. UPenn. Iowa born and raised.



Documents reveal the granular details of the billionaire Leon Black’s net worth, from 69 bank accounts to a $484 million loan backed by his art collection on.wsj.com/3MkRlcS





This is a story about how skin substitutes, materials used to improve healing of complex wounds, grew from a niche product in 2019 to scamming taxpayers and patients out of $10 bln/year, not because of a medical breakthrough, but from billing abuse. It’s a case study in how hard it is to cut even waste, fraud, and abuse. Medicare, run by CMS, reimburses bandages based upon the average sales price (ASP) at which the private sector is transacting. But in the first 6 months of product introduction, CMS doesn't have the data to compute ASP, so it pays whatever price the company sets. You can see the logic of the rule but probably also see the potential problem. Manufacturers figured out how to game the system. Introduce a new product at an inflated price, which Medicare will pay for the first 6 months. Then, phase it out and introduce an almost identical, but new, product. CMS now covers that product at whatever price the manufacturer set. Five years ago, the most expensive skin substitute was $1,000/sq in. Today it is $21,000/sq in. Why do medical providers support this scam instead of choosing a cheaper product? First, CMS pays providers a fee that includes a % of the bandage’s price, which rewards higher costs. Second, manufacturers offer steep “bulk” discounts on purchases as small as a few inches, and providers keep the difference. The higher the list price, the more they earn. This loophole has become a major revenue stream for dishonest manufacturers and providers. Mobile wound care clinics have popped up to generate demand from patients who never needed the product in the first place. Skin substitutes, unlike drugs, do not need successful randomized controlled trials to come to market. This creates two problems. First, manufacturers have negligible barriers to introduce substitute products every 6 months. And second, there is low quality of evidence on what type of wounds on which these products are effective, leading to overuse. In 2023, an Inspector General warned about the abuse, but fixing even blatant fraud takes time. CMS announced in 2024 a fix would happen in early 2025. In January, the Trump admin paused all Biden admin policies. Ultimately, the Trump admin finalized a rule reducing the price that will go into effect in 2026. Delays have cost taxpayers and patients billions. More concerning, the industry is making very large political donations in an attempt to delay or kill the changes. There’s a constant cat and mouse game between regulators who set healthcare reimbursement rules and companies looking to exploit them. The IG and CMS have done their job. Now they need political support to identify and stop this sort of fraud broadly. Congress must resist industry lobbying to undo the pricing change. Politicians say they’re furious about rising healthcare costs. The real test is whether they’ll address even blatant abuse to actually bring them down.


@shmira55 @Keshmarf My $DGXX forecast: $6+ by Labor Day, $10 y/e, $20-25 y/e 2026.







Stoner's Pizza Joint burns bright as it grows. Stoner's Pizza Joint has 50 units and will build another 15 next year. With its systems and franchising down, owner John Stetson expects the brand to excel as it grows. ow.ly/n0LR105PPm3









