Nathan Varady

“I didn’t write those penalties.” - Pete Stark The Stark Law prohibits a physician from referring patients to an entity in which they have a financial interest. That sounds neutral but it isn’t. A hospital-employed orthopedic surgeon who refers every post-operative patient to the hospital’s owned SNF, physical therapy, imaging center, and home health agency has a financial interest in every one of those referrals. His salary, his productivity bonus, and his continued employment depend on staying within the system. None of that triggers Stark. The bona-fide employment exception covers it entirely. An independent orthopedic surgeon who owns an MRI with two partners? Well, they would have to go through a full stark analysis and legal review with complex written arrangements and ongoing compliance infrastructure. One technical violation of Stark and the False Claims Act exposure is existential. These scenarios show the same financial conflict with radically different legal treatment. The consequences for patients are hard to ignore. A recent NORC survey found that 61% of employed physicians have moderate or no autonomy to make referrals outside their system, and nearly half said they adjust treatment options based on organizational incentives. Hospital employment doesn’t eliminate the financial conflict of the referral relationship. It just hides it inside a compensation structure Stark never touches. Marc Greenberg, MD, an orthopedic surgeon in Baltimore, put it plainly in Becker’s this week: “We’ve created a system where for-profit entities can have healthcare ownership. But the people who took an oath to serve the patient — who’ve shown a commitment to caring — can’t.” There is no federal prohibition on hospitals requiring employed physicians to refer within the system. No law prevents health systems from structuring compensation, call coverage, or scheduling to steer referrals to owned facilities. No equivalent of Stark governs the institutional referral relationship at all. Congressman Stark was trying to protect patients from corrupted referrals. What his law produced was a system where the most powerful referral relationships in American healthcare are completely unregulated and the physicians most accountable to patients are the ones most restricted.

Darius Acuff Jr. of @RazorbackMBB is the only player to have 60+ points, 10+ assists & 5 or fewer turnovers over any 2-game span in the NCAA Tournament (since assists became official in 1983-84). He did it in his first 2 tourney games as a freshman.

He’s the best in the country and he’s not done yet 😤 #AcuffPOY

.@RazorbackMBB is headed back to the Sweet 16 for the second consecutive NCAA Tournament and the fifth time in the last six seasons.

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.

Darius Acuff Jr.: 24 points, 7 assists Meleek Thomas: 21 points, 5 assists First freshman duo ever with 20+ points and 5+ assists in an NCAA Tournament game, per CBS Sports research.

Darius Acuff today against Vanderbilt: 30 points, 11 assists The best freshman point guard to ever play for John Calipari.

I've used em-dashes my whole life — they add rhythm and grace to writing. But now they're an AI tell. Can we get a grandfather clause for those of us who were fluent in em-dashes before ChatGPT launched in November 2022?

Darius Acuff becomes the 28th player in D1 men's basketball history to reach 700+ points, 200+ assists, and 100+ rebounds in a season. The last player to achieve this was Ja Morant in 2018-19.

Baum-Walker Stadium. One of one.

@RERB Update on evacuation? Train is just before Le Bourget

❌ Le trafic du #RERB est interrompu entre Châtelet-les-Halles et l'Aéroport Charles de Gaulle 2-TGV / Mitry-Claye dans les deux sens de circulation à la suite d'une panne informatique impactant le réseau SNCF. ⏱️ La reprise du trafic est repoussée à 16h30

Most underrated cities I've ever spent time in Bentonville, Arkansas Draper, Utah Boulder, Colorado Oklahoma City, Oklahoma Tampa, Florida Dallas, Texas Nobody talks about these as top places for jobs or entrepreneurship All of them surprised me

Hospitals have convinced a generation of doctors that the building is the value. (Funny how that theory disappears the second there is a lawsuit) Without doctors: no admissions, no surgeries, no procedures, no E&M billing, no facility fees, no DRGs, no MCC/CC capture, no 340B scripts, no quality metrics. The building collects the fee. The doctor creates the value. That is the relationship. Time physicians started acting like it.

🏆 SEC Player & Freshman of the Year! 5️⃣ owned the season and he’s not done yet. 💪🔥 #AcuffPOY

@DrAntoniaChen @jbjs @AAHKS @womenAAHKS Incredible. Congratulations!!

Honored to serve as the next President of @AAHKS and the second female president in its history. I look forward to advancing surgeon well-being, addressing burnout, promoting equity, and strengthening the future of hip & knee arthroplasty for the patients we serve. @womenAAHKS

So far this season, @RazorbackMBB freshman Darius Acuff Jr. has put up: 20.0+ PPG 5.0+ APG 40.0+ 3P% 3.00+ A/TO ratio No other Division I player of any class has ever done that in a season (min. 75% of team games played).

Sean Miller on Darius Acuff: "In my time of 34 years, I've never seen a point guard better... He's a generational player. This No. 1 pick thing, I don't know why people aren't talking about him more. I can't imagine anybody better" 👀 (🎥: @PigTrailNation)

LASIK eye surgery cost $2,200 per eye in 2000. Today it's around $1,000 per eye despite 24 years of inflation. Meanwhile, an MRI that cost $1,200 in 2000 now costs $3,000+. The difference? LASIK operates in a free market with no insurance interference and minimal regulation. When patients pay directly, providers must compete on price and quality. LASIK clinics advertise prices, offer financing, and constantly improve technology to attract customers. Compare this to hospital procedures where prices are hidden, patients never see bills, and insurance companies negotiate opaque rates that somehow always increase faster than inflation. Cosmetic surgery follows the same pattern. Breast augmentation, rhinoplasty, and other elective procedures have become more affordable and safer over decades. Surgeons invest in better techniques and equipment because they must satisfy paying customers, not insurance bureaucrats or hospital administrators focused on maximizing reimbursements. The lesson is clear: remove third-party payment systems and excessive regulation, and you get Austrian economics in action. Prices fall, quality rises, and innovation accelerates. Healthcare costs aren't rising because of aging populations or new technology—they're rising because we've destroyed the price mechanism that makes markets work.

There’s no justifiable reason - that I’m aware of, anyway - to shut down Global Entry processing at airports while continuing to handle applications and interviews. Those are far more labor intensive than waving approved travelers through passport control after a selfie.

To my knowledge, this is unprecedented. And likely counterproductive. PreCheck & especially Global Entry (which is largely automated through facial recognition for verification) help federal employees handle more travelers. This will lead to huge bottlenecks affecting everyone.