Paul Grayburn

@amyklobuchar Shame on you, Senator. You have cheered this war on without an exit ramp. You continue to cheer it on - the deaths of millions of young men - to what end? How does this conclude? You don't know, don't care, as long as you can preen about standing with Ukraine. Be serious.

Here’s a proposal for DOGE to reduce physician burnout and improve physician access: revoke the nonprofit status of monopolistic federal “medical organizations” such as the American Board of Medical Specialties (ABMS) and its specialty subsidiaries, and file an injunction to stop the Maintenance of Certification (MOC) process. These organizations force physicians to “maintain” their hard-earned board certification by paying annual fees and participating in various activities that claim to maintain and improve quality. This is in addition to—and often just as burdensome, if not more so, than—the Continuing Medical Education (CME) requirements that all physicians must complete regularly. There is no evidence that these activities, which are largely generic and disconnected from actual clinical practice, provide any meaningful benefit. They were gradually introduced over the past few decades by fiat and imposed without question, leaving no control group or clear metrics for evaluation. This is unrealistic from the outset, given that every physician manages different patients under unique circumstances. The MOC process—now renamed the Continuing Certification Process (CCP)—directly impacts a physician’s ability to obtain insurance credentialing, hospital privileges, and malpractice insurance rates. This amounts to a cartel-like system that drains physicians of their time and money, enforced under the threat of severe financial consequences and loss of professional standing. And this happens after a physician has already completed specialty training, passed board exams, and been certified. Ironically, these measures were introduced under the banner of “public demand.” Yet few outside the medical field even know what these boards are or what they do. Meanwhile, non-physician professionals are now creating their own “boards” and claiming “board certification,” further eroding what little public awareness or prestige the concept of board certification ever had. In summary, the Maintenance of Certification system is a monopolistic racket that forces physicians to spend valuable resources without proven benefit. It demoralizes countless physicians, restricts patient access to care, and has become increasingly meaningless to the public with the rise of alternative professional boards. @elonmusk @DutchRojas @realdocspeaks @noahkaufmanmd @anish_koka @CoffeeBlackMD

NEW: Elon Musk delivers the PERFECT comeback to people complaining, “Nobody voted for Elon.” “Speaking of unelected, there’s a vast federal bureaucracy that is implacably opposed to the president and the cabinet. “And you look at D.C. voting, it’s 92% Kamala. Okay, so we’re 92% Kamala. That’s a lot... That’s basically almost everyone. And so, if the will of the president is not implemented and the president is representative of the people, that means the will of the people is not being implemented. And that means we don’t live in a democracy.”

@MCoylewright @iamritu @pattypellikka Most are not really asymptomatic if you take a careful history (including immediate family) or do a simple treadmill test.

In 1990, @pattypellikka was first author on an important study. She warned that patients with asymptomatic severe AS were at "significant risk for cardiac events within 2 years." Today, she is senor author on a call for a change in the guidelines. sciencedirect.com/science/articl…

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Hi @AOC, this you? Literally shaking.

How many former cowboys players will be in the NFC Chip? Lol Dorance Armstrong (draft pick) Dante Fowler Tyler Biadasz (draft pick) Noah I. Connor McGovern (draft pick) Amari Cooper Jordan Phillips How many careers will this man waste? It is TIME for a CHANGE!

Joe Biden presenting George Soros with the Presidential Medal of Freedom

@awfulannouncing Refs must have had money on Texas

"We definitely have a defenseless receiver and just as he's turning after catching the ball, he gets hit in the head by the defender. I would not be surprised if this is called targeting from the booth." Despite what Matt Austin said, this was NOT called targeting.

Why Does America Spend So Much Money on Administrative Systems in Healthcare? The process of caring for a recent patient highlighted how much of my time is consumed by tasks unrelated to actual care. The stages of patient care, each with its own purpose and burdens, reveal the imbalance between clinical work and administrative demands. Ironically, the first stage—clinical decision-making and treatment implementation—is the foundation of patient care, yet it requires the least time. The subsequent stages, addressing legal, administrative, and systemic demands, consume the majority of a clinician’s effort—without even considering the legions of administrators supporting these systems. Let’s break it down: 1. Clinical Decision-Making This is the core of patient care: gathering data, making a diagnosis, discussing the plan with patients and families, and implementing treatment. Documentation here serves continuity of care and future reference. In many cases, this stage can be completed in just a few minutes. For example, managing a small head bleed or incidental MRI finding might only require a quick review of imaging. Even complex cases demand less time than the stages that follow. Yet this stage, the most critical to patient care, represents the smallest fraction of a clinician’s day. 2. Risk Mitigation and Medicolegal Protection This stage involves actions and documentation aimed at reducing exposure to liability. Defensive medicine, such as ordering extra tests or admissions as precautions, often goes beyond clinical necessity to ensure legal protection. While these actions offer some safety from lawsuits, they add time without directly benefiting patients. 3. Billing and Compliance Documentation Reimbursement requires compliance with CMS’s increasingly complex billing rules, including documentation of record reviews, severity of illness, and decision-making—much of it exceeding clinical needs. On top of this, armies of administrators double-check codes and process claims, adding enormous costs. This machinery is expensive. 4. Health System Optimization and Metric Gaming Hospitals push clinicians to maximize financial outcomes by documenting comorbid conditions (CCs) and major comorbid conditions (MCCs) to enhance DRG capture and case mix index (CMI). This often means inserting buzzwords to make patients seem sicker on paper. These tasks prioritize financial optimization over patient care, sometimes bordering on ethical concerns like upcoding or metric gaming. Once again, this stage requires administrators—not to improve care, but to pressure clinicians to maximize revenue. 5. Systemic Inefficiencies and Operational Delays This stage encompasses inefficiencies imposed by poorly designed systems. Examples include endless EHR clicks, redundant processes like “breaking the glass,” convoluted discharge workflows, and external burdens like prior authorizations. The result of these layers is an inverted allocation of effort. The most time and resources are spent on tasks that do not directly benefit patients, while the least time is spent on the clinical work that defines medicine. This imbalance frustrates clinicians and detracts from quality and efficiency. More and more administrators are needed to manage non-clinical aspects of care. Government payers don’t reward hospital systems for patient-centered care but for navigating convoluted billing systems that incentivize bureaucracy over efficiency. These aren’t rules that come from private industry. They come from Medicare & Medicaid. The result is a healthcare industry where administrative costs dwarf those of any other developed nation. As non-clinical demands grow, they threaten not only the professional satisfaction of healthcare providers but also the system’s ability to meet patients’ needs. This isn’t just inefficiency—it’s a structural failure in American healthcare priorities. @DOGE @therabbithole @anish_koka @VivekGRamaswamy

@femalebodybuil6 17

I’m tired of everyone arguing about this. What number do you see?

@iamnot_elon A. Flat tax

@profstonge IRS.gov says it should take me 68 hrs to figure out my taxes. That is a lot of lost productivity! The tax code is a disaster!

Americans spend $546 billion trying to figure out their taxes. Because the tax code is 10 million words of incomprehensible legalese. 21 times longer than the Lord of the Rings trilogy. And if you disobey one word they'll put you in a cage.

Wonder where the graph is in 2024? Totally need #DOGE @elonmusk @VivekGRamaswamy @RobertKennedyJr @realDonaldTrump

FOUR reasons why Trump should repeal capital gains tax on Bitcoin: 1. Prevent Operation Chokepoint 3.0 by enabling a credible decentralized permissionless alternative to the fiat banking system. 2. As a digital commodity btc is uniquely mobile, zero cost of transportation, meaning that it easily migrates out of high tax jurisdictions. 3. Level the playing field between bitcoin Lightning network and the Visa/Mastercard card duopoly. Give consumers competitive choice and lower fees. 4. Remove cap gains and btc spending comes to the United States, stimulating the economy and growing the sales and income tax base.

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F Jerry Jones. 🧡 If this gets 100K Retweets Jerry will sell the team. He just told me. LET’S GOOOO!!! 🥳

@DrPlantel Been doing it for years. The hard part is patient compliance.

Many doctors already do this, it’s not the future, it’s happening now

#KariLakeWon and some of those involved w/ AZ elections are going to find themselves in very hot water.

@VoiceOfTheStar If there were curtains and Cee Dee catches the TD, we still lose big. The issue is the roster mgmt by the idiot GM.

CeeDee Lamb on the attempted TD pass from Cooper Rush that sailed past him in the end zone in a sun spot: “I couldn’t see the ball. Couldn’t see the ball, at all. The sun.” In favor of curtains? “Yes. One thousand percent.” #Cowboys