Maggie O

@TraemoorVillage, trying to kick this off

@SeanLangenfeld @mcuban @NeilFlochMD I am switzerland, neither pro nor anti. But, you couldn’t know what it was like working with Walter Merrill putting in a ginormous VAD with no rep. No rep. just him, anes, perf, RNs. chefs kiss!

I used to be very anti-industry, and decline all meetings, etc. Over the last 10 years, I've instead focused on partnering with industry colleagues, and I'm happy to see reps in the OR if they can help me with the case. Industry is essential to innovation and surgical education. I say that despite receiving minimal "payments" over the years.

The greatest problem in healthcare ? Hospitals, even market dominant hospitals, won’t walk away from the big ins companies that underpay, late pay, clawback, deny claims, waste their time in denial appeals, and require them to pay up to 8 pct of revenue to RCM consultants so they think they are getting what they are owed. Here is the crazy part. The ins companies ARE NOT THE ONES ACTUALLY PAYING THEM on commercial plans. Employers are. 60 pct of employees get their insurance from their self insured employers. The ins carrier is just a middleman that pretends to add value. All the clinical “value” they add, the hospital could do better, for both medical and pharmacy. Most hospitals have no idea whether they make or lose money with their big ins contracts. They are just afraid to lose patient flow. But. They actually know which companies their patients are coming from. They actually know or can find out, how much more the employers are paying the ins company, than what the ins company pays them (the spread, just like in pharmacy ) And to make it worse, those ins companies negotiate their rates as a discount from the “charge master “, which is like WAC in pharmacy. Just a made up list price. Because the hospitals are afraid or too uninformed to walk away from these deals, the hospitals use the inflated charge master prices as the basis to charge uninsured , or out of network , or insured but not covered for their care, at charge master rates. Which of course the patients can’t afford. And it crushes their finances or they go without care I’ll summarize. Employers , and their members , are paying far more than they should to companies they don’t like working with , that effectively rip off both the employer and hospital , and they could eliminate the middlemen if they went directly to to the employer. It’s so simple. Sell your services to the employers that use your services at a price that is less than what nine companies charge for your services and you will make MORE money and employers will save a ton And if they did this, they could dump the chargemaster and reduce the price they bill patients when they are at their most vulnerable But they don’t want to change. And don’t get me started on how much hospitals over pay for drugs and devices because of the GPO deals they do. It’s just stupid. Which in turn leads to the hospital being a bad actor with 340b , facilities fees and afraid of their doctors who demand they pay more for things like glue and implants so they can get vacations. If you are a politician and reading this. Now you know why this is so fucked up and it’s not about capping rates. The insurance companies are smarter than you. They will just move the money to other places. It’s not about giving money to patients. You can’t shop for care from hospitals that are too gutless to walk away from the ins companies that distort all of healthcare economics Go to your local hospitals , particularly those at risk of closing and ask for their profitability by carrier. Fully burdened. Ask how much they spend on RCM and consultants. In many cases they could survive if they ran like a real business and hired execs that could do the work rather than just manage consultants. They could work out contracts in their communities rather than with ins companies and benefit everyone. The middlemen are not needed. Get rid of them

@SeanLangenfeld @mcuban @NeilFlochMD I may not see much vacations anymore but rep influence is alive and well in ORs. Especially teaching hospitals. schmooze at conferences. He is following the money.

The stakes are pretty high (leaks, deaths, etc) so surgeons do prefer to work with familiar equipment, but cost is a big part of our decisions. Also most hospitals have contracts that limit our ability to use whatever "brands" we want. It's hard not to feel insulted by the vacation comment since I've dedicated my life and spent countless difficult hours trying to help patients. Very few surgeons receive substantial money from industry. Industry-funded vacations haven't existed for 30 years. My $ from industry is listed below. It's probably a couple of conference sandwiches and a dinner to learn about a new intervention. They keep track of every penny spent, as do our employers and societies, who are hyper focused on any conflicts of interest. openpaymentsdata.cms.gov/physician/1085…

@mcuban @thoughtson_tech Let me know when you want to see an actual CDM. I have the goods. Also, Steven Brill made some adjustments to his observations AFTER surgery

@thoughtson_tech Hospitals can definitely make money on Medicare/caid , if you build your hospital to be able to make money from those programs. But that doesn’t get CEOs or PE paid.

@drkeithsiau I love the man because he is normalizing hair transplants! Gotta love a man who owns his plastic surgery!!

Shoutout to John Cena, the only celebrity who randomly follows 1 million people just so that we can feel special 🫶🙇🏻‍♂️

"I had the pleasure of meeting Jessica today. She was doing her job at Kroger, outside wrestling some very heavy carts in the wind. I walked by just in time to hear a grumpy lady in a car roll down her window and proceed to scream at her for being in her way. This poor girl was so embarrassed, she was almost ready to cry. I put my arm around her and told her she did nothing wrong, she was doing a great job, and some people are just grumpy. We walked into the store together, and she wanted me to stay while she told her manager what had happened. Even retelling the story, she got visibly upset again. I assured the manager Jessica had done nothing wrong and handled herself very well. I asked if I could take her picture, and she asked..What for? I told her that I wanted to share with the Facebook world that I had met a beautiful young lady today, and she just may get famous😉 This smile said it all. I followed up with the manager and asked how many special needs people they hired there. He stated at least 12, and they never turn them away if they want to work. Shout out to Kroger in New Albany!" Credit: Michelle Bulmer

@BrentAWilliams2 I think this article should be mandatory reading for anyone who wants to blabber about docs being paid too much

The number of cucks on here whining about how much $$$ physicians make is ridiculous. Go to medical school.

@BrentAWilliams2 $800/hr 😂😂

When St. Vincent’s hospital in NYC was closing they brought in a group of consultants and “Vice Presidents” that were making $800/hour and asked us to take weekend call for free. That is US healthcare in a nutshell.

I renew my invitation for everyone to join me for the Prayer Vigil for Peace, which we will celebrate in St. Peter’s Basilica on Saturday, April 11, at 6:00 PM Rome time. #PrayTogether #Peace

@dadmann_walking I always loved your posts about being a bad husband unknowingly. Glad to hear some sun is getting in there

tomorrow marks 1 year of my wife's death. that was the longest and fastest year of my life. all the firsts are past us. My boys are doing well. I've been healing. Rediscovering me. the year still had a lot of good for us too. Love each other well. Do what makes you happy. Life's too short. ❤️❤️

@real_jackstoner do you know that back in the 90s they had to have events to get people to go downtown? #dancininthedistrict tennessean.com/story/entertai…

You go to a place in Nashville you actually like and then you try to go back 2 months later and it’s a vintage clothing store or a bar called scrimpy dimple with $13 beers

@mcuban They need consultants to evaluate the options quickly for systems that intersect their mission. Kronos aka UKG Pro. Hospitals pay staff. Staff clock in and out. Consultants should help hospitals set up the payroll system (migrate to cloud) but all I see consultants do is bill

Most hospitals don't know their costs. Things I've asked for that made them roll their eyes : A BOM for surgeries P&L for each insurance carrier P&L for Medicaid or Medicare business Why do they need consultants for everything. Why doesn't their CSuite know how to do any of it Why do they use GPOs when prices are insane Why do they work with carriers that underpay, late pay, deny everything, waste docs time with denial committees run by 97 yr old pediatricians. Why do they make no effort to sell direct to employers (excluding those on costpluswellness.com to avoid all the carrier abuse , and avoid being sub prime lenders for patient OOP Why do they abuse 340b Why do facilities fees exist Why do they abuse site neutrality Why do they abuse patients with charge master based bills Why do they not push for standard contract templates to reduce admin. Why do they accept so many different ins plans Anyone want to add more And for context, remember I think the biggest insurance companies are worse

@jointdocShields Rocky hate Mark

New helmet sticker

@bendreyfuss @tharrisonTexas @UHC share.google/2wDcN6s1IAOUvU…

@tharrisonTexas @UHC Why? I don’t know anything about this.

My mom fell and broke her hip last week and I have spent the last seven days dealing with every part of the American health care system. The doctors and nurses at St Luke’s have been so kind, but her Medicare Advantage with @uhc has been obstinate.

@bendreyfuss @tharrisonTexas @UHC Check out this video, "medicare vs medicare advantage funny" share.google/2wDcN6s1IAOUvU…

@bendreyfuss @tharrisonTexas @UHC So many tweets waiting for you to dive into this. let me see if I can find one of them

This is Banjo. His mom’s ex dumped him at the shelter without telling her. She drove 8 hours straight to get her good boy back. One sniff of her scent and he’s launching into her arms with pure rocket-fueled joy! Peak loyalty. ❤️

@jointdocShields work out buddy is a hard position

Current situation

@sophiegrenham USA hospitals typically use case managers for placement of patients with no safety net. Many people pass away for the reason you bring up here. Gene Hackman is an example. If no one is checking in on you, this could be end of your story.

What do hospitals do when they can't rely on the availability of grownup children (usually tired, time-poor women, I'm sorry) to manage a parent's aftercare following a procedure? I put this question to the nurse looking after my mother today, making it clear that I wasn't being smart, and she said usually there is someone to help, whether it's a family member or a friend. What if you have no one at all? What if you have no family and your friends are busy or you alienated them all years ago - what then?

@elliotthaut @HopkinsMedicine @hopkinssurgery @JohnsHopkins @AndrewMCameron @lilahfran @ErrolBushMD @SocietyofBAS @HopkinsACCM

This is the team of senior residents (and one critical care fellow) staffing the Halsted Trauma and Acute Care Surgery team with me this week at @HopkinsMedicine. What a perfect photo for #BlackHistoryMonth w/ portrait of Vivien Thomas.