Physician conversion factors: 2000: $36.6173 2003: $36.7856 2006: $37.8975 2009: $36.0666 2012: $34.0376 2015: $35.7547 2018: $35.9996 2021: $34.8931 2024: $32.7442 UHC stock up 8,556% Insurance premiums up 342% Inflation up 86% Physician pay down 10% We should keep cutting physician pay so families have more money in their pockets through reduced costs and reduced premiums based on the last 25 years of experience.

Some people see construction. I see freedom. I see the future home of patient-first care. Left the system to create something better: care focused on patients, not quotas. Helping build it from the ground up. Doors opening here in 2-3 weeks. New office. Same flip-flops. #Urology #SmallBusiness #Entrepreneur #LebanonPA

I want to reflect on the broken culture of innovation in U.S. healthcare delivery—and its nefarious impact on the system. We declare success prematurely. We obscure failure. And we move on without inquiry. Within the delivery system, the same organizations whose basic and clinical researchers perform rigorous, thoughtfully designed controlled trials of medicines will tout the success of delivery and financing innovation without requisite evaluation. In the broader innovation ecosystem, we too casually equate funding, valuations, and transactions with success—and we too often elevate and declare success without applying appropriate skepticism. Many believe this culture of salesmanship and hucksterism is harmless. But on the other side of it are patients whose care is not getting better and an industry with misplaced conviction about progress when there is none. I’ve seen this firsthand throughout my career. To make this less abstract, I’ll focus on my own area of work over the last decade: leading and operating Medicare Advantage plans and care delivery organizations. It is a sector that has birthed many venture capital darlings. But with the benefit of hindsight, many of those companies had clinical outcomes that were, at best, thin— And whose primary innovation was exploiting arbitrage opportunities in risk adjustment. And yet, in retrospect, these “innovators” were platformed. They were celebrated on the stages of major national forums. And while Medicare Advantage is now a space where some of these behaviors are more widely understood, it is not unique to Medicare Advantage. Rather, some of the distortions we see there are a window into a broader cultural problem. One that, in a different form, was on display in the case of Elizabeth Holmes and Theranos. We might like to believe that was an exceptional story in exceptional circumstances. I don’t. I think we have many Theranoses among us—just less visible, and more socially accepted. Why? I believe there are two root cause. First, expert and funding bias. We believe that startups revered and validated by experts are worthy of celebration. And if they are richly funded, we assume they have been appropriately vetted. Commercial success—often driven by relationships and the favor economy—is prematurely equated to clinical success. Second, optimism bias. We have such a strong desire to believe that things are getting better that the first hint of progress is met with celebration—rather than the skepticism we typically reserve for results that seem too good to be true. This is how many of us have convinced ourselves that American healthcare delivery is improving—while most consumers, patients, and clinicians tell us otherwise every single day. So how do we move forward?

Call. At the hospital used to be the deal with devil for privileges of private practice community docs to admit and use the ORs. If that day is done and is still expected then call needs to be a paid part of the compensation package.

With all due respect find me a profession that is working for 70 percent less than 20 years ago inflation adjusted, that does what docs do, with the risk, liability, responsibility, training and expertise that docs provide. We all agree there’s lots of fraud.

WOW 🚨 Delta Dental is considered a nonprofit but the CEO skyrocketed her pay from $4.5 million per year all the way to $48 million over 4 years That’s $1 million dollars per month pay for one employee as a nonprofit “Delta Dental is considered a non-profit, and as such you can be their taxes online. So I got curious in their 2014 filing, the IRS requests for the organization's top accomplishments. Delta Dental reported that over 95% of claims electronic, online and paper were processed without any manual intervention. That means when your care is denied, there is less than 1 in 10 chance a human reviewed it — That same year, Delta dished out up to a 30% pay cut on the care that doctors deliver, and for a decade, they did not raise what they pay for your dental care by a single penny. Meanwhile, their CEO's salary skyrocketed. She went from 4.5 to $15 million a year. From 2014 to 2018, she made off with almost $48 million before leaving her position. That's a million dollars a month. Must be nice. And she's not even a clinician. She's a CPA. You don't have to be an accountant to do the math. Dr. Pay cuts stagnant reimbursements. They were never about saving patients money on premiums.”

If you're thinking about healthcare spending in the US, one fact worth noting About 9% of healthcare spending goes to physician compensation Another 9% goes to nurses Yes, doctors and nurses get paid more in the US than they do in other countries and yes, a small proportion of physicians really do get paid a lot But I've never thought we're going to solve our healthcare spending by going after physician and nursing salaries Not enough there -- and slashing physician or nursing compensation would be a great way to demoralize the core of the US healthcare workforce

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