Biden Out of Race

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So I voted for Trump all of one time. Never cared about Hunter Biden AT ALL. Never cared about Pelosi but for the fact that liberals swear up and down they're the purity party for the little guy.

I've never looked to this country's leaders for morals because it doesn't affect my day to day in the slightest. Let me know when selling out our "country's best interests" start to affect me in some material way. I'll be on the lookout for it. The worst thing to happen to all of our careers in recent memory has been the ACA, by the way.

Maybe you're just too partisan yourself to have a normal conversation without going into liberal REEEEEEEE mode.
How did the ACA negatively impact anesthesiologists?

The anesthesia quality metrics are nonsense..but generally not a big issue

ACA increases the number of patients, I which increases surgeries, which increases demand for anesthesia. Good thing.

Insurance reimbursement? Goes down because it's always going down. This is primarily affected by the non compete contracts and OON billing bans. ACA didn't change those

I wasn't able to find any concrete info on Google about significant impacts
 
The only possible reversal of this trend is with a Bernie-like candidate, or gulp AOC. Bernie as a white male was potentially electable on a national stage. AOC has no chance. I don’t know much about Josh Shapiro. Gavin Newsome is a typical douchey politician.

The people here who voted for Trump for ‘personal reasons’ will gain more wealth (so will I!!) but America is on the decline if life gets worse for the middle class and below. Trump is a populist but he speaks for the upper class. The days of ‘I’m bringing coal mining back to WV!!’ are over. Now it’s ’I’m getting filthy rich off my memecoin and market manip and I’ll toss you other upper class folks a bone too occasionally!!’. And the upper class folks go ‘yep he gets my vote!!’.

Listen to Bernie on Rogan a couple years back. Nothing radical. This country was bought and sold by lobbyists, insurance companies, and big pharm.


Newsome is very polarizing. The right and center right will never trust him. And he is doing his best to lose the left. He is trying to win over moderates but he has too much history and baggage to appeal to them.
 
The ACA defacto pushed hospital consolidation into official CMS policy. As hospitals get bigger they demand a bigger share of the pie which is why facility fee and other non-physician-work revenue keeps going up and physician reimbursements keep going down.
 
The ACA defacto pushed hospital consolidation into official CMS policy. As hospitals get bigger they demand a bigger share of the pie which is why facility fee and other non-physician-work revenue keeps going up and physician reimbursements keep going down.
Exactly. The facility fees go up and up. No other fees go up. I don’t think it’s a coincidence that private equity doom started around 2010 nationwide
 
Newsome is very polarizing. The right and center right will never trust him. And he is doing his best to lose the left. He is trying to win over moderates but he has too much history and baggage to appeal to them.
The dems are in the wilderness and probably won't win a presidential election in the next 12-16 yrs.
 
The ACA defacto pushed hospital consolidation into official CMS policy. As hospitals get bigger they demand a bigger share of the pie which is why facility fee and other non-physician-work revenue keeps going up and physician reimbursements keep going down.
Aren't anesthesiologist making more $$$ than ever?
 
Exactly. The facility fees go up and up. No other fees go up. I don’t think it’s a coincidence that private equity doom started around 2010 nationwide
Private equity lived due to OON billing and greedy anesthesia groups/hospitals and died when it OON billing died.

I don't see how facility fees going up would result in anesthesia rates dropping. They are independent of each other.

Hospitals can raise facility fees because of supply and demand. There are only so many hospitals...lots of anesthesia.

They raised fees and drove business to ASCs (supply and demand)..but replaced it with older and sicker patients that ASCs won't take
 
The ACA defacto pushed hospital consolidation into official CMS policy. As hospitals get bigger they demand a bigger share of the pie which is why facility fee and other non-physician-work revenue keeps going up and physician reimbursements keep going down.
Hospitals will always ask for as much as they can get and pay as little as they have to.

Insurance companies will do the same.

I still don't see how the ACA would force anesthesia salaries down. Medicare can do that because it forces us to accept non market rates. Insurance can do that because of OON billing bans (not part of the ACA).

I am honestly interested in how. I hear the talking point but I haven't heard any logical reason how the ACA negatively impacted us. In 2014, anesthesia was a terrible labor market (no jobs) and now it's great. Seems to be unrelated to the ACA and more related to general labor supply principles
 
Aren't anesthesiologist making more $$$ than ever?

Since the ACA most private practices have shut down and become hospital employees or AMC employees. Payor mix has worsened. Insurance reimbursement hasn’t kept up w inflation.

Anesthesiologists are making more due to a supply demand imbalance. Hospitals want more more more. There’s only so many of us to go around.
 
Since the ACA most private practices have shut down and become hospital employees or AMC employees. Payor mix has worsened. Insurance reimbursement hasn’t kept up w inflation.

Anesthesiologists are making more due to a supply demand imbalance. Hospitals want more more more. There’s only so many of us to go around.
Well payor mix will continue to worsen as the population ages into medicare.

Medicaid pays as poorly as ever, so nobody takes it.

It's the commercial stuff that has dropped rates because they can unilaterally drop contracts and we have no leverage. Nothing to do with ACA.
 
Well payor mix will continue to worsen as the population ages into medicare.

Medicaid pays as poorly as ever, so nobody takes it.

It's the commercial stuff that has dropped rates because they can unilaterally drop contracts and we have no leverage. Nothing to do with ACA.
You guys (anesthesia) are in a peculiar environment because

1. ORs make a ton of money (due to facility fees)

2. Because of the increased demand for anesthesia services, you are indirectly getting a piece of the facility fees either through direct W2 employment or hospital subsidies. These are not common in Radiology by contrast. In fact groups are threatening to walk and extracting a piece of a subsidy in this new era, but it is very new for radiology (and we have effectively unlimited competition due to telerad) so it’s a fine line.

3. ACA encourages hospital consolidation which for a hospital based specialty means if you ever become oversupplied, you suddenly have a shortage of potential employers and no competition between them for your own employment. Further, ACA banned physicians from opening hospitals which is coupled with CON rules that tightened up around the same time as the ACA to make starting your own thing even difficult legally.

You can see the effects of ACA consolidation on non anesthesia hospital based specialties like ER, Hospital medicine, Radonc…

My city is 4 hospital systems. Each system has 1 group. I have 4 potential employeers in a 40
mile area. That sucks since the group presidents all collude and offer the same deal to everyone.

I’ve become a (remote) W2+1099 telerad because the local jobs suck. They suck cuz as hospitals buy each other they forced the rad groups to merge or rfp for the favored “system” group.

4. Due to the SOS payment disparity, hospitals can literally buy groups and do nothing and profit from it. It kills independent private practice. This is spurred on by the ACA incentives for hospital consolidation.
 
You guys (anesthesia) are in a peculiar environment because

1. ORs make a ton of money (due to facility fees)

2. Because of the increased demand for anesthesia services, you are indirectly getting a piece of the facility fees either through direct W2 employment or hospital subsidies. These are not common in Radiology by contrast. In fact groups are threatening to walk and extracting a piece of a subsidy in this new era, but it is very new for radiology (and we have effectively unlimited competition due to telerad) so it’s a fine line.

3. ACA encourages hospital consolidation which for a hospital based specialty means if you ever become oversupplied, you suddenly have a shortage of potential employers and no competition between them for your own employment. Further, ACA banned physicians from opening hospitals which is coupled with CON rules that tightened up around the same time as the ACA to make starting your own thing even difficult legally.

You can see the effects of ACA consolidation on non anesthesia hospital based specialties like ER, Hospital medicine, Radonc…

My city is 4 hospital systems. Each system has 1 group. I have 4 potential employeers in a 40
mile area. That sucks since the group presidents all collude and offer the same deal to everyone.

I’ve become a (remote) W2+1099 telerad because the local jobs suck. They suck cuz as hospitals buy each other they forced the rad groups to merge or rfp for the favored “system” group.

4. Due to the SOS payment disparity, hospitals can literally buy groups and do nothing and profit from it. It kills independent private practice. This is spurred on by the ACA incentives for hospital consolidation.
Well. That all sounds like issues of labor supply and demand .not the ACA

Telerad was inevitable and it's a very strong downward pressure on incomes. Not ACA related

If local groups underbid each other, that's because they have enough labor and not enough jobs. Otherwise, they have to increase their pro forma to account for higher labor costs

If physician's owned hospitals, it may makes things more profitable for the owners, but not for the rank and file.

If each hospital needs 10 radiologists, and they consolidate, then each hospital still needs 10. You could argue that if one hospital had 8 then they might have to pay more of they needed 10, but then another hospital might pay less because they have 12. Supply and demand again.

If the hospital consolidates and demands that the radiology group covers for less money, then the radiology group should say no and then it depends on supply and demand.

None of those are ACA related issues from what I can see.

ER is hurt by the ability of an ER to be run by one doc and 5 NPs. However hospitals may realize that RNs order much more testing and imaging (unnecessarily) and drive up costs.
 
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Since the ACA most private practices have shut down and become hospital employees or AMC employees. Payor mix has worsened. Insurance reimbursement hasn’t kept up w inflation.

Anesthesiologists are making more due to a supply demand imbalance. Hospitals want more more more. There’s only so many of us to go around.
ACA has given you more customers.
 
Newsome is very polarizing. The right and center right will never trust him. And he is doing his best to lose the left. He is trying to win over moderates but he has too much history and baggage to appeal to them.

Newsom is a clown. He's been a terrible governor.

He's your typical greasy empty headed politician. He's not very smart and if it wasn't for the Getty family propping him up, he'd be a nobody.

His management during Covid was bad.
He's in the pocket of PG and E.
He's going to be linked to the homelessness problems we have.

None of this plays well with the rest of the country. I can't see an independent from Michigan looking at Newsom and thinking " he's my guy."
 
Well. That all sounds like issues of labor supply and demand .not the ACA

Telerad was inevitable and it's a very strong downward pressure on incomes. Not ACA related

If local groups underbid each other, that's because they have enough labor and not enough jobs. Otherwise, they have to increase their pro forma to account for higher labor costs

If physician's owned hospitals, it may makes things more profitable for the owners, but not for the rank and file.

If each hospital needs 10 radiologists, and they consolidate, then each hospital still needs 10. You could argue that if one hospital had 8 then they might have to pay more of they needed 10, but then another hospital might pay less because they have 12. Supply and demand again.

If the hospital consolidates and demands that the radiology group covers for less money, then the radiology group should say no and then it depends on supply and demand.

None of those are ACA related issues from what I can see.

ER is hurt by the ability of an ER to be run by one doc and 5 NPs. However hospitals may realize that RNs order much more testing and imaging (unnecessarily) and drive up costs.
The ACA structurally set in motion the hospital consolidation machine which reduces the ability for competition to exist.

All politics is local; maybe your state doesn’t have CON. But in places that still do, CON + ACA leads to outcomes like mine where no new hospital has been built in 20 years, and many have closed despite the state population increasing substantially.

In general, I think the goal of having more insurance access is a net benefit to society. However, the power it gives hospitals and insurance companies is a net negative.
 
ACA has given you more customers.

certainly there’s been a slow steady increase in medicare and Medicaid. Anesthesiologists don’t like this - they don’t pay well. Private payors have effectively stopped negotiating with us due to the NSA. UH has always been awful IMO both with rates and negotiation.

Power and money are controlled by hospitals and especially insurance companies. Pretty easy to look at revenue of companies like BCBS and UH.

I’m personally a supporter of universal healthcare. Is that a perfect system? No. But it seems better than what we have now.

People have to take responsibility for their health and especially their diet. I expect RFK to appease his anti-vaxxers more than make any sort of real impact on the fast food/cheap processed food industry.
 
ER is hurt by the ability of an ER to be run by one doc and 5 NPs. However hospitals may realize that RNs order much more testing and imaging (unnecessarily) and drive up costs.
For the moment, ancillary services like lab and imaging can be a source of profit for hospitals. If the ER itself loses money, that's OK since it's a source of admissions ($), diagnostic testing ($), and surgery ($$).

Is there any real incentive for hospitals to put the brakes on midlevels shotguunning diagnostic tests?
 
How’s it going with Ukraine and Russia? Trump end that war yet? Israel/Gaza?

How’s our debt? Tariffs eliminate it yet? Last I looked (April, when we were Liberated) tariff income was like $16 billion and the interest on our debt was like $80 billion. That math doesn’t work. Since then Trump seems to have given up on tariffs bc it crashed the market. He still has time, maybe he’ll go back to reciprocal tariffs to free us from the chains of trade deficits.

I’m becoming more exhausted and fed up with partisan politics. The things Republicans care about today (brown people out, handout via tax break (which will worsen our US debt)) are stupid. There’s no one on the Democratic side that’s remotely appealing and willing to run on a real progressive agenda that doesn’t cater to lobbyists and insurance companies.

I’m still a Bernie supporter.

Edit - almost forgot. After repeatedly saying they wouldn’t touch Medicaid, Republicans are going after Medicaid. Shocker.
 
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After repeatedly saying they wouldn’t touch Medicaid, Republicans are going after Medicaid. Shocker.

CBO's most recent projection estimates >7M Americans going uninsured if the current GOP bill passes.

In defense of the Medicaid spending cuts, Trump states he is "cutting waste, fraud and abuse". These 7M Americans healthcare needs must be "waste".

 
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For the moment, ancillary services like lab and imaging can be a source of profit for hospitals. If the ER itself loses money, that's OK since it's a source of admissions ($), diagnostic testing ($), and surgery ($$).

Is there any real incentive for hospitals to put the brakes on midlevels shotguunning diagnostic tests?
I had thought that insurance paid mostly based on the diagnostic codes, so I am not sure if they pay for unnecessary extra CT scans, labs?

I honestly don't know
 
The ACA structurally set in motion the hospital consolidation machine which reduces the ability for competition to exist.

All politics is local; maybe your state doesn’t have CON. But in places that still do, CON + ACA leads to outcomes like mine where no new hospital has been built in 20 years, and many have closed despite the state population increasing substantially.

In general, I think the goal of having more insurance access is a net benefit to society. However, the power it gives hospitals and insurance companies is a net negative.
Competition only helps salaries if there is a labor shortage. Most markets have some degree of competition, having 5 vs 3 hospital systems doesn't change much.

Building a new hospital is prohibitively expensive. Many hospitals do expansions instead

The NSA and non-competes are vastly more impactful to physician reimbursement. Since 2014, insurance reimbursement dropped (due to both of those) but stipends (which were dying off) have now rebounded substantially and have had to fill the gap left by low insurance rates. Labor supply and demand

The ACA didn't move the needle much
 
CBO's most recent projection estimates >7M Americans going uninsured if the current GOP bill passes.

In defense of the Medicaid spending cuts, Trump states he is "cutting waste, fraud and abuse". These 7M Americans healthcare needs must be "waste".

It also is going to lose money in the long run instead of save it. The vast majority of people on Medicaid have some kind of chronic condition. The fact that they are using healthcare resources through Medicaid indicates that they are getting some kind of preventative care that will instead transition to emergency/hospital care only at significantly increased cost. This care won't ever be paid for and will hurt the healthcare system badly over time as hospitals take the financial hit from mandated care for these now uninsured very sick people.
 
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Fascism creeping closer in the guise of incompetence.
 
Well. That all sounds like issues of labor supply and demand .not the ACA

Telerad was inevitable and it's a very strong downward pressure on incomes. Not ACA related

If local groups underbid each other, that's because they have enough labor and not enough jobs. Otherwise, they have to increase their pro forma to account for higher labor costs

If physician's owned hospitals, it may makes things more profitable for the owners, but not for the rank and file.

If each hospital needs 10 radiologists, and they consolidate, then each hospital still needs 10. You could argue that if one hospital had 8 then they might have to pay more of they needed 10, but then another hospital might pay less because they have 12. Supply and demand again.

If the hospital consolidates and demands that the radiology group covers for less money, then the radiology group should say no and then it depends on supply and demand.

None of those are ACA related issues from what I can see.

ER is hurt by the ability of an ER to be run by one doc and 5 NPs. However hospitals may realize that RNs order much more testing and imaging (unnecessarily) and drive up costs.
My thinking on this is that the ACA incentivizes hospital systems to consolidate practices. They receive money from CMS to buy out physician practices in various specialties and then get to pocket the cost savings that may arise from bringing those practices in house.

This has been happening to private equity practices all over the country in recent years, as their income is still tied to reimbursement structures. The NSA was another nail in the coffin of the private equity groups but the slow trend since 2011 or so has been for hospitals to bring groups in house.

How is it that you think hospital employed positions are able to pay more than private practice or private equity backed groups? I think it's because the government incentivizes them to bring these groups in house and call it all "integrated". The more integration that an organization has, the more government money they're entitled to.

Now, as for why private equity was able to thrive after 2011, my theory is that as documentation requirements became more onerous and outcomes were more emphasized as conditions for payment, i.e. "value based care", which is all over the ACA, it became too much to manage for previously wild-west type private practices.

For example, who has time or resources to pour over paper anesthesia records and check for 2 anti-emetics? Who has time or inclination to ask about smoking history? To document sterility in central line placement? This stuff was not very common before EMRs, and EMRs in anesthesia weren't super common in the 2000s.

So a private equity group comes in, promising the new world of "better outcomes" and "streamlined documentation." Old fogie private practice partners who can barely handle Windows 98 look at this new world and think "Do I really want to deal with this shift in my autonomous, exploitative practice? Will I still be able to string alone my new associates if I'm dealing with all this new stuff? What is a hard drive? AAGGGHHHH"

So their options become:

1. Sell to the hospital (some of them)
2. Sell to private equity (more of them, due to buyout rewards)

The eventuality of all this, though, is what you said. The reimbursements will never keep up. The NSA was very clearly a populist effort by politicians and insurance companies to accelerate this process. So now, even private equity cannot negotiate the higher rates, and the hospitals win in the end.

My theory of the ACA is that it's a multi-decade strategy to eventually consolidate all healthcare under the umbrella of organizations like United, Cigna, and Kaiser. As you've no doubt seen, the labor shortage demands that more of the extremely large profits that these organizations get is doled out to anesthesiology services, in an effort to keep the facility fees coming.


How does this add up to being terrible for anesthesia? Mainly because it destroys the intangible satisfaction that used to come from being in a well functioning private practice, although much of those days was only due to exploitation of the new hires. However now with the destruction and rebuilding of groups constantly trust from new grads is at an all time low, and stress for people in groups that always claim “we’ve been here 25, 50, 5000 years! The hospital loves us! We’re so profitable!” Is through the roof.
 
My thinking on this is that the ACA incentivizes hospital systems to consolidate practices. They receive money from CMS to buy out physician practices in various specialties and then get to pocket the cost savings that may arise from bringing those practices in house.

This has been happening to private equity practices all over the country in recent years, as their income is still tied to reimbursement structures. The NSA was another nail in the coffin of the private equity groups but the slow trend since 2011 or so has been for hospitals to bring groups in house.

How is it that you think hospital employed positions are able to pay more than private practice or private equity backed groups? I think it's because the government incentivizes them to bring these groups in house and call it all "integrated". The more integration that an organization has, the more government money they're entitled to.

Now, as for why private equity was able to thrive after 2011, my theory is that as documentation requirements became more onerous and outcomes were more emphasized as conditions for payment, i.e. "value based care", which is all over the ACA, it became too much to manage for previously wild-west type private practices.

For example, who has time or resources to pour over paper anesthesia records and check for 2 anti-emetics? Who has time or inclination to ask about smoking history? To document sterility in central line placement? This stuff was not very common before EMRs, and EMRs in anesthesia weren't super common in the 2000s.

So a private equity group comes in, promising the new world of "better outcomes" and "streamlined documentation." Old fogie private practice partners who can barely handle Windows 98 look at this new world and think "Do I really want to deal with this shift in my autonomous, exploitative practice? Will I still be able to string alone my new associates if I'm dealing with all this new stuff? What is a hard drive? AAGGGHHHH"

So their options become:

1. Sell to the hospital (some of them)
2. Sell to private equity (more of them, due to buyout rewards)

The eventuality of all this, though, is what you said. The reimbursements will never keep up. The NSA was very clearly a populist effort by politicians and insurance companies to accelerate this process. So now, even private equity cannot negotiate the higher rates, and the hospitals win in the end.

My theory of the ACA is that it's a multi-decade strategy to eventually consolidate all healthcare under the umbrella of organizations like United, Cigna, and Kaiser. As you've no doubt seen, the labor shortage demands that more of the extremely large profits that these organizations get is doled out to anesthesiology services, in an effort to keep the facility fees coming.


How does this add up to being terrible for anesthesia? Mainly because it destroys the intangible satisfaction that used to come from being in a well functioning private practice, although much of those days was only due to exploitation of the new hires. However now with the destruction and rebuilding of groups constantly trust from new grads is at an all time low, and stress for people in groups that always claim “we’ve been here 25, 50, 5000 years! The hospital loves us! We’re so profitable!” Is through the roof.
Well, I agree with some of those general principles.

The ACA doesn't purposefully incentivize hospitals to buy practices per se. I think its a side effect.

Private practice is dying. Insurance reimbursement drops, overhead increases, prior auth, etc. if private practices made tons of money, they they would be less interested in selling. But private practices barely make ends meet, and hospitals are ok to lose money buying a practice because they gain it back on the back end with facility fees. So these market forces drive the consolidation of hospitals and practices..but this has been going on for decades, not due to the ACA

I expect that heath insurance wants to continue to obtain market share and increase profits, and they will lobby government to facilitate that. As they did with the NSA.

Our only option is to leverage our supply and demand, unions, etc. if we are all becoming employees, we should start acting like them instead of being employees and making the sacrifices of PP guys
 
Trump has demoralized the democratic base because is teflon don.
 
My thinking on this is that the ACA incentivizes hospital systems to consolidate practices. They receive money from CMS to buy out physician practices in various specialties and then get to pocket the cost savings that may arise from bringing those practices in house.

I agree with most of your post but is this part actually true? Didn’t hospital systems buy primary care practices to drive referrals to their own facilities for big money maker services? Do hospital systems actually receive money from CMS to buy physician practices? I thought consolidation happened because hospitals wanted control of referrals and revenue stream. My primary always refers specialists in the same health system and same medical group. But I pick people I know and trust. I thought hospital systems front the money to buy physician practices knowing it will pay off down the road.
 
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I agree with most of your post but is this part actually true? Didn’t hospital systems buy primary care practices to drive referrals to their own facilities for big money maker services? Do hospital systems actually receive money from CMS to buy physician practices? I thought consolidation happened because hospitals wanted control of referrals and revenue stream. My primary always refers specialists in the same health system and same medical group. But I pick people I know and trust. I thought hospital systems front the money to buy physician practices knowing it will pay off down the road.
That's a fair point, I am not sure where the money comes from, but there is an incentive for them to consolidate their systems once they've done so. Maybe the hospitals end up assuming it pays off, but I honestly haven't seen a hospital, even ones that go bankrupt, close their doors due to poor financial management. So they must know that it's essentially risk free to make these practice purchases and put out huge salaries to people when they do because of their bottom line increasing so much.
 
This is why I harp on it so much that the intention of the ACA is to put private physicians out of business, anesthesia included. Look at this nonsense:

"As in many other markets in the U.S., hospitals in North Carolina are highly consolidated and politically powerful. Medicaid expansion would not have become law in North Carolina without the support from hospitals. To win their support, the state and the Centers for Medicare and Medicaid Services (CMS) decided to reimburse hospitals for their Medicaid services at the commercial payment rates. Most of the funding comes from federal taxpayers. Healthcare policy expert Ann Kempski and I provided more details in a recent Health Affairs Forefront article. Similar schemes permeate in many other states."

 
I agree with most of your post but is this part actually true? Didn’t hospital systems buy primary care practices to drive referrals to their own facilities for big money maker services? Do hospital systems actually receive money from CMS to buy physician practices? I thought consolidation happened because hospitals wanted control of referrals and revenue stream. My primary always refers specialists in the same health system and same medical group. But I pick people I know and trust. I thought hospital systems front the money to buy physician practices knowing it will pay off down the road.
This indirectly happens through the facility fee.

Pick your outpatient medical specialty.

Private practice renting from a hospital, E&M charges. They get the global E&M all good.

Hospital owned practice. Same building. Same clinic. E&M charge. Physician gets the “Professional”. Hospital gets the PE and MP components. But hospital also adds a huge facility fee that the Private Group cannot charge even if they owned their own building.

Hence hospitals are deeply incentivized to buy physician practices of all kinds. They even can go so far as to offer to keep the physician pay the “same” but charge enough facility fee to more than make up the difference.

Page 5

Hospitals get paid 80% more for the same service.

This topic is discussed a ton in the pain forums. It’s often referred to as $O$.
 
This indirectly happens through the facility fee.

Pick your outpatient medical specialty.

Private practice renting from a hospital, E&M charges. They get the global E&M all good.

Hospital owned practice. Same building. Same clinic. E&M charge. Physician gets the “Professional”. Hospital gets the PE and MP components. But hospital also adds a huge facility fee that the Private Group cannot charge even if they owned their own building.

Hence hospitals are deeply incentivized to buy physician practices of all kinds. They even can go so far as to offer to keep the physician pay the “same” but charge enough facility fee to more than make up the difference.

Page 5

Hospitals get paid 80% more for the same service.

This topic is discussed a ton in the pain forums. It’s often referred to as $O$.

Agree it is indirect. The hospitals are incentivized to buy practices but CMS doesn’t actually give them money for it.



The hospitals argue they need to get paid more for the same services because they need cost shift to provide other services. Your local surgicenter or doctors office doesn’t have 24/7 ICU, radiology, lab, OR, ER, blood bank, etc. They don’t have any medical specialists on call. All that stuff costs a lot of money. They need to pay smart guys like @aneftp $400/hr to be on call from home. Even if they could take care of you, if you get hit by a bus or bitten by a shark on a Sunday afternoon, no surgicenter is going to open up to do it.
 
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Agree it is indirect. The hospitals are incentivized to buy practices but CMS doesn’t actually give them money for it.



The hospitals argue they need to get paid more for the same services because they need cost shift to provide other services. Your local surgicenter or doctors office doesn’t have 24/7 ICU, radiology, ER, blood bank, etc. They don’t have any medical specialists on call. All that stuff costs a lot of money. Even if they could take care of you, if you get hit by a bus or bitten by a shark on a Sunday afternoon, no surgicenter is going to open up to take care of you.
I mean sure for inpatient or hospital level care the facility fee is understandable. Remember they get paid lot for that stuff too. And in the vast majority of states, they have a state enforced monopoly.

But getting a facility fee for outpatient services where they buy a random bunch of endocrinologists or heme onc or whatever doesn’t really make sense.
 
"Social solidarity is destroyed when you have too much migration too quickly... that's not because I hate the migrants or I'm motivated by grievance. That's because I'm trying to preserve something in my own country." - JD Vance


Could be a fun game to guess if some of these quotes came from Vance or David Duke. "We don't hate them, we just think they don't belong here" plays well for this crowd.
 
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Just nonsense. They're courting (and enlarging) the Republican constituency that believes the Covid vaccines caused more deaths than the virus.

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Crickets on revoking Harvard's ability to admit international students? We are witnessing weaponization of the federal government against ideological opponents and the educated members of the right are fine with this? Have we considered the logical sequence of events following this persecution or is this another 'let the courts decide' moment because somehow they have no culpability or requirements of the leadership they have elected?
 
Crickets on revoking Harvard's ability to admit international students? We are witnessing weaponization of the federal government against ideological opponents and the educated members of the right are fine with this? Have we considered the logical sequence of events following this persecution or is this another 'let the courts decide' moment because somehow they have no culpability or requirements of the leadership they have elected?
Was about to post up and ask this. I'm sure there are conservatives on here that are all for the removal of ANY immigrant whether here legally or not and are all for any means necessary to get rid of them.

EDIT: forgot to add: Harvard's one of those elitist, leftist schools, so **** em /conservatives
 
Crickets on revoking Harvard's ability to admit international students? We are witnessing weaponization of the federal government against ideological opponents and the educated members of the right are fine with this? Have we considered the logical sequence of events following this persecution or is this another 'let the courts decide' moment because somehow they have no culpability or requirements of the leadership they have elected?
I have a feeling that won't stand up against scrutiny in a court of law.
 
Was about to post up and ask this. I'm sure there are conservatives on here that are all for the removal of ANY immigrant whether here legally or not and are all for any means necessary to get rid of them.

EDIT: forgot to add: Harvard's one of those elitist, leftist schools, so **** em /conservatives
Trump has a core MAGA supporters (40--43% of the country) that will support no matter what he does.

Corruptions are wide out in the open. Politicians do not need to hide their corruptions anymore.

I wonder if we gonna be able to put that genie back in the bottle when Trump leaves office.
 
I have a feeling that won't stand up against scrutiny in a court of law.
Issue is is that it does not have to. If they're allowed to just continually weaponize the government's unlimited resources against opponents eventually they'll win by attrition. Especially if they wield it someone with less resources. The constituents that voted this government in should be holding them to some form of account since this seems extremely un-American
 
Issue is is that it does not have to. If they're allowed to just continually weaponize the government's unlimited resources against opponents eventually they'll win by attrition. Especially if they wield it someone with less resources. The constituents that voted this government in should be holding them to some form of account since this seems extremely un-American
I knew it wouldn't stand up. I guess you are right that they are playing a game of attrition since they unlimited amount of power/$$$.

Federal judge halts Trump administration ban on Harvard’s ability to enroll international students​


 
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