Think fixing site neutrality will fix consolidation? Not if you don’t fix 340B also. This paper from @MelindaBBuntin and colleagues shows that 340B hospitals increased the share of services delivered at off-campus hospital departments from 18.2% in 2016 to 24.1% in 2022; non-340B hospitals barely moved. Even newly opened sites paid at “site-neutral” rates grew faster at 340B hospitals. This is a clear sign that even with site neutrality, hospitals will continue to consolidate.

"I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands?"

I’m struck by how many hospitals have gone from treating physicians as professional colleagues to treating them with outright disdain. Emergencies happen and surgeries get bumped. Everyone understands that. What is harder to understand is the complete absence of basic professional courtesy. A simple notification, an apology, or an acknowledgment that you’re asking someone to rearrange their entire day goes a long way. Instead, physicians are often expected to simply wait. Many surgeons receive no additional compensation for doing emergency procedures on weekends. They leave their families, assume significant medicolegal risk, and make themselves available because patients need them. The least a hospital can do is communicate honestly, provide updates, and acknowledge the burden. Professional respect should not be too much to ask.

That chart doctors love to cite — administrators growing 2,000% faster than physicians? Cremieux checked the underlying data. The real number: about a 50% increase. Not 2,000x. The authors of the original chart stopped showing their methods years ago.

If you haven’t ever seen this, watch it. It is devastating. Thing is, Milton was routinely this devastating in debates. Always with a smile. Only James Q Wison could rival him (in my acquaintance) for extemporaneous fluency.

Some super nuance here from a neurosurgeon: She almost certainly was not misdiagnosed. At the time, IDH mutation was not the distinguishing determining feature for WHO for what gliomas were/weren't GBMs. That being said we've known for twenty years that IDH1/2 mutations are super important in prognosis. But other things greatly influence prognosis as well - age, EOR, MGMT status, etc Obviously there are no details here on her talks with her care team. But prognosis in cancer is quiet difficult to communicate. Patients have just been hit with a train and trying to have some nuance around long tails, distributions and median survival can get comrpessed into "you have X months to live" even when communicated well. Ideally humans need to be presented complex information like this MULTIPLE times to fully grasp it. But these conversations are hard and often times with different providers and so discussion of prognosis, especially early in a cancer diagnosis, at least from personal experience, can be very one and done. Even if her IDH status and MGMT status and what it meant was communicated it may not have been done enough. Or maybe it wasn't at all and that's something of a failure. But its not like ChatGPT fixed a misdiagnosis.

Clickbait. Pt was diagnosed with glioblastoma, survives, then pathologists changed the classification system. Neuro-onc doesn’t update the diagnosis retroactively, as no treatments ongoing. Failure in pt counseling at most, not diagnostic malpractice.

This is an important problem with trying to price healthcare according to “marginal cost.” What is the marginal cost of professional labor? Physician time is not an IV bag with a wholesale acquisition cost. Its economic cost is the value of the next best use of that time. I know what the market will pay me for consulting. I know what hospitals will pay for call coverage. I know what alternative clinical work pays. Those do not mechanically determine the correct price for neurosurgery, but they provide information about the opportunity cost of my time. In the short run, the “marginal cost” of asking an already employed surgeon to do another case might appear very low. Price every case that way and eventually there will be no surgeon standing there. For No Surprises Act IDR, the better question is “What would a physician and insurer have voluntarily negotiated before the emergency, in a competitive market where neither could exploit the patient?” There is no easy answer.

Thank you @DRsLoungePod @anish_koka @DrDiGiorgio for the repeat invitation! It is great having a discussion with two colleagues who share my passion for free exchange of ideas outside of what our medical establishment considers standard or politically correct.

Watched a 60 Minutes segment on a guy whose company spent $3 billion working on curing a rare and deadly disease in children. The dose of the resulting drug is very expensive. Commenters are calling for “Luigi” to be released to kill him.

It’s rare to find a resident who is truly skilled at research. Those that are should definitely do that. Most will be very skilled clinicians, and that’s what they should do instead of pumping out low quality publications.

When both the U.S. Congress and the Texas Legislature want to hear from you, you're doing something right. @DrDiGiorgio testified before both bodies this spring. We had a great time with him at last year's conference, and we can't wait to have him back at PHA's 2026 Leadership Summit this September 20–22 in Napa. Learn more and register today: