I love 340B. As a nonprofit hospital administrator, I consider it one of the great miracles of American healthcare. It started as a program to help poor patients get access to medicine. Beautiful. Then we found the spread. I buy the drug at the 340B discount. I bill the commercial plan at the regular rate. I keep the difference. The patient gets the deductible. The employer gets the renewal increase. The manufacturer gets blamed. I get a new tower. That is called mission. And the best part? I don’t have to pass the savings to the patient. I don’t have to pass the savings to the employer. I don’t have to lower premiums. I don’t have to prove the vulnerable patient ever saw a dime. I just say “access” three times, put “community benefit” in the annual report, and everyone nods like I’m running a soup kitchen with oncology margins. Then came dual classification. Urban hospital? No problem. I’m rural now. Yes, my hospital is in Manhattan. Yes, my campus sits on billions of real estate. Yes, my lobby looks like a Four Seasons. But on paper? Country doctor. Dusty road. Single stoplight. Maybe a cow. That’s the business model. Rural when I want the subsidy. Urban when I want the commercial rates. Nonprofit when I want the tax exemption. Monopoly when I negotiate with employers. Charity when Congress asks questions. Private equity when I buy physician practices. Wall Street when BlackRock underwrites my bonds. Mission when the reporter calls. This is why I love 340B. Manufacturer must provide the discount. Employers pays full freight. Patients pays out of pocket. I keeps the arbitrage. Then I build a cancer tower and call it hope. Do I pass the 340B discount to the self-funded employer? No. Do I pass it to the fully insured commercial plan? Absolutely not. Do I use it to make healthcare cheaper? Please. I’m a nonprofit hospital administrator. Not a threat to my own margin. In 2024, 340B purchases hit $81.4 billion. That’s scale. I call it stewardship. And I serve vulnerable populations. Use the correct language. Now excuse me. I have to explain why my nonprofit hospital needs another tax exemption, another rate increase, another physician acquisition, another rural designation, and another debt issuance. The poor are counting on me. I love the US taxpayer…

Memorial Hermann did not have one lucky year. It recorded seven consecutive surpluses totaling more than $4.3 billion. Through a pandemic. Through a labor crisis. Through record inflation. Patients were told hospitals were barely surviving. The Form 990 says Memorial Hermann never stopped winning.

Do you pay your plumber or mechanic this way? Do you pay them a "Facility Fee" that is way higher than the mechanics fee? Do the parts for your car cost $Thousands and can fit in a pill bottle? Does your Mechanics fee get CUT Every year? #HealthInsurance# #Hospital# #Congress# #Fraud# #Scam# #Corruption#

Site-specific payment fees are not just dumb, THEY'RE CRIMINAL. There is ZERO reason reimbursement should be higher because of the address only! Hospitals now buy practices and call them "outpatient facilities" as part of the grift. What absolute crap!

This is how commercial insurers dinged independent practices for years. You do a suture for the patient after writing prescriptions for antibiotics, but you did not get paid for time or materials for the sutures. You provided injection shots for something that was bothering the patient during his annual wellness visit; you got shafted on the costs for anything done outside the annual wellness visit. But two years ago, I saw @aetna boldly going into the new territory of undercoding, which would be called wage theft in any other industry. But it seems it is allowed in insurance. Then @cigna followed it, and now I hear BCBS too is following it. Soon, Medicare, too, will do it. If you still have a doctor who is seeing you despite your insurance, make sure you do not extend the visit beyond 4 minutes if you want them to continue to see you. This mess has been perpetrated on those who are altruistic, and it is all going to be over. The pendulum will swing, and all insurance companies will lose. With AI, disruption is coming. It will be the death of all insurance if doctors understand what AI can do to medicine.

@DutchRojas I’ve always pushed back against this. If an elderly patient needs say corticosteroid injection, why shouldn’t I do it the same visit to give the patient relief and saved the system money? Because it’s too logical Chapter 7. Govt interference In book #HealthcareFromTheTrenches#

@DutchRojas Exactly it’s completely stupid. It should be the other way around if you recommend a procedure and get it done at the same time you get to Bill 100% if you bring the person back and make them pay another co-pay, you only get 50%.

@crappiedoc @DutchRojas ✌️😎 Insurance companies, the government nor hospitals give 2 shits about the patients or the doctors. Only the money matters to them now. That’s “Healthcare”. Not Medicine. (Big Pharma either). Wake up everybody. The elderly are especially at risk.

CMS spent years mailing checks to organizations it barely verified. Now Dr. Oz is walking around New York asking why every block has a home health agency. Excellent question. I’d start with the federal agency whose name is on every check.

Washington talks about physicians as though they wander into operating rooms and improvise surgery for fun. Reality looks different. Coverage rules. Clinical indications. Peer review. Audits. Malpractice liability. Licensure boards. Civil penalties. Criminal fraud statutes. The physician already carries the downside. Prior authorization gives the insurer the veto without giving it the liability.

Medicare's plan to slash payment by 50% when two services are done the same day is pure hypocrisy. It's far better for physicians to schedule a separate visit and bring the patient back for the ultrasound. Ordering both on the same day often means the visit isn't paid at all—even with a modifier. Patients frequently have unrelated concerns, and many travel long distances (e.g., 2 hours). Forcing separate days is inefficient, logistically burdensome, and bad for patients. This isn't cost control. It's a shell game Bad for everyone except Medicare. Government wins again.