Jimmy Madeksho @jmadeksh
Son of Alzheimer’s, a Father to Autism, and a Husband in Awe. Employee Benefits, Health and Welfare Consultant Tennessee, USA Joined October 2008-
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Nobody teaches you that discipline feels like punishment until the results start feeling like freedom
I love that @MorePerfectUS is highlighting the downsides of healthcare consolidation. This is a bipartisan issue. Let’s fix it: Site neutral payments, 340B reform, CON repeal, stark reform, and roll back the physician owned hospital ban.
NEW: You might be charged double for a routine medical visit. Corporations and hospitals are buying up private practices across the country, then tacking “facility fees” onto standard appointments. While Americans are stuck paying hundreds more for a single doctor’s visit,
NEW: You might be charged double for a routine medical visit. Corporations and hospitals are buying up private practices across the country, then tacking “facility fees” onto standard appointments. While Americans are stuck paying hundreds more for a single doctor’s visit, corporate executives are raking in billions.
@NewsHour @TheStephSy @l_e_whyte This would be a huge mistake @WhiteHouse
@TreyEdward “Iconic” haha. Young and dumb with No life jackets
𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥𝐬 & 𝐓𝐡𝐞𝐢𝐫 𝐅𝐚𝐤𝐞 𝐏𝐫𝐢𝐜𝐞𝐬 A must-read, hard-hitting piece from Anthony DiGiorgio @DrDiGiorgio on the economics of nonprofit hospitals and the growing gap between their public mission and financial reality. He lays out the extensive subsidy ecosystem supporting hospitals: • Property and sales tax exemptions • Public funding (DSH payments, GME, research support) • 340B Drug Discount Program revenues • Market power–driven pricing from consolidated health systems …among others Then comes the key question: "After all of those subsidy streams, what exactly is still unfunded"? As he puts it, hospitals should provide a true accounting: • What is the net Medicaid shortfall after supplemental payments? • What is the real value of tax exemptions? • Where does 340B revenue actually go? • How are funds allocated across executive pay, administration, expansion, reserves, M&A, and lobbying? Until we see that level of transparency, claims about underfunding deserve more scrutiny. Strong, provocative piece. 👉 drugch.nl/3OgIl9B
Let’s not change how hospitals and doctors work with the insurance companies. The current system works for doctors and patients. Perfectly. If the insurance companies cared about outcomes and efficiencies they wouldn’t do dumb shit like this. Why won’t hospitals and practices fight back in any way at all ? Not even mean tweets lol
So I need to take esomeprazole (Nexium) instead of omeprazole (Prilosec). They are both generic - at @costplusdrugs they cost $5.86 and $6.34 respectively (so the eso version is actually cheaper). But on the Blue Cross Medicare formulary, they only allow omeprazole. So my doctor
Great question. Answer: smart one. Every dollar saved on benefits goes right to the bottom line. A public company with 100m shares can add 25c per share, annually, if they had a clue about their benefits. You can start counting down to the shareholder lawsuits. This is money sitting on the table and every ceo is ignoring their fiduciary responsibilities. Never trust your benefits vendors or consultants. Never. Just run your name redacted contracts through an LLM, with training the AI vendor turned off
@mcuban @CPMou2022 @sama What janky ass CEO is dealing with employee benefit contracts themselves
The public should be far angrier about facility fees than it is. Picture two clinics. One is an independent physician practice. The other is the exact same type of clinic, same doctors, same rooms, same services, but owned by a large hospital system. That second clinic is classified as a hospital outpatient department. Nothing about the care is different. But the prices a "hospital outpatient department" gets to charge the government are multiple times higher than the independent clinic. Routine office visits, imaging, echocardiograms, in office procedures all get marked up simply because a hospital’s name is on the door. The independent doctor gets paid one rate. The hospital owned clinic gets paid more for doing the exact same thing. That extra money lets the hospital pay higher staff salaries, outbid independents for equipment, spend more on marketing, and layer on amenities that have nothing to do with care. The independent physician is now competing against a system that is legally allowed to charge more for identical services. Patients are mostly blind to this. They are not told they are walking into a higher priced clinic. They do not see the facility fee until the bill shows up. And then the patients are screwed again once enough independent practices are driven out of business. Patients lose the option of seeing a lower cost physician altogether. They are forced into hospital owned clinics that charge more and often deliver a worse experience. This is not an accident. Medicare explicitly wrote these payment rules into its fee schedules. Private insurers largely follow Medicare’s lead, so the distortion spreads across the entire system. It's almost as if the system is designed to elminate independent physician practice...
The one point that the general public must understand is that the cost of medicine, the rise of hospitals systems, and the fall of private practice has occurred largely because government has allowed hospital systems to be paid a “facility fee” that independent physicians cannot
Corporate speak for “yes, we are aware of this and we’re going to keep doing it.”
💊 The Hidden Cost of "Savings": Is Price Gouging Subsidizing Insurance Giants? Ever wondered why a generic medication that costs $55 can be priced at $6,600? 🤨 In a recent Congressional hearing, CVS CEO David Joyner defended this practice as "cross-subsidized pricing." 🔍
Top 10 reforms at @US_FDA in Year 1 of the Trump administration. 🧵
@braves2430 @HawkEmDownChris Yup. Blessed!
@MLFootball Why can’t I find the roughing the passer penalty in Bosa? The very next play and same as the pass interference play… that may have been it.
Thank you… 🙏 Free markets. Physician independence = higher quality outcomes at lower prices. Lower prices and better outcomes = lower premiums.
Dear @CMSGov and @TRICARE It’s 5:25AM. I’m having coffee with my friend Terry. Terry is 71. Spent 20 years on active duty. 10years in the reserves. Civil engineer. Master carpenter. Built houses. Still in excellent shape. Friends with service members across the globe. Everyone who meets him loves him. His cervical spine is falling apart. He needs an ACDF, anterior cervical discectomy and fusion. Not experimental. Not elective. A surgery he needs. It was scheduled. Then rescheduled. Then rescheduled again. This morning he found out it’s been pushed again. Why? Because Tricare, the benefit he EARNED with three decades of service, is trying to coordinate benefits with Medicare before they do the procedure. Two government programs pointing at each other. Both owed to him. Neither willing to move first. So Terry sits here with a lidocaine patch, acetaminophen, and stretching exercises. Managing a deteriorating spine with what you’d grab off the shelf for a sore back. What the hell is going on when the government screws over veterans like this? This isn’t a coverage gap. He HAS coverage. He has TWO coverages. Both earned. The problem isn’t that Terry doesn’t qualify. The problem is the government backed healthcare system treats its own promises like liabilities to be minimized. Tricare doesn’t act like a debt owed to those who served. It acts like an insurance company trying to subrogate its way out of responsibility. Terry didn’t serve 30 years so two bureaucracies could play hot potato with his surgery authorization. He served because he loves this country. And right now, this country is telling him to wait, not because the surgeon isn’t ready (I spoke with his surgeon), not because the OR isn’t available (brand new updated VA two miles from here) but because the paperwork hasn’t decided which government account gets debited. You guys suck ass. And my man is in pain. He did it all right. And you’re f-ing him over.
Yup!
An American doctor says the SAME scan that costs $2,000 through insurance often costs $200–$300 in cash — same room, same machine, same images. “It’s like the price only explodes once insurance gets involved.”
"By categorizing as fees, not rebates, and laundering through the GPOs, they don’t have to pass through the rebates, they’re somehow carving it out." Unflattering look at PBM group purchasing organizations just released by @hntrbrkmedia hntrbrk.com/pbmgpo/
"Capitalism created the possibility of the win win win. It used to be a zero sum game where somebody won, somebody else lost. The biggest mistake people make, intellectuals in particular, they still think we're in a zero sum world. They're obsessed with some billionaires because Bernie Sanders thinks that Jeff Bezos and Elon Musk somehow stole the money from the people. They don't understand that it's this prosperity machine that's creating more, not just for those billionaires, but for everything that they're touching. They're creating value for their customers, they're creating value for their employees. Their suppliers are flourishing, their investors are seeing their capital go up. It can be reinvested and compound. All philanthropy ultimately comes from business. That's where the profits are. Where does all the taxes come from? It ultimately comes from business as well. This is the engine that's lifting humanity out. The entrepreneurs are the drivers of that engine. Somebody like Elon Musk, he gets a very, very, very tiny sliver of the value that he creates for the whole world." —@iamjohnmackey
My Conversation with John Mackey (@iamjohnmackey), co-founder of Whole Foods Market. 0:00 Fanatical Entrepreneurs: Why Work Feels Like Play 2:18 The Missionary vs. Mercenary Co-Founder Conflict 6:16 The Shirtless Hitchhiking Hippie and Johnny Rockefeller 8:12 Entrepreneur
“‘I don’t need it, I don’t want it,’” (data services ), the drugmakers would say. And in return, Zinc would threaten to “disadvantage you versus your competitors.” “Will you buy it? Yeah. Do you use it? Probably not,” they said of drugmakers, adding, “If you’re not compliant, they’ll try to disadvantage you versus your competitors. … This is Caremark, Express Scripts, Optum, they all do that.” This is the exact same threat brand manufacturers have said they received if they sold to Cost Plus “If you are not compliant we will disadvantage you verus your competitors “ @doj @ftc @PamBondi @AFergusonFTC
@mcuban told us about PBMs: "They are covers for the Big Three to say in a contract that they pass through 100% of the rebates they get." Former Harvard Pilgrim Chief Medical Officer: "You get 100% back of what you know about, but not the stuff they're hiding." Former Zinc
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