🧵 Health Systems didn’t beat independent physicians.
Health Systems bought Congress,
rigged the rules,
and outlawed competition.
Here are the 11 structural advantages that protect health systems and punish independent physicians.
This isn’t free-market healthcare.
It’s a policy heist.
👇
Health Systems bought Congress,
rigged the rules,
and outlawed competition.
Here are the 11 structural advantages that protect health systems and punish independent physicians.
This isn’t free-market healthcare.
It’s a policy heist.
👇
340B Arbitrage: $54B/year
Health Systems buy cancer drugs at 50% off.
Then bill insurers full price,
and pocket the spread.
Independents physicians?
Pay retail.
The result: buy the oncologist,
bill the difference.
1
Health Systems buy cancer drugs at 50% off.
Then bill insurers full price,
and pocket the spread.
Independents physicians?
Pay retail.
The result: buy the oncologist,
bill the difference.
1
Medicaid Bonus Loops (UPL & DSH): 30B+
Health Systems get massive “supplemental payments” just for serving Medicaid.
Same patient in private practice?
No bonus.
It is supposed to be safety-net funding.
Instead it’s a commission payout.
Bonus bucks!
2/
Health Systems get massive “supplemental payments” just for serving Medicaid.
Same patient in private practice?
No bonus.
It is supposed to be safety-net funding.
Instead it’s a commission payout.
Bonus bucks!
2/
GME Windfall – $16–$20B/year
Health Systems receive federal cash to train residents.
Independents train the same residents for free.
They cut the check, but only if you wear the right badge.
3/
Health Systems receive federal cash to train residents.
Independents train the same residents for free.
They cut the check, but only if you wear the right badge.
3/
Nonprofit Tax Exemptions: $37.4B/year
Health Systems avoid income tax, property tax, and sales tax.
Then spin “charity care” as virtue.
Meanwhile, independents pay all taxes and compete on brand.
4/
Health Systems avoid income tax, property tax, and sales tax.
Then spin “charity care” as virtue.
Meanwhile, independents pay all taxes and compete on brand.
4/
Tax-Free Bonds
Need a surgical tower?
Nonprofits issue municipal bonds at 2–3%.
Independents borrow at 9%, if they qualify at all.
The capital markets are rigged.
5/
Need a surgical tower?
Nonprofits issue municipal bonds at 2–3%.
Independents borrow at 9%, if they qualify at all.
The capital markets are rigged.
5/
Health System-Owned Insurance Plans
121 health systems run their own Medicare Advantage plans.
They write the contracts and keep both sides of the ledger.
It’s not just vertical integration.
It’s full-spectrum control.
6/
121 health systems run their own Medicare Advantage plans.
They write the contracts and keep both sides of the ledger.
It’s not just vertical integration.
It’s full-spectrum control.
6/
Site-Neutral Fraud
Same CPT code.
Same patient.
But Centers for Medicare and Medicaid (CMS) pays 145% more to a hospital outpatient department than to a physician office.
Reimbursement follows the real estate, not the care.
More government 💩💩💩
7/
Same CPT code.
Same patient.
But Centers for Medicare and Medicaid (CMS) pays 145% more to a hospital outpatient department than to a physician office.
Reimbursement follows the real estate, not the care.
More government 💩💩💩
7/
CMS Fee Adjustments Favor the House
Health Systems receive taxpayer funded built-in bonuses: teaching, trauma, geography.
Independents get the flat-rate Physician Fee Schedule.
If you’re not under a hospital license, you’re underpaid by design.
8/
Health Systems receive taxpayer funded built-in bonuses: teaching, trauma, geography.
Independents get the flat-rate Physician Fee Schedule.
If you’re not under a hospital license, you’re underpaid by design.
8/
Ban on Physician-Owned Hospitals
Since 2010, doctors haven’t been allowed to build their own hospitals.
Why?
Because they worked too well.
High quality.
Low cost.
So Congress banned them.
9/
Since 2010, doctors haven’t been allowed to build their own hospitals.
Why?
Because they worked too well.
High quality.
Low cost.
So Congress banned them.
9/
Consolidation Incentives
Every policy above inflates revenue the moment a system buys an independent medical practice.
Same doctors.
Same patients.
5x the payments.
That’s not M&A.
That’s arbitrage.
10/
Every policy above inflates revenue the moment a system buys an independent medical practice.
Same doctors.
Same patients.
5x the payments.
That’s not M&A.
That’s arbitrage.
10/
Regulatory + Political Immunity
Health systems don’t just lobby.
They weaponize nonprofit status, brand halos, and “community benefit” reports, while paying CEOs like private equity titans.
11/
Health systems don’t just lobby.
They weaponize nonprofit status, brand halos, and “community benefit” reports, while paying CEOs like private equity titans.
11/
This is not a broken market.
It’s a protected racket.
Every physician must see this.
Every employer must demand change.
Stop asking for permission.
Build new infrastructure.
Share this thread.
I’m Dutch Rojas and I build healthcare companies that patients and physicians love.
It’s a protected racket.
Every physician must see this.
Every employer must demand change.
Stop asking for permission.
Build new infrastructure.
Share this thread.
I’m Dutch Rojas and I build healthcare companies that patients and physicians love.
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