Follow up from today’s post I looked into the group whose video ad is running in the Root post, and what I found is concerning. The ad is titled "EXPOSED: Double Billing." Its disclaimer reads "Paid for by Patients for Safe and Affordable Health Insurance." It is a limited liability company. The only place its legal name appears is the website's privacy policy. There is no named executive director, no board, no staff, no spokesperson, and no press release. Its listed address is 712 H Street NE, Suite 1403, in Washington, DC. That address belongs to a FedEx and UPS shipping store. "Suite 1403" is a mailbox. Its website launched in January 2025. The files behind it are hosted on a WordPress network that also hosts campaign pages for Republican candidates. Most of its pages were written by an account called "Web Ops," not by anyone at the group. This isn't a patient organization that hired a web designer. It's a political vendor's product with a patient-sounding name on the front. In 18 months, its campaigns have covered oncology drug vials, out-of-network doctors, upcoding, hospital facility fees, a state-specific attack on a hospital system in Indiana, and now modifier 25. Every single one targets a doctor or a hospital. Not one targets an insurer. Not one mentions prior authorization, claim denials, or the profits of the companies that sit between patients and their care. Look at who it lets speak. Its "facts" page cites AHIP, the insurance industry's trade association. Its billing campaign is built on a Blue Cross Blue Shield Association report. Its surprise-billing pages repeat the insurer line that arbitration costs too much and doctors win too often. The op-eds it promotes are written by a former Florida Blue executive, a former chief medical officer of Regence Blue Cross, and a former chief medical officer of AmeriHealth Caritas. Not one practicing physician. Not one patient. A group that says it speaks for patients, has no patients, no leaders, and no address, and only ever points in one direction is suspicious at best. Notice the timing. The comment period closed September 14. More than 150 medical organizations told CMS to withdraw this proposal. CMS tried the same cut in 2019 and pulled it. The final rule is due within weeks. Nine influencers and a video ad showed up in exactly that window, with the same talking points, thanking the administration for a rule it hasn't finalized yet. That is a pressure campaign not a public awareness campaign. Why would an insurer care about a Medicare rule? Commercial plans already fight physicians over modifier 25 claims. Physicians push back because Medicare, the benchmark, pays in full. If CMS cuts it, every commercial contract in the country follows, and the cut stops being something a doctor can appeal. The savings won’t ever go to seniors. They will go to the plans and their shareholders. Who funds this and why are we hearing from a mailbox instead of a person? If you want to argue that Medicare should pay less for same-day services, make that argument. Put your name on it. Publish your data. Tell us who you work for. Defend it in the comment period and in the open. What you shouldn't do is fund a video from a mailbox, pay nine accounts to run the same script, and call it a grassroots movement. Patients do deserve transparency. That starts with knowing who is talking to them.

No reasonable person would ever conclude that any doctor visit which could accomplish two things on the same day should be unnecessarily split into 2 separate visits in the name of efficiency and monetary savings. @CMSGov needs to keep the 25-modifier. And we need to find out who’s behind this very odd PR campaign of misinformation. @DrOz

Attention Plumbers—you have been over-billing if you charge for the house call/consult/diagnostic work up and parts order, AND if you charge for the repair. And you should (by law) not do all that on the same day! Apparently that’s not allowed in medicine (but it sure is allowed in the plumbing world—as it should be). Billing for the consult and assessment and taking everything into account before doing the procedure should be paid separately from the procedure and should be paid at 100%— even if done the same day. Whoever says otherwise is selling snake oil (or they are a comedian trying to be funny).

This is probably the most misguided and erroneous tweet I’ve seen in 2026. Ending the 25-modifier will be a great INEFFICIENCY for patients and physicians (and patient families who have to takeoff to bring grandma into the doctor) and will not save money, there’s absolutely no data or even a suggestion that it will. If @DrOz lets this change go through, I believe it will be one of the most demoralizing policy change we’ve seen hit healthcare in the last 15 years. We need to keep the 25-modifier and CMS needs to reject that proposed 2027 change.

Chef opens a restaurant. People really like it. He books out reservations for 3 months. But now people are upset there’s a 3 month wait to go to the restaurant. Then, the government decides to put price caps at how much he can charge customers. He still needs to pay overhead and staff and ingredients, though. So he decides he needs to serve more customers to cover his costs. So he shortens the allowable time for meals. Of course, now the customers aren’t happy about having to rush through their meals. Many of them insist on eating at a leisurely pace, or they send their food back because they didn’t like it, or they show up late for their reservation and insist on being seated anyway. Meanwhile, the chef is trying to keep up. He feels bad he can’t put the same attention into each meal he did before. But if he doesn’t serve enough people in a day, he will have to close down (or sell to the large restaurant conglomerate down the street). Oh, and the government also decides that he now needs to do two hours of computer work for every hour he spends cooking. They force him to use a terrible, but expensive, computer system, too, not the one he wanted. So he needs to serve even more customers to cover those costs as well. The customers are rightly upset. They’re waiting longer and getting less personalized service. The chef is also upset that he’s spending more on overhead but delivering worse meals. Nobody is happy here.

Your bill specifically excludes the largest employer of physicians: not-for-profits hospitals and health systems.

The problem: 1) Hospitals (and first insurers) were allowed to massively consolidate 2) Consolidation never led to the promised/projected efficiencies and lower costs. The opposite occurred 3) Doctors avoided consolidation until late, leading insurers and the government to dramatically reduce payments driving them to consolidate underneath the protected insurers and hospitals The result: Costs are up and access is dropping. Insurance is not healthcare and may not be worth more than the paper it is written on for most insured patients.

Please @SenBillCassidy I implore you to make a last stand for your physician colleagues and for every rural patient who has to drive a long ways for physician appointments—do not allow the proposed changes to the 25-modifier to take effect. This is life and death for so many practices. Please.

Imagine a chef employed at a restaurant that charges $100 for a hamburger. One day he gets sick of his institution ripping off customers, so he goes across the street and opens a shop with $5 hamburgers. Now the hamburger loving people are better off. Competition drives down prices and increases quality. The original restaurant, angry over the lost business, gets a law passed that bans chefs from owning restaurants. Everyone would recognize this as a corrupt, protectionist law. And yet, in healthcare, with skyrocketing costs, we still outlaw physician owned hospitals.

The 3 reasons why AI won't reduce clinician jobs: —Jevon's paradox (more efficiency, more use) —"Lump of labor" fallacy (the type of work changes) —Tasks ≠ Skills @NEJM @DhruvKhullar nejm.org/doi/full/10.1056/NE…

In a component of the proposed 2027 Medicare physician fee schedule Texas physicians are decrying as particularly disturbing from a patient care standpoint, the Centers for Medicare & Medicaid Services (CMS) proposes to slash doctors' payment when they bill an office/outpatient evaluation and management (E/M) service using Modifier 25 on the same day as certain global procedures. TMA President Bradford W. Holland, MD, explains how this cut represents a double whammy for patients' access to care and physician practice viability.

We are fixin’ to! #txlege

This!!!

Seems so obvious and yet so obscured….

This is why non employed doctors are getting crushed. My surgeon was paid $456 for an hour+ long robotic abdominal procedure. And if you knew the anatomy, risks, training needed, etc… is just an absurdly low sum of $. Stop telling me it’s the doctors fees. And. He didn’t get paid for 3+mos by @Aetna despite a clean claim. You can send your attorney an email and be charged more 😒

This!!!

This is not a popular opinion. But true. When I explain that the average Pediatrician is earning less than a Buc-ee’s gas station manager, and the average surgical specialist earns around what a Walmart General Manager earns, then the idea starts to ring true. #txlege

A well written article on the legislative options for PBMs finance.yahoo.com/sectors/he…

It’s time to restore physician ownership of hospitals! #txlege #medtwitter #medstudent #surgeon #medicine

“A growing bipartisan consensus is emerging around one of the biggest drivers of America’s healthcare affordability crisis: hospital consolidation.” Both sides agree: hospital systems are becoming too big and driving up prices. And the fact that hospitals get paid more than physician offices for the same same procedure is fueling the fire to acquire! #txlege