They say laughter is the best medicine. Surgery works pretty good, too.
Atlanta, Georgia
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Daniel McDevitt MD FACS FSVS retweeted
Great meeting with great folks
Register now for the 2027 Annual Meeting: oeisweb.com/meetings/2027-an…
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Daniel McDevitt MD FACS FSVS retweeted
A physician wants to own the facility where she operates.
Suddenly, everyone discovers financial incentives.
The hospital wants to own the facility, employ the physician, and collect the revenue.
Apparently, ethics improves when you add a boss.
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$37,824 for a family of four.
Milliman’s 2026 Medical Index. Average person hit $8,460 — up 7.9%, the biggest climb in over a decade outside COVID. Pharmacy alone jumped 14.8%. Outpatient facility care is about a third of the bill and has quadrupled for that family since 2005.
That’s not a benefit. That’s a second mortgage with copays.
We take care of patients for a flat monthly fee. No claim. No network. The number on the door is the number you pay.
milliman.com/en/insight/2026…
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Daniel McDevitt MD FACS FSVS retweeted
Single payer will never need 218 votes in the House.
State-backed academic systems are constructing it through vertical integration.
They acquire hospitals, employ physicians, control referrals, operate pharmacies and, in several markets, own insurance businesses.
Tax exemption and public capital subsidize the expansion. Regulatory privilege constrains whoever might compete with it.
Multiple insurance companies can survive inside this arrangement. Their continued existence creates administrative pluralism, which looks remarkably similar to consumer choice from a sufficient distance.
Then every insurance card leads to the same medical empire.
Payer count becomes irrelevant after one institution controls the supply.
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Daniel McDevitt MD FACS FSVS retweeted
📢We are excited to share that UVA Surgery's BRAND NEW Integrated Vascular Surgery Residency is now accepting applications through ERAS. Apply today!
@MedicineUVA #VascularSurgery #VascularSurgeryResidency #SurgicalResidency #Match2027 #ERAS2027
ALT UVA’s new ACGME-accredited Integrated Vascular Surgery Residency is accepting ERAS applications! Our inaugural resident begins July 2027, receiving comprehensive training, progressive autonomy and individualized mentorship.
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Daniel McDevitt MD FACS FSVS retweeted
📢We are excited to share that UVA Surgery's BRAND NEW Integrated Vascular Surgery Residency is now accepting applications through ERAS. Apply today!
@MedicineUVA
#VascularSurgery #VascularSurgeryResidency #SurgicalResidency #Match2027 #ERAS2027
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Daniel McDevitt MD FACS FSVS retweeted
Medicare’s 2027 physician pay proposal is out.
Qualifying APM docs: $33.17 (−1.19%)
Everyone else: $32.84 (−1.68%)
The statutory updates are positive. The cut comes from the 2.5% 2026 bump expiring.
Comments close Sept 14.
federalregister.gov/document…
If this hits your clinic, say so on the record.
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Daniel McDevitt MD FACS FSVS retweeted
CPT revenue is within "royalties"-While physician reimbursement falls, the AMA profits
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Daniel McDevitt MD FACS FSVS retweeted
Private equity can buy a medical practice, change the paperwork, and double or triple its value before changing anything about patient care.
As always Michael makes an extremely intelligent observation.
A ton of money is being made rolling up healthcare practices.
Physicians should be asking how this keeps happening and why they have been unable to defend themselves.
3 reasons:
You have no balance sheet.A guy with three rental properties owns more appreciating assets than an independent medical practice producing millions of dollars in annual revenue.
The physician built a very good job. The income can be substantial. And almost every dollar gets distributed, taxed, or spent. Very little remains inside an enterprise that accumulates value.
The valuable assets have been separated from the practice.
Physicians bought interests in surgery centers, hospitals and medical real estate individually.
Meanwhile, the practice generated the patients, referrals and surgical volume that made those investments valuable while retaining none of the ownership.
You built the accounting system around minimizing this year’s taxes.
The books tell you what came in, what went out, and how much you can distribute. They rarely help the practice allocate capital, carry investments, measure enterprise value or build a balance sheet.
Then private equity arrives.
They buy the income stream at four to six times EBITDA, combine it with dozens or hundreds of other practices, and sell the larger platform at a much higher multiple.
Nothing magical happened.
The physicians spent decades producing the value. Private equity understood where to hold it…
18% of physicians are now independent. That’s a shit show for patients.
A TON of money is being made by rolling up healthcare practices.
A client of mine runs his own PE firm.
He buys practices around a 4-6x EBITDA multiple.
As soon as he closes, the practice becomes worth 12x because it's now part of his larger 200 practice platform. That's up to a 3x return day 1.
How's that for an implied IRR?
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Daniel McDevitt MD FACS FSVS retweeted
Real numbers that tell the tale. And that doesn’t count ANY of the many other burdens/hurdles to a viable independent practice. This was never docs “ letting it happen”. It was designed and orchestrated to kill private practice
Why did Doctors give up their own practices?
Our practices were stolen from us. We didn’t allow anything. Why would a Doctor sacrifice 7-10 years of their life to be treated like dogs?
Doctors are paid with RVU Coupons, not money when we submit a bill for payment to your Health Insurance. The RVU Coupons are then redeemed for cash to feed our children. We can’t buy a a slurpee with RVUs.
They started paying Doctors with RVUs in 1992.
1 RVU in 1992 was worth $31.00. Without even a pay raise, Adjusted for inflation 1 RVU should be worth $71.00.
1 RVU in 2025 was worth $32. That’s a 56% pay cut.
You can’t pay staff, rent, electricity, medical supplies or feed your children without money.
Physician independence was stolen by your Health Insurance and Hospitals.
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Daniel McDevitt MD FACS FSVS retweeted
Dear physician,
Your instinct is to work harder every time the system demands more of you.
This approach is a trap.
You can never satisfy the system.
It is only a matter of time before it moves the target to extract more productivity from you.
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Daniel McDevitt MD FACS FSVS retweeted
Healthcare has prices everywhere and price discovery nowhere.
Take one procedure performed in one hospital on one morning.
The hospital has a chargemaster price.
Every insurer has negotiated another price.
Medicare has an administered price.
The hospital may offer a cash price.
The patient may receive an estimate that resembles none of them.
Which one tells an employer what the procedure is worth?
None of them can.
The chargemaster is a sticker price. The negotiated rate records the bargaining power of two organizations. Medicare reflects a government formula. The estimate comes wrapped in qualifications.
Money changes hands, but no open market establishes the price.
That distinction becomes unavoidable when an employer tries to contract directly with a physician, surgery center, imaging center, laboratory, or pharmacy.
The employer asks a simple question:
What should we pay?
Most direct contracts eventually fall back on a percentage of Medicare. Not because Medicare discovered the value of the service, but because healthcare has no trusted market price of its own.
That is the infrastructure we never built.
Price transparency can reveal what hospitals and insurers negotiated in private.
Price discovery allows qualified buyers and sellers to establish an executable price through trade.
Healthcare does not need another portal filled with downloadable files.
It needs a market that can answer the employer’s first question.
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Responding to Epic Chat and Epic notifications should be an independently billable CPT code.
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Daniel McDevitt MD FACS FSVS retweeted
Celebrating Pediatric Vascular Care:
Dr. Alex Fairman
For Alex Fairman, MD, the path to vascular surgery began long before medical school.
bit.ly/45whThg
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The “Medicare for All” discussion is reminiscent of Obama’s 2008 presidential campaign slogan “Hope and Change”.
It was never precisely clear what that actually meant.
And that was the beauty of it.
In an atmosphere of vagueness, people filled in the blanks with personal aspirations. It was very compelling because it meant whatever anyone wanted it to mean at the time to themselves.
The details of M4A are never really outlined in a practical way. Therefore, it’s easy to imagine it anyway that suits you. Nancy Pelosi famously announced that we had to pass the ACA to find out what’s in it.
Trip me once…..
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I’m sitting in the surgeons lounge. There is a TV on in the background. Daytime television programs are playing.
What the hell is this mindless drivel? Who watches this crap?
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These were some type of show that had hosts and featured people talking about stuff that was absolutely insipid.
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Daniel McDevitt MD FACS FSVS retweeted
Important info. I would follow this account folks
Let’s talk about physician payment for a minute and why that AMA graph just doesn’t feel like it tells the whole story. Here’s why…
Let’s start with how the AMA calculates its graphic. They work on the specified update, which is what Congress set out to do that year… but that’s only half the story
Each year, the conversion factor (CF) is recalculated by multiplying the prior year CF by the statutory update by the budget-neutrality adjustment. When you only go on the statutory update, you miss a big potential gain or loss due to budget neutrality.
@anish_koka has explained why budget neutrality has doomed the physician fee schedule permanently. The AMA has provided Congress with years of bad data that ignores the massive financial trouble that budget neutrality has caused and created a far rosier picture.
When you look at the AMA graph, it appears doctors have seen a 10% increase since 2000. The 2000 CF was $36.6137. The 2027 proposed CF is $32.84. That’s over 10% in the negative direction.
We need truth in advertising. I begged the specialty societies and the AMA to fix their graphs. I spent 3 years asking for it. No one listened.
So, I did what I had to do and I pulled the data together. Below is the work product of that venture and a graph that I think (visually) shows the much more striking reason why doctors are leaving medicine or selling their practices.
The first graph looks at things from the perspective of the 2000 CF. If we just compare how much doctors and hospitals are paid, we see that physician pay via CF has declined 10.3% while hospital pay has increased 97% and inflation (MEI) has increased 71%. That seems pretty stark but I think the second graph uses the same numbers but in a more effective way.
The second graph assumes that MEI is the baseline. In other words, what if doctors just got what they were paid in 2000, updated for the cost of inflation. Now we see what really has happened. Doctors are 81.3% behind inflation while hospitals are 26.8% above inflation. No wonder hospitals are buyers and doctors are sellers in this market.
It’s time for truth in advertising. It’s time Congress and CMS heard the real numbers. 81% behind inflation over 25 years and even worse when compared to HOPDs. Our government created this crisis and they will need to understand the issues they created to get us out. Follow us at @IndeMedAction as we shine the light on issues critical to independent physicians.
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