This is where scalpels meet systems and physicians say what they really think. @anish_koka @DrDiGiorgio @sdixitmd @drdanchoi
United States
- Tweets 528
- Following 15
- Followers 3,306
- Likes 196
Pinned Tweet
Baseball Arbitration, Benchmarking, and Physician Leverage with Dr. Adam Bruggeman
Episode Summary
Orthopedic spine surgeon and independent-practice owner Adam Bruggeman joins The Doctor’s Lounge to explain the No Surprises Act (NSA), its independent dispute resolution (IDR) process, and the controversy over how out-of-network care should be paid. Hosts Anish Koka, Anthony DiGiorgio, and Sanat Dixit examine what the dispute means for physician negotiating power, patient access, and the future of independent practice.
Timestamps
- Meet Adam Bruggeman and his health policy background
- What the No Surprises Act is designed to do
- Patient protections and baseball-style arbitration
- How often claims reach IDR, and who wins
- Why the arbitration backstop matters in contract negotiations
- The QPA and proposals to tie payments to it
- Why the hosts question QPA as a measure of physician value
- The reported $22 billion cost and uncertainty in the data
- Who pays arbitration costs, and what is known about premiums
- Why New York’s experience may not predict national claim volume
- Out-of-network strategies, physician assistants, and possible gaming
- Medicare rates, insurer market power, and physician consolidation
- Comparing NSA payments with the old out-of-network system
- Physician negotiating power and the limits of independent practice
- Cash-pay surgery, insurance, and maintaining patient access
- How arbitration decisions and offers are being scrutinized
61:08 - Why the dispute over a small share of claims matters
64:34 - Physician fees as a loss leader for hospital revenue
Co-Host Handles
@anish_koka and @DrDiGiorgio
Show Handle
@DRsLoungePod
Subscribe Links
Spotify:open.spotify.com/show/44vw8e…
Apple Podcasts:podcasts.apple.com/us/podcas…
YouTube:piped.video/@TheDoctorsLoung…
2
2
6
572
Tufts promised to keep premiums down by staying out of network for Partners, now Mass General Brigham.
Public backlash. Tufts took Partners' price.
Andrew Tsang on what came next: “premiums went up fifty-five percent.”
🎧 Full episode:
No Villains, Just Incentives: A Healthcare Consultant Turned Writer on Why the System Fights Itself
This episode examines why US healthcare keeps rewarding consolidation, even when it raises costs and makes the system harder to navigate. Andrew Tsang, writer of Health is Other People, brings a cross-industry view from consulting, policy, providers, and payers to explain how hospitals, insurers, and Medicare rules all shape behavior. We discuss why the system feels adversarial, how incentives drive consolidation, and why policies like the No Surprises Act and MLR can produce unintended consequences. The conversation also turns into a broader argument that the real problem may be cultural and existential, not just technical or legislative.
Timestamps
00:00 - Introducing Andrew Tsang and his healthcare writing background
00:53 - From consulting and Medicaid work to healthcare writing
03:10 - Why hospitals are political systems, not just businesses
05:23 - Mass General Brigham, consolidation, and incentive-driven growth
10:20 - What the No Surprises Act is trying to do for patients
12:39 - Independent dispute resolution and the provider payer dynamic
15:49 - Why arbitration may favor providers and still raise costs
18:26 - MLR, insurer incentives, and the limits of cost containment
22:19 - Why US healthcare fights over scarce resources instead of throughput
23:46 - The scale of utilization management and billing conflict
24:23 - Medicare DRGs, coding complexity, and upcoding incentives
26:24 - How hospital market power affects commercial pricing
28:28 - What actually drives merger strategy inside health systems
31:39 - Why insurers and hospitals still claim cost control while behaving differently
37:37 - The Tufts and Partners negotiation as a lesson in market power
40:33 - Essential benefits, narrow plans, and how coverage rules shape leverage
44:42 - Why the US wants both public guarantees and private market incentives
47:11 - Vertical integration in insurance and why it is rewarded
53:39 - Why policy fixes are incremental and often politically compromised
56:21 - Why Andrew left consulting and what felt futile about the work
58:18 - The case for healthcare as a cultural and moral problem
59:12 - Why selfishness, greed, and apathy may be the real barriers to reform
Co-Host Handles
@anish_koka and @DrDiGiorgio
Show Handle
@DRsLoungePod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Mr. Andrew Tsang LinkedIn
linkedin.com/in/tsang1219
Mr. Andrew Tsang Substack handle is
substack.com/@andrewtsang
Mr. Andrew Tsang Substack Health is Other People link
blog.healthisotherpeople.com…
Mr. Andrew Tsang Substack Mass General Brigham merger link
substack.com/@andrewtsang/no…
1
2
860
Andrew Tsang on what the payer-provider fight does to patients:
“patients themselves are like children watching their parents fight.”
“it's like children tiptoeing into a room to make sure the parents are okay.”
🎧 Full episode:
No Villains, Just Incentives: A Healthcare Consultant Turned Writer on Why the System Fights Itself
This episode examines why US healthcare keeps rewarding consolidation, even when it raises costs and makes the system harder to navigate. Andrew Tsang, writer of Health is Other People, brings a cross-industry view from consulting, policy, providers, and payers to explain how hospitals, insurers, and Medicare rules all shape behavior. We discuss why the system feels adversarial, how incentives drive consolidation, and why policies like the No Surprises Act and MLR can produce unintended consequences. The conversation also turns into a broader argument that the real problem may be cultural and existential, not just technical or legislative.
Timestamps
00:00 - Introducing Andrew Tsang and his healthcare writing background
00:53 - From consulting and Medicaid work to healthcare writing
03:10 - Why hospitals are political systems, not just businesses
05:23 - Mass General Brigham, consolidation, and incentive-driven growth
10:20 - What the No Surprises Act is trying to do for patients
12:39 - Independent dispute resolution and the provider payer dynamic
15:49 - Why arbitration may favor providers and still raise costs
18:26 - MLR, insurer incentives, and the limits of cost containment
22:19 - Why US healthcare fights over scarce resources instead of throughput
23:46 - The scale of utilization management and billing conflict
24:23 - Medicare DRGs, coding complexity, and upcoding incentives
26:24 - How hospital market power affects commercial pricing
28:28 - What actually drives merger strategy inside health systems
31:39 - Why insurers and hospitals still claim cost control while behaving differently
37:37 - The Tufts and Partners negotiation as a lesson in market power
40:33 - Essential benefits, narrow plans, and how coverage rules shape leverage
44:42 - Why the US wants both public guarantees and private market incentives
47:11 - Vertical integration in insurance and why it is rewarded
53:39 - Why policy fixes are incremental and often politically compromised
56:21 - Why Andrew left consulting and what felt futile about the work
58:18 - The case for healthcare as a cultural and moral problem
59:12 - Why selfishness, greed, and apathy may be the real barriers to reform
Co-Host Handles
@anish_koka and @DrDiGiorgio
Show Handle
@DRsLoungePod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Mr. Andrew Tsang LinkedIn
linkedin.com/in/tsang1219
Mr. Andrew Tsang Substack handle is
substack.com/@andrewtsang
Mr. Andrew Tsang Substack Health is Other People link
blog.healthisotherpeople.com…
Mr. Andrew Tsang Substack Mass General Brigham merger link
substack.com/@andrewtsang/no…
209
Why is Andrew Tsang's Substack called Health Is Other People?
It's a nod to Sartre's No Exit. His read on hospitals and insurers:
“they keep doing things that are really counter to those specific missions that they state.”
🎧 Full episode:
No Villains, Just Incentives: A Healthcare Consultant Turned Writer on Why the System Fights Itself
This episode examines why US healthcare keeps rewarding consolidation, even when it raises costs and makes the system harder to navigate. Andrew Tsang, writer of Health is Other People, brings a cross-industry view from consulting, policy, providers, and payers to explain how hospitals, insurers, and Medicare rules all shape behavior. We discuss why the system feels adversarial, how incentives drive consolidation, and why policies like the No Surprises Act and MLR can produce unintended consequences. The conversation also turns into a broader argument that the real problem may be cultural and existential, not just technical or legislative.
Timestamps
00:00 - Introducing Andrew Tsang and his healthcare writing background
00:53 - From consulting and Medicaid work to healthcare writing
03:10 - Why hospitals are political systems, not just businesses
05:23 - Mass General Brigham, consolidation, and incentive-driven growth
10:20 - What the No Surprises Act is trying to do for patients
12:39 - Independent dispute resolution and the provider payer dynamic
15:49 - Why arbitration may favor providers and still raise costs
18:26 - MLR, insurer incentives, and the limits of cost containment
22:19 - Why US healthcare fights over scarce resources instead of throughput
23:46 - The scale of utilization management and billing conflict
24:23 - Medicare DRGs, coding complexity, and upcoding incentives
26:24 - How hospital market power affects commercial pricing
28:28 - What actually drives merger strategy inside health systems
31:39 - Why insurers and hospitals still claim cost control while behaving differently
37:37 - The Tufts and Partners negotiation as a lesson in market power
40:33 - Essential benefits, narrow plans, and how coverage rules shape leverage
44:42 - Why the US wants both public guarantees and private market incentives
47:11 - Vertical integration in insurance and why it is rewarded
53:39 - Why policy fixes are incremental and often politically compromised
56:21 - Why Andrew left consulting and what felt futile about the work
58:18 - The case for healthcare as a cultural and moral problem
59:12 - Why selfishness, greed, and apathy may be the real barriers to reform
Co-Host Handles
@anish_koka and @DrDiGiorgio
Show Handle
@DRsLoungePod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Mr. Andrew Tsang LinkedIn
linkedin.com/in/tsang1219
Mr. Andrew Tsang Substack handle is
substack.com/@andrewtsang
Mr. Andrew Tsang Substack Health is Other People link
blog.healthisotherpeople.com…
Mr. Andrew Tsang Substack Mass General Brigham merger link
substack.com/@andrewtsang/no…
1
239
The Doctor's Lounge - Dr. Adam Bruggeman nitter.siddz.com/i/broadcasts/1yxBePWvz…
4
370
The Doctor’s Lounge Podcast retweeted
1/3
It's understandable why oncologists and patients want crossover, and it's easy to argue for it after a positive trial. But when the trial was designed, no one knew divarasib would win, and G12Ci after G12Ci was unproven. Crossover makes sense when the later-line benefit is already established.
“If PFS is the primary endpoint, why isn't crossover allowed?”
I haven't heard a more justified complaint from an oncologist in a long time.
Dr. Benjamin Besse💯👏👏
#ESMO26
2
9
41
8,100
The Doctor’s Lounge Podcast retweeted
Capitalism is Free Market Medical Care and the BEST option we have.
Health Insurance is a Government Mandated monopoly.
Medicare for All is One Health Insurance company in charge of EVERYTHING. If you hate Health Insurance how is it logical or sane that you want ONE SINGLE Health Insurance Company Running the entire Healthcare system?
Stupid is as stupid does.
#Healthinsurance #Healthcare #Congress #CORRUPTION
1
4
22
717
The Doctor’s Lounge Podcast retweeted
AI researchers take up smoking; You can see everything; Moderna hazard ratio
15
19
132
42,609
SNAP, Medicaid Fraud, and the Case for Letting Prices Work
In this episode, Dr. Anish Koka and Dr. Anthony DiGiorgio talk through the trade-offs of government-run programs using SNAP as a model for thinking about healthcare. They also dig into Medicaid fraud, managed care, Medicare Advantage, and the risks of bringing overt politics into patient encounters.
The discussion is grounded in real policy examples and a shared concern that well-intended programs can balloon, distort markets, and create worse outcomes if the incentives are wrong.
Timestamps
00:00 - Cold San Francisco, small talk, and setting up the policy agenda
00:01:30 - Previewing Dr. Adam Bruggeman and the next episode on IDR and the No Surprises Act
00:03:54 - Why SNAP is the right model to think about when designing healthcare subsidies
00:05:48 - No program is perfect, but SNAP may be better than the alternatives
00:06:13 - How SNAP can be gamed through cash-equivalent arbitrage and junk food purchases
00:07:11 - Why a healthcare HSA-style subsidy would still need rules on eligible spending
00:08:01 - SNAP spending has grown from about 6 billion to about 120 billion per year
00:09:07 - The risk that healthcare subsidies could also incentivize unhealthy consumption and fraud
00:11:22 - Why every government program seems to drift toward vested interests and regulatory capture
00:12:18 - The case for a market-based subsidy instead of direct government service delivery
00:13:16 - What a fully government-run food system would look like if modeled on Medicare
00:14:32 - Government-run hospitals, the VA, and the limits of parallel public systems
00:17:02 - Public schools, vouchers, and why incentive structure matters more than more money
00:18:25 - Why a subsidized private system may work better than a broad public option
00:20:46 - Tiers already exist in American healthcare, whether people admit it or not
00:22:39 - How corporate actors lobby for government intervention once subsidies exist
00:24:05 - Why a public option may preserve the same distortions rather than fix them
00:26:26 - Medicaid fraud news, investigative journalism, and the Nick Shirley reporting
00:28:59 - Medicaid fee-for-service versus managed care and the fraud-control trade-off
00:31:52 - How 1915 waiver services are especially vulnerable to abuse in fee-for-service systems
00:32:46 - The Medicare Advantage debate and disputed overpayment estimates
00:35:37 - Traditional Medicare’s own problems with fraud control and payment distortions
00:37:13 - Why price suppression harms both physicians and patients
00:40:30 - Concussion care as an example of how shortages and waitlists emerge
00:43:22 - The moral argument for prices and patient choice
00:46:26 - Critiquing the MedPage piece on doctors talking to patients about politics
00:48:46 - Why the exam room is the wrong place for political persuasion
00:50:48 - The vulnerability of the patient and why political advocacy should stay out of clinical care
00:53:19 - Why overt political endorsements can damage physician-patient trust
00:57:48 - Why academic monoculture is overstated and many dissenters are simply quiet
00:59:53 - What is coming next: IDR with Dr. Bruggeman and future healthcare and AI discussions
01:01:09 - Hoover Institute Medicare event, 340B, quality metrics, and incremental reform
Co-Host Handles
@anish_koka and @DrDiGiorgio
Show Handle
@DRsLoungePod
Subscribe Links:
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
1
2
6
572
Ten cardiologists in a room will fight over how long to use dual antiplatelets after a stent.
Dr. Anish Koka on why the cash model gets around that:
"you're not contracting with other people's money."
🎧 Full episode:
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
1
478
Administrators are supposed to care about money.
Dr. DiGiorgio on telling them "I can make you more money":
They "shrug their shoulders" or "they don't trust us because we're doctors and not accountants."
🎧 Full episode:
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
1
4
419
Dr. Mollie James's first step for a new graduate who wants independence:
Be a 1099 contractor.
"You set your own call, you set your own time."
🎧 Full episode:
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
1
2
5
468
Dr. Mollie James on a common mistake doctors make going independent:
"I want to help people, so I need to keep my prices low."
Her verdict: "one of the biggest fallacies out there."
🎧 Full episode:
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
2
7
627
Dr. Mollie James wrote an order for her patient's venous access port.
The hospital wouldn't take it.
It needed an order from a doctor inside the system.
Her take: "you have to walk through our front door."
🎧 Full episode:
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
4
12
2,411
Last year: $50 copay, 10-minute oncology follow-up.
This year, after a hospital bought up the practices: $1,800.
Facility fee. Lab fee. Same 10 minutes.
🎧 Full episode:
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
2
5
17
5,332
A hospital COO was asked what happens if a code one trauma comes in.
Her answer: "We're a level two trauma center."
She didn't know the difference between a code trauma and a level designation.
Dr. Mollie James: "The inmates are running the prison."
🎧 Full episode: nitter.siddz.com/DRsLoungePod/status/21…
Leaving the Employment Model: Dr. Mollie James on Going Independent
Dr. Mollie James joins Anish Koka, MD, and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
(03:19) Administrative overload and trying to rebuild trauma services after a tornado
(04:43) Why job-hopping did not solve the real problem
(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery
(08:29) Why administrators miss the clinical big picture
(09:59) The COVID straw that broke the camel's back
(11:49) Pushback over medication choices and committee control
(13:45) Launching James Clinic during the pandemic
(16:17) Treating 4,000 COVID patients in four months
(17:30) Telemedicine, a low-rent clinic, and building from scratch
(18:23) Cash pricing, two-week coverage, and tiered support
(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked
(21:32) The treatment approach: steroids, antihistamines, and more
(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations
(25:51) Omicron, collapsing COVID volume, and pivoting the business
(27:30) Pricing mistakes, layoffs, and how a practice has to evolve
(28:10) Why the integrative cancer program was underpriced
(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support
(30:12) Why the market can solve care shortages better than administration
(31:46) Why cash pay and patient-funded care reduce conflict over evidence
(35:48) Independent medicine requires results, service, and rapid feedback
(36:42) Why low prices can limit your ability to help anyone
(37:24) Why physicians should consider independence and self-funded models
(40:01) Diversifying privileges and not putting all your eggs in one basket
(40:52) How a new grad can start as a 1099 contractor
(42:39) Networking, call coverage, and building cooperative physician relationships
(43:22) Why scarcity thinking hurts doctors outside the hospital
(44:56) The modifier 25 and CMS reimbursement frustrations
(46:28) Fear, pricing transparency, and why patients and doctors both lose
(47:42) Knowledge replacing fear in healthcare decisions
(49:46) Why splitting procedures across days feels absurd to patients
(50:48) The real mechanism problem behind billing rules
(53:26) Social media manipulation, CPT complexity, and administrative bloat
(55:08) Why single payer does not actually mean simple
(56:03) Maverick Medical Ventures and the playbook for leaving the system
(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps
(60:15) Monopolization, referrals blocked by system rules, and loss of access
(61:11) Why hospital privileges can still be a barrier for outpatient procedures
(62:10) Culture wars, division, and the need to align on shared physician priorities
(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handle
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Dr. Mollie James X Handle
@molsjames
Dr. Mollie James Website
maverickmedicalventures.com/
5
8
39
4,874
This shouldn't be partisan.
Regardless of politics, we should be able to look at the data and agree on one thing: the strategy failed.
🎧 Full episode:
From Addiction to Advocacy: Tom Wolf's Journey
In this episode, Anthony DiGiorgio and Anish Koka engage with Tom Wolf, a recovery advocate, who shares his personal journey through addiction, homelessness, and eventual recovery. The conversation delves into the complexities of homelessness, the impact of substance use, and the evolving definitions and policies surrounding addiction treatment. Tom discusses the harm reduction approach, its origins, and its implications, while emphasizing the need for accountability and the role of physicians in addressing the opioid crisis. The episode highlights the importance of lived experiences in shaping drug policy and the ongoing challenges faced by individuals in recovery. In this conversation, Anthony DiGiorgio and Tom Wolf delve into the complexities of addiction treatment, mental health, and the political landscape surrounding these issues. They discuss the challenges of psychiatric holds, the balance between autonomy and compulsion in treatment, and the failures of current drug policies in major cities. The dialogue emphasizes the need for a recovery-oriented system of care and critiques the harm reduction approach, drawing comparisons to international policies, particularly in Portugal. The conversation highlights the intersection of mental health and addiction, the political ramifications of policy failures, and the urgent need for effective solutions to the ongoing drug crisis.
Chapters
00:00 Introduction to Recovery Advocacy
00:55 Tom Wolf's Journey Through Addiction
06:33 Finding Recovery and Advocacy
10:08 The Complexity of Homelessness and Addiction
11:22 The Evolving Definition of Homelessness
12:26 The Impact of Substance Use on Housing
15:06 Harm Reduction: A Double-Edged Sword
20:30 The Role of Physicians in Substance Abuse
25:02 The Historical Context of Opioid Prescription
30:02 The Future of Drug Policy and Recovery
34:39 Navigating Psychiatric Holds and Treatment Options
38:30 The Dilemma of Autonomy vs. Compulsion in Treatment
40:40 Evaluating Policy Failures in Major Cities
44:51 Building a Recovery-Oriented System of Care
47:39 Comparing Drug Policies: Lessons from Portugal
49:40 The Intersection of Mental Health and Addiction
51:51 The Political Landscape of Addiction Recovery
56:55 The Challenges of Acknowledging Policy Failures
Co-Host Handles
@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
Guest Handle/Links
@Twolfrecovery
tomwolfrecovery.com/
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
8
492
No Villains, Just Incentives: A Healthcare Consultant Turned Writer on Why the System Fights Itself
This episode examines why US healthcare keeps rewarding consolidation, even when it raises costs and makes the system harder to navigate. Andrew Tsang, writer of Health is Other People, brings a cross-industry view from consulting, policy, providers, and payers to explain how hospitals, insurers, and Medicare rules all shape behavior. We discuss why the system feels adversarial, how incentives drive consolidation, and why policies like the No Surprises Act and MLR can produce unintended consequences. The conversation also turns into a broader argument that the real problem may be cultural and existential, not just technical or legislative.
Timestamps
00:00 - Introducing Andrew Tsang and his healthcare writing background
00:53 - From consulting and Medicaid work to healthcare writing
03:10 - Why hospitals are political systems, not just businesses
05:23 - Mass General Brigham, consolidation, and incentive-driven growth
10:20 - What the No Surprises Act is trying to do for patients
12:39 - Independent dispute resolution and the provider payer dynamic
15:49 - Why arbitration may favor providers and still raise costs
18:26 - MLR, insurer incentives, and the limits of cost containment
22:19 - Why US healthcare fights over scarce resources instead of throughput
23:46 - The scale of utilization management and billing conflict
24:23 - Medicare DRGs, coding complexity, and upcoding incentives
26:24 - How hospital market power affects commercial pricing
28:28 - What actually drives merger strategy inside health systems
31:39 - Why insurers and hospitals still claim cost control while behaving differently
37:37 - The Tufts and Partners negotiation as a lesson in market power
40:33 - Essential benefits, narrow plans, and how coverage rules shape leverage
44:42 - Why the US wants both public guarantees and private market incentives
47:11 - Vertical integration in insurance and why it is rewarded
53:39 - Why policy fixes are incremental and often politically compromised
56:21 - Why Andrew left consulting and what felt futile about the work
58:18 - The case for healthcare as a cultural and moral problem
59:12 - Why selfishness, greed, and apathy may be the real barriers to reform
Co-Host Handles
@anish_koka and @DrDiGiorgio
Show Handle
@DRsLoungePod
Subscribe Links
Spotify: open.spotify.com/show/44vw8e…
Apple Podcasts: podcasts.apple.com/us/podcas…
YouTube: piped.video/@TheDoctorsLoung…
Mr. Andrew Tsang LinkedIn
linkedin.com/in/tsang1219
Mr. Andrew Tsang Substack handle is
substack.com/@andrewtsang
Mr. Andrew Tsang Substack Health is Other People link
blog.healthisotherpeople.com…
Mr. Andrew Tsang Substack Mass General Brigham merger link
substack.com/@andrewtsang/no…
1
2
6
2,299