Medicare Rates, Device Margins, and the Case for Owning the Building

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Episode Summary

Spine surgeon Eric Potts, co-owner of Indiana Spine Hospital, joins hosts Anthony DiGiorgio and Anish Koka to discuss why physicians built a hospital, how it operates without Medicare patients, and what ownership changes for patients and clinicians. The conversation also examines hospital billing, physician incentives, and whether more competition could make care less costly and more responsive.

Timestamps:
00:00:00 - Meet Eric Potts and Indiana Spine Hospital
00:01:10 - Why a surgery center led to a hospital
00:01:28 - The Affordable Care Act’s Section 6001 restriction
00:03:03 - A distinct patient and family experience
00:05:02 - Physician ownership, business, and consolidation
00:08:05 - Lower-cost care and the hospital’s market
00:11:06 - Could elective spine surgery work outside insurance?
00:14:55 - DRGs, billing, and delayed payment
00:18:00 - Outlier payments and the incentives behind costs
00:21:32 - Aligned incentives and direct contracts
00:24:45 - Conflicts of interest and variation in surgical opinions
00:28:26 - Supplier-induced demand and patient information gaps
00:32:58 - Medicare-only payment and the future workforce
00:40:04 - How comorbidity coding can affect reimbursement
00:45:43 - The case for allowing Medicare patients at physician-owned hospitals
00:48:49 - How the hospital manages costs
00:55:12 - Staffing, recruitment, and the appeal of ownership
01:00:59 - Physician ownership, device rules, and making implants

Co-Host Handles
@anish_koka and @DrDiGiorgio

Show Handle
@DRsLoungePod
 
Subscribe Links
Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658
YouTube: https://www.youtube.com/@TheDoctorsLoungePod
 

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• Dr. Dan Choi on X

• Dr. Sanat Dixit on X