Baseball Arbitration, Benchmarking, and Physician Leverage with Dr. Adam Bruggeman
The Doctors’ Lounge · Oct 29, 2026 · 1:09:18
The Doctors’ Lounge · Oct 29, 2026 · 1:09:18
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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
00:00 - Meet Adam Bruggeman and his health policy background
02:21 - What the No Surprises Act is designed to do
04:14 - Patient protections and baseball-style arbitration
08:33 - How often claims reach IDR, and who wins
10:54 - Why the arbitration backstop matters in contract negotiations
14:35 - The QPA and proposals to tie payments to it
19:14 - Why the hosts question QPA as a measure of physician value
23:54 - The reported $22 billion cost and uncertainty in the data
26:15 - Who pays arbitration costs, and what is known about premiums
29:08 - Why New York’s experience may not predict national claim volume
31:53 - Out-of-network strategies, physician assistants, and possible gaming
34:56 - Medicare rates, insurer market power, and physician consolidation
38:47 - Comparing NSA payments with the old out-of-network system
42:38 - Physician negotiating power and the limits of independent practice
47:10 - Cash-pay surgery, insurance, and maintaining patient access
54:39 - 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
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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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