Arming The Independents. Exposing The Cartel.

Seven stories from the last seven days. Your malpractice carrier decoupled premium from risk. Five companies took 76.1% of the 340B pharmacy market and more...

Seven days.
Seven things every physician needs to know.

1. Your malpractice carrier raised your premium while your risk dropped 55.7%. Claim frequency has fallen for three decades. Premium rates have climbed seven years running. The AMA calls it a litigation crisis. The data calls it a captured market. The party that captured it is not the trial bar. If you are paying premium without exploring a captive structure, you are subsidizing a 30-year decoupling.

2. Five companies are skimming your prescriptions. Five companies hold 76.1% of all 340B contract pharmacy relationships. Three of them sell the insurance, adjudicate the claim, dispense the drug, and retain the spread. When you write a script that fills at Walgreens or CVS, one parent company is sitting on multiple sides of that transaction. Every time.

3. Hospitals are double-billing your MVA patients. Nancy got hit by a car on her bike. BCBS paid the hospital its full contracted rate. Two weeks later, a law firm sent her a letter demanding $80,000 more under the state hospital lien statute. Her auto settlement went to the hospital. She got nothing for lost wages or her destroyed bike. 42 states still permit it. If you treat trauma or refer to hospitals, your patients are walking into this without warning.

4. State AGs cannot stop the merger eating your market. Only 8 state attorneys general have pre-approval authority to block a nonprofit hospital merger before it closes. 38 states logged zero enforcement actions in the last decade. If a system in your market files notice, the deal is already done. Your contracted rates collapse on the closing date, not the announcement date.

5. Your local “nonprofit” hospital is bleeding the tax base. UPMC owns $2.07B of tax-exempt property in Allegheny County. Local governments and school districts eat $58.3M every year. Pittsburgh homeowners just accepted a $28M annual property tax hike in perpetuity. UPMC made a one-time $10M ambulance gift and the mayor called it generous. The Steelers practice at the UPMC Rooney Sports Complex through 2030.

6. Six advisor categories are working your rural hospital board. David Walz of Madelia Health told Becker’s this week: “The day we can’t make payroll, it’s over.” $31M per hospital walked out the door over the last 60 years, and the federal cost-report mechanism subsidized the walk. If you sit on a rural board, there is a legal structure that has existed since the 1950s that nobody has shown you.

7. Misread data is protecting the cartel from policy reform. Calley Means posted that 90% of healthcare costs are tied to chronic disease. The underlying 2017 RAND study said 60% of adults with at least one chronic condition account for 90% of spending. Those are not the same claim. The misread points the policy conversation at food instead of consolidation. That is the strategic work it was built to do.

Malpractice capture. 340B vertical integration. Lien statutes. AG enforcement gaps. Nonprofit tax extraction. Rural board capture. RAND misreads.

None of this ran in your local paper. None of it ran in your specialty society newsletter. All of it changes what you do Monday morning.

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-Rojas out.