Dutch Rojas

CareMax and Steward Health Care are besties What is CareMax you ask? But of course a value based care provider that went public via SPAC in 2021 $297 open price at IPO $487 high price post IPO $3.00 current trading price Notably, CareMaxbought Steward's Medicare VBC business in 2022 for $135M As part of that transaction, double yacht owning Ralph de la Torre became a board member of CareMax Solid foreshadowing Here's what CareMax recently said in it's 10-Q related to its business: "These conditions raise substantial doubt regarding the Company’s ability to continue as a going concern..." Meaning, it may file for bankruptcy if it can't turn things around Some numbers from the quarter: $156M current assets $507M current liabilities $232M revenue ($21.7M) op loss ($23.8M) cash from ops 1:30 reverse stock split recently issued Translation, you had 30 shares and now you have 1 Some more numbers: 55 centers 218,000 covered members 99% under VBC arrangements And last interesting bit of info: "Our principal sources of liquidity have been cash generated by our centers and MSO operations, and borrowings under our credit facilities." When your third key source of liquidity is borrowing, that's an issue Sorry, sorry, one more thing... Apparently, after the acquisition of Steward's VBC business, Steward doctors continued to serve these patients, though they would then be paid from CareMax... which didn't happen What's going on at CareMax? P.S. If you liked this mystery breakdown, you'll love The Healthcare Breakdown, where I breakdown the business of healthcare and all these wheelings and dealings so you can see what's really going on Check it out here: https://buff.ly/47NeASx See you out there!

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Sociopaths destroy everything around them without an emotional attachment or care. Trump destroys GOP. Trump destroys SCOTUS. Trump destroys last mid term elections. Trump destroys his first Presidency, his allies, our government. Trump destroys our foreign allies. Trump destroys our economy. Trump destroys the middle class. Trump destroys our government entities that regulate healthcare, health infection surveillance. Trump destroys his own university. Trump destroys own confidential national secrets. Trump destroys women’s lives from rape. Trump destroys social media with his failed Truth platform. Trump destroys minorities across the Board. Trump destroys higher educational institutions. Soon…Trump will destroy his own, MAGA. It’s guaranteed, only a matter of time. MAGA think Trump is “strong” and respect him. He’s not strong. He’s mentally ill, a personality disorder, ignorant of fact, devoid of soul. He manipulates and lies, turns his back on everyone. Loyal to none. It’s embarrassing that MAGA cannot see these obvious facts and faults and failures and nefarious conduct of Trump. It’s all characteristic for sociopathic personality disorder. It’s about him, not anyone else. He burns down all he touches. Vote wisely 2024. The evidence is there. America does not need or want a Dictator. 🧐

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🩺💻 The Achilles Heel of Telehealth: Why Walmart and Village MD Stumbled 🩺💻 Walmart’s recent decision to shutter its entire healthcare division, including 51 physical clinics and its virtual care platform, sent shockwaves through the industry. This news, following the closure of Village MD clinics by Walgreens, begs the question: what went wrong with these seemingly promising ventures? 🤔 The Walmart Case: Walmart cited “a challenging reimbursement environment and escalating operating costs” as the reason for its exit. While convenient and affordable, their model struggled to compete with established healthcare providers and navigate the complex insurance landscape. 🏥💰 What Didn’t Work: Lack of Integration: The clinics operated independently, lacking deep integration with existing healthcare systems, which made patient data sharing and continuity of care difficult. 🔄📊 Focus on Price Over Value: While offering low costs, Walmart may have prioritized affordability over building strong patient relationships and personalized care. 💲🤝 Limited Scope of Services: The clinics primarily offered basic primary care, potentially failing to attract patients needing more specialized services. 🏥🔍 Models that Work: While Walmart’s venture faltered, other telehealth models are showing promise: Value-Based Care: Providers focus on preventative care and managing chronic conditions, potentially lowering overall healthcare costs and improving patient outcomes. 🌿🏥 Integrated Telehealth: Seamless integration with existing healthcare systems ensures smooth patient data sharing and a more holistic care experience. 🔄🔗 Specialized Services: Telehealth platforms that connect patients with specialists in specific fields, like mental health or dermatology, are proving successful. 🌟👩‍⚕️👨‍⚕️ Village MD Closure: Walgreens’ closure of 160 Village MD clinics highlights another challenge: ensuring the financial viability of these ventures. While Village MD focused on primary care, the high cost of acquiring and operating clinics might have outweighed the revenue generated. 💼💔 The Takeaway: Telehealth holds immense potential, but its success hinges on overcoming these critical hurdles. Building a sustainable model requires: Strong partnerships with established healthcare providers. 🤝🏥 Focus on value-based care and patient outcomes. 🌟📈 Integration with existing healthcare systems. 🔄🔗 Offering specialized services alongside primary care. 👩‍⚕️🔍 The recent closures serve as a cautionary tale, but they shouldn’t overshadow the potential of telehealth to revolutionize healthcare access and delivery. By learning from these missteps and focusing on sustainable, patient-centered models, the future of telehealth remains bright. 🌐🏥🌟 What are your thoughts? #telehealth #healthcare #technology #medicine #futureofhealthcare

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Insights on hospital CEO compensation Currently, there are over 6,100 hospitals across the United States. It's reasonable to assume that a significant portion of them provide their physician compensation data to MGMA. However, it's perplexing that despite this wealth of data, there seems to be a dearth of information for benchmarking hospital CEO compensation. This raises suspicions and hints at a possible conspiracy. It appears that while physician salaries are openly disclosed, there's a reluctance to share CEO compensation details. As an executive with years of education and experience, it's understandable that you consider yourself an important figure deserving of privacy regarding your compensation. Nevertheless, the apparent lack of transparency in this area is concerning and warrants further scrutiny. Dennis Hursh is a veteran attorney with over 40 years of experience in health law. Link in bio or visit https://lnkd.in/eEgKJj_6 #HealthcareTransparency #HospitalCEO #PhysicianCompensation #ExecutiveSalaries #HealthcareData #CEOIncome #PhysicianPay #TransparencyIssues #HealthcareLeadership #ExecutiveCompensation

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Shocking news - government spends $24m on over complicated white elephant. Private industry competitor literally just calls practices and lists the fees….. The $250/month stuff is click bait and how they are monetising but what they’ve really done is scraped for listings, called the clinics and asked for the initial consult prices and written a directory. ““We supplemented that by calling practices ourselves and asking about the initial consultation, the cost and wait times for a non-urgent case…..A lot of them were just giving it away over the phone.” Is there a take away from all this? Not really - government spending obscene amounts on over complicated populist response rather than looking at why gap fees exist and considering how our health system can work better? Nah- not click baity enough…. https://lnkd.in/gFm3V3VG

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Physician-Owned Hospitals versus Corporate Healthcare - Is That the Real Question? This Medscape article by Charlotte Huff discusses existing Federal regulations essentially banning physician-owned hospitals - and new legislative proposals (H.R. 977/S. 470) to lift some of those bans.   This article notes that available reports, analyses, and debaters on f this issue are conflicted on whether physician-run hospitals improve patient outcomes - or just “cherry pick” optimal patients, increase or reduce competition or costs, and improve rural healthcare?   MY TAKE: What SHOULD be looked at - the OTHER SIDE of the equation: What happens when you REMOVE all clinically-practicing doctors and nurses from hospital management decision making groups = totally NON-physician-run hospitals? - Studies should look at similar outcomes analyses from Corporate Healthcare Systems where CLINICALLY PRACTICING doctors and nurses have been progressively and purposefully ELIMINATED (citing conflicts of interest) from senior decision-making boards and policy groups. Link - https://lnkd.in/e35CQxDx FYI: current Federal mandates including Stark Laws, Anti-Kickback Statutes, the Affordable Care Act - all support this corporate mantra of Doctor/Nurse conflict of interest!   I think we would find that – in such corporate situations (now increasingly dominating healthcare) where these major decision-making boards are now made up of and recruited from successful “Captains of Industry” with no clinical backgrounds - and with their focus entirely on profit (what they were recruited for) and with no clinically practicing physician/nurse input= no conscience – that patient outcomes and other measures the article mentions -are worse, healthcare workplaces are more turbulent, violent and increasingly in disarray, more doctors and nurses are quitting healthcare.    – BUT - profits are up. U.S. Senate Committee on Health, Education, Labor, & Pensions American Medical Association American College of Emergency Physicians Tennessee Medical Association Paige Haeffele Michael Arroyo Peter Stavros Chadd Kraus Noah Tong Aria Bendix Joseph Choi Ryan Stanton Molly Gamble Susanna Vogel Molly Fredriksson Deidre McPhillips Gabe Kelen, Erin Schumaker Alison Haddock, MD, FACEP Susan Morse Heather Landi Steven Ross Johnson Ben Leonard Amy Feldman C. Scott Franklin Claire Sandström Christina Jewett Jesse Ehrenfeld MD MPH Kevin Hern Larry Bucshon, M.D. Samantha Koehler Linda Restrepo Linda Lawrence Tisha Titus, MD, MPH Jonathan Fisher, MD, MPH Leon C. Adelman, MD, MBA, FACEP, FAAEM Shannon Firth Hannah Miao

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Imagine a world where a doctor can diagnose you without ever seeing you. Your condition can go untreated and make a company millions. "Your" doctor never touches you, and you can't hold them responsible for illegal billing or misdiagnoses. Guess what? You don't have to imagine this farfetched world. It happens in Medicare Advantage every day. Once pitched as a way to decrease cost, insurers are paid to take on additional risk, and that's become highly lucrative for them. And yet, those same "sick" patients are the same ones who will run into prior authorization, AI denials, and more when they try to seek services. We also need to discuss insurance companies practicing medicine. If you are diagnosing a patient, you are determining their treatment plan. We can't fool ourselves anymore. This is 100% treatment. #sickcare #medicaredisadvantage https://lnkd.in/eFzCRs2V

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Access to quality affordable preventive, medical, surgical and palliative care in america is rationed, segregated and inequitably subsidized according to age, sex, illness, location, net worth, income, job and military status.

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Many of Medicare's COVID-era telehealth flexibilities are set to expire at the end of 2024, including coverage of audio-only telehealth visits, which may improve access for individuals with limited internet connectivity. In a new JAMA Health Forum paper, we examine recent trends in audio-only telehealth use, and find that certain groups may be disproportionately affected, including low-income patients, people with multiple chronic conditions, and members of racial/ethnic minority groups.

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Mr Evanson wants the answer to a question, but he is NOT asking the correct question. The question is NOT: equal accountability. The question is: What are the evidences that you have, Mr, Evanson, that would lead anyone to charge and convict the aforementioned Presidents (other than Trump) with a crime against the country of the USA? Your presumption that crimes have occurred is pretentious and false. Once Presidents have been charged and convicted, many people, hopefully most and all, would then say, that the violating President should be held accountable. The assumption that the other prior Presidents before Trump have committed acts, without evidence, charges or convictions, is simply not correct. We should hold them all to the law. But they have to break the law first. 🧐 Addendum: No distraction here to assess if Mr Evanson is MAGA-Russia-Publican or simply trying to make a fair statement about holding all Presidents equally accountable ONCE EVIDENCE EXISTS, CHARGES ARE FILED AND CONVICTIONS ARE MADE.

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I found this on NewsBreak: $83,000,000,000,000 Transfer of Wealth Kicks Off – With Trillions Shifting To Spouses Before Being Surrendered To Next Generation: Report https://lnkd.in/ei-MaNxK If true then #women should have more say over the #future of the country without old male dominated #influence #ideas and #behaviors, they should have more ability to #lead #decide and #impact the future of the #country , over their #body and those of their #daughters , and how we treat one another. I dare say that the #world would be different. Example - #Mental #makeup #mindset difference: #collaborative #constructive versus #power #driven and #destructive - #personality types to show this is #melindagates versus #elonmusk so this could be #transformative if more women become #leaders and are in charge... versus #greed, and #egodriven that #create #war #famine and a lack of #compassion for their #fellowman women have more of a #circular #view versus #up and #down view so they are more able to #compromise for the good of all. According to UN Women, companies with more women in senior management tend to perform better in all areas of #organizational #performance. Catalyst reports that #companies with #higher #percentages of #female board #directors can #outperform those with a lower #percentage by up to 66%. #SandP #Global also found that companies with more #gender #diversity on their #executive #boards are more #profitable, and that female #CEOs can see a 20% #increase in #stockprices #momentum in the two #years #following their #appointment. https://lnkd.in/e62n2uKJ.

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Truth to Power The recent article by Bob Berenson and Kevin Hayes in Health Affairs makes a strong statement to Congressional leaders that they are perpetuating a flawed Physician Fee Schedule (PFS) and misguided if they trust that simply shifting to value-based payments (VBPs) will correct the flaws. The authors point out that the PFS is at the heart of the VBPs and without correcting the PFS the VBPs are doomed to fail. The connection between the VBPs and PFS may not be immediately obvious but it is real, with a major impact. As the authors point out, the roots of the issue go back to policy decisions made decades ago that were heavily influenced by industry lobbyists. The underpayment for primary care and the emphasis on procedural payments is hardwired into the 10,000 billing codes. With the PFS underpayment for primary care services as the foundation, most CMMI primary care VBPs are statutorily handcuffed to budget neutrality (with some flexibility if they can produce savings over the short haul). The budget neutrality issue compels the programs to create winners and losers, but does not substantially raise the overall payments to providers. For example, in the Maryland Primary Care Program and the ACO Flex Model the capitated payments to primary care are designed to reflect the historical billing of the practices which is based on the inadequate payments in the PFS, leaving the basic services perpetually underfunded. CMMI has employed thoughtful payment adjustments for Care Management Services and health equity which are still inadequate to address an aging population suffering from overwhelming racial, ethnic and geographic disparities.  Even if the CMS goal of having every beneficiary under an Accountable Care relationship by 2030 is met, it does not address the underlying primary care payment deficiency since primary care providers will still derive the majority of their income from fee for service based of the PFS. This situation is not the fault of HHS, CMS or CMMI. The smart, dedicated, hardworking folks in those administrations must adhere to the statutes they are governed by. The problem and the solutions belong to our Congressional policy makers. The authors draw two conclusions- “the Centers for Medicare and Medicaid Services should correct misvalued services and establish a hybrid payment for primary care that blends fee-for-service and population-based payment. Second, Congress should alter the thirty-five year-old statutory basis for setting Medicare fees to allow CMS to explicitly consider policy priorities such as workforce shortages in refining fee levels” and close with the statement “Value must be sought in both the fee schedule and APMs….. it is time to repudiate the judgment that fee-for-service has no link to quality and value” Truth to Power Howard https://lnkd.in/eRt_natp

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Reporter questions to SCOTUS justices concerning Presidential Immunity: Question for SCJ Thomas: Justice Thomas, does it worry you that full immunity could allow the President to buy you and your positions in SCOTUS? SCJ Thomas: No, my SCOTUS decisions are for sale every day, every case. And my price is high. Question for SCJ Alito: Justice Alito, do you think giving full immunity would allow a President to become a dictator, and create unparalleled genocide in America similar to Germany under Hitler? SCJ Alito: Well, maybe America needs that? Question for SCJ Roberts: Justice Roberts, do you worry that full immunity would allow an already perverse America without gun control to further plague the innocent Americans with more gun violence, under the orders and pardons of the fully immune President? SCJ Roberts: The human life cycle can be long or short and I think the President should personally select who has short or long life cycles and the manner of termination of the cycle. It’s the new American way of life. Question for SCJ Barrett: Justice Barrett, how do you feel as a woman about registering your entire health to your State and your obligations to follow their laws about your personal health habits? SCJ Barrett: I think women have made sacrifices for America before and I think they should make them again. We should let others decide how we lead our lives. In addition, I would relinquish my right to vote under such a President anytime. Praise the new America. Question for SCJ Goresch: Justice Goresch, does it concern you that many people that follow certain Presidents lack intelligence, rational thinking, ability to extrapolate future events, tie together cause and effect, and cannot correctly determine fact from fiction, even when informed fact from its source. SCJ Goresch: No. I have that problem too. Readers. It’s your America. And it’s eroding quickly into a dictatorship fueled by ignorance, racism, misogyny and violence. People living in a future Trumpian country will wish they lived in Nazi Germany, Putin Russia or KYU North Korea in comparison. Vote wisely in 2024. 🧐

America, its unfortunate habit of enabling nefarious conduct: Let’s be clear: America is a bubble, its government and citizens disregard threats against America and prefer denial and the blind eye. Unfortunately, such denial and enabling is a security risk for our country and its citizens. 30 years ago, George Bush would not have threatened Bill Clinton’s life. Such behavior would have been considered extraordinary. In evil axis countries, you would get poisoning, death or disappearance. In America, now Trump and MAGA have made violent threats and violent acts mainstream, common place, acceptable and even coveted by politicians. It’s not a male game, it’s a female game too. I get my way or I threaten your life=American political motto of choice. This is a failure of Democracy. Democracy has become too liberal and now allows unconstitutional acts across the Board; violent President threats, acts against our elections, acts against Congress at the Capitol, and acts against our sovereign government with confidential and nuclear secret transmissions to enemies. Alex Jones deserves Title 18 punishment, 5 years in prison for this threat to the President. Let’s start enforcing our laws….if not, ignore them, there is little middle ground. America needs to do better. 🧐

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STEVE KIRSCH: "Official government record-level data obtained through a FOIA request from the Czech Republic shows that the Moderna COVID vaccine increased all-cause-mortality (ACM) as measured over a 12-month period from the time of vaccination for every age as compared to the Pfizer vaccine.  If the COVID vaccines were safe, the overall ACM across different vaccine brands would be very similar. This is not the case. They are radically different and the difference is highly statistically significant.  For example, for ages 46-69 who got two shots of Moderna vs. two shots of Pfizer in 2021 in the Czech Republic, there is over a 50% higher risk of death measured over a 1 year time window since the time of the shot as shown in the chart above.  The younger you were, the greater the percentage increase in risk. For 20 to 29 year old’s for example, the MRR (mortality rate ratio between Moderna to Pfizer) approached 2:1 which means you more than doubled your all-cause mortality if you took a Moderna shot.  So even if the Pfizer vaccine was 100% safe, the Moderna vaccine should be immediately stopped as being far too deadly to use for any age group. The 50% number is an absolute ACM increase compared to the Pfizer ACM value, not a comparison of excess mortality risk.  That’s a train wreck. Vaccines are always supposed to reduce absolute ACM. Vaccines are never supposed to increase ACM, even by a little bit. The Pfizer COVID vaccine is also too unsafe to use, but we don’t have enough data to accurately estimate how much it increases all-cause mortality. From the limited data, I believe it’s safe to say Pfizer appears to have at least 10% higher all-cause mortality than Novavax (that is a very conservative estimate since all the data was much higher than that), making Pfizer also completely unsuitable for public use.  To put it in numbers, if everyone in the US got the initial 2 dose Moderna shot, it would cause a minimum of 650,000 excess deaths (which I estimated at a 20% increase in overall US ACM because the ACM rates are much higher for older ages where the % impact of the vaccine is much smaller). That is a conservative estimate. Rancourt et alestimated the COVID shots kill on average for all ages 1.26 people per 1,000 shots. In the US with over 677M shots given, the estimate is over 850,000 deaths. "Even more problematic is that no world health authority, local, national, or international, was able to detect such a massive relative mortality increase of Moderna compared to Pfizer.  The reason is simple: none of them bothered to look. There isn’t a single mortality comparison by brand posted by a public health agency anywhere in the world ever. Not even in internal documents.  That’s appalling. Yet nobody in the mainstream medical community ever voiced a concern about the lack of this sort of obvious safety monitoring and the total lack of data transparency."

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