Spine Surgeon Specializing In Minimally Invasive Techniques / Endoscopic spine surgery / Outpatient Spine Surgery
Newport Beach, CA
Joined June 2024
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Brandon Hirsch retweeted
Make no mistake, the physician, hospital and supporting advocacy community is engaged in a "David v. Goliath" battle to prevent repeal of the #NoSurprisesAct.
The community was one when we defeated the health plans in '18, '19 and early '20 and we will have to come together with one voice again.
One recalls the famous proverb: "It is not the size of the dog in the fight, it's the size of the fight in the dog."
"Health Care Companies Are On Defense. It’s A Windfall For K Street.
POLITICO| Amanda Chu | October 21, 2026 (excerpts below)
Lobbyists and policy analysts said efforts to prepare companies for oversight in a likely Democratic-controlled House, advance proposals in a year-end legislative package, and rethink the No Surprises Act will dominate the agenda for the remainder of the year....
Congress passed the No Surprises Act in 2020 to address out-of-network bills patients received after emergency care, but it has led to outsized claims. The effort to rewrite it has embroiled doctors and insurers. There were approximately 158 lobbying registrations related to the law in the third quarter, up 52% year over year, according to an analysis of public lobbying disclosures by Baron Public Affairs, a government relations consultancy....
“This has become one of the main health care policy arenas, if not the main one,” Riley Kruse, a director at Baron Public Affairs, said of the No Surprises Act....
UnitedHealth, the largest U.S. health insurer, reported $2.1 million in third-quarter lobbying spending, its highest for the period on record. Its peers Centene, Cigna and Humana also reported elevated spending, with Humana recording its highest year-to-date spending for the period.....
"Q3 was my busiest part of the year without question,” said Miranda Franco, senior policy adviser at law and lobbying firm Holland & Knight, the country’s largest health care law practice, which counts hospitals, drugmakers and physician groups as clients.
"It’s the second year of this administration, which means that a lot of the proposals and policy agendas are really taking hold,” said Franco, who is tracking proposed rules spanning the Medicare physician fee schedule and the implementation of the One Big Beautiful Bill Act, President Donald Trump’s domestic policy package that cut nearly $1 trillion in future Medicaid spending....
Lobbyists told POLITICO they expect the scrutiny to continue regardless of the midterm results, which will determine control of Congress. “The pharmaceutical industry is under increasing bipartisan pressure on pricing…The threats are coming at them from all sides,” said a lobbyist for large drugmakers, granted anonymity to speak about their client work....
AHIP, the trade group for insurers, spent $3 million on third quarter lobbying, on par with the prior quarter. Year-to-date spending has surpassed $11.3 million, the group’s second highest for the period behind last year. Chris Bond, a spokesman for AHIP, said it continues to “actively engage with policymakers in support of affordable, high-quality coverage options” and blamed hospitals and drugmakers for high costs.
Spending at the American Hospital Association, meanwhile, is down. The trade group spent $3.8 million on lobbying in the third quarter, its lowest in at least a decade. The association declined POLITICO’s request for comment.
Lobbyists and policy analysts said efforts to prepare companies for oversight in a likely Democratic-controlled House, advance proposals in a year-end legislative package, and rethink the No Surprises Act will dominate the agenda for the remainder of the year.
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Brandon Hirsch retweeted
This is an INSULT to every Sick American, Physician and Healthcare Worker.
I’m a staunch President Trump supporter and Conservative. I’ve been a Family Physician for 23 years.
2 years in and there has been ZERO real Healthcare Reform.
You even CUT Doctors Pay while making Corporate Healthcare and the AMA WEALTHIER.
Healthcare purchased through Health Insurance is 18% the Economy! Healthcare purchased through Health Insurance costs more than Food, Energy and Military Spending COMBINED.
Healthcare purchased through Health Insurance costs $1 of every $6 you spend EVERY DAY.
It has destroyed our economy. We will never fix Healthcare without a Robust Free Market Medical Care economy.
Cheers to @HEALTHCOSTtruth
YES!! Direct Care and he could also build hospitals and let doctors run them the right way. He could start with CA, CO, ID, KS, NH, NM, ND, PA, SD, TX, UT, WY, IN, OH and SC that have no CON for hospitals.
The real estate itself would be his investment. Doctors (you know - the people that actually understand healthcare) run it for cash pay (no networks). THAT would be a significant contribution to humanity (in the US anyway).
We could flood those hospitals with employer groups and their employees (and others) and reduce the costs of healthcare by A LOT!!
Doctors regain their ability to actually practice medicine.
Americans regain their healthcare freedom.
No CMS determining what "value" is - the people will decide.
No insurance carriers making billions.
No brokers if no insurance.
No PBM since prescriptions can be dispensed on-site.
The list goes on... if I had his money, that is exactly what I would do.
@elonmusk @AtlasMD
Pure evil, some would call diabolical
Follow up from today’s post
I looked into the group whose video ad is running in the Root post, and what I found is concerning.
The ad is titled "EXPOSED: Double Billing." Its disclaimer reads "Paid for by Patients for Safe and Affordable Health Insurance."
It is a limited liability company. The only place its legal name appears is the website's privacy policy. There is no named executive director, no board, no staff, no spokesperson, and no press release.
Its listed address is 712 H Street NE, Suite 1403, in Washington, DC. That address belongs to a FedEx and UPS shipping store. "Suite 1403" is a mailbox.
Its website launched in January 2025. The files behind it are hosted on a WordPress network that also hosts campaign pages for Republican candidates. Most of its pages were written by an account called "Web Ops," not by anyone at the group. This isn't a patient organization that hired a web designer. It's a political vendor's product with a patient-sounding name on the front.
In 18 months, its campaigns have covered oncology drug vials, out-of-network doctors, upcoding, hospital facility fees, a state-specific attack on a hospital system in Indiana, and now modifier 25. Every single one targets a doctor or a hospital. Not one targets an insurer. Not one mentions prior authorization, claim denials, or the profits of the companies that sit between patients and their care.
Look at who it lets speak. Its "facts" page cites AHIP, the insurance industry's trade association. Its billing campaign is built on a Blue Cross Blue Shield Association report. Its surprise-billing pages repeat the insurer line that arbitration costs too much and doctors win too often. The op-eds it promotes are written by a former Florida Blue executive, a former chief medical officer of Regence Blue Cross, and a former chief medical officer of AmeriHealth Caritas. Not one practicing physician. Not one patient.
A group that says it speaks for patients, has no patients, no leaders, and no address, and only ever points in one direction is suspicious at best.
Notice the timing. The comment period closed September 14. More than 150 medical organizations told CMS to withdraw this proposal. CMS tried the same cut in 2019 and pulled it. The final rule is due within weeks. Nine influencers and a video ad showed up in exactly that window, with the same talking points, thanking the administration for a rule it hasn't finalized yet. That is a pressure campaign not a public awareness campaign.
Why would an insurer care about a Medicare rule? Commercial plans already fight physicians over modifier 25 claims. Physicians push back because Medicare, the benchmark, pays in full. If CMS cuts it, every commercial contract in the country follows, and the cut stops being something a doctor can appeal. The savings won’t ever go to seniors. They will go to the plans and their shareholders.
Who funds this and why are we hearing from a mailbox instead of a person?
If you want to argue that Medicare should pay less for same-day services, make that argument. Put your name on it. Publish your data. Tell us who you work for. Defend it in the comment period and in the open.
What you shouldn't do is fund a video from a mailbox, pay nine accounts to run the same script, and call it a grassroots movement.
Patients do deserve transparency. That starts with knowing who is talking to them.
Brandon Hirsch retweeted
Between October 5 and October 7, nine social media influencers all posted the same Medicare argument about a relatively unknown coding modifier physicians use. A content creator, a commentary account, a MAGA account that rescues animals, a radio host, an Outkick writer, a comedian, a newsletter guy, a Townhall columnist, and a RedState columnist who used to carry the nuclear football all suddenly became experts in the minutia of healthcare billing. They don’t regularly discuss Medicare and physician coding in their posts. Their posts reach hundreds of thousands to millions of followers depending on the account. One was labeled “paid partnership”.
Modifier 25 is not a scam. It’s not a loophole. It’s not some get rich scheme. Modifier 25 allows a doctor to indicate that a second, separately payable procedure was performed at the same time as another visit.
What does that mean in real terms? It means an orthopedic surgeon had you on their schedule for “knee pain”. After careful examination and discussion (the clinic visit), they recognize that you would best be served with an injection (the procedure) to help with the symptoms. They then provide the injection and attach a 25 modifier to indicate that this is a separately identifiable treatment from the visit and requires its own payment for those services.
CMS wants to pay the highest-priced service in full and cut every other same-day service by 50%. It is unclear how they came up with 50% and the agency even stated that they aren’t sure there is overlap in work for the two separate codes, but stated the overlap is “likely”.
I’ve been clear in my opposition and why.
When a plumber comes out to your house because your water supplier sent you a note that you might have a leak and then the plumber finds that leak, do they charge you half price for fixing the leak?
Our own government doesn’t even follow these rules. If you go to the post office and have two packages to send to the same address, do they charge you half price for the second box since it is going to the same address?
What will happen? First, we’ve determined that 80% of the impact of the -25 modifier will be on independent, private practicing doctors. We’ve created a new tax on independent physicians, pushing them further into consolidation. When doctors become employed, costs go up dramatically leading to increased premiums and increased out of pocket costs.
The other impact will be on patient care. Doctors will refuse to be paid half for the same work. They will tell patients to come back on another day for the procedure. That’s another copay. That’s another day finding help with children or loved ones. That’s reduced productivity while waiting for needed treatment. And at the end of the day, the cost to the payer and patient will end up being worse as doctors consolidate.
Brandon Hirsch retweeted
Medicare paid hospitals 211% more than independent physician offices for the same drug administration services in 2021. Ridiculous policies are incentivizing hospitals to acquire physician practices, consolidate care and drive up costs. American taxpayers pay the price.
washingtonexaminer.com/op-ed…
Brandon Hirsch retweeted
MAHA has totally jumped the shark.
They have a MAHA summit coming up next week and guess who is on the "Affordability First" panel?
UnitedHealth (largest health insurance plan)
Elevance (second largest health insurance plan)
American Health Insurance Plan Association
Clearly these folks have done a stellar job at making "Affordability First."
@MAHA_Action, if you want some fireworks at that panel, and actually make it relevant, our CEO @andyjschoonover would be happy to join.
Brandon Hirsch retweeted
Senators, Representatives, and D.C. bureaucrats make healthcare expensive.
I’m nearly 51 years old and I’ve seen politicians complain about the ACA and healthcare policy. And yet the Republicans have done nothing.
In fact, like the demoncrats, they have supported Section 6001, the Balanced Budget Act of 1997, Stark Law, Anti-kick back and all of the nonsense @CMSGov imposes on the America people.
Are there some decent ones, sure. And yet the results speak for themselves.
Tax exempt health systems are making a killing and carrier execs are buying their 7th home and 3rd jet.
Change will not come until Americans demand it.
Brandon Hirsch retweeted
2/ best friend was thwarted by the physician & hospital advocacy community before the House Ways and Means Committee and was none to happy about it.
That he cites that highly flawed Georgetown University study is no surprise (pun intended)—see previously posts here and elsewhere for the reasons that the GU study is biased and ignores key data.
If the Rep. wants to know why the open negotiation (ON) process is not resolving OON disputes, he should ask his buddies at the health plans as they rarely show up for it &/or rarely make legitimate offers.
Since in ‘25 per the official CMS data the plans either default or offer $1.00 or less in the official best and final offer stage in over 30% of the cases, we know that the plans are also ignoring the ON process, but we know that from experience as well.
Brandon Hirsch retweeted
1/1st, Rep. Pallone (D-NJ) was chair of the E&C committee in ‘18-19 and pushed very hard for a benchmarking bill for out of network payments to Medicare w/ little to no IDR process—health plans….
Pallone probing NSA arbiters amid concern about IDR costs fiercehealthcare.com/payers/…
Brandon Hirsch retweeted
Dear Physicians,
Haven’t you suffered enough indignities? When will it be enough?
Why do you continue to allow ghouls and parasites to diminish (and now openly seek to replace) your profession?
Do you care about your guild at all?
If you do not seize control of your medical boards (and the federation) they will dutifully fall in line with this nonsense. At some point, paying your annual licensing fee becomes little more than financing the diminishment of your own profession.
This foolishness will have to be stopped at each and every medical board. Congress and HHS will gleefully do whatever the technofeudalists want. They have the money, after all.
Find out who sits on your state medical board today. Find out who appoints them. Find out when their terms expire. If they will not publicly oppose this craziness, find someone who will and begin the process of replacing them today.
Physicians surrendered control of medicine institution by institution. You will have to reclaim it institution by institution.
There is an all-out, multi-front war being fought over medicine, and everyone seems to know it except the group being warred against.
Hospitals and health systems want their cut. Payers want theirs. State and federal governments want theirs. Tech wants theirs. They may have different motives, but they are all staring at the same prize and this more than 20% of American GDP.
And standing inconveniently between all of them and the patient is the physician!
Do not wait. No one is coming to save you.
This isn’t merely a fight for your profession. It is a fight for humanity. Do not misunderstand or fail to appreciate the stakes here.
The physician-patient relationship is sacred. Once it is reduced to just an obstacle to efficiency, a cost center to be managed, or an interaction to be automated, we will discover (albeit too late) that something essential, something fundamental, was lost.
Make no mistake - preserving it will require swift and substantial action. Govern yourselves accordingly.
Not peer reviewed but some real life " indicative proof" at xitter.cf/nealkhosla/status/2036… . If FDA allowed "AI physicians as a category with human performance as a predicate" we'd have proof very quickly! try AI intake and full process at @CuraiHQ
Brandon Hirsch retweeted
Let's talk about the -25 modifier. For those that don't know, a -25 modifier is added to codes for office visits (among others). What that modifier means is that it is a separate and distinguishable service.
CMS, in it's infinite LACK of wisdom, has decided that, at times, that modifier could result in the payment being reduced significantly. A lot of commercial payers are following that lead (I am not).
What does it mean to a patient? Assume you discover a mole on your body. You schedule a doctor's appointment to have it looked at. The doctor determines that it needs to be taken off (simple in-office procedure). IF that doctor takes the mole off while you are there, he/she will bill for an office visit and the mole removal. Insurance will cut the office visit portion of the payment in half.
What does it mean for the independent physician? Two visits, two insurance claims to file, two insurance claims to have to wait on payment for, more administrative work, more health record maintenance, more everything - because CMS thought it was a good idea.
This is where it gets interesting. Independent doctors cannot afford to have their office visit reimbursements cut in half because they're already getting screwed out of payments on every corner. To avoid that, they must reschedule you to come back on another day to have the mole removed. You change your schedule, you drive back to the doctor's office for the second visit, you miss work and probably don't get paid for the missed work BUT, the insurance company and the broker will show "look how much you saved on that office visit".
A hospital owned physician likely appreciates this set-up because now, you don't pay one facility fee, you pay two - how convenient is that? Yet another reason to use an Independent Physician.
The fix? Find a DPC that can see you in the office, take off a mole, treat a hurt shoulder, look at an infected ear, talk to you about anything you have going on all in one visit for one monthly fee AND you get to go back to him/her as many times as you want. Call, text, email, visit - all for one fee.
Stop being played by the industry.
#DPC #supportindependentdocs
Brandon Hirsch retweeted
Throughout my timeline. Here is the “short”, off the top of my head.
Cure all would be, to make the big carriers divest all non insurance assets.
Smaller stuff:
1. Make all cash purchases that are lower than current out of pocket, deductible
2. Require all contracts with any company or agency or org that gets taxpayer funds to be publicly posted, with prices.
3. If a HC entity gets fined by a state or federal agency more than once in 5 yrs, they can’t do business with the feds, or states, for 5 yrs
4. All non profit hospitals must publish their detailed general ledgers, prices paid to vendors, and any fees charged. Also require them to show yield (actual net revenue earned ) by plan
5. End Anti kickback waivers, require sales from brand manufacturers to distributor to be net of any rebates or fees. (Effectively cost plus)
6. End in network PAs/Denials. Your plan picked the doctors. If you don’t trust their judgement, don’t put them in your network
Then, Require a denial list provided daily to CEOs of self insured employers so they can see how their carrier is hurting or killing their members.
7. Create nationally standardized PBM, ASO/TPA, and other HC contracts employers sign, only the numbers and length can change
8. End all provider networks. End chargemaster pricing. Require direct contract cash prices to be inclusive of deductible so no patient OOP, but the cost is still less to the employer.
9. 10. Allow the fed or state government to negotiate the pricing of all accessories, like implants, screws, glues, etc , and it be made available to all providers.
10. Have the fed gov (taxpayers) guarantee the cost of any medical care that is priced at Medicare or less, for anyone not on Medicare or caid. Paid up front.
Repaid by the patient, on a means tested basis that starts at 3 pct of take home pay , but never exceeds 10 pct. With a maximum term of 20 years. After which it is written off.
Think of it as a guaranteed student or SBA loan. The key here is, because of the price caps, providers will find Ways to meet the price and push down pricing across the board. (They say they don’t make money at Medicare rates, but they make contribution margin and they know it. )
Since there is no insurance premium required , the pay back amount would be less than what you would pay in ACA premiums. The fed would have the option of buying stop loss insurance or taking the risk for high $ care.
Insurance carriers would have to innovate.
To each according to their healthcare needs, from each according to their ability to pay ✔️
@SenWarren @BillCassidy @RogerMarshallMD @AbdulElSayed @AOC @HawleyMO @BernieSanders @1klomp
Brandon Hirsch retweeted
You’ve undoubtedly heard the political aphorism: “You can’t legislate morality.” And, it’s true.
Here’s a little behaviorist pro tip.
If I want to shape your behavior, the last thing I do is tell you what I want you to do or where I’m trying to lead you.
I create incentives.
People respond to incentives far more consistently than they respond to lectures, regulations, or moralizing.
The same is true of healthcare.
We cannot reliably regulate outcomes. It’s impossible. We’ve been trying for decades. It doesn’t work. It has never worked as well as its advocates and acolytes promise.
What we can do is create incentives that make the desired outcomes the rational choice.
That isn’t as emotionally satisfying. There’s no righteous finger-wagging. It requires precision instead of platitudes, systems instead of slogans, and patience instead of politics.
Change the incentives, and the outcomes will eventually follow.
Or continue living in a regulatory morass that primarily protects incumbents - the goobers, grifters, and gomers who helped build the hellscape we now call the American healthcare system.
@RepHuffman @RepKiley @RepThompson @RepMcClintock @RepBera @DorisMatsui @RepGaramendi @RepJoshHarder @RepDeSaulnier @SpeakerPelosi
@RepLSimon @RepAdamGrayCA @RepKevinMullin @RepLiccardo @RepRoKhanna @RepZoeLofgren @RepJimmyPanetta @RepVinceFong @RepJimCosta @RepDavidValadao
@senthomtillis @SenTedBuddNC @virginiafoxx 🚨
Congress passed the No Surprises Act (NSA) & Insurers are ignoring the payment requirements under the law.
Physicians are fed up w/ delayed payments & insurers defying binding rulings.
H.R. 4710/S. 2420 is a simple fix: enforce the law.
Lawmakers — cosponsor now. Patients & physicians can’t wait.
All US physicians should be entering comments for this rule making document. This takes 30 seconds and should generate thousands of comments. If done this would be tough for @DrOz and @CMSGov to ignore. The walkout from Medicare participation is imminent.
The lesson beneath it all: independence survives when physicians own the practice, own the assets, control patient access, diversify revenue, and build political power equal to that of the institutions trying to buy them.
Everything short of that is negotiating the terms of the sale.
File the comment by September 14.
The docket is open at regulations.gov/docket/CMS-2…, file code CMS-1848-P.
Not because one comment bends a number.
Because a comment carries weight when the physicians behind it are funded, organized, and voting.
That machine is not built in the week a rule drops.
Then build the institution that gives the next comment weight.
Brandon Hirsch retweeted
The lesson beneath it all: independence survives when physicians own the practice, own the assets, control patient access, diversify revenue, and build political power equal to that of the institutions trying to buy them.
Everything short of that is negotiating the terms of the sale.
File the comment by September 14.
The docket is open at regulations.gov/docket/CMS-2…, file code CMS-1848-P.
Not because one comment bends a number.
Because a comment carries weight when the physicians behind it are funded, organized, and voting.
That machine is not built in the week a rule drops.
Then build the institution that gives the next comment weight.
Brandon Hirsch retweeted
See the graph above. We are getting beyond screwed. Adjusted for inflation, doctors are earning 30% less than they did in the year 2001. Please go to @STzorfas call and email CMS. I tell you how.
Www.saveprivatepracticemedic…
Brandon Hirsch retweeted
If you're an employer or an individual, you may think this doesn't affect you. It does.
I'm not a physician, but my concern is that policies which make independent practice more difficult could accelerate a trend we've already been seeing for years: hospitals buying physician practices.
Why should you care?
Facility fees.
When a physician becomes hospital-owned, you may be charged a hospital facility fee in addition to the physician's professional fee—even if the office is miles away from the hospital.
If you're an employer:
Design your health plan so independent physicians are paid fairly. Paying an independent physician $250 for an office visit may cost less than paying a hospital-owned practice $150 for the office visit plus a $100–$500 (or higher) facility fee.
If you're an individual:
Support independent physicians when you can. Once an independent practice is gone, it's difficult to bring it back.
Here's the difference between price and cost.
The price is what you pay for today's office visit.
The cost is what happens when independent physicians disappear, competition declines, and employers and patients have fewer choices.
Sometimes paying a little more today can cost you a lot less tomorrow.
Link to article in comments.
