Andy Rink, MD

It had to be said! 🎯 Epic's stranglehold on healthcare IT has stifled innovation for too long and the writing is on the wall. The consolidation myth needs to die already. We were promised efficiency and lower costs, but what we got was bloated bureaucracies that prioritize profits over patients. The data doesn't lie: smaller, agile providers consistently outperform these healthcare monopolies on both outcomes and patient satisfaction. Time for a major reset in how we think about healthcare delivery.

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FORCING CHANGE IN SITE OF CARE McKinsey & Company's recent paper on the forces pressuring healthcare, including the possibility of margin compression of up to 13 percentage points for health systems, does a good job of putting numbers around what most operators already feel. Two of the biggest drivers they mention are policy shifts in reimbursement and rising utilization driven by an aging population. The cohort of 70+ year old Americans will grow the fastest over the next 5 years, and it is well established that older patients have more complex needs, more chronic disease, and more touchpoints within the healthcare system. Layer that on top of continued clinical workforce shortages, and the supply-demand gap widens further. From my perspective, optimizing for site of care is the most important lever we have to address this challenge. We can’t quickly reduce how much care older patients need, but we can change where and how services are delivered. Supporting aging patients in lower-cost settings like the home, ambulatory sites, and virtual environments is no longer just a preference or convenience, it’s a necessity. This is where the conversation around site-neutral payments becomes so relevant. CMS is moving quickly in this direction, and hospital outpatient departments (HOPDs) are squarely in the crosshairs. The shift will undoubtedly clamp down further on hospital margins, but it shouldn’t be surprising. We’ve been talking about the demise of HOPD reimbursement for years, and the health systems that will fare best are the ones who are working towards aligning their approach with where patients can be treated safely, efficiently, and at lower cost, rather than relying on legacy reimbursement structures to fill the gap. And just like it doesn’t make sense to try to replicate a hospital or nursing home environment in a patient’s home, we also shouldn’t try to carry the same clinical staffing model into every care setting. Yes, there are non-negotiables when it comes to patient safety and clinical expertise, but there’s also a meaningful opportunity to rethink how teams are built. That means clinicians at every level working at the top of their licenses, thoughtfully involving family members and community resources, and using technology to surround these sites of care with non-clinical operational support. From my health system days, I understand why rising costs, margin pressure, and site-neutral payments feel like threats. While painful, I’m hopeful they can also serve as a positive forcing function, pushing us toward care models that are better aligned with our aging population and the realities of today’s workforce.

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1 Comment

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Value based care must die. So must any model that separates physician work from the physician. The issue is not that value based care has not worked yet. It is that it cannot work without damaging the physician-patient relationship. And all of the value based care data continues to show that. CMMI’s own numbers tell the story: over 6.4 billion dollars lost, no models endorsed by PTAC, and only 4 of 18 showing any meaningful quality improvement. This failure hits employed physicians the hardest. They are judged by system-level metrics they do not control. Their pay, autonomy, and job security are tied to performance scores built by administrators and consultants, not by patient outcomes. Value based care strips physicians of control. It inserts bureaucracy between doctor and patient. And when the metrics fail, the physician pays the price. This is not a flaw in the system. It is the system. If we want better care, we need physician led models grounded in trust, relationships, and clinical judgment — not in dashboards or compliance reports. The future of medicine is not in tracking metrics that do not matter or committee-based reviews of outdated outcomes. It is in restoring the physician-patient relationship and trusting those who actually deliver the care.

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Very timely and wise comments by Nathan H. “$10 billion in digital health investments made healthcare WORSE last year” AI is transforming healthcare, but in 90% they are making problems words. 35 years of experience trumps bad idea with money. Healthcare is the one industry in America that throwing money or technology makes it worse. We have lived it. Silicon Valey loves new ideas and young founders who can’t relate or have practical experience. They fail horribly in time. Great examples below. We can look at example of Amazon, JPM, Berkshire with Haven Health. I was in SFO when they made the announcement January 30. 1988. It was child’s play to predict it would fail.

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