Dutch Rojas - Healthcare

The ACA banned new physician-owned hospitals because doctors owning hospitals was dangerous.

Luckily, health systems owning doctors, labs, imaging, surgery centers, insurers, pharmacies, and Congress is perfectly safe.

Stark Law is the only federal statute where the penalty depends on your W-2. Own the MRI center, go to court. Work for the hospital that owns the MRI center, go to lunch.

In April 2025, the Senate HELP Committee, under the chairmanship of Senator Bill Cassidy, published its 340B reform report.

Inside the report, in a section the press did not quote, was a data point that ended the policy debate. No one in policy noticed.

CVS Health charges insured patients dispensing fees of up to $44 per prescription for brand-name drugs.

CVS Health charges uninsured patients $5 for the same dispensing service.

Consultant’s deck said the merger would unlock $80M in synergies. Two years later the hospital is in default. He’s presented at HIMSS last month. His topic: resilience.

340B is an $81 billion drug program with zero disclosure requirements. You’ve never heard of it. That’s the point.

No one is coming to save independent medicine.
240+ physician-owned hospitals exist.
AHA. FAH. BCBSA. PHA. AMA. Every trade association will file.
The only voice the docket is missing is yours.
File before June 9.
-Rojas out.

Doctor: “I bought into an ASC because I was tired of sending surgical economics to the health system.”

Great.

Now do malpractice.
Now do property insurance.
Now do workers’ comp.
Now do cyber.
Now do employee benefits.

Now do every insurance line where your premium leaves the building, gets invested by someone else, and comes back as a renewal increase.

You already understand the game.

You bought into the ASC because you wanted to own the economics.

Insurance is the same damn trade.
The only difference is the OR had better lighting.

DM me.

A $30 billion enterprise that pays no property tax does not need naming rights to recruit physicians.

It needs them to launder the optics.

The Steelers logo on a 501(c)(3) practice facility is the most expensive piece of credibility infrastructure in western Pennsylvania.

https://open.substack.com/pub/dutchrojas/p/the-upmc-tax-exemption-will-cost?r=3mc0ds&utm_medium=ios&shareImageVariant=poster

It is rather odd that two megachurches forty minutes apart will share a denomination, a worship style, and a youth retreat circuit, but not a property insurance broker.

The theology travels.
The procurement does not.

An Island Is Not Independence What every American institution used to know, and forgot.

Every lobbyist in Washington gets paid to file on this rule.

Every physician who operates a physician-owned hospital gets paid to show up Monday morning.

That asymmetry is the architecture.