DC EKG: Daily Summaries Delivered

E139 | Elizabeth Chamblee Birch on The Pain Brokers

Elizabeth Chamblee Birch, law professor and author of The Pain Brokers, exposes a coordinated healthcare fraud scheme targeting over 100,000 women. Stolen HIPAA-protected health records were weaponized by call centers in India and South Florida to convince women they needed emergency mesh removal surgery. Many women were left permanently incontinent after unnecessary procedures. The scheme involved call centers using stolen medical data, South Florida surgical operations, lawyers creating hidden liens, and litigation funders profiting from women's suffering. Birch introduces the villains: Vince Chabra (online pill mill founder), Blake Barber (travel concierge), and complicit doctors. She also highlights heroes: Barbara Bennis (defense attorney who uncovered the conspiracy) and J.R. Baxter (young plaintiffs lawyer who fought back). The episode reveals how electronic health record systems enabled massive data breaches, how private equity infiltrated the legal system, and what reforms are desperately needed to prevent future schemes.Key Timestamps0:53 Joe Grogan introduction1:25 Joe asks Elizabeth about her background1:37 Elizabeth's background: 21 years teaching mass torts2:25 Elizabeth's MFA in narrative nonfiction at UGA3:26 What is vaginal mesh used for?5:21 Sharon gets intimate stolen medical data in phone call6:00 Sharon didn't know she had mesh inserted6:32 Call centers in India and South Florida7:32 Alpha Law: Frankenstein firm through D.C. loophole9:31 Outbound calls fueled by illegal stolen HIPAA data10:12 Sharon's journey through the system12:39 Sharon's financial devastation: $69-120K lien13:24 Litigation funders threaten Sharon's house after settlement15:00 Multi-district litigation vs class action16:15 The perverse economics of the scheme17:33 Economics: $15K vs $215K+ for removal19:10 Women left permanently incontinent after unnecessary surgeries21:15&n

John Bertrand on FDA Approval, CMS Reimbursement, and AI Healthcare Reality

Guest: John Bertrand, former Digital Diagnostics Episode DescriptionJoe Grogan sits down with John Bertrand, a veteran healthcare technology executive who scaled Digital Diagnostics to 75 health systems and achieved the first FDA approval and CMS reimbursement for an autonomous AI diagnostic device without a physician in the diagnostic loop. Bertrand reveals the harsh realities of bringing AI innovation to market: FDA and CMS regulatory frameworks are built for traditional medical devices and physician-driven care, not autonomous AI diagnostics. The conversation covers the shocking CMS reimbursement draft that came in 40-60% below cost of goods sold, the massive first-mover disadvantage in regulated medical device AI, and why reimbursement is the true gating factor for adoption—not clinical superiority. Bertrand explains how workflow integration and financial incentives matter far more than being clinically better. The episode explores the massive gap between what entrepreneurs think should happen with new innovations and the regulatory reality. He concludes with a sobering assessment: if building diagnostic AI again, he would choose supply chain automation instead because the regulatory and reimbursement headwinds are so significant they punish innovators. Where AI is actually making an impact today is patient-facing triage agents, administrative automation, and revenue cycle management—areas with far less friction.KEY TIMESTAMPS0:40 Joe introduces John Bertrand and his healthcare tech background1:28 John clarifies he recently left Digital Diagnostics for supply chain work2:40 John's career: 13 years at Epic Systems across multiple roles6:10 What does Digital Diagnostics' AI device do? Automating retinal imaging7:56 First FDA approval and first CMS reimbursement for autonomous AI diagnostic9:02 Joe's threshold question: shouldn't better innovation be easily adopted?9:50 Reality: workflow integration and reimbursement matter more than clinical quality11:50 The adoption curve: all successful FDA-approved AI devices have CMS reimbursement14:10 FDA experience: desire to help but frameworks built for old technology15:40 FDA scrutiny on AI exceeds scrutiny on human clinicians18:05 FDA guidance changes every 6-12 months, creating constant pivoting and delays20:08 Shifting to CMS: the shocking draft reimbursement story20:45 Draft came in at $10 per test, needed $30+ to be viable22:42 Four months of negotiations with CMS to shift value argument24:40 Process not codified: each company follows unique regulatory path28:04 Six years at Digital Diagnostics: was it worth it?28:44 John would not recommend diagnostic AI to new founders33:02 Turning down multiple diagnostic AI opportunities post-Digital Diagnostics34:19 AI hype vs reality: where are patients actually seeing life improvements?34:19 Patient-facing triage agents are the second inning of real AI opportunity36:25 Reimbursement for chat-based triage: who gets paid?38:23 Autonomous vs assistive AI: the regulatory gap that exists40:31 Could Digital Diagnostics have done physician-in-loop from the start?41:33 Real opportunity: clinical practices deploying their own AI42:20 State licensing nightmare: deploying AI across 50 states44:55 The real concern: RCM automation becoming a zero-sum AI bot battle45:20 Dead Internet Theory applied to healthcare revenue cycle47:38 Closing: a tour de force on AI healthcare realityKey TopicsAI in healthcare, FDA approval process, CMS reimbursement, autonomous AI diagnostics, Digital Diagnostics, diabetic retinopathy, regulatory frameworks, first-mover disadvantage, workflow integration, reimbursement strategy, patient-facing AI, healthcare innovation, regulatory friction, adoption barriers, state licensing, RCM automation, healthcare AI reality About the GuestJohn Bertrand is a veteran healthcare technology executive with over 20 years of experience. He spent 13 years at Epic Systems in analyst, product manag

REFILL | Tomas Philipson on IRA, Inflation, Real Wages, and COVID Policy Tradeoffs (Originally Aired: June 2, 2023)

REFILL | Naomi Lopez on Healthcare AI, ACCESS, TEMPO, and the Future of Care (Originally Aired: January 23, 2026)

This is a legacy episode recorded in January 2026. At the time of recording, Naomi Lopez was founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform.Joe Grogan sits down with Naomi Lopez from Nexus Policy Consulting to recap the first Healthcare AI Policy Summit held in December 2025 in Washington, DC. They discuss big themes shaping healthcare AI, HHS approaches to AI adoption, and what regulatory clarity could look like. The conversation covers new federal initiatives like ACCESS and TEMPO that may reshape chronic disease management for Medicare patients. They unpack HHS Deputy Secretary Jim O'Neill's vision for AI in government, including using large models to improve physician productivity, payment integrity, and care coordination. They dig into ACCESS Medicare payment model and FDA TEMPO initiative, explaining how these pilots test AI tools in real-world chronic disease management for hypertension, diabetes, musculoskeletal pain, and depression. The discussion widens to physician burnout, interoperability, rural care, states and federal preemption, and what tech companies becoming Medicare Part B providers could mean for healthcare innovation.Key Timestamps0:00 Intro and why the Healthcare AI Policy Summit matters2:00 Summit recap: big themes and regulatory pressure points6:00 Jim O'Neill at HHS: regulatory clarity and adoption inside government12:00 ACCESS explained: Medicare chronic disease management payment model18:00 TEMPO explained: FDA's risk-based approach for chronic care tools24:00 Wearables, remote patient monitoring, and virtual ICU models30:00 Privacy, de-identification, and re-identification risk35:00 AI inside HHS and FDA: productivity, payment integrity, care coordination41:00 Reducing admin burden and physician burnout47:00 Rural healthcare: scaling diagnostics and access with AI52:00 Interoperability and data sharing: APIs, friction, and incentives58:00 State AI laws versus federal preemption1:04:00 2026 outlook: tech companies as Medicare Part B providers1:09:00 Wrap-up and what to watch nextKey TopicsHealthcare AI, ACCESS payment model, TEMPO initiative, FDA regulation, Medicare reimbursement, chronic disease management, AI in government, physician productivity, care coordination, wearables, remote patient monitoring, privacy and de-identification, rural healthcare, interoperability, state AI regulation, federal preemption, healthcare innovation, payment integrityAbout the Guest (at time of recording, January 2026)Naomi Lopez is the founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. She co-founded a healthcare AI working group and co-hosted the inaugural Healthcare AI Policy Summit in December 2025 in Washington, DC. Her work focuses on how regulation, Medicare and Medicaid policy, and state law shape healthcare innovation, access, and affordability.Podcast: DC EKG with Joe GroganHost: Joe GroganGuest: Naomi LopezSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast

REFILL | Jackson Hammond on NHE, CMS Reform, and Making Insurance Almost Obsolete (Originally Aired: January 22, 2026)

In this "REFILL" episode, Joe Grogan sits down with Jackson Hammond from Paragon Health Institute to unpack what the latest CMS National Health Expenditure data says about where U.S. healthcare is headed. They break down spending trends from $5.2 trillion to projections of $8.6 trillion, explaining what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. The conversation connects spending outlook to Jackson's work on CMS Innovation Center reform and debates whether CMMI is bending the cost curve or adding bureaucracy without accountability. Jackson argues we should aim for healthcare so affordable you barely need insurance, exploring how choice and competition could reshape the system.Key Timestamps0:55 Jackson's background and how he got into health policy3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B5:14 What the NHE report is showing6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters8:00 Why health spending is not really optional10:11 Where the money goes: payer mix and per-enrollee costs12:23 Medicaid costs, provider taxes, and state financing tactics15:58 Medicare spending pressure and fiscal risk21:06 Misconception: coverage equals care26:18 Why provider payments keep rising after COVID demand and consolidation33:01 Rural care, consolidation, and rural emergency hospital models40:08 Drug pricing: retrospective versus prospective MFN approaches49:20 2026 outlook and closing thoughtsKey TopicsNational Health Expenditure, healthcare spending, CMS reform, CMS Innovation Center, Medicare spending, Medicaid costs, hospital consolidation, rural healthcare, drug pricing, PBMs, 340B program, provider payments, patient-centered care, healthcare affordability, choice and competition, fiscal policyAbout the Guest (at time of recording, January 2026)Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's Paragon Prognosis analyses and has written extensively on CMS Innovation Center reform and strategies for making healthcare more affordable through competitive market approaches.Podcast: DC EKG with Joe GroganHost: Joe GroganGuest: Jackson HammondSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast

REFILL | Michael Cannon on STLDI and ACA Coverage: Costs, Choice, and Tradeoffs (Originally Aired: January 27, 2026)

This is a legacy episode recorded in January 2026. At the time of recording, Michael Cannon was Director of Health Policy Studies at the Cato Institute, a leading voice on healthcare reform, the Affordable Care Act, and market-based health policy solutions.Episode DescriptionJoe Grogan sits down with Michael Cannon from the Cato Institute to discuss short-term, limited-duration insurance (STLDI), also known as "Obamacare-exempt" plans, and why they can be significantly cheaper than ACA exchange coverage. Cannon explains how renewal guarantees work and why allowing more consumer choice can reduce pressure on exchange risk pools. The conversation covers the politics of pre-existing conditions, how ACA rules change insurers' incentives, and why coverage debates often miss the real drivers of cost, access, and quality. They also discuss public trust in healthcare following the Brian Thompson murder and explore how policy choices shape what insurers can and cannot do.Key Timestamps0:23 Michael Cannon joins and what STLDI is2:27 STLDI explained: Obamacare-exempt plans, renewal guarantees, and lower premiums6:00 ACA history: why STLDI was restricted7:46 International comparisons and pre-existing conditions incentives12:10 Why healthcare stays broken: regulation, lobbying, and government-designed systems16:59 Subsidies and the politics of pre-existing conditions22:22 Renewal guarantees, employer tax exclusion, and Medicare history30:37 Public trust after Brian Thompson's murder and Cannon's letter41:56 Wrap-up and key takeawaysKey TopicsSTLDI insurance, short-term limited-duration plans, ACA coverage, renewal guarantees, risk pools, pre-existing conditions, insurance regulation, healthcare costs, consumer choice, affordability, public trust, healthcare policy, market-based reform, junk insurance debate, employer-based coverage, Medicare policyAbout the Guest (at time of recording, January 2026)Michael Cannon is the Director of Health Policy Studies at the Cato Institute and a leading voice on healthcare reform, the Affordable Care Act, health insurance regulation, and market-based health policy solutions. He is a policy expert focused on expanding consumer choice and reducing the regulatory barriers that limit access to affordable coverage options.Podcast: DC EKG with Joe GroganHost: Joe GroganGuest: Michael CannonSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast

REFILL | Ryan Long on 340B Drug Pricing, Enhanced ACA Tax Credits, and Medicare Part D (Originally Aired: September 24, 2025)

Joe Grogan sits down with Ryan Long, healthcare policy expert and senior research fellow at Paragon, to discuss three critical healthcare policy issues facing Congress. First, the Congressional Budget Office's landmark analysis of the 340B drug pricing program, which revealed the program increases federal spending, drives up premiums, and channels most benefits to wealthy hospitals rather than those serving low-income patients. Second, the enhanced premium tax credits set to expire at the end of 2025, which have been plagued by fraud and fraudulent enrollment. Long explains how unscrupulous brokers have exploited the system, enrolling people without their knowledge, with billions in improper payments going to insurance companies. Third, the Inflation Reduction Act's devastating impact on Medicare Part D, including premium increases from thirty to sixty dollars monthly, coinsurance replacing copays, and seniors paying higher out-of-pocket costs despite the legislation's promise to lower drug costs.Key Timestamps1:20 Welcome to DC EKG and introduction of Ryan Long 2:15 Congressional Budget Office analysis of 340B program 4:06 Why CBO conducted the 340B study 4:25 How 340B increases federal spending and premiums 4:58 Studies showing 340B drives higher-cost drug utilization 5:30 Will CBO analysis lead to legislative reform efforts 6:15 Program expansion from 90 to 2,600 participating hospitals 8:06 Timeline for 340B reform legislation 10:43 340B program growth from two billion to sixty-six billion annually 11:52 Why insurance companies support limiting 340B 12:20 Enhanced premium tax credits and ACA credits expiring 14:22 Difference between baseline and enhanced ACA credits 16:34 Zero-dollar plans and fraud mechanisms 18:19 Broker fraud and fraudulent enrollment schemes 21:09 How fraudulent brokers exploit free plans and commission structure 22:53 Paragon study showing four times over-enrollment in Florida 25:30 Misleading polling about ACA credits expiring 28:18 Groups pushing misleading messaging on enhanced credits 29:31 Political dynamics and Republican position on credits 33:17 Government shutdown politics and Democrat strategy 36:09 Elevance exiting standalone Medicare Part D plans 38:03 Migration from Part D to Medicare Advantage due to IRA 39:15 How IRA's out-of-pocket cap restructuring increased premiums 40:34 Coinsurance replacing copays and cost shift to seniors 42:20 IRA using fictitious list price to calculate negotiated savings 44:47 Multiple factors causing Medicare Part D premium increasesKey Topics340B program, Congressional Budget Office, drug pricing, hospital consolidation, enhanced premium tax credits, ACA fraud, fraudulent enrollment, broker fraud, government subsidies, Medicare Part D, out-of-pocket costs, coinsurance, Inflation Reduction Act, pharmaceutical pricing, program integrityAbout the Guest (at time of recording, September 2025)Ryan Long is a Senior Research Fellow at the Paragon Health Institute and affiliated with the USC Schaefer Center for Health Policy and Economics. He is a healthcare policy expert with extensive experience on Capitol Hill, including service as a staffer on the House Energy and Commerce Committee and chief health policy advisor to Speaker Kevin McCarthy. Long specializes in healthcare reform, pharmaceutical pricing policy, Medicare and Medicaid issues, and legislative strategy.Podcast: DC EKG with Joe GroganHost: Joe GroganGuest: Ryan LongSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast

"REFILL" | Dutch Rojas on Healthcare Economics, Direct Contracting, and Tax-Exempt Health Systems (Originally Aired: September 15, 2025)

This is a "REFILL" episode recorded in September 2025. At the time of recording, Dutch Rojas was a healthcare entrepreneur, founder of multiple direct contracting companies, and board member of Physician Led Healthcare for America, with a growing following on social media advocating for market-based healthcare solutions.Joe Grogan sits down with Dutch Rojas, healthcare entrepreneur and social media advocate, to discuss his journey from accounting to building direct contracting companies that revolutionize employer healthcare. Rojas explains how direct contracting allows employers to negotiate directly with physicians, bypassing insurance middlemen. The conversation covers his experience building ambulatory surgery centers, certificate of need laws, self-funded employer plans, and his critique of not-for-profit health systems. Rojas argues that academic medical centers masquerade as not-for-profit organizations while receiving seventy-four subsidies annually from taxpayers, acquiring massive real estate holdings, and avoiding property and federal taxes. He advocates for policy changes on not-for-profit tax status and site-neutral payments, arguing these represent unfair advantages that harm independent physicians and patients.Key Timestamps0:18 Joe introduces Dutch Rojas and asks who is Dutch Rojas1:32 Dutch's background, career path, and journey to social media2:22 Physician-led Healthcare for America and PHA board4:32 Starting in accounting, real estate investment trust, and ambulatory surgery centers5:14 150 ambulatory surgery center deals and certificate of need experience7:34 Building a practice in Scottsdale and expanding to 16 states9:30 First direct contracting company in 2009 and how direct contracting works12:45 Self-funded employer plans and 106 million Americans not covered by insurance15:22 Deals with banks and large employers in New York City18:09 The difference between clinical medicine and business in medicine22:15 Building insurance products on top of physician-led care28:30 How direct contracting saves employers money32:18 The three companies Dutch has started and sold38:45 Healthcare as a percentage of GDP and rising costs42:10 Regulatory hurdles and state-level barriers46:54 Not-for-profit tax status and academic health systems48:07 How health systems receive subsidies but claim non-profit status48:22 Academic medical centers owning four to five percent of city real estate49:21 Site-neutral payments and payment disparities between settings50:28 Dutch's social media reach and audience impactKey TopicsDirect contracting, healthcare economics, physician-led care, ambulatory surgery centers, certificate of need, self-funded employer plans, not-for-profit health systems, tax exemptions, site-neutral payments, healthcare regulation, real estate holdings, academic medical centers, employer negotiations, insurance reform, market-based healthcareAbout the Guest (at time of recording, September 2025)Dutch Rojas is a healthcare entrepreneur with over 25 years of experience in healthcare economics and business. He started in accounting and real estate investment, then moved into healthcare, developing over 150 ambulatory surgery centers. Rojas founded multiple direct contracting companies that help employers negotiate directly with physicians, bypassing traditional insurance intermediaries. He serves on the board of Physician Led Healthcare for America. He has built a significant social media following on X (formerly Twitter), sharing his analysis of healthcare policy and economics. Rojas is the author of the Rojas Report and hosts a YouTube channel and Substack focused on healthcare reform and market-based solutions.Podcast: DC EKG with Joe GroganHost: Joe GroganGuest: Dutch RojasSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast