Dutch Rojas - Healthcare

The most dangerous hospital CEO in America is not fighting Washington.

He is thanking it.
He knows the game.

Lose in the headline.
Win in the formula.
Take the cut.

Collect the adjustment.
Delay the enforcement.
Call it compliance.

The patient sees reform.
The hospital sees routing instructions.

CMS “cut” hospital drug payments by $5.7 billion. Then handed hospitals the same $5.7 billion back somewhere else.

That is what budget neutral means.
The hospital did not lose the money.

It changed registers.

Drugmakers want their spread back.
Hospitals want to keep theirs.

That is the entire 340B rebate war.

Two billion-dollar industries fighting over a discount meant for a dying patient.

She paid for the table.
She still was not invited.

Make 340B help patients again.

Wild idea.

Not hospitals.
Not PBMs.
Not contract pharmacies.
Not manufacturers.

The patient.

You know, the person everyone keeps mentioning right before they cash the check.

Silverstone this weekend.

The fastest people on earth are arguing over tenths of a second.

American hospitals need six weeks to tell you the price of a bloody MRI.

Formula 1 found speed.
Healthcare found billing departments.

Same blood.

Same tube.

Same lab machine.

Independent lab: $24.99.

Hospital-owned lab: $194.

The difference is not science.

The difference is the logo on the bill.

Nonprofit hospital math:

CEO: $7 million
CMO: $3.4 million
CFO: $3.4 million

Patient: deductible
Employer: renewal increase
Physician: prior auth
Taxpayer: subsidy

Mission accomplished at Henry Ford!

I love 340B.

As a nonprofit hospital administrator, I consider it one of the great miracles of American healthcare.

It started as a program to help vulnerable patients access medicine.

Then I found the spread.
I buy the drug at the 340B discount.

I bill the commercial plan at the regular rate.
I keep the difference.

The patient still has a deductible.
The employer still gets the renewal increase.

The manufacturer still gets blamed.
I get a new tower and a bonus!

That is called fulfilling the mission

And the best part?

I do not have to pass the savings to the patient.
I do not have to pass the savings to the employer.

I do not have to lower premiums.
I do not have to prove the vulnerable patient ever saw the benefit.

I just say “access,” put “community benefit” in the annual report, and everyone nods like I am running a soup kitchen with oncology margins.

That is the business model.

Rural when I want the subsidy.
Urban when I want the commercial rates.

Nonprofit when I want the tax exemption.
Monopoly when I negotiate with employers.

Charity when Congress asks questions.
Private equity when I buy physician practices.

Mission when the reporter calls.

Manufacturer gives the discount.
Employer pays full freight.

Patient pays out of pocket.
Hospital keeps the arbitrage.

Then I build a cancer tower and call it hope.

And when Congress gets too curious, my lobbyist calls it protecting access…

-Rojas out.

Your surgeon trained for 14 years to examine you, read the scan, and decide whether surgery makes sense.

The insurer denied it in 1.2 seconds, and no physician ever touched the case.

Americans are going to find out more about Dutch culture during the World Cup and I’m just going to say it now:

We drink something called koffie verkeerd.

That means 𝙬𝙧𝙤𝙣𝙜 𝙘𝙤𝙛𝙛𝙚𝙚.

Not “artisan milk-forward espresso.”
Not “European café experience.”

Wrong coffee.

The Dutch looked at a cup of mostly warm milk and said: accurate.

Hup Holland Hup 🇳🇱…
Monday Netherlands vs Morocco 9pm EST.