This piece by Dr. Michael Meneghini really resonated with me. I have come to realize the larger the business or institution, the more risk adverse leaders are to talk in clear objective terms on complicated challenges.
Leadership, after all, is supposed to require courage. Not institutional cowardice.
The $265 billion administrative overhead number is the one that stopped me too — because it reframes the whole argument. The problem isn't that healthcare costs too much to provide. It's that we've built an apparatus around it that consumes nearly a third of every dollar before it reaches a patient.
I'm a retired educator, not a clinician, but I spent a year trying to build a policy framework that takes your two cancers seriously from the outside. The administrative bloat you're describing isn't just a hospital management problem — it's baked into how we fund the whole system. A universal funding floor with private delivery intact would eliminate most of the billing and denial infrastructure overnight. Same doctors, same hospitals, no insurance middlemen to manage. The doctor-patient relationship you're describing becomes possible again when the compliance filter disappears.
If you're interested in what that looks like from a policy architecture standpoint, it's at burnedatbothends.org. Built by someone who got angry at the right numbers.
I like this direct approach. Over my 30 years in healthcare I observed a power shift from healthcare providers to business type administrators leading medical settings. The reason is simple: Physicians and healthcare personnel are trained to optimize health. MBAs are trained to optimize profits. Accountants are trained to optimize efficiency. Attorney's are trained to optimize legal protection. This has led to a massive bureaucratic system where organizations are optimizing self-preservation, profits, reimbursements, legal protections, but somewhere the optimization of patient health got lost. In fact, most discussions I see today involve reimbursement, how to prevent denials, how to code diagnosis, document, etc. The patient's well being is rarely a topic of concern, and now with about 10-15 cents on the dollar going to actual patient care and the rest to administration, it's time the healthcare providers place administrators back in their rightful positions as support personnel rather than decision makers.
This is one of the most honest reflections on healthcare leadership I’ve read in a long time. The idea that honesty is respect really stayed with me.
Your example about challenging the routine use of tourniquets in TKA struck a chord. It takes courage to question something that has simply become “the way we do things.”
From where I sit as a PT working almost exclusively with knee replacement patients, I see a similar issue on the post-op recovery side of TKA. Surgical technique, implants, and robotics have advanced dramatically. But in many cases, the post-operative home program still looks almost identical to what patients were given 20 years ago.
Patients undergo one of the most sophisticated procedures in modern medicine… and then go home with a sheet of generic exercises.
Seeing that gap led me to spend the last several years rethinking what the home recovery model could look like if it were designed with the same intentionality as the surgery itself. That work ultimately led me to develop a different approach for guiding patients through their early recovery at home.
You talk about institutional courage. I think part of that courage is also being willing to ask whether we’re advancing the patient’s recovery experience at the same pace we’re advancing the surgery itself.
If you’re ever interested in comparing perspectives on what the post-op reality looks like from the patient side, I’d genuinely welcome that conversation. I suspect there’s a lot of opportunity there.
I have lived in a world of administrative leadership most of my career…..managing risks, making tough decisions, and fostering truth. This article resonates with me mimicking so many organizations, large and small, that create leaders to become uncomfortable and ultimately stifled when values and truth don’t align with their demands. It’s shameful but we are here. Thank you for your article. I follow you in all that you do and the respect I have for you and what you have boldly created is more than just medicine……it’s character, competence, and commitment. Thank YOU for your continued dedication to the mission of our patients!
This piece by Dr. Michael Meneghini really resonated with me. I have come to realize the larger the business or institution, the more risk adverse leaders are to talk in clear objective terms on complicated challenges.
Leadership, after all, is supposed to require courage. Not institutional cowardice.
An important and refreshing read.
Thanks for reading and sharing, Daniel. Without courage to challenge the broken status quo, are we really leaders?
The $265 billion administrative overhead number is the one that stopped me too — because it reframes the whole argument. The problem isn't that healthcare costs too much to provide. It's that we've built an apparatus around it that consumes nearly a third of every dollar before it reaches a patient.
I'm a retired educator, not a clinician, but I spent a year trying to build a policy framework that takes your two cancers seriously from the outside. The administrative bloat you're describing isn't just a hospital management problem — it's baked into how we fund the whole system. A universal funding floor with private delivery intact would eliminate most of the billing and denial infrastructure overnight. Same doctors, same hospitals, no insurance middlemen to manage. The doctor-patient relationship you're describing becomes possible again when the compliance filter disappears.
If you're interested in what that looks like from a policy architecture standpoint, it's at burnedatbothends.org. Built by someone who got angry at the right numbers.
I like this direct approach. Over my 30 years in healthcare I observed a power shift from healthcare providers to business type administrators leading medical settings. The reason is simple: Physicians and healthcare personnel are trained to optimize health. MBAs are trained to optimize profits. Accountants are trained to optimize efficiency. Attorney's are trained to optimize legal protection. This has led to a massive bureaucratic system where organizations are optimizing self-preservation, profits, reimbursements, legal protections, but somewhere the optimization of patient health got lost. In fact, most discussions I see today involve reimbursement, how to prevent denials, how to code diagnosis, document, etc. The patient's well being is rarely a topic of concern, and now with about 10-15 cents on the dollar going to actual patient care and the rest to administration, it's time the healthcare providers place administrators back in their rightful positions as support personnel rather than decision makers.
This is one of the most honest reflections on healthcare leadership I’ve read in a long time. The idea that honesty is respect really stayed with me.
Your example about challenging the routine use of tourniquets in TKA struck a chord. It takes courage to question something that has simply become “the way we do things.”
From where I sit as a PT working almost exclusively with knee replacement patients, I see a similar issue on the post-op recovery side of TKA. Surgical technique, implants, and robotics have advanced dramatically. But in many cases, the post-operative home program still looks almost identical to what patients were given 20 years ago.
Patients undergo one of the most sophisticated procedures in modern medicine… and then go home with a sheet of generic exercises.
Seeing that gap led me to spend the last several years rethinking what the home recovery model could look like if it were designed with the same intentionality as the surgery itself. That work ultimately led me to develop a different approach for guiding patients through their early recovery at home.
You talk about institutional courage. I think part of that courage is also being willing to ask whether we’re advancing the patient’s recovery experience at the same pace we’re advancing the surgery itself.
If you’re ever interested in comparing perspectives on what the post-op reality looks like from the patient side, I’d genuinely welcome that conversation. I suspect there’s a lot of opportunity there.
- Shehla Rooney, PT
I have lived in a world of administrative leadership most of my career…..managing risks, making tough decisions, and fostering truth. This article resonates with me mimicking so many organizations, large and small, that create leaders to become uncomfortable and ultimately stifled when values and truth don’t align with their demands. It’s shameful but we are here. Thank you for your article. I follow you in all that you do and the respect I have for you and what you have boldly created is more than just medicine……it’s character, competence, and commitment. Thank YOU for your continued dedication to the mission of our patients!