This is granular. Going over the basics here. Statues and Regulations are what most people have a working knowledge of. It is the guidance -the "sub regulatory" where the trouble lies. Unfixed and can change overnight.

W/o a doubt, when our tax dollars are helping fund these hospital systems, we should have a clearer picture of what we’re actually getting in return — better access, better care, or just bigger systems. Appreciate you digging into this. @jldobrinsky Patients first is the right priority. @wvsenate @JoeyGarciaWV @AmyMSummers @kaylayoungforwv @DutchRojas

The Surgeon Who Chose Rural West Virginia Dr. Erik Stapleton came to Greenbrier County to build the orthopedic care it lacked. His firing has become a lawsuit against the hospital, owned by CAMC and Vandalia Health. @RayCanterbury @GregoryAWatt @JackDWoodrum @PushkinPress @jldobrinsky jessicadobrinsky.substack.co…

Brigham (~4,000): Still live. Nurses rejected MGB’s “last, best, and final” offer last week, mainly over Across-the-board COL/wage increases on top of the existing step system (5% annually to year 20). Strike was postponed; no new date set. Hospital notes starting pay ~$86.7k and top-of-scale ~$220k+, already high for the market.⁠ Allegheny General (~1,500): 99% authorization led to a deal. They just ratified a 3-year contract with nearly 16% average raises ($35M wage investment), staffing commitments, protected benefits/pension, end to forced rotating shifts, and AI language. Leverage produced a settlement.⁠ Santa Rosa (~800): Two-day strike underway this week (98% authorization) over benefits, differentials, retirement, and reliance on travel nurses. Hospital has replacements lined up; wage talks described as early-stage.⁠ McLaren Lapeer: 94% authorization in September, then a 3-year contract ratified in early October (strike averted). Hospital had offered ~15%.⁠ Wages and cost of living are front and center in high-COL markets, and the shortage gives nurses cards. At the same time, looks like #staffing ratios appear as the top issue in most recent nurse walkouts (far more often than pure pay), and many hospitals—especially #nonprofits—face tight margins, fixed reimbursements, and rising overall labor costs. High authorization votes force movement; they don’t automatically produce unlimited raises. Deals are getting done where both sides compromise.

A major antitrust lawsuit against HCA Healthcare and Mission Hospital has hit a critical roadblock in NC business court. @susanrmims @MountainXpress @DutchRojas @MyNCSenate Judge Mark Davis denied class action certification, ruling that plaintiffs relied on broad assumptions and failed to prove common, system-wide impacts on healthcare quality. The motion was denied without prejudice, giving the plaintiffs an open door to adjust their economic models and file again. Read the full breakdown on how this impacts healthcare costs and monopoly pushback in Western NC: northcarolinahealthnews.org/…

📁MF #116 Presbyter Power Speaks In 1970, Maggie Kuhn was forced to retire from her work with the Presbyterian Church at age 65. The message was familiar: her time was up. The emerging ideal of retirement encouraged older people to withdraw from public life, taking their experience and accumulated knowledge with them. Kuhn broke the mold. She helped found the Gray Panthers, organizing older people to challenge ageism and reclaim their place in shaping society. In an era when the Black Panthers had made collective action impossible to ignore, Kuhn helped older people turn shared experience into a public voice. She did not wait for permission or for conditions to become favorable. She called the organization—and society—to attention. This is capacity in action. Kuhn drew on what she and others already possessed: experience, judgment, conviction, and the ability to organize. By bringing people together around a common purpose, she helped turn individual capacities into collective power. The work changed what older people could do—and what society had to reckon with. The word presbyter means elder. Kuhn gave that word renewed force. Her history reminds us that capacity can exceed the roles an organization assigns and the expectations a culture imposes. Self-renewal begins when people recognize what is already there, exercise it, and create possibilities that did not previously exist. Kuhn did not wait for the world to make room for elder power. She helped make that power a force the world had to answer. @CMAorg @ConsumerVoices @RonWyden @GrayPanthersNY @GrayPanthers Ask Better Questions.

📁MF #115 The Knowledge Is Already Here Organizational capacity begins with what people already know. A CNA may notice a subtle change in a resident because she has seen that person through many ordinary shifts. A nurse brings clinical assessment and knowledge of the resident’s condition. A family member may recognize a familiar expression, routine, or shift in personality that no one else has seen. Environmental and housekeeping staff may notice patterns in the surroundings that affect comfort, movement, or daily life. Each person sees from a different position, and each position reveals something. Together, these perspectives build a fuller understanding of the work and the people it serves. The opportunity for an organization is to recognize this knowledge, understand what each kind contributes, and create reliable ways for it to inform decisions. When observations can travel across roles and reach people who can act on them, experience becomes an organizational resource. The first step toward renewal is learning to see what is already there. @consumervoices @NYNHCare @INOmbudsman Ask Better Questions.

📁WF #17 Capacity for Self-Renewal An organization’s capacity for self-renewal is its ability to learn from its own work, connect what it knows, and develop new ways of meeting its purpose. Every organization has resources. People bring experience, judgment, technical knowledge, relationships, and pattern recognition. Processes and programs supply structure. Leadership sets priorities and allocates resources. The real question is how these elements work together—and what becomes possible as a result. Some resources keep daily operations running. Others enable people to learn, share knowledge across roles, and build capabilities that strengthen the whole organization. Seeing the difference means looking at the organization’s composition: what its parts do, how they relate, and what emerges when they work in concert. Capacity develops through use. Assessment establishes Point A—coordinates clear enough to understand where you stand. Point B remains in view. The work itself builds the road between them. This week we examine how an organization recognizes the capacity it already has, creates the conditions for that capacity to grow, and carries learning into practice. What does an organization need to understand about itself to renew its capacity? @mtaylorstark @ConsumerVoices Ask better questions.

The parenthetical on Great Bend and the “at least 25” figure do broaden the piece beyond the Marshall–Tasset facts. The sharper claim is the one right before it: PE securing doctors as owners “in name only” so the vehicle can still claim the physician-ownership advantages while the equity and extraction sit with the sponsor. @CMAorg That’s the pattern that shows up across the PE footprint—roughly 9–10% of hospitals and 10–12% of nursing homes, with several firms accelerating acquisitions during COVID. Clicking the red underlines in that section pulls up the underlying sources (including the Great Bend docket). The disclosure-compliance suit against Great Bend was dismissed without a finding of liability, so it doesn’t itself prove the model is corrupt. It does illustrate how contested the “physician-owned” label has become once PE is involved. The ACA restrictions on self-referral were aimed at the risk that physicians would steer volume to facilities they own. A PPO network has its own version of that incentive: the plan profits by keeping care inside the contracted network and limiting out-of-network options. Both arrangements create structural pull toward preferred facilities; the difference is who captures the margin and how visible the ownership is.

The piece isn’t treating all physician-owned facilities as the problem. It specifically flags how PE has co-opted the label—“securing doctors who are hospital owners in name only”—so the vehicle can claim the advantages of physician ownership while the equity, control, and extraction sit with the PE sponsor. That’s the pattern Maureen has tracked for years: physicians lend their names and licenses, PE runs the financial engineering. The Marshall–Tasset/Nueterra examples are presented as instances of that, not as an attack on independent physician-led models. @moetkacik

Good one! The interest compounds either way. One path just has a lower rate and a better maturity date.

📁MFR*V #114 — The Power of Unity: What Becomes Possible Together? This week began with a deceptively simple proposition: the power of unity lies in the value of people. Each person brings knowledge, experience, judgment, ability, and potential. That capacity exists before people assemble. The organizational question is how to recognize its value and create conditions in which it can contribute to a shared purpose while allowing individuals to retain their distinct perspectives and strengths. A shared point of orientation brings those distinctions into relationship. Relationships allow knowledge to travel, perspectives to inform one another, and contributions to build on what others have already accomplished. In this way, a collection of capable people can develop shared capacity that no individual possesses alone. Shared capacity changes what a group can sustain. Unity can become load-bearing: people together can carry weight that would otherwise overwhelm individuals. Participation can expand individual capacity while strengthening the group's ability to meet demands, solve problems, and support its members. The process can become self-generating. The work changes the people doing it; those people change what the group can do; and the group's growing capacity changes what becomes possible next. New knowledge, stronger relationships, and new resources can expand the field of possibility still further. Yet these outcomes depend on the conditions in which people work. People can influence some of those conditions, and institutions have considerable power to shape them. Institutional decisions can cultivate the capacity on which an organization depends, or erode the resources and relationships that sustain it. When those supports are diminished, the burden shifts to individuals and residents. Calling for unity cannot excuse that transfer of burden. The question, then, is whether an organization enables people to develop their capabilities, support one another, and build a capable whole—and whether it takes responsibility for sustaining the conditions that make this possible. The week's progression MF #107 — The Value of People: Recognizing the capacity people bring and the potential that remains undeveloped. MF #108 — A Shared Point of Orientation: Bringing different perspectives into relationship with a common purpose without requiring uniformity. MF #109 — The Work Between Us: Understanding how relationships transform individual capability into shared capacity. MF #110 — The Weight We Carry: Recognizing unity as load-bearing capacity, not merely the redistribution of tasks. MF #111 — A Whole That Generates More: Exploring how collaboration can renew and expand the capacities of both individuals and the group. MF #112 — Changing the Conditions: Recognizing people's ability to create new relationships, resources, and fields of possibility. MF #113 — The Institution We Make Possible: Examining whether organizational decisions cultivate human capacity or consume it. Reflection Unity is not sameness. It allows people to bring distinct capacities into relationship with a shared purpose, even when their perspectives differ. Its strength lies in the relationships that enable people to contribute, learn, and build on one another's work. When those relationships are supported, the group can carry more while individuals gain capacity of their own. At its most generative, unity creates conditions for further growth. Shared purpose provides orientation. Relationships make cooperation productive. Stewardship determines whether the resulting capacity is cultivated and sustained. The power of unity lies in the value of people—not only in what they bring, but in what they can develop, sustain, and create together. Looking forward Unity opens the possibility of shared capacity. The next question is how that capacity develops within the systems where people work. How does shared knowledge become collective intelligence? How does collective intelligence inform decisions? And what organizational structures allow human capacity to travel through a system and become reliable institutional capability? These questions lead toward the next focus: Capacity for Self-Renewal. We will examine how organizations recognize the capacity they already possess, develop it through the work itself, and create the conditions to move toward what becomes possible next. Unity establishes what people can begin to accomplish together. Self-renewal asks how that capacity can continue to develop. @NYNHCARE @mtaylorstark @INOmbudsman Ask Better Questions. #TheMossFiles #AskBetterQuestions