In the summer of 2002 I was in Lincoln, Nebraska riding my Trek 1000 road bike along the shoulder of Highway 2 which ran on the outskirts of town. Right around Pioneers Boulevard where most of the land was rural. There were a few housing developments on the edge of town. A Wal-Mart had been built a few miles down the road. The bike ride would take me past it.
Along the road a big awning, driveway, parking lot and medical office building were also being built. Who were the builders? A large group of cardiologists, surgeons and anesthesiologist who pooled their money together to build a physician-owned specialty hospital.
These physicians had spent the preceding 20-years serving the population of Lincoln. But they didn’t just stay in the city. They took turns flying out to small towns across the state of Nebraska where there was no access to specialty cardiac services.
The physicians who built this hospital were revered by the community. Many of them were my personal heroes. A few of us kids were in school together. We swam together, played summer tennis leagues together and played Madden video games in each others basements.
One by one we all spread out across the United States, pursuing careers, businesses and dreams of our own.
When we would come back home to Lincoln to visit family, the specialty hospital was fully functioning, seeing patients and performing high-complexity surgeries. The place was a regular business, for-profit. Nobody had any problem with it. It was not uncommon for poor and indigent patients to show up at the doorstep with aortic aneurysms and STEMI’s. The physician-owners of the hospital would perform the services heavily discounted or in some cases for free.
The summer before medical school, I took a job as a file-clerk in this institution. As a young, naive student, I had no idea what forces were at play behind the scenes.
That idyllic bike ride through the rolling hills outside of Lincoln, Nebraska would be one of the last positive memories I would have about a physician-owned enterprise. Not because anything bad happened from the physicians.
But in 2009, Obama’s Affordable Care Act included Section 6001 which banned physician-owned hospitals. This was under the false pretense that physicians are greedy money-maximizing scoundrels who were over-billing Medicare and over-charging local patients.
Nothing could have been further from the truth.
In this episode of 3DEEPERCUTS PODCAST we delve into Dr. Luis M. Tumialan’s detailed critique of Section 6001 of the Affordable Care Act, which prohibits physician ownership of hospitals. We analyze the origins, intentions, and unintended consequences of this legislation, comparing data from McAllen and El Paso, Texas, and debunking misconceptions about healthcare costs.
Dr. Tumialan argues that physician-owned hospitals often perform better in quality, cost, and access, urging a repeal of Section 6001 to re-align incentives and foster competition. Our host shares personal insights from his career in private practice, highlighting the symbiotic relationship between surgeons, oncologists, and pathologists. Stay tuned for a well-rounded discussion on one of the most impactful yet controversial healthcare policies in recent history.
00:00 Introduction to Dr. Luis M. Tumialan and Section 6001
01:00 What is the health care “cost conundrum”?
04:05 What were the Flawed Assumptions of Section 6001 of the ACA?
05:55 What were the unintended Consequences of Section 6001?
07:09 What happened with the Shift in Physician Practice Ownership?
08:38 Why should Section 6001 be rescinded?
09:44 CHUCK-G’s personal reflections on the US healthcare system?
12:06 Conclusion and Podcast Information
ARTICLE LINKS:
https://aansneurosurgeon.org/the-origins-of-section-6001/
AANS Spine Surgeons on 𝕏 (@spinesection)
HOST LINKS:
https://x.com/chuckg_md
https://x.com/3deepercuts_pod
Website: www.3deepercuts.net
Hope you enjoyed this week’s episode of
Until next time, be well and stay curious.
In strength,
3DEEPERCUTS PUBLISHING 2025
