I · Section 6001
2010
The physician-owned hospital ban
The year Congress froze physician-owned hospitals in place. No new ones. No expansion of the ones that survived.
Lobby holding · Unchanged
Healthcare intelligence
Follow the money in healthcare.
Why healthcare costs what it does, who profits, and how physicians take it back.
I · The cost drivers
Six reasons your care costs what it does.
None of these are accidents. Each one is a rule, a subsidy or a payment formula, and each one has a sponsor.
II · Price Transparency
2021
Prices you can see but cannot use
Hospitals have been required to publish prices since January 2021. Almost none of it is usable to shop for care.
On paper · Enforced, not actionable
III · Certificate of Need
34 states
Permission to compete, granted by your competitors
And the District still require a state board's approval to open or expand a facility, with incumbents allowed to object.
In play · State by state, 2026 sessions
IV · Hospital Subsidies
Figure pending
Tax exemption, the 340B program, DSH and provider taxes
A year in public money flowing to the same systems that lobby to keep competitors out.
In court · 340B rebate model
V · CMS Favoritism
Figure pending
Same service, higher price, if a hospital owns the building
What Medicare pays a hospital outpatient department over an independent office for the same infusion or scan.
Reform moving · Site-neutral, partly final
VI · Stark & Anti-Kickback
1989
The rules that keep physicians from building rivals
Written to stop self-referral. Now the reason independent physicians cannot integrate the way health systems already do.
Lobby holding · Unchanged
II · The tracker · As of November 6, 2026
Where the fights stand.
Each rule the hospital lobby is fighting, where it stands, and who is winning. The five that matter most this week.
| The fight | Status | What's next |
|---|---|---|
| Site-neutral pay: drug administration at off-campus hospital departments | In effect | Jan. 1, 2026 · Final rule. Paid at the physician-office rate. |
| Site-neutral pay: imaging without contrast | Final | Nov. 4, 2026 · CY2027 Medicare outpatient final rule. Physician-office rates from Jan. 1, 2027; rural sole community hospitals exempt. |
| Hospital price transparency | Enforced | Apr. 1, 2026 · Hospitals must post actual allowed amounts; a senior official attests. |
| 340B program: Medicare payment cut | Final | Nov. 4, 2026 · 340B drugs paid at ASP minus 28% from Jan. 1, 2027, down from ASP plus 6%. CMS had proposed minus 33.4%. |
| 340B program: rebate model | In court | Oct. 9, 2026 · AHA sued to stop the revised pilot set to start Jan. 1, 2027. |
III · The state dossiers
Where it costs you.
Every state, graded. Its CON law, its tax-exempt systems, its subsidies, its attorney general, and the lawmakers who decide.
Pick a stateDossier publishedIn preparation
This week's cover · The Lobby · November 4, 2026
Who Controls American Hospital Policy.
A new AHA board takes its seats on January 1 under a new CEO. We profiled all 32 people: their pay, their lobbying and their red flags, every line sourced to public filings.
32
Board members profiled
Jan. 1
New board seated
IV · Get the intelligence
Read it. Download it. Own the data.
Everything on this site is free to read. The reports and datasets are for the people who need the detail.
Free
The Reader
Every article, every cost-driver brief, every state dossier and the weekly newsletter.
Subscribe freeReports & datasets
Physician-Owned Hospitals
Every POH in the country, with ownership, contacts and state context. $300 per state, or $3,500 a year for all access.
Browse reportsMembership · 100 seats
The Builders Table
For physician owners, operators, founders and investors. $25,000 a year, by application.
ApplyV · Support the Report
Keep the record open.
Reader-supported intelligence on why healthcare costs what it does. Your support funds the data, the filings and the reporting that keeps every dossier free to read.
$10
$25
$100
Any
VI · For physicians
Don't just read about it. Build.
Three companies built for physicians who want to own what they run.
MedMergeOwn your group's benefits instead of renting them from a carrier.
Cornerstone IndemnityPhysician-owned malpractice coverage. Keep the underwriting profit.
PhyCap FundCapital for physician-led companies.