American Doctor Substack - Ebrahim Barkoudah MD

Healthcare Economics & Quality
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My Substack will address quality in healthcare and value-based care delivery. ebrahimbarkoudahmdmph.substack.com

  1. Financial Engineering Drove 40% of Hospital PE Returns. Operational Efficiency Drove 1%. We Need to Talk About That.

    29 MAR

    Financial Engineering Drove 40% of Hospital PE Returns. Operational Efficiency Drove 1%. We Need to Talk About That.

    This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    21 sec
  2. A 10x Multiple Spread Within One Healthcare Subsector - That’s Not a Market - That’s an Arbitrage

    28 MAR

    A 10x Multiple Spread Within One Healthcare Subsector - That’s Not a Market - That’s an Arbitrage

    This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    27 sec
  3. Healthcare PE Outperforms by 520 Basis Points. The Real Question Is Why.

    26 MAR

    Healthcare PE Outperforms by 520 Basis Points. The Real Question Is Why.

    This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    1 min
  4. Automating the Bottleneck Isn’t Fixing It. The Real Capacity Problem Is Upstream

    25 MAR

    Automating the Bottleneck Isn’t Fixing It. The Real Capacity Problem Is Upstream

    Agentic AI can sequence discharges, assign beds, and predict surges. It cannot create a bed that doesn’t exist or discharge a patient who has nowhere to go.Full article at This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    1 min
  5. Nobody Is Watching the National Curve

    21 MAR

    Nobody Is Watching the National Curve

    Thirty percent of all U.S. hospital revenue runs through ten ownership entities. That’s roughly $420 billion — Kaiser, HCA, CommonSpirit, Ascension, and six others — out of approximately $1.4 trillion across nearly 2,000 ownership entities in the country. The math is available in public data. What’s not available, anywhere in federal surveillance infrastructure, is a single instrument that watches whether that number is going up or down, how fast, and what it means when it crosses a threshold that someone has actually defined. I’ve been building a division of hospital medicine for several months now — four sites, four completely different ownership contexts: a public safety-net system, an academic medical center, a community hospital, a VA. Contract negotiations at one site bear no relationship to what’s happening at another. The administrative gravity of each setting — who holds the levers, what the real margin picture looks like, where the staffing decisions actually get made — runs through ownership in ways I hadn’t fully internalized until I was inside all four simultaneously. And what became obvious to me, sitting in those rooms, is that the consolidation problem the policy literature keeps circling isn’t primarily about what any one market looks like in Morristown or Spokane or outside Dallas. It’s about the aggregate shape of who owns American hospitals, at the national level, measured against something. Right now, we measure it against nothing. Read the full article at This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    1 min
  6. The Trillion Dollar Global Market for Obesity Medications

    08/02/2025

    The Trillion Dollar Global Market for Obesity Medications

    The full article: This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    1 min
  7. The U.S. Healthcare Claims Landscape in 2025: Challenges and Strategies

    02/02/2025

    The U.S. Healthcare Claims Landscape in 2025: Challenges and Strategies

    The U.S. Revenue Cycle Management market is undergoing a rapid revolution driven by advancements in technology, regulatory changes, and evolving care delivery models. RCM plays a critical role in managing the financial processes of healthcare organizations, ensuring efficiency in billing, claims processing, and revenue collection. Emerging technologies such as artificial intelligence, machine learning, and automation enhance workflows, reduce errors, and streamline operations, while regulatory shifts demand providers to stay compliant with new reimbursement models. The RCM market will continue to evolve, adapting to factors like value-based care initiatives and patient-centric approaches. Stakeholders, including healthcare providers, payers, and technology vendors, must remain agile in responding to these dynamic trends. This proactive adaptation is essential for maintaining financial stability and delivering high-quality patient care. The U.S. RCM market is anticipated to hold a vital role in shaping healthcare organizations' operational and financial success. By staying informed and leveraging innovative solutions, industry players can effectively address ongoing challenges while preparing for future opportunities. This evolution underscores the importance of aligning financial management practices with the broader objective of improving the patient healthcare experience. Full article This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    1 min
  8. Senate Committee 'Profits Over Patients' Report

    01/02/2025

    Senate Committee 'Profits Over Patients' Report

    Executive Summary The increasing involvement of private equity in the U.S. healthcare sector has raised widespread concerns regarding its impact on patients, providers, and the overall healthcare system. This report examines the dual outcomes of private equity investment in healthcare, focusing on the significant financial returns for investors juxtaposed with the potential risks for patients and communities. Key issues explored in this report include rising healthcare expenses driven by aggressive billing practices, labor reductions that strain patient care, and a growing trend of rural hospital closures tied to PE ownership. Additionally, the lack of transparency surrounding PE acquisitions often keeps stakeholders, including patients and policymakers, unclear about the motivations and practices of these firms. This analysis underscores the importance of balancing innovation and efficiency with the ethical obligation to prioritize patient outcomes and access to care. By addressing the opaque and profit-driven nature of private equity in healthcare, stakeholders can work toward a system that fosters both financial sustainability and equitable health access for all. Policymakers and advocacy groups have begun responding with legislative and regulatory initiatives to address these challenges. State and federal policies aim to increase transparency, limit harmful cost-cutting measures, and evaluate the socioeconomic implications of PE investments. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit ebrahimbarkoudahmdmph.substack.com

    1 min
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My Substack will address quality in healthcare and value-based care delivery. ebrahimbarkoudahmdmph.substack.com

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