Manhappiness, Moratoriums & “Bone-on-Bone” Reality: Dr. James McAtee on Building Physician Power

Why Listen:  An orthopedic surgeon who built and sold a physician-owned surgical hospital explains, in plain language, how practices win on contracts, culture, and capital. If you’re serious about independence, this is your operating manual for the next 12–24 months.

👥 Host: Dutch Rojas – Founder, Rojas Media and Bliksem Health

Guest: Dr. James “Jamie” McAtee – Orthopedic Surgeon, Partner at Orthopaedic & Sports Medicine Center (Manhattan, KS); Co-founder/leader at Manhattan Surgical Hospital; K-State alum and lifelong advocate for physician ownership

Episode Overview

Dutch sits down with Dr. McAtee to unpack how a small college town became a case study in physician leadership. They cover the origin story of Manhattan Surgical Hospital, raising capital (OpCo + PropCo), negotiating payer contracts (and why implants make or break your margins), and the cultural discipline required to keep a practice aligned for decades. McAtee details insurer tactics like retroactive “medical necessity” denials and AI-driven auth games—and how to respond. The conversation closes with strategy: federated models, MSO mechanics, retreats that actually matter, and the political trench war over the physician-owned hospital moratorium.

Notable Quotes

• “You have to have one or two partners willing to carry the workload on strategy.”

• “Insurers say no pre-auth…then deny it retroactively. That’s not fair.”

• “We built OpCo and PropCo—and used local banking that participated in the loan.”

• “Culture is an expectation: if you want to be here, this is how we behave.”

• “Physician-owned hospitals consistently lead on outcomes—and still face a moratorium.”

📚 What You’ll Learn

– How to structure and finance a physician-owned facility (OpCo vs. real estate)

– The payer math: DRGs, implant costs, and why case-level analysis wins contracts

– A practical approach to pre-auths in the age of AI (speak patient vs. legal charting)

– Building durable culture: expectations, accountability, and quarterly deep-dive retreats

– Federated models/MSOs: why “coopetition” beats isolation for independent groups

– Policy reality check: navigating the POH moratorium with creative ownership models

⏱ The Episode (Timestamps)

00:00 – Why Manhattan, KS and the K-State effect on practice growth

06:00 – From OR to boardroom: why McAtee built a surgical hospital

09:45 – Capital stack 101: OpCo, PropCo, and local bank participation

12:00 – Blueprints vs. flow: designing for industrial engineering, not just code

14:35 – Payer reality: DRGs, implants, and uneven reimbursement

15:55 – Retro denials & AI: “bone-on-bone” vs. clinical nomenclature

18:30 – Near-term ops: authorizations, EHR/AI, and squeezing waste

19:45 – Federated MSO vision and why organic physician growth stalled

21:30 – Coopetition mindset: uniting against carrier/system leverage

22:45 – Property & casualty: moving from premiums to contributions and float

26:45 – Leadership cadence: create “productive chaos,” then guide the team

27:50 – Retreats that work: weekly huddles + quarterly deep dives

28:55 – Strategy ownership: two partners carry the torch; others cede control

32:00 – Culture rules: high standards, low drama, long-term alignment

33:20 – Policy: POH moratorium, workarounds, and the path forward

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