we regulated subliminal advertising in 1974 based on a literal hoax.

the real version is here now — prompt injection that persists in your AI's memory — and nobody's regulating it.

now imagine it hits healthcare.

https://youtu.be/4vECwmEUHEs

Developers budget $1,000/day in AI tokens. Doctors still get measured by how many patients they see. The RVU system is broken and everyone knows it. New episode: Are Tokens the New RVU?

Which one do you want to go with, or want me to remix elements?
https://open.substack.com/pub/danmccoymd/p/are-tokens-the-new-rvu-the-research?r=11z0su&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true 

Medicare physician payment: down 26%. Value-based care spending: up $5.4B. Physician burnout: at record highs. The RVU system is failing. In this episode I make the case that tokens — not RVUs — should be healthcare's new unit of productivity. Full episode + sources on Substack.
https://www.buzzsprout.com/2599894/episodes/18802224

Rethinking Healthcare Productivity

The one AI company that said no to mass surveillance just lost a $200M Pentagon contract for it.

I wrote about why that matters for your medical records — not the Pentagon's.

HIPAA was written before AI could re-identify 800,000 "anonymous" patients from their clinical notes alone.

The deep dive: 

https://open.substack.com/pub/danmccoymd/p/what-does-capturing-venezuelas-dictator?r=11z0su&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true

AI, Privacy, and Contracts

1/12 You walk into the ER with chest pain. Three months later: $47,000 bill.

Meanwhile, nonprofit hospitals just pocketed $37.4 billion in tax exemptions while providing only $16 billion in actual charity care.

The "charity" hospital hoax is America's biggest healthcare scam. 🧵
https://blog.rockettools.io/p/1ad2c8f1-920a-447e-9e67-6b6d55c391fa/


2/12 Almost 25% of nonprofit hospitals receive MORE in tax exemptions than they spend on ALL community benefits combined.

These aren't struggling institutions. Many reported record profits during the pandemic while simultaneously slashing charity care spending.



3/12 Hospital CEOs are paid millions in salaries and bonuses - compensation that often exceeds the total value of charity care their institutions provide.

The math is obscene: Executives profit more personally than hospitals spend helping patients who can't afford care.



4/12 In Texas, the game is rigged from the start.

Hospitals can count marketing budgets, community health fairs, and advertising as "charity care" - reducing pressure to provide actual financial assistance to patients who need it.



5/12 Here's how the scam works:

Step 1: Redefine "charity" to include marketing
Step 2: Use lobbyists to block reform bills
Step 3: Post charity care notices where patients won't see them
Step 4: Target vulnerable communities with aggressive collection



6/12 Real example: One woman had $2,200 garnished from her wages in two months for a $5,000 ER bill.

She qualified for free care under the hospital's own charity policy but was never told it existed.

This happens thousands of times across the country.



7/12 Geographic patterns reveal systematic targeting.

Research shows hospitals focus aggressive collection practices on areas with high Black, Latino, and immigrant populations while providing better charity care in affluent areas.



8/12 While Texas law protects wages from garnishment, hospitals can still freeze bank accounts and seize other assets through court orders.

Most patients facing lawsuits never show up to court because they can't afford legal representation.



9/12 During COVID-19, the hypocrisy became impossible to ignore.

Hospitals reported record financial surpluses in 2021-2022 while charity care spending fell as a percentage of revenue. Pandemic profits soared while patient assistance disappeared.



10/12 The industry's defense? "We follow all legal requirements."

Translation: We count marketing as charity, deploy lobbyists to block reform, and target the most vulnerable with collection tactics while taking billions in taxpayer subsidies.



11/12 Federal action is coming. The Consumer Financial Protection Bureau is exploring stripping medical debts from credit reporting.

But hospitals are lobbying hard to stall these protections, just like they've blocked state-level reforms.



12/12 There's no excuse for taking $37.4 billion in taxpayer benefits while paying executives millions and destroying patients' financial lives.

What's your experience with hospital "charity care"?

Full investigation: 
https://blog.rockettools.io/p/1ad2c8f1-920a-447e-9e67-6b6d55c391fa/

#HealthcareAccountability #CharityCare #MedicalDebt

You can read the unrolled version of this thread here: https://typefully.com/docdano/OqJGRwO

Healthcare Scam: Charity Hospital Hoax

1/12 🧵 Your clinical expertise is being captured by AI systems. And you probably don't even know it.
Every ambient AI conversation is training models on how YOU think, diagnose, and treat patients. 

But who owns that knowledge? 🤔
https://blog.rockettools.io/p/f98d5133-321e-42d0-b841-656e19bece3d/



2/12 Here's what's happening:

Ambient AI isn't just transcribing your notes. It's learning your:
• Diagnostic reasoning patterns
• Communication style with patients  
• Clinical decision-making process
• Teaching methods

Your decades of expertise → Their competitive advantage

You can read the unrolled version of this thread here: https://typefully.com/docdano/oUaloGi

3/12 The bias problem is HUGE 📈

Most AI training data comes from expensive academic medical centers (Mayo, Hopkins, Cleveland Clinic).

When community docs get AI recommendations based on AMC patterns, every suggestion skews toward high-cost interventions.

4/12 Think AI can't identify you after removing your name?

Think again.

Your clinical "fingerprint" is as unique as your signature:
- How you explain conditions
- Your diagnostic approach
- Specific phrases you use
- Decision-making patterns

AI is really good at pattern recognition. 🎯



5/12 The numbers are staggering:

• 1M+ AI-generated clinical drafts monthly
• 180+ organizations using ambient AI
• $400M+ in venture funding for AI scribes in 2024

But ZERO governance frameworks for physician knowledge rights.



6/12 This isn't just about Epic.

Nuance DAX Copilot (Microsoft), Abridge, Suki, Nabla, Augmedix - they're all capturing clinical expertise across every EHR platform.

The problem is industry-wide. 🌐



7/12 Current consent processes focus on patient data privacy.

But what about YOUR intellectual contribution?

When you explain your diagnostic reasoning and AI captures it, who owns that expertise?

Spoiler: It's not you. 😬



8/12 The public good vs. private profit tension:

✅ AI trained on expert physicians could help underserved areas
❌ Private companies controlling that knowledge creates competitive moats
❌ Expensive hospital patterns become "standard care" everywhere



9/12 What healthcare leaders need to do NOW:

📋 Negotiate physician knowledge rights in AI contracts
🔍 Require bias testing across community vs. academic settings  
⚖️ Establish governance committees for AI knowledge capture
🛡️ Create opt-out provisions for physicians



10/12 Red flags in ambient AI contracts:

🚩 No disclosure of how physician reasoning is used
🚩 Cross-tenant training without opt-in
🚩 No cost-awareness in AI recommendations
🚩 Missing re-identification testing



11/12 We have a narrow window to get this right.

Once ambient AI is deeply embedded, governance becomes impossible.

The question: Should your clinical expertise serve patients or platform profits?



12/12 Bottom line: This isn't about stopping innovation.

It's about ensuring YOUR decades of medical training and expertise don't become someone else's proprietary advantage without your consent.

What's your take? Should physicians have rights to their captured clinical reasoning? 💭

Full analysis: 
https://blog.rockettools.io/p/f98d5133-321e-42d0-b841-656e19bece3d/

#HealthcareAI #PhysicianRights #AmbientAI

AI Capturing Clinical Expertise

You've been seeing the same doctor for 10 years. Same office, same staff, same care.

Your $15 copay just became a $563 bill.

Welcome to "facility fees" – healthcare's most insidious surprise billing scheme.
https://blog.rockettools.io/p/31afbb19-2bba-43ee-a190-94f87d343587/



You can read the unrolled version of this thread here: https://typefully.com/docdano/2jGastB

2/8
Here's what happened: A hospital bought your doctor's practice.

Everything looks identical – same building, same receptionist, same exam room.

But now they can charge you "facility fees" on top of your regular visit cost.

Pure regulatory arbitrage.



3/8
The numbers are staggering:

• Hospital employment of doctors doubled from 2012-2024 (now 55%)
• Facility fees rose 53% from 2011-2017
• Real patient charges: $503 for pediatric visits, $488 for ADHD meds

Each hospital acquisition creates new billing opportunities.



4/8
The four-step scheme:

1. Hospital buys independent practice
2. Converts to "hospital outpatient department" on paper
3. Keeps everything else identical
4. Starts billing facility fees + professional fees

Result: You pay hospital prices for clinic visits.



5/8
The most absurd example? Facility fees for telehealth visits.

You're literally at home, but hospitals claim you're using "hospital facilities."

Charging hospital-level fees for a video call from your couch is pure exploitation.



6/8
In Texas, 64% of residents skipped care in 2023 due to costs.

Recent bills to ban facility fees for preventive care and telehealth? Both died after hospital lobbying.

When preventive care becomes financially punitive, we've broken healthcare.



7/8
Hospital industry defense: "We need the revenue to survive. It's an insurance problem."

Translation: "We have the right to surprise patients with hidden fees because we want more money."

That's economic hostage-taking, not patient care.



8/8
74% of voters want facility fees banned for outpatient services.

The patients have spoken. Time for policymakers to act.

What's your worst surprise medical bill story? 
https://blog.rockettools.io/p/31afbb19-2bba-43ee-a190-94f87d343587/

#HealthcareReform #SurpriseBilling #FacilityFees

Healthcare's Sneaky Facility Fees

1/10 Instagram just made a move that changes everything about content discovery.
https://www.linkedin.com/pulse/instagrams-google-search-integration-content-game-just-dan-mccoy-md-hppqc

You can read the unrolled version of this thread here: https://typefully.com/docdano/nFVkZfP

Starting July 10th, your Instagram posts now show up in Google search results. This isn't just another algorithm update—it's a fundamental shift in how content visibility works.
https://blog.rockettools.io/p/b0ab1104-6076-4d0f-a2ff-b4cdf07b8d86/


2/10 For years, Instagram was a walled garden. Amazing content, engaged communities, but invisible to Google's crawlers.

That wall just came down.


Your Reels, posts, and carousels from professional accounts can now compete directly with blogs and websites for search traffic.


3/10 The data was already telling this story:

• 32% of US users search for content on Instagram monthly
• Google had already indexed 613k+ Instagram Reels
• Social platforms have become search engines

Instagram's move just made it official.


4/10 Here's what this means for your content strategy:

Your Instagram captions now function like webpage titles. Your alt text becomes searchable metadata. Your hashtags aren't just for Instagram's algorithm—they help Google understand your content too.
https://www.linkedin.com/pulse/instagrams-google-search-integration-content-game-just-dan-mccoy-md-hppqc


5/10 Think about this: A local gym's squat demo video can now appear when someone Googles "how to squat properly."



A wedding photographer's portfolio shot surfaces in Google Images for "Pittsburgh wedding photographer."

Your social content just became search traffic.


6/10 This creates a content longevity problem (in the best way).

Traditional Instagram posts had a short shelf life—a few days of engagement, then archive obscurity.

Now, well-optimized posts can drive traffic for months or years through search results.


7/10 The strategic shift: You're no longer creating content for just one platform.

You're creating for an ecosystem where social and search intersect. Content needs to serve both human engagement AND search intent.


8/10 Right now:

→ Writing captions with keywords in mind (but keeping them human)
→ Using descriptive alt text on every post
→ Adding text overlays to Reels with search-friendly phrases
→ Optimizing bios with relevant keywords



9/10 The bigger picture: This is part of the LLM era transformation.

Social content isn't just competing for engagement—it's training AI systems and becoming part of how information gets discovered and shared across the internet.
https://www.linkedin.com/pulse/instagrams-google-search-integration-content-game-just-dan-mccoy-md-hppqc


10/10 The brands that win will master the balance: creating content that feels native to Instagram while being structured for search optimization.


Your Instagram content now has the potential to reach people who've never heard of your brand. 

The question is: Are you ready?
https://blog.rockettools.io/p/b0ab1104-6076-4d0f-a2ff-b4cdf07b8d86/

Instagram's Google Integration

1/8 🧵 Everyone thinks Google's AI will kill their website traffic.

But the data shows something completely different.
https://blog.rockettools.io/p/fa7ff8fa-da4b-4987-925c-81dcb1799eaf/

2/8 Shift #1: Questions have replaced keywords

Search behavior fundamentally changed. People now ask complete questions instead of typing fragmented keywords.

Result: 87% increase in question-based searches in just 8 months.

3/8 Shift #2: Surface content gets ignored

Google's AI doesn't just scan your page anymore. It runs dozens of background searches to understand full context.

If your content lacks depth, you're invisible to the algorithm.

4/8 Shift #3: Citations Rankings

AI overviews work like news citations. Getting mentioned in AI results builds instant credibility without users even visiting your site.

Think: trusted source, not traffic source.

5/8 Shift #4: Visual content wins

Text-only content is losing ground fast. AI pulls from videos, diagrams, and infographics because that's how people actually consume information.

Multi-modal content = higher citation probability.

6/8 Shift #5: Brand memory beats immediate sales

90% of people discover companies through search, but only 5% buy right away.

The other 95% remember your brand and return weeks later when they're ready to purchase.


7/8 Smart companies aren't fighting AI—they're training it.

Instead of optimizing for clicks, they're becoming the source AI trusts for complex industry questions.

This builds long-term authority while competitors chase short-term traffic.


8/8 The window is still open, but closing fast.

Most brands haven't adapted yet.

Those who move now lock in early advantages.

What's one question your company can answer better than anyone else in your space?
https://blog.rockettools.io/p/fa7ff8fa-da4b-4987-925c-81dcb1799eaf/

You can read the unrolled version of this thread here: https://typefully.com/docdano/jYuSpXA

AI Impact on Search Trends

Switched to the BOOX Go 7 for my morning newsletter routine and it's completely transformed how I start my day.

No more getting sucked into social media when I just wanted to read industry updates.



The magic is in what it DOESN'T do:

❌ No push notifications
❌ No social media temptation  
❌ No blue light assault at 6am
❌ No battery anxiety

Just pure, focused reading exactly when your brain is sharpest.

E-ink display = game changer for morning reading:

✅ Reads like paper, even in bright sunlight
✅ Zero eye strain during long sessions
✅ Won't mess with your sleep cycle
✅ Weeks of battery life (I charge it monthly)



Physical page turn buttons are underrated.

One-handed reading while holding coffee? Perfect.
No accidental taps when you're barely awake? Even better.

The Kindle Oasis knew what it was doing with this design.



But here's where it gets interesting - it runs Android 13.

Feedly for RSS feeds ✅
Readwise Reader for saved articles ✅  
Pocket for read-later content ✅
Even Kindle app if you want ✅

One device, every reading source.



The highlighting and annotation features turn morning reading into business intelligence.

I capture insights, sketch connections between articles, then upload everything to Claude for analysis.

My morning coffee routine now feeds my content strategy.



If you're tired of your phone hijacking your morning focus, the BOOX Go 7 creates the perfect reading sanctuary.

$249 to reclaim your most productive hours? Worth every penny.

What's your distraction-free reading setup? 👇

You can read the unrolled version of this thread here: https://typefully.com/docdano/8j1829S