The Rojas Report
The Rojas Report with Dutch Rojas cuts through the noise in American healthcare.
From policy fights in Washington to the boardrooms of venture-backed startups, Dutch brings physicians, investors, and entrepreneurs into real conversations about money, power, and independence in medicine.
Expect sharp takes on healthcare policy, candid talks with startup founders, and even the occasional cigar-fueled debate about where the system is headed next.
If you care about the future of healthcare, and who really gets to shape it, this is your show.
The Rojas Report
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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