"REFILL" | Dutch Rojas on Healthcare Economics, Direct Contracting, and Tax-Exempt Health Systems (Originally Aired: September 15, 2025)

This is a "REFILL" episode recorded in September 2025. At the time of recording, Dutch Rojas was a healthcare entrepreneur, founder of multiple direct contracting companies, and board member of Physician Led Healthcare for America, with a growing following on social media advocating for market-based healthcare solutions.Joe Grogan sits down with Dutch Rojas, healthcare entrepreneur and social media advocate, to discuss his journey from accounting to building direct contracting companies that revolutionize employer healthcare. Rojas explains how direct contracting allows employers to negotiate directly with physicians, bypassing insurance middlemen. The conversation covers his experience building ambulatory surgery centers, certificate of need laws, self-funded employer plans, and his critique of not-for-profit health systems. Rojas argues that academic medical centers masquerade as not-for-profit organizations while receiving seventy-four subsidies annually from taxpayers, acquiring massive real estate holdings, and avoiding property and federal taxes. He advocates for policy changes on not-for-profit tax status and site-neutral payments, arguing these represent unfair advantages that harm independent physicians and patients.Key Timestamps0:18 Joe introduces Dutch Rojas and asks who is Dutch Rojas1:32 Dutch's background, career path, and journey to social media2:22 Physician-led Healthcare for America and PHA board4:32 Starting in accounting, real estate investment trust, and ambulatory surgery centers5:14 150 ambulatory surgery center deals and certificate of need experience7:34 Building a practice in Scottsdale and expanding to 16 states9:30 First direct contracting company in 2009 and how direct contracting works12:45 Self-funded employer plans and 106 million Americans not covered by insurance15:22 Deals with banks and large employers in New York City18:09 The difference between clinical medicine and business in medicine22:15 Building insurance products on top of physician-led care28:30 How direct contracting saves employers money32:18 The three companies Dutch has started and sold38:45 Healthcare as a percentage of GDP and rising costs42:10 Regulatory hurdles and state-level barriers46:54 Not-for-profit tax status and academic health systems48:07 How health systems receive subsidies but claim non-profit status48:22 Academic medical centers owning four to five percent of city real estate49:21 Site-neutral payments and payment disparities between settings50:28 Dutch's social media reach and audience impactKey TopicsDirect contracting, healthcare economics, physician-led care, ambulatory surgery centers, certificate of need, self-funded employer plans, not-for-profit health systems, tax exemptions, site-neutral payments, healthcare regulation, real estate holdings, academic medical centers, employer negotiations, insurance reform, market-based healthcareAbout the Guest (at time of recording, September 2025)Dutch Rojas is a healthcare entrepreneur with over 25 years of experience in healthcare economics and business. He started in accounting and real estate investment, then moved into healthcare, developing over 150 ambulatory surgery centers. Rojas founded multiple direct contracting companies that help employers negotiate directly with physicians, bypassing traditional insurance intermediaries. He serves on the board of Physician Led Healthcare for America. He has built a significant social media following on X (formerly Twitter), sharing his analysis of healthcare policy and economics. Rojas is the author of the Rojas Report and hosts a YouTube channel and Substack focused on healthcare reform and market-based solutions.Podcast: DC EKG with Joe GroganHost: Joe GroganGuest: Dutch RojasSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast