MEEKA KIYADHA?
Published in the March 14, 2026 edition.
I made public record requests this week to compare the Mammoth Orthopedic Institute (MOI) contracts with Northern Inyo Hospital and Mammoth Hospital. The result was fairly striking.
Northern Inyo Hospital is paying $3,500 per day to MOI for 24/7 on-call service.
In comparison, Mammoth Hospital’s contract pays $475 per day to MOI.
I tried to set up an interview with NIHD CEO Christian Wallis to ask him why there might be such a large discrepancy in what each hospital pays.
NIHD’s lovely public relations manager, Barbara Laughon, wrote back “Thank you for reaching out. Christian will not be available for a phone interview on this topic … At this time, NIHD does not have additional comment beyond the information that has already been shared publicly regarding Northern Inyo Healthcare District’s orthopedic partnership.”
She provided a link to the initial press release where all parties said all the right things. Regional cooperation. Setting aside lines on a map. Efficient, coordinated care.
“The partnership comes at a time of growing concern for rural healthcare. Nearly two-thirds of California’s 37 critical access hospitals are losing money, according to the California Hospital Association. Since 2019, hospital profits have dropped by about eight points. This is largely due to lower payments from insurance and government programs, along with rising costs to provide care.
‘We risk becoming healthcare deserts without new solutions,’ [then NIHD Board member David] Barrett stressed. ‘Our Board acted on this because we believe in collaboration over competition. This is not about replacing what is already here. It’s about strengthening it. With our team’s dedication and our community’s trust, we believe this model can thrive.’”
This still doesn’t address the discrepancy.
And you would expect some discrepancy simply because you’ve got doctors who are on-call not down the street but 45 minutes away, at any hour, all seasons and weather conditions.
But $3,500 times 365 = $1.28 million before the vehicles of any of the five MOI surgeons even leave the garage.
Then there’s the compensation if surgery is performed.
A wRVU is defined as a “work relative value unit.”
Each procedure not only has an estimated number of wRVUs associated with it, but there are also sometimes “multipliers” attached if the surgery is especially difficult or involved.
A typical hip replacement may be priced at 20 RVUs according to fastrvu.com.
If you ask AI, it’ll tell you the average physician compensation per wRVU is $76.81. Although “orthopedic surgeons in rural areas often receive higher compensation per work RVU (wRVU) due to higher market demand and incentives to address critical staff shortages.”
Sometimes 55-60% higher, says AI, which would place the rate at somewhere around $125.
The MOI contract with NIHD sets the rate at $175.
The MOI contract with Mammoth Hospital was set at $162 when established in 2023.
My biggest frustration is the absolute lack of transparency from the NIHD Board. Tell us why this is a superior model to the salary-based compensation of previous orthopedic surgeons whom you had on-staff and living in the community. Are more surgeries being performed? Is the hospital making more money as a result?
Odds and Ends
This from the hotbed of free market capitalism, Sri Lanka.
From the February 18 issue of the Wall Street Journal.
Legislators overwhelmingly voted to scrap their pensions in a bid to fulfill a key pre-election campaign promise by the ruling Marxist-leaning government following anger over the country’s economic crisis.
The vote was 156-2.
In Sri Lanka, a lawmaker was previously entitled to a pension after serving a five-year term. The new law stops payments to anyone who already receives or qualifies for the pension.
What do you think about that Supervisor Candidate Carleton?
I’ve spent my whole life in private business saving for my own retirement. Sounds like a decent idea for politicians to forsake the gravy boat at Christmas dinner.
Then from the February 28 issue, there was a story in the Review section about the history of U.S. board games. And it referenced the Game of Life, which both my daughters liked to play growing up.
In its current iteration, even the unluckiest of players ends Life with a couple million bucks in the bank. Further, they pay you out $50,000 per kid at the end – maybe to signal to the kid you’re playing with that kids are more than just a huge expense! No, no child, kids are not only awesome but they MAKE you money.
Compare the modern, varying-degrees-of-winning version versus the original game created in 1860. In its earliest iteration, “players navigated a board with spaces identifying the highs of life – college, success, Happy Old Age among others – and several frightening lows, including Ruin, Disgrace and Suicide.
Those 19th century Americans were a tough crowd.
And finally, Vail Resorts announced this week that it is cutting price of next year’s Epic Pass 20% for skiers and snowboarders ages 13-30. They’ll pay $869. Adults over 30 will pay $1,089, a 3.6% increase.
Vail sold 2% fewer season passes year-over-year in 2025-2026 versus 2024-2025. According to its earnings call, total skier visits to its North American resorts were down 20% through Jan. 4 due to lack of early season snowfall.
