Maged Tanios, MD, MPH, MBA, FCCP

OUR NEW YEAR RESOLUTION: ELEVATING PCOS CARE TOGETHER https://lnkd.in/gy5SWQjX My heartfelt purpose is helping primary care providers to deliver expert care to women with PCOS in their communities. At the University of California, Davis Medical Center, I developed the PCOS program, treating thousands of women who had to travel long distances. My experience underscored the necessity of community-based care for over seven million PCOS patients in the USA. I strongly believe primary care physicians can provide expert PCOS care. Diagnostic tests for PCOS are readily available, and primary care doctors frequently prescribe treatments like birth control pills, metformin, and spironolactone for other disorders already. Unfortunately, the current medical care model and education do not prepare primary care physicians to provide the optimal care for PCOS patients. The current models lack a cohesive approach, dividing care among various specialties such as obstetrics, gynecology, dermatology, and endocrinology. To bridge this educational gap, I am launching the "Advancing PCOS Care: Empowering Health Care Professionals" course for primary care providers. This course offers comprehensive knowledge and skills, along with mini-coaching sessions to enhance competence, confidence, job satisfaction and career growth. By downloading the free Resource Guide for Diagnosing PCOS, you allow me the opportunity to share further insights about my course with you. I assure you that your privacy is paramount, and your contact information will never be shared. Join me on this exciting journey to improve PCOS care. #PCOS #Insulinresistance #Obesity

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Proud of the excellent work by our Satyan Lakshminrusimha for his incisive look at funds flow from a chair’s perspective. His findings have helped to inform our own administration and others around the nation about what works and what doesn’t. Some context (and more details below in the journal article): UC Davis Health implemented an aligned funds flow model in July 2021 to create a mission-aligned model in which all departments had financial margins to optimize recruitment, retention, research, and teaching. Results: Total collections for departments increased by 4% in the first year, 0.2% in the second year, and 11.3% in the third year of funds flow. Total productivity increased by 4.9% during the first year, 3.6% during the second year, and 8.4% during the third year. 

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Satyan Lakshminrusimha-- thanks for the post and work you are doing in this area. Can all missions of an academic medical center align? ....In this era of diminishing cash flows as costs increase and traditional revenue streams decrease? Can clinical care, education, research, and healthcare administration/operations truly align for common missions and funds flow sustainability? You even highlight that this model may not be sustainable at UC Davis; "the implementation of funds flow had a negative fiscal effect on the academic medical center." Thoughts? #UsingWhatWeHaveBetter

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As California goes all in on CHW’s, it will be important for them to have a role connecting everyone to social support and activities. Maybe this hasn’t been part of the conversation as much because Medi-Cal rolled out a strangely separate “Peer Support Specialist” benefit at the same time, strictly kept to county BH plans. 🤷🏻‍♂️ (It really shouldn’t be only for those with SMI FYI, there’s plenty of data peers reduce mental illness burden across all risk strata.) Or maybe we still need to do a better job of reframing social support systems and relational health as part of standard of care “health education” whether CHW’s or other health professionals deliver it. We haven’t seen that framing much to be honest and I’m not sure why. Either way, the UK and many US physicians and other PCP’s who now prescribe social activities are showing this is the way in an increasingly isolating digital age. California is also leading this charge, however not under Medi-Cal for all, so much as under child welfare reform. New plans to allow child welfare dollars to go to these kids’ social activities highlight the importance. In reality, the same should be true for Medicaid dollars for pregnant women (ala the Birthing Care Pathway?), kids and youth thankfully NOT involved in child welfare systems (but with high ACE scores?), and seniors (ala MSSP?). Essentially everyone needs safe, stable, nurturing relationships to be healthy. The moment we make relational health a cornerstone of all healthcare investments, including but not limited to paying for social activities, the more we will beat the toxicity of stress and drive down costly physical and mental health conditions. Hopefully this can be a consideration in the next round of CalAIM Community Supports - let’s pay for straight up social supports and activities through a Medicaid waiver and measure the impact. Now that would be amazing! #mentalhealthishealth. #relationalhealth investments and patient education are keys to #healthequity

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What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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𝐀𝐧 𝐚𝐫𝐭𝐢𝐜𝐥𝐞 𝐢𝐧 𝐭𝐨𝐝𝐚𝐲’𝐬 𝐖𝐒𝐉 𝐡𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬 𝐭𝐡𝐞 𝐛𝐢𝐠𝐠𝐞𝐬𝐭 𝐝𝐚𝐧𝐠𝐞𝐫𝐬 𝐨𝐟 𝐣𝐨𝐢𝐧𝐢𝐧𝐠 𝐚 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞 𝐩𝐥𝐚𝐧 – 𝐭𝐡𝐞 𝐜𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞𝐬 𝐨𝐟 𝐥𝐞𝐚𝐯𝐢𝐧𝐠, 𝐞𝐬𝐩𝐞𝐜𝐢𝐚𝐥𝐥𝐲 𝐚𝐬 𝐲𝐨𝐮 𝐠𝐞𝐭 𝐨𝐥𝐝𝐞𝐫 𝐚𝐧𝐝 𝐬𝐢𝐜𝐤𝐞𝐫. And when older, sicker patients do leave, taxpayers wind up footing the bill. https://lnkd.in/gXY5gdRB 𝐅𝐈𝐍𝐃𝐈𝐍𝐆𝐒 “A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage’s sickest patients dropping their privately run coverage just as their health needs soared…. “As recipients get sicker, though, they may have more difficulty accessing services than people with traditional Medicare. That’s because the insurers actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use. “People in the final year of their lives left Medicare Advantage for traditional Medicare at double the rate of other enrollees from 2016 to 2022, the Journal’s analysis found…They cost the federal government an average of $218 a day during that period. That is more than seven times the cost of a typical Medicare recipient, and about twice the cost of other recipients in the last year of their lives.” Kudos to Anna Wilde Matthews, Christopher Weaver, and Tom McGinty for fine reporting. 𝐌𝐘 𝐏𝐄𝐑𝐒𝐎𝐍𝐀𝐋 𝐓𝐀𝐊𝐄 I would NEVER consider joining a MA plan. The deal killer: the requirement for individual (vs. community) rating of patients' health/sickness levels if they choose to leave a Medicare Advantage plan. I can’t fathom why this isn’t more widely understood and discussed. If you choose to get into traditional Medicare before your 66th birthday, you are eligible to buy a Medigap supplement policy at a community rating, i.e., you pay a price based on the health status of all Medicare patients in your age group. If you want to LEAVE a Medicare Advantage plan after your 66th birthday, the pricing of your Medigap plan will be determined by your INDIVIDUAL health status; you can be denied coverage. This has the effect of LOCKING people into their Medicare Advantage plan when they are older, sicker and want to leave to go to traditional Medicare...and this is where prior authorization requirements can really screw older, sicker patients. This is more a criticism of how MA is structured, and less a criticism of MA plans themselves. I'm not clear on the legislative history of why this loophole exists, but as the WSJ article notes some states have regulated against this. Can anyone enlighten? …and then you get into the arbitrary prior authorization requirements. But that’s another post. “You can check out any time you like, but you can never leave" – The Eagles, Hotel California #MedicareAdvantage #Medicare The Fast Future Executive

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Medical student loan debt is rapidly rising, with new MDs averaging over $200,000 in debt. The rise of free or reduced tuition from schools such as NYU and Kaiser Permanente have caused waves. Advocates hope that reducing student debt will increase the numbers of primary care physicians and physicians serving underserved areas as new physicians deprioritize salaries that can bear hefty student loans. Additionally, decreased student debt and the anxiety that accompany them may reduce physician burnout. The jury is out as most schools reducing or eliminating tuition have done so in the last six years and recent match results have not shown an increase in primary care spots. What are your thoughts? Can eliminating student loans significantly decrease stress and bolster physician wellness? #healthcare #healthcareleadership #physicianburnout

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Many people overlook joint pain, stiffness, and swelling, dismissing them as simply part of "getting older." This #NationalArthritisAwarenessMonth, AZ Health and Wellness Clinic emphasizes the importance of early detection and treatment of arthritis, which can greatly enhance your quality of life. Don't delay seeking help until the pain becomes severe! #ArthritisAwareness #ArthritisMonth #CureArthritis #PainManagement #JointHealth

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I had the chance to speak with Joshua Parry, MD, MS, of DENVER HEALTH MEDICAL CENTER, about results presented at the Orthopaedic Trauma Association Annual Meeting that showed patients with stress-positive lateral compression type 1 pelvic ring injuries who had #fixation were more likely to ambulate without assists at last follow-up and have a lower mortality rate vs. those who did not have surgery. “Right now, the standard of care for these injuries is nonoperative treatment, but I do think some patients, similar to hip #fractures, warrant early fixation and mobilization and that may prevent mortality,” Parry said. Read the full article on Healio 👇

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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Frustrated with stone retrieval after a long lithotripsy case? In this episode of the BackTable Urology Podcast, I hosted guest Roger Sur, MD, director of the Comprehensive Kidney Stone Center at UC San Diego Health, to delve into the latest technological advancements in the treatment of kidney stones. The episode focused on the CVAC (continuous vacuum aspiration and irrigation) device as a suction platform for endourologists. I learned interesting historical detail on the evolution from open surgery to modern techniques including percutaneous nephrolithotomy, shockwave lithotripsy, and ureteroscopy. Dr. Sur highlighted the CVAC development journey from lab experiments to FDA approval. We covered data on CVAC’s superiority in patient outcomes and stone-free rates compared to other technologies. Key insights from recent studies, such as the ASPIRE trial, underscore the benefits of CVAC in reducing postoperative events and stone regrowth. Our conversation also explored practical aspects of integrating suction platforms into practices and looked ahead towards the potential for machine learning to refine these technologies. Thank you to Photocure for sponsoring this episode. Learn more at: https://www.photocure.com/ Listen here: https://lnkd.in/gz2qRgVX #Uro197 #residency #BackTable #Urology #Urologist

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Is your Academic Medical Center considering #FundsFlow - Detailed impact of funds flow on UC Davis Health in @acdaemic medicine journal - both positive and negative, improvement in mission, individual productivity and physician salaries and financial impact on the health system - using Association of American Medical Colleges (AAMC) and @Clinical Practice Solutions Center benchmarks - with Susan Murin, Joseph Galante, Zishan Mustafa, Noel Sousa, Stanley Chen, Debbie Aizenberg, Elizabeth Morris, and David Lubarsky

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Not only are midwives being challenged by health care systems to practice to the full scope of their education and licensure, but even growing a workforce of midwives is now significantly diminished by UCSF School of Nursing mandate to move the historic masters graduate midwifery program to a DNP. Why? This article hit the San Francisco Chronicle today! I hope the readership and citizens of CA can understand significant barriers exist to not only practice midwifery, but now to become a midwife, particularly those from underrepresented groups. Once again we see the ramification of profit over purpose. There are NO published studies that demonstrate value for cost as an entry degree to practice in midwifery, or any other advanced practice provider role. I urge heightened pressure for this decision to be reversed and reinstate a historic and predominantly BIPOC faculty remain as educators. The dismantling of the midwfiery program is beyond reason and provides suspect to many inherent struggles within the SON. #Enough #GrowMidwives

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New urgent update from Medicare Codes G0463 and G2211 G0463 Represents hospital outpatient clinic visits for the assessment and management of patients. • Modifiers: • PO: For excepted off-campus provider-based departments. • PN: For non-excepted off-campus provider-based departments. • Usage Examples: • GI Clinic: Follow-up on GERD management. • Orthopedics: Evaluation of knee pain and treatment planning. • Podiatry: Diabetic foot ulcer care with procedures like debridement. • Vascular Surgery: Comprehensive vascular assessment for leg ulcers. Important Notes: G0463 is specific to hospital outpatient settings and does not apply to regular office E/M codes like 99202-99205 or 99211-99215. G2211 Designed for outpatient office visits to reflect visit complexity. No changes in its usage for outpatient settings. Cannot be paired with G0463. G2211 is intended for office visits only, while G0463 is strictly for hospital outpatient visits with the required PO/PN modifiers. #CMSGuidelines #HealthcareUpdates #MedicareBilling #BillingAccuracy #HealthcareProfessionals #RevenueCycleManagement #HealthAdmin #MedicalEducation #OutpatientCare

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The start of a new approach? #Medical #Education is steeped in tradition. Kaiser Permanente Bernard J. Tyson School of Medicine, started in 2020, has added Health Systems Science as a third pillar in its curriculum (very commendable), complementing more traditional Biomedical and Clinical Science pillars (https://lnkd.in/g4aHus4d) However, as the medical landscape rapidly evolves, it's imperative to ask: What additional competencies should medical education incorporate to prepare physicians for the future? Beyond traditional medical training, future physicians will need: ⏺️ Business Acumen: Understanding healthcare economics and management is crucial for effective practice and leadership (https://lnkd.in/gum_7CFS) ⏺️ Innovation and Entrepreneurship: Encouraging creative problem-solving and the ability to develop and implement new healthcare solutions (https://lnkd.in/gt7X-tXS) ⏺️ Artificial Intelligence (AI) Literacy: Navigating and leveraging AI technologies to enhance diagnostics, treatment plans, and operational/revenue cycle efficiencies (https://lnkd.in/gQ582GXp). ⏺️ Critical and Adaptive Thinking: Making informed decisions in complex, unpredictable healthcare environments (https://lnkd.in/gJZNgQQB) ⏺️ Leadership and Interpersonal Skills: Effectively leading diverse teams and communicating across various healthcare stakeholders (https://lnkd.in/g-ECEjcZ). If I were to develop five pillars for medical education to train future physicians this is what I would choose: 1-Biomedical Science: Maintaining a strong foundation in the biological and physiological principles of medicine. 2-Clinical Science: Developing hands-on patient care skills and clinical decision-making abilities. 3-Health Systems Science: Understanding healthcare delivery, policy, and economics. 4-Innovation and Technology Integration: Training in the application of AI, digital health tools, and fostering an entrepreneurial mindset. 5-Leadership and Management: Cultivating skills in team leadership, business management, and effective communication. By incorporating these pillars, medical education can produce physicians who are not only clinically proficient but also equipped to lead, innovate, and adapt to the ever-changing healthcare landscape. What would you choose? #UsingWhatWeHaveBetter

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When is Switzerland reinstalling mask mandates in health care to protect the most vulnerable from SARS-CoV-2 and other airborne illnesses? It’s a scandal that health care has simply given up on vulnerable people. Hospital hygiene is stuck in mid 19th century, at the times of Semmelweis… Healthy indoor air, mask mandates depending on the situation, more vaccinations and isolation of infected persons would stop the pandemic for real. Excess mortality: In Switzerland >21’000 persons have died until December 31, 2023 who wouldn’t have died without the pandemic – 9000 of them after all safety measures were lifted.

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