Sunil Desai, MD, FCCP

The Psoriatic March: PsA before PsO https://buff.ly/3CQxT2s

1

Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

1

Mark Your Calendar: December 17th! Join me at 10:00 AM PST | 1:00 PM EST for the Medicare Quarterly Updates Webinar - 4th Quarter hosted by McVey Seminars. Stay informed with the latest Medicare updates! Register today: https://lnkd.in/gmgzbjSg Let’s navigate these updates together! #McVeySeminars #TerryTuesday

29

Out today in JAMA Health Forum, Wayne Winegarden and I envision 340B reform that follows the patient instead of going directly to the institution: https://lnkd.in/gnt6hC6i Imagine if SNAP funds went to restaurants and grocery stores instead of beneficiaries, or if TANF funds went to banks instead of beneficiaries. The 340B program should fund patients, not institutions. If patients controlled the powerful discount, hospitals would need to provide services that attract those patients. This approach would curb program abuse and reduce the $54 billion in annual rents extracted by large hospital corporations. These rents are passed on to the public through increased insurance premiums, the drawdown of the Medicare trust fund, and inflated pharmaceutical costs. Cutting back on abuse would benefit everyone. We must shift our mindset in healthcare. Funding institutions with massive subsidies has only led to a large, consolidated, sclerotic system. By funding patients instead of institutions, we allow the end-users of healthcare services to direct where those funds are applied, promoting quality and efficiency through market forces. Most importantly, this approach prioritizes patients. Isn't that who healthcare is meant to serve? Meanwhile, the hospital industry insists they need #340B subsidies to maintain operations. Does that include starting a film studio? Northwell Health, a 340B entity, is going to be producing its own movies and TV shows: https://lnkd.in/gnsmJdWk When I testified on 340B in front of the House Committee on Energy and Commerce, the argument in favor of 340B kept coming back to: hospitals need the subsidy! Look at all these great things we are doing with your money! They forgot to mention they were purchasing a movie studio. So, you are paying more for pharmaceuticals due to 340B exploitation. You are paying more for insurance premiums due to 340B exploitation. And in return, the health system is focusing on its mission of providing high-quality entertainment... Maybe it's time to rein in the 340B abuse? Adam Fein Deborah Williams Tom Romeo, MPH Mercatus Center at George Mason University Stand Together John Strom Colin Yokanovich Peter Stein Joanne Spetz William Sarraille Jesse Ehrenfeld MD MPH

57

11 Comments

My Friday good news celebrates the heroes of value-based care: primary care physicians and teams. The most successful #Medicare ACOs, those delivering value for Medicare and Medicare beneficiaries and sharing in that value, are primary care-centric #ACOs. We know how they do it; the playbook often includes support from enablers like Aledade, Inc.. Dr. Menard and his colleagues didn't give up when success wasn't immediate. How do we grow more primary care-centric ACOs and generate more value for Medicare and more access and quality care for beneficiaries? There are some health system ACOs investing in primary care and integrated teams. But it might take more forceful nudges from Medicare to get big health systems participating in total cost-of-care risk models. Or, we might need payment policies to give primary care more independence to practice comprehensive care. Congress could also consider restructuring the APM bonus to reward primary care "centricity". #primarycare #valuebasedcare Primary Care Collaborative David Raths David Muhlestein AAFP Foundation Thomas Culhane, MD, MMM, MS Darrin Menard, M.D. Stacey Richter https://lnkd.in/dThMvJrQ

11

1 Comment

Are your MIPS scores not looking good? Do you practice in FL, GA, SC? Even if your don’t before you take an additional Medicare Reimbursment hit (that is in additional to the 5th consecutive physician pay cut in the setting of record inflation) consider checking out the 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application. Between the Change Health Care Cyberattack, a tropical storm early this year causing record flooding in my area and then a Hurricane causing more than a week of power outages it’s impressive if anyone in my area had amazing MIPS scores. It has been a year of considerable challenges. Check out the link below if you are in Tx, FL, GA, NC, SC, or TN as some counties are eligible https://lnkd.in/eJiH7g7z https://lnkd.in/eHyp8qh7

10

I’m thankful that I could share my thoughts at that very hearing. There is so much misinformation about 340B. For me, it comes down to two main points: 1- if hospitals need that money as a subsidy to fund everyday activities, they should just ask for a subsidy. Let’s open up the books of these institutions, which already get a huge subsidy with their non-profit status, and see why they are running in the red. Are they really losing money on Medicaid patients or are they just bloated and inefficient? 2- let the subsidy follow the patient. This is a drug benefit program. Why does the funding go to an institution? Imagine if we did that with SNAP, giving a bunch of money to large restaurant chains in exchange for their promise to use the revenue to provide food for poor people (with no oversight to ensure that’s done). We don’t do that; instead we give the benefit to the person who needs it. Let’s change 340B to match that model. Adam J. Bruggeman, MD, MHA, FAAOS, FAOA Daniel Choi Colin Yokanovich John Strom Peter Stein Adam Fein Deborah Williams Lisa Grabert Maya Babu, MD, MBA Katie Orrico Larry Bucshon, M.D. Ann M. Richardson, MBA

23

1 Comment

Prostate Health for Veterans: Key Risk Factors Prostate health is a critical concern for many men, but especially Veterans. While prostate issues are common among men in general, Veterans face some unique risk factors that may increase their susceptibility. Studies have recently shown that former military aviators and aviation support personnel are at a significantly higher risk of developing cancers of many kinds but prostate is always at the top of the list. Age Age is one of the most significant risk factors for prostate health issues. As men age, the risk of developing prostate problems, including benign prostatic hyperplasia (BPH) and prostate cancer, increases significantly. Regular check ups, including prostate-specific antigen (PSA) screening becomes essential as Veterans enter their 40s and beyond. Family History A family history of prostate cancer is a significant risk factor. Men with a close male relative who have had prostate cancer are more likely to develop the disease themselves. Understanding their family medical history is essential, as it can guide when and how often to undergo screenings. In addition, screening protocols, such as genetic testing & advanced biomarker tests, can help identify higher risk & ensure early intervention. Military-Related Exposures Unique to Veterans are exposures which elevate the risk of prostate cancer. A recent study by the Department of Defense with a cohort of over 100,000 subjects focused on cancer incidence in military aviators & aviation support personnel. Compared to a demographically similar U.S. population, aircrew had a 20% higher rate of prostate cancer. Another issue was the median age of diagnosis for malignant cancer of all sites was 55 years in aircrew & 54 years in support personnel. In contract the median age at diagnosis for malignant cancer of all sites was 67 years in the reference U.S. population. Other potential exposures which affect prostate health include ionizing radiation, chemicals, and burn pits, which have been used in various combat zones to dispose of waste. These environmental factors may increase inflammation, disrupt hormonal balance, or cause DNA damage, all of which can contribute to prostate cancer. Lifestyle and Health Factors In addition to age, family history, and military-related exposures, Veterans should be aware of other factors including diet, physical activity, and overall health. Obesity, a lack of physical activity, smoking, and poor diet have been linked to an increased risk of prostate cancer. For Veterans age, family history, and military-related exposures can all contribute to the likelihood of developing prostate issues. However, with awareness and regular screening, Veterans can reduce their risks and catch potential problems early. Understanding these risk factors can empower men to take charge of their prostate health, ensuring a better quality of life as they age. Visit Veterans Prostate Cancer Awareness for more information.

80

5 Comments

Do you want to see who knows what we need to do and what is most important to fix health care? Listen to Sue Veer addressing this Committee. Hear from those who have a heart for serving most Americans most behind and are willing to sacrifice to address the next generation always ignored - and then we wonder why outcomes get worse. She was discussing 340B in about them most balanced and informative way possible. She noted how the CHC used 340 B "supports health care services that would otherwise be unavailable in many of the communities that we serve... the one that is near and dear to my heart are those early childhood services that are otherwise unfunded because we are building the health of the future generation" - Early Childhood Services - Sue Veer - More than a Hero - A leader for our nation and absolutely on target with her heart and her service and her testimony $600,000 margin lost and 0.6 FTE of labor to comply with 340 B - loss of nearly $700,000 in delivery capacity for those most in need! Did you hear this Congress, CMS, and others how you cut the lifeblood and distract the delivery team members time and time again over the past 40 years of design changes. Stop killing hospitals, practices, and delivery team members where most Americans are most behind. Start paying attention to Sue Veer and many others like her who can teach you how your designs fail and how they can work - for future generations. You do not fun health care where needed. You have forced a patchwork. Please don't kill the patches and pieces before you actually implement a plan for sufficient basic health access for 95% of the nation, not just 50 - 60%. Listen to the heart of health care delivery. Listen to those that you must fully fund who are the only ones that can be most and best for most Americans most behind.

1

1 Comment

Very important points about hospital consolidation. ⏺ Has led to the majority of physicians now being employed by a system. ⏺ A hospital system may have different priorities than physicians (in private practice). ⏺A system in which physicians have very little leverage to negotiate or change factors important to patients and clinical care. The real reason highlighted around 2 minutes 50 seconds. Short interview with beneficial insight. ⏺Physicians have joined unions not for wage negotiation but to focus on changes that affect clinical care. We as physicians do not have a unified voice. We have not organized ourselves well to create a unified voice. I am not sure that a union is the right path, but uniting to have a common voice, leverage, and negotiation power is needed. At 9 minutes Kevin Schulman highlights how this could be done without creation of a union (we need a system clinical strategy, not a market strategy) based on thoughts by @atul gawande. #UsingWhatWeHaveBetter https://lnkd.in/g5YTjFbD

8

1 Comment

Artificial intelligence is having a Glow Up✨ Ai isn’t new but Federal oversight is becoming more necessary. I have been talking in my most recent videos about how important risk management is as more organizations adopt AI. The White House released a policy this spring on AI Governance , Innovation , and Risk Management. We know that regulations are coming forward to change the Healthcare landscape because what happens at the Federal level always trickles down. I am looking forward to attending this event with Digital Risk Compliance Solutions and so many other leaders in the AI innovation space. I’ll be sharing what I learned at this FedLab. Follow Digital Risk Compliance Solutions so that you won’t miss out on the up-to-date information #riskmanagement #governance #ai #healthtech #hospitals #healthcarestartups

2

My next Signal takes a closer look at the latest antitrust probe into large dialysis companies and the shifting role of non-competes in kidney care. A recent POLITICO article provides helpful background around topics like NCAs in dialysis and impacts on the adoption of home dialysis technologies. This is an important discussion, so I'd love to hear from you. If you have something you'd like to share, whether it's an anecdote, comment or question for other readers, please leave a comment or send me a message. H/t to Tom Mueller for sharing the article last week. https://lnkd.in/e95a23JF

30

8 Comments

IRA Implementation Is in Trouble: We Need Straight Talk, Not PR from CMS Check out my latest Substack. In a STAT article, Dr. Meena Seshamani, the Director of the Center for Medicare, offered an uncompromising defense of the #InflationReductionAct and its implementation by the Centers for Medicare & Medicaid Services and U.S. Department of Health and Human Services (HHS). Published on the eve of the election, the article read, to me, like #IRA cheerleading. Though I celebrate her public service in the ultra-marathon that has been #IRA implementation under a (ridiculously) aggressive time table, I felt compelled to draft this open letter response. My bottom line? The views expressed in Director Seshamani’s article, a perfect reflection of CMS’s position, shows us the agency doesn't appreciate the challenges it faces and is disinterested in honest, candid dialogue about its extensive implementation failures. We can't address challenges we refuse to acknowledge. #CMS #HHS #PartD #Medicare #MedicareAdvantage #pharmaceuticals #medications #drugs #lifesciences #biotech #biotechnology #M3P #smoothing #access #patientaccess #affordability #innovation #pharmacies #pharmacy #pharmacist #PBM #PBMs #insurance #plans #costsharing #copays #premiums #transparency #healthequity #inclusiveness #federalbudget #raredisease #orphandisease #orphandrugs #goodgovernment #publicservice Health Resources and Services Administration (HRSAgov), HHS #HRSA #340B

27

10 Comments

It’s Sepsis Awareness Month! Are you looking for peer inspiration to get started on improving Sepsis practices? Check out our 2023 Sepsis Honor Roll hospital journey posterboards, compiled in this Excellence in Practice Hospital Journey virtual booklet. https://hubs.ly/Q02MWxGn0 #SepsisAwarenessMonth

6

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

11

Veterans who served in specific regions, including the Middle East, parts of Africa, and South and Central Asia, such as Afghanistan and Uzbekistan, now have easier access to benefits for certain cancers. The VA has expanded the list of presumptive service-related diseases to include acute and chronic leukemias, multiple myeloma, bladder, ureter, and similar cancers. This designation streamlines the process for affected veterans to receive disability compensation and other benefits. They no longer need to prove a direct link between their illnesses and their service; instead, they only need to demonstrate service in the designated areas and a diagnosis. Learn more about these changes at the provided link.

4