Unbiased Analysis of Today's Healthcare Issues
Joe Paduda of Managed Care Matters discusses rising Workers Comp cost in California: Of particular interest is the growing prevalence of unlisted codes in physical medicine (PM). Last year saw a huge jump in PM services coded as 97799 – “unlisted physical medicine”. Note that jump happened while the use of normal/traditional/common PM codes for…
There is only one difference between a bad economist and a good one: the bad economist confines himself to the visible effect; the good economist takes into account both the effect that can be seen and those effects that must be foreseen.” ― Frédéric Bastiat
According to a recent Health Affairs Perspective from Michael Chernew, the answer is ‘no’. In fact, physician and hospital prices may be too low. Although much has been made of high prices contributing to high spending in the US, 5 spending growth in Medicare is not driven by price growth. In fact, inflation-adjusted Medicare physician…
Payers will often look to disease analogs when making pricing and coverage decisions. These disease analogs can inform the level of rebates, need for prior authorization/utilization management, and the drug’s cost sharing tier. Traditionally, however, disease analogs are selected on an ad hoc basis. In a recent JMCP paper titled “A structured approach for identifying…
Today’s AI is not truly agentic because it’s not truly independent of you. The current crop of agents can’t set complex goals, or properly verify outputs. You have to spend a lot of effort on prompting, verifying, and system integrating. That just means the smarter you are, the smarter the AI is. It’s really amplified…
That is the title of my most recent paper published in Clinical Lung Cancer with co-authors Mark Danese, Melissa Laurie, Beata Korytowsky, Shane Jordan, Debbie Ryan and Sukhmani K. Padda. The study abstract is below. ObjectiveThis study examined brain metastases among patients with metastatic non-small cell lung cancer (mNSCLC), characterizing prevalence, use of brain imaging,…
Trump drug price ultimatum. Baumol cost disease: Child care vs. pet care & health care vs. veterinary care editions. Jennifer Doudna interview on CRISPR. AMA on PBMs. Life 30,000 feet underwater.