Harvey Castro, MD, MBA.

Like an unfazed young quarterback who keeps firing it downfield despite a spate of interceptions, CMMI keeps tossing around VBC models hoping something will connect. Contrary to its intent, CMMI's programs increased spending by $5.4 billion from 2011-2020 with another increase in net spending of $1.3 billion by 2030. Of the more than 50 models the Center has implemented, only 6 have generated "statistically significant" savings. Only 4 (Home Health Value-Based Purchasing, Prior Auth Model for Non-Emergent Ambulance Transport, Diabetes Prevention Program, and Pioneer ACO) were certified for expansion. CMMI points to the voluntary nature of the programs as a challenge to achieving cost savings. However, CMS hasn't done itself any favors here by aggressively ratcheting down payments and making downside risk >>> upside risk. (Notably, two upcoming programs -- TEAM and Inpatient THA/TKA PROMs are mandatory). Finding the VBC sweet spot was always going to require some trial and error. Perhaps CMMI has learned from the programs that failed or weren't chosen for expansion. TEAM doesn't seem to be all that different from CJR. Making Care Primary aims to closely integrate primary and specialty care (or, more likely, incentivize PCPs to take on more of this work). Not surprisingly, one of the criticisms is lack of provider input. The programs are too complex, too expensive to administer, and aren't transparent. CMMI should take note of several studies demonstrating the success of physician-led VBC efforts. Here are some other thoughts: - Offer financial grants in 5- or 10-year terms for any organization that designs its own VBC program and presents a reasonable and viable clinical/business model. CMMI would do itself a favor by partnering with or at least listening to innovators. - Medicare Advantage complexity and risk adjustment handwaving shouldn't be the only mechanisms by which advanced providers can profitably care for beneficiaries. That program isn't saving money either, but it's the only way many of these approaches can generate meaningful revenue (and most still aren't profitable). - Have regular meetings with those building VBC models, particularly those with strong physician leadership. Those meetings should be transparent and productive of action plans and iterative changes that increase model viability. - Be more open about what your goals and targets are. No one should be a victim of their own success, and if you keep moving the goalposts, you shouldn't be surprised when people get frustrated and drop out. I'm certain that, given fair incentives, a meaningful voice, and an equal seat at the table, healthcare innovators can design sustainable VBC programs. But there needs to be more collaboration and a willingness to listen and engage. Otherwise, you're just slowly adding to the alphabet soup of also-ran programs. #medicine #healthcare #health #vbc #healthcareinnovation #valuebasedcare

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Warren Buffett said it best: “Price is what you pay, value is what you get.” When it comes to transactions involving physician practices, price and value are interconnected yet distinct. While price is a tangible, objective measure, value is more subjective, and can vary among individuals and circumstances. The regulatory environment for physician transactions generally requires that price be set at fair market value, which may preclude consideration of certain subjective value measures.  A proper FMV opinion requires comprehensive analysis of financial, operational, and market trends, applied with industry specific expertise.  Learn more: https://lnkd.in/g-WM5EqK #healthcarevaluation #valuation #healthcareadvisoryservices #advisoryservices

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How Ozempic ™️and Botox ™️ are Alike™️: 🤷‍♂️ Botox, the first aesthetic product to spark a generational shift, launched a revolutionary movement in medicine. Now enter the GLP-1 agonists—a drug class with 20X the appeal of anything similar, transforming the landscape. These drugs are poised to have a tremendous health, cultural, and economic impact for years to come. As a researcher, clinician, and professor on the cutting edge, I see similarities: 1. Widely Popular and Beneficial 🌍 - Botox: Over 10 million treatments per year. - GLP-1s (Ozempic, Wegovy, Mounjaro): With over 70% of the US population overweight or obese, already 1 in 8 Americans have tried it. Newer indications for heart disease and adolescent use could make it the first $100 billion drug. 2. Incredibly Effective 💯 - Patient satisfaction is in the 93% to 95% range for both.* 3. Low Side Effect Profile 🚫 - When used as indicated, both are safe and effective with few serious side effects. 4. Unexpected Benefits 😲 - Botox: From migraines to excessive sweating and urinary incontinence. - GLP-1s: Emerging benefits for cardiovascular, renal, and brain health. 5. Maintenance Required 🔄 - Continued benefits with regular treatment. 6. Success Breeds Adversaries 🤺 • The “vanity police” criticize, while the food, alcohol, and diet industries face challenges from reduced overindulgence. 7. Fear-Mongering on Social Media 📲 - Profiteers amplify rare, minimal side effects, claiming they have a better solution. 8. Highlights Societal Ills 🔦 - Raises awareness on the issues with processed foods and exposes beauty products making exaggerated claims. 9. Mood-Boosting Effects 😊 - Published data shows both help with major mood disorders.** 10. Big Bang! 💥 - Both launched a new discipline in health and wellness. But beware: Many “fly-by-night” providers and online pharmacies claim to be your supplier. Only seek reputable specialists; treatments can pose risks if not prescribed by experienced professionals. Matza LS et al., Patient. 2022 May;15(3):367-377* **The Antidepressant Effects of GLP-1 Receptor Agonists. The American Journal of Geriatric Psychiatry, Volume 32, Issue 1, 117–127 #ozempic #botox #botoxfacial #botoxday #botoxinjections #botoxfiller #botoxcosmetic #ozempicface #ozempicjourney #glp #glp1weightloss #glp1weightloss #glp1community

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As Epic Systems faces a new challenge in the healthcare EHR market, Particle Health has filed a lawsuit accusing the industry giant of unlawfully restricting access to U.S. medical records. The lawsuit, lodged in the U.S. District Court for the Southern District of New York, alleges Epic of anticompetitive practices. Particle Health claims that Epic is leveraging its market dominance to hinder competition and constrain the flow of patient data. Key points from the lawsuit include: - Particle Health filed a lawsuit against Epic Systems on Sept. 23, accusing the company of intentionally impeding its competitor's platform in violation of U.S. antitrust laws. - The lawsuit alleges that Epic is directing clients away from Particle Health's "payer" software, designed to enable health plans to retrieve and leverage medical records stored within Epic's system. - Particle Health argues that Epic asserts control over health data for up to 94% of the U.S. population. Epic Systems has refuted the claims made by Particle Health, dismissing the lawsuit as groundless. Stay informed as this legal battle unfolds in the healthcare tech industry.

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The #Turingtest of online reviews: humans cannot recognize #GPT4 #AI-written reviews. Human reviews were often mistaken for AI-generated reviews, and even more frequently, AI-generated reviews were mistaken for human reviews. (Marketing Letters, 12 April 2024) Source in comments.

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Digital Health Reimbursement Strategies of 8 European Countries and Israel. US healthcare can follow the example of European countries with a viable digital ecosystem, and functional model of reimbursement. At this point, there remains ambiguity on the standard of care, delivery process, method of contact, and the base layer of licensure needed to deliver "labeled" care. There is a lot of variability with what "digital health" looks like, who is delivering it, and what would be considered the standard of care. A good conversation starter, especially in the MSK community, prior to attempting to scale digital health and call of digital front door being the standard of care.

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#HealthAI #Ai is revolutionizing every aspect of our lives, including healthcare. But are we ready for this change? AI is transforming medical diagnosis: systems now analyze X-rays, MRIs, and ultrasounds with unprecedented speed and accuracy, identifying critical issues in real-time. Companies like Aidoc have developed technologies that detect brain hemorrhages and tiny tumors often missed by human doctors. The advantages are clear: 1. Faster #diagnosis, potentially saving lives 2. Increased accuracy in identifying subtle patterns 3. Reduction of human error However, we must remember: 1. Humans tend to over-trust #technology, especially AI 2. AI can make mistakes, particularly with incomplete or inaccurate data 3. AI is a powerful tool but doesn't replace medical judgment (yet?) The key is combining AI capabilities with human expertise. This collaborative approach leverages the strengths of both, leading to better outcomes.

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The Rising Cardiovascular Spend for Seniors and Medicare: The Case for a Value-Based Cardiac Model with AZ Cardiology. As the population ages, the prevalence of cardiovascular diseases among seniors is increasing, leading to a significant rise in healthcare expenditures. This trend presents a pressing challenge for Medicare and the broader healthcare system. To address these growing costs while ensuring high-quality care, a shift towards a value-based cardiac model is essential. The Burden of Cardiovascular Diseases on Seniors and Medicare Cardiovascular diseases (CVDs) are the leading cause of death and a major contributor to disability among older adults. Conditions such as heart disease, stroke, and hypertension are particularly prevalent among seniors, driving up the need for frequent medical interventions, hospitalizations, and long-term care. Key Statistics: Prevalence: Approximately 70% of adults aged 65 and older have some form of cardiovascular disease. Costs: In 2020, the United States spent an estimated $555 billion on cardiovascular diseases, with projections suggesting this could rise to $1.1 trillion by 2035. Medicare: Cardiovascular diseases account for a significant portion of Medicare spending, with nearly 25% of Medicare beneficiaries being treated for these conditions annually. The Need for a Value-Based Cardiac Model The traditional fee-for-service (FFS) model, which reimburses providers based on the quantity of care delivered rather than the quality, often leads to inefficiencies and higher costs without necessarily improving patient outcomes. In contrast, a value-based cardiac model focuses on patient outcomes, quality of care, and cost-effectiveness. Benefits of a Value-Based Cardiac Model: Improved Patient Outcomes: By emphasizing preventive care and chronic disease management, this model can reduce the incidence and severity of cardiovascular events. Cost Savings: Value-based care incentivizes providers to eliminate unnecessary tests and procedures, thus reducing overall healthcare costs. Strategies for Implementing a Value-Based Cardiac Model 1. Preventive Care and Early Intervention: Screenings and Risk Assessments: Regular screenings for risk factors such as high blood pressure and cholesterol can help in early identification and management of cardiovascular diseases. 2. Chronic Disease Management: Comprehensive Care Plans: Tailored care plans that include medication management, lifestyle advice, and regular monitoring can help manage chronic conditions effectively. 3. Care Coordination and Integration: Multidisciplinary Teams: Utilizing teams of healthcare providers, including cardiologists, primary care physicians, nurses, and dietitians, can ensure holistic patient care. 4. Outcome-Based Reimbursements: Incentive Programs: Medicare and other payers can implement incentive programs that reward providers for achieving specific health outcomes and cost savings.

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* Workshop announcement: Clinical trials to practice. * Clinical trials are crucial for testing the efficacy and safety of new medical treatments, but their successful implementation into everyday patient care requires careful consideration and understanding. * Join me as we explore how to effectively apply clinical trial findings to real-world medical practice. * Enroll at https://lnkd.in/dZSsKc9i * Applying Clinical Trial Findings to Real-World Practice - Translating Trial Results: * Translating clinical trial findings into real-world practice involves analysing and interpreting the data in the context of patient populations, clinical settings, and treatment guidelines. Learn a template for doing this in your clinical setting. * Implementing Evidence-Based Medicine: * Evidence-based medicine integrates clinical trial findings, patient preferences, and clinical expertise to inform medical decision-making. * Learn how to do this with real-world case studies from Dr Sengupta’s own practice. * Enroll at https://lnkd.in/dZSsKc9i * What you will learn during the workshop: 1. How to interpret clinical trials from published papers – with examples 2. A template for adopting clinical trial recommendations in your own practice. 3. Real-world case studies on disease response when treated exactly with clinical trial protocols. 4. How to balance trial recommendations with real-world limitations such as cost and availability. 5. Concept of non-inferiority incorporated in majority clinical trials globally and how this differs from superiority trial designs. 6. Statistical concepts such as intention-to-treat (ITT) analysis, Least Square Means used to present visual acuity in clinical trials, and many exciting concepts help you interpret trials better. 7. Live Q&A with Dr Sengupta Dont miss this chance. 🌟 Clinical Trials to practice - Workshop 29 🌟 Details: 🗓️ Date: 17th May, 2024 ⌚ Time: 20:00 – 21:00 📍 Location: Google Meet Investment: Rs 525 or $10 USD Reserve Your Spot: Max 100 seats available! * How it works: 1. Once payment is completed, you will get an email confirmation about the payment receipt. 2. The Google Meet Link will be shared with you on the morning of the meeting. 3. This meeting will be recorded and shared with all participants after the meeting so that you can watch it again, or if you missed the live session. * Enroll at https://lnkd.in/dZSsKc9i Contact information: For any inquiries or assistance, don't hesitate to contact +91-9943909766 via WhatsApp. Ready to apply clinical trial findings to real-world practice? Contact us today to learn more about our services and how we can help you optimize patient care and improve healthcare delivery.

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I attended the RAISE (Responsible AI for Safe and Equitable Health) Health Conference at Stanford University last week. Virtually. I still prefer in person conferences for the personal interaction, networking, the humanity, and the enjoyment of a personal common purpose-- to do better for our patients and families. But, I have been able to learn a lot more about the rise of #AI in healthcare by attending many virtual, free conferences with outstanding speakers. The RAISE Health Conference (https://lnkd.in/gfaYP5ub) was remarkable. A few highlights: -"Does AI work? Does AI work in my institution? Who pays for AI? Who is liable when AI goes wrong and a patient is harmed?" Jesse Ehrenfeld MD MPH president of the American Medical Association; questions that are yet to be answered. -"We are physicians. We take an oath to do no harm. That needs to be the first way that we’re assessing any of these AI tools." Nina Vasan, MD, MBA clinical assistant professor of psychiatry at Stanford, where she is founder and executive director of Brainstorm: The Stanford Lab for Mental Health Innovation. ---- I agree, but are big tech companies and data scientists taking the same oath? I believe there needs to be partnership between those creating and those using the technology. Presently it is an unbalanced partnership. -"AI is a mirror that reflects the society that we are in. I’m hopeful that every time we get an opportunity to shine a light on a problem—hold up that mirror to ourselves—it will be a spur for things to get better." David Magnus, PhD, Stanford Professor of Pediatrics and of Medicine. I certainly believe this to be true-- we have determined that tools that we use in medicine everyday have inherent bias to a much larger degree that would have been anticipated; look into automatic EKG interpretation and their race and gender bias-- that AI has recently uncovered by analyzing big data (prediction models of future heart failure using 12 lead EKGs does worse for African American females than others). Here are the videos of the symposium for those of you who missed out. They were quite good, informative, and thought provoking (https://lnkd.in/gw2m3WmH). We need more clinicians to become AI conversational with the goal to be AI literate if AI is to be applied safely, effectively, ethically, and unbiased in healthcare. #UsingWhatWeHaveBetter

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AI is good and growing fast but we are still in the developmental stages. Companies need to be careful with the claims they make. Texas Strikes Settlement with Dallas AI Firm Over Misleading Healthcare Tech Claims 📢 Issue: The State of Texas, through its Attorney General, filed a petition for the approval and entry of an Assurance of Voluntary Compliance (AVC) with Pieces Technologies, Inc. The key issue involves whether Pieces Technologies, Inc. engaged in deceptive practices under the Texas Deceptive Trade Practices - Consumer Protection Act (DTPA) by making false or misleading representations about the accuracy of its artificial intelligence (AI) products used in healthcare. 📢 Rule: The Texas Deceptive Trade Practices Act (DTPA) prohibits false, misleading, or deceptive practices in the advertising and sale of goods or services (Tex. Bus. & Com. Code §§ 17.41-.63). Specifically, Section 17.47 allows the Consumer Protection Division of the Attorney General’s office to investigate and take action on violations. 📢 Application: Allegations by the State of Texas: Pieces Technologies developed and marketed AI products intended to assist healthcare providers in treating patients. It claimed its products had very low error rates (referred to as "hallucination rates") in creating outputs like clinical notes. The state alleged these claims were false or misleading, violating the DTPA, since the AI could produce incorrect or misleading outputs. Response by Pieces Technologies: The company denied any wrongdoing or liability, stating that its claims about the AI’s accuracy were accurate and did not violate any laws. Assurance of Voluntary Compliance: To settle the matter without prolonged litigation, Pieces Technologies agreed to a series of actions, including: Providing clear and conspicuous disclosures in all marketing materials regarding the accuracy and metrics of its AI products. Prohibiting misleading or unsubstantiated representations about the accuracy or testing of its AI products. Ensuring transparency with customers about the potential risks and limitations of its products. Complying with the AVC terms for five years and implementing internal processes to monitor compliance. 📢 Conclusion: Pieces Technologies agreed to settle the matter by entering into the AVC, which does not constitute an admission of liability. The company agreed to specific practices and disclosures to comply with Texas law, as outlined in the AVC, and the court’s approval was sought for the AVC. --------------- Sanjay Juneja, M.D. Douglas Flora, MD, LSSBB, FACCC Nixon Gwilt Law Sean Weiss Ronald Chapman II, Esq. LLM Michael Crocker Rebecca E. Gwilt David Penberthy, MD MBA FACCC VMG Health ECG Management Consultants Etyon HLTH Inc. Aashish Shah ------ https://lnkd.in/enduqyDe.

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Concerns about medical note-taking tool raised after researcher discovers it invents things no one said — Nabla is powered by OpenAI's Whisper  An ambient AI assistant helps clinicians transcribe the patient-doctor interaction, and create notes or reports after the visit. This type of AI Assistant is becoming more predominant in use as a means to save clinicians time in charting. A study has identified Open AI's Whisper generates inaccurate information in Nabla. This potentially raises suspicion of how many other AI assistants generate a note that contains inaccurate patient information. Creative writing has no place in the medical record. The company behind Nabla says that it’s aware of Whisper’s tendency to hallucinate and that it’s already addressing the problem. However, Raison also said that it cannot compare the AI-generated transcript with the original audio recording, as its tool automatically deletes the original audio for data privacy and safety. Is Ambient AI ready for prime time when it comes to reporting patient information? Yes, the physician must proof his/her note just like Dragon or other similar tools. The level and degree of proofing required to look for hallucinations consume physician's time to the extent that one questions the viability of using these ambient AI tools. #OpenAI, #hallucinations, #bogusinformation https://lnkd.in/eq4m6sGj

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The 5 Golden rules of responding to reviewers' comments. Receiving a long list of reviewers' comments and edits my your article can be depressing. These are the rules you shouldn't miss. 1️⃣ Respond as FAST as you can. A prompt response shows the journal editor that you are serious and professional. 2️⃣ Respond point by point. Don't leave any reviewer's comment or question without addressing it. You can either comply to the suggested edit or politely explain why you wouldn't. 3️⃣ Keep track of your edits. You should keep all versions of your manuscript available to go back to. This is essential when submitting your manuscript to multiple journal in sequence (of course after rejection 😥). 4️⃣ Revise all your files before resubmission. Make sure you do all the needed edits to the separate files with tables, figures and supplementary materials. When resubmitting, make sure you upload the new ones. 5️⃣ Read all the edited manuscript one more time. This helps to make sure no conflicting statements are present and no more edits are needed. Follow me for more tip on research and publication. #ResearchersToolbox #research #publication #phd #scientificwriting #academicwriting #cancerresearch

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Have you been using ChatGPT or Google Gemini? "AI will not replace doctors, but doctors using AI will replace doctors not using AI" The world of medicine is a whirlwind of patients, paperwork, and complex decisions. Luckily, artificial intelligence (AI) is stepping up to be a doctor's not-so-secret weapon. While AI isn't replacing doctors anytime soon, it's offering a suite of helpful tools to streamline workflows and improve patient care. "AI will not replace doctors, but doctors using AI will replace doctors not using AI." Edge Copilot AI: Microsoft Edge Copilot is a built-in AI assistant that boosts productivity while browsing the web. Living in a sidebar within the browser, Copilot understands your browsing context, allowing you to ask questions directly related to the webpage you're on. This saves time and enhances efficiency by generating different creative text formats, such as emails and social media posts, without switching apps. Google Gemini AI: Google Gemini stands out with its versatility and real-time access to information. Seamlessly integrating web searches and data analysis, Gemini provides creative responses supported by real-time data. This makes Gemini a more well-rounded and informative AI companion for research and creative tasks. AI as Your Medical Scribe: Imagine composing a detailed patient email summarizing test results or treatment plans in a flash. Enter ChatGPT, a large language model that can draft personalized emails, explaining complex medical jargon in clear and concise language. This not only saves time but also fosters better patient understanding and adherence to treatment plans. AI for Enhanced Visuals: Need a quick and informative infographic for patient education? AI tools like Edge Copilot can help by creating compelling visuals to enhance presentations or patient materials. Imagine explaining a complex medical procedure with a clear and concise infographic – AI can make it a reality, improving patient education and reducing cognitive load. A Word of Caution: While AI offers a helping hand, it's crucial to remember its limitations. AI-generated content should always be reviewed and edited by a doctor before sending. Similarly, AI-created visuals might require adjustments for accuracy. Always ensure the information aligns with medical expertise. The Future of AI in Medicine: AI in medicine is rapidly evolving, extending beyond administrative tasks. AI analyzes vast datasets, uncovering hidden patterns for personalized medicine. Doctors can tailor treatment plans to an individual's unique genetic makeup and medical history, leading to more effective interventions. AI algorithms are aiding in drug discovery, offering a glimpse into a future with targeted treatments. #AIinMedicine #HealthcareInnovation #MedicalTechnology #AI #Productivity #PatientCare https://wix.to/j7Tpt1W #newblogpost

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Knowledge Is Power: Will AI Democratize Medicine? — An adapted excerpt from the new book, ChatGPT, MD While patients can consult "Dr. Google" about their symptoms, it rarely helps. Many of my colleagues are physicians, frequently they come to the office for a problem-focused visit and provide a diagnosis they think they have from researching the internet. This article goes on to state: "With training on how to enter comprehensive medical information, patients will soon have the ability to make an accurate diagnosis, monitor their chronic diseases, and obtain reliable answers to medical questions -- skills that today remain the sole purview of clinicians." It will be interesting to see if AI will replace the physician, I confidently say not in my lifetime as medicine is still an art where clinical judgment and medical decision-making will still be needed to best serve the clinical needs of the patient. #AI, #medicine, #practiceofmedicine, Patrick Desamours, PA-C, MBA, SFHM, CHCQM, Cesar M. Limjoco, M.D. https://lnkd.in/eMWnT4MV

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Imagine a world where a doctor can diagnose you without ever seeing you. Your condition can go untreated and make a company millions. "Your" doctor never touches you, and you can't hold them responsible for illegal billing or misdiagnoses. Guess what? You don't have to imagine this farfetched world. It happens in Medicare Advantage every day. Once pitched as a way to decrease cost, insurers are paid to take on additional risk, and that's become highly lucrative for them. And yet, those same "sick" patients are the same ones who will run into prior authorization, AI denials, and more when they try to seek services. We also need to discuss insurance companies practicing medicine. If you are diagnosing a patient, you are determining their treatment plan. We can't fool ourselves anymore. This is 100% treatment. #sickcare #medicaredisadvantage https://lnkd.in/eFzCRs2V

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