tag:blogger.com,1999:blog-83343212718272177592026-10-30T16:46:11.234-07:00Ideas for or from an evolving healthcare systemBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comBlogger3590125tag:blogger.com,1999:blog-8334321271827217759.post-54614631377461652912026-10-30T16:45:47.809-07:002026-10-30T16:46:11.234-07:00

 Here's a mini post to guide you to a press release at Guardant.  Pennsylvania has passed a biomarker law, HB 1123, aligning CRC coverage with ACS aand NCCN guidelines.https://investors.guardanthealth.com/press-releases/press-releases/2026/Guardant-Health-Applauds-New-Law-Ensuring-Access-to-Colorectal-Cancer-Screening-Innovations-with-No-Cost-Sharing-for-Pennsylvanians/

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-7484802952335620412026-10-30T13:19:10.518-07:002026-10-30T14:00:50.251-07:00

In an adjacent blog, I asked Claude to find publication dates for PFS and OPPS rules.  It sourced the data from different sites.  Sometimes it used McDermott plus, where you might find snippets of archives but the main site went down when the entity closed around September 1.I noted my own Discoveries in Health Policy has had 8M views and 3500 articles in over ten years.Here's what

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-23209060671927654192026-10-30T12:47:38.726-07:002026-10-30T13:59:08.356-07:00

 Annual "final rules" for Physician Fee Schedule and Outpatient Prospective Payment System (PFS and HOPPS or OPPS) come out around November 1, always after "market close."  November 1, so they are 60 days ahead of the implementation date of January 1, 2027.I asked Claude for a look-back and here's what I got.  BTW the query took about a minute.  The rules are named for the

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-65910557190045961002026-10-30T07:57:00.469-07:002026-10-30T08:35:43.259-07:00

In a recent analysis, Guardant has nearly $1B in market cap per 100 employees, rising to $25B market cap and 2500 employees since its founding fourteen years ago.  Here's an essay built on that theme.###Innovation Must Live in an EcosystemSometimes the most interesting number is one you weren’t looking for. Yesterday I was reading an article tracing Illumina’s financials over 15 years. A few

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-22101318636439491902026-10-30T07:44:12.817-07:002026-10-30T08:36:24.803-07:00

We have the multiple of share price over revenue, and share price over netcome.  Another one is share price per 100 employees.   For this metric, many molecular labs rank high, but Guardant and Natera lead the pack at about $1B market cap for every 100 employees hired.Here's the chart:click to enlargeQuest has market cap $28B, 57,000 employees, per 100, $49M.  LabCorp has

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-34304289443905072722026-10-29T22:07:30.695-07:002026-10-29T22:12:55.313-07:00

 For the Precision Medicine World Conference - 3 days at the end of January 2027 -here's the website:https://pmwcintl.com/And here's the agenda:https://pmwcintl.com/program/I'm on a panel this year.  The panel is chaired by Gabriel Bien-Willner, and includes Dawn Cardeiro of Roche Diagnostics, Stacey Brown of Cepheid, and Asad Ali Ahmad of Network Bio. Friday, 2 pm, track 3, session 3.&

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-47790876645916518972026-10-29T06:20:19.968-07:002026-10-29T06:23:31.380-07:00

 A companion blog discusses the excellent Michagan conference, December 10-12, 2026, sponsored by Association for Pathology Informatics.Here, we take a deep dive, reviewing the Journal of Pathology Informatics publications in 2026,  We used the same framework to take a look-back to 2022.  Finally, we discusses changes in interest, momentum, and emphasis.Find the white  paper

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-87673284621238690722026-10-29T02:30:49.266-07:002026-10-29T08:08:39.848-07:00

 Digital Pathology Gets Real: A Timely December Workshop at Michigan Medicine / Dec 10-11-12Byline: Chat GPT 6 (Los Angeles, October 29)An unusually practical conference on digital pathology and AI arrives as CAP and DPA join forces and federal regulators reconsider longstanding approaches to laboratory oversight and reimbursement.Digital pathology is entering a new phase. After years of

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-19875832769181828742026-10-28T11:54:03.287-07:002026-10-28T11:54:18.800-07:00

 GenomeWeb Makes PAMA’s Impact Personal—with a Downloadable SpreadsheetThe reporting: substantial cuts, and uncertain reliefChat GPT 6 (Los Angeles, October 28)GenomeWeb’s October 27 coverage pairs Adam Bonislawski’s reporting on looming PAMA cuts with a companion “By the Numbers” data feature. Together, they translate a national reimbursement debate into estimated consequences for

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-9367862409970978942026-10-27T14:04:12.647-07:002026-10-28T11:43:13.940-07:00

 A week ago, we used PAMA raw data to show not just the median price for codes, but the actual distribution of  payments (normal vs bimoda vs skewed left or right, etc).  Blog here.   In a later blog, we wondered if accusations (from employers) that United Healthcare was overpaying some providres, might be related to the most extreme prices seen on the far-right column of

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-83249864858412254012026-10-27T12:25:32.665-07:002026-10-27T12:35:29.250-07:00

 Header:  A large group of employers sues United Healthcare, asserting it overpays providers when it is merely dolely out third-party administrator payments (the employer's money.)  They say it is more careful when it is acting as an insurer and paying its own money.   ?Could this show up as high-end payments for lab tests (e.g. $200 for $10 test) in PAMA data?###See

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-33775026029042894742026-10-26T12:28:43.374-07:002026-10-26T17:46:00.426-07:00

Header:  Should digital pathology have a true revolution in the quality of input devices?###Recently, we blogged about how digital pathology advances slowly.  And rather than looking to radiology for advice, we should look to...the adoption of Da Vinci robotic surgery.Robotic surgery probably took half the prostatectomy market in ten years - at huge cost in equipment and infrastructure.

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-63382492887584371792026-10-25T11:46:49.447-07:002026-10-25T11:50:34.641-07:00

VERSION TWO - SUPER INTELLIGENCEThe original version of this blog discussed government websites switching to "SUPER INTELLIGENCE" terminology.  I included a playful, silly parody news article as well.This triggered a content warning from Google Blogger (my blog host), apparently because any kind of parody is something that is "not true" so it needs to be flagged.Here, I move the

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-39747971222479096022026-10-25T10:55:24.492-07:002026-10-25T12:29:32.097-07:00

VERSION ONE  (TRIGGERED GOOGLE PARODY WARNING)##You might have heard the White House use the phrase "Super Intelligence" a couple times.  This stems from a September 29 Executive Order that talks about AI policy but includes an order that the government switch exclusively to the term "Super Intelligence," not artificial intelligence.   That's wide-ranging - every webpage,

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-6674440163394574462026-10-24T21:08:28.034-07:002026-10-27T12:53:41.894-07:00

Here's an analysis run mostly by AI, based on my ability to "vibe code" instructions of what AI had to do with raw PAMA Excel data.Data shows the bar charts of the private payer price distribution for about 15 codes.  The distributions are strange and not many are "Guassian" or "normal."  While some are tightly distributed and others spread evenly around the price range.   See

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-66332082088932639932026-10-24T15:42:30.933-07:002026-10-24T20:28:54.000-07:00

This month, RFK Jr gave CMS itself the elective exclusion authority long reserved only for referral to the OIG's attorneys. Blog.Here I've asked Claude to put on its virtual law school professor hat and discuss how case law may have shaped the interpretation of the statute.   (The statute allows years of exclusion for violations as loosely defined as "unnecessary services" or "

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-45717525414802523882026-10-24T15:02:34.079-07:002026-10-24T15:12:09.157-07:00

HEADERDr. Oz’s recent and biting criticism of laboratory pricing and CMS’s unusual fraud documentary reveal an increasingly aggressive agency. This review examines the alleged schemes, enforcement strategy, and implications for CRUSH and exclusion authority—with one welcome observation for laboratories: the October 21 documentary and press conference did not single them out.###Something

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-41175870125018080072026-10-22T09:08:03.195-07:002026-10-22T17:06:13.414-07:00

 We often hear that adoption of digital pathology (since, for example, the $100M acquisition of Bioimagene by Roche almost twenty years ago)...is so slow due to microeconomics.Let's look at another transformation.  Robotic surgery aka da Vinci blew into the markets like a tornado.  There were four possible drivers -Better clinical outcomesBetter economics (faster-cheaper)Urologist

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-11250404497561496442026-10-21T22:42:08.839-07:002026-10-21T23:38:10.329-07:00

On the October 21, 2026, Abbott earnings call, there were some remarks on the pricing of Cologuard 2.0 in 2027 and forward.I'll  show the dialog, from Motley Fool transcript, and then some screen shots of the CMS pricing data and its sources.##https://www.fool.com/earnings/call-transcripts/2026/10/21/abbott-abt-q3-2026-earnings-call-transcript/....Our next question will come from Vijay Kumar

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-74787688634720643952026-10-21T21:40:16.254-07:002026-10-26T13:24:36.374-07:00

We often hear the first step in learning to use AI, is using it as a big powerful kind of Google.I find AI can often work as a "big powerful PubMed," going beyond the use of keywords in Pubmed and using instructions that AI can interpret and understand.  Also, since the domain is PubMed to start with, the risk of (hallucinations) should go from tiny to zero.Here's an example from my work

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-21802068883493831052026-10-21T14:19:03.290-07:002026-10-21T21:19:26.411-07:00

One brick at a time, FDA has been advancing LLM-based SAMD.  See the approval of draft-report software for ultraound and see the breakthrough status for radiology CXR draft-report software and see FDA's $1.3M contract for accelerating the regulatory science for radiology diagnostic reporting with AI.There's also the "big story"- in August FDA released a major concept paper for SAMD in an

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-25976361369398810902026-10-20T20:53:58.008-07:002026-10-21T21:18:13.872-07:00

A new national kidney care plan was a major effort in the Trump-1 administration (2019 here).  One of the leaders, Abe Sutton, now heads CMMI.   In October 2026, HHS announces an updated Kidney Plan.  Worth tracking. It gives important sightlines into how this CMS views healthcare innovation.A Google-AI summary is here.The new Kidney Care National Plan, KCNP, home page is

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-70422069406232313562026-10-20T12:43:55.221-07:002026-10-20T12:49:21.698-07:00

Just days after LabCorp agrees to acquire BioReference from OPKO, LabCorp agrees to buy Myriad Prenatal Health assets for $210M.Here, we let Chat GPT write the full case, including the assets, their origins, and how Myriad's public discussion of the business evolved over four quarters.As always with these reports, they are AI generated reported and not ground truth.  However they service as

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-51080329306219803482026-10-19T23:25:12.956-07:002026-10-20T12:29:25.827-07:00

Over the last several months, this blog has covered rapidly advances in AI software that will prepare radiology and pathology reports ready for human review, validation, and sign-out.  Radiology at Lightning SpeedThe scale tends to be bigger in radiology, and the benchmarks further.  For example, AIDOC gets Breakthrough Status for FIRST READ, meaning it's well along in the FDA

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-60144961695827932542026-10-18T07:23:25.112-07:002026-10-18T22:07:16.783-07:00

According to plans announced, Labcorp will acquire most remaining assets of Bioreference labs from OPKO.  See this new 12-page report developed entirely by AI from existing records, especially the past year of Investor Call transcripts. Find it HERE: https://drive.google.com/file/d/1e9dQl6vaZLcGq1q2561iAWz4tSCjlJoZ/view?usp=sharing # # # The PDF above is an AI-generated

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.com