tag:blogger.com,1999:blog-83343212718272177592026-05-16T06:04:37.037-07:00Discoveries in Health PolicyIdeas for or from an evolving healthcare systemBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comBlogger3342125tag:blogger.com,1999:blog-8334321271827217759.post-87257223773785661052026-05-15T15:52:36.943-07:002026-05-16T06:04:37.036-07:00Dr Bien-Willner Is Departing MolDx - An Update Gabriel Bien-Willner to Transition Out of MolDX Medical Director RoleMay 15, 2025 (Columbia, SC)LinkedIn by GBW: here.Gabriel A. Bien-Willner, MD, PhD, the medical director most closely associated with the modern expansion of Palmetto GBA’s MolDX program, has announced that he will transition out of the MolDX Medical Director role as Palmetto seeks a successor.The move is significant Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-71449468508264683912026-05-14T19:36:18.055-07:002026-05-15T13:49:53.090-07:00Digital Pathology Dollars. Re-live the Film-Digital Switchover at the RVU Ranch. (What's Past is Prolog?)What’s Past Is Prologue: Medicare, Radiology, and the Strange Migration from Film to Digital##The CMS-RVU migration from film to digital radiology was not simply a technology upgrade; it became a revealing Medicare payment episode. Around 2013–2017, CMS and the AMA/RUC translated the disappearance of film, processors, view boxes, and related supplies into the mechanics of practice Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-3027354902922882026-05-14T15:10:49.381-07:002026-05-14T15:10:49.382-07:00Updated: Amal Thommil's MRD Roadmap Amal Thommil of DeciBio updates his map of MRD coverage in oncology.Find it here:https://www.linkedin.com/posts/amalthommil_reimbursement-of-mrd-in-solid-tumors-may-ugcPost-7460780354581303298-xIVG? see original at linked inBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-8766756805930117312026-05-14T15:01:18.710-07:002026-05-14T15:07:28.796-07:00AI Guest Column: Chat GPT on TROP2 CDx from Roche Diagnostics Day A previous blog summarized the 3-hour, annual Roche Diagnostics Day.I asked Chat GPT to go back to the transcript and discuss the news as far as TROP2 CDx coming through FDA using the AZ QCS technology.As always, take this as an example of the current state of "AI thinking and writing" - not as gospel truth.###Roche’s TROP2 / AstraZeneca CDx StrategyWhy Roche is treating this as more than “Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-86274655888187389222026-05-14T14:55:25.960-07:002026-05-15T13:48:06.607-07:00AI Guest Column: ChatGPT & Opus: Roche Diagnostics DayOn May 12, 2026, Roche held its annual Diagnostics Day with a 3-hour webinar and a 150-slide deck.Find them here: https://www.roche.com/investors/events/diagnostics-day-2026I gave the materials separately to Chat GPT and Opus 4.7, which provided 13p and 24p reports. I asked Chat GPT to produce a single combined report with a cover page (15pp).Remember, this isn't an example of Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-1372230069493478842026-05-14T13:53:43.885-07:002026-05-14T17:43:17.112-07:00To Fix Software and AI Reimbursement - Do We Need to Understand the RUC?To Fix Software and AI Reimbursement - Do We Need to Understand the RUC?Maybe.For at least five years, CMS has had difficulty pricing software-intensive services like AI. In 2025, CMS included an RFI for "public comment" on these problems in both the July 2025 Physician (Part B) rulemaking and the Hospital Outpatient rulemaking. One Damn Thing After AnotherOne case study was the Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-39270219040048813802026-05-14T13:32:29.467-07:002026-05-14T13:58:42.532-07:00Understanding FDA Regulatory Documents for Digital Pathology: PAIGE and ARTERA-AIWe often hear there are 1000 FDA software/AI devices or SaMD for radiology, and only a few for pathology.Let's look at pathology, and see what the FDA regulatory publications are. We also look at the sometimes-confusing delays and timelines in the appearance of documents.Classification Letter and "Safety and Effectiveness" ReviewFDA issues a clearance or classification letter, reflecting Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-37756186433525417262026-05-11T13:31:00.000-07:002026-05-11T13:50:43.376-07:00WISeR Prior Authorization - It's Worse Than We Knew. Case study: DBS in PD.Announced last summer, CMS has now instituted the WISeR program to force prior authorization into Medicare Part B using outside venders and their software.There's a new piece about it in JAMA Internal Medicine currently. Kannarkat et al. They note, CMS puts forth a thoughtful effort through WISeR to reduce health care waste....With WISeR, AI tools prescreen PA documentation for Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-21314818519580991122026-05-11T08:12:00.000-07:002026-05-11T08:12:48.205-07:00AI Guest Column: Will Genomics Move In-House or to Send-Out?Header: For years, one of the Grand Questions in genomics has been "in house versus send out." I asked Claude Opus 4.7 to write a book chapter on how the pro's and con's currently align.As always with "AI Guest Column," the point is not the "answer" but to show us a checkpoint on how AI currently researches data and assembles an argument.####Will new landmark events, like the approval of Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-26474731710930209522026-05-11T08:06:00.000-07:002026-05-11T11:47:11.930-07:00AI Guest Column: What Next for ArteraAI?Header: Digital pathology at warp speed - Tempus acquires Paige, Roche aquires PathAI, ArteraAI gets a true FDA application (Breast cancer prognostics). What should ArteraAI do next? I asked Claude Opus 4.7 to write a guest column.###1. Overview2. ArteraAI Options Map3. What a CEO Thinks at Night4. Using High-Low Scenario Modeling####1. OverviewThree AI Pathology Companies — Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-76947066889349632862026-05-10T18:01:00.000-07:002026-05-10T19:01:12.295-07:00What? CMS Runs RFI on Why Labs Hate Prior AuthorizationA big thanks to Vitali Khvatkov at Linked In for highlighting a CMS RFI on 'Prior authorization" with specific attention to the nightmare it creates for clinical laboratories. (See also a blog by Brendan Keeler). (See also a CMS announcement and Fact Sheet.)Find the April 14, 2026, Fed Reg page here:https://www.federalregister.gov/documents/2026/04/14/2026-07205/Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-68874011091142850562026-05-08T20:17:00.000-07:002026-05-11T07:57:53.376-07:00AI Guest Column: the Roche-PathAI Acquisition?Big news that Roche buys PathAI for up to $1B. I pulled together some twenty viewpoints harvested from Linked In, press releases, a Health Advances podcast, and put Chat GPT into "agentic" mode to review it all. I specifically asked for some perspective from the earlier Tempus-Paige deal.As always with this kind of blog, the point is not exactly what stance Chat GPT takes Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-84794676248187907002026-05-07T19:13:00.000-07:002026-05-13T09:56:59.339-07:00H.R. 8500: Ensuring Timely LCDs! The Bill's Language is Posted!HEADER: Old News: Last week, CAP and some Congressionial offices announced H.R.8500, the "Timely Access to Coverage Decisions Act." Early news - Here. New News:The legislative language is now posted! Find the full text of the bill in "Congressional Legalese" here.Find the full contents of the bill described in "Just Plain English" right here below.For Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-26815740881871254722026-05-07T18:07:00.000-07:002026-05-07T18:52:32.702-07:00Deep Dive: The New UPMC/Pitt Report on Access to Genomic TestingUPMC report here. See subscription coverage at Genomeweb here. (Alexandra Byrne.)###AI CORNER (Chat GPT)##UPMC Precision Medicine Report: When “Access” Means More than Just the Test Precision medicine has spent two decades being described as the future of care. The new UPMC/University of Pittsburgh report offers a more practical update: in many health systems, the future has Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-41435921063842633622026-05-07T17:49:37.068-07:002026-05-07T22:58:02.531-07:00HUMOR: I Start Using CLAUDE OPUS. Claude Opus Reviews "Me"
Header: Using CLAUDE. I have been using Chat GPT exclusively for three years. Recently, friends have introduced me to areas where Claude Opus has advantages. I asked Claude Opus to review "me." I haven't altered the result - it's below.###
Claude Opus 4.7 Researches Bruce Quinn MD
Professional Identity
Bruce Quinn is an expert on health reform, Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-38719061901999635702026-05-06T09:28:00.000-07:002026-05-07T19:41:15.619-07:00Legislation Would Demand Faster LCDs. See H.R. 8500 from Congressman Dunn (R FL).SEE UPDATE: THE BILL IS POSTED.CAP and LCD PolicyCollege of American Pathologists has taken the point position, for years, on improving LCDs at Medicare. For example, some of their ideas were incorporated in 21st Century Cures, which passed during the Obama-Trump transition.New NewsApril 28, CAP announces creation of H.R. 8500, "Timely Access to Coverage Decisions Act" (TACDA).I'll cut and Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-58927687090977667802026-05-05T07:35:00.000-07:002026-05-11T08:15:44.885-07:00Medicare's 14 Day Rule and 3 Day Rule: Why One is Crazy and the Other Isn't .I learned much about this when I recently asked Chat GPT to write long detailed essays on the history of each rule, 3-day and 14-day. Since I first worked as a CMS medical director in 2004–2008, I have been familiar with Medicare date-of-service rules and their interaction with hospital billing. For inpatient admissions, Medicare generally bundles related hospital services, and Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-54659288712323661682026-05-05T07:06:00.000-07:002026-05-06T11:59:06.814-07:00Congr Comer Asks CMS - Does AMA CPT Complexity Support Fraud?Header: Congressman Comer (KY) writes CMS, raises questions about AMA CPT structure and coding, and fraud and abuse issues.Comer letter here. Comer press here. STAT PLUS (subsc.) here.###Could the complexities of US coding systems contribute to healthcare fraud? Certainly something went awry in Medicare - when the Novitas MAC got lost in the forest of CPT genetic Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-50095104990426636172026-05-04T18:04:00.000-07:002026-05-04T18:43:42.520-07:00Chat GPT Discusses the Serena-6 Trial, ESR1 by LBx, and FDA Advisory Committee ODACChat GPT summarizes the data on the recently released SERENA-6 trial and ODAC-FDA advisory board. OncLive here. Fierce Biotech here. Precision Medicine Online (Turna Ray) here.###Chat GPT:SERENA-6 was a Phase III trial in HR-positive, HER2-negative advanced breast cancer testing whether therapy should be changed when an ESR1 mutation first appears in circulating tumor DNA, Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-86186415867459830302026-05-03T20:10:00.000-07:002026-05-06T15:10:53.927-07:00RFK Blog 02: Chat GPT Assesses the Seven RFK-Hill Transcripts (April 2026) RFK Jr.’s Seven-Hearing Hill Marathon: April 16–22, 2026Blog 01 - I asked Chat GPT to find all 7 hearings and identify transcripts. Blog 01 is all the source material for Blog 02.https://www.discoveriesinhealthpolicy.com/2026/05/chat-gpt-saves-hours-finding-7-rfk-jr.htmlBlog 02 - Here - I ask Chat GPT to write about the 7 documents, based on 200,000 words in 7 transcripts (see Blog 01Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-20008688256139496582026-05-03T19:42:00.000-07:002026-05-12T14:19:41.096-07:00AI Guest Column: Twenty Years of Lab Date of Service Rules Memorandum on the Medicare
Laboratory Date of Service Rule
Executive
summary
This memorandum was written by Chat GPT in its “deep research” mode,
after I gave it brief remarks on some of the key dates to look for (1997, 2001,
2006.)
I would add an explanation of how outpatient hospital patients have been handled:
Outpatient Hospital Specimens
1) Before 2006, Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-61589723060405800202026-05-03T17:25:00.000-07:002026-05-03T22:05:17.894-07:00RFK Blog 01: Chat GPT Saves Hours: Finding the 7 RFK Jr HearingsBlog 01 - HERE - I asked Chat GPT to find all 7 hearings and identify transcripts. HERE.Zip file of the 7 transcripts at google drive here. For example, upload the transcripts into your AI and ask it questions (E.g., "Did the meetinsg discuss telehealth?")Blog 02 - I ask Chat GPT to write about the 7 documents.https://www.discoveriesinhealthpolicy.com/2026/05/Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-25696862207230797762026-05-01T08:44:00.000-07:002026-05-03T19:28:17.913-07:00CMS Announces Summer CLFS Pricing Meetings + Special PAMA Pricing MeetingCMS has posted dates for its regular summer meetings for new lab code pricing. In addition, CMS has planned a September two-day meeting for pricing those codes with missing or anomalous results in the current PAMA pricing survey.click to enlargePublic Comment June 10CMS will hold its public comment meeting for pricing new lab tests for 2027, on June 10, 2026. That's quicker than the Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-40341215618653121022026-04-29T07:44:00.000-07:002026-05-12T14:19:02.185-07:00AI Guest Column: Can It Explain the Three-Day Rule (for DRG) Can Chat GPT explain gnarly tortuous Medicare policies? One example is the 3-day-rule. Services to a patient by a hospital are bundled for 3 days backwards from the admission date. This includes time in the emergency room, but potentially quite a bit more. It's a tricky policy and I asked Chat GPT to research and explain it. This Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-20005152042227245392026-04-29T07:35:00.000-07:002026-04-29T10:24:08.393-07:00Chat GPT Explains Its Understanding of Where AMA Appendix S (AI Services) Comes FromFor a year, AMA has been extensively revising its Appendix S, which is guidance for categories and coding of software-intensive services like AI.See the current Appendix S here. See a peer reviewed article on its goals here. (PMC9719561.) See an online article by its co-author Dr Frank, November 2025, here.AMA has multiple bodies - like the Digital Medicine Payment Advisory Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.com