tag:blogger.com,1999:blog-83343212718272177592026-07-14T06:18:48.490-07:00Ideas for or from an evolving healthcare systemBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comBlogger3415125tag:blogger.com,1999:blog-8334321271827217759.post-2370977055489041212026-07-14T06:06:56.391-07:002026-07-14T06:18:48.490-07:00

 A flurry of news for Alzheimer diagnostics, and we're closing in on the international Alzheimer conference in Toronto, AAIC-26.   Two longstanding organizations, the Michael J Fox Foundation [Parkinson's] and te Alzheimer Drug Discovery Foundation, ADDF, are partnering, initially with $5M, to develop noninvasive testing.  This $5M is part of a broader $50M effort of the ADDF

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-80314984335696467942026-07-13T21:34:53.211-07:002026-07-13T21:38:07.555-07:00

In July 2026, CMS released a proposed revision of its coverage policy for TAVR - Trans-vascular aortic valve replacement. The proposal and rational are at link.   See also this news story : https://www.scai.org/media-center/news-and-articles/proposed-tavr-ncd-released-key-changes-and-next-steps   Please review the history and rationales of CMS NCD coverage of TAVR discuss

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-7489341996644813372026-07-13T21:20:41.617-07:002026-07-13T21:38:21.608-07:00

News today of Anthem covering blood-based Alzheimer tests (here, here, policy here) reminded me of the tortured history of CMS and amyloid PET scans, plus the fact that no MACs have yet brought out any Alzheimer test policies (neither for serum tau nor PET).I asked Chat GPT to research and write up the history of CMS coverage of Amyloid PET.   (Prompt at bottom).# # # Amyloid PET

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-55984171352891851052026-07-09T06:42:50.010-07:002026-07-09T07:02:13.459-07:00

MolDx MACs finalize an LCD, proposed last summer, on "Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis."See draft DL40187 here.   See final L40187 here.   See request letter #1 9/19/2023 here.  #2 7/1/2024 here.   Posted as MA Connelly and H Imai,

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-69359146122338534842026-07-07T20:02:55.239-07:002026-07-08T15:53:58.013-07:00

Header: AI is making analytical reports cheap enough that they become tools for thinking, not just finished products.(Note - this essay generated by Chat GPT 5.5; fifth draft; substantial prompting.)(This essay began in April, when Stephane Budel/Decibio showed me a 10-page multi-part Claude Opus report.) When Reports Become Part of ThinkingPatterns from Index Medicus to ChatGPT Reveals

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-90528343846162417222026-07-07T12:44:15.939-07:002026-07-07T13:12:10.232-07:00

Here's another exercise where we give Chat GPT the ~600 current PLA codes and we ask it to find rhyme or reason in their multitudes.  The text and the analysis below are entirely machine-written with minimal instructions from me.###Here are AMA CPT PLA codes up to code 0659U. Some codes have been deleted, so the active file contains 583 lines rather than 659 separate items.Study them and

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-30191921984244428012026-07-07T06:30:28.024-07:002026-07-09T13:17:59.636-07:00

 A few days ago, this blog flagged that CMS was proposed to take software-intensive lab tests OFF the clinical lab fee schedule (at least in the hospital outpatient setting.)  Here.   We flagged that this is not a lab-only policy but a whole new field of CMS policy for "software as a medical service" or SaMS.  Here. "SaMS" occurs 91 times in the outpatient rule.On

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-8890486751416476042026-07-06T18:50:22.687-07:002026-07-07T13:13:53.655-07:00

 I saw a headline that Mdxhealth received a NASDAQ minimum price warning.  July 2.  https://mdxhealth.com/press_release/mdxhealth-announces-receipt-of-nasdaq-notification-regarding-minimum-bid-price-deficiency/I had recently seen it had closed an infectious molecular testing line of business, perhaps related to numerous payor cutbacks in 87798 payments.I asked Chat GPT for a

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-42610071044921664072026-07-06T17:54:42.832-07:002026-07-06T17:54:42.833-07:00

 AMA has posted applications (for public comment) for the July-August application cycle.  Find them here:https://www.ama-assn.org/system/files/aug-2026-pla-public-agenda.pdfComment via the indicated portal, by deadline July 20.  (I'm not sure the deadline but I'd suggest noon central.)

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-26228376077777469952026-07-06T17:34:09.903-07:002026-07-06T17:43:57.682-07:00

Palmetto MolDx and its pending decision on DCIS test coverage has made national news on NBC.  The news includes a detailed article as well as video stories. This article quotes Linkd-In, quotes an NBC video, and abstracts points from a long NBC article.See an article on Linked In by Dan Forche, CEO at PreludeDX.  Prelude makes the "DCISionRT' test to help make decisions about RT (

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-3333865980711871052026-07-02T23:20:52.525-07:002026-07-05T12:53:06.335-07:00

Entry point:The June 2026 issue of CAP TODAY features an article on pathology business economics by Dr Thomas Mezzetti.  He cites a 2025 AMA report on health insurance consolidation, and 2024 CAP report on adverse impacts of private payors.  What happened next:I asked Chat GPT to read these AMA and CAP reports, and discuss them.  I then asked Chat GPT to frame the

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-32408881325737613262026-07-02T13:46:39.749-07:002026-07-06T17:44:31.486-07:00

 Header:  The OPPS proposed rule for 2027 is released.  After a couple years of patchwork solutions, CMS adopts broad interim measues for software-dominant services.  CMS also promised a more worked-out plan for next year.##Find the proposed rule here:https://www.federalregister.gov/public-inspection/2026-13656/

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-18263380570532631912026-07-02T09:29:44.364-07:002026-07-02T09:29:44.364-07:00

Run, Don’t Walk: AMA CPT Big Changes for Software-Dependent ServicesI wrote a long blog on Appendix S a few days ago, here's the concise version I used as a mini-post on Linked In.###AMA has published the 2027 version of “Appendix S,” its greatly-revised policies for software-intensive services. But there’s more! AMA is also rolling out BIG changes and never-before-seen requirements in

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-9392479434899915032026-07-02T09:23:36.614-07:002026-07-07T11:40:52.444-07:00

HEADER: CMS Proposes Big Shift for Software-intensive Lab Services See pages 457-462 of the new Hospital Outpatient rulemaking for CY2027:https://www.federalregister.gov/public-inspection/2026-13656/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-paymentUpdate: The July publication in Fed Reg is here:https://www.govinfo.gov/content/pkg/FR-2026-07-07/

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-29416032322643826772026-06-30T14:56:42.884-07:002026-06-30T14:56:42.884-07:00

Back on April 23, I posted an AI-driven analysis of a new qui tam court case involving, "MD Labs."Lighthouse Lab Services will host a webinar on the topic on July 22, with some of the original attorneys involved.  (Some of them also spoke at Executive War College a month back.)Register here:https://www.linkedin.com/events/7477359203842482176/

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-18565454862491276032026-06-29T15:41:26.975-07:002026-06-29T16:20:22.018-07:00

Hannah Mamuszka, a cofounder of consultancy Alva10, has released a Go-To Essay on the Value of CDx, particularly in a world where drugs are increasingly expensive.This caught my attention in part because I was able to co-author an article this spring about how diagnostics get more and more cost-effective as drug costs rise (Kansal et al., 2026).  Mamuszka discusses a wide range of

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-65228415045583307902026-06-27T15:38:42.513-07:002026-06-30T06:30:47.244-07:00

Header: All About a New Blog about Appendix SJune 27, 2026 (Los Angeles)By: Chat GPT 5.5In a new post at Discoveries in Health Policy, medical innovation and reimbursement expert Bruce Quinn uses an unusual but effective format: he asks two advanced AI systems to analyze the AMA’s revised 2027 CPT Appendix S, then compares their conclusions. The result is a layered review of one of the more

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-79861968277885336342026-06-27T15:13:47.653-07:002026-06-30T06:30:00.577-07:00

 Two AI's Review the AMA's New Artificial Intelligence Coding Rules "Appendix S 2027"See AMA"s press release about early-release of a new Appendix S on AMA CPT AI Policy.https://www.ama-assn.org/practice-management/cpt/cpt-editorial-panel-strengthens-ai-taxonomy-keep-pace-techAs of June 27, I believe the 2027 version of Appendix S is here:https://www.ama-assn.org/practice-management/cpt/

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-3180475055977807902026-06-27T14:47:03.955-07:002026-06-27T15:49:14.087-07:00

 AMA has released a website that displays "early release" updates in policy in five areas:Category I CodesCategory III CodesPLA CodesAppendix S: The "AI Taxonomy"Administrative MAAA codesFind them all here:https://www.ama-assn.org/practice-management/cptEarly ReleaseThe Category I, Category III, PLA, and administrative MAAA code sets all include some form of early-release codes. Category III

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-44714716762857260382026-06-27T11:00:06.493-07:002026-06-30T14:53:09.983-07:00

 Radiology AI Is Starting to Write Reports. Pathology Should Pay Attention. [Claud Opus 4.8]Radiology AI is crossing the line from flagging findings to drafting the report. STAT's recent coverage of Cognita, Aidoc, RSNA 2025, and two new FDA breakthrough designations is, for digital pathology, a preview of the next three years — including the awkward part nobody markets: a draft report

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-58529211606724909282026-06-26T11:36:54.373-07:002026-06-26T11:44:15.144-07:00

The next AMA CPT meeting is in Minneapolis, September 17-19, 2026.The registration isn't open yet, but will be found here:https://www.ama-assn.org/membership/events/cpt-editorial-panel-meetingLab tests follow an early comment cycle, from now June 26 to July 13.Note that comments are due noon central, ten pacific, on July 13.(Regular, non-lab code list to be released July 10).See the lab code

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-21801362107049704192026-06-26T11:01:20.828-07:002026-06-26T11:08:40.624-07:00

 We're gearing up for PAMA cycle II, CMS will release millions of lines of data in August or September 2026, in preparation for the new CLFS fee schedule in 2027.Here's a look back at some of the wild data results in 2017.https://www.discoveriesinhealthpolicy.com/2017/09/pama-raw-data-provides-unprecedented.htmlHere's one panel from the 2017 blog.Eg BRCA pricing ran from $1000 to $3220 (

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-42696840383157612042026-06-26T10:25:32.413-07:002026-06-26T10:56:29.893-07:00

From time to time, there are articles about the wide dispersal of prices in US healthcare.  (One patient and health plan pays $1000, another patient and health plan pays $6000).  We saw that wide dispersal of pricing in the 2016 clin lab payment data released in mid 2017 by CMS as part of PAMA market rates for lab test pricing.  By August 2026, we'll have a huge update of 1H2025

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-28441658577126678972026-06-26T09:40:24.127-07:002026-06-26T10:40:51.249-07:00

Digital Pathology Association Issues Two Linked Documentson AI Validation and Reimbursement1. Recommendation Statement for the Validation, Implementation, and Clinical Application of Artificial Intelligence Within a Clinical Laboratory from the Digital Pathology Associationhttps://journals.sagepub.com/doi/10.1177/2993091X2614559752. Full Speed Ahead: Shaping the Future of Digital Pathology

Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-26938373343717834352026-06-25T13:50:17.381-07:002026-06-28T11:48:41.264-07:00

In December 2025, HHS announced an RFI on how it could improve access to AI for clinical care.  See webpage here, Fed Reg here.  (90 FR 60108, 12/23/2025).On June 25, HHS held an hour-long webinar to update the public on progress.  While the three arms of the program are regulation, research and development, and reimbursement, they opened by announcing this webinar would include

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