Gopal Bajaj, MD, MBA, FASTRO

My next Signal takes a closer look at the latest antitrust probe into large dialysis companies and the shifting role of non-competes in kidney care. A recent POLITICO article provides helpful background around topics like NCAs in dialysis and impacts on the adoption of home dialysis technologies. This is an important discussion, so I'd love to hear from you. If you have something you'd like to share, whether it's an anecdote, comment or question for other readers, please leave a comment or send me a message. H/t to Tom Mueller for sharing the article last week. https://lnkd.in/e95a23JF

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Consolidation is a reaction to the forces at work. Declining reimbursement, increasing administrative complexity, rising overhead. To remain independent, there are a couple options. One approach is to be very small, nimble, and able to keep overhead down. This often involves exiting the traditional system altogether. Doing so is risky, challenging, and difficult as a specialist. Not easy, but possible. Alternatively, you can find strength in numbers without resorting to the typical consolidation tactics. Things like supergroups or physician-led MSOs that have economies of scale and negotiating power. Full marks if you're able to improve quality, value, and access at the same time. Also no easy, but possible. Of course, reversing the forces that led to consolidation in the first place is also a possibility. Unfortunately, it seems like the least likely one. #medicine #healthcare #health #healthcarepolicy

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The role of AI and new technology to aid cardiology “As cardiology starts to face staffing shortages and continued decreases in CMS payments, Biga believes technology advances need to be leveraged in cardiology to help improve outcomes, make workflows more efficient to do more with less, and to help cut costs.” “Many of the solutions that can help were displayed on the expo floor, including telehealth and real-time remote monitoring systems. "I think this area will experience an explosion in use," Biga said. Another major area that will likely see an explosion of use is artificial intelligence (AI). She said AI will begin playing a rapidly growing role in cardiology in the coming years to augment cardiologists and other clinical staff. And not just on the front lines of patient care, but also in the back offices where AI will play a growing role in IT systems, smoothing workflow, analytics, automated quality metrics capture and many other areas. "We must use AI to reduce administrative burdens and improve patient outcomes," Biga explained. “

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Great meeting today and more work planned over the coming weeks to bring some interesting research insights as to what makes PNS effective and how we can design future systems that are consistently effective for our patients in order to drive greater payor coverage and improve patient access. Looking forward to crafting a really interesting presentation for this interactive presentation at NANS and cuing up Dr. Evan Peskin to share data on functional outcomes with PNS #innovation #PNS #neuromodulation #research #patientoutcomes #understandhowitworks #NANS

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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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Very important points about hospital consolidation. ⏺ Has led to the majority of physicians now being employed by a system. ⏺ A hospital system may have different priorities than physicians (in private practice). ⏺A system in which physicians have very little leverage to negotiate or change factors important to patients and clinical care. The real reason highlighted around 2 minutes 50 seconds. Short interview with beneficial insight. ⏺Physicians have joined unions not for wage negotiation but to focus on changes that affect clinical care. We as physicians do not have a unified voice. We have not organized ourselves well to create a unified voice. I am not sure that a union is the right path, but uniting to have a common voice, leverage, and negotiation power is needed. At 9 minutes Kevin Schulman highlights how this could be done without creation of a union (we need a system clinical strategy, not a market strategy) based on thoughts by @atul gawande. #UsingWhatWeHaveBetter https://lnkd.in/g5YTjFbD

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An interesting JCO commentary about MCEDs and how "adjusting the knobs" (increasing sensitivity to improve NPV) may be a smarter strategy in higher-risk populations like cancer survivors or smokers, whereas general population screening should prioritize specificity and NPV. (BTW, the podcast linked in the article is worth a listen.) https://lnkd.in/e242NSKs #mced #ai

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How can we leverage technology to improve antimicrobial stewardship? Guest expert Renuga Vivekanandan, MD and I review a new randomized clinical trial on EMR prompts and stewardship and discuss CommonSpirit Health’s approach. #5minutecheckin #antimicrobial Reference 🔗's: - JAMA https://lnkd.in/dCUGH4aU - Centers for Disease Control and Prevention https://lnkd.in/dGvXtYBV - Infectious Diseases Society of America https://lnkd.in/dn7D6UPB

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"The first thing is I worry about [with the IRA] the financial risk. Number two, [community practices] will have to add staff to implement this program because it’s complicated. Number three, what’s crazy is that this policy will decrease the financial viability of our practice pharmacies. At the same time, CMS [has proposed] decreasing the reimbursement for services to physicians by [approximately] 3% in the face of inflation [starting in the 2025 calendar year]. I don’t know if the government is trying to put physicians out of business, but they’re certainly implementing policies that are making it difficult to stay independent and viable. Our clinics can deliver care at approximately a third of the cost of hospitals, so putting your low-cost provider out of business so that they join a higher cost care setting, ie hospitals, makes zero sense." Jeff Patton, MD in OncLive on the impact of the #IRA for #CommunityOncology https://lnkd.in/eNRnbVz7

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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This is an interesting talk that challenges a basic assumption that more spending in healthcare leads to better outcomes. They defined health value by looking at mortality rates across 6 diaseases and healthcare spending per capital. Florida ranked 3rd and Vermont 46th. While healthcare spending was correlated with lower heart disease it was not correlated with opioid use disorder. This sheds light upon the fact that social determinants of health have a big impact on outcomes. #healthcare #healthspending

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"Compensation for U.S. cardiologists is up across the board, according to a recent survey published by MedAxiom, an American College of Cardiology company. The report identified similar trends for cardiovascular surgeons, highlighting the country’s high demand for all heart specialists in 2024 and beyond. The 2024 Cardiovascular Provider Compensation and Production Survey Report included updated data from more than 200 cardiovascular programs throughout the United States. Cardiovascular Business reached out to Jerry Blackwell, MD, MBA, MedAxiom’s president and CEO, to dive deeper into the report’s findings. Blackwell, a veteran clinician himself, discussed several trends sure to interest cardiologists and cardiovascular surgeons alike." Read the full conversation below: American Heart Association Heart Rhythm Society American College of Cardiology

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Dr. Ami Bhatt, MD is the chief innovation officer for American College of Cardiology. We discuss Ami's journey in medicine, her philosophy on innovation in healthcare, and the importance of collaboration between clinicians and technology leaders. Ami shares insights on the role of telemedicine, AI, and cybersecurity in cardiology, as well as her experiences with the FDA Digital Health Advisory Committee. The conversation emphasizes the need for a collective approach to improving patient care and the evolving landscape of healthcare.

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What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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Great analysis and facts... Short term horizons reinforce poor decision making and ultimately undermine healthcare. Value creation, serving communities, tackling SDoH, building community wellness, and ultimately creating impact takes time. You can’t use short term horizons to achieve long term goals and objectives in healthcare.

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"How to Live Longer" - reflecting on a fascinating discussion about the future of healthcare at the #newyorkerfest between Dr. Atul Gawande and Dr. Dhruv Khullar: A few key insights worth sharing: 💡 The future of medicine isn't just about living longer—it's about living better. We're finally recognizing that healthcare should align with patients' life priorities and values, not just survival metrics. 🔍 While maximum lifespan remains stubborn (~120 years), we're getting better at helping more people reach their 80s and 90s with quality of life. Countries like Japan and Korea are leading the way with 85-year average life expectancies. 📊 The power of accessible healthcare is striking: Thailand reduced deaths before age 50 from 60% to just 35% in 20 years by building strong primary care infrastructure and deploying community health volunteers. That's the difference good healthcare systems can make. 🌡️ Climate change is emerging as a major health crisis. From heat-related illnesses to changing disease patterns, our healthcare systems need to adapt quickly. ⚖️ The biggest challenge ahead? Healthcare equity. When our top 1% live to 89 while others barely reach 72, we have work to do. Countries succeeding in this space prioritize accessible primary care and community health workers. One measure Dr. Gawande uses in his work at USAID is % of people dying under the age of 50. This is what this measure looks like in different parts of the world: - Japan 2% - Europe -5%  - USA - 10%  - Africa - 65% #Healthcare #FutureOfMedicine #PublicHealth #HealthEquity #ClimateHealth

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Sharing key takeaways on the CMS Hospital Inpatient Quality Reporting program for FY2025. - Seven new measures are added (which are welcome, with the caveat of let's see how they work out) -> Patient Safety Structural Measure beginning CY 2025 with payment determination in FY 2027 -> Age Friendly Hospital CY 2025/FY 2027 -> Catheter-Associated Urinary Tract Infection Standardized Infection Ratio Stratified for Oncology Locations (CAUTI- Onc) CY 2026/FY 2028 -> Central Line-Associated Bloodstream Infection Standardized Infection Ratio Stratified for Oncology Locations (CLABSI-Onc) CY 2026/FY 2028 -> Hospital Harm – Falls with Injury (eCQM) CY 2026/FY 2028 -> Hospital Harm – Postoperative Respiratory Failure (eCQM) CY 2026/FY 2028 -> Thirty-day Risk-Standardized Death Rate Among Surgical Inpatients with Complications July 1, 2023–June 30, 2025/ FY 2027 - Five existing measures are removed (which is a breath of fresh air) - the unpopular PSI-04, and measures related to 30-day episode payments for acute myocardial infarction, pneumonia, total hip/ knee arthroplasty, heart failure - Two existing measures are modified (Global malnutrition composite score expanded from seniors over 65 to anyone older than 18 - this is very positive; and Refined HCAHPS measure - will post details on this next week.)

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At Ardent, I'm proud of the way we are leveraging technology to make healthcare better. Take our partnership with Qventus, Inc, which uses AI to make operating rooms across our system run more smoothly, for example... Navigating OR logistics to schedule surgeries can be a slow and complicated process, too often resulting in wasted blocks of surgical time and delays for patients. Qventus makes this process more efficient by using AI to predict surgeon schedules, expected case volume and OR space, and sharing this information with surgeons and schedulers to ensure the right surgeries happen in the right rooms at the right times. As a result, patients can get their procedures sooner, surgeons' time is better managed, and the OR team can spend more time on patient care instead of coordinating schedules. There's no doubt AI has the potential to improve healthcare. But it isn't a magic bullet. It's up to us to identify ways we can use it to improve broken processes or bridge time-consuming, inefficient gaps. And, most importantly, we have to answer the question: Does this make healthcare better for the people at the heart of it - the patient and caregiver? This one is a win-win and I'm grateful for our teams' willingness to embrace it! https://lnkd.in/eMzzFmBD #AIhealthcare #healthcare #innovation

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