Christina Brennan, MD

It’s Sepsis Awareness Month! Are you looking for peer inspiration to get started on improving Sepsis practices? Check out our 2023 Sepsis Honor Roll hospital journey posterboards, compiled in this Excellence in Practice Hospital Journey virtual booklet. https://hubs.ly/Q02MWxGn0 #SepsisAwarenessMonth

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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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📢 Check out the latest issue of the Journal of Diabetology! (Apr-Jun'24, Volume 15, Issue 2) Highlights include: • Review articles delve into diabetes mind-body interactions, cardiovascular benefits of newer combinations, neuromuscular taping and Clinical and Biochemical Features for diabetes classification. • Original articles cover diverse topics such as non-pharmacological diabetes management, Insulin Degludec impact on COVID-19 patients, and new-onset diabetes in Long COVID-19. • Case reports spotlight persistent hypoglycemia and a prolonged honeymoon phase in type 1 diabetes. • A letter to the editor discusses the potential of AI in gestational diabetes management Read more: https://lnkd.in/gFvprUmM #Diabetes #Research #Healthcare #Innovation #JournalOfDiabetology

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Novel Efficacy Index Compares Long-Term Therapy Outcomes in AD Treatments. To assess long-term treatment outcomes for atopic dermatitis (AD), researchers have introduced a novel efficacy index that accounts for both on-drug and off-drug responses. https://lnkd.in/d2PGB4s3

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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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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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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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5 yr outcomes of 150 difficult-to-treat RA (D2T RA) pts - D2T RA resolved in 45%, persisted in 50%, & 5% died. Resolved D2T RA was signif younger, had more Rx changes, & more IL-6i use. Mortality predicted by comorbidity index, steroid escalation (OR 3.50; & 32) https://buff.ly/4bG7aRQ

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I get Dr. Yang's concern about large, wealthier health systems adopting AI sooner than smaller, poorer organizations, but this is actually a good thing...unless your time horizon is myopically short. Big organizations, with much larger budgets and sophisticated IT teams, can afford to take risks, make mistakes, and test out exciting (but still unproven) emerging tech while smaller organizations certainly can't (for the most part). So let the behemoths take all the risk, do the heavy lifting first, and then smaller organizations get to adopt truly proven solutions at lower risks/prices...once these have run the Kaiser, Mayo, Intermountain, etc., gauntlet. It's all part of the plan... #healthcare #startups #startup #ai #generativeai #digitalhealth #emergingtech Kaiser Permanente Cleveland Clinic Mayo Clinic Risant Health Intermountain Health https://lnkd.in/gckgQB_q

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In my latest interview with Becker's ASC Review, I shared that One of the most important leadership lessons I have learned is the value of resilience and strategic adaptability. Building an Ambulatory Suregery Center from the ground up comes with many challenges, from regulatory hurdles and staffing complexities to financial constraints and operational setbacks. Resilience is essential for navigating these obstacles and is not just about having a vision. It is about being determined to push through difficulties while staying focused on the end goal. The ability to adapt strategies when circumstances change is equally important. In the dynamic healthcare environment, being flexible and open to new approaches is crucial for overcoming unforeseen challenges and capitalizing on emerging opportunities. I firmly believe in adopting an entrepreneurial mindset, allowing flexibility, and fostering innovative problem-solving. I believe that leadership is about empowering a team to remain motivated and aligned with the vision, particularly during challenging times. It involves cultivating a culture of trust, collaboration, and continuous improvement, where every challenge is viewed as an opportunity for growth and innovation. 

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It seems that the government is serious about finally realizing the vision of true health data interoperability. The attached Point-of-Care Partners blog post describes the recently released HTI-2 Proposed Rule which is another step in the fruition of that vision. Point-of-Care Partners can help your healthcare organization stay ahead of the waves of regulatory activity around interoperability. Let me know if you are interested in learning how.

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The 25 most popular (or priciest/popular?) #prescriptiondrugs in the US: This was recently published by Beckers: https://lnkd.in/gBpHgQkv Just for fun, I analyzed to see what drugs, if any, are actually acquired over at the pharmacy vs. billed in the medical benefit. Spoiler alert - many of them are billed in the MEDICAL benefit, NOT picked up at your local retail pharmacy. (And to my pharmacist colleagues out there - yes, most if not all of these can be billed under either benefit, but I marked where they're typically billed...). Next, I looked to see which we had available at teamcubancard.com. Self-funded employers - you can save a ton of money for your plan by allowing patients or employees to move to biosimilars to adalimumab below (#2). We're striving to add more drugs and biologicals every day at Mark Cuban Cost Plus Drug Company, PBC! #pharmacy

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Are your MIPS scores not looking good? Do you practice in FL, GA, SC? Even if your don’t before you take an additional Medicare Reimbursment hit (that is in additional to the 5th consecutive physician pay cut in the setting of record inflation) consider checking out the 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application. Between the Change Health Care Cyberattack, a tropical storm early this year causing record flooding in my area and then a Hurricane causing more than a week of power outages it’s impressive if anyone in my area had amazing MIPS scores. It has been a year of considerable challenges. Check out the link below if you are in Tx, FL, GA, NC, SC, or TN as some counties are eligible https://lnkd.in/eJiH7g7z https://lnkd.in/eHyp8qh7

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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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The Psoriatic March: PsA before PsO https://buff.ly/3CQxT2s

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