LUKASZ KOWALCZYK MD

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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I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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Discover Amarasate—a plant-based approach designed to target appetite control. Join Dr. Ed Walker as he explains how it signals the gut to tell the brain you’re full, offering a natural and scientifically validated method for managing hunger. Dive into the science behind this innovative solution!

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Digital health leaders should be *hoping* for an investment boom this year instead of *bracing* for one... One statistic jumped out at me: 46% are *still* working to achieve meaningful product-market fit. Doesn't seem to bode well for fundraising? Don't get me wrong - I'm hopeful that digital/virtual care options as part of the continuum of care can help people improve their health and finally start to bend the cost curve in healthcare. But a crowded market, with operating cash stretched and less purchasing activity suggest consolidation this year. Any investors care to weigh in? https://lnkd.in/gtG8uz6d

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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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Is Value-based care (VBC) the panacea that everyone now thinks it is? VBC is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes rather than the volume of services provided. Pros: 1. Improved Patient Outcomes: VBC incentivizes healthcare providers to focus on preventive care and managing chronic conditions, leading to better overall health outcomes for patients. 2. Cost Efficiency: By emphasizing preventive care and reducing unnecessary procedures, VBC can lower healthcare costs for both patients and the healthcare system as a whole. 3. Increased Patient Satisfaction: As healthcare providers are encouraged to spend more time on patient care and wellness, patients often report higher satisfaction with their care. 4. Holistic Care: Providers are motivated to address not only acute medical conditions but also long-term health through personalized care plans that consider a patient’s entire medical history and lifestyle. 5. Better Care Coordination: VBC encourages integrated care, where different providers collaborate to offer seamless and coordinated treatment across various specialties and stages of care. 6. Reduction in Hospital Readmissions: Providers are financially incentivized to reduce avoidable hospital readmissions by focusing on appropriate follow-up care and managing conditions proactively. Cons: 1. Implementation Challenges: Transitioning from a fee-for-service model to a value-based one can be complex and costly for healthcare systems, requiring new infrastructure, data collection methods, and staff training. 2. Risk for Providers: Providers take on financial risks if they fail to meet the agreed-upon health outcomes. This might deter some providers, particularly smaller practices, from adopting the model. 3. Data Requirements: Successful implementation of VBC requires sophisticated data analytics to track and measure outcomes, which can be difficult and expensive for smaller providers to implement. 4. Potential for Underservice: There’s a risk that some patients might receive less care than they need if providers become too focused on cutting costs and avoiding expensive treatments to meet value targets. 5. Variation in Patient Needs: Patients with complex or chronic conditions may be harder to treat under this model, and providers may be penalized for factors outside their control that affect patient outcomes. 6. Provider Burnout: The increased emphasis on performance metrics and patient outcomes might lead to added pressure and administrative work for healthcare providers, contributing to burnout.

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I found this on NewsBreak: $83,000,000,000,000 Transfer of Wealth Kicks Off – With Trillions Shifting To Spouses Before Being Surrendered To Next Generation: Report https://lnkd.in/ei-MaNxK If true then #women should have more say over the #future of the country without old male dominated #influence #ideas and #behaviors, they should have more ability to #lead #decide and #impact the future of the #country , over their #body and those of their #daughters , and how we treat one another. I dare say that the #world would be different. Example - #Mental #makeup #mindset difference: #collaborative #constructive versus #power #driven and #destructive - #personality types to show this is #melindagates versus #elonmusk so this could be #transformative if more women become #leaders and are in charge... versus #greed, and #egodriven that #create #war #famine and a lack of #compassion for their #fellowman women have more of a #circular #view versus #up and #down view so they are more able to #compromise for the good of all. According to UN Women, companies with more women in senior management tend to perform better in all areas of #organizational #performance. Catalyst reports that #companies with #higher #percentages of #female board #directors can #outperform those with a lower #percentage by up to 66%. #SandP #Global also found that companies with more #gender #diversity on their #executive #boards are more #profitable, and that female #CEOs can see a 20% #increase in #stockprices #momentum in the two #years #following their #appointment. https://lnkd.in/e62n2uKJ.

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Join me and Bradley Davie on my latest episode, Why Do We Care About Body Composition with Bradley Davie, as we break down body composition and why tracking more than just weight or BMI can be a game-changer for your health!

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Any mention of physician shortage, these days, gets linked to the problem of burnout and stress, which in turn gets connected to the documentation burden ("pyjama time"), which then takes us to the problems of #EHRs. As a result, ambient AI scribing, has become one of the fastest emerging use cases of generative AI in healthcare. An ambient AI scribing tool "listens" in the background during the physician-patient encounter and automatically produces the physician's note without the need for the physician to write anything. This is the promise of ambient AI scribing: by eliminating the need to write a note after the visit, physicians will have more time for patients or for themselves/families. I often wonder if the writing of the note is purely "wasted" time. Is note-writing not integral to our cognitive process and therefore to our ability to learn from each patient encounter and improve our 'practice' of medicine? To get some answers, I listened to this 1971 grand rounds by Larry Weed MD who invented the problem-oriented medical record: https://lnkd.in/g-WftXvi. Dr. Weed says at the beginning of the video: "...this record cannot be separated from the caring of the patient. This is not something.....the practice of medicine over here and the record over there. It is intertwined with it. It determines what you do in the long run." Therefore, in addition to studying the accuracy, evidence, and benefits (time, productivity, cost etc.) of these AI scribing tools, we should also consider the impact of the elimination of note-writing on physician's cognitive processes especially trainees - students and residents. #AI #generativeAI #ambientAIscribing #EHR #cognition #medicaleducation

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🏜️𝗘𝗛𝗥𝘀 𝗔𝗿𝗲 𝗗𝗮𝘁𝗮 𝗗𝗲𝘀𝗲𝗿𝘁𝘀: 𝗪𝗶𝗹𝗹 𝗔𝗜 𝗣𝗿𝗼𝘃𝗲 𝘁𝗼 𝗕𝗲 𝗮𝗻 𝗢𝗮𝘀𝗶𝘀 𝗼𝗿 𝗮 𝗠𝗶𝗿𝗮𝗴𝗲? ⏱️As a physician, EHR's are frustrating. I find myself navigating vast data deserts every day within them. The majority of my time is spent aggregating and synthesizing data. This is a sentiment echoed by many in my field. ➡️According to a 2020 study by Cerner, physicians spend the majority of their EHR time on chart review, approximately 33% and another 24% dedicated to documentation. This significant investment of time highlights the inefficiencies currently embedded in clinician daily workflows. 💥𝗧𝗛𝗘 𝗛𝗬𝗣𝗘 The buzz around artificial intelligence (AI) suggests it could be the oasis we've been searching for, promising to streamline these processes. However, some recent publications urge us to temper our excitement. For instance, while AI can help summarize information, it also presents challenges, such as the generation of content by large language models (LLMs) that may actually increase the workload. Physicians now find themselves not only reading patient messages but also deciphering AI-generated content, which can sometimes be misleading due to the "hallucination" problem where AI fabricates or misrepresents data. ❌𝗧𝗛𝗘 𝗖𝗥𝗢𝗦𝗦𝗥𝗢𝗔𝗗𝗦 Despite these challenges, AI does hold promise. It has the potential to transform our interactions with data, provided it is implemented thoughtfully. It is crucial that we conduct careful objective, peer-review studies to ensure AI is used effectively, enhancing the lives of both physicians and patients without exacerbating current challenges. ✅𝗣𝗘𝗥𝗦𝗢𝗡𝗔𝗟 𝗘𝗫𝗣𝗘𝗥𝗜𝗘𝗡𝗖𝗘 𝗮𝗻𝗱 𝗖𝗛𝗘𝗖𝗞𝗣𝗢𝗜𝗡𝗧𝗦 For me, the jury is still out. While I have seen AI effectively summarize complex information, the ongoing issues of accuracy and reliability cannot be overlooked. As we move forward, our focus should be on understanding the appropriate use cases for this technology to ensure it serves as a true aid in our clinical decisions, not as a hindrance. ✅Here are my Personal Checkpoints for Useful AI 1️⃣ Accuracy➡️Trust: AI must demonstrate consistent accuracy and reliability, to earn my trust. 2️⃣Integration➡️Usability: AI should seamlessly integrate into existing my workflows, enhancing usability without complicating my already tedious workflow. 3️⃣Clinical Relevance➡️Impact: 𝗔𝗜 𝗶𝗺𝗽𝗹𝗲𝗺𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻𝘀 𝗺𝘂𝘀𝘁 𝗵𝗲𝗹𝗽 𝗺𝗲 𝗺𝗮𝗸𝗲 𝗯𝗲𝘁𝘁𝗲𝗿 𝗱𝗲𝗰𝗶𝘀𝗶𝗼𝗻𝘀 𝗶𝗻 𝗹𝗲𝘀𝘀 𝘁𝗶𝗺𝗲. 𝗕𝗼𝘁𝘁𝗼𝗺 𝗹𝗶𝗻𝗲. 🤩Your thoughts and comments are appreciated. #artificialintelligenceinhealthcare #aiinhealthcare #ai #physicianburnout #healthcareinnovation #healthtech

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What does health insurance do? The conversation in the attached screenshot sums it up. We have a distorted market in healthcare. For drugs, there is a middleman called PBM between the insurance and the drug companies. The PBM negotiates a higher rate than the cash price - usually 2x or 3x and then receives an under the table rebate from the drug company. It passes of portion of this rebate to the insurer. The end effect is that the bottom price for the consumer is increased. The consumer believes that their insurance saved them a lot of money. #healthcare

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Lets find solutions to lingering issues. Healthcare is a privilege that employers who can afford to subsidize it and people can afford to pay for it in America. If the government provided funding, not just tax incentives, to small businesses and businesses in general we could open up care to lower, middle income families as well as self employed. I would assume this would be more affordable than revamping the entire system. But interesting to see the numbers Thoughts?

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I truly believe that virtual/ AI based scribes will finally create the much sought for, true acceptance of the EHR era for physicians and other professionals! I will highly recommend that clinicians and their administrators should start some level of planning and experimentation of early pilot programs with various AI-based scribing options. Like any innovative solution there will be economical, work flow and regulatory challenges, but nothing I believe will be insurmountable. Good days are coming-- days that will finally put an end to the disruptions that were initiated by the paper to digital transition! The coming generations of clinicians truly owe a lot to the previous and our generations, who suffered through the tough paper to digital transition, and paved the way for a better future, both for clinicians and the patients! Abode Care Partners BrightSpring Health Services AMDA - The Society for Post-Acute and Long-Term Care Medicine

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Each year, Modern Healthcare's Top 100 includes numerous CEOs from massive hospital systems, PBMs, digital health/technology companies and carriers whose actions have played a significant role in creating the most expensive healthcare system in the world, one that delivers shockingly poor outcomes. It’s no surprise, given that many of these institutions are prioritizing profits over patient care, and in some cases, they’ve been found guilty of practices that harm both taxpayers and vulnerable populations. Let's take a look at some of the past honorees—leaders from companies like Tenet Healthcare, which paid over $500 million in fines for defrauding Medicaid and exploiting pregnant women through illegal kickback schemes, or Pfizer, whose $2.3 billion settlement for fraudulent marketing was the largest healthcare fraud case in history. UnitedHealth Group leadership always makes the list and has faced multiple False Claims Act lawsuits for inflating Medicare Advantage payments, and Oak Street Health, under Annie Lamont, recently agreed to pay $60 million to resolve allegations of kickbacks in Medicare Advantage recruitment. Centene Corporation, led by Sarah M. London, has paid billions to settle claims of overcharging state Medicaid programs. UPMC, RWJBarnabas Health, AdventHealth, Ascension and other hospitals' leaders are always on the list. And we cannot leave out Steward Health Care's Ralph de la Torre. He has made the list multiple times, including as recently as 2021. In all fairness, the list is "most influential," not necessarily "most influential in a good way..." Look, It’s not about the list itself, but imagine the powerful statement we could make if those who want real change inundated Modern Healthcare with a new kind of nominee. It would serve as an indictment of the current system—a call for leaders like Marilyn Bartlett, Cynthia Fisher, Dave Chase, Health Rosetta-discovering archaeologist, Kevin Lyons, Dave Chase, Health Rosetta-discovering archaeologist, Hugh O'Toole, Ryan Kline, Mark Cuban, Scott Conard, MD, Stacey Richter, Ann Lewandowski.... those who are genuinely working to reshape healthcare for the better. Let’s show that we demand integrity, transparency, and results—not just shareholder returns and growth. Make your voice heard- it’s time to send a message to the industry that we want a different kind of influence—one that is about integrity, transparency, and results for the American people. #healthcare #leadership #changemakers #modernhealthcare #nominate #transparency

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Insurance companies can own hospitals Venture capitalists can own hospitals Private equity can own hospitals But a doctor can't Yet... Physician owned hospitals saved Medicare $1.1B in 2019 They also have: Higher quality Better outcomes Higher patient satisfaction Higher employee satisfaction The same is true in physician led healthcare organizations Why are we keeping doctors out of the business of healthcare and out of leadership? Well, other than the American Hospital Association looking to make as much money for its constituents as possible Oops, did I say the quiet part out loud again? My bad P.S. Interested to see more insanity in healthcare and reasons why our system is upside down from the inane financial interests of the broader industry? Then check out The Healthcare Breakdown: https://buff.ly/47NeASx It's fun, really See you out there!

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What would it take for CMS to actually have sufficient primary care by 2030. Spending in primary care would need to go up, not down as in 5.8% to 4.6% of total spending as indicated by the Milbank Scorecard 2010 to 2020 (purple squares at bottom). Flat lined 250 billion in primary care spending with cuts and new types of costs added can only decline capacity by about 20 - 30 billion or 10% of capacity year after year due to less workforce and other team members supported (green line). Worst case orange line reflects cuts, higher turnover costs, even worse retention, and higher costs of delivery. Primary care delivery capacity should have continued to increase slightly faster than population growth (purple line), ideally at 2% annual increase (turquoise) to cover population increases and increases in a number of complexities. Fewer and fewer primary care years per class year indicate declines, not advances. Primary care retention would need to increase. It continues to decline for all 5 sources decade after decade. CMS would have to prioritize delivery team member numbers and quality while decreasing metrics, micromanagement, and team member burdens. CMS would have to focus on volume increases rather than volume to value. In primary care, volume is what enhances access. In particular the cost cutting and overutilization focus must go away for 40% of the nation with half enough primary care and basics where underutilization and inappropriate utilization worsen by the financial design. The nation would have to address the fatal flaw of employer based health insurance - payments lower than cost of delivery where the weaker employers are concentrated. CMS would have to increase payments to 110% of the cost of delivery, up from 60 - 85% CMS would need to audit its plans and discipline them such that lower payments are not associated with lower levels of workforce - as in 15% lower office payments for primary care where it is half enough for 40% of the population in 2621 counties across vast regions. Primary care year production since the class of 2010 needed to exhibit regular annual increases in the numbers of primary care years from IM NP FM PA and PD (blue line) CMS would have to look back historically and see that the only major increase in primary care was 1965 to 1980 with the new billions from the original Medicare and Medicaid design (blue line left) CMS would need to understand that no training design, especially graduate medical education funding, can address deficits of primary care and basics where the public plans and worst private employer based plans are concentrated. CMS would need to see that its designs prevent improvements in PC delivery capacity including regulatory capture, RBRVS, budget neutrality, and better payments and more lines of revenue for those larger - especially when CMS votes its 1.4 trillion annual budget against basic health access.

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