Jack Beal

Listen Here: https://lnkd.in/gTQ7ncjF In this episode of the Becker's Healthcare Podcast, Peter Charvat MD, MBA, FACHE, Chief Clinical Officer at Bon Secours Mercy Health Richmond, discusses his transition from clinical practice to executive leadership and the innovative initiatives his team is implementing. Dr. Charvat highlights the challenges of managing a complex patient population and the strategies to optimize workflows and enhance patient care through technology and team-based models. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcare #leadership

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The Czar is speaking TOMOROW on the new 2025 Medicare rules from Centers for Medicare & Medicaid Services!!! pretty much the biggest legal webinar in the Medicare vertical ever... still free. for now. Puja J. Amin Christopher Deatherage John Henson #tcpa #cms #aep #oe #Medicare #advantage #leadgen #tpmo #ptc #pewc #2025 #webinar #learn #deservetowin

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Listen Here: https://lnkd.in/gh_-ss9a In this episode, Laura (Miller) Dyrda, Vice President and Editor-in-Chief at Becker's Healthcare, provides updates on the latest financial results from Kaufman Hall’s "National Hospital Flash Report," the recent Change Healthcare cyber attack, and Parkview Health's partnership with CommonSpirit Health for home-based care initiatives. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcarenews #womensleadership

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One much discussed topic as artificial intelligence (AI) is increasingly introduced onto diagnostic radiologists' workstations has been whether an economic model can help support the investment made by health care providers in these software platforms. In the just published final fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment Systems (IPPS) rule, the Centers for Medicare & Medicaid Services (CMS) has created a temporary add on payment to hospitals for one such product, an obstructive hydrocephalus (OH) software tool from Annalise.ai used to triage suspected OH cases. The final rule notes that Annalise's software device - as described by the company - analyzes studies using an AI algorithm to identify suspected OH findings in non-contrast computed tomography brain scans to provide study-level output for an order and imaging management system for worklist prioritization or triage. The add on payment arises from a CMS program to temporarily assist in the launch of such products through new technology add-on payments (NTAPs). In 2023, the U.S Food and Drug Administration (FDA) granted a breakthrough designation for the first time for this same radiology triage software medical device. FDA continues to clear artificial intelligence/machine learning (AI/ML) devices, and radiology devices have consistently constituted the majority of those AI/ML devices being cleared by that agency. My Reed Smith LLP colleague, Sung Park and I provide an overview of these Medicare add on-payments for use of this AI software in the attached blog post.

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Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.

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Hey all! As promised, we've posted a more in-depth article focused on the new Advanced Primary Care Management codes proposed in the 2025 Medicare Physician Fee Schedule Proposed Rule that was released by #CMS last week. (Was it only last week?? Feels like a lifetime ago...) Headlines: * The new monthly APCM codes are NOT based on time spent by practitioners or clinical staff, opening the door for use of AI tech to automate certain care coordination/management functions. * The codes provide a reimbursement opportunity where time requirements for CCM/PCM are not met. * The APCM codes are another step towards preparing primary care physicians for the shift to value-based care -- BUT, proposed reimbursement rates combined with requirements for implementation could hamper adoption. Please share your thoughts in the comments when you have a moment! I also strongly encourage all stakeholders -- vendors of care management services, PCP practices, etc. -- to submit comments to the Proposed Rule by no later than September 9th. We've seen CMS reference specific comments in their Final Rule as reason for changes to their original proposal. We're happy to help! https://lnkd.in/eV4CxPmg

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Listen Here: https://lnkd.in/eFs8XvFy Tune in as regular guest, Laura (Miller) Dyrda, Vice President & Editor-in-Chief, Becker's Healthcare shares insights into Optum’s plans to close a Change Healthcare facility in Ohio, why healthcare leaders are praising Ascension’s cyber attack response, & why hospitals across the U.S. having capacity issues is leading to unnecessary stays and higher costs overall. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcarenews #womensleadership

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#Dems, Behold that Which You Have Wrought! Adam Fein’s brilliant visual says it all. The #Democrats’ #AffordableCareAct was the capstone to decades of government subsidies that funded the creation of #BigInsurance. What began, with #Republican sponsorship in #MedicareAdvantage and #Medicaid #managedcare, reached its one party zenith in the #ACA. Collectively, those government markets have brought #BigInsurance control over the health care of more than 110 million Americans—roughly a third of the entire U.S. population. The profits from those contracts, replete with massive #governmentsubsidies, have been the engine of Big Insurance #consolidation and #verticalintegration. #Democrats, in #Congress and in the #BidenAdministration, have long railed against #BigInsurance, but #Dems need only look into the mirror to see where a good deal of the blame lies for its creation and massive stranglehold on our economy. They—and they alone—made insurance companies the big winners in passing the #ACA, now the fastest growing source of Big Insurance dollars to fund further vertical integration. But it’s worse than that. The #Dems actually we’re duped by Big Insurance into legislating a vertical integration con. In the #ACA, Dems naively comforted themselves that their embrace of insurance companies could be mitigated by their imposition of “caps” on the profits and admin costs of plans. It was a wonderful piece of politically self-interested self-delusion. What those caps actually did was provide Big Insurance with the means, through vertical integration, to gorge on government subsidies, without really being restrained by the “caps” at all. The caps were effectively evaded simply by pushing profits from the plans down to captive #PBMs, specialty, #mailorder, and retail #pharmacies, #physician practice, #ASC, and other provider affiliates—a strategy the companies pursued with self-interested vigor. This #ACA dynamic, at the core of President #Obama’s signature legislation, is what has led, inevitably, inexorably, and directly, to Adam’s visual.

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Listen Here: https://lnkd.in/g3Pg2EAj In this episode, Molly Gamble, Vice President of Editorial at Becker's Healthcare highlights points from 3 articles on Becker’s Hospital Review “17 quick notes on healthcare”, “GLP-1s: 8 things hospital leaders should know” Paige Twenter, and “Leaders leave patients in PE hospital shell game”. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcarenews #womensleadership

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The #IRA Price Negotiation Provision Will INCREASE #Copays? Yes, says #Milliman, in an analysis performed for its oft adversary, #PhRMA. It’s a frustrating possibility, with disturbing #compliance, #adherence, and #persistency implications for vulnerable #Medicare #PartD beneficiaries. The Price of “Negotiation”: Milliman says that #MedicareFairPrices on the “select #drugs” subject to #InflationReductionAct “negotiation” will result in HIGHER #outofpocket costs, on average, for those beneficiaries using a select drug in 2026, compared to 2025. That’s true, Milliman predicts, for low income and all other #patients: • Low Income: OOP costs increase 27% from $43 to $54; • Others: OOP costs increase 11% from $903 to $1,007; and • Combined: The weighted, aggregate impact is an increase of 12%, from $598 to $668. To Be Fair: I’m on record, riffing on Adam Fein’s work, with the prediction that plans, #PBMs, #340B entities, #LTC #pharmacies, and others will be switching Medicare select drug patients, with gusto, to alternative high list/high rebate products. If so, then the issue Milliman says it has identified won’t affect “switched” patients—though they will be likely subject to even HIGHER costs based on the costsharing associated with high list/high rebate alternatives. Still: But these Milliman identified increases in costsharing would remain decidedly bad news for patients that DON’T get switched. In addition, as more and more drugs get “selected”, as we get further and further into IRA implementation, “switching” strategies will become less effective—and more patients will, if Milliman’s analysis holds true, face higher #copayments relative to a 2025 baseline. Not to Be Poo-Pooed: Defenders of the IRA may say that these dollar increases are too “nominal”, in absolute terms, to be impactful, but that is just wishful thinking, in my view. The studies show that even very small additional #copay dollars impede medically necessary utilization—and that the patients the MOST likely to benefit from #drug therapy are DISPROPORTIONATELY likely to not initiate or to discontinue therapy in the face of even small increases in costsharing. This analysis makes it even more upsetting that #OIG and #DOJ are standing in the way of #costsharing assistance for financially needy #cancer patients in the PCPA case pending in the Fourth Circuit Court of Appeals. It’s maddening. #lifesciences #healthcare #health #pharmacy #pharmacists #pharmacies #Protect340B #drugpricing #charity #charitycare #marketaccess #patientaccess

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Attention DME providers! The #OIG has recently updated its WorkPlan, which includes the review of fraudulent billing practices in the DME space. It's imperative for providers to stay informed and conduct their own internal audit to ensure compliance. If you have any questions, don't hesitate to reach out and get started. Click on the link below to learn more about this review: https://lnkd.in/eMGVQjPe #OIG #OIGWorkPlan #Compliance #fraudulentbilling #DME

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FYI: This takes effect on August 1! This new final rule sets penalties for healthcare providers, including individual clinicians, hospitals, healthcare systems, and Accountable Care Organizations (ACOs), found guilty of information blocking. Information blocking involves knowingly hindering the access, exchange, or use of electronic health information (EHI), which can detrimentally affect patient care and interoperability. There is a fact sheet within this link that shares more information! #HealthcareReimbursemen #HealthcareRegulatoryEnforcement #EHI #ACO

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Good News!: CMS Backs Away from Its Clearly Unlawful Best Price “Stacking” Proposal At a time when the #Biden Administration seemed determined to pull every possible lever in its “war on #drug prices”, #CMS has decided not to pull one, clearly illegal lever. CMS is backing away from its #BestPrice “stacking” rule, saying it has decided to “collect additional information” before proceeding. But I don’t think that CMS lacked any “information”. What it lacked was any statutory authority to convert Best Price from a price to a single customer into a price reflecting multiple concessions made to multiple, unaffiliated customers. The agency had to know that, if it proceeded, multiple suits would be filed, and CMS would lose. Good riddance to a bad proposal—if finalized, this rule would have been a devastating blow to #innovation. #drugpricing #drugdevelopment #MDRP #drugrebates #Medicare

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New Blog Alert! Is creating and then profiting from a healthcare monopoly not considered anticompetitive? No, according to a recent court decision dismissed private equity giant Welsh Carson from a lawsuit alleging monopolistic practices in the Texas anesthesia market. Despite their pivotal role in funding and setting up US Anesthesia Partners , which was later charged by the Federal Trade Commission for anticompetitive behavior, Welsh, Carson, Anderson & Stowe escaped direct legal consequences. This raises significant questions about the accountability of private equity in healthcare and exposes gaps in antitrust enforcement. Its especially instructive as we think about the Steward Health Care bankruptcy case and the role PE played in its shaping and ultimate demise. As the healthcare industry faces increasing consolidation, this ruling certainly signals open season for similar strategies by private equity firms. It also exposes a huge gaping hole in the regulatory environment that I don't think even the latest U.S. Department of Justice' Task Force on Health Care Monopolies and Collusion (HCMC) is equipped to handle. Stacey Richter Lee LewisJeffrey HoganWendell PotterHannah AndersonPatient Rights AdvocateKevin MorraMarni Jameson Carey

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