Anthony DiGiorgio, DO, MHA’s Post

Do evidence-based guidelines actually matter? CMS has proposed “appropriate-use criteria” (AUC) for imaging tests. Major societies have followed suit for surgeries. And value-based care initiatives are now trying to reduce “over-utilization” of surgeries. Should these criteria/guidelines be used to determine which surgeries are appropriate vs inappropriate? The world of spine is complex. Patient history, exam findings, risk factors, and imaging nuances all contribute to sound decision-making. Do guidelines really capture all of that nuance? Are we even sure if guideline-concordant spine surgeries produce more value? Check out our latest publication (link in comments). Introducing the Operative Value Index (OVI)! It measures the improvement in patient-reported outcomes… per $1000 spent in the operating room. No more accounting gimmicks… the OVI uses time-driven activity-based costing. And you can customize the OVI to the diagnosis and surgery of your choosing (not just spine). It’s high-time we quantify value in a surgery-specific, condition-specific way for every patient we treat. How else can we be sure that all these “value-based” initiatives… guidelines-based or otherwise… are doing any good? Hopefully the OVI is a step in that direction. Philip Louie - I’m excited to join forces with you soon to explore these kinds of ideas more deeply! Robert Masson MD, FACS FAANS Armen Khachatryan, MD Sanjay Konakondla Sanjay Dhall Sanjay Khurana MD FACS Anthony DiGiorgio, DO, MHA Peter B. Derman, MD, MBA Muhammad Abd-El-Barr MD PhD FAANS David Yam Mike Selby Raymond Gardocki Jian Shen John H. Shin Ali A. Baaj MD Lali Sekhon, MD PhD MBA Alan H. Daniels, MD Kern Singh J. Alex Sielatycki Jared Ament, MD, MPH, FAANS Moby Parsons, MD Nick Aubin Benjamin Schwartz, MD, MBA Sidney Haitoff Sachin H. Jain, MD, MBA Aneesh Chopra Stacey Richter Scott Sigman MD Ira Kirschenbaum MD Charlie DeCook Tommy Weilbacher Amol S Navathe Joshua M. Liao Russell Bodner NCH Jefferson Health Hospital for Special Surgery Bryan T. Kelly, MD, MBA Robert Cubeddu Preston Alexander

New paper out examining markups on clinician-administered oncology drugs at pediatric 340B hospitals. As with other types of 340B covered entities, we find high markups and substantial variability in payer-negotiated prices both between and within hospitals. Study led by Ian Liu and Aviva Wang with Ameet Sarpatwari and Aaron S. Kesselheim, M.D., J.D., M.P.H. at Program on Regulation, Therapeutics, and Law (PORTAL). https://lnkd.in/giwQmiiX

The U.S. maternal mortality rate continues to far exceed those of other high-income nations, despite a decline since the end of the COVID-19 pandemic.

#HRSA’s Presentation at the 340B Coalition Conference: Insightful, Deeply Disappointing The 340B Coalition’s Summer Conference kicked off today. Jordan Grossman, the Deputy Administrator at the Health Resources and Services Administration (HRSAgov), HHS presented. It was equal parts interesting and deeply disappointing. The presentation started with a bit of a thud, when the announcement was made—repeatedly—that he would not be taking questions. It was indicative of a defensive tone that wound its way through the presentation. More about that later. For a big chunk of the presentation, Grossman was all in in support of the 340B community’s view that 340B revenues are used for the benefit of patients. • He began with a full throttled statement that the agency’s own vast array of programs “simply could not exist without 340B program”. • Next, he called 340B the “irreplaceable pillar” of the #healthcare system. • HRSA is “concerned” about the “pillar” in light of the current environment (which sounded like a veiled reference to the #contractpharmacy policies). • From there, he said over and over again “we know that” 340B CEs use revenues to support dozens of specified “beneficial” programs. There was no call for more of the revenues to be used by #coveredentities to provide lower cost access to #prescription #drugs—zip, none, zed. Although I resist Adam Fein’s conclusion that HRSA has succumbed to “regulatory capture”—where an agency becomes focused on advancing the positions of regulated stakeholders, rather than providing oversight—it was hard not to think exactly that during this section of the presentation. Grossman’s presentation here had the flavor of a political stump speech. Having expressed support for 340B CEs, Grossman turned to decrying the fact that, despite HRSA’s support of CEs, the agency “has been subject to a wide range of legal challenges in recent years… [that] have come … from covered entities and from manufacturers”. The subtext was pretty clear, though unstated—we support CEs, stop suing us. Grossman completely sidestepped any substantive references to the federal court cases, the state laws declaring those policies illegal, and the various #legislative proposals that have been advanced. Rather blandly, he stated that HRSA’s recent budget proposal reflected HRSA’s policy positions: 1) covered entities should be obligated to report how much they have in #340B revenues and how they use them; 2) Congress should codify contract #pharmacies, with what conditions it thinks appropriate (i.e., #Congress fix this because we are done); and 3) Congress should give #HRSA regulatory authority (i.e., insulate us from these lawsuits by giving us clear authority to act). Most telling is what HRSA DIDN’T address. The words compliance, diversion, and duplicate discounts were never used. Not a one. Not once. #lifesciences #drugpricing #Protect340B #Defend340B

Enjoyed a Happy Fourth of July with the neurosurgery residents, fellows, and students at UCSF. UCSF Department of Neurological Surgery University of California, San Francisco

UPMC officials said the jet is an efficient way to conduct business. They have leased a similar jet in the past. However, some nurses dealing with staff shortages said they were outraged not only by the jet but also by UPMC paying millions to its former CEO.

Has Stifling Reasonable Dissent Hit Health Affairs? Much is made in the press that Americans are divided into camps and don't talk with each other. On May 23, 4 current and former MedPAC members published a dissent on the MedPAC MA recommendations. The authors concluded that MedPACs new model is incomplete and overestimates certain effects. It does not suggest that the current situation is copacetic; its a matter of degree. (Link in comment) On July 1, in a rebuttal to the rebuttal, 4 Health policy experts write that the rebuttal was wrong. I won’t belabor analytical details from the July article (I intend to follow up.) But in an example, the July article says MA is out of whack because plans report codes for CHF for a diabetic with that condition because the payment is higher. This is sadly outdated, just google the 2019 AHA scientific statement on the importance of treating to both so the medication is correct. I share my concerns about the July 1 conclusion below:  First, the study says the Commission operates by consensus. The law only requires reporting individual votes. No Congressman would write a requirement for consensus (and I can personally validate the rationale for the language.) Second, it characterizes the May rebuttal as an “attack’ on MedPAC that was “highly unusual”. Why do the July authors say a disagreement is an “attack"? Strong word. Instead could they have not contacted or asked the May set "why did you make a rebuttal" and reported on that rather than say "unusual" (gaslighting term)? Finally, the July piece says the May rebuttal reflects the authors’ "normative values.” What does that mean in this context? Was it their desire to see "Medicare as a sacred promise”? Or, the premise of “holistic thinking”? A political comment? You got me. In contrast, Gail Wilensky and I wrote a letter to MedPAC laying out questions on the MA analysis this winter. We were received graciously by Chairman Chernew who followed up and spoke to us for an hour (even tho he was ill). I still have two questions and will lay those out in the later correspondence. #MedPAC #MA Eric Hargan Lisa Grabert Kenny Kan Abigail Chance Colin Yokanovich Gail Wilensky Brian DeBusk Matthew Hittle Brian Miller Craig Samitt, MD, MBA Charles Chapman

This fall could bring a sea of change in thinking about health policy. Please join us at American Enterprise Institute on Wednesday, July 10th at 4 PM EST as we explore this with a an event next week on "Health Policy and the 2024 Election." As both candidate’s campaigns ramp up with the election less than 4 months away, voters need understanding what the next administration will do to confront a range of important questions, including addressing #Medicare solvency, identifying ways to lower health care costs, and facilitating access to new innovative technologies and therapies for Americans of all backgrounds. I’ll moderate a panel featuring a wide range of former Trump Administration officials, former Congressional staff, and policy analysts including: ----------------------------------------------------------------- -Ryan Long, former Senior Policy Advisor for Speaker McCarthy -Charlie Katebi, Deputy Directory of the America First Policy Institute's Center for a Healthy America  -Nina Owcharenko Schaefer, Director of the The Heritage Foundation's Center for Health and Welfare Policy -Brian Blase, President of the Paragon Health Institute Please join us in-person at AEI or register online below 👇 ----------------------------------------------------- https://lnkd.in/eBWhYjtZ #healthpolicy #Medicare #Medicaid #artificialintelligence #elections #2024 Brian M. Fahey FAHAD LODHI, MD Kendyl Willox, MPS Tina Reed Hannah Anderson Eric Hargan Lisa Grabert Deborah Williams Kenny Kan Terra Marie Jouaneh John O'Brien Grace Graham Abigail Chance Alexandra Davis Colin Yokanovich Joe Grogan Colin Rom Niraj Gowda Vrushab Gowda, MD, JD Ted Cho Gail Wilensky Janet Woodcock Tom Romeo, MPH Jesse Ehrenfeld MD MPH Jeff Kimbell Chip Kahn