Tuesday, March 13, 2018

Modifier 59 and X Modifiers - Saga to 2018

2014 article on creation of X modifiers

2015 article on X modifiers

2018 Update on X modifiers

Thursday, March 8, 2018

HBR Publishes Case Study, Interview about Adaptive Trials

  • Harvard Business School has published a 26-page case study about Adaptive Trials, download for $9, here.    
  • Read an interview with the author, here.

The interview is from Harvard's business school case study podcast series.   The case is about GBM-AGILE, which starting as an ad hoc working group to make a blueprint for adaptive studies in GBM.   The case study is about converting the blueprint from the drawing board to a real world funded study.

For a different perspective on GBM Agile see these two links:


I recently pulled up a few new review articles on umbrella and basket and adaptive trials.

Open Access, see Savoia 2017, Clin Sci 131:2671 [view is general but focus is cardiology], here:

...Not open access, but sound good:

Renfro 2017, Ann Oncol 28:34, Statistical Controversies... [in such trials],  

Simon 2017, Clin Pharm Ther 102:934, Critical review... [of such trial designs], 


See also Simon 2017 in Ann Intern Med, 165:270, Adaptive oncology trials...

See also Renfro 2017, Cancer Lett, 387:121, Precision oncology: new era of trials...

See also Renfro 2016, Cancer Treat Rev 43:74, Clinical trial designs incorporating predictive biomarkers...

See also Beckman et al. 2016, Clin Pharm Ther 100:617, Adaptive dsign for confirmatory basket trial...

NGS Sequencing and Reimbursement: Panel at PMWC 2018 (Feb 2018) Video


Updated Chart on BRCA Payments by Year 2014, 2015, 2016, with Natl, State, and Lab Data

I've written about the quirky range of BRCA coding and payments in different geographies under Medicare Part B.   It's a big deal; in 2016 it was about $70M payments at anywhere from $900 to $2600 per patient, depending on coding choices and MAC claims processing.   There were about 31,000 patients in CY2016, so the minimum payment would have been 31,000x$900 or about $31M, and the maximum about 31,000x$2600 or about $81M.   For most of these, a median payment would be 81432+81433 or $1400, giving $43M.

click to enlarge

Chart above.  Dollar data sums codes.  Utilization data assumes 81211/81213 or 81432/81433 patients overlap.   Payments are dollars allowed, including deductibles, so they are slightly less than fee schedule pricing.     Overall patient/dollar volume was up about 20% from 2014 to 2015, and up a total of about 70% from 2014 to 2016.

Data sources are:
Data sheet, as shown in figure above, in the cloud, here.

I also charted UTAH STATE VOLUME of dollars and patients over NATIONAL VOLUME of dollars and patients.   Utah percent of total dollar volume and total patient volume appears to drop from 84% to 72% to about 40%.

click to enlarge
My first blog on 2016 state level data, when the data was just newly released, early November 2017, was here.  The charts above are generally a superset that gives a 2014 2015 2016 view at one glance.

Wednesday, February 28, 2018

The Hidden Auto Transcript Button in YOUTUBE

I accidentally discovered the Hidden Transcript Button in Youtube. 

If you see the "closed caption" cc symbol (very common) tap the "three button" logo, section "open transcript."  You can copy/paste transcript.  Cool.

For a serious use, lots of CMS and FDA and Hill hearings are archived on Youtube.  I knew about the "closed caption" button [cc] but it's more useful to skim the whole video by seeing the whole text at once. 

Tuesday, February 27, 2018

WSJ: What Medicare Can Learn from Netflix.

Article:  Medicare could learn from Netflix
   Ezekiel Emanual & Robert Koch

Letter: Medicare doesn't have competition

HIMMS pre announced May 17-18 2018 Precision Medicine Summit in DC



May 17 8:00am - 18, 2018 4:30pm EDT
Washington, DC

Precision Medicine Is on Fire

In fact, it’s gotten so big that analysts expect the market to skyrocket past $87 billion worldwide by 2023. As more healthcare organizations nationwide put precision medicine into practice, the opportunities it brings for disease treatment and prevention are enormous. But the challenges are also very real.
The HIMSS Precision Medicine Summit provides attendees with the insights and tools they need to address those challenges head on – and take the next steps. Join us for 2 full days of case studies, best practices, panel discussions, and unrivaled networking opportunities.
What you'll get:
  1. Dip deeper than ever into precision medicine barriers with 2 full days of expert keynotes, panels and breakout sessions
  2. Learn emerging technologies, the latest trends, and success strategies around personal genomics, diagnostics, immunotherapy, analytics, infrastructure and more
  3. Network with peers, thought leaders, and precision medicine experts, and get the insights you need to move forward
Stay tuned, registration will be open soon!

HIMSS Precision Medicine Summit: Call for Speaking Proposals closes this Friday
There’s still time but the clock is ticking to submit a speaking proposal for the HIMSS Precision Medicine Summit in Washington DC, May 17 and 18. The deadline to submit a proposal is 5 p.m. ET on Friday, February 9. Click here to submit a speaking proposal and for more information.
Over two days, speakers will share their work, discuss industry trends, and, importantly, address what healthcare must do to make precision medicine – and personalized care – an everyday part of primary care.
The event will be attended by 150 healthcare clinical and IT leaders from hospitals, health systems, and other provider, payer, pharmaceutical, government organizations.
If your organization has a precision medicine success story to share, or you have expert insights into what’s required to move precision medicine to the point of care, you’re the perfect speaker for this event.
Topics of interest include: Technology and infrastructure, especially machine learning; big data and precision medicine; genomics; clinical integration; knowledge and expertise; reimbursement; the regulatory landscape; investment; and more.