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.

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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:

• Provider Specific Data (to 2015; updated in June after 18 months)
• https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html 
• 
  
• State Data (to 2016; updated in November after 11 months)
• https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Part-B-Carrier-Summary-Data-File/2016-Part-B-Carrier-Summary-Data-File.html 
• 
  
• National Data (to 2016; updated in November after 11 months)
• 
  
• https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Part-B-National-Summary-Data-File/Overview.html 

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%.

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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.

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. 

WSJ: What Medicare Can Learn from Netflix.

Article:  Medicare could learn from Netflix
   https://www.wsj.com/articles/what-medicare-could-learn-from-netflix-1519168902
   Ezekiel Emanual & Robert Koch

Letter: Medicare doesn't have competition
  https://www.wsj.com/articles/netflix-has-competitors-medicare-doesnt-1519749845

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

http://www.theprecisionmedicinesummit.com/washington-dc/2018

http://www.himss.org/event/precision-medicine

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

Washington, DC

Save the Date

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!

OLD NEWS:

http://www.mobihealthnews.com/content/calls-proposals-precision-medicine-summit-big-data-and-healthcare-analytics-forum-and

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.

Pulling threads together: GAO Report on Medicaid Demos Triggers Thoughts about CMMI and CMS CED

CMMI is allowed and required to do demos that aim to reduce cost and improve quality.  However, of numerous demos conducted, very few have been able to meet this dual metric.  In part, it's hard to have the data, outcomes, comparisons, and statistics.  Comparisons to historical control groups based on administrative records can be dicey for obvious reasons.  (For disease management, see Al Lewis's book (and blogs) "Why Nobody Believes the Numbers.")   CMMI has published huge collections of project summaries without having much hard data on results.   In a video interview, I once heard former CMMI director Patrick Conway say that CMMI staff were stumped by the hurdles of designing and reporting that would meet the CMS Actuary's accounting standards for cost estimates.  My point.  Maybe a missing link was enough in-service learning sessions between CMMI design staff and CMS Actuary staff to write the rulebook for outcomes and evaluations before starting the $1B a year investments.

A Health Affairs article on innovation acceleration focused on CMMI largely sidestepped the problems in February 2018.  See Perla et al., but wear your happy-hat.  Here.

Similarly, many of the evidence demo projects by the CMS coverage group under "Coverage with Evidence Development" have a mixed history at best.  Here.  And there is NO comprehensive evaluation and lessons learned written about all of them together.

The New GAO Report on Medicaid Demos

In February 2018 GAO released a report that demo follow up was also badly done in Medicaid.  Report here, Dive Healthcare here, MedCityNews here.

• Author Phil Galewitz at MedCity noted that even a big Indiana Medicaid demo's reports were tardy - and the demo was designed by Seema Verma who now heads CMS.

It seems like whether CMS does innovation demos via CMMI, or Coverage "CED" or Medicaid, it's really really hard to pull off the follow-through and execution, probably in some cases, because the up front planning didn't at CMMI or Medicaid have the potential for a successful story arc.  Designing good trials is hard, whether you're a senior expert at NIH or a senior expert at Harvard, and whether you're on staff at CMMI or a Medicaid plan.

I don't think this is Dr Ronald Hirsch....

I don't think this is Dr Ronald Hirsch....

Simpler Medical Student Physician Documentation Rules (2018/02)

In early February 2018 there were several articles that the Trump Administration had simplified physician documentation rules in cases where medical students write notes.  Here, here.

The CMS documentation of the reduced documentation is here and here.

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