Author Archives

Christina Liu

It’s complicated. A deep dive into the Viz/Medicare AI reimbursement model.

Sep 24, 2020• 1

By LUKE OAKDEN-RAYNER

In the last post I wrote about the recent decision by CMS to reimburse a Viz.AI stroke detection model through Medicare/Medicaid. I briefly explained how this funding model will work, but it is so darn complicated that it deserves a much deeper look.

To get more info, I went to the primary source. Dr Chris Mansi, the co-founder and CEO of Viz.ai, was kind enough to talk to me about the CMS decision. He was also remarkably open and transparent about the process and the implications as they see them, which has helped me clear up a whole bunch of stuff in my mind. High fives all around!

So let’s dig in. This decision might form the basis of AI reimbursement in the future. It is a huge deal, and there are implications.

Uncharted territory

The first thing to understand is that Viz.ai charges a subscription to use their model. The cost is not what was included as “an example” in the CMS documents (25k/yr per hospital), and I have seen some discussion on Twitter that it is more than this per annum, but the actual cost is pretty irrelevant to this discussion.

For the purpose of this piece, I’ll pretend that the cost is the 25k/yr in the CMS document, just for simplicity. It is order-of-magnitude right, and that is what matters.

A subscription is not the only way that AI can be sold (I have seen other companies who charge per use as well) but it is a fairly common approach. Importantly though, it is unusual for a medical technology. Here is what CMS had to say:

Minding the Competition: Ginger’s Karan Singh & Russell Glass on Digital Mental Health Investments

Sep 23, 2020

By JESSICA DaMASSA, WTF HEALTH

Digital Mental Health startups continue to scale up — in customers, revenues, and investments — as the covid19 pandemic wears on. One of these companies, Ginger, has tripled its revenue this past year, expanded its client base to count more than 200 health plans and self-insured employers, and, for good measure, just added a fresh $50M Series D to their coffers. How much more money can investors put into digital mental health startups? Are things “frothy” in this space, or is investment just “catching up” to meet a latent demand that’s just really been brought to light? And, what is one of this category’s leaders planning to do now that they’re extra flush with cash? (Don’t forget, they’re sitting on a $35M round that closed late 2019…)

Ginger’s co-founder & COO Karan Singh and CEO Russell Glass join us to weigh in on the mental healthcare market’s state-of-play, including the buzz around their own business as both a potential acquisition target and a potential acquirer of additional behavioral health tech. We cover everything from investment to healthcare incumbent’s recent cries for more clinical validation, but my favorite part of this whole interview is when we start talking about the competition and tackle Lyra Health’s recent $100M raise and $1.1B valuation. Tune in around the 15:55-minute mark for some very DETAILED competitive analysis about Lyra-versus-Ginger from Ginger’s own CEO.

As this market gets more crowded, competition heats up, and healthcare consumers receive the benefit of more solutions to access at lower prices, Karan and Russ also help me speculate on what’s ahead, including whether or not they think we’ll see a “digital mental health equivalent” of a massive game-changing-market-moving deal like we saw when Teladoc merged with Livongo to shake up of both the virtual care and chronic condition management spaces.

Congress Is Getting the Transition to Alternative Payment Models Wrong

Sep 23, 2020

By TAYLOR CHRISTENSEN

Alternative payment models (APMs) are a hot topic these days, and everyone seems to agree that we need to transition toward them and away from fee for service (FFS). But how should we do it?

First, let’s think about this task as government policy makers would think about it.

They would probably start by saying, “We need to find a way to give incentives to providers and payers to try out these different APMs.” This would be fairly easy to do through Medicare, so they would create some Medicare APM programs and structure them in a way that makes the benefits of joining large enough that lots of providers will want to participate.

And for the sake of uniform provider incentives, they would also want to encourage private insurer-provider diads to start using APMs, preferably ones as similar to the Medicare APM programs as possible. And so they would probably have to offer private insurers and/or providers money to do so.

WeChat to Many, WeDoctor to Some

Sep 22, 2020

By KIM BELLARD

You’ve probably heard about TikTok, especially lately. President Trump wanted a ban on it, and seems to have endorsed a deal for a U.S.-based version of it. The hundred million U.S. users, and probably their parents, are undoubtedly watching the sequence of events with mixed amusement and concern.

But you may have paid less attention to what’s been going on with WeChat, another China-based app. WeChat was part of the original proposed ban, which a federal judge blocked this weekend, hours before it was due to go into effect (the Commerce Department plans to appeal). The ban is on “transactions,” which, in WeChat’s case, covers a lot of ground.

TikTok was overlooked by authority figures for a long time because it was mostly used by young people and mostly for what seemed, to them, to be trivial purposes. Not so with WeChat; it is deeply engrained in users’ lives, including for their health.

WeChat is owned by Tencent Holdings, one of China’s internet giants. It has been described as a “Swiss Army knife” app, able to do many tasks – not just messaging and social networking, but also games, shopping, and payments. You can order food or book travel. For many users it is a primary source of news, which is part of the problem.

Now Is Not the Time to Forget About the AIDS Epidemic

Sep 21, 2020• 2

By SOMA SEN

I keep hearing the voices of colleagues and friends that have been part of the AIDS epidemic compare it to the current COVID-19 pandemic. In fact Dr. Kathy Creticos, Director of Infectious Disease at Howard Brown Health spoke about the politicization of both the pandemics.

“Here we are in 2020 with this disease that kills people, that we don’t have any treatments for, that we really don’t understand the full manifestation and presentation biology of the virus,” Creticos said In the final segment of an interview with Contagion during International AIDS Society (IAS) AIDS 2020 Virtual Sessions. “We’re really dealing in the same situation as in the HIV epidemic.”

Her words make me reflect on the levity with which the Raegan administration treated the AIDS epidemic and it’s parallel to the Trump administration’s treatment of the current pandemic. However, she makes an important distinction between the two when she says, “I think a lot of it has to do with the fact that COVID affects everybody, but HIV was certainly perceived as not affecting everybody.”

As an Asian American researcher with more than 15 years of experience in this area, whenever, I bring up the issue of the scourge of HIV/AIDS in our community, the common response both from inside and outside the community is “It’s not a problem in this community.”

If I Can Be Safe Working as An ER Doctor Caring for COVID Patients, We Can Make Schools Safe for Children, Teachers, and Families

Sep 18, 2020• 5

By AMY CHO

We need to stop arguing about whether schools should reopen and instead do the work to reopen schools safely. Community prevalence of COVID-19 infection helps to quantify risk, but reopening decisions should not be predicated on this alone. Instead of deciding reopening has failed when an infected student or teacher comes to school, we should judge efforts by our success in breaking transmission chains between those who come to school infected and those who don’t. We should judge our success by when we prevent another outbreak. We should pursue risk and harm reduction by layering interventions to make overall risk of transmission in schools negligible. This CAN be done, as healthcare workers all over the United States have shown us. Unlike politics, we should avoid thinking this is a binary choice between two polarized options. At the heart of these decisions about tradeoffs should be the assumption that the education of our children is an essential, public good.

I advocated for school closures in March. We had little understanding of the risks and transmission of COVID-19 and faced massive shortages of personal protective equipment (PPE). The closures were a blunt force instrument but bought precious time to learn and prepare. Pandemic control, by flattening the curve and buying time for discovery of more effective therapeutics, care and a vaccine, remains a critical tool to save lives. But COVID-19 will not be eradicated. We must come to terms with the reality that COVID-19 will circulate among us, likely indefinitely. Shutdowns slow spread but at a great cost, disproportionately paid by vulnerable groups including children, women, minorities, and those with the least financial resources. Getting children safely back to in-person school should be among our highest priorities.

Hospitals never considered closing. As healthcare workers, we cannot physically distance from patients. We watched in horror as hot spots like Bergamo suffered high nosocomial and staff infection rates as they were quickly overwhelmed. In response, we worked tirelessly and collaboratively to protect one another while continuing to provide care.

The good news is that we seem to have learned how to prevent in-hospital transmission of COVID-19. A recent study showed that at a large US academic medical center, after implementation of a comprehensive infection control policy, 697 of 9,149 admitted patients were diagnosed with COVID-19. But only TWO hospital-acquired patient infections were detected. COVID-19 is not “just the flu,” but it isn’t Ebola either. I no longer worry that I will become infected with COVID while working in my emergency department. It is not easy, comfortable nor cheap, but a bundle of universal masking and eye protection, appropriate PPE use, sanitation, improved room ventilation, and protective policies have proven effective at preventing in-hospital outbreaks.

Doctors Urge Caution in Interpretation of Research in Times of COVID-19

Sep 17, 2020

September 9, 2020

To:

American College of Cardiology

American College of Chest Physicians

American College of Physicians

American College of Radiology

American Heart Association

American Society of Echocardiography

American Thoracic Society

European Association of Cardiovascular Imaging

European Society of Cardiology

European Society of Radiology

Heart Rhythm Society

Infectious Disease Society of America

North American Society of Cardiovascular Imaging

Radiologic Society of North America

Society of Cardiovascular Magnetic Resonance

Society of Critical Care Medicine

Society of General Internal Medicine

Society of Hospital Medicine

Dear Society Leadership:

We are a group of clinicians, researchers and imaging specialists writing in response to recent publications and media coverage about myocarditis after COVID-19. We work in different areas such as public health, internal medicine, cardiology, and radiology, across the globe, but are similarly concerned about the presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.

Hospitals Must Give Up Power to Save Healthcare

Sep 16, 2020

By KEN TERRY

(This is the sixth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

As hospital systems become larger and employ more physicians, healthcare prices will continue to rise and independent doctors will find it harder to remain independent. Hospitals will never fully embrace value-based care as long as it threatens their primary business model, which is to fill beds and generate outpatient revenues. To create a viable, sustainable healthcare system, the market power of hospitals must be eliminated.

Federal antitrust policy is not adequate to handle this task. Even if the Federal Trade Commission had more latitude to deal with mergers among not-for-profit entities, the industry is already so consolidated that the FTC would have to break up health systems involving thousands of hospitals. Such a gargantuan effort would be practically and legally unfeasible.

All-payer Systems

The government could curtail health systems’ market power without breaking them up. For example, either states or the federal government could adopt “all-payer” models similar to those in Maryland and West Virginia. Under the Maryland model introduced 40 years ago, every insurer, including Medicare, Medicaid, and private health plans, pays uniform hospital rates negotiated between the state and the hospitals.

Healthcare Can Learn From Chess

Sep 15, 2020

By KIM BELLARD

Oh, gosh, two of my favorite things are in the news together: Twitch and chess.

Just kidding. I barely know what Twitch is, and the last time I played chess was, well, not in this century (and, even then, not well). But I’m not kidding about their convergence. Chess has become a big hit on Twitch, especially in these COVID times.

I figure, if two such seemingly divergent things are meshing, there must be some lessons there, even for healthcare.

For those of you over, say, fifty, Twitch is an online service that facilitates livestreaming, particularly of gaming. That is, people watch other people playing games, such Fortnite or League of Legends.

E-sports, as this is known, have become a big thing; colleges are even giving out scholarships for e-sports. Major news outlets, such as The New York Times and The Washington Post, reported on Twitch re-signing video game star Tyler Blevins, a.k.a “Ninja,” much as they might have reported an NFL team signing a star player.

As I write, 2.7 million people are livingstreaming on Twitch. Its all-time concurrent viewers peak is just over 6 million. There were 1.6 billion hours watched in August, with over 11 billion year-to-date. It draws more viewers than network television hits. There are 93,000 live channels at this moment.

Will COVID-19 Force The South To Finally Confront Structural Racism Within Their Medicaid Programs?

Sep 14, 2020• 3

By MIKE MAGEE

If you would like to visit the meeting place of America’s two great contemporary pandemics –COVID-19 and structural racism – you need only visit America’s Nursing Homes.

This should come as no surprise to Medical Historians familiar with our Medicaid program. Prejudice and bias were baked in well before the signing of Medicaid and Medicare on July 30, 1965.

President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was the endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Predictably, Southern states feigned support, and enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South “Black Belt.”

Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards” by 1977. But by 1972, after seven years of skirmishes, the provision disappeared.