Thursday, May 15, 2025

HHS Advice on De-regulation: Now Comment on Deregulation Ideas Across the HHS

 A few weeks ago, Medicare issued a call for ideas on how Medicare can  rapidly decrease regulatory burdens.  The input is open until June 10.

This week, all of HHS asks for about the same thing - how any part of HHS can kill burdensome regulations.

###

There are some special webpages for deregulation like here and here.   

For example, AHA has already submitted 100 ways to deregulate on May 12 - here.

ACLA submitted deregulatory ideas to OMB, April 10, 12 pp.  here.

##

See an RFI for "the market for digital health products for Medicare beneficiaries."

https://public-inspection.federalregister.gov/2025-08701.pdf   (click link at top after 5/16).

See the Medicare simplification request, from April 22, open til June 10.

https://www.discoveriesinhealthpolicy.com/2025/04/cms-asks-for-ways-to-simplify-its.html

Although it goes in a different direction, you might also like to see this week's announcement of new directions and goals for CMMI - here.

###

Here's an AI take on the HHS-wide deregualtory request from May 14.

##

AI CLIENT MEMORANDUM
TO: Health Industry Clients
FROM: [Your Law Firm], Senior Partner, Healthcare Regulatory Practice
RE: HHS Request for Public Comment on Massive Deregulatory Initiative under Executive Orders 14192 and 14219
DATE: May 15, 2025


Overview

On May 14, 2025, the U.S. Department of Health and Human Services (HHS), under Secretary Robert F. Kennedy Jr., issued a sweeping Request for Information (RFI) as part of what is described as the largest deregulatory effort in the Department’s history. The initiative is aligned with President Trump’s Executive Orders 14192 (“Unleashing Prosperity Through Deregulation”) and 14219 (“Ensuring Lawful Regulation and Implementing the President’s Department of Government Efficiency Deregulatory Agenda”).

The RFI invites all stakeholders—including healthcare providers, payers, state agencies, technology firms, and patient advocates—to submit proposals to eliminate, streamline, or radically modify HHS regulations, policies, guidance documents, and reporting requirements.

Deadline for submissions: July 14, 2025, 11:59 PM ET


Context and Legal Basis

Executive Order 14192 mandates a “10-for-1” deregulatory model—for every new regulation issued, at least 10 existing regulations must be repealed, and the net cost of all new regulations must be significantly less than zero.

Executive Order 14219 compels agencies to identify regulations that are:

  • Unconstitutional or legally dubious,

  • Rooted in unlawful legislative delegation,

  • Inconsistent with statutory authority,

  • Imposing unjustified economic burdens,

  • Stifling innovation or small business,

  • Or otherwise exceeding executive power.

These actions are being coordinated through OIRA (Office of Information and Regulatory Affairs) and integrated into a new Unified Regulatory Agenda.


What HHS Is Asking From You

HHS seeks detailed stakeholder input on how specific regulations should be:

  • Modified, rescinded, or repealed;

  • Replaced with less burdensome alternatives (state or private-sector analogs encouraged);

  • Updated to reflect technological advancement or better regulatory alignment.

Submissions should ideally include:

  • Regulation citation or title;

  • Responsible HHS office or program;

  • Statutory authority for proposed changes;

  • Detailed cost-benefit analysis (preferably consistent with OMB Circular A-4 and HHS economic guidance);

  • Real-world implementation examples or data.


Questions HHS Wants Addressed

  1. Which HHS rules are unconstitutional, unauthorized, or overly burdensome under E.O. 14219?

  2. What rules interfere with reversing chronic disease trends (E.O. 14212)?

  3. Which regulations are confusing, outdated, technologically obsolete, or duplicative?

  4. Are there less burdensome alternatives used by states or the private sector?

  5. Are any HHS rules inconsistent with other executive orders (e.g., E.O. 14151, 14154)?

  6. What are the estimated cost savings of proposed repeals?


Strategic Considerations for Industry Clients

  • This is a real opportunity to influence policy rollback. The Kennedy-led HHS appears serious about publishing stakeholder proposals directly into the Federal Register as draft rules or notices.

  • Target regulations that impede innovation, such as legacy reporting requirements, burdensome IT documentation standards, or overlapping state/federal licensure rules.

  • Use economic data and clinical case studies to frame deregulatory asks. The more “shovel-ready” your proposal, the better.

  • If your organization operates under both CLIA and FDA, this is an ideal forum to challenge overlapping regulatory burdens on lab-developed tests or RUO products.

  • Be aware: this is not a grant solicitation or funding opportunity, and HHS disclaims any obligation to respond individually.


Next Steps for Clients

  1. Identify top 3–5 HHS regulations that are costly, obsolete, or duplicative for your organization.

  2. Work with counsel or your compliance office to articulate statutory authority and suggest precise modifications or repeal language.

  3. Submit your proposal before July 14 at www.regulations.gov/deregulation, under docket AHRQ–2025–0001.

  4. Consider whether you want your organization’s name to appear on the record or to submit anonymously.


Conclusion

This RFI opens a window into the new regulatory strategy of the Trump Administration and Secretary Kennedy’s HHS. It is designed to rapidly unwind large portions of the administrative state—and healthcare stakeholders who submit thoughtfully supported proposals could have an outsized role in shaping which regulations survive and which do not.

We strongly encourage your compliance, legal, and policy teams to participate.

Let us know if you would like our firm’s assistance in developing or reviewing your submission.


Prepared by:
[Name]
Senior Partner, Healthcare Regulatory Practice
[Your Law Firm]

###

I also asked Chat GPT to directly compare the April CMS regulation RFI with the brand new HHS-wide deregulation RFI.

 ##

CLIENT MEMORANDUM
TO: Health Industry Clients
FROM: [Your Law Firm], Senior Partner – Healthcare Regulatory Practice
RE: Comparison of April 15 and May 14, 2025 Federal Deregulatory RFIs from CMS and HHS
DATE: May 15, 2025


Overview

In April and May 2025, two significant deregulation Requests for Information (RFIs) were issued by the Department of Health and Human Services (HHS). While both respond to Executive Order 14192, “Unleashing Prosperity Through Deregulation,” they differ in scope, target agencies, policy rationale, and deregulatory ambition. This memo compares:

  • April 15 CMS RFI: Focused solely on Medicare-related regulations.

  • May 14 HHS-wide RFI: Broad call to deregulate all HHS divisions, including FDA, CDC, NIH, and CMS.


Key Differences

CategoryApril 15 CMS RFIMay 14 HHS-Wide RFI
Issuing AgencyCenters for Medicare & Medicaid Services (CMS)Department of Health and Human Services (HHS)
Target ScopeOnly Medicare program regulationsEntire HHS portfolio (CMS, FDA, NIH, CDC, AHRQ, etc.)
DeadlineJune 10, 2025July 14, 2025
Submission Portalcms.gov/medicare-regulatory-relief-rfiregulations.gov/deregulation
Legal Authority CitedEO 14192 (10-for-1 repeal of regulations)EO 14192 and EO 14219 (lawful regulation mandate); references also EO 14212 (chronic disease), 14151, 14154, 14168, 14213
Tone and FramingEfficiency, administrative simplification, provider reliefSweeping deconstruction of the administrative state, restoring constitutional authority, and “Making America Healthy Again”
Stakeholder TargetsMedicare providers, Medicare Advantage plans, Part D plans, suppliersEntire U.S. public: health plans, providers, state and local agencies, faith-based orgs, researchers, food producers, technology companies, etc.
Topics of InquirySpecific burdens in Medicare rules: reporting, documentation, duplicative requirements, cross-agency conflictsEntire HHS regulation universe: unconstitutional rules, burdensome mandates, outdated tech, conflicting EO alignment, innovation barriers
Preferred Submission FormatCMS Form #s and OMB Control #s requested for clarityLegal citations, economic estimates, and pre-drafted NPRM/DFR content encouraged
Deregulatory Metric10 regulations repealed for every new one proposed; net cost of all new regs < $0Same 10-for-1 repeal rule, but also a constitutional test, national interest test, and innovation test for all HHS rules

Strategic Insights

  1. CMS RFI = Practical, Bottom-Up
    The April 15 CMS RFI is a relatively conventional deregulatory effort. It encourages providers and plans to highlight inefficiencies in Medicare’s Conditions of Participation, reporting rules, and documentation burdens. It focuses on administrative simplification and Medicare-specific cost relief.

  2. HHS RFI = Ideological, Top-Down
    The May 14 RFI goes much further. It frames federal regulation as constitutionally suspect and economically harmful, and openly aims to dismantle major portions of the administrative state. It invites public participation in rewriting the regulatory role of HHS itself—from the FDA’s drug and device policies to NIH research protections and beyond.

  3. Cross-Submission Opportunity
    Stakeholders with concerns that span both Medicare and other programs (e.g., Medicaid, FDA clinical trial requirements, LDTs, digital health tools) may submit parallel comments to both RFIs. HHS encourages submissions that can be directly adopted into the Federal Register.

  4. Political Climate Caution
    The May 14 RFI’s constitutional language (e.g., “unlawful delegations of power,” “deconstructing the administrative state”) is ideologically charged and could face resistance in courts, Congress, or the next administration. Submissions should be grounded in cost-benefit analysis and statutory clarity, regardless of tone.


Recommendations for Clients

  • Medicare-Only Clients: Focus your resources on the April 15 CMS RFI. Identify specific Medicare reporting/documentation rules that duplicate private payer policies or state mandates.

  • Broad-Scope Clients (e.g., diagnostics, life sciences, health tech): Prepare submissions for the May 14 HHS RFI. Address overlapping FDA/CLIA/LDT burdens, 21st Century Cures Act conflicts, or outdated regulatory assumptions.

  • Format Matters: Wherever possible, cite OMB Control Numbers (CMS RFI) or propose draft regulatory language (HHS RFI). Quantify burdens and potential savings.

  • Review Past Submissions: Both RFIs build on Trump-era 2020 RFIs. Review past deregulatory ideas and update them for 2025.


Please let us know if you would like assistance drafting or reviewing RFI submissions or identifying high-impact regulatory targets.

RFK Jr at Senate, May 14, 2025: Chat GPT Assesses the Day

The Hill posts a video of the full 2.5 hour RFK JR testimony at Senate on May 14, 2025.

https://thehill.com/video-clips/5299375-watch-live-rfk-jr-testifies-before-house-on-hhs-budget/

Links to YouTube:

https://www.youtube.com/watch?v=DVz-l_maWug

Pull an auto transcript by clicking on the message/info section.

####

AI CORNER

Here is an AI-generated summary, in the format of a memo from a health law firm to its health industry clients.

###

CONFIDENTIAL MEMORANDUM
To: Health Industry Clients
From: [Your Law Firm] – Healthcare Regulatory and Policy Group
Date: May 15, 2025
Subject: Senate Testimony of HHS Secretary Robert F. Kennedy, Jr. – May 14, 2025


Executive Summary:
On May 14, 2025, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. appeared before the U.S. Senate HELP Committee for a two-hour hearing on the President’s FY2026 health budget proposal. The session was marked by stark political divisions, protests in the hearing room, and contentious questioning around Kennedy’s policies, rhetoric, and staffing decisions. Secretary Kennedy defended significant structural cuts to HHS programs and laid out a reorganization agenda under the Trump administration’s “Make America Healthy Again” (MAHA) banner. Senators expressed bipartisan concern about the implications for research, public health infrastructure, vaccine confidence, and program continuity.


1. Structural Priorities and Budget Themes

Secretary Kennedy emphasized cost-cutting and reorganization across HHS, framed around three goals:

  • Combat chronic disease and addiction through consolidation of mental health and nutrition programs.

  • Rebuild public trust through transparency and science-based reform, claiming previous administrations suffered from “industry capture.”

  • Eliminate inefficiencies, with plans to reduce bureaucracy, end gain-of-function research, and phase out DEI and "ideologically driven" research.

Despite the dramatic realignment, Kennedy claimed that legacy programs like Medicare, Medicaid, and Head Start would be preserved.


2. Personnel Cuts and Service Interruptions

Kennedy acknowledged the reduction of approximately 20,000 HHS employees, including:

  • 10,000 "riffs" (reduction in force, April 1)

  • 10,000 "forks" (probationary terminations post-confirmation)

He asserted these were necessary to eliminate redundancy (e.g., 27 HIV offices, 59 behavioral health initiatives, 40 procurement offices). However, senators cited evidence that the reductions directly impacted cancer trials, lead poisoning programs, domestic violence services, and CDC disease tracking. For example:

  • A stage IV cancer patient faced delayed NIH trial access.

  • Milwaukee schools closed due to lack of CDC lead poisoning support.

  • Head Start funding delays were attributed to administrative chaos.

Kennedy admitted some delays were due to "staff sabotage" and internal resistance but maintained that patient services were not intended to be affected.


3. NIH, Research Cuts, and Vaccine Policy

The committee questioned sharp NIH cuts and apparent abandonment of long COVID and Alzheimer’s programs. Kennedy defended the budget as focused on “front-end prevention,” citing nutrition, environment, and chemical exposures as under-researched drivers of disease.

However, he was grilled over:

  • NIH grant cuts described as ideological (e.g., microaggression studies).

  • Imposition of a 15% indirect cost cap for grantees, replacing traditional F&A rates.

  • Controversial positions on vaccine safety. Kennedy reiterated his pledge to “tell the truth” about vaccine risks and said he does recommend the measles vaccine—though critics claimed his statements undermine public trust.


4. Partisan Flashpoints

Several exchanges were especially contentious:

  • Sen. Sanders (I-VT) accused Kennedy of supporting Medicaid cuts affecting 13 million and giving tax breaks to the wealthiest Americans.

  • Sen. Murphy (D-CT) confronted Kennedy with earlier promises on vaccines, alleging he misled Congress. Kennedy pushed back, citing "radical transparency" as his obligation.

  • Sen. Murray (D-WA) was visibly angry over delayed NIH care for a constituent with advanced cancer and the near-elimination of the CDC lead poisoning team.

  • Sen. Paul (R-KY) commended Kennedy for eliminating “woke science” and halting gain-of-function research, citing lab risks at Fort Detrick.


5. Program-Level Impacts of Concern

Based on testimony and follow-up requests, clients should note potential material impacts in the following areas:

  • NIH Clinical Trials: Delays and reductions in capacity; 1,300+ NIH staff cut.

  • CDC Public Health Infrastructure: State grants cut or frozen; multiple disease surveillance branches affected.

  • Lead Poisoning and Environmental Health: Entire CDC childhood lead unit reportedly fired.

  • Violence Prevention Programs: Funds delayed or uncertain; national groups seeking clarification.

  • LIHEAP Energy Assistance: Budget proposes elimination despite high cold-weather mortality risk.

  • Head Start Funding: Delays in disbursement; at least one center closed due to payroll uncertainty.

  • Tribal Health Programs: IHS protected, but surrounding programs at risk (e.g., marine safety studies).


6. Regulatory Implications for Industry

Secretary Kennedy’s remarks signal several emerging trends for healthcare stakeholders:

  • CDER & FDA Direction: Continued rollback of gain-of-function research and “radical gender ideology” in clinical trials may portend stricter FDA gatekeeping on social-science-aligned protocols.

  • NIH Grant Environment: Institutions relying heavily on NIH funding—especially those with >40% indirect rates—face a more hostile and cost-conscious environment.

  • Vaccine Policy Uncertainty: Kennedy’s nuanced position may create communication risk for public-private partnerships focused on immunization.

  • Data Access & Transparency: HHS has yet to fully disclose its FY2025 operating plan or provide consistent reporting to Congress. Expect growing investigations and FOIA requests.


Recommendations for Clients

  1. Academic medical centers and grantees should prepare for a more restrictive and political NIH grantmaking environment. Reassess indirect cost structures.

  2. Clinical trial sponsors should monitor NIH capacity changes, especially for early-phase trials.

  3. Public health contractors should clarify program continuity for violence prevention, childhood environmental health, and disease surveillance.

  4. State health agencies may require legal or lobbying support to reinstate frozen grants.

  5. Workplace health/safety vendors should track NAOSH and occupational health status—future funding appears selective.


Please contact us if your organization would benefit from tailored regulatory assessments, risk mitigation strategies, or Hill outreach based on yesterday’s testimony.

####

Any humorous moments?

###

Here are three notable examples:


1. C-SPAN-Worthy Protest Interruptions

Around 19:22, during Kennedy’s opening remarks, the hearing was interrupted by protestors in the gallery. The committee chair had to request Capitol Police to remove individuals while stating, deadpan:

“That was a made-for-C-SPAN moment.”
This line was delivered with dry understatement, and some members chuckled, recognizing the surreal theatre of policy hearings intersecting with public activism.


2. “Alligators in the Lake” Vaccine Analogy

During a heated exchange with Sen. Murphy about vaccine safety, Secretary Kennedy responded to the senator’s “toxic lake” metaphor with one of his own:

“Senator, if I advise you to swim in a lake that I knew had alligators in it, wouldn’t you want me to tell you there were alligators in it?”
Though intended to underscore his commitment to “radical transparency,” the image of unsuspecting swimmers and lurking vaccine “alligators” caught the room off guard with its absurd vividness. It briefly diffused the rising tension.


3. Bureaucracy Bingo: 27 HIV Offices & 40 Procurement Systems

In response to Sen. Marshall’s question about HHS bloat, Secretary Kennedy rattled off a dizzying list of overlapping agency components:

“There are nine separate offices on women’s health, eight for minority health, 27 separate offices for HIV, 59 behavioral health programs, 40 opioid programs…”
The sheer volume and specificity of the list became comically excessive, culminating in the revelation that there are 40 procurement offices with 4 computer systems that don’t talk to each other.
Even critics smirked at the image of 40 government buyers unable to email each other.


While rare, these lighter moments served to punctuate a contentious and high-stakes policy hearing with flashes of levity and human absurdity.

####

SIDE BAR - TEN TAKE AWAYS


###

Here's a well-crafted sidebar featuring ten enlightening and substantive takeaways from RFK Jr.'s May 14, 2025 Senate testimony. These points reflect both policy implications and strategic signals relevant to stakeholders in healthcare, life sciences, and public health.


📌 SIDEBAR: 10 Key Takeaways from RFK Jr.’s Senate Testimony (May 14, 2025)

1. The MAHA Doctrine Signals a Fundamental Shift at HHS
Kennedy repeatedly invoked “Make America Healthy Again” (MAHA), reframing HHS not as a passive payer or regulator, but as a proactive force for addressing root causes of chronic disease—through food safety, environmental toxins, and lifestyle interventions. This elevates prevention over downstream clinical intervention.

2. NIH Cuts Target “Ideological” and “Low-Yield” Science
Kennedy defended large NIH staff reductions and indirect cost caps by claiming that too much funding supports marginal or politicized research (e.g., on “microaggressions” or foreign grants). He proposes a research portfolio that excludes gain-of-function studies and DEI-linked projects, while prioritizing nutrition, toxins, and chronic illness origins.

3. Radical Consolidation Is Underway at HHS
Citing over 100 communication offices, 59 behavioral health programs, and 40 procurement units, Kennedy revealed a plan to collapse bureaucratic silos and enforce vertical integration. This poses risks to targeted programs, but may appeal to fiscal conservatives and efficiency hawks.

4. The Vaccine Debate Is Reframed Through “Informed Consent”
Kennedy’s vaccine comments weren’t anti-vaccine per se, but sharply questioned the evidence base and transparency around vaccine safety. He pledged to inform the public of both “what we know and what we don’t know”—which unsettled Democrats but aligned with his longstanding skepticism of public health messaging.

5. HHS Is Retreating from Federal Public Health Centrality
Kennedy stated repeatedly that many functions—pandemic preparedness, emergency response, public health outreach—should be localized, with the federal role scaled back. Critics fear this undermines national readiness, while Kennedy frames it as subsidiarity and respect for state capacity.

6. The Childhood Lead Poisoning Branch Was Quietly Fired
When asked why CDC could not help Milwaukee respond to a school-based lead crisis, Kennedy admitted the entire team working on childhood lead poisoning had been let go. This raised alarms about silent eliminations of mission-critical teams, even where funding had been appropriated.

7. Vaccine Infrastructure Is Being Undermined Indirectly
While Kennedy denies targeting vaccination programs, $12B in CDC public health grants used for immunization tracking, outreach, and systems has been cancelled. Critics argue this is functionally indistinct from sabotaging vaccination efforts—even if not labeled as such.

8. Clinical Trial Access Has Already Been Disrupted
Senators cited patient cases (e.g., a stage IV cancer patient at NIH) in which Kennedy-era staffing cuts have delayed or derailed enrollment in clinical trials. While Kennedy pledged to intervene personally, this admission suggests real-time harm resulting from budgetary reorgs.

9. LIHEAP Cuts Based on Energy Optimism, Not Climate Data
The decision to zero out energy assistance for low-income households was justified on the premise that Trump’s energy policies would soon lower costs. Lawmakers from Alaska and Navajo regions pushed back, saying these assumptions endanger lives now—not hypothetically later.

10. Internal Sabotage Allegations Reflect Dysfunctional Transition
Kennedy alleged that some HHS staffers intentionally withheld checks or delayed funding in order to make the Trump administration “look bad.” If true, this reveals a breakdown in civil service neutrality—but also indicates management chaos and retaliatory politics within HHS.


Tuesday, May 13, 2025

Center for Medicare Innovation: Abe Sutton Highlights New Goals under Trump Administration

The Center for Medicare Innovation launches "New Strategy to Make America Healthy Again" (MAHA). 

There was a webinar on May 13, 2025, led by CMS Administrator Dr Mehmet Oz, and Innovation Center director Abe Sutton.   

Here's a summary from the announcement:

Building on 15 years of Innovation Center experience and lessons learned, the strategy focuses on three pillars: 

  • Promote evidence-based prevention. Prevention will be part of every model; interventions will be closely monitored to ensure they are on the path to certification for expansion, contributing to broader disease prevention, health promotion and reduced overall costs.
  • Empower people to achieve their health goals. The Center will increase patient access to information and tools for disease management and healthy living and align financial incentives with health.
  • Drive choice and competition. The Center will reduce administrative burden and increase independent provider participation in models, giving patients more options for care at a lower cost.

See also: A memo by the center's director, Sutton, here.  See a CMS Newsroom Blog by Sutton here.   A CMS website on innovation strategy priorities here.   PPT deck 25pp here.

##

Sutton was featured in an article at Stat Plus back on January 15, 2025.  As I wrote at the time,

  • Abe Sutton, who's crammed McKinsey, White House, Harvard Law School, and Rubicon Advisors into the last several years, was said to be a pivotal figure in a big, cross-agency renal program rolled out by the prior administration in 2019.
###
AI CORNER
I gave the Abe Sutton press release, his "white paper," a new CMMI powerpoint, and a CMI web strategy page, to Chat GPT for a write up.
###

Here is a detailed strategy analysis of the four CMS Innovation Center (CMMI) documents released May 13, 2025—including the PowerPoint deck, formal strategy statement, white paper, and blog-style press release by Deputy Administrator Abe Sutton. This briefing is designed for health industry stakeholders—payers, providers, policy strategists, and innovators—who want to understand and leverage the CMS Innovation Center’s evolving direction.


🔷 Executive Summary: Strategic Imperatives for the Health Industry

CMMI's 2025 strategy, branded "Make America Healthy Again," pivots sharply toward prevention-first health care, demanding deeper provider accountability and intensifying financial risk transfer from CMS to providers and plans. The message is clear: the health industry must adapt to a taxpayer-protective, risk-bearing, and prevention-aligned future—or risk exclusion from upcoming models and value-based frameworks.

CMMI is explicitly repositioning itself as a market shaper, not just a pilot funder. Industry leaders must now align with this directional vision in real time, even before models are formally released or codified.


🔷 Structural Overview of the Strategy

The four documents share a consistent three-pillar framework:

  1. Promote Evidence-Based Prevention

  2. Empower Patients

  3. Drive Choice and Competition

All are anchored by a foundational commitment to taxpayer protection and systemic cost reduction.


🔶 Detailed Strategic Insights by Pillar

1. Evidence-Based Prevention

“Prevention will be embedded in every model we test.” – Abe Sutton

Key Initiatives:

  • Primary, secondary, and tertiary prevention incorporated across all payment models

  • Incentives for nutrition, exercise, and even alternative medicine

  • Waivers to enable non-traditional services (e.g., caregiver payments, flexible DME rules)

  • Evaluation metrics include “days at home” and intermediate markers of health gain

Implications for Industry:

  • Payers and ACOs must integrate lifestyle medicine and prevention support into core benefits

  • Vendors and digital health companies offering preventive tools (e.g., mobile nutrition tracking, virtual coaching) have a clear alignment path

  • Providers must prepare for new performance metrics tied to early-stage intervention and prevention, not reactive care

2. Patient Empowerment

“Access to relevant and usable data is key.” – CMS White Paper

Key Initiatives:

  • Data democratization: Patients get app-based tools and transparent provider cost/quality data

  • Providers evaluated on patient-reported outcomes (PROMs), ADLs, lifestyle measures

  • Testing of predictable cost-sharing models for high-value services

Implications for Industry:

  • Plans and provider groups must build patient-facing tools with decision support and transparency

  • Health IT companies should accelerate integration of PROMs and consumer-friendly data

  • Industry must track how CMS handles cost-sharing waivers and V-BID insurance designs

3. Choice and Competition

“CMS will support more independent physician participation in VBP models.”

Key Initiatives:

  • Support for independent providers through advance shared savings and prospective payments

  • Expansion of site-neutral payments, at-home care, and scopes of practice

  • Standardized model design features to reduce administrative burden

  • Potential limits on state-level rate setting

Implications for Industry:

  • Health systems must prepare for competition from nimble, risk-ready independents

  • Private equity and MSOs supporting independent physician practices have significant growth opportunity

  • MA plans and ACOs must optimize model administration and prepare for simplified benchmarking/attribution

  • Expect a regulatory tilt away from state control (e.g., Certificate of Need limits)


🔷 Cross-Cutting Themes to Watch

🔹 Strong Language on Risk Transfer

CMS is mandating downside financial risk across all future models and will prohibit “risk-only” conveners.

Industry Takeaway: Entities must demonstrate real capital or actuarial credibility. Pass-throughs and loose affiliations will be scrutinized.


🔹 Emphasis on Evaluation and Certification

Models will not be sunset prematurely and will require certification paths to justify continued expansion.

Industry Takeaway: CMMI seeks to avoid churn by stabilizing models longer—but only if early metrics are favorable. Prepare to align with certifiable outcomes from day one.


🔹 Prevention as an Economic Strategy

“Ultra-processed foods, sugary drinks, and sedentary lifestyles” are explicitly named as root problems.

Industry Takeaway: Expect CMS to intervene indirectly in food, fitness, and lifestyle markets through coverage rules, flexibilities, and incentives. Nutrition and lifestyle companies are adjacent beneficiaries.


🔹 Federalism Shift and Preemption Signals

CMMI may seek to curtail state roles in rate setting and reduce barriers like state CON laws.

Industry Takeaway: CMS is moving toward greater federal authority in defining payment norms across states. This could disrupt state-run Medicaid innovation models and recalibrate commercial rate negotiations.


🧭 Strategic Recommendations for Health Industry Leaders

  1. Prepare for full-risk models. Health systems and ACOs must build the governance, capital, and analytics backbone to shoulder global risk—CMS will no longer fund passive experiments.

  2. Position early in prevention infrastructure. Engage in pilots or pre-model initiatives for lifestyle-based, app-driven, or virtual prevention tools.

  3. Elevate your data strategy. Patient-facing data tools, cost transparency, PROMs capture, and interoperable dashboards are no longer optional.

  4. Revisit MA strategy. Expect pressure on MA plan design, benchmark reform, and consumer tools.

  5. Back independent provider growth. Investors and MSOs should expand capital and operational support for physician practices who will now be favored in risk-bearing models.

  6. Track waivers. Stay alert for flexibilities CMS grants under model authorities—this includes new DME access rules, scope expansions, and caregiver payments.

  7. Engage CMMI. They explicitly invite “partnership”—early feedback can shape waiver designs, flexibilities, and model definitions.


🧩 Final Thought

These CMMI documents constitute more than a roadmap—they mark a governing philosophy. The future CMS envisions is proactive, consumer-informed, market-engaged, and taxpayer-protective. Health industry players must pivot from reacting to pilots to actively designing for a system that rewards prevention, transparency, and real fiscal discipline.

Let me know if you'd like a slide deck, executive summary, or action plan derived from this strategy brief.


Monday, May 12, 2025

Diagnostics & Differences of Opinion: New Case Study from Alzheimer's Disease

Update:  See similar coverage at 360Dx.

##

For decades, there have been differences of opinion about when any particular diagnostic test is "medically necessary," and there's a new case study today.  It's an article from UCSF and appears in JAMA Internal Medicine.

In the past couple years, there has been an explosion of interest in blood-based tests to help make the diagnosis of Alzheimer's disease.   It's driven in part by the availability of Alzheimer- or amyloid-specific drugs, but also by substantial improvements - finally - in the clinical chemistry of proteomics for the related proteins.  See an an article by Palmqvist et al. in JAMA 2024, and revised biomarker-based diagnostic criteria also from Alzheimer Association Workgroup, 2024, Jack et al.  Those are just two landmarks; it's a booming area of publications.

See a new opinion in the reverse direction, by Widera & Covinsky, in JAMA Internal Medicine, May 12.  The authors are at UCSF Geriatrics and the SF VA, and Covinsky is a JAMA editor as well.   

They open by citing "a recent television commercial..directs viewers to a disease  awareness website."  This leads to "the allure of early detection" but "clinicians should be wary."   But, the topic is not just  driven by TV commercials; it's a wide range of research publications and expert consensus publications.   Recognizing this, the authors add, "Recent efforts to redefine the diagnosis of Alzheimer disease from a clinical-pathological construct that starts with symptoms to a purely biological one that potentially begins with a laboratory test are deeply problematic if incorporated into current clinical care.  ... Enthusiasm should be tempered."

Without taking sides, I'll note that some of their points are:

  • Subjective complaints are common with normal aging.
  • Diagnosis should not be made on subjective comlaints or an abnormal test.
  • Diagnosis requires comprehensive evaluation.
  • Cognitive dysfunction is a syndrome, not a cause.
  • Alzheimer pathology does not imply dementia; many with neuropathology [biomarkers] do not progress to disease.
  • Risk of overdiagnosis = anxiety and worse.
  • Blood based biomarkers should be used in the same cases, where you would have used an amyloid PET scan.
We can expect a few Letters to the Editor over the summer.



##

See also JAMA Neurol, May 2025, Binette et al., on discrepancies between clinical and biological stage in Alzheimer's.

Trump Administration and Drug Prices: What Happened, May 12, 2025?

Over the weekend of May 10, 2025, President Trump posted that American drug makers would soon provide drugs at "most favored nation" pricing in the US - that is, the US price being pegged to the lowest price of any nation.

What happened on Monday, May 12, was different.   As discussed by New York Times, DJT signed an executive order that drugmakers should take voluntary actions and some agencies should pursue somewhat vaguely described goals.   NYT here.   Executive Order here.  

For example, "the Secretary of Health and Human Services (Secretary) shall facilitate direct-to-consumer purchasing programs for pharmaceutical manufacturers that sell their products to American patients at the most-favored-nation price."   

And, IF "significant progress towards most-favored-nation pricing for American patients is not delivered, to the extent consistent with law: (i)    the Secretary shall propose a rulemaking plan to impose most-favored-nation pricing."

###

Let's rewind.   In November 2020, shortly after the election, HHS released a Center for Medicare Innovation (CMMI) interim final rule (read: instant final rule) setting Medicare prices at the lowest international price.   This was challenge in court, and eventually dropped (in the Biden administration).  See some history from 2020 here.

CMMI, in Section 1115A of the Affordable Care Act, has extraordinary latitude to set demonstration projects, of undefined scope and duration, and they are not reviewable by the courts (per the law).   However, the interim final rule was challenged as not having a clear rationale for being an emergency rule (with no comment period before implementation).   

My reading is that HHS could issue a proposed rule for most favored nation pricing (MFN), taking 30 days comment, write a concise but rational response to comments, and then publish a final rule (say, at 60 days).   This would then be unreviewable by the courts.

However, there would still be a lateral attack on the MFN if it is engineered this way.  This is to challenge the statute itself (1115A) as unconstitutional, as an unconstitutionally vague delegation of authority from Congress to CMS.   

I put an extensive Chat GPT discussion as a side bar to this blog.

https://brucedocumentblog.blogspot.com/2025/05/mfn-returns-from-2020-to-2025-ai.html

See also this blog from 2022 on whether CMMI might be found unconstitutional.

https://www.discoveriesinhealthpolicy.com/2022/01/gorsuch-court-writings-suggest-cmmi.html



An Update on: Medicaid Pricing versus Medicare Pricing

 A quick pointer to a topic of ongoing interest - the gap between Medicaid prices and Medicare prices.  

See article by Skopec at Health Affairs, May 2025.

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.01530

Medcaid fees to physicians "for a basket of services" run about 75% of Medicare.   They also write:

  • Medicaid physician fees were approximately 71 percent of Medicare physician fees in 2024, including 
  • 69 percent for office visits, 
  • 68 percent for hospital and emergency department visits, 
  • 87 percent for obstetric care, and 
  • 79 percent for other services under our updated approach.

##
Here's a search you can run yourself in Google, I'm just reporting the topline Google results and I haven't researched the info links provided (in Google-AI format as response to search).    Google - medicare versus commercial insurance rates

  • Hospital services - commercial insurers pay nearly double.
  • Commercial insurance pays 143% of Medicare for physicians, some specialties higher.
  • [Hospital] Outpatient services, commercial pays 289% of Medicare

Remote Monitoring: Peterson Center, OIG See Medicare Vulnerabilities

It was a big deal a few years ago when CPT created, and CMS accepted, remote monitoring codes of several types.  

Part of the issue was that Medicare didn't traditionally pay for much, from a physician, that was provided explicitly "incident to" himself/herself, e.g. in the office.  For example, home-use allergens for desensitization were a line-item special statutory benefit, billed by the Part B physician but used at home.   And oral anti-emetics require a statutory benefit, too (1861(s)(2)(T).)

For the first couple years, there was limited usage of the remote home telemonitoring codes, at least in Medicare.   And there were no LCDs to address them, either.

Look for two updates, one from the OIG, one from the Peterson Center for Healthcare.  Hogan Lovells recently posted about the two reports.

HOGAN LOVELLS

Find the Hogal Lovells update here, dated April 21, 2025. It points to the Peterson Center study, and to a report last fall from OIG.

https://www.hoganlovells.com/en/publications/ai-health-law-policy-remote-patient-monitoring-reimbursement-coding-concerns

PETERSON CENTER

Find their report here. It clocks in at 24 pages.

https://petersonhealthcare.org/news/evolving-remote-monitoring-report/

OIG (Fall 2024)

Find the OIG report, "Additional Oversight Needed," 31 pages, September 2024.

https://oig.hhs.gov/reports/all/2024/additional-oversight-of-remote-patient-monitoring-in-medicare-is-needed/

##

AI CORNER

Chat GPT reads the two reports and discusses.

##

OIG 2024 Report: “Additional Oversight of Remote Patient Monitoring in Medicare Is Needed”

This 31-page report from the HHS Office of Inspector General (OIG) focuses on the explosive growth of remote physiologic monitoring (RPM) in Medicare from 2019 to 2022 and highlights critical oversight vulnerabilities. Key findings include a tenfold increase in utilization and a twentyfold increase in Medicare spending on RPM, mostly for chronic conditions like hypertension. Alarmingly, 43% of patients received incomplete services — lacking one or more of the three components (education/setup, device transmission, treatment management). OIG emphasizes that many services are billed without clear evidence of medical necessity, often lacking provider identifiers or condition-specific diagnoses. The report raises concerns about potential fraud, especially from companies aggressively enrolling patients without need. Recommendations include requiring provider orders, adding claim modifiers, collecting data on devices and health metrics, and conducting provider education. CMS agreed to consider most of these changes, although some require formal rulemaking.


Peterson Center 2025 Report: “Evolving Remote Monitoring: An Evidence-Based Approach”

This 24-page report from the Peterson Center on Healthcare and its research arm PHTI takes a clinical and policy reform approach, synthesizing claims analysis with rigorous evaluations of RPM and RTM (Remote Physiological Monitoring, Remote Therapeutic Monitoring) technologies. It differentiates itself by presenting condition-specific effectiveness data, showing that RPM is most effective for hypertension (notably within the first 6 months) and RTM for musculoskeletal issues (typically within 2–4 months). Diabetes RPM yielded limited long-term clinical benefit. Peterson’s data shows growth in both patient volume and episode duration, mirroring OIG’s findings. However, their focus is forward-looking, recommending that coverage and payment be tied to demonstrated clinical value — including time-limited payment windows, mandatory coding of health metrics and device types, and outcome-based models. Peterson also critiques the flat reimbursement structure that fails to account for condition-specific effectiveness or clinical engagement.


Comparison

Both reports converge in identifying rapid growth, data gaps, and the need for greater oversight in Medicare's use of remote monitoring services. However, they diverge in their lens and strategic focus. OIG adopts a regulatory and compliance framework, driven by fraud prevention and proper claim submission, while Peterson provides a clinical and economic optimization strategy, advocating for alignment of coverage with actual health outcomes. OIG emphasizes billing integrity and administrative safeguards, whereas Peterson advances evidence-based reimbursement and a more nuanced use of digital health tools. OIG's approach is more reactive and compliance-driven; Peterson’s is more proactive and reform-oriented, targeting payment policy reform to drive higher-value care.


Thursday, May 8, 2025

CMS Issues Instructions for PrEP Therapy for Medicare Beneficiaries

Despite the brouhaha over the USPSTF and preventive services, especially HIV-related services, under the Affordable Care Act, CMS has gone ahead and issued instructions for HIV PrEP in Medicare patients.  

##

Note: I think I have the fact patterns correct, but this is not my chief policy expertise, and I've worked from several web resources.  E.g. see the NCA, "Transition of Coverage of Oral PrEP Medications from Part D to Part B."

##

Medicare made the PrEP coverage decision following endorsement of PrEP therapy by USPSTF.   CMS can write NCDs that create new preventive benefits, if they are endorsed by USPSTF.   This one was tricky, because it is an oral medication and Medicare Part B does not normally cover tablets which the patient takes home.  The HCPCS codes include the drugs J0739, J0799, J0750, or J0751. Note that a number of these are injectible drugs (J codes). Oral therapies include Truvada and Descovy, injectibles include Apretude and others.   Oral drugs usually use NDC codes.

The benefit, besides tablets or injections include up to 8 counseling visits and up to 8 screening blood tests per year.  

There are no age limits but the physician must determine the patient is "at increased risk of HIV."

Benefit Category Puzzle

After a public request letter from VIIV in February 2022, the decision process was opened in January 2023, and finalized not in fall 2023, but in fall 2024.  That’s approaching 3 years.  See the complex timeline in section IV of the national coverage analysis.   

Under "Benefit Category," despite the fact that self-administered drugs (esp. tablets) are not a Part B benefit, CMS notes that Congress gave nonspecific or unrestrained abilities to create "other preventive services" and therefore, the oral drug exclusion rule does not apply.  

  • (For comparison, oral anti-emetics in Part B required a statutory benefit, too (1861(s)(2)(T).)

CMS writes, “To bill for oral HIV PrEP drugs under Part B, a pharmacy must be enrolled in Medicare as either: 1) a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier (CMS855S), or 2) a Part B Pharmacy supplier (CMS-855B).”  

See article MM13843, May 2, here:

https://www.cms.gov/files/document/mm13843-national-coverage-determination-21015-pre-exposure-prophylaxis-prep-hiv-prevention.pdf

The NCD language (core language) is here:

https://www.cms.gov/files/document/r13209ncd.pdf-0

###

CED for "Medicare-age data" used inconsistently

From my viewpoint, CMS is inconsistent in making complaints that a service isn't studied enough in Medicare patients.  The whole TCET apparatus  (temporary coverage for emerging technologies) is set up for CED because there supposedly aren't enough Medicare patients studied at the point of FDA approval.  OK, well... very few Medicare age patients were studied in HIV PrEP studies (see tables in NCA), nor were there special studies of Medicare disabled persons (e.g. blind or ESRD).  

Since the mean age was often around 25,  CMS could easily have raised the spectre of not enough Medicare-age data (like, none) and therefore, required CED.   This time around, CMS simply dealt with the issue by not mentioning the issue.

###

Equity Vintage 2024

The NCD, from last fall, has a section on health equity issues, which might be less likely to be written in the same way in the current administration.  See: HIV disproportionately affects racial/ethnic minorities, transgender women, and MSM, and equitable provision of PrEP to populations at highest risk of HIV acquisition is not occurring [etc].


Surgeon General Proposed: "L.A. Holistic Doctor and Wellness Influencer"

The Trump administration has proposed a second candidate (replacement candidate) for the post of Surgeon General.   This is Casey Means MD, a Los Angeles-based holistic medicine physician.

See a quite detailed article by Jenny Jarvie at LA Times here.  There are numerous other articles in case that one is firewalled for you; e.g. NPR and The Hill.


Means attended Stanford Medical School and did most of a surgery residency at OHSU before switching to clinical holistic medicine.   

Her book, Good Energy, has 3674 reviews on Amazon and 16,679 ratings on goodreads. Her coauthor and brother Calley Means has an MBA from Harvard.


##

The Hill writes, regarding the prior candidate,

President Trump has pulled his nomination of Janette Nesheiwat to be U.S. surgeon general and has instead chosen chronic disease entrepreneur Casey Means, a physician with close ties to the “Make America Healthy Again,” or MAHA, movement, as his new pick to fill the role.

Nesheiwat’s credentials came into question last month when CBS News reported that records showed she had graduated from the American University of the Caribbean School of Medicine, and not the University of Arkansas School of Medicine, as had been said when her nomination was announced.


Stevenson et al: Navigating PGx Testing in Practice

See a new open-access paper from the Pharmacogenomics Global Research Network (PGRN), Stevenson et al. in Clin Pharmacol Therapeutics.

See also, Patel et al, 2025, Medical policy determinations for PGx among US health plans.  Am J M Care.

Here's the authors' abstract for Stevenson et al:

There is increasing attention on the clinical utility and value of pharmacogenetic (PGx) testing to individualize medication management. Most clinical practice guidelines from medical professional societies do not recommend routine PGx testing, with a few key exceptions. Inconsistent recommendations across clinical practice guidelines, FDA product labeling, and payer reimbursement policies have hampered widespread adoption of testing. 

Multiple resources exist to aid in the adoption and use of actionable PGx test results in clinical practice; however, most of these resources do not provide guidance on who should receive PGx testing and when-a critical question the clinical community continues to struggle with. There are multiple considerations when answering this question beyond the clinical validity of the drug-gene interaction itself, such as the actionable result frequency, severity of the adverse clinical outcome, predictive power of the PGx test, suitability of alternative treatments, cost, and turnaround time of test results. This perspective discusses these considerations and models for testing including preemptive screening, pretreatment testing, and reactive testing, highlighting advantages and disadvantages of each approach. The authors provide their perspectives on identifying candidates for PGx testing in the current real-world environment and how that differs from a clinically ideal scenario.

AI CORNER
Here's a Chat GPT Summary of the same paper:

In their comprehensive 2025 mini-review in Clinical Pharmacology & Therapeutics, Stevenson and colleagues address one of the thorniest issues in pharmacogenomics (PGx): identifying who should be tested and when. While the clinical validity of drug–gene interactions is increasingly well-supported, real-world implementation remains limited by inconsistent guidance from CPIC, FDA labeling, and clinical practice guidelines—not to mention payer resistance. 

The authors distinguish among three key PGx testing models: preemptive screening, pretreatment testing, and reactive testing..

  • Preemptive testing offers maximal long-term value and enables instant decision support, but is rarely reimbursed and difficult to operationalize outside of well-funded academic programs.
    • Pretreatment testing—triggered by a diagnosis or high-risk drug—is more feasible and often covered, especially for medications with FDA boxed warnings or CPIC Level A/B recommendations. 
    • Reactive testing, though more common, is least efficient, coming only after adverse events occur. The authors argue that shared decision-making, education of prescribers (especially via PGx-trained pharmacists), and robust EHR-based clinical decision support are critical for broader adoption. 
    The authors propose a tiered strategy, starting with PGx for drugs linked to severe toxicities or regulatory requirements, and evolving toward more expansive panel-based testing as infrastructure and payer alignment mature. For clinicians and health systems alike, the paper provides a pragmatic roadmap for integrating PGx into practice while recognizing current structural, scientific, and reimbursement limitations.

    Thermo Fisher Ebook on Clinically Relevant Genomic Testing (24pp)

     Thermo Fisher has issued a number of white papers on genomics recently.   Here's one titled, "Expert Interviews - Revolutionize Patient Care through Clinically Relevant Molecular Testing."

    You can download it directly from this Linked In page.  Click to 'enlarge' the article display box, then see a 'download' error at top right.

    https://www.linkedin.com/posts/thermo-fisher-scientific_clinically-relevant-molecular-diagnostic-activity-7204931874492706816-KmSK


    AI CORNER
    Here's a Chat GPT summary:

    In this expert-driven primer on clinically relevant molecular testing, leaders in molecular pathology and clinical microbiology weigh in on the expanding role of PCR-based diagnostics in infectious disease and pharmacogenomics. The publication underscores that while analytic and clinical validity are foundational, it is clinical utility—the test’s ability to guide meaningful treatment decisions—that ultimately determines value in modern lab medicine. 

    Syndromic panels, especially for infectious diseases like pneumonia, gastrointestinal infections, and STIs, are highlighted as transformative tools due to their speed, sensitivity, and multiplexing capabilities, though experts caution that panels must be tailored by patient population and setting. Cost-effectiveness and stewardship remain pivotal themes throughout. Experts such as Joseph Yao, MD, and Stella Antonara, PhD, emphasize the need for partnerships between laboratorians and clinicians to identify the most appropriate use cases, avoid overtesting, and guide payer policies. 

    Meanwhile, pharmacogenomics is positioned as a rising frontier: Sherin Shaaban, MD, PhD, explains how COVID-era lab infrastructure and advances in high-throughput platforms are accelerating PGx adoption, despite persistent barriers like clinician education and data interpretation challenges. 

    Across all interviews, the core message is clear: molecular testing is no longer just about lab innovation—it’s about targeted, collaborative implementation that improves outcomes, controls costs, and redefines diagnostic strategy in precision medicine.

    Tuesday, May 6, 2025

    FDA Seats Dr Vinay Prasad as Head of Biologics, Vaccines

     


    HHS has chosen Dr Vinay Prasad, a UCSF-based oncologist, as head of CBER - the biologics and vaccines division.  The former head was Dr. Peter Marks.  The FDA's commissioner, Marty Makary, announced Prasad's appointment in an email to staff.

    https://www.cnn.com/2025/05/06/health/fda-vinay-prasad-vaccines

    https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-names-agency-critic-vinay-prasad-top-vaccine-official-2025-05-06/

    CNN writes, Prasad "became a harsh critic of the government’s response and its vaccine policies during the Covid-19 pandemic."  

    Reuters writes, "In a note to clients, RBC Capital Markets analyst Brian Abrahams called Prasad an "anti-establishment physician" who has been vocal on a broad range of matters, "including COVID-19, oncology studies, and randomized clinical trial designs in general."

    ###

    Asked for a neutral capsule bio, Chat GPT offered this:

    Dr. Vinay Prasad, MD, MPH, is a hematologist-oncologist and professor at the University of California, San Francisco, where he leads research on cancer drugs, clinical trials, and health policy. He has authored over 500 academic articles and two books—Ending Medical Reversal and Malignant—and is known for his critical stance on aspects of medical evidence and regulatory practices. In May 2025, Dr. Prasad was appointed director of the FDA’s Center for Biologics Evaluation and Research (CBER), a role overseeing vaccines and biologic therapies.
    His selection marks a departure from tradition, as the position is typically held by career FDA scientists. Dr. Prasad has previously expressed skepticism about accelerated drug approvals and COVID-19 vaccine mandates for young people, positions that have drawn both support and criticism. His appointment has been met with concern from some public health experts and has coincided with a drop in biotech stock prices, reflecting uncertainty about the FDA’s future regulatory approach under his leadership. 


    Sunday, May 4, 2025

    Natera Data, DEFINE HT Trial: Donor DNA Testing Can Outperform Cardiac Biopsy

    For several years, both CareDx and Natera have offered transplant patients the chance to detect organ rejection earlier, by quantifying the release of donor DNA from damaged graft cells.

    See news on the DEFINE-HT trial (Natera), presented an an international transplant meeting this past week.  Natera's share price is up from about $40 to $160 over 18 months.

    • See press release here.
    • See clinicaltrials.gov here.
    • See subscription article at 360Dx here.

    AI Corner:

    See an AI Summary of the press release:

    In the prospective, multicenter DEFINE-HT study, Natera’s Prospera™ Heart test with Donor Quantity Score (DQS) demonstrated a strong correlation between elevated donor-derived cell-free DNA (dd-cfDNA) levels and adverse clinical outcomes in heart transplant patients.  Outcomes included treated rejection, graft dysfunction, re-transplantation, and death at one year.

    Among over 1,100 samples analyzed, patients with elevated dd-cfDNA had a 2.6-fold higher risk of adverse outcomes (p=0.0299), and dd-cfDNA levels were three times more predictive of graft dysfunction than endomyocardial biopsy (EMB). Prospera with DQS outperformed donor fraction alone and offers a noninvasive, SNP-based assay with potential to replace EMB in surveillance, pending results from the ongoing ACES-EMB trial.

    MolDx Recruiting Add'l Medical Director

     See a post by Dr. Gabriel Bien-Willner of MolDx, on Linked-In.  MolDx recruits an additional medical director. It has an open-listing date up until May 9, 2025.

    https://www.linkedin.com/posts/gabriel-bien-willner-52a332117_palmetto-gba-is-hiring-another-medical-director-activity-7324463803578863617-GyWY/

    Find the full job description here:

    https://ourhrconnect.wd5.myworkdayjobs.com/PalmettoGBA/job/WH-South-Carolina/Clinical-Genetics-Director_R1044299-2

    They write:

    Position Purpose: 

    The Clinical Genetics Director is involved in all aspects of the Molecular Diagnostic Program (MoIDX) and DEX application and services operations, and serves as an internal subject matter expert, applying medical knowledge to advise decision makers in support of Palmetto GBA’s mission to create payor controls for molecular diagnostic testing that improve access to critical services and reduce payor and provider abrasion. Responsible for policy and procedure generation, technical assessment reviews, review and approval of documentation and reports. Serves as an ambassador for comprehensive genomic and molecular profiling through education and research efforts within and external to MoIDX. Reviews current literature and formulates policy and direction for MoIDX and DEX. Serves as the subject matter expert (SME) in germline or infectious disease testing for MoIDX and DEX.

    To Qualify for This Position, You'll Need the Following: 

    • Required Education: PhD in genetics or related field; OR Medical Doctor (MD) with current active medical license, without restriction.
    • Required Work Experience: 5 years experience in molecular laboratory testing, with 3 years experience in laboratory management. Experience may be concurrent.
    • SEE ADDL BULLETS at website.

    Thursday, May 1, 2025

    MolDx Medical Director Dr. Charnot-Katsikas: Hear the Podcast

    Dr. Angella Charnot-Katsikas has been a medical director with Palmtto/MolDx since December 2020. Dr. Charnot-Katsikas is featured on the first episode of a new series over at Precision Medicine Podcast, led by Karan Cushman.     

    It's Episode 66 of the Precision Medicine Podcast - and kicks off their Series 6.  Find the webpage for this edition here.  It's sponsored by Trapelo Health.   (When the episode is ready, find the transcript library here.)   

    ###
    And below, an AI auto summary of the podcast transcript.
    ###

    Podcast Summary: “Bringing Precision Medicine to Everyone” (Episode 66)

    Host: Karan Cushman for Trapelo
    Guests: Dr. Kashyap Patel (Community Oncologist, No One Left Alone)
    Dr. Angella Charnot-Katsikas (Molecular Pathologist, Palmetto GBA)

    Overview:
    This inaugural episode of a new series on the Precision Medicine Podcast centers on a pressing issue: how to close the access gap in precision oncology—especially for patients in community and rural settings. Although precision medicine is now the standard of care in oncology guidelines, uptake remains uneven. The episode brings together two perspectives—clinical and payer—to discuss solutions that move beyond innovation to implementation.

    Key Themes:

    • Real-world barriers to access:
      Dr. Patel emphasizes that lack of provider awareness, financial constraints, and restrictive payer policies still prevent many patients from receiving appropriate biomarker testing and targeted therapies—even in major academic centers.

    • Underutilization of biomarker testing:
      Dr. Charnot-Katsikas highlights not only delays in results and treatment initiation but also underuse of existing guidelines and failure to act on results when tests are ordered.

    • Calls to action:

      • Expand education efforts to include pathologists, surgeons, and all care team members.

      • Address "two-week rule" constraints in DRG billing that disincentivize timely biomarker add-ons.

      • Leverage platforms like Trapelo to streamline decision support and align test selection with payer policy in real-time.

      • Promote team-based care and frequent tumor boards to ensure rapid, informed clinical decisions.

    • Equity in practice:
      Dr. Patel shares moving patient success stories, including one involving international molecular profiling that led to life-saving targeted therapy. His nonprofit, No One Left Alone, demonstrates a localized, replicable model for delivering precision care and support services (e.g., transportation, food, housing).

    Takeaway:
    Precision oncology cannot fulfill its promise without structural reform in access, education, and workflow integration. The podcast sets the stage for a solution-oriented series aimed at ensuring every patient, regardless of geography or socioeconomic status, receives guideline-based molecular testing and appropriate therapy.