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"A Mystery in the E.R.? Ask Dr. Chatbot for a Diagnosis" What’s Happening: GPT-4 is a chatbot that is trained on a 600-billion-word dataset of medical literature and can generate text that mimics the reasoning of an experienced physician. Instructors at Beth Israel Deaconess medical school in Boston are using ChatGPT in training exercises to help teach students how to think like doctors. Why It Matters: “Doctors are terrible at teaching other doctors how we think,” said Dr. Adam Rodman, an internist, medical historian and organizer of the event at Beth Israel Deaconess. GPT-4 will create something remarkably similar to an illness script. Experienced doctors use illness scripts—pattern recognition—to figure out what is wrong: signs, symptoms and test results put together to tell a coherent story based on similar cases they know about or have seen themselves. Instructors like Dr. Rodman hope that medical students use GPT-4 and other chatbots as something similar to a curbside consult—pulling a colleague aside to ask for an opinion, suggestion, and insight about a difficult case. A study released last month in JAMA found that GPT-4 did better than most doctors on weekly diagnostic challenges published in The New England Journal of Medicine. Yes, but: AI is a new technology. There is an art to using the program, and there are pitfalls and shortcomings for now. “It’s a great thought partner, but it doesn’t replace deep mental expertise,” Read more about this experiment at https://tinyurl.com/2rw8h54s

Every time the government passes a law or regulation to provide a resolution to our impossible health system, there is a period between passage and going live. During that time, the sector of the health industry affected mounts legal challenges or creates other tactics to frustrate or prevent entirely the adverse effects to its business. Case In Point: One provision of the 2022 Inflation Reduction Act bill finally authorizes Medicare to negotiate the price of high-cost prescription drugs. Seniors will see the new prices on the first 10 Medicare Part D drugs starting in September of this year. State of Play: The Pharmaceutical Research and Manufacturers of America, the National Infusion Center Association, and the Global Colon Cancer Association (together known as PharMA), was filed June 21, 2023 in federal district court in Texas. This is the last suit (so far) following three others filed by Merck, Bristol Myers Squibb, and the US Chamber of Commerce. Each suit was filed in a different federal court with difference reasons why the provision should be enjoined (stopped from going into effect until the legal challenges are resolved). Why it Matters: By claiming different multiple reasons in each case, different from those in the other cases, there is a chance at least one will be a winner. If the plaintiffs can prevail in at least one of the courts, there will be a national-wide injunction against the provision going into effect. Bottom Line: It could take years for the case(s) to be resolved. The pharmaceutical industry will keep escalating prices, and seniors will pay dearly for drugs. If they can. For more see https://tinyurl.com/ycx8rsf3

What: In the latest Biden administration effort to rein in Medicare Advantage, CMS issued a final rule prohibiting “misleading” Medicare Advantage advertisements plus other abuses. Why: Last year, the Senate Finance Committee released a report highlighting an increase in deceptive Medicare Advantage plans’ marketing practices targeting seniors and recommended that CMS take action to reduce the prevalence of such marketing tactics. Why It Matters: Seniors and people with disabilities are complaining about misleading and confusing Medicare Advantage and Part D plans ads. The final rule includes changes to protect people those types of misleading marketing practices. Below is a summary of some rules: A Few Details: Prohibits advertisements that do not mention a specific plan name, misrepresents what a plan offers, and uses Medicare logos or language in a way that could mislead and confuse enrollees into believing that the advertisement is for traditional Medicare. Clarifies criteria guidelines to help ensure that people with Medicare Advantage receive access to the same “medically necessary” care they would receive with traditional Medicare. Expands the list of populations to which Medicare Advantage companies must provide “culturally competent” services, such as people with limited English proficiency or those in the LGBTQ community. Requires that a prior authorization approval for care remain valid for as long as “medically necessary” to avoid disruptions in care for beneficiaries. Minimum wait time standards for behavioral health and requiring that most types of Medicare Advantage plans include behavioral health services. Support: The American Hospital Association applauds the action because Medicare Advantage beneficiaries are routinely experiencing inappropriate delays and denials for coverage of medically necessary care. It noted that this rule will protect patients, ensure timely access to care, and reduce administrative burdens on an already strained health care workforce. Other Action: On Friday, CMS issued controversial final payment policies for 2024 seeking to limit over billing by Medicare Advantage plans, e.g., updating the risk adjustment model to better ensure that payments are in line with patients’ medical conditions and prohibit insurers from adding diagnoses to inflate their billing. Yes But: Insurers protested the proposed rule vehemently, leading CMS to phase in the changes over three years, instead. See: Biden administration finalizes rule to target 'misleading' Medicare Advantage ads | CNN

In the fall of 2022, Congress passed the MOBILE Health Care Act. The law gives federally qualified health centers (FQHC) greater flexibility to use federal funding to create and operate mobile units in rural communities where there aren’t enough patients to support brick-and-mortar offices. Why It Matters: Currently, almost 1,400 FQHCs nationwide receive federal funding for providing comprehensive health services in underserved areas. Up to this new law they were required to have brick and mortar locations, an expensive proposition which stymied expansion. Rural residents face more significant healthcare provider shortages, including dentists, compared with their counterparts in larger cities. Since the beginning of the pandemic, mobile clinics have increased access to a range of services in hard-to-reach places with sparse populations. Mobile units would be a boon to West Virginia residents. Yes BUT: For now, the law is dependent on congressional funding. It could be at least a year before FQMC centers can access the grant money. In early March, more than 2,000 health center advocates went to Washington, D.C. to ask lawmakers to support multiyear grant funding. Action: Write to our state and federal officials and ask them to fund this new law as soon as possible. For more see Modern Healthcare.com

Medicare is undergoing a subtle but fundamental transformation from government program to public benefit provided by private companies, a shift with major implications for both patients and taxpayers. This long article is an exhaustive report of the history of Medicare Advantage. Each sentence is a succinct pearl. VOX.com

Adopting the proposed site-neutral payment policy would reduce private insurance premiums, increase federal tax revenues by tens of billions of dollars, reduce patient cost, and gained bipartisan support. For more, search for this post title.

Two doctors at a outpatient surgical clinic in Oklahoma thought the health industry need to be disrupted. They started a direct physician-to-patient practice and posted the costs of procedures on line. There are now 30 chapters around the county. See FMMA.org

Private equity investors are rapidly scooping up thousands of health businesses, emergency rooms or entire hospitals, and physician practices. The Kaiser Health News (KHN) has multiple articles showing how their profit motives raise concerns about rising prices and the quality of treatment. You will read how health professionals and patients are the brunt of their greed.

Doctors saying that however reasonable guidelines may seem, their cumulative burden causes “constant frustration” to medical practice. There are just not enough hours in a workday to discuss and act on all the guidelines. For more see FierceHealthCare.com The New York Times updated recently followed up.

Many people view single-payer universal healthcare, aka Medicare for All (M4A), as a “progressive” issue. But an article on The Medium website considers how M4A looks remarkably solid from a conservative standpoint.

The mass vaccination drive is a quiet preview of what Medicare-for-All could be.