TKG PACT Executive Briefings - 3-Minute Market Insights

On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "urgent") prior authorization requests within 72 hours and standard (or "non-urgent") requests within seven days. Insurers must also include their reasons for denying a prior authorization request and will be required to publicly release data on denial and approval rates for medical treatment.You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACTWe welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com

Today’s topic is the Federal No Surprises Act.The Federal No Surprises Act is intended to protect consumers from unexpected medical bills that occur when a patient unknowingly receives medical services from physicians and other providers who are outside of their health insurance network; in other words, healthcare providers who are not “in network”. The law protects consumers specifically from surprise medical bills in three main scenarios:1.    Emergency care from an Out-of-Network provider at an In-Network facility;2.    Any care from an undisclosed Out-of-Network provider; and3.    Uninsured or self-pay patients from unknown costs.You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACTWe welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com

Welcome to our new and revised market insights podcast format, where we have renamed our program the TKG PACT Executive Briefing. The new format will be condensed into 3-minute episodes of market insights, where we highlight one of healthcare’s critical market access issues, policies, challenges, or trends.We hope you enjoy this new “3-Minute Market Insights” format and hope that this resource provides helpful information in smaller, easier to digest, sound bites. Most of these TKG PACT Executive Briefings will have a downloadable PDF that you can access on our website. Instructions will be given with each episode. Look for a new episode to be available about every other week.Need more information? Or have suggestions for topics of interest? Please email us at Insights@thekinetixgroup.com

Telehealth Policy Gaps: Challenges with Remote PrescribingOn May 11th, the Public Health Emergency (PHE) and some of the provisions that supported the explosive growth of telehealth, will expire, leaving telehealth providers scrambling to address some of the challenges of proving remote care.My special guest in this episode is Dori Martini, Vice President of Operations and Regulatory Affairs for Circle Medical, a large, multi-state, contemporary, personalized primary care practice that offers high quality care, both in person, and via telemedicine. They are an affiliate of the University of California at San Francisco.Dori has an impressive understanding of the gaps – especially policy gaps - becoming evident in the day-to-day use of telehealth. In this episode, she shares some unique “best practices” in working around a few of the gaps and some practical ideas for managing your remote patients.

Circling the Wagons… to Solve Real Problems in NeurologyIt is estimated that globally, one in six people are affected by a health issue that includes some form of a neurological disorder. Within the United States, as many as 100 million people are having some kind of an issue related to a neurological disorder. Add to that the explosion of breakthrough new therapies for challenging neurologic diseases and disorders, like Alzheimer's, Parkinson's, epilepsy, migraines, multiple sclerosis, stroke, and ALS. The field of neurology is growing rapidly and the demand for services from this specialty is way outpacing capacity. It’s an exciting, yet challenging, moment in the treatment of neurological disorders!Our special guests today are the Chief Executive Officer and Chief Operating Officer from DENT Neurologic Institute and NeuroNet Pro, Joe Fritz and Christine Mann. They are the leading experts in the business side of neurology, and we are going to dig into this unique specialty in today's episode.

"Period Poverty"... a Taboo Topic?Unfortunately, there are some issues in healthcare that seem to get ignored, or simply don’t get discussed appropriately, and today’s topic is one of these challenging issues.   In many circles, menstruation is a topic that is difficult to discuss openly, which complicates the challenges of period poverty. Today we explore the challenges of period poverty and how that may contribute to the significant global problem of Iron deficiency in reproductive age women.Our special guests today are Mindy Olivarez, Vice President of Innovation at The Kinetix Group, and Michela Bedard, the Executive Director at PERIOD, a nonprofit that aims to support individuals affected by challenging menstrual cycle issues.For mor information on PERIOD, visit their website at Peroid.org.

NCCN Policy & Advocacy Priorities Supporting high quality cancer care through the NCCN Guidelines is a strategic pillar for the NCCN. Alyssa Schatz is the Senior Director of Policy & Advocacy at the National Comprehensive Cancer Network. She shares the current strategic priorities for her team in this week’s episode.

Musical Chairs... Improving Infusion Therapy“Musical Chairs”… how are we managing infusion center operations amid the financial and staffing woes of a healthcare system exhausted from nearly 3 years of a roller coaster ride due to the pandemic? Our guests for this episode are Christine Mann, Chief Operating Officer and Director of the DENT Infusion Center, DENT Neurologic Institute, and Andre’ Diamant, Chief Executive Officer of Gray Oncology Solutions. Both are experts in infusion therapy operations.

Who trains surgeons what medications to prescribe?We don't often think about surgeons as being significant prescribers of medications, but they actually prescribe a lot of medications and help patients manage their medications, as they prepare for and recover from a surgical procedure.  And in today's world of team based care, the surgeon is actively engaged in patient care planning. So how does a surgeon learn what medications to prescribe?  Our special guest on this episode is Dr. Andrew Smedley, a PGY2 general surgery resident at the UAMS Medical Center in Little Rock, Arkansas.

Impact of Operating Room Shut Downs Due to Staffing ShortagesA recent article in the Boston Globe raised a red alert on hospital operating rooms being temporarily closed due to staffing shortages and other pandemic related challenges. In the article, Dr. Eric Dickson, CEO of UMass Memorial Health, reported that, “… closing ORs is a near daily event.” He stated that UMass Memorial has nearly 2,000 staff vacancies, including 500 openings for nurses, making it hard to keep the ORs functioning at normal capacity. In the article, Mass General Brigham, Beth Israel Lahey, and Lowell General all reported similar challenges in keeping their operating rooms open.Our special guest on this episode is Richard Palarea, CEO of Kermit PPI, a Baltimore-based healthcare cost reduction and spend management company focused on maximizing operating room efficiencies and profitability. Rich is an expert in hospital OR operations and has seen the good and bad side of healthcare systems from a business and management perspective.

Advancing Health Equity: Individual Point of Care SolutionsHealth equity is a complex issue, with a broad range of governmental, social service, and health care stakeholders who are wrestling with these issues. My guests today are The Kinetix Group’s four summer interns. They’ve been researching the  challenges of improving health equity and how each of us can make a positive contribution to achieving the Quadruple of Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers and staff. In this episode, we explore how some innovative point of care solutions to help advance health equity.

Advancing Health Equity: How are we doing?Health equity is a complex issue, with a broad range of governmental, social service, and health care stakeholders who are wrestling with these issues. My guests today are The Kinetix Group’s four summer interns. They’ve been researching the  challenges of improving health equity and how each of us can make a positive contribution to achieving the Quadruple of Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers and staff.

Advancing Health Equity: Using Data and Technology to Improve Outcomes.Health equity is a complex issue, with a broad range of governmental, social service, and health care stakeholders who are wrestling with these issues. My guests today are The Kinetix Group’s four summer interns. They’ve been researching the  challenges of improving health equity and how each of us can make a positive contribution to achieving the Quadruple of Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers and staff. In this episode, we explore how stakeholders can come together to collaboratively work on advancing health equity.

Are Staffing Shortages Increasing Adverse Events?In March, The Advisory Board reported on the Top 10 Patient Safety Concerns for 2022 according to ECRI, a 60-year-old nonprofit committed to the safety, efficacy, and cost-effectiveness of healthcare. ECRI publishes an annual report on safety concerns and this year, number one on their list is “Staffing Shortages.” ECRI stated that, “Adverse events… were happening because the staff… were exhausted, and that contributes to human error.”The Advisory Board cited other research that found nurses are 67% more likely to have a failure of patient safety when working overtime, and that insufficient staffing is the number 1 factor influencing nurses’ intention of leaving their current position. Today's guest is Mark Lloyd, Senior Vice President at Guideway Care, a tech-enabled, patient activation, and care navigation company, that is addressing staffing shortages and clinical team exhaustion with care guidance and navigation. Email us at: oncology@thekinetixgroup.com#TKGoncology.com

The Unintended Impact of Medicaid Expansion on Drug PricesRecently, we attended the Hematology Oncology Pharmacy Association’s annual meeting in Boston, where we presented research our team did on the effect of Medicaid Expansion on the price of drugs. We were curious about the impact of Medicaid Expansion on the price of drugs, which is one of the more significant topics of discussion these days. What we discovered is that there may be some unintended consequences on drug pricing.

Hospital Flash Report: January was Devastating for Finances In February, Kaufman Hall published their Hospital Flash report that showed hospital finances in major distress mode, following the end of the Coronavirus Aid, Relief, and Economic Security Act or, CARES Act, funding. They reported that in January the median change in operating margin without CARES decreased 71.3 percent; operating room minutes fell by 15.7 percent; the average length of stay rose 8.6 percent; labor expense per adjusted discharge jumped 14.6 percent; and total expense per adjusted discharge increased 11.6 percent. Sounds like a bad start to 2022… Our guest is Mike Blair, Chief Financial Officer at CentraCare Health in St. Cloud, Minnesota.

Genetic Testing Errors Negatively Impact Therapeutic Decision MakingIn this episode, we continue our discussion with Meagan Farmer and Danielle Bonadies as we discuss how the Top Errors in Genetic Testing may be negatively affecting therapeutic decision making. We also discuss ways that life science companies may be able to appropriately support the accurate interpretation of genetic testing results and make sure patients receive the right therapy for their situation. To help you understand this issue better, The Kinetix Group has developed an infographic that summarizes the Top Errors in Genetic Counseling and some of the findings from the patient case studies highlighted in today's episode. If you would like a copy of this infographic, titled, “Challenges and Errors in Genetic Testing Negatively Impact Therapeutic Decision-Making,” please email me directly or send a request to our podcast email address: oncology@thekinetixgroup.com. I would be happy to send you a free copy.#TKGOncology

Top Errors in Genetic Testing Negatively Impact Therapeutic Decision MakingIn today's episode we take a look at some of the significant challenges and errors we are seeing in the use of genetic and genomic testing, as they become mainstreamed into our clinical treatment protocols. Today we highlight the Top Errors in Genetic Testing and how these errors may be impacting therapeutic decision making. To help you understand this issue better, The Kinetix Group has developed an infographic that summarizes the Top Errors in Genetic Counseling and some of the findings from the patient case studies highlighted in today's episode. If you would like a copy of this infographic, titled, “Challenges and Errors in Genetic Testing Negatively Impact Therapeutic Decision-Making,” please email me directly or send a request to our podcast email address: oncology@thekinetixgroup.com. I would be happy to send you a free copy.#TKGOncology, #genetictesting

The Battle over Site-of-CareIn this episode, my good friend and colleague, Ellen Feinstein, and I continue our debrief of the December Oncology Thought Leader’s panel meeting. Today, we focus on how our panel member’s are handling their battles over Site-of-Care, also some of their thoughts on care redesign, as well as looking at care coordination and patient navigation to help address social determinants of health. December’s meeting was particularly insightful. This is part 2 of our Oncology Thought Leaders meeting debrief. #TKGOncology

Critical Issues Facing Academic Cancer CentersA few weeks ago, we hosted our December meetings of the Oncology Thought Leaders Network, a part of TKG’s Networks of Excellence, where we discussed many of the critical issues in cancer center administration and care delivery.  In this episode, we debrief our Thought Leader's discussion on the top issues "keeping cancer center leadership up at night." #TKGOncology