Discoveries in Health Policy

Assessing the New MolDx LCD for Transplant Rejection; And Our First LCD Report from Agentic Instructions

2026-07-16T20:32:58.013-07:00

Header: MolDx releases a long-awaited LCD on transplant rejection testing. Clear improvements in coverage and some explanatioins. The actual coverage rules could still be improved for clarity. For this blog, this is the first time a report has been entirerly self-generated by AI. There were 9 steps for creating a report, for example, #10 create a 500-word blog article

Tying Together: New CLIA Reform RFI, and CMS Summer OPPS/PFS Proposals; All Circle Around Computational Pathology

2026-07-16T10:15:46.106-07:00

Cat III Not on CLFSOver the past two months, CMS omitted new Category III codes for Digital Pathology [Computational Pathology] from CLFS meetings June 10. (Blog).OPPS Rule; Push Dig Path onto APC Policy SystemThen, July 2, CMS published the OPPS rule, taking the position that computational pathology per-se was not a clinical lab service at all (not under CLIA) and any such codes should be

Posted: Agenda for Digital Pathology Europe / London, December

2026-07-16T09:53:57.686-07:00

The agenda for the Digital Pathology & AI Europe conference has been posted over at Linked Iin by Lauren Dennison. Dates are 9-10 December in London. See the 15 page PDF agenda. Novotel London West (just west of Kensington).https://www.linkedin.com/posts/lauren-dennison-8059151a7_13th-dpai-congress-europe-agenda-ugcPost-7483513733999308800-m14j/ # #AI CORNER# #

CMS RFI: CMS Asks, How Should We Update CLIA Regulations?

2026-07-16T09:32:54.669-07:00

Header: CMS Publishes Request for Information: Let's Update CLIA, But How? After several weeks of rumors, CMS has released a formal national "request for information" as to how CLIA regulations could be updated. Such updates have been rare.Find it here: July 16, 2026, 91 FR 43586. Six pages. Comment 60 days, September 14.Christine Bump summarizes highlights at Linked In,

AI Guest Author: Lyric Acquires Well-Known Consultancy "Concert"

2026-07-15T15:54:13.685-07:00

Header: Concert Joins Lyric; by Chat GPTConcert Joins Lyric—Finding a Much Larger Stage for Precision-Health IntelligenceBig news arrived from Nashville on July 15: Concert, known for most of its history as Concert Genetics, has been acquired by Lyric, the large healthcare payment-accuracy and “decision intelligence” company. For those who have followed Concert and its outstanding executive team

AI Finds and Assesses a New Alzheimer Risk Study (Buckley 2026)

2026-07-15T05:58:45.967-07:00

We recently reported the news that Anthem would soon be covering FDA approved pTau217 blood tests, with conditions, as part of dementia work-ups in the clinic.And today, I saw headline news at CNN that there's a new study, pTau217 is a strong marker of 5-year risk of developing MCI or dementia in healthy elders. The CNN article said that high pTau217 matched a 38% increased risk of

WaPo Jumps on CMS RFI Against AMA CPT, RUC

2026-07-14T20:44:42.363-07:00

Header: WaPo Slams AMA Hard, Lands Punches EarlyOn Tuesday, July 14, the Washington Post had a headline article ready to run, featuring a lot of information from the RFK Jr HHS. Here. The article describes the Administration's new healthcare target: the AMA CPT and AMA RUC. Appearing so fast after the proposal came out in an obscure place, this likely indicates it was placed in

CMS Releases Physician Fee Schedule Rule - Proposals for 2027

2026-07-14T17:20:17.369-07:00

On July 14, 2026, CMS released the Physician Fee Schedule (aka Part B rule) as proposals for 2027. Find the early release version here (a typescript of 1500 pages).Wait for the Federal Register version here on July 16.See the FACT SHEET here. (Shared Savings programs get their own Fact Sheet here.)See the PRESS RELEASE here. See rapid coverage of the CMS RFI at

Things AI Can Do: Analyzing Trends in Today's CMS Lab Experts Meeting

2026-07-14T13:58:31.482-07:00

Today, July 14, CMS held its annual experts advisory committee for the 100-odd codes it is pricing for CY2027.In a previous blog, I showed how AI could quickly make a structured complete transcript of the day, including features like writing the code descriptor just before each discussion. Here.In this blog I took the whole transcript of the day - 82 pages and 32,000 words - and I asked Chat GPT

Things AI Can Do - Builds Structured/Merged Transcript of CMS Lab Pricing Meeting - in Minutes

2026-07-14T11:16:05.182-07:00

Header: AI Makes Super-Notes from a Federal Meeting.##Today, CMS held its professional advisory panel for pricing of new lab tests for 2027. The meeting was broadcast by Zoom.Here's what AI can do.1. I ran an audio auto record during the Zoom broadcast.2. Otter.ai made an auto transcript (somewhat rough, not great formatting).3. I gave two documents to Chat GPT. (1)

Flurry of News for Alzheimer Diagnostics

2026-07-14T06:06:56.391-07:00

A flurry of news for Alzheimer diagnostics, and we're closing in on the international Alzheimer conference in Toronto, AAIC-26. Two longstanding organizations, the Michael J Fox Foundation [Parkinson's] and te Alzheimer Drug Discovery Foundation, ADDF, are partnering, initially with $5M, to develop noninvasive testing. This $5M is part of a broader $50M effort of the ADDF

AI Guest Author; CMS TAVR Proposed Revisions & TAVR History at CMS

2026-07-13T21:34:53.211-07:00

In July 2026, CMS released a proposed revision of its coverage policy for TAVR - Trans-vascular aortic valve replacement. The proposal and rationale are at link. See also this news story : https://www.scai.org/media-center/news-and-articles/proposed-tavr-ncd-released-key-changes-and-next-steps ; Please review the history and rationales of CMS NCD coverage of TAVR discuss

AI Guest Author: History of CMS Coverage of Amyloid PET Scans

2026-07-13T21:20:41.617-07:00

News today of Anthem covering blood-based Alzheimer tests (here, here, policy here) reminded me of the tortured history of CMS and amyloid PET scans, plus the fact that no MACs have yet brought out any Alzheimer test policies (neither for serum tau nor PET).I asked Chat GPT to research and write up the history of CMS coverage of Amyloid PET. (Prompt at bottom).# # # Amyloid PET

MolDx Finalizes LCD: Liver Disease Risk Stratification

2026-07-09T06:42:50.010-07:00

MolDx MACs finalize an LCD, proposed last summer, on "Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis."See draft DL40187 here. See final L40187 here. See request letter #1 9/19/2023 here. #2 7/1/2024 here. Posted as MA Connelly and H Imai,

AI Reports as Part of Thinking? The Falling Friction of Knowledge Work

2026-07-07T20:02:55.239-07:00

Header: AI is making analytical reports cheap enough that they become tools for thinking, not just finished products.(Note - this essay generated by Chat GPT 5.5; fifth draft; substantial prompting.)(This essay began in April, when Stephane Budel/Decibio showed me a 10-page multi-part Claude Opus report.) When Reports Become Part of ThinkingPatterns from Index Medicus to ChatGPT Reveals

CHAT GPT Tries to Understand All 600 PLA Codes

2026-07-07T12:44:15.939-07:00

Here's another exercise where we give Chat GPT the ~600 current PLA codes and we ask it to find rhyme or reason in their multitudes. The text and the analysis below are entirely machine-written with minimal instructions from me.###Here are AMA CPT PLA codes up to code 0659U. Some codes have been deleted, so the active file contains 583 lines rather than 659 separate items.Study them and

CMS Publishes Federal Register Rules for Software as a Medical Service (Incl Lab Tests)

2026-07-07T06:30:28.024-07:00

A few days ago, this blog flagged that CMS was proposed to take software-intensive lab tests OFF the clinical lab fee schedule (at least in the hospital outpatient setting.) Here. We flagged that this is not a lab-only policy but a whole new field of CMS policy for "software as a medical service" or SaMS. Here. "SaMS" occurs 91 times in the outpatient rule.On

Example of AI Company Research; What's up with Mdxhealth?

2026-07-06T18:50:22.687-07:00

I saw a headline that Mdxhealth received a NASDAQ minimum price warning. July 2. https://mdxhealth.com/press_release/mdxhealth-announces-receipt-of-nasdaq-notification-regarding-minimum-bid-price-deficiency/I had recently seen it had closed an infectious molecular testing line of business, perhaps related to numerous payor cutbacks in 87798 payments.I asked Chat GPT for a

AMA Posts PLA Applications for July-August Cycle

2026-07-06T17:54:42.832-07:00

AMA has posted applications (for public comment) for the July-August application cycle. Find them here:https://www.ama-assn.org/system/files/aug-2026-pla-public-agenda.pdfComment via the indicated portal, by deadline July 20. (I'm not sure the deadline but I'd suggest noon central.)

Palmetto MolDx Shows Up in National News (DCIS)

2026-07-06T17:34:09.903-07:00

Palmetto MolDx and its pending decision on DCIS test coverage has made national news on NBC. The news includes a detailed article as well as video stories. This article quotes Linkd-In, quotes an NBC video, and abstracts points from a long NBC article.See an article on Linked In by Dan Forche, CEO at PreludeDX. Prelude makes the "DCISionRT' test to help make decisions about RT (

Payors, Pathology, and MBA Economics: A New 20p AI White Paper

2026-07-02T23:20:52.525-07:00

Entry point:The June 2026 issue of CAP TODAY features an article on pathology business economics by Dr Thomas Mezzetti. He cites a 2025 AMA report on health insurance consolidation, and 2024 CAP report on adverse impacts of private payors. What happened next:I asked Chat GPT to read these AMA and CAP reports, and discuss them. I then asked Chat GPT to frame the

The 2027 OPPS Proposed Rule: CMS Wrestles Actively with Software as a Medical Service (SaMS)

2026-07-02T13:46:39.749-07:00

Header: The OPPS proposed rule for 2027 is released. After a couple years of patchwork solutions, CMS adopts broad interim measues for software-dominant services. CMS also promised a more worked-out plan for next year.##Find the proposed rule here:https://www.federalregister.gov/public-inspection/2026-13656/

Run, Don’t Walk: AMA CPT Big Changes for Software-Dependent Services

2026-07-02T09:29:44.364-07:00

Run, Don’t Walk: AMA CPT Big Changes for Software-Dependent ServicesI wrote a long blog on Appendix S a few days ago, here's the concise version I used as a mini-post on Linked In.###AMA has published the 2027 version of “Appendix S,” its greatly-revised policies for software-intensive services. But there’s more! AMA is also rolling out BIG changes and never-before-seen requirements in

CMS Drops a Bomb on top of AI Lab Policy (OPPS Rule)

2026-07-02T09:23:36.614-07:00

HEADER: CMS Proposes Big Shift for Software-intensive Lab Services See pages 457-462 of the new Hospital Outpatient rulemaking for CY2027:https://www.federalregister.gov/public-inspection/2026-13656/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-paymentUpdate: The July publication in Fed Reg is here:https://www.govinfo.gov/content/pkg/FR-2026-07-07/

Lighthouse Lab Services / July 22 / Webinar on Qui Tam Developments

2026-06-30T14:56:42.884-07:00

Back on April 23, I posted an AI-driven analysis of a new qui tam court case involving, "MD Labs."Lighthouse Lab Services will host a webinar on the topic on July 22, with some of the original attorneys involved. (Some of them also spoke at Executive War College a month back.)Register here:https://www.linkedin.com/events/7477359203842482176/