Discoveries in Health Policy

Piling on to Software as a service; MEDPAC Plans

2026-08-26T18:58:28.290-07:00

Everyone's piling onto Software as a Medical Service (SaMS), and related terms. AMA CPT has been working on its Appendix S software coding paradigms. CMS in July offered radical changes to come, beginning with a new acronym, SaMS. Now the advisory body MEDPAC piles on.Here's how Google Gemini summarizes some new MEDPAC initiatives:The MEDPAC agenda specifically

Revisited: CAP and CMS Go in Opposite Directions on Digital Pathology

2026-08-26T13:00:09.103-07:00

In July rulemaking, in both OPPS (hospital outpatient) and Physician (aka Part B) proposed rules, CMS announced it will evict digital pathology / computational pathology services from CLIA services, and therefore strip them of their position on the Clinical Laboratory Fee Schedule.Whether you love or hate CLIA, love or hat the CLFS, my reading of the SSA 1834A PAMA statute is that "clinical

Very Brief Blog: CMS OPPS CY2027 Comment Due Aug 31

2026-08-26T10:47:32.516-07:00

There was a lot of action in summer rulemaking - both the OPPS and PFS (outpatient & physician part b) rules.The deadline for comment on the OPPS policies is Monday, August 31.Find it here:https://www.federalregister.gov/documents/2026/07/07/2026-13656/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-paymentBroad actions include new policies for "

AI Reviews: ADAPT OR BECOME IRRELEVANT - Alternative Visions for Pathology

2026-08-26T10:29:45.681-07:00

You may have seen it cited on Linked In - a new position paper on the future of pathology called, “Adapt or Become Irrelevant: The Pathologist as the New Diagnostic Architect.” It is co-authored by Mariano De Socarraz, MD, Founder and CEO of CorePlus, and Jochen K. Lennerz, MD PhD, Medical Director for Pathology Innovation at Natera.See a Linked In article here.See the original article

AI Guest Author: Waiting for CRUSH Regulations from OMB

2026-08-25T07:52:18.162-07:00

CRUSH at OMB: The Next Stage of a Twenty-Year Medicare Anti-Fraud CampaignAI Corner: Chat GPT 5.6; 8-25-2026The next major Medicare and Medicaid program-integrity proposal is now under review at the Office of Management and Budget. OMB’s public record shows that it received the proposed Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, rule from CMS on August 7, 2026.

CRUSH Reaches White House / OMB, Who Will Release the Proposed Regulations

2026-08-23T17:29:39.427-07:00

NEWS: CMS Sends Major CRUSH Anti-Fraud Rule to OMBThe February request for information has quietly become an actual proposed rule, with new Medicare enrollment and enforcement provisions potentially only weeks away.A major anti-fraud regulatory proposal is on the desk of management officials at the White House Office of Management and Budget, awaiting signoff for publication.CMS transmitted

Blog 5 of 5: AI Rewrites My Human Blog #3 (88305 Super-Providers)

2026-08-22T16:55:20.544-07:00

In this series of 5 blogs, Blog 3 (national and super-provider utilization) was written by Quinn by hand. Here is Blog 3, rewritten from source material entirely by Chat GPT 5.6.###88305: Blog 5 of 5 — What Medicare’s Biggest Users Tell Us About the 25-Minute ProblemThe developing Medicare controversy over CPT 88305 can be approached from two directions. The Maryland Health Care

Blog 4 of 5; We Discover the Source of the CMS 88305 Data: Mesta et al., June 2026!

2026-08-22T16:27:13.757-07:00

50-word summaryCMS’s July 2026 CY2027 Physician Fee Schedule proposal reproduced striking Maryland data suggesting CPT 88305 may be overvalued -- without naming the source. Discoveries in Health Policy has discovered that the trail leads to Maryland Health Care Commission officials Mesta, Chappel, and Jacobs in Health Affairs. Their open-access article adds useful detail—and

88305: Blog 3 of 5: National and Busy-Individual Usage for 88305 in Medicare Part B

2026-08-21T16:55:11.708-07:00

In summer rulemaking, CMS proposed surgical biopsy billion-dollar-code 88305 as a mispriced code. Blog #1 here. I also had Chat GPT research the policy history of the odd surg path coding system (it took 26 minutes!). Blog #2 here.In this third blog, I look at provider-by-provider Medicare Part B data for 88305. (I got the 88305 data from here. It's

FDA Approves De Novo Software that Makes Diagnosis on Brain MRI: NeuroPacs

2026-08-20T15:13:59.587-07:00

August 7, we published a blog on software diagnosis in radiology and asked how fast it might come to pathology. Here. And we've already updated that once, August 14. Here.Below, FDA approves de novo software that auto classifies MRIs as Parkinson disease vs several other disorders. Brave new world.##AI Corner##A few weeks ago, this blog reviewed DeepHealth SMART-B,

88305: Blog 2 of 5: The Ancient History of Surg Path Coding (88305 1960s?)

2026-08-20T10:00:13.940-07:00

Here's a challenge I gave to Chat GPT 5.6. What's the origin of the coding system for surgical pathology - biopsies 88305, etc. CPT produces Surg Path Levels "I" to "VI," scattered between 88300 and 88309.The levels are different than Tier II genetic procedure levels, where one is to use a level ("I" to "IX") only if your specific gene is named there. For Surg Path levels,

88305: Blog 1 of 5: CMS Proposes Review of Code 88305. Chat GPT Writes White Paper Report.

2026-08-19T18:57:07.076-07:00

In July, when CMS released the proposed policies for physician fee schedule aka Part B, it included a proposal to review the valuation of code 88305, one of the most frequently used pathology codes. The proposal came over the transom from State of Maryland.Below, summaries of a white paper report written by Chat GPT on the topic. Find the 20-page AI report HERE.###50-Word

Chat GPT Reviews History of McDermott Plus Consulting - After News from Politico

2026-08-18T23:52:10.881-07:00

We're waiting for confirmation of a news item in Politico that McDermott Plus is closing in August 2026.While we wait, Chat GPT ran a internet search for information about the history of the firm. This article is AI-written. It can be used as an example of current AI ability to understand a task, do research, organize it, and write it up. It should not be taken as ground truth.#

New Proposal Introduces Broader Authority for Political Input to NIH Grant Decisions

2026-08-16T20:39:44.462-07:00

Back in May 2026, OMB issued a proposed rule that would lay out the authority and framework for political appointees to have a much stronger hand in grant approval decisions. See article by AP here. AP also linked back to a Executive Order on the topic back in August 2025 - here. It might reduce the chance the political grant cuts would get contested in court as happened when

Why CMS MAC Questions for Synuclein Diagnostics Miss the Main Point

2026-08-16T12:30:30.864-07:00

This week, on August 20, several Medicare MACs will hold a public session on the literature on alpha-synuclein tesitng for Parkinson's and related disorders (synucleinopathies). It's an important opportunity for the neurologic community as most physicians get very little training in neurology. I suspect as few as ten percent take a full elective month in neurology (they only get

You Can Still Register for "CAC" Meeting on Synuclein Testing (Neurodegeneration)

2026-08-16T12:01:30.263-07:00

On Thursday, August 20, 2026, Noridian and some other MACs will hold a listen-only conference on neurodegeneration, specifically, use of alpha-synuclein testing. This is typically for Parkinson's and related conditions. The webinar is 2-4 central, 12-2 pacific, 3-5 eastern.Find the home page here, and see the bar at upper right for "Register."https://events.teams.microsoft.com/event/

Patient Rights Group Sues AMA Over the "CPT Monopoly"

2026-08-15T05:26:59.385-07:00

AMA CPT was in the spotlight in mid-July, when CMS released a "request for information" that was highly concerned about both the AMA CPT (coding) and AMA RUC (valuation). Entry point from my blog at the time, here.Now, headlines that the "Patient Rights Advocate" organization has sued AMA over the CPT "monopoly" (so called). Find PRA here, find the legal case here, find

AI Guest Author: How Far Away Are AI-Generated Path Reports? Closer Than You Knew! (Ver2)

2026-08-14T23:09:18.669-07:00

Only seven days ago, we published a white paper asking, “How Far Away Are AI-Generated Pathology Reports?” Since then, we encountered several important papers, commercial programs, and industry reports that we had not incorporated in the original review—and they materially change the answer. In particular, current prostate-biopsy AI is considerably closer to assembling and prepopulating a

AI Guest Author: A New White Paper, The Ten-Year Outlook of Pathology and AI

2026-08-14T15:42:12.200-07:00

This week, I ran across an interesting article in Modern Healthcare on radiology, AI, and rural hospitals. And that led to a new 22-page report from BAAI on the ten-year outlook of AI in radiology and how it could affect the field as a profession.I put those together with about ten other sources and asked Chat GPT to write about the ten-year outlook for AI in Pathology. Find it

CMS NTAP: CMS Didn't Kill Breathrough Status, But Gave It a Leave-By Date

2026-08-14T14:33:10.734-07:00

For several years, CMS granted a special easier review path for new devices that had breakthrough status, and who wanted NTAP (hospital extra payment) or the equivalent in OPPS.In Inpatient rulemaking released around August 1, CMS didn't kill the BT pathway, but gaved it a timed closure date. You still get the easy road if you get BT from FDA by 9/30/2026, and if you get FDA approval

Chat GPT Asks Why MEDPAC is Different

2026-08-13T13:57:06.188-07:00

With the current administratioin, some federal activities like PAC CARB (experts for antibiotic resistance) and USPSTF (for prevention) seemed to come to a halt. But others, like MEDPAC (advisory body on Medicare) percolate right along.Why is this?###Could We Have Predicted Which Federal Health Agencies Would Keep Running Under Trump?Could an expert, looking ahead from December 2024,

CMS Releases List of CPT Lab Codes with No 1H2025 PAMA Pricing Data

2026-08-13T09:15:22.412-07:00

HEADER: CMS RELEASES PAMA CODES WITH "NO DATA"CMS’s PAMA “no data” list included roughly 90 conventional CPT codes, seven M-codes, and about 300 PLA codes—fully 60% of all active PLA codes. The PLA pattern is not simply “new codes lack data”: code age was a weak predictor. Instead, commercial traction differed sharply by test type. Infectious-disease and transplant assays were far more likely to

Medicare Neurodegeneration Tests - Public Meeting - Question List Posted.

2026-08-12T12:07:17.093-07:00

On August 20, 2026, Medicare MACs will hold a public workshop (Contractor Advisory Committee) about neurodegeneration tests, with a focus on synuclein tests used in Parkinson's and other movement disorders.See our original blog about it, here.See the MAC home page, here.Question List Now ReleasedA very detailed question list to guide discussion, has been released. Find it here;https:/

Role of Pathologists in Molecular Ordering: in Breast Cancer, Kohle et al.

2026-08-12T09:51:00.780-07:00

Just a few days ago we covered Pineault et al, clinical behavior around ordering molecular testing in NSCLC. Find the blog here: https://www.discoveriesinhealthpolicy.com/2026/08/clinical-behavior-in-genomics-new-paper.htmlDon't miss a similar article, but in breast cancer, by Kohle et al., August 2026 in J Molec Dx. Find it here: https://www.jmdjournal.org

Example of AI at Work: AI Runs a Very Specific Information Request for Me, Every Monday

2026-08-10T14:15:19.421-07:00

Last week, I was struck by FDA approval of software that generates a ready-to-edit report for the radiologist from ultrasounds. (Here).I asked Chat GPT to do a recurrent comples search every Monday.1) Track FDA K260303 webpage for any updates like release of safety & effectiveness review.2) Track trade journals for articles on auto-generation of reports, in radiology &