Divinity Seven📚🏥🌏🪧 @SevenDivinity

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Sally Pipes @sallypipes

4 hours ago

The biggest threat to Medicaid's future is allowing fraud and improper payments to continue unchecked. Protecting the truly vulnerable starts with protecting taxpayer dollars. forbes.com/sites/sallypip…

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#WellnessWednesday The most surprising thing about healing wasn’t peace…it was humility.✨🙏🏽✨

😂🤏🏽

Magablonde @jwkm1989

6 hours ago

@RepSusieLee Thanks to President Trump.

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@RepSusieLee It’s embarrassing, when you refused to stand for Americans!

@RepSusieLee Why hasn't the Richard Star Act passed yet? Why haven't you even mentioned it?

👇🏽👇🏽👇🏽

Governor Joe Lombardo @JosephMLombardo

a day ago

Mining is an essential part of the Silver State’s history, economy, and culture. It’s also vital to our future, as Nevada is poised to lead the nation in lithium production, processing, manufacturing, and recycling, completing the lithium loop.

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@anish_koka TY for the RT! Happy Wednesday!🌱🍃✨

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Anish Koka, MD @anish_koka

5 hours ago

STAT News and the Wall Street Journal, both of which produced wall-to-wall negative coverage sourced overwhelmingly from anonymous FDA staff with an institutional interest in the status quo, should not have their account be the only historical record of what happened here. A

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😂😂😂😩

Anish Koka, MD @anish_koka

5 hours ago

This is the anti-keto diet.

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@EricTopol We see this same thing in the newest GLP-1 - Retatrutide, in the TRIUMPH-4 phase 3 trial: rheumatologyadvisor.com/news/triumph-4… And you can get retatrutide - the most effective GLP-1 medication yet, for under $300/year - if you know where to look: peptidesforcheap.substack.com/p/how-to-buy-g…

Knee OA is increasingly being viewed as a metabolically active disease rather than purely mechanical. This real-world analysis linking sustained GLP-1 RA use with lower arthroplasty risk adds an important dimension to the conversation around inflammation, metabolism, and joint preservation.

@EricTopol Anecdotal, but I had this rhomboid pain while sitting that just wouldn't go away and after about 8 months of a very low (0.06-0.1mg) of semaglutide, I realized it had gone away.

The anti-inflammatory effect independent of weight loss is the more telling finding. Systemic inflammation directly suppresses parasympathetic tone, CRP and HRV are inversely correlated across pretty much every population study. People on GLP-1 agonists who track with wearables often notice improved nocturnal HRV weeks before meaningful weight change. Suggests the cardiovascular protection mechanism kicks in before the scale moves.

85% (at least) of the data in Electronic Medical Records is worthless digital slop, we are all being forced (still) to pay for it, and it will just get worse with AI.

Paleoncologist @JOSEPH45075332

3 days ago

They were *never* great And the reason we *know* they were not great is we had to be FORCED to buy them Never, in the history of innovation, since the invention of the wheel, has anyone needed to be *FORCED* to buy a product that made their job easier

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They were *never* great And the reason we *know* they were not great is we had to be FORCED to buy them Never, in the history of innovation, since the invention of the wheel, has anyone needed to be *FORCED* to buy a product that made their job easier

David States MD PhD @statesdj

3 days ago

@SurgeryCenterOK @realdocspeaks Electronic medical records were great in the beginning, but then they became electronic administrative records and it all went downhill

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Google is about to conduct one of the LARGEST open-air biological experiments in U.S. HISTORY. 64 MILLION bacteria-infected mosquitoes are set to be released into Florida and California — potentially causing irreversible ecosystem disruptions. This must be STOPPED.

The cooling-off period is our next stop because the final rule made real progress on it and also left the most important questions unanswered. First, the progress. The Departments shortened the cooling-off period for batched disputes from 90 to 30 business days, which is a meaningful reduction. They also committed to publishing clarifying guidance on how the cooling-off period applies under the finalized batching provisions, and they acknowledged directly in the rule that stacking could lock physicians out of arbitration for years. Congress designed the cooling-off period as a contracting incentive. After an IDR determination establishes what a fair payment looks like, the parties should use that information to negotiate an in-network contract rather than return to arbitration for the same service. While that is a very reasonable idea, in practice, no meaningful in-network contracting is happening during the cooling-off period. What is happening instead is that insurers are using ambiguity in the statute as a prospective payment denial tool. The mechanism is straightforward. An insurer receives a claim. It decides on its own that the claim falls within a cooling-off period from a prior IDR determination. It refuses to pay. The physician disagrees. The IDRE disagrees. Two of the three parties agree the cooling-off period does not apply. The insurer still does not pay. The physician cannot challenge that through IDR, because the claim is already adjudicated. After the Fifth Circuit's June 2025 decision in Guardian Flight (and multiple others), the physician cannot sue to collect. Their only option is a CMS complaint with no guaranteed timeline and no penalty on the insurer. The insurer's unilateral assertion, even when wrong, is self-executing. The reason this works as a trap is that the statute never defined who constitutes the same parties for purposes of triggering the cooling-off period. Is it the insurer, meaning a determination against UnitedHealthcare triggers cooling-off for every employer plan UHC administers as TPA? Or is it the specific employer plan, meaning a determination against Employer A's self-insured United plan does not affect Employer B's self-insured United plan, even though they share the same TPA? Insurers read same parties as broadly as possible while physicians and IDREs read it narrowly. There is no mechanism to resolve the disagreement because the insurer holds the money and refuses to pay while the physician is prevented from resubmitting the same claim. It is a circular trap that the insurer wins by default. As I stated clearly at the Ways and Means panel on May 18, the cooling-off period is being used as a weapon to not pay. So, for review, a physician submits a claim. The IDRE reviews it and determines it is eligible. Arbitration proceeds. The physician wins. The payer then looks at the award and decides, based on its own interpretation of the cooling-off period, that the claim was actually ineligible because it was filed a day or several days early. Not that the patient was wrong. Not that the physician was wrong. Not that the IDRE made an error on the merits. Just that in the payer's unilateral view, the timing fell inside a cooling-off window the payer defined for itself. So the payer does not pay. That award, won on the merits through the process Congress created, is gone. There is no mechanism to resubmit. There is no mechanism to appeal. The payer holds all the money and has appointed itself judge and jury. The final rule removed the option to resubmit inappropriately batched disputes. That provision was intended to reduce gamesmanship, but in the context I just described, it eliminates the only potential corrective pathway for a physician whose claim was handled correctly in every material respect and then declared ineligible retroactively by the party that owes the money. I was at a panel on May 18 where a representative from Elevance Health said, with apparent conviction, that everyone must follow the law. That is the right standard. I agree with it completely. But the same industry is currently running significant advertising in Washington describing IDREs as the fox in the henhouse, arguing that the arbitrator and the attorney representing the physician are corrupt actors tilting the process unfairly. What that framing obscures is that the insurer is simultaneously acting as judge and jury on its own payment obligations, with no oversight, no appeal mechanism, and no penalty for getting it wrong or acting in bad faith. If the IDRE is the fox, what do we call a party that unilaterally decides which of its own legal obligations it intends to honor? The NSA imposed automatic civil monetary penalties of up to $10,000 per occurrence on physicians for balance billing violations, enforceable without a complaint being filed. That same exposure applies to failing to provide a Good Faith Estimate, violating the notice and consent process, or failing to display required patient notices. For insurers, the penalty for failing to pay a binding IDR award is zero. The penalty for miscalculating the QPA is zero. The penalty for bad faith conduct during open negotiation is zero. Senator Marshall's legislation, S.2420, describes H.R. 4710 explicitly as providing parity between penalties imposed against parties who are not compliant with the law. That language is an acknowledgment from Congress itself that no such parity currently exists. A physician in a cooling-off dispute has no private right of action. After Guardian Flight, there is no lawsuit to file. There is no appeal process. There is no mechanism to compel payment short of a CMS complaint with no guaranteed timeline and no penalty on the other side. The physician is structurally a claimant and nothing more, while the insurer holds the money, interprets the rules, asserts its own compliance, and faces no consequence for getting any of it wrong. Physicians lack the plan-level data to make accurate eligibility determinations at the point of submission. They lack any appeal mechanism when an insurer asserts cooling-off after the fact. They lack enforcement tools when an arbitration award goes unpaid. And they face unilateral civil monetary penalties for procedural violations while the counterparty faces none. The real insurer win rate across all NSA-eligible claims is over 95%, documented using the insurance industry's own survey data. And yet the narrative being advanced in Washington is that physicians are the bad actors ruining the system. Tomorrow I will talk about where we go from here, including where I think genuine consensus with insurers is possible and what Congress needs to do where it is not. @IndeMedAction