Podcasts about drgs

Play Episode Listen Later Nov 9, 2023 15:33

Every year, the Centers for Medicare and Medicaid Services (CMS) makes revisions, additions and deletions to the coding guidelines that healthcare organizations and practices use for reporting, billing and reimbursement. The guidelines for 2024 include a number of new guidelines dealing with social determinants of health (SDOH) issues. It is crucial for practices to fully understand all the guideline updates for accurate reporting and maximized reimbursement. In the next two episodes, Tomas discusses the latest coding guidelines with two leading clinical documentation experts. Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Senior Principal Clinical Operations and Quality Vizient Guests: Sheila Bowlds, MBA Associate Principal Clinical Documentation Improvement Vizient Jim Tamburini, BS, RHIT, CCS, CSS-P, CDIP Senior Consulting Director Clinical Documentation Improvement Vizient Show Notes: [01:39] Background and explanation of CMS coding updates [03:19] When changes go into effect [03:37] Impact on providers and hospitals [04:42] Number of diagnosis and procedure codes added, deleted and revised [06:48] Specificity drives the documentation [07:26] Changes to complications/comorbidities (CCs) and Major complications/comorbidities (MCCs) [11:58] Changes to DRGs and MS-DRGs Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Sheila's email: sheila.bowlds@vizientinc.com Jim's email: james.tamburini@vizientinc.com ICD-10-CM Official Guidelines for Coding and Reporting: https://www.cms.gov/files/document/fy-2024-icd-10-cm-coding-guidelines.pdf Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify RSS Feed

impact mba bs reporting medicare centers coding cms ccs specificity sdoh medicaid services cms modern practice drgs rhit

Episode 18: Unwort "Bett" oder alles fuer den Prozess

das ist Lean Hospital

Play Episode Listen Later Jul 17, 2023 12:59

Seit zwanzig Jahren werden Krankenhausleistungen über DRGs vergütet. Immer noch diskutieren wir über Betten und ihre Auslastung. Wäre diese Diskussion nicht so schädlich, man könnte amüsiert sein ob der menschlichen Beharrungskompetenz. Das einseitige Stieren auf Belegung verhindert jedoch, dass Patientenaufenthalte in Zukunft deutlich kürzer ausfallen und wir ruhige, strukturierte und geplante Behandlungsprozesse schaffen. "Raus aus dem Chaos" wird ein Traum bleiben. Der einseitige Auslastungsfokus verhindert echte Effizienz- und Qualitätsfortschritte.

chaos alles zukunft immer qualit traum diskussion prozess raus bett krankenhaus effizienz gesundheitswesen betten auslastung fuer unwort prozessmanagement belegung drgs

Readiness of nociceptor cell bodies to generate spontaneous activity results from background activity of diverse ion channels and high input resistance

Play Episode Listen Later Jul 2, 2023

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.06.30.547260v1?rss=1 Authors: Tian, J., Bavencoffe, A. G., Zhu, M. X., Walters, E. T. Abstract: Nociceptor cell bodies generate spontaneous discharge that can promote ongoing pain in persistent pain conditions. Little is known about the underlying mechanisms. Recordings from nociceptor cell bodies (somata) dissociated from rodent and human dorsal root ganglia (DRGs) have shown that prior pain in vivo is associated with low-frequency discharge controlled by irregular depolarizing spontaneous fluctuations of membrane potential (DSFs), likely produced by transient inward currents across the somal input resistance. Here we show that DSFs are associated with high somal input resistance over a wide range of membrane potentials, including depolarized levels where DSFs approach action potential (AP) threshold. Input resistance and both the amplitude and frequency of DSFs were increased in neurons exhibiting spontaneous activity. Ion substitution experiments indicated that the depolarizing phase of DSFs is generated by spontaneous opening of channels permeable to Na+ and/or Ca2+, and that Ca2+-permeable channels are especially important for larger DSFs. Partial reduction of the amplitude and/or frequency of DSFs by perfusion of pharmacological inhibitors indicated small but significant contributions from Nav1.7, Nav1.8, TRPV1, TRPA1, TRPM4, and N-type Ca2+ channels. Less specific blockers suggested a contribution from NALCN channels, and global knockout suggested a role for Nav1.9. The combination of high somal input resistance plus background activity of diverse ion channels permeable to Na+ and/or Ca2+ produces DSFs that are poised to reach AP threshold if resting membrane potential (RMP) depolarizes, AP threshold decreases, and/or DSFs become enhanced -- all of which have been reported under painful neuropathic and inflammatory conditions. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

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The impact of sepsis diagnosis and documentation, Part 2

diagnosis drift merchandising dressy drgs

Play Episode Listen Later Jun 15, 2023 11:45

This episode continues examining effective coding and documentation for sepsis cases and the impact accurate coding practices can have on clinicians and hospital operations. Paying attention to those who have sepsis present on admission (POA) is crucial to the process. Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Senior Principal Clinical Operations and Quality Vizient Guest: Linda Wiseman, BSN, RN, CCDS Senior Consulting Director Clinical Documentation Improvement Vizient Show Notes: [00:50] Sepsis is one of the highest-denied DRGs; what documentation needs to include [01:16] Coding guidelines to follow [02:05] Is bacteremia sepsis? [02:22] Present on admission (POA) – need to document even if sepsis only suspected [03:51] Avoiding denials for sepsis [04:58] Need to pay attention to “minimal” co-morbid conditions [05:51] Sepsis due to graft or device [07:12] Viral sepsis underdiagnosed [08:37] Sepsis, expenses and fear of denial [10:35] Need to link any organ involvement believed due to sepsis Links | Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Linda's email: linda.wiseman@vizientinc.com Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify Stitcher RSS Feed

mba paying viral diagnosis rn coding documentation bsn sepsis poa modern practice drgs

#D273 (dressy to drift)

The Dictionary

Play Episode Listen Later Apr 30, 2023 23:01

I read from dressy to drift. More info on DRGs (diagnosis-related groups). https://en.wikipedia.org/wiki/Diagnosis-related_group The word of the episode is "dribble". Theme music from Jonah Kraut https://jonahkraut.bandcamp.com/ Merchandising! https://www.teepublic.com/user/spejampar "The Dictionary - Letter A" on YouTube "The Dictionary - Letter B" on YouTube "The Dictionary - Letter C" on YouTube "The Dictionary - Letter D" on YouTube Featured in a Top 10 Dictionary Podcasts list! https://blog.feedspot.com/dictionary_podcasts/ Backwards Talking on YouTube: https://www.youtube.com/playlist?list=PLmIujMwEDbgZUexyR90jaTEEVmAYcCzuq dictionarypod@gmail.com https://www.facebook.com/thedictionarypod/ https://twitter.com/dictionarypod https://www.instagram.com/dictionarypod/ https://www.patreon.com/spejampar https://www.tiktok.com/@spejampar 917-727-5757

NOCICEPTRA2.0 - a comprehensive ncRNA atlas of human native and iPSC-derived sensory neurons

Off the Record with Brian Murphy

Play Episode Listen Later Apr 24, 2023

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.04.24.536852v1?rss=1 Authors: Zeidler, M., Tavares-Ferreira, D., Brougher, J., Price, T. J., Kress, M. Abstract: Non-coding RNAs (ncRNAs) play a critical role in regulating gene expression during development and in the pathogenesis of diseases. In particular, microRNAs have been extensively studied in the context of neurogenesis, the differentiation of pain sensing nociceptive neurons and the pathogenesis of pain disorder, however, little is known about the developmental signatures of other ncRNA species throughout sensory neuron differentiation. Moreover, there is currently no information available about the general expression signatures of ncRNAs in human dorsal root ganglia (DRGs) harboring the cell bodies of primary afferent nociceptors. To bridge this knowledge gap, we developed a comprehensive atlas of small ncRNA species signatures during the differentiation of human induced pluripotent stem cell (iPSC)-derived nociceptive neurons. By employing a combination of iPSC-derived sensory neuron and human DRG long and short RNA co-sequencing, we identified specific signatures that describe the developmental processes and the sig-natures of all currently known small ncRNA species in detail. Our analysis revealed that different ncRNA species, including tRNAs, snoRNAs, lncRNAs, and piRNAs, are associated with different stages of sensory neuron differentiation and maturation. We retrieved pro-nounced similarities in ncRNA expression between human DRG and late-stage iPSC-derived sensory neurons, which further supports the use of iPSC-derived sensory neurons to uncover functional and regulatory changes in ncRNAs and their suitability as a as a human model system to bridge the transla-tional gap between preclinical findings mostly from rodent models and our understanding of human disorders for the development of mechanism-based treatments. In summary, our findings provide important insights into the role of ncRNA species other than microRNAs in human nociceptors. The updated NOCICEPTRA2.0 Tool will be the first fully comprehensive searchable ncRNA database for human sensory neurons enabling researchers to investigate important hub ncRNA regulators in nociceptors in full detail. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

price llc tool native copy comprehensive sensory rna neurons derived kress ipsc drg micrornas biorxiv drgs lncrnas ncrna

CDI-ing like its 1999: A conversation with Atrium Health Wake Forest Baptist director Tamara Hicks

Play Episode Listen Later Apr 19, 2023 49:16

How long have you been in CDI, oh listener? Three years, five, 10? Maybe as many as 16, if you started back when CMS adopted MS-DRGs and ACDIS began, in the hazy, pre-Tik-Tok days of 2007? My most recent guest on Off the Record has been in CDI for 24 years, starting in 1999. Longer than she served at the bedside as a nurse. It's possible some of my listeners are 24. She's been there, done that, but still driving her program forward, never settling. Tamara Hicks is the Director of Clinical Documentation Excellence at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina. She's a two-time member of the ACDIS advisory board, served on the ACDIS CCDS certification committee, and in 2019 won CDI professional of the year from that organization. She's also acquired the nickname Grandmother of CDI. So it behooves us to listen to her wisdom. We get into that deep pool of wisdom on this episode of Off the Record, covering the following topics: What was life like for a CDI professional in the 20th century? A day in the life of Tamara Hicks and the Atrium Health Wake Forest CDI department Is there such a thing as “advanced CDI”? If so how do you define that, and practice it? Career ladders for staff retention What is the ideal CDI candidate (if you could clone one, who would they be)? Much more, including Tamara's family of dogs, cruise obsession, and favorite classic rock hit

director tiktok conversations career north carolina record longer baptist grandmothers hicks cms wake forest winston salem cdi atrium health drgs atrium health wake forest baptist acdis

Sex-specific developmental changes in spinal cord pain pathways following neonatal inflammation

Play Episode Listen Later Apr 13, 2023

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.04.12.536647v1?rss=1 Authors: Hedley, K. E., Cuskelly, A., Quinn, R. K., Callister, R. J., Hodgson, D. M., Tadros, M. A. Abstract: Early-life inflammation can have long lasting impact on pain processing and pain behaviours. For example, we have shown neonatal inflammation can result in changes within spinal neuronal networks and altered flinching of the hind paw 5 following formalin injection three weeks later. This suggests mechanisms for altered pain behaviours lie in first and second order neurons in the pain neuroaxis. Exactly how these changes progress during postnatal development is not known. Accordingly, we investigated neuroinflammatory markers in sensory neurons (dorsal root ganglia; DRGs) and spinal cords of Wistar rats (both sexes) after 10 early life inflammation. Rats were injected with LPS or saline on postnatal days (P) 3 and 5. DRGs and spinal cords (SC) were isolated on P7, 13 and 21, and the expression of six inflammatory mediators were quantified via RT-qPCR. In the DRG, four proinflammatory mediators were elevated in P7 rats exposed to LPS. By P13, only two proinflammatory agents were elevated, whereas at P21 the levels of all six inflammatory mediators were 15 similar between LPS and saline-treated rats. There were no sex-specific differences in the expression profile of any mediator in DRGs. In the spinal cord this expression profile was reversed with no change in inflammatory mediators at P7, elevation of two at P13 and four at P21 in LPS treated rats. Interestingly, these differences were greater in the spinal cords of female rats, indicating sex-specific modulation of neuroinflammation even at these early 20 stages of postnatal development. The increased inflammatory mediator profile in the spinal cords of P21 LPS-treated rats was accompanied by sex-specific modulation of astrocytic (GFAP) activation, with females showing an increase and males a decrease in GFAP following LPS exposure. Together, these data indicate sensory neurons are more susceptible to acute inflammation whereas inflammation in the spinal cord is delayed. The sex-specific 25 modulation of inflammation during critical phases of development may help explain altered pain behaviours in adult males and females. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

pain llc copy rats pathways inflammation lps developmental hodgson neonatal spinal cord drg callister p7 biorxiv wistar drgs gfap rt qpcr

Deficient mitochondrial respiration impairs sirtuin activity in dorsal root ganglia in Friedreich Ataxia mouse and cell models

Play Episode Listen Later Feb 3, 2023

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.01.526688v1?rss=1 Authors: Sanz-Alcazar, A., Britti, E., Delaspre, F., Medina-Carbonero, M., Pazos-Gil, M., Tamarit, J., ROS, J., Cabiscol, E. Abstract: Friedreich ataxia (FA) is a rare, recessive neuro-cardiodegenerative disease caused by deficiency of the mitochondrial protein frataxin. Mitochondrial dysfunction, a reduction in the activity of iron-sulfur enzymes, iron accumulation, and increased oxidative stress have been described. However, the mechanisms causing such cellular disturbances in mammals are not completely understood. Dorsal root ganglion (DRG) sensory neurons are among the cellular types most affected in the early stages of this disease. We have previously demonstrated that frataxin depletion in primary cultures of DRG neurons results in calcium dysregulation, neurite degeneration and apoptotic cell death. However, its effect on mitochondrial function remains to be elucidated. In the present study, we found that in primary cultures of DRG neurons as well as in DRGs from the FXNI151F mouse model, frataxin deficiency resulted in lower activity and levels of the electron transport complexes, mainly complexes I and II. As a consequence, the NAD+/NADH ratio was reduced and SirT3, a mitochondrial NAD+-dependent deacetylase, was impaired. We identified alpha tubulin as the major acetylated protein from DRG homogenates whose levels were increased in FXNI151F mice compared to WT mice. Mitochondrial superoxide dismutase (SOD2), a SirT3 substrate, displayed increased acetylation in frataxin-deficient DRG neurons. Since SOD2 acetylation inactivates the enzyme, and higher levels of mitochondrial superoxide anion were detected, oxidative stress markers were analyzed. Elevated levels of hydroxynonenal bound to proteins and mitochondrial Fe2+ accumulation were detected when frataxin decreased. Honokiol, a SirT3 activator, restores mitochondrial respiration. Altogether, these results provide the molecular bases to understand mitochondria dysfunction in sensory neurons which have greater susceptibility to frataxin deficiency compared to other tissues. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

llc root models fa activity copy mouse elevated nad respiration wt mitochondrial deficient dorsal ataxia drg friedreich biorxiv ganglia drgs sirtuin tamarit britti sod2

The pharmacovigilante

2Scientists

Play Episode Listen Later Dec 13, 2022 66:23

He's here, he's there; Dr. Hillman brings drug safety everywhere! So given the rules and regulations he needs to follow, the title “vigilante” could be nothing but ironic.We chart David's progress through choosing pharmacology as a subject to study, and settling on pharmacovigilance as a career to pursue. Listen: The Bollywood beats come courtesy of Cambridge-based artist Anish Kumar whose music you can also find on Bandcamp: anishkumarmusic.bandcamp.com, YouTube, Instagram and Twitter.Watch:Subscribe to our YouTube channel now for all future recordings. Episode transcript[Background intro music playing is "Nazia" by Anish Kumar]Parmvir: Hello everyone. And welcome to another episode of the 2Scientists podcast, where inspiring scientists share their work with you, wherever you like to listen. Today we come to you from a rather unique spot, rather than a cafe or bar we are camped out in Kensington Gardens in London, because it's a glorious day and our podcasting equipment allows us to do that. But enough about me and us, we are here today, of course I am your host Parmvir Bahia here and we're here with David Basanta, but we also have with us another David who is very special to me, he is an old friend of mine from my PhD program, and we shared much time and much swearing over experiments together at University college London. How are you David Hillman? David: I'm doing well. Thank you. It's, as you say, it's a, it's a lovely day and, it's nice to be back with old friends. Parmvir: Yes, yes. Of course everything rotates background to COVID and whereas we would normally see each other once a year. It's been three, four, possibly? David: Three, I think that's yeah.Parmvir: Miserable. David: Yeah. Sad times we shall have to make up for it. Parmvir: We will, we will. There's a bottle of Cava with our name on it. Once we've done with this. David: And onion rings. Parmvir: And onion rings. Yes. Fancy Marks and Spencer's one's though. So let's start at the beginning. I'm not talking about like, where were you born kind of thing. Although you can mention Kidderminster if you'd like. So as I understand it, we had a relatively similar track as undergraduates. So you did a bachelor's in pharmacology, correct? David: Yeah, that's right. Parmvir: So tell us why, why pharmacology? David: So this is gonna age me, age us.So I, for my A levels, so for my senior school exams, I, studied chemistry, biology, and maths, and I wanted to study something at university that combined chemistry and biology. And so this is the bit that will age us. So back in the day, if you remember, you would go to the, career advice department who were trying to help people to steer people towards what options they might want to pick at university.And they had this huge telephone directory effectively, which, mapped together people's different, combinations of A level courses and then gave you a list of options that you could, study at university. So I was sat in this little tiny room with this career advisor person, and they were basically running through this list of different courses.And when they came to pharmacology, they'd already mentioned pharmacy, which, you know, most people know what it is, but then they said pharmacology and I stopped them and said, well, what's, what's the difference? And they actually gave a pretty good summary. They said, it's more the biology of medicine. It's more the, the research and development of new medicines. They said it's potentially a controversial topic because it's the pharmaceutical industry is itself sometimes controversial and there's other aspects to the industry, which are, challenging sometimes. But yeah, that's how it started. So I picked a few different pharmacology courses, one of which was King's College London. I was always very practical, so I liked the idea of doing a year in industry at some point. So I chose a sandwich course like you and yeah, so that took me to KCL all that time ago. Parmvir: Mm. So I didn't realize how similar our tracks had been, because I also did biology, chemistry and maths, and I wanted to do something with the chemistry and the biology.And I got put in that direction by David: did you pick it out of the phone book as well? Parmvir: I did. What was it called? There was a name for it. David: It was pretty like a UCAS publication. Parmvir: Yes. It was just, it was enormous. David: Yeah. Parmvir: But yeah, in any case, I also, I did a sandwich year and I got to go and hang out in Germany for a year, which was fun.But yeah. So obviously after that you came to do a PhD at UCL where we were, well, I was a year ahead of you, I think. David: Yeah. You were. Parmvir: Why? Why did you do a PhD? David: So well for the reasons that I guess a lot of people do them, which is that I wasn't sure what to do next [both laugh] and a PhD seemed like a good way to string it out for another few years before I figured that out.But the reason I landed on UCL was that when I did go and do my year in industry, which like you was for a large pharma company, I worked in a lab looking at some non-clinical safety models. And we were using electrophysiology techniques at the time that was sharp electrode electrophysiology.Parmvir: You're gonna have to explain what electrophysiology means. David: Oh, don't make me do that. It's been 20 years [Parmvir laughs]. Oh, it's basically where you take either isolated cells or tissues and you put tiny, tiny electrodes into them and measure the changing currents across cell membranes. And as you put different drugs on, you can look at different effects of those drugs how they affect the electrical signals that you can measure.And really it's ions moving back and forward across membranes by little things called ion channels. So yeah, so I'd done sharp electrode electrophysiology there. I went back to university to finish my last year, and then the question came up about what to pick for a PhD. And I thought, well, although I hadn't enjoyed electrophysiology, it's something that I had started to, I guess, gain an interest in. Plus I had some skills that in that area. So, yeah, so I found a course, rather a PhD studentship at UCL, which seemed to fit the bill. It was looking at using a slightly different electrophysiology technique, so patch, clamping in a different area, but I thought it was something that I could use what I'd learnt in my year in industry Parmvir: I gave you some of these questions beforehand. David: Yes, because I'm incapable of spontaneous reaction to questions [Parmvir laughs]. Parmvir: Actually, I loved it so much that I have to read out your description of what your memory is like. David: I was quite proud of that. I coined that yesterday. I used to think of my memory as a lobster pot. Parmvir: All right. So you said I've just come up with a good analogy for my recall memory. It's like a reference library. You have to put in a request and then go away for a bit. When you come back, I'll have retrieved something from the vaults. Hopefully. David: Yeah, exactly. Parmvir: But aside from that I wanted to say this might be something of a loaded question, but what did you think of your PhD experience?David: You know, I really, I look back on those years with fond memory. Now it's partly because looking back, you edit out all of the stress and anxiety associated with doing a research project like that. I remember at the time when I first started UCL ran some induction courses where they pulled together PhD students and other postgraduate students from all sorts of backgrounds and John Foreman who you'll remember who was the Dean of students at the time, he gave a little introduction to UCL, but also gave some interesting advice let's say and pointers.And one of the things he pointed out in that session was the high degree of mental illness that is encountered by students in general taking these types of courses because they are stressful. And you often feel like you are kind of on your own. Driving your own research project forward. Sometimes through difficult times. So I do remember that in particular, but you know, what I remember mostly is just how impressed I was with all of the people that surrounded me because our department was not particularly flashy in its kind of presentation, but there were some seriously impressive people there.So I always like to think of our lab in the sense of, you know, it was run by effectively by Dennis and, and Guy when we got there. But before then it had been run by Don and before then it had been run by Bernard Katz who was a Nobel laureate. So it felt like we were the either grandchildren or great grandchildren of a Nobel Laureate and the whole department was a bit like that. It had a lot of very understated people who were world experts in their, in their field. And I always felt like the dumbest person in the department. But that didn't bother me too much because you know, being surrounded by all this greatness and even just, you know, the little glimpses of things you would see at the kind of coffee breaks and in the corridors, some of those memories still live with me, you know. Bearing in mind, this was back in what, between 2001 and 2005.So very, very early days of smartphones, things like trios and things like that, which seem antiquated now. But I remember coming across two old professors, so probably in their seventies or eighties comparing their smartphones and that like little microcosm, are the things that I loved about the department.Parmvir: Actually, I mean, I think you're, you're definitely selling yourself short. Like nobody would say that you weren't smart enough to be there. And I think one of the things that kind of ties into the, the mental health aspect is that we all felt that way. David: Yeah. Parmvir: Except we didn't express it to anyone else. It's, it's utterly ridiculous. How can we all be the least smart person in the room that's just not possible. David: Yeah. Parmvir: And after that, we all got our PhDs anyway, so, you know yeah. David: I certainly have no regrets about it. And I look back on those times with, with very fond memories, for sure. Parmvir: Yeah. Just talk briefly about what you did for your project and what the difficulties were.David: So the lab that I joined, so which, which you were a part of as well, their specialty was calcium activated potassium channels. And over time, the lab had looked at these ion channels in various different settings. The project that I was given was looking at these channels in vascular endothelial cells, which was a cell type that no one in the lab had ever studied before.Parmvir: Mm. David: So one of the biggest challenges that we were hit with straight away was that no one in the lab could really help that much with firsthand experience of how to obtain these cells, how to isolate them, how to culture them, how to grow them and really how to manage those cell types. So you might well remember that, the first, probably nine months of my PhD was just spent trying to culture these cells. Parmvir: Mm-hmm David: and it started with you know, available tissue from rats and other small mammals.But then eventually we were not having success with culturing cells from those models. So I switched onto pigs and, you know, I'd done a bit of reading that, you know, these vessels, because they were much larger the blood vessels, it was easier effectively to culture cells from, so I looked in the phone book and I found the address of an abattoir out in the middle of Essex.And there began my weekly trip for getting on for two and a half years to the deepest, darkest corners of Essex to go and retrieve pig, coronary artery cells once a week. Parmvir: Yeah. And essentially you suffered because these things were so flat. [David laughs] And when you're trying to, so you, for anyone who's listening, you have to picture trying to get a very, very fine tube onto something that is incredibly flat, and essentially you need this thing to form a vacuum seal and that just wasn't gonna happen. David: No, so, you know, vascular endothelial cells, they're the cells that line blood vessels, which is why they're, they're very flat. They're like tiles almost on the inside of veins and arteries.And you know, with other cells in the lab that were being looked at like the ones that you were looking at, like DRGs and like neurons and things like that, you know, you were basically putting the, the electrode down onto like a ball. Parmvir: Yeah. David: So the gap between the bottom of the dish and the top of the cell was who knows, 10, 20 microns, something like that. The cells that we were looking at, they flattened themselves out so much, they were about one micron, I think we estimated and therefore the tiniest vibration in the room would destroy the cell. And yeah, so the first stage was trying to culture, the damn things, and that was extremely challenging. It took a long time, but nine months of the way through managed it, and then began the whole pain of trying to get electrical recordings from them, which turned out to be as difficult. Parmvir: Yeah. So one of the things, I don't know if we ever talked about this, but what did you aspire to do after you'd done your PhD originally?Like, did you have any kind of idea? David: I mean, I think I was always headed into the pharmaceutical industry, which is where I landed up. In my undergrad degree in, I think my either first or second year, I did a very nice course, which was a kind of practical introduction to the pharmaceutical industry and from very top level, how drugs are developed and how pharma companies are organized internally and how the research progresses. And that, I'd always found that interesting. I mean, I find the entire pharmaceutical industry absolutely fascinating. And still do to this day. It's such an amazingly complex industry. And so, yeah, so I think I'd always been heading in that direction. Sure enough, the PhD certainly made me decide I was done with bench science [Parmvir laughs]. So, you know, by the time you've spent three plus years plodding along with these experiments that have a success rate of one in 50 sometimes. Parmvir: Yeah. David: You know, days and weeks without getting any data, and towards the end, still being in the lab at three o'clock in the morning, trying to get something to work and breaking more and more glassware as time goes on [Parmvir laughs]Yeah, I decided I was done with bench science, although I loved being in the labs, I loved playing in the labs. But I was never that into the kind of reading of the scientific papers and that sort of thing. Once it came down to maths and things like that, I wasn't so engaged. I needed to see practical things. Parmvir: Yeah. I feel like at some point we realized we were both some kind of engineer at heart rather than David: Yeah. Maybe Parmvir: scientist, David: maybe. Parmvir: It's more like, how does this work rather than trying to answer a bigger scientific question. David: Yeah. Parmvir: But obviously you were, you were a little bit scarred by your experience there, and you ended up going off in, I guess, a very different track from what the standard academic education leads you towards. So I think at this point this might be a good place to put your disclaimer in. David: Yes. So I work in the pharmaceutical industry and over time I've worked for, and with a variety of different companies.Any of the content that I describe today are my opinions and my opinions alone, and often they're really based off things which are in the public domain. In fact it's all based off things that were in the public domain and also some of the education that I've received, because actually, even after I finished my PhD, I then years later went on to study a, another academic course specifically in pharmacovigilance and pharmacoepidemiology.Parmvir: Oh, where did you do that? David: London school of Hygiene and Tropical Medicine. Parmvir: Oh. David: And it's interesting because it's a short course and I felt was a very valuable course. It's a course where regulatory authorities also send their people to learn too. Parmvir: So there's a lot of questions I can ask next.But one of the things that your job description throws up is this word "pharmacovigilance". What does that mean? David: Okay. So somewhere because I'm not gonna do it justice from memory, I'm going to read out the WHO definition of pharmacovigilance. It doesn't roll off the tongue, unfortunately, which is why it's never quite there in my head.So per the WHO: pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects, or any other medicine, or vaccine-related problem. So essentially it is the process and the science relating to drug side effects. Now as you'll remember from pharmacology days, very early on, you're taught that all pharmacologically active substances, if it applies to the human body have side effects. The same side effects are not encountered by every person.And you know, some of the side effects might have obvious clinical manifestations. Some might not, you might get side effects, never know you've had them. And of course they vary massively in severity. So when you are looking at a medicine, particularly one that you're introducing to kind of general use in humans, you have a trade-off to make because you have an expected therapeutic benefit, but you also have to be mindful of potential side effects, particularly serious side effects and how much tolerance you have for those versus the good that the drug is supposed to do.And achieving that balance is one of the big challenges that's faced in drug development.Parmvir: So what you do really, it kind of comes at the end of the whole process of clinical trials and so on for given products, right? David: It actually starts right at the beginning of clinical development.So. Parmvir: Oh, hang on, I have to ask David's question: does that make you a Pharmacovigilante? David: [David and Parmvir laugh] I've often wondered the same thing myself. But yeah, so pharmacovigilance takes off really where toxicology leaves. So before you can put a drug into clinical development, by which I mean development in humans, drugs first have to go through preclinical development and that's where all the various toxicology studies are run.Parmvir: Can you quickly define toxicology for us? David: Sure. It is really focusing on the well, the potentially toxic side of medicines. So before you put a drug anywhere near a human, you want to be absolutely certain that it doesn't cause various catastrophic side effects in humans.So, for example, you need to be confident that it doesn't cause cancer. You need to be confident that it's not gonna cause a heart attack immediately, or cause a stroke immediately or things like that. So as per regulations in pretty much every country in the world, before you put a drug anywhere near a human in a clinical trial, it has to go through a standard set of tests.And there's various ways to achieve that. You know, sometimes those are tests using computer simulated models. Sometimes they are using individual cells or cultured cells or tissues. And sometimes as is well known in the industry they're using animal models and these are legally required tests.So every drug that goes through the process has to go through these. So that's done before it gets to clinical development. And then you start with phase one clinical trials which are studies on, usually on healthy volunteers and they're very small trials. They involve perhaps a few tens of patients. And the only purpose of those trials is to look at the safety and tolerability of the drug. So this is the first time you're putting the drug into humans. There is a bit of an exception to that. So although these are usually conducted on healthy volunteers, for some drugs, including, for example oncology drugs. Those drugs are usually along the more kind of toxic end of agents, so it's not ethical to put those into healthy volunteers. So sometimes those studies are conducted in a patient population. So once a drug moves into human studies into phase one, from that point, really for the rest of the lifetime of that drug as a human medicine pharmacovigilance is involved. So all the way through the phase one, two and three studies and then once the drug goes onto the market, pharmacovigilance continues.So the companies or the pharmaceutical or biotech companies that are developing these assets have a legal requirement to collect and analyze this data on an ongoing basis pretty much forever. Until that drug is eventually, perhaps if it's lucky enough to get to the market, until it's withdrawn from the market, perhaps many decades later.Parmvir: Very good. And I think that there are probably some very topical things that have come up recently as a result of COVID 19, which is important to consider when we're talking about these things, in that we are not just relying on these clinical trials that have gone out to ensure that these things are safe, but once they're out there that you have to continue to get feedback from people who are taking these to ensure that they continue to be safe in the long term, right?David: That's true. So, you know, ordinarily in clinical development, once you get through phase 1, 2, 3, and if you are lucky enough to have a drug, which is sufficiently efficacious, tolerable to go to market, then yes, you know, the drug's released to market and you continue to monitor for this stuff.Vaccines are in a particularly special category because they are drugs that are given to healthy people. Mm yes. And so therefore the benefit risk balance is more complicated in some ways, because , you know, it's, it's hard to consider the benefit to the individual of taking a product when they don't yet have that disease.So now there are other drugs that are in a similar category, other drugs that are given to healthy people. This is where I can ask you some questions. So what, what do you think those other drugs include? Parmvir: Oh, goodness. Um, I'm trying to think off the top of my head, what they might be. David: Yeah. It's very unfair. Parmvir: All I can think of at the moment are the other vaccines. David: Okay. So, Parmvir: but there are lots of prophylactic things. Yeah. Yeah. I can't think of anything David: Contraceptives. Parmvir: The obvious prophylactic. Yes. David: Drugs used for travel. So things like anti-malaria tablets. Parmvir: Oh yeah. David: Drugs used for things like smoking cessation Parmvir: mm-hmmDavid: stuff like that.So again, these are all drugs that are generally given to healthy people. So, you know, and this is where benefit risk balance comes into sharp focus, because if you have a drug that has been developed to treat a very hard to treat cancer, let's say, then when you consider benefit risk balance you know, if these patients are effectively going to die without a treatment, and this is the only treatment available, you might be able to accept that a drug has a one in a hundred chance of causing a fatal stroke. Particularly if that drug is given in hospital and these things can be, can be managed. If however, you are developing a cough medicine, then your tolerance for any type of dangerous side effects is basically zero, and of course, many drugs elsewhere on that scale. So yeah, benefit risk balance is a key part of what has to be looked at during drug development. And yeah, as we say, vaccines are particularly challenging. Often these days when a new drug is developed the clinical development and the studies don't stop necessarily when the drug is released for marketing. So, often as a condition of the marketing authorizations that are granted for these drugs, there have to be continuing studies to look at safety. These are called post-authorization safety studies. And so there's ongoing collection of data in a rigorous way to keep monitoring for various things. Either new things that we didn't know about the drug before, because of course when you're in clinical development, your number of patients is normally quite small Parmvir: mm-hmm David: so you're less likely to spot very rare side effects. You wouldn't usually detect a one in 50,000 probability side effect in a clinical trial cohort. Parmvir: Yeah. David: But sometimes these post authorization safety studies allow you to pick up more of that and enable you to characterize some of the side effects that you do know about more in detail.Parmvir: Yeah. So David B here asks essentially how long do these things go on after the drug's been on the market? For example, is there still pharmacovigilance for aspirin? David: Yes. Every single drug that has a marketing authorization out there it is the law in pretty much every country in the world that all safety data that becomes available to the marketing authorization holders, that's the company that owns the rights to the drug and effectively sells the drug, they're required by law to collect process, analyze and report this data. Now as drugs age, the natural reporting rate for some of these drugs drops so the probability of a physician or a pharmacist or a nurse, or even a patient reporting a side effect probably drops over time because theses are not new medicines anymore, but even so, any data that is collected has to go through that process, which is the pharmacovigilance that we were referring to earlier. In addition to that, all companies with marketing authorizations have to look at scientific and medical literature. It all has to be reviewed, so in European requirements, including the UK on a weekly basis, companies have to trawl some of the big literature databases, such as PubMed and M base, they have to trawl that information for any articles on their drugs. And any indication of side effects or other similar challenges. Parmvir: So how is this information collected and processed? Cause you've said obviously doctors, nurses, patients, they will all report certain things. Mm-hmm how do you kind of get them to a central place and cataloged and how do you decide what are actual side effects versus David: So if we think about the front end of the process, most pharma companies out there will have medical information help lines. So these are help lines that are set out there so that healthcare professionals. So that's the physicians, the, the pharmacists, the nurses and others but also consumers can contact the company for more information about the medicine and also potentially report adverse events, side effects. In parallel to that the same thing's going on with the regulators. So in the UK, for example, we have the yellow card scheme, which these days is a web portal system where anyone can go in and report side effects of medicines they're taking. In the us, you have the MedWatch scheme, which is very similar. Most companies around the world have similar things. Plus you've also got ongoing clinical trials, clinical studies, so data is coming in that way too. We've got data coming in from literature that I've mentioned. The regulators, when they receive stuff directly, they often pass that information over to the pharma company.So essentially all this information is coming towards the pharma company. It all gets directed to a pharmacovigilance department. And then we go through the process of processing that data. And so that data comes in from everywhere around the world where the drug is available for patients to take both in clinical trials and on the market.So the process basically consists of firstly translating the data, if it needs to be translated that gets captured into a safety database and there are various commercial safe databases out there. This is where companies collate all the information received on their drugs. And it goes through a process whereby data is kind of standardized it's put into standard terminology in a way that is compatible with the regulatory requirements. A narrative is constructed. So we write a story of what's happened to the patient from beginning to end. We look at various things like if the information is available to us, you know, what other medications were the patients taking? What's their medical history? What was the sequence of events? So what was the time to onset if possible, if we have that information between the patient taking the drug and them reporting the side effect, what the clinical course of the side effect was, so did the patient recover? Was any adjustment made to the the, the dosing or any treatments given? And so all that gets written up, we then decide what other information do we need to know?And then there's a feedback loop to go and ask the reporter if they'll provide additional information. Usually we ask for more information on more serious adverse events. We don't wanna overburden the reporters. Now reporters in clinical trials, so physicians involved in those, they're legally obliged to help with that process. Spontaneous reporters that we refer to, which is just where any healthcare professional or consumer contacts, the company, that's a voluntary reporting system, so we can ask them for additional information, they don't have to provide it, but we have to ask the questions anyway. So the information gets pulled together. It then goes, usually goes through a medical review, so we have kind of scientists pulling the data together. And then we have physicians reviewing the case, making sure it makes medical sense. And then depending on the seriousness of the case and other attributes, that case might have to be reported out to regulators worldwide.And a lot of the reports which are serious, have to be reported out within 15 days of what we call day zero, which is the first day anyone in the company became aware of the report. Parmvir: Mm-hmm. David: But to give you an idea, the large pharma companies are dealing with potentially tens of thousands of reports a week that are coming in on all of their products. So these are vast systems that are set up and they have to be set up to be able to meet all of the regulatory requirements in terms of timelines, for reporting. So the data's coming in, the expedited reports are going out in the format that the regulators require. We also have to pull together what we call aggregate reports. So these aggregated analyses of data over time for newer drugs, for example, those are submitted in Europe every six months. And then over time as the drug gets older, the gap between reports gets longer. And then also we're doing something, what we call signal section, which is where we are analyzing the data. And we're looking for trends in the data. Where we think we've got patterns we're starting to then look into researching those patterns a little bit more, you know, if we start to see, for example that I don't know that we are getting what appears to be a disproportionate number of nose bleeds, let's say, in a patient cohort, we would, you know, do background research on, well, you know, is there a plausible biological mechanism that we know about through the development of the drug? Was there stuff seen in the animal studies or even the human studies that might indicate that there's a, there's a root cause here.We'll look into confounding effects. Are all these patients on other drugs, which actually are likely causing that? And yeah, so kind of an appraisal is done: what's going on? Is it likely to be caused by something else? And if not, you know, we, keep on looking and those conversations then have to be shared with the regulatory authorities.And over time, what you'll see is the labeling of the product, the professional labeling which in Europe, including the UK, is the SMPC, the summary of product characteristics, which is a bit like the instruction manual for the product, which is available to healthcare professionals and the simplified version of that PIL those little leaflets you find inside of packs, those eventually get revised on an ongoing basis to accommodate the new knowledge that we are gaining on the side effect profile of the drug. So this is an ongoing process and it happens throughout the entire lifetime of the, of the drug. Parmvir: But yeah, so here's a subject that no one's talked about for a little while. COVID 19 David: mm-hmm Parmvir: [laughs] Obviously I know there's probably a collective groan from people listening right now, but it seems like a relevant subject, given the conversations around safety that people are having with regard to the vaccine. So do you know if there's been like a major uptick in these reports by individuals, of side effects from the vaccines, or do you take account of the fact that so many billions of people essentially at this point have received at least one shot of the vaccine versus how many reports you get coming in?David: Yeah. So this is one of the big challenges, and one of the things I should have said about drugs like vaccines is because they're given to such vast numbers of people, it becomes a particular challenge to differentiate between things which are being caused potentially by the vaccine and other things, which unfortunately are just bad luck of being a human being.And by that, I mean, so years ago when I was doing one of the academic courses we were being taught about the vast amounts of research that had to be done in terms of epidemiology before the HPV vaccines were released. So these vaccines were being released for use in teenage girls, and at the time it was felt that there was perhaps an insufficient understanding of the general health of that population, including things like what is the probability of a freak occurrence that a teenage girl is going to have a stroke or something like that? Things which we think of as of course, they're exceptionally rare, but they do happen.Parmvir: Mm-hmm David: and I'm talking about in untreated populations. Parmvir: Yep. David: But of course, you know, some of these patients are also on birth control and things like that, that also have other risk factors associated with them so my understanding is before the HPV vaccines were released, a huge amount of epidemiology research was done so that when the new vaccines were released, we knew that we would expect, and I'm just gonna make up a number here that, you know, one in 500,000 teenage girls would have, I don't know, some kind of fatal event which would just naturally occur, you know, even without them having the vaccine. And so that's similar for other vaccine rollouts as well. There has to be a good understanding of the background events of other things that, people will have happen to them, which have nothing to do with the medicine that you are giving.So, you know, that data is kept available and kept an eye on by the regulatory authorities and also the pharma companies. We don't have background rates for everything, so being prepared for what might come and then, you know, there perhaps isn't so much panic when the first case comes in of a patient that has one of these catastrophic events but if you start to see more than that, that's when you start to perhaps get more interested in: is this really being caused by the vaccine or the drug of interest. So, yeah, a lot of upfront work has to be done before you even put the drug out there. I mean, in terms of the COVID vaccines and the treatments, because of the high degree of public interest and scrutiny a lot of these drugs when they were first given and the vaccines were first given, so adverse events, side effects were tracked through post-authorization safety studies. So actually a lot of people, when they got their first doses, consented to have maybe a follow up call from an investigator who would ask them about various side effects that happened. So in addition to all of the natural spontaneous reporting that was coming in, there were very large cohorts of past study data coming in which is a robust way to look at these things. I know as well, there were legitimate questions about, you know, the COVID vaccines in particular were produced fairly quickly compared to the usual 10 to 15 years in development of, of a product. But you know, there are various reasons for this. So vaccines are perhaps one of the medicines where it's more possible to template out the product and therefore switch out components. But they still have a product which is similar to other products that have previously been used. But also, the COVID era in terms of vaccine development and treatment development was, in my opinion at least a completely unique event in terms of drug development so far. If you think of drug development as a kind of universe, or I'm gonna use some wonky analogies here, but let's say as galaxies, which have solar systems within them that have planets within them.So if you think of the galaxy of drug development you have all of these different stakeholders involved. You have the pharmaceutical companies and biotech companies and the service companies that support them, that's one area. You have the regulatory authorities but you have many other stakeholders.You have patients, of course they're the most important. For chronic diseases you might have patient advocacy groups. But also, you know, you guys are part of this universe as well, because you are the ones doing basic research, which is the foundation on which all, you know, all of this is, is ultimately built. So you have universities and other research organizations. You have the funding bodies that sit behind those that decide where the research money goes. And then out the other end of the process you have ethics committees that are involved in approving clinical trials. You have payers. So these are the organizations that ultimately pay for medicinal products in the UK, for example, that's the NHS. Parmvir: Yep. David: In the US, that would be insurance companies. Parmvir: Yeah. David: You have many other stakeholders. So you have obviously healthcare professionals at the end of the day, new drugs have to be woven into the fabric of medicine. And so you have to bring HCPs along with you. There are the learning bodies as well in relation to HCPs, the kind of professional bodies.So that's really at a kind of galaxy level, these are all the different solar systems. And then within them, if you look at the pharmaceutical biotechnology and service provider solar system, within those you have an incredibly complicated set of different skills departments, functions, you have the functions that are doing discovery.So these are the early days of, development where, you know, biologists and chemists are working out, you know, what are the new therapeutic targets we can look at? Then you have the clinical development division. You have the patent divisions, you have the regulatory affairs functions. You have the pharmacovigilance functions. You have the medical affairs functions, you have the medical information functions [Parmvir cackles]. There are, and I'm going to miss out many, many. You have the, the bio stats folks, you have the medical writers. And then of course you have the manufacturing, which is in itself a completely different, you know, specialized world.So yeah, you're dealing with a very complicated process with lots of things which are interlinked. But for me, if you think of all these things, like if you use layout or different compass, let's say, and I'm talking about the compass you use to check direction, not the ones you used to draw circles [Parmvir laughs] and if you scatter them all out they'll all be pointing at different directions. You know, all of these different entities have their own priorities. Because of course the industry as a whole is developing many different medicinal products for different reasons. I think when COVID came along, it was like drawing a magnet across the top of all those compasses and it got all the needles to point in the same direction.So you had governments who had a clear incentive to try and support the development of treatments. So you had governments putting up money, which was perhaps slightly unusual. They were putting money into basic research, such as the type of stuff that you guys do. They were putting money into diagnostics, which are critical for things like COVID.They were putting money into the development of vaccines and into treatments. And then of course, you know, you have the pharma companies where there was a scramble to try and develop something, to help humanity in its hour of need. You had the regulators with a lot of focus on them you know, and everyone watching their, every move and trying to ensure that you know, as many processes that often might take months, or perhaps even years were made as efficient as possible.Parmvir: Mm-hmm David: And it was a unique point in time because everyone was lined up with the same objective. So it meant, for example, that, you know, parts of the industry, which are normally a nine to five job, became a 24/7 job. Parmvir: Yeah. David: For a short period of time.And there was a huge amount of collaboration, which happened between the different stakeholder groups, you know regulatory authorities offered perhaps free scientific advice to companies that were developing this stuff. They met very regularly with companies that were in development. They gave a lot of advice as to what their expectations were when the data was received by them. They shortened some administrative pathways let's say which usually take a lot of time. They prioritized resource. So there's resource specifically waiting for this data to come in. And so, yeah, a lot of normal processes were adapted so that things could be done as efficiently as possible.And the outcome was that, you know, these drugs went through the entire process in a much more efficient way than would usually be encountered. I think another thing as well is with things like vaccines, the side effects that we anticipate to see, including the rare unusual ones ordinarily these manifest within, you know, days or weeks.It's not something that usually we anticipate things to occur years later. So there was that aspect too, but yeah, it was a, it was a unique time. Parmvir: Yeah. And actually this is a good throwback to Dr. Carina Rodriguez's podcast because she ran one of the clinical trials for the vaccine in children at USF where I work.David: Oh, fascinating. Parmvir: Yeah, so she talked about some of the things that you mentioned as well. David: I should say I was not involved sadly in any of the COVID vaccine development, but you know, it was fascinating to watch and actually to see my profession become a talking point in the news every day. Parmvir: Yes. David: It was very interesting to see all of this play out.Parmvir: Yeah. So actually, that's probably a good point to pause and ask you, what do you actually do? David: Okay. So [everyone laughs]. So as I've kind of indicated the process of pulling in adverse event data of coding it, which is the term we use for tidying up all of the data, putting it into a safety database, writing those narratives, getting the medical review, getting the important cases out the other end to the regulators, writing the reports, doing the signal section.These are very complicated processes and every company will develop them slightly differently. You know, small biotech companies, they might only have one product. It might only be approved in one or two countries. A top five pharma company will have hundreds of products authorized in many countries around the world. But all of these processes are put together in compliance with extremely strict regulations. Regulations that as I said exist in almost every country in the world and actually the regulations kind of cross over in the sense of, if you have a product that's authorized for marketing in the UK and the US, for example you know, the UK requires you to collect all the data and analyze it as does the US.They also require you to collect the data from each other's territories so companies are in the middle of the very complicated regulatory framework, which is a little bit different in each country, but fortunately is harmonized through some international bodies and international terminology. But building pharmacovigilance systems is complicated and it has to be done right. Firstly, for the obvious reason that we want to protect patients it's in no one's interest that that that patients are not protected. But also, you know, the penalties for not complying with these complex regulatory requirements are severe. And so my job really, as a, let's say senior leader within a pharmacovigilance department is to make sure that we build the right structures.And for these companies that we that we keep an eye out on all the areas, which are potential challenges and that companies are being compliant with the legislation to which we're all held. And so, so yeah, so building pharmacovigilance systems, I think is the simplest way I can describe it.Parmvir: It sounds pretty heavy and pretty complicated. David: Yeah. I mean, if you look at the larger pharma companies, if you add up all of the resource that they put into pharmacovigilance that they're legally required to put into pharmacovigilance, to service the needs of their products. A lot of things are outsourced these days, if you the count everything that comes from the outsourcing organizations as well, the big pharma companies have thousands of people like me involved in the processing and analysis of this data. So it is a big area, and that is all we do. You know, we are not involved in any other aspect of the drug. Not involved in the sales and marketing, for example, with the product, that's almost the complete opposite side of the company to us, all we do is you know, work in this very professionalized, very standardized discipline, which is pharmacovigilance. Parmvir: So David has a couple of questions. So first one should be relatively quick, which is that, is there a regulatory authority that is the gold standard? David: [David laughs] This is a very politically sensitive one.There are certainly some regulatory authorities who, particularly in some of the larger markets who are let's say more prominent. So examples would be the US FDA, the food and drug administration that is the drug regulatory authority for the United States. In the UK, we also have an extremely prominent regulator, the MHRA they're one of the oldest regulators, I believe in the world. So that's the UK medicines and healthcare products, regulatory agency. But you know, every country has its own regulator and whilst there are some who put themselves out there, perhaps as world leading regulators, there are just as many others that are doing the same important job for their countries. The European Union and European Economic Area has a slightly more complicated system because they have a coordinating regulatory authority, which is the European Medicines agency, the EMA, who many of you all have heard about in news reports, particularly during the COVID situation. But at a national level, you also have all of the national regulators who are working in tandem with the EMA. Parmvir: Okay. So this sounds quite different from, obviously it's very different from what you were doing during your PhD. David: Yes. Parmvir: He also wants to know, how did your PhD work, prepare you to do what you do now. David: If I could sum it up in one phrase, and this is a phrase which is overused, but I think in this case, it is really true: problem solving.Parmvir: Mm-hmm David: because it's interesting, you mentioned earlier that you and I we're almost engineers. Well, I went from becoming a physical engineer, at least in a lab environment to a process engineer. And, you know, I always used to think very naively when I was doing the basic research with you, I used to think, look, we are solving problems that no one knows the answer to. This must be the hardest job in the world. [Parmvir laughs] We're not solving manmade problems. Manmade problems must be so easy to solve. But no manmade problems [Parmvir laughs] are also particularly challenging. And when I say manmade problems, you know, I'm not talking about problems that someone is deliberately created, it's just, you know, logistical challenges, and just the challenges caused by working in, you know, different regulatory envionments with different sets of requirements and how to build processes that meet all of the requirements at the same time. And react to events, of course, because it might well be that you've had a product that has been ticking along nicely for a long time. And then suddenly there is a safety concern with the product. And if that safety concern is in the public domain, you will be deluged with reports in relation to that product called stimulated reporting. And you know, of course sometimes companies will be subject to class action lawsuits particularly in the US. So they might also receive large volumes of reports all in one go. All of those reports have to meet the same legal timelines, but now suddenly you've got 10,000 reports landed on your desk. Each one takes four hours to process and they're all due to the regulators in 15 days. So yeah, it is challenging working in a hyper regulated environment. Parmvir: Essentially these are problems that come about because we are humans. David: Exactly. Yeah. Parmvir: And we have to somehow live together. David: Yeah. Parmvir: So I had a couple of questions from my little sister and these might not be directly related to your work, but they are related to the fact that you work within an environment that involves clinical trials and patients and so on.And so Sukhy wants to know are side effects from drugs, usually the same for healthy people versus patients. David: This is a great question and cause me a little bit of head scratching. I think, I mean, the answer is it depends, I think by and large. Yes. But there will be some exceptions and those exceptions include things like some of the oncology treatments, because obviously there is an interaction often between the drug and the tumor, for example, so in a healthy person you can't emulate that because there is no tumor. So an example would be a phenomenon called tumorlysis syndrome which can only occur when there's a tumor to react to the particular drug. But by and large, yes, we extrapolate safety data from healthy individuals initially, which is why the earlier phases of studies are done often in healthy volunteers with some exceptions. But yeah. Then when we move on to phase two and then phase three, phase two and three are conducted in patients that have the indication of interest, I have the disease that we're trying to treat.Parmvir: So another question she had: how do you know people who are not healthy will be able to tolerate the drugs given that initially that they're tested on healthy people?David: So the first thing I would say is I'm not an expert in the design of clinical trials, but as I said, as you go through phase one which are the trials that are normally on healthy patients, you actually start out with a tiny, tiny dose. So you have an idea of dosing from your animal studies, but the data isn't always transferrable. But you take the maximum tolerable dose in animals, including in the most sensitive animals. And you then cut that by huge factor by perhaps 500 fold. Parmvir: Right. David: So you start out with a tiny amount and then you escalate up the doses to see how the patients are tolerating the drug, not the patients subject, I should say. So these are healthy volunteers usually. Parmvir: Yep. David: So that's phase one, but yeah, then of course, when you go into phase two, you're dealing with a different patient population. I don't know exactly how that's always done, but of course, you know, trials are put together by experts in the field. And they involve, you clinicians whose expertise is this particular area of medicine.Parmvir: Yeah. David: And of course it's not just the physicians at the pharmaceutical company and the biopharma company and the scientists, I should say as well. Also, this stuff is going to regulatory authorities, it's going to ethics committees, all of whom will have their own areas of expertise. So, you know, protocols are designed around the patient and to ensure the patients are not put at unnecessary risk.Parmvir: Ah, sometimes David sends me one of those questions that really makes me giggle. And this is if regulations are so important and onerous, how do I start my own biotech in the garage? David: [David laughs] Well, it's interesting, you know, companies don't necessarily have to be that big themselves to get started, but what they will need is a lot of help.Parmvir: Yeah. David: So what you'll see these days is you know, new biotechs starting up. But they rely very heavily on outsourcing. So they will partner with service providers with contract research organizations, with contract manufacturing organizations, all sorts of other parties that have the expertise that perhaps they aren't able to pull together themselves.But yeah, there are some companies out there, particularly smaller companies in earlier development that are, you know, pretty small might have 20 people in the company. Parmvir: Yeah. David: But they will need to rely on the help of many others, because going back to the kind of universe description that I gave, you know, there are so many specialized areas that you need to have covered in order to pull together everything you need, both to run a clinical trial. and also to submit a marketing authorization application. And then also keep your product compliant with all of the legal requirements that are out there.Parmvir: It's a lot.David: It is a lot, and you know this is why drug development is so costly because it needs a truly vast number of specialists involved. And, you know, quite a lot of physicians as well. And also, you know, most drugs that enter drug development don't make it all the way through the other end, so the end costs of medicinal products also have to cover the cost of the drugs that didn't make it.And plus companies only have a certain period of exclusivity before their drug becomes generic, i.e., other companies can start making it. Parmvir: So this is purely from a personal perspective, from your point of view: what do you think about the fact that obviously you have these companies who have put so much money developing these things, which were designed to treat a global pandemic. And yet we found that for example, like entire continents, like Africa still don't have a lot of people vaccinated against COVID 19, and those companies will refuse to open up the patents to allow them to be able to get people to stay healthy. David: Yeah, it's an area that really I'm not really sufficiently qualified to talk on. And I'm not just saying that, you know, through not wanting to put my foot in my mouth, but particularly with some of the vaccine technologies that were used, they were not simple medicines to manufacture. So not simple to manufacture, not simple to store, not simple to distribute. And sometimes I guess, it is perhaps a legitimate concern of a company that if other companies start making their same drug to a lower quality, that can have ramifications elsewhere. Now I'm not saying that that was the reason behind some of what you mentioned. Now there was a vaccine that was developed the UK vaccine which was specifically developed from the outset to be made available in developing world countries, let's say, and specifically to be made available at cost. And even the way that product was designed, it can be manufactured and stored at fridge temperature Parmvir: mm-hmm, which is a big deal. David: Exactly. It is a big deal, you know, those are all very important components to consider. A vaccine that could be used in those environments. But even, I remember because I vacuumed up all of the documentaries I think on television, Netflix, everywhere else about all of the challenges that were being faced. And, you know, there were even things that you just wouldn't think about, which was, you know, because the mRNA vaccines had to be stored at -80 [degrees Celsius], there wasn't enough minus 80 freezers in the developed countries, let alone figuring out how to develop and ship these to other countries with different climatic conditions.And so you even had the manufacturers of that type of equipment, having to up their game and suddenly churn out much more equipment than they previously had. So, yeah, there's no simple answer. I mean, historically there've been other challenges in the past with other types of drugs, such as the HIV medications. In the end access to those drugs was resolved through very careful dialogue between companies, regulators others. Access issues, I believe to those drugs, and again, this is just basically what I see on documentaries and other things; where are access problems these days, they're not in relation to the drug supply chain they're in relation to other things like people not wanting to come forward and receive treatment because of the stigma associated with things like that.Parmvir: So in short, do you enjoy your work? David: I do. I mean, I can honestly say that in my work every day is different. I'm very privileged in my job to support a number of different companies that are developing different products with a very wide variety of indications. And also, you know, just when you think you've seen it all worked with a wide variety of medicinal products, suddenly something completely new will come along. For example, we are now on the precipice of many commercial gene therapies coming out. Parmvir: Ooh. David: And you know, those products have some different considerations. Perhaps some of these interventions are irreversible Parmvir: mm-hmm.David: So, you know, what happens if patients do start developing something rare and unexpected. You have patients surviving a lot longer than was originally envisaged so, you know, are there other things which come about you know, as a result of the underlying disease that just no one had ever seen before. And yeah, many other types of technologies and the regulations are always having to evolve to take into account of these new therapies and the challenges associated with them.Parmvir: Well, it sounds like you will continue to live in interesting times. David: Yeah. I don't think I'm going anywhere anytime soon . Parmvir: Well, thank you so much for your time today, David. That was fantastic. And yeah, as I say, we kind of thought of you as soon as we started thinking about the safety surrounding things like COVID vaccines and knew that was your jam.So yes, we very much appreciate your time today. David: Okay. Thank you very much. [musical interlude]David: So I mentioned earlier that at an early point in my PhD, I switched to studying vascular endothelial cells that were harvested from pigs. So essentially these were pigs that were being slaughtered for the meat industry. And so I had to look through a phone book and identify an abattoir that I could go to and get the tissue that I needed to do my experiments so obviously this all had to start somewhere. So I put in a call to an abattoir in deepest, darkest Essex. And I gingerly made my way on the train to this place, which of course was in the middle of rural nowhere. And unfortunately the first day that I picked to go, it was snowing. Now we don't get vast amounts of snow in Southern England, but this was a decent sprinkling of snow. So I arrived in this quiet rural destination and I walked across various fields. I think I'd perhaps just got GPS on my phone, but it was very early days. And I was lost in fields of white in no time at all. So I ended up putting in a call to, the guys, to, come and pick me up, which they very kindly did. So then, you know, at that time I really didn't know what a coronary artery looked like so what I decided to do for that first trip was I just collected the fresh hearts that they were able to bring out the processing facility. So these were kind of warm pig hearts, freshly harvested from animals. I think I had three hearts or something like that. And so I had a large polystyrene box with me with some ice in it. And I think they were kind enough to give me the ice, as I put these hearts inside bags and put them in the box and then started making my way back to London. And of course, you know, this being a cold day, the heating was on, on the train, and so as I was sat on the train, in fact, I think it was when I got onto the tube, I suddenly became horrified that my polystyrene box was starting to leak water. And of course I knew, but no one else knew on the tube that within that water were bags, perhaps not secured, very tightly containing hearts and containing probably a fair amount of blood.And I suddenly started sweating that this puddle that was starting to pull around my polystyrene box on the floor of the tube would suddenly start to go pink and then red. And then before I knew it, I would be in serious trouble. So it was just one of those situations where the tube journey seemed to get longer and longer, and I was sweating more and more and then it got to the point where I felt that I couldn't wait any longer, so I kind of dashed outta the tube at the next station went up what was perhaps one of the longest escalators on the underground and managed to just get out the other side before I caused perhaps a fake terrorist incident or something like that. I was trying to think about how I would explain that I'd got three hearts in my polystyrene box and a set of scalpels bearing in mind that pig's hearts are very similar size to human hearts as well. So, yes, I managed just about to get to the lab. I clearly looked quite distressed, I suppose when I got back to the lab. So I started telling this story to my PhD supervisor, Dennis, and uh a retired professor that had come into the department, Don. And before too long, the two of them were crying with laughter at my story.So, um, so yeah, so that was my very first trip and yes, never, never forgotten.[musical outro]David: Our lab, when we first joined, it was quite old and a bit dog eared. And there was one particular chair in the office, which was, I mean, it was like a typical office swivel chair, but it had definitely seen better days and it was extremely uncomfortable. And when we had lab meetings, no one wanted to sit on this chair. And so Parmvir and I nicknamed it, Beelzebub's stool.

covid-19 united states university netflix europe uk germany phd africa european european union vaccines driving cambridge gps hiv sad nobel nhs bandcamp regulations hygiene mm bearing essex mrna ucl spontaneous celsius hpv college london usf beelzebub man made nobel laureates cava tropical medicine pil hillman pubmed david david us fda hcps kcl ucas mhra southern england kidderminster david it david oh david no david so david you david yeah kensington gardens european economic area drgs david yes john foreman medwatch david for david sure david london

Capsaicin-induced endocytosis of endogenous presynaptic CaV2.2 in DRG-spinal cord co-cultures inhibits presynaptic function

Real Estate Marketing Dude

Play Episode Listen Later Oct 4, 2022

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.10.03.510587v1?rss=1 Authors: Ramgoolam, K. H., Dolphin, A. C. Abstract: The N-type calcium channel, CaV2.2 is key to neurotransmission from the primary afferent terminals of dorsal root ganglion (DRG) neurons to their post-synaptic targets in the spinal cord. In this study we have utilized CaV2.2_HA knock-in mice, because the exofacial epitope tag in CaV2.2_HA enables accurate detection and localization of endogenous CaV2.2. CaV2.2_HA knock-in mice were used as a source of DRGs to exclusively study the presynaptic expression of N-type calcium channels in co-cultures between DRG neurons and wild-type spinal cord neurons. CaV2.2_HA is strongly expressed on the cell surface, particularly in TRPV1-positive small and medium DRG neurons. Super-resolution images of the presynaptic terminals revealed an increase in CaV2.2_HA expression and increased association with the post-synaptic marker Homer over time in vitro. Brief application of the TRPV1 agonist, capsaicin, resulted in a significant down-regulation of cell surface CaV2.2_HA expression in DRG neuron somata. At their presynaptic terminals, capsaicin caused a reduction in CaV2.2_HA proximity to and co-localization with the active zone marker RIM 1/2, as well as a lower contribution of N-type channels to single action potential-mediated Ca2+ influx. The mechanism of this down-regulation of CaV2.2_HA involves a Rab 11a-dependent trafficking process, since dominant-negative Rab11a(S25N) occludes the effect of capsaicin on presynaptic CaV2.2_HA expression, and also prevents the effect of capsaicin on action potential induced Ca2+ influx. Taken together, these data suggest that capsaicin causes a decrease in cell surface CaV2.2_HA expression in DRG terminals via a Rab11a-dependent endosomal trafficking pathway. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

copy function cultures homer dolphin induced rim rab spinal cord endogenous drg capsaicin biorxiv inhibits ca2 drgs trpv1 endocytosis

Back to the Basics with Andres Bustamante

Play Episode Listen Later Aug 13, 2022 35:49

I think we need to go back to the basics and I got a really cool story. Last week I was at an event in Kansas City and met a lot of cool people, including my new friend, Andres Bustamante, who is killing it. He's got a killer story about how he started real estate in college and over game a lot of adversity, and now he is a realtor for a professional soccer player. Check out his website and his Tik Tok and Instagram accounts; andresbustatx.Three Things You'll Learn in This EpisodeHow at 19, Andres helped college students as a leasing realtor.Why new agents should join a team.How to take ownership.ResourcesCheck Out His WebsiteReal Estate Marketing DudeThe Listing Advocate (Earn more listings!)REMD on YouTubeREMD on InstagramTranscript:What's up ladies and gentlemen, welcome another episode of the real estate marketing dude, podcast, what we're gonna be chatting about today are I think we need to go back to the basics. And I got a really cool story. I was in Kansas City. Last week doing an event, met a bunch of cool people were things I like about doing these events. And one of them, this guy, this kid, guy, kid, whatever you want to call him. He's a young realtor. But he's a killer reminds me a lot of myself. When I started not only are we both Hispanic male. But we hustlers you know, and we both started real estate at a very, very early age. And when you start real estate, just like right out of college, and none of your friends are people, you know, I've actually owned or bought a product before, it can be intimidating. I know how I overcame it, he's got a really killer story, and how he overcame it. But what we're gonna do is share his story because today, he's 26 years old, and he is the realtor of a professional soccer team in his market, and he's crushing it at 26 years old. And this is a relationship based business you guys regardless of what the hell you say, if people like you, they will use you. That's what it comes down to. But to be like you have to be trusted. So without further ado, we're gonna go ahead and introduce our guests. He's going to share his story exactly how he landed this account, where he started the trials, the journeys, and all of the above. And a lot of you guys are going to relate to this. So take notes and pay attention. Without further ado, let's go ahead and introduce our guests. Mr. Andres Bosa monk dead and I say, Hey, yougot it, Mike. Thank you, brother.Why don't you tell everybody? Who the hell are you? Where are you from? And I got a whole kinds of questions for you.Perfect. I'm from El Paso, Texas. And really, the real estate side started when I was 19. I just got into the University of Texas at Austin, go Longhorns. And I needed to find a way to pay for college because I didn't want my parents to pay for college. And I really want it to be like independent from any of that having to rely on someone. I wasn't going to do an eight to five though I did not like having a boss. Sure. So what better way to make my own schedule and make as much money as possible. Then real estate. I got my license at 19. I started doing leasing, which is when I would find apartments for students. There were a ton of students, I was a part of a lot of groups, I'd find apartments and those apartments would pay me because I brought people over. That's how I got my foot in the door on the real estate side. My mindset was really look, I'm just going to do leasing. I'm not like worthy of being able to make a sale or any of that sort. Why would people trust a 19 year old? That's in college? Yeah. Then when I was 21, I had two years of experience under my belt, I got a call from someone that's like, Hey, I'm this and they'll let me know that you can help with real estate. And he tells me right away my budgets 1 million to 3 million I said holy shit in my head right away. What started in my head was like, this is not going to happen. I'm not going to be able to close. I'll just throw it to someone else. I just told them Yeah, I know exactly what to find. And I hung up and I was like I got nervous I was what the hell am I going to do? The thing with that limited mindset and I partnered with one of the best agents that have just giving it to him I said I'm going to learn as much as possible. And you're going to take care of like handling the transaction with the other realtors Isn't that all take care of the relationship building. Long story short, we sold a $1.1 million condo and then after that you think okay, I'm this No, no knows a lot about real estate and this and that. But in my head, I would get more clients from referrals from him. But my subconscious mind said no, I can't do this. You just got a one shot at this and you got it and that's that. So I didn't really make any other sales. I kept doing leasing. You know, that was my whole college. I was able to pay for college through leasing. But I only did that one sale, even though I had a ton of opportunities. It was a mindset that really got to me at that time.So good. I agree. I had similar situation. First of all, congratulations for putting yourself through college. That's impressive. This is this is this is what the Mexican population breeds right here. Okay, guys, we work hard, right? And this is very simple, right? That that same philosophy is instilled in me as a kid. And if you work hard, it's going to happen. I don't know when I don't know how long it's gonna take. I don't know the trials are gonna go through. But if you keep your head down and you keep going forward, it's going to fucking happen. Okay, so let's go through Whoo, that's 19 years old love it. Most people, if you're listening to this, you're on the treadmill and you're young, like, do I think I should get into real estate? Should I not get into real estate? What should I do? Or this is equivalent to you could be 35 years old and go into your first listing presentation, you're gonna have the damn same for the same reservations as we both had, we first did it. Andres just tells you didn't have the confidence to go out there. And it's true. If you don't sell houses, like, you're gonna get a million dollar house. You're like, bro, I don't know what the hell I'm doing. But those people are calling you because they like you. You have a relationship with them. And you learn like I did not go to my first listing presentation because I was scared shitless I went to my first listing presentation. Yes, I didn't sleep the night before. But I went in there and I didn't get it. But I got the next one because I wasn't scared to go ahead and put my head down and just see what happens. And this entire business is mindset. I agree. It's can this has a lot of ups and downs like peaks and valleys of real estate's very easy to get burnt out, isn't it?Oh, yeah, my gosh, I remember just all the leasing, leasing is the best way to get your foot in the door, because it's lower stress. And a lot of people don't take that into account. They want to go all by right away by right away. That leasing is probably the best way because it's less stress. You have conversations with property managers, you get to see contracts, the Apartment Association contracts, and then these people eventually will become buyers. Most of them are they know people, like the person I helped lease. She leased a $900 a month apartment. She knew someone that was going to buy a million to a $3 million. Condo, yes, huge referral, and it's a warm lead. It's not a cold where you're cold calling, right? Yeah, that's the beauty of real estate.Here's the beauty what he just said, folks, there's so many times that I'll give you a really good story. You are always focused on the relationship. So many agents will go out there and be like, Hey, dude, well, you know, a $900 rental what I'm going to make $450. And I'm going to split half of that with my brokerage, I would pay $250, I would pay $250 for the relationship because everyone lives somewhere in 10 to 15% of the population will move this year, but what 100% of them have a referral for you. And when you're playing the long game in this business, it's not about spiking the football, when you get paid the commission check you spike the football when you get your first referral or source of business from the one person you sold seven years ago. That's the long game in this business.And a lot of a lot of people, it's pretty interesting. A lot of people see it just transaction wise. Yeah, what does that person bring you and there's a big dollar amount to what that relationship will bring. It's a big misconception or like you were saying, Oh, it's just a $500 check and this and that. What does it bring you in the long run because those relationships are so crucial to nurture on that it can be a hundredfold exponential, to what it will bring.So there is a back in the short sale days, I had a similar situation, very similar to this. And we used to do a ton of short sales like 3025 35 a month. So we were the number one team not only in Chicago, but in the country. And so we'd get a lot of referrals right and I get a referral from a good friend of mine. That was his old roommate. And this referral ended up being a $15,000 short sale on the south side of Chicago. Have you guys watched the fucking news lately? All right, it hasn't changed. Okay. Southside Chicago, this is the hood. $18,000 Short Sale. Okay. Mind you a short sale take 90 120 days i We negotiated over $200,000 a debt. It was a tough deal to get done. But we still got it done. We lost money doing the deal. Okay, we made at the end of the day, you had a short sale negotiator to pay. And what do you what do you think 6% 3% on $15,000? How much is that it's probably like $900 is our commission check half went to our agent. The other half went to the brokerage I think we walked away with a net of 150 bucks. So we lost money on the deal. But why we took it on was because I don't believe I believe it's our job to serve others first and foremost. And sometimes you won't make as much money off of a transaction. But this has happened several times over the course of my career. Three days after the closing, the same seller calls us he failed to tell me that he owned three other properties throughout the time, because he just wanted to get this one off his hair. And right when we close two days, he's like, Hey, Mike, I want to tell you about this. But yeah, I got a $400,000 condo and Bucktown I got a $2,000 condo up there. And then I got another $300,000 condo up here. Not only did we list those, and none of them were shorts, so they're easy deals. It's just a regular transaction. Once you do a ton of short sales, you do regular transaction, you're like this fucking piece of cake. And so what ended up happening was and then not only that, not only to give us those listings, but he became my number one referral source for the next 12 months and he won our award that year. You guys you don't behind every sale there's another transaction and the people that you help in the times that no one else will help them are remembered for the long haul. And that person becomes part of your sales force just like it happened in the story. I just told you just like it just happened and Andres story if You serve people, right? They will return to you. And it's no differently if you go to a good restaurant or you go back. Yeah, of course not a service. Yeah, if you if you go to a restaurant and then you find a hair and your food, you go back. So agents could fucking put hair on your food and your services and quit being shady. serve everyone the same way quit discriminating over purchase price. I can't stand that's the biggest. I hate that when an agent says that. Another one. I'm not showing that house. They're only offering two and a half percent. I want three. Oh, I actually, if you do that, like stop doing that.I never look at what anyone offers. Here. Yeah, I'm just like, I'll just whatever. Yeah, you know. And then it's how you make people feel. I know you talked about that. It's so important. How do you make someone feel you know what you do for them? Okay, obviously, that's important. How do you make them feel?That's all they remember. At the end of the day? Yeah. Yeah. I love it. Alright, so you started off in leasing. I like that you probably learned a lot of the landscape, the streets, the back rallies. And, you know, remember, we were selling real estate guys, we're not selling the freaking houses that we saw the community those houses resided, okay, if you don't know the community, you're not going to be good at your job. You don't need to know the process of real estate that'll come to you. But you do need to be an expert in your community first, and as long as you can position yourself that way. Everyone will think you're an expert.1%what happened? Let's get out. You get out of college. And you're like, What do you major ininternational business? I don't use that at all. My minor. Yeah. I don't use any of what I majored in. And to tell you the truth, I didn't really learn much from it.When I went to college, I learned how to like, do my laundry interact with people of different races and all this stuff, socialize, and I learned how to generate relationships, which is the best skill I ever learned. What I didn't use was the Boolean class. The wine class, I took a class on frickin geography and weather. I'm like, Dude, you think?I always thought that was hilarious. Yeah. And I actually talked to my dad yesterday about it. And it's crazy how we're both from Mexican backgrounds. But one thing that is very relevant is money is bad. That I was ingrained with that. Now, obviously, I don't think that but I remember every time Oh, that guy's rich and Spanish. Bad that. No, that's not good. The second one, I talked to my dad about this yesterday. And he was like, You should go back to college. And I think college really helped you? Yes. It helped me rebuild relationships become more street smart. But it was like, I told him I didn't really need College, though, outside of that, and he was like you did trust me. So it's funny how. It's way. It's still different, you know?Yeah, comes back tenfold. But you didn't plan on going into real estate, right?No, I did. And I just needed to find a means to pay for college. And then not having a boss and on my own time,and when you graduated, what happened? And then how did you transition into and you're like, dude, I'm gonna do this like full time. This is dope.I graduated with a lot of uncertainty. I had a full time offer for JLL. And that was my dream quote, unquote, job.What's jaoa dol isJones Lang LaSalle. It's one of the biggest commercial real estate apart from CBRE commercial real estate firms. And I had interned with them. Ever since I was a junior. I was like, this is the job I want. But I started reading about mindset books. I read The Power of Now the Miracle Morning, started looking to bigger pockets. And when I graduated college JLL was like we want you to work for us eight to five financial analyst in Houston. Apart from the shitty weather in Houston, I was like, I don't want to do the eight to five. And I told my parents I'm not going to accept the offer. They were like, are you crazy? You've been working two years for this. Me dual stay andsent you to college. You're the first.Yeah, I was like, Oh, shit. So legit. That's what they told me. And I had a lot of uncertainty. All of my friends were doing eight to five. Nobody else was doing real estate. So I think I read The Power of Now in one day. I was like, Screw it. Fuck what everyone else is doing. Like I don't want to do that. I'm going to stick to real estate. I stayed with the leasing company. I moved to Austin. I only made one sale. It's like okay, maybe I keep doing leasing, leasing, after college. If you already have experience, it can get pretty stressful. So I did four months of that. Then I said I need to find a mentor. I need to join another team and stick to sales. Because I hadn't made any other sale from the time I had graduated. That's seven months. Listen to a bigger pockets episode do of course it was on that episode. And he said if anyone's in Austin, hit me up, immediately send them a message. And he said Hey, call me back next week because you got to level those calls out. That's how you'd bet people call them back the next week we meet up a month later I joined his team and then that's when it started picking up first month I made a sale, that it took six months to make another sale. But then I started making sales, maybe two that year, like two per month or three per month, as a first year full time. It will take a while man took a while. Yeah,this is it's, you know, like there's a reason why 87% agent's failed or five years, it's most of them come into it thinking it's a sales job, but it's not. If you're an entrepreneur, and you're building a business, even though you might be at a brokerage or part of a team. Ultimately, you're still an entrepreneur and no one. Like regardless if you join a brokerage or join a team, the worst thing you could do for any of them is make them money. And it's also the best thing you can do for him. There's really no lie extra liability to have you on a team because you're 100% Commission, right? So yeah, you gotta sweat, you got to put in the work. I it took me two and a half years to make real estate marketing to profitable. Right, and we're on your three, this is a fucking grind goes. Like this is any business as a grind, right?Oh, yeah. And it was Dude, it was probably relate with that. You're like, oh, shit, so much uncertainty. But I did have my own time. And I didn't have a boss. And I knew I knew. And I know I'm going to be very successful. Because I'm putting myself in that alignment. Even though it takes time. I was just like certain of it. And I would do my miracle morning routine. And I was like, Dude, I'm going to be successful. One thing a lot of people have to realize as well about real estate is that our job is threefold. We're storytellers, which is so crucial. Problem solvers. And we're educators. Those are the three things I tell any new agent, it's like, Dude, you have to be great, or start learning how to become great at those things.Yep. Yeah, the the expertise in running comps and all that no one cares. Like you do that after you get hired, but you don't get hired unless you have those first three first 100%, you know, and people expect you to be good at that being really good at running comps, or knowing your market doesn't earn you the deal. The relationship does every time. So I'm here to do tell me. You landed Oh, real quick. Where was that business coming from?My my business was sphere of influence. The first ones 100%. Yeah. From UT Austin from people that knew me and trusted me. The real business I started get was when I bought bought a home myself and told my story, because I had, I knew I was going to target I knew what my target audience was was house hackers, people that just graduated, that think you have to put 20% down meaning that they're not educated, that are thinking that they're going to rent for a long run, people that aren't educated and with those things, that's my target audience. And how, what is the best way to get out your target audience and help them by doing it yourself? So I bought a house, I lived in it for free. I had a lot of uncertainty. Can I buy a house? Can I afford it? Are there ways to do this? I just graduated college What the hell's where am I going to find the money? So I put that story out there. And a long post on Instagram shared my story made it as relatable as possible to the audience. Facts tell story sell. And I didn't know what to say, Oh, I close know what's the story behind it told that story. And then that's when I felt a big pickup. People are like holy shit on this. You did this. I'm not the same position, I can do it. That's when it really started to pick up. It's greatto businesses right in front of you guys. And it's not even that you are relatable. Like your IG friends are just like you, your Facebook friends, they're just like you and you attract like people. So in 10 years from now, whatever story you're telling, I guarantee they're going to be people around your age. People always ask me this question, Mike, I want to sell luxury listings. Well go start hanging out with a bunch of people that own a bunch of expensive s houses. That's how you start. You have to put yourself in that room. I don't meet on dress. He's 26 years old. He's flying around the country doing events and speaking and stuff. Because he put himself in that room. I don't meet Andres last week, if he doesn't put himself in that room. How did Andres get in that room? I believe you join a mastermind you probably invested into that mastermind. You put yourself around other people and you made these relationships. The truth is that most of you guys don't have the balls to spend money and invest in yourself. That's it. That's the sad reality of this you guys. And if you're not going to believe in yourself, I can promise you that no one else is going to believe in you either.I can agree on 100% with that.So we start rolling. You landed a big contract. Let's get into that. Or big deal. Like you're like the agent for the soccer team and whatnot. So walk us through the process. Awesome.The process started when I was in college through doing leasing and meeting the Spanish dude that was friends with my roommate. He started following me on Instagram after he came over for like a week and we're just hanging out partying, this and that college stuff. Sure. He followed me on Instagram and I post a lot of real estate stuff on Instagram. So All, whenever he thought about real estate I was top of mind even though he was in Spain, which is pretty insane like what the hell a dude from Spain. And one of his really good friends is was a coach for the Qatar national team soccer. That guy was moving to Austin, who was the first person he thought about with real estate me. So it was like undress. This coach from Qatar is moving to Austin to help with a new team. They had just they have just started two years ago, actually 2020. And I want you to help them just get to know the city, I did a great job of telling him about the whole city showing him around, I took a whole day off to show him around. That's the beauty about being in real estate, you can take those days off, not really take a day off, but you have the luxury to do that. Show them around the whole city, I met the whole family, help them sign on a lease for an apartment was a lease for an apartment. So I knew all about the leasing lingo. And then from there just picked up he introduced me to the other coaches, then some of the players. And that's how I started helping Austin FC with plenty of there. I think there's one or two other agents, but they send me a lot of the business to me. I like it.But look where that seed planted like, let's just go back, because people want to get that that. Like, you tell someone Hey, I'm the agent of a professional team. Everyone wants that account. But not everyone's willing to it didn't you didn't get it overnight. It wasn't an accident. You got that? As a matter of fact, what most people would have probably have done is that the second that Coach told you he was leasing an apartment versus buying they probably would have stopped calling him back.Yeah, that's true. Actually. It took it took like, four or five days of touring. Sure, six to seven apartments per day. Oh, yeah, I remember that. So grind. When we found the apartment, the the wife actually started crying because she was so happy. That's how crazy was it? I like it. Folks,this isn't theory we're talking about when you start cementing your relationships, whether they're renting, and they're buying, it's mathematical, because every three to five years in a city living or six to nine and suburban. They're gonna move. And then what Andreas has said he's done a great job reminding people on his social account of what he does, he's probably not doing in a shady salesman, like type way, just probably storytelling on Instagram. And because of that he was top of mind when someone needed a referral. So people always ask, like, hey, how do you attract all this business? Well, I stay present. All right. And if you're not present, or you're out of sight, you're what you're out of mind. Right? So half of marketing and half of business is just even from the relationship actually, I would say it's 90% of it. Yes. Staying active, nurturing the relationships infiltrating more creating more, because they all live somewhere? For sure, you know, it's not like they're gonna Where do you live in a box? Like who says they live in boxes? Or they're a bomb? Right? Yeah, you can't sell them a house. But you will eventually the average person buys three to five houses over the course of their lifetime.And sometimes they don't use the same realtor. Most of the times actually.20 83% of people say they will use the same agent, but only 19 or 29% actually do. Yeah. And the reason for that is they forgot they forgot your number. Most times they forget their name. 80% of people forget their agents name after six months. That's horrible. It's horrible. Like, can you can you imagine? That's like equivalent to the Ritz. You guys ever stayed at the Ritz before you go there? It's a great it's quite an experience. But it's also quite an expensive experience. But everything's catered to you like you go into the hotel room like Hey, Mr. Cuevas Bobo, they have a little note for you that you won't forget. You don't you don't you don't forget that. You go to the Holiday Inn across the street, don't get any of that type of service.I can assure you, any of my clients will never forget my name. I can assure you of that. Because I know the service that I provide with my team is just like top class. So yeah, it's it's pretty crazy. How eight 90%? Will I mean? Well, we'll use the same Damn, that's insane.Yeah, I mean, think about it, like the second most Realtors the second you you transact you, you're gone. You become best friends with this person because you're you're buying or selling. It's an emotional process. Like you're talking to these people every other day, right? You develop a friendship like I always ended up parting with my clients because that was sort of my style. And I go out we have dinner like a party like club style, but like go to dinner, have some wine, beer, whatever hanging out we became friends. Because I knew that if I became friends with them that all of them would refer me business a lot more likely than if I did it.Once for sure. Yeah.Where do you see the and how are you staying in front of now? Like walk us through your cadence in terms of staying in front of people? How are you doing it? I know you're doing a lot on Instagram, but what's your sort of methodology on this?For birthdays I usually send like a video tailored to them and then I am also part of by referral only So it's like monthly emails to the clients just reminding them and it's like a little, little, it's called a Monday, how Monday game something and then you can earn a prize if you participate. So you know, it's like something fun. I don't I didn't want to do it a weekly I don't, I don't want to be the weekly this and that's to two emails a month. One is on the first week of the first week of the month. And then the other one is like, it's called the letter from the heart. And it just, it's a gives like a story. Pretty, pretty awesome stories every month. So I'm part of by referral only. And then all of my Instagram, I usually post like three stories about what I'm doing. documenting my journey. It doesn't have to be real estate, it can be playing soccer doing this and that because people don't want to see just clothes just listed. I honestly hate when I see that. Yeah, I'm like, dude, what's, what story behind it? What did you help accomplish? What were they thinking they could not do? So you'll never see me posted just close unless it has a story behind it. And also document my journey. Like, what is it through inspection? What did I struggle with? big misconception is that people that just do disclose, they're like they're perfect. No, there's as to be vulnerability so that people can also connect. Because it's not it's not. There's never going to be a perfect transaction. Yep.If you're struggling share it.Yeah, yeah. People love that. Probably all that stuff. Close stuff.People are so scared to like, voice what's really happening behind closed doors, being vulnerable is the number one thing you could do for anything in marketing. The more you can play people cry, the more they'll remember you.It's social media, the emails that I send videos for birthdays or gifts for birthdays, events, we have several events a year. Definitely the Christmas parties. Those are a lot of fun.Let's do the events. Let's go through that. Yes, how many and walk me through all those?Well, some we do like boat parties in the summers and get like a big as boat. It's a lot of fun. That's when you really get to meet the clients better. It's funny. And then Christmas parties. We invite all of our so like I said, I have a team, with my business partners of Well, I haven't said that before, but 14 agents to office managers. And last year we did 20 and 50. We helped 256 families. Yeah, you're crushingweight. Are you the youngest guy on the team?Yes. Really? Sure. Or we just hired one? I'm not sure. But I believe so. Or we're the same age. The rest are like 3040 30. Exactly. Yeah. So I'm meant I'm a mentor to like, all those agents. So it's pretty funny. And at first, that was one thing that really got in my head, I'm like, oh, shoot, what are they going to think and this and that, that I know what I can offer. So now I'm like, I'm totally fine with that. That before it was something that would get in my head,probably. But why though, that's just the way society paints the picture. You got to be older and you get wisdom. But that's not necessarily true. If you're 26, you could have way more experience than a 35 year old who just got a license, it doesn't matter.That's so true. And I'm actually reading a book, The Four Agreements, but then the next book, it's about attachments. And I knew that I had an non attachment agreement that I had with myself. And as create crazy when I found that I was writing down my agreements, then I was like, Oh, shit, I know that. My family will always tell me respect your elders. Yes, I will respect an elder. But in my head what I think that would mean and I would have translated it to anyone that's older than you has more authority. And they're always right. When I realized that I was like, holy shit. That's what I delimiting Oh, my God. Yeah, I realized that that was a game. That was like, two months ago, actually. I just was astounded.So most of the stuff like it seems like a lot of your mindset came from your own self education, whether you're reading attending these masterminds and whatnot. Would you agree with that? Yes. Repeat those books that you suggest people can should read. Because if you guys aren't, if you guys want some good reads like he just told you a story, everything that he's been talking about as a result of what he read in there. And I think he just put it into action. Basically, the principles in there so you guys, the roadmaps always out there. Like, it's not like, people are like, how am I gonna do it? How am I gonna do it? Well pick up a book, go join a team, follow someone who's already doing it. But follow someone who's been there before because there's no reason why you want to try to create it all on your own. All you want to do is r&d and rip off. Put it in your own way.Why reinvent the wheel, the book four agreements, mastery of self Power of Now Untethered Soul a Miracle Morning? Holy shit, incredible books, The Four Agreements, be impeccable with your word. Never assume. Don't take anything personally and always do your best. It's incredible. It's such a game yougood? Any other? Final or closing thoughts? Like what? People we're going through a shift right now. So, I mean, this is everyone's gonna like, what do I do? What do I do? We're gonna lose a bunch of agents in the next year. So, which is a good thing for those that are full time. But what should you were in a shift? She got the experience. So what are you going to do right nowI've started a cold call, I don't need to cold call. But I've started it because it's something that gets me out of my comfort zone. And I actually enjoy being able to better respond to objections on my feet. That's so important as an agent being able to respond to objections on your feet, but I'm going to do is just hit Instagram harder as in putting more posts, I used to do a lot of stories and then a post maybe once or twice every three weeks, but now it's going to be like twice or three times a week. And I need to get clear on that. And I will get clear on that after actually I met you I really liked all that you had to say. And I know it's being intentional. So that's one thing being very intentional on social media and tick tock tick tock is actually something that's grown insanely, which is weird, but it Yeah, I recommend everyone get that. Then also, with my team, obviously having to do open houses, do all those things. sphere of influence will still be the biggest thing and referrals for me. So touching more more touches with my clients on referral basis, you know? Yeah, I assure you, if anyone calls people you know, you'll have people that need help with buying or selling or they know people are assured, I surely call them.The your Soi. Like the industry is horrible in general market st in front of Soi, but it's the only recession proof marketing model there is because people are still going to move, you know, like, and when they do move, whether it's a crash of 2007, or it's going to be whatever happens in 2022 Here, there's still gonna be life circumstances, some are gonna get sick, some are gonna die, they're gonna lose their jobs, and we're getting married, some are gonna have kids. And when those life changes happen, people will move despite what the market does. However, 80% of them are needed the first person they come into contact with, and if you're not all over, you know, I don't know what to tell you. I mean, they're gonna probably cheat on you with another agent. You're gonna log on to Facebook and see that Andreas here just so well, it's not you. Yeah, and then you get mad at Andreas but don't get mad at Andreas get mad at you because it's not your networks job to remember what you do for a living but it is yours to remind them.Take Extreme Ownership. Don't be a little Bish.I love it, dude. Any closing thoughts?I would say if you're a new agent, join a team. That's the best way to learn as fast as possible. And as soon as possible. Have a morning routine. If you're an independent contractor. It's crazy. It's a double edged sword. Read the Miracle Morning, meditate, do your routine. And that'll definitely help you exponentially reach your goals. Write your goals down as well. So cliche everyone says that yes, I know. It works for a reason. And that's why people that are crushing it do those things.I need to get into the meditating game because everybody I follow and I look up to are meditators accepted. And I'm going to take your advice I'm going to my business partner has been like dude, I meditate every day. I'm like, what's fucking when you meditate? Like you sit there and like, I don't want to do that, man. I don't have time. We got three kids running around. He's like, No, you have to do it. You have to do it, Mike. So I'm gonna give a world is thecall nap. And the big thing about meditating you using your diaphragm to breathe. Don't use your like lungs, don't use your diaphragm. Breathe out through your mouth. It's a game changer. Like very, very much so it's helps a lot become present. Because there's so much shit that goes on all the time in our lives. We're in our head all the time. You need to calm those thoughts down. Yep.I love it. Man. Why don't you go ahead and give everybody your info again so they can follow you either on your IG channel to see exactly how you're doing it. I highly recommend that guys. Or reach out to you if you guys have a referral that is in the Austin area, reach out to undress and his team and they could definitely take good care of you. Obviously they're doing it right. And you want to make sure your clients are being taken care of and there's a lot of people moving to Austin.Yeah, just any questions feel free to DM me. My Instagram is Andres Boustead, TX and DRGs be usta Tx and that's the same handle for tick tock, feel free to reachout. Cool, man, we appreciate you dude. And we appreciate you guys listening to another episode of the real estate marketing dude podcast. You guys know where to find us if you need help scripting, editing and distributing your videos or you just need us to train your videographer because they don't know what the hell they're doing. We could do anything you want and there's no doubt in my mind this is the number one stop if you're going to create real estate content whether you need my consulting, training, editing distribution, I don't care if you want to get on video I got your back and you need to visit our site at real estate marketing do.com real estate marketing dude.com visited take the content download subscribe this podcast visit me on my social handles I don't care. Start making content start generating attention and you will start attracting clients and you'll ditch chasing leads I promise you there's a reason why it works for everything. No person. The only time it doesn't is that people don't like you and that's nothing we can help you with. So, thank you for watching. See you guys next week peace. Thank you for watching another episode of the real estate marketing dude podcast. If you need help with video or finding out what your brand is, visit our website at WWW dot real estate marketing dude.com We make branding video content creation simple and do everything for you. So if you have any additional questions, visit the site, download the training, and then schedule time to speak with a dude and get you rolling in your local marketplace. Thanks for watching another episode of the podcast. We'll see you next time.Transcribed by https://otter.ai

EinBlick – nachgefragt: Ambulantisierung und Hybrid-DRGs u.a. mit Prof. Josef Hecken G-BA

EinBlick – Der Podcast

Play Episode Listen Later Jul 15, 2022 12:32

EinBlick – nachgefragt Podcast mit Interviews und Diskussionsrunden mit Expert:innen des Gesundheitswesens Ambulantisierung und Hybrid-DRGs Die Ambulantisierung der stationären Versorgung ist ein drängendes Thema, insbesondere vor den aktuellen Herausforderungen wie Demographie, Fachkräftemangel und Finanzierung. Hybrid-DRGs gelten als Lösung, sind bisher jedoch nicht eindeutig definiert. Die Fachjournalistin und Einblick-Redakteurin Mirjam Bauer sprach auf einem Expertenforum am sechsten Juli 2022 in Berlin mit Prof. Josef Hecken, dem unparteiischen Vorsitzenden des Gemeinsamen Bundesausschusses G-BA, Doktor Gerald Gaß, dem Vorstandsvorsitzenden der Geschäftsführung der Deutschen Krankenhausgesellschaft und Professor Doktor Boris Augurzky, Leiter des Bereichs ›Gesundheit‹ am RWI, Geschäftsführer der hcb GmbH, Vorstandsvorsitzender der Stiftung Münch.

Lucrative Financial Incentives Behind the Lethal Covid Practices According to AJ DePriest (Part 2)

The Counter Culture Mom Show with Tina Griffin Podcast

Play Episode Listen Later Jun 24, 2022 27:08

AJ DePriest, founder of the Tennessee Liberty Network, warns that the Centers for Medicare and Medicaid Services (CMS) are involved in the destruction of American patients' rights by enforcing government agencies' lethal Covid protocols. In this second exclusive conversation with AJ, a federal policy and legislation analyst for over three decades, we will uncover the lucrative financial incentives that motivate hospitals to treat Covid patients with deadly drugs like Remdesivir or it's market name Veklury. The total average reimbursement that hospitals receive for each Covid admission is a staggering $293,000. To fight back against receiving potentially deadly hospital sedatives, drugs, and ventilators, AJ advises early treatment, as well as finding a solid doctor who will prescribe safe and effective medication. TAKEAWAYS CMS set up Diagnosis-Related Groups, or DRGs, to reimburse hospitals at a high rate Parents need to make sure their kids' schools aren't using extremely toxic Triethylene Glycol in their HVAC systems The CMS is directly involved in issuing waivers that have allowed hospitals to treat patients without their consent Covid protocols serve a two-fold purpose: to eliminate those who are considered a “drain” on society and to flood hospitals with funding

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The use of international DRGs

government international focus mba diagnostic icd modern practice drgs

Play Episode Listen Later May 26, 2022 9:39

As health care organizations expand into international markets, reimbursement for clinical services offered involves the use of international Diagnosis Related Groups (DRGs). How these differ from Medicare Severity Diagnosis Related Groups (MS-DRGs) and what they include is the topic of this episode of Modern Practice. Guest speaker: Linda Wiseman, RN Senior Consulting Director Vizient Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Principal Clinical Operations and Quality Vizient Show Notes: [00:53] Various DRG systems and their uses [01:46] Government oversight in other countries, including IR-DRGs [03:32] Diagnostic categories by country [04:48] Focus on three main areas [06:26] ICD-11 issues [08:26] Need to understand procedural coding when working overseas Links | Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Linda Wiseman's contact email: linda.wiseman@vizientinc.com Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify Stitcher RSS Feed

2023 IPPS Proposed Rule: Important Coding and CDI Implications

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Play Episode Listen Later May 3, 2022 30:42

The Centers for Medicare & Medicaid Services (CMS) has released the hospital Inpatient Prospective Payment System (IPPS) Proposed Rule for short- and long-term acute-care hospitals. The Proposed Rule not only updates the Medicare approach to Medicare-Severity DRGs (MS-DRGs) reimbursement, but also advocates for the President's executive orders addressing quality, inequities, and outcomes in healthcare. While there are no new MS-DRGs, minimal changes to the MS-DRG algorithms, and another one-year delay to implementing a comprehensive complications and comorbidities (CCs) and major CCs (MCCs) restructuring, proposed four years ago, CMS proposes 10 new Inpatient Quality Reporting measures, such as Hospital Commitment to Health Equity, Screening for Social Drivers of Health, Screen Positive Rate for Social Drivers of Health, the Cesarean Birth Electronic Clinical Quality Measure (eCQM), a Severe Obstetric Complications eCQM, a Hospital-Harm/Opioid-Related Adverse Events eCQM, the Global Malnutrition Composite Score eCQM, and others that certainly will have clinical documentation integrity (CDI) and ICD-10-CM/PCS coding implications. During the next live edition of Talk-Ten-Tuesdays, James S. Kennedy, MD, president of CDIMD, will briefly outline which of these warrant the immediate attention of ICD-10-CM/PCS-oriented physicians, providers, coders, and CDI specialists, who are being asked to formulate and submit comments prior to CMS's June 17 deadline. The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news. Talk Law: Knicole Emanuel, Partner with Practus, will continue with the broadcast's newest segment. RegWatch: Stanley Nachimson, former CMS career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington, D.C. News Desk: John Zelem, MD, FACS, founder and CEO for Streamline Solutions Consulting, will anchor the Talk-Ten-Tuesdays News Desk. Point of View: Susan Gatehouse, a guest cohost who will be substituting for Dr. Erica Remer, will report on payor strategies that should be implemented to mitigate the already long road to payment.

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Elevating Newborn DRGs. The case of DRG 794 and the broken MSDRG system for peds

Coder vs CDI

Play Episode Listen Later Mar 16, 2022 27:11

Support the show

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PflegeStandard S02E12 - Alexander Eichholtz

PflegeStandard

Play Episode Listen Later Feb 22, 2022 75:31

In Folge 12 begrüßen wir Herrn Alexander Eichholtz, den Personalrat der Berliner Charité. Wir sprechen über die Situation der Pflege im bekanntesten deutschen Universitätskrankenhaus, dem neuen Personalbemessungsinstrument, dem Marktwert einer (Leasing)Pflegekraft, Tarifverträgen, DRGs und Pflegebudgets und mehr! Wir wünschen viel Spaß!

Episode 75 – Intro to Value-Based Care Part 1 with Barbara Strain

Medical Device Success - Your Success is Our Mission!

Play Episode Listen Later Jan 9, 2022 69:49

Understanding this important subject is part of knowing your customer. Here is a factoid from today's conversation, the sickest 5% of the US population consumes 50% of healthcare resources. One of many reasons fee for service is not sustainable and that the move to value-based care is gaining momentum. Today's episode is the first of several episodes on Value-Based Care. I am calling it "Intro to Value-Based Care Part 1". Our guest for both part 1 and part 2 is Barbara Strain, Principal of Barbara Strain consulting. Prior to her recent move into consulting, Barbara was the Director of Supply Chain Analytics and later Director of Value Management at the Univ. of Virginia Health System. She is also a founding member of AHVAP, the Association of Healthcare Value Analysis Professionals. So, she has lived the history of DRGs, Bundles and Value-Based Care. Barbara is going to give us a foundation in the subject so we will be better prepared for guest speakers from a hospital system, a physician practice and from industry. Before I get to today's episode, I want to share what the podcast content will look like over the first half of the year. We (when I say we, I mean you and me)…We will be exploring 3 big themes. These themes are Value-Based Care, Artificial Intelligence and Robotics. I really believe these three areas will have a major impact on healthcare and MedTech going forward. I have been working hard rounding up guest experts in these areas. If you know someone I should consider as a guest speaker, let me know. I am serious. Use the contact link in the show notes or message me via LinkedIn or the MedTech Leaders community. Of course, there will be some other subject matter experts and “In the C-Suite” guests mixed in. And, due to the difficulties scheduling guests, the themes will be mixed up in order of publication. So, one week you may get value-based care and the next week artificial intelligence followed by robotics. By the way, Barbara is a member of the MedTech leaders' community. A place for MedTech leaders and sales and marketing professionals to help each other out, learn from each other and subject matter experts. Several people joined last week. A warm welcome to all of you. You can learn more at medtechleaders.net. There is a free trial and the cost is equal to about 3 or 4 cups of artisanal coffee depending how big the cup is you drink. Now Go Win Your Week!! Barbara Strain's LinkedIn Profile link Barbara's website link “Building New Pathways” Whitepaper link Ted Newill's LinkedIn Profile link More Medical Device Success podcasts link Medical Device Success website link MedTech Leaders Community link Link to Ted's contact page

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Clinical validation and denials

The Hospital Finance Podcast

Play Episode Listen Later Dec 9, 2021 9:04

When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials. Guest speaker: Erica Braun, MS, RN, CCDS Consulting Director Vizient Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Principal Clinical Operations and Quality Vizient Show Notes: [01:11] Clinical validation denial [01:31] Implications for denials: downgraded DRGs and lower reimbursement [02:31] Avoiding denials [03:25] When diagnoses are at high risk for denial [03:59] Examples of disputed diagnoses [04:30] Establishing criteria for diagnoses [05:15] What physicians can do to help improve documentation [06:17] What to do when a denial occurs [07:29] Negotiating and coordinating with payers Links | Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Erica Braun's contact email: erica.braun@vizientinc.com Fact sheet on Vizient's clinical documentation improvement services: Click here Clinical Validation: The Next Big Challenge in Inpatient Coding (American Academy of Professional Coders, AAPC): Click here Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify Stitcher RSS Feed

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DRGs - Das Fallpauschalensystem verstehen und mitdiskutieren

AMBOSS Podcast

Play Episode Listen Later Oct 10, 2021 48:30

Alle kennen sie, niemand mag sie: DRGs. Wer etwas ändern möchte, sollte wissen, wie die Fallpauschalen funktionieren.

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MS DRG Changes for 2022

Play Episode Listen Later Sep 15, 2021 8:08

In this episode, we welcome back Mary Devine, BESLER's Senior Director of Revenue Cycle, to discuss the 2022 changes to the Inpatient Prospective Payment System and the impact to IPPS facilities. Learn how to listen to The Hospital Finance Podcast® on your mobile device. Highlights of this episode include: The big changes to DRGs for Read More

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PflegeStandard S02E04 - Pia Zimmermann

PflegeStandard

Play Episode Listen Later Aug 31, 2021 56:41

Herzlich Willkommen zur neuen Folge von PflegeStandard – dem pflegewissenschaftlichen Podcast mit aktuellen Themen aus Politik, Wissenschaft und Zeitgeschehen. Heute ist der 31. August 2021 und mein Name ist Mark Szemeitat. Zusammen mit Prof. Dr. Martina Hasseler möchten wir die pflegewissenschaftliche Perspektive stärken. Heute sprechen wir mit Pia Zimmermann, Mitglied des Bundestags für Die Linke und Mitglied des Bundesausschusses für Gesundheit. Wir sprechen über die – im Gegensatz zu vielen anderen Parteien – sehr konkreten Forderungen der Linken in Bezug auf Pflege und Gesundheit, die geforderte Finanzierung durch eine solidarische Pflegevollversicherung, der Personalsituation in den Krankenhäusern und Pflegeeinrichtungen unter dem Aspekt des neuen Pflegepersonalbemessungsinstruments und der generalistischen Pflegeausbildung sowie den Veränderungen, die sich Die Linke für die DRGs wünscht.

How to Control Your Sense of Pain & Pleasure | Episode 32

Huberman Lab

Play Episode Listen Later Aug 9, 2021 135:53

This episode I discuss our sense of pain and pleasure: where and how they each arise in our mind and body and various ways to control their intensity. I discuss the science of behavioral tools like acupuncture and hypnosis and directed pressure, including the neural circuits they each activate to modulate our experience of pain or pleasure. I also discuss whole body pain, pain "syndromes" and novel pain relief compounds such as Acetyl-L-Carnitine, SAMe and Agmatine. I discuss neuroplasticity of the pain system and the key role that visual perception plays in pain modulation. Finally, I address the link between dopamine, serotonin, and oxytocin, with arousal, pleasure and pain. As always, both basic science and various protocols are described. Note: The description of the dorsal root ganglia (DRGs) was intentionally simplified and does not include mention of dorsal horn spinal relay neurons, etc. For an excellent full text review of this anatomy and circuits for touch sensing, please see: https://bit.ly/3jH9CPf Thank you to our sponsors: InsideTracker - https://www.insidetracker.com/huberman Helix Sleep - https://www.helixsleep.com/huberman Athletic Greens - https://www.athleticgreens.com/huberman Our Patreon page: https://www.patreon.com/andrewhuberman Supplements from Thorne: http://www.thorne.com/u/huberman Social: Instagram - https://www.instagram.com/hubermanlab Twitter - https://twitter.com/hubermanlab Facebook - https://www.facebook.com/hubermanlab Website - https://hubermanlab.com Join the Neural Network - https://hubermanlab.com/neural-network Links: Instagram discussion with Dr. Sean Mackey, MD, PhD - https://www.instagram.com/p/CMVq0X8Bk1D/ Agmatine study - https://bit.ly/3CtTwRn Mechanistic basis of acupuncture - https://bit.ly/2VHi0pz Timestamps: 00:00:00 Skin, Pain, Pleasure 00:01:50 Protocol 1: Maximizing Motivation (with Dopamine & Pleasure) 00:07:12 Sponsors: InsideTracker, Helix Sleep, Athletic Greens 00:12:04 Pleasure & Pain, & Skin Sensors 00:18:13 Sensing Touch with Your Brain: Magnification of Feet, Hands, Lips, Face, Genitals 00:22:16 Two-Point Discrimination, Dermatomes 00:28:11 Thoughts & Genes That Make Physical Pain Worse 00:33:45 Expectations, Anxiety, & Pain Threshold 00:40:27 Protocol 2: Cold Sensing Is Relative; Getting Into Cold Water 00:45:22 Protocol 3: Heat Is Absolute 00:48:10 Injury & Pain 00:52:04 Protocol 4: Plasticity of Pain: Key Role of Vision 00:58:08 Sensing Disparate Body Parts As Merged 01:01:00 Pain “Syndromes”, Psychogenic Fever, “Psychosomatics” 01:04:40 Fibromyalgia, Naltrexone, Protocol 5: Acetyl-L-Carnitine 01:12:24 Protocol 6: Agmatine, S-adenosyl-L-methionine (SAMe), L-5-Methyltetrahydrofolate* 01:17:27 Acupuncture: Mechanism, Non-Responders, Itch & Inflammation 01:28:20 Laser Photobiomodulation, Protocol 7: Hypnosis (reveri.com) 01:30:00 Protocol 8: Pressure-Based Pain Relief, “Gate Theory of Pain (Relief)” 01:37:53 Redheads & Pain Thresholds, Endogenous Opioids 01:44:02 Protocol 8: Love & Pain, Dopamine 01:49:23 Pleasure & Reproduction, Dopamine & Serotonin, Oxytocin 01:51:40 Protocol 9: PEA, L-Phenylalanine (Precursor to Tyrosine) 01:55:40 Contextual Control of Pleasure by Autonomic Arousal, Dopamine Baselines 01:59:40 Pleasure-Pain Balance 02:01:24 Protocol 10: Controlling Pleasure, Dopamine & Motivation Over Time 02:06:40 Protocol 11: Immediate, Non-Goal-Directed Pleasure, PAG 02:08:40 Direction of Touch: Pleasure Versus Pain, Arousal & Touch “Sensitivity” 02:13:00 Synthesis & How to Conceptualize Pain and Pleasure, Support Please note that The Huberman Lab Podcast is distinct from Dr. Huberman's teaching and research roles at Stanford University School of Medicine. The information provided in this show is not medical advice, nor should it be taken or applied as a replacement for medical advice. The Huberman Lab Podcast, its employees, guests and affiliates assume no liability for the application of the information discussed. Title Card Photo Credit: Mike Blabac - https://www.blabacphoto.com

New methods to avoid future drug shortages

The Hospital Finance Podcast

Play Episode Listen Later Jul 5, 2021 11:26

The Post-Acute Transfer Rule reduces Medicare reimbursement to hospitals by millions of dollars each year. In fact, when an account is impacted by the Rule, it reduces reimbursement, on average, by $3,000 per discharge. Accounts are impacted by the Rule if: the account is one of the DRGs included on the impact list in table Read More

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Ökonomisierung im Krankenhaus – Mit Robin Mohan und Kaspar Molzberger

Das Neue Berlin

Play Episode Listen Later Jun 17, 2021 118:27 Transcription Available

Wie so viele gesellschaftliche Bereiche wurde auch das Krankenhaus in den letzten Jahrzehnten nach neuen Prinzipien organisiert. Mit gedeckelten Budgets und Fallkostenpauschalen sollte das vermeintlich überteuerte Gesundheitssystem auf Effizienz getrimmt werden. Kliniken sollten zu Konkurrentinnen werden, die Marktbereinigung unwirtschaftliche Häuser aussortieren. Eine tiefgreifende Ökonomisierung hat die Arbeitsweise im Krankenhaus grundsätzlich verändert. Kaspar Molzberger und Robin Mohan haben beide zu diesem Thema promoviert und die Ökonomisierung des Krankenhauses intensiv erforscht. In Interviews mit Pflegern, Ärzten und Management sind sie der Frage nachgegangen, wie sich Ökonomisierung in der konkreten Praxis der Klinik zeigt. Im Zentrum steht dabei das Klassifikationssystem der DRGs, mit dem Krankheitsbilder zusammengefasst und mit durchschnittlichen Behandlungszeiten und -kosten versehen werden. Wer über dem Durchschnitt liegt, macht Minus, wer besser ist, kann Gewinne erwirtschaften – was viele privatgeführte Krankenhäuser rentabel tun. Im Gespräch mit unseren beiden Gästen rekonstruieren wir die historischen Entwicklungslinien des modernen Krankenhauses. Ebenso sprechen wir über dessen traditionelle Arbeitsteilung und wie unterschiedlich sich die Ökonomisierung beim ärztlichen und dem Pflegepersonal auswirkt. Während bestimmte ärztliche Prozeduren hochrentabel sein können, wird die Pflege zum Kostenfaktor. Personalabbau und Arbeitsverdichtung sind die Folge. Andererseits kommt auch das ärztliche Professionsethos immer wieder in Konflikt mit ökonomischen Zielsetzungen. Zuletzt diskutieren wir, wie sich Ökonomisierung theoretisch fassen lässt. Unsere Gäste sind uneins: Robin Mohan plädiert dafür, die Ökonomisierung der Organisation ins gesellschaftstheoretische Verhältnis zu setzen und den Begriff in Zusammenhang mit der Warenlogik des Kapitalismus zu bestimmen. Kaspar Molzberger verortet die Ökonomisierung in einer historisch spezifischen Praxis der Kalkulation, die nur in der Organisation selbst wirklich rekonstruierbar ist.

Outpatient CDI: Payer perspective

Play Episode Listen Later Mar 31, 2021 32:29

Today's guest is Susan Richards, CPHQ, CCS, CPC, CRC, COMA, CPC-I, CDEO, CEMC, who served as the director of clinical documentation for Humana Medicare Advantage from 2020-2021. The show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, a CDI education specialist at HCPro/ACDIS in Middleton, Massachusetts. Featured solution: Today's featured ACDIS solution is the Live Virtual CDI Boot Camp®! The Live Virtual CDI Boot Camp is ACDIS' premier training for CDI specialists. Trusted by hundreds of CDI specialists as the go-to source for CDI education, this course defines the role of CDI specialists and provides comprehensive training on their responsibilities. Improve your CDI know-how with ACDIS-endorsed best practices for medical record review and compliant physician querying. This class is taught live in a convenient virtual setting. Get the same small classes and personal touch and interaction we provide in the classroom! Specifically, participants learn about MS-DRG methodology, including how MS-DRGs are assigned and how documentation affects code assignment and sequencing. This is a rich, deep experience that includes discussion with CDI boot camp instructors regularly featured on the ACDIS Podcast. To learn more or to register, click here! (http://ow.ly/7gbK30rvtrZ) In the News: “A roadmap for value-based payment in 2030,” from Healthcare Innovation (http://ow.ly/K1NZ30rCSyl) ACDIS update: Register for the ACDIS Conference, October 25-28, in Dallas, Texas! (http://ow.ly/1jQp30rB3Lq)

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Registered respiratory therapist: Risk and reward

Play Episode Listen Later Mar 17, 2021 32:00

Today's guest is Brian Simpson, MS, RRT, CCDS, CDIP, CCS, CRC, CCDS-O, a CDI specialist at Penn Highlands Healthcare in DuBois, Pennsylvania. The show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, a CDI education specialist at HCPro/ACDIS in Middleton, Massachusetts. Featured solution: Today's featured ACDIS solution is the Live Virtual CDI Boot Camp®! The Live Virtual CDI Boot Camp is ACDIS' premier training for CDI specialists. Trusted by hundreds of CDI specialists as the go-to source for CDI education, this course defines the role of CDI specialists and provides comprehensive training on their responsibilities. Improve your CDI know-how with ACDIS-endorsed best practices for medical record review and compliant physician querying. This class is taught live in a convenient virtual setting. Get the same small classes and personal touch and interaction we provide in the classroom! Specifically, participants learn about MS-DRG methodology, including how MS-DRGs are assigned and how documentation affects code assignment and sequencing. This is a rich, deep experience that includes discussion with CDI boot camp instructors regularly featured on the ACDIS Podcast. To learn more or to register, click here! (http://ow.ly/7gbK30rvtrZ) In the News: “News: Medicare spending on inpatient stays raises upcoding concerns, OIG report shows,” from CDI Strategies (http://ow.ly/rowC30rB3KY) ACDIS update: Register for the ACDIS Conference, October 25-28, in Dallas, Texas! (http://ow.ly/1jQp30rB3Lq)

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Episode 4 - Reviewing the Basics of DRGs

Healthcare Fraud Shield

Play Episode Listen Later Mar 9, 2021 19:05

Welcome to Season 2, Episode 4 of the Healthcare Fraud Shield podcast. In this episode we will discuss Diagnosis Related Groups (DRGs). If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar. Do you have any questions or podcast topic ideas? Email us at kweintraub@hcfraudshield.com.

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From the mailbag: Listener Q&A

Pacific Spine and Pain Society Podcast

Play Episode Listen Later Mar 3, 2021 35:19

Today's show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, a CDI education specialist at HCPro/ACDIS in Middleton, Massachusetts. Featured solution: Today's featured ACDIS solution is the Live Virtual CDI Boot Camp®! The Live Virtual CDI Boot Camp is ACDIS' premier training for CDI specialists. Trusted by hundreds of CDI specialists as the go-to source for CDI education, this course defines the role of CDI specialists and provides comprehensive training on their responsibilities. Improve your CDI know-how with ACDIS-endorsed best practices for medical record review and compliant physician querying. This class is taught live in a convenient virtual setting. Get the same small classes and personal touch and interaction we provide in the classroom! Specifically, participants learn about MS-DRG methodology, including how MS-DRGs are assigned and how documentation affects code assignment and sequencing. This is a rich, deep experience that includes discussion with CDI boot camp instructors regularly featured on the ACDIS Podcast. To learn more or to register, click here! (http://ow.ly/7gbK30rvtrZ) In the News: “Medicare cuts payment to 774 hospitals over patient complications,” from Kaiser Health News (http://ow.ly/fNaT30rzdRP) ACDIS update: “Note from the Instructor: Grow the profession” by Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, in CDI Strategies (http://ow.ly/2swI30rzdTj)

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S1E9 - Why does Interventional Pain Managment Matter and Where is the Field Going? With Ramo Naidu MD

Play Episode Listen Later Mar 2, 2021 22:24

Dr. Ramana (Ramo) Naidu is an anesthesiologist and pain physician who is the medical director of pain management at MarinHealth Medical Center and the medical director of Marin Specialty Surgery Center. He helps patients manage, reduce, or eliminate pain and suffering that occurs after medical illness, trauma, or surgery and puts an emphasis on preventing pain from becoming persistent. Naidu is primarily based at California Orthopedics & Spine, serving to help patients with pain before and after surgery. He emphasizes trying to manage pain without relying on opioid medications using a multi-disciplinary approach involving pain psychologists, physical therapists, complementary and integrative approaches. He performs advanced interventional procedures with the goal of sustained relief. Beyond epidural, joint, sympathetic and peripheral nerve injections, Naidu performs radiofrequency ablation of major joints and nerves and minimally-invasive spine procedures such as indirect and direct lumbar decompression, posterior sacroiliac joint fusion, and intradiscal therapeutics. As a neuromodulator, he is an expert on spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), and peripheral nerve stimulation (PNS). Naidu earned a medical degree at the University of Wisconsin School of Medicine and Public Health in Madison where he was born and raised. He completed a residency in anesthesiology at the University of Washington in Seattle, followed by a fellowship in pain management at University of California – San Francisco (UCSF) where he continued to practice for another five years as an assistant professor. He was a Fulbright Scholar in public health in Copenhagen, Denmark, with the World Health Organization (WHO) Regional Office for Europe. During this time, he studied hospital-acquired infections and the dissemination of information regarding prevention. Dr. Naidu is engaged in clinical research as he is interested in ensuring that we have safe, economical, and effective therapies for specific pain conditions. For any questions about which studies and therapies he is involved with, please enquire. The professional societies Naidu belongs to include the American Society of Anesthesiologists, California Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, International Association for the Study of Pain, American Society of Interventional Pain Physicians, California Society of Interventional Pain Physicians, North American Neuromodulation Society, International Neuromodulation Society, American Society of Pain and Neuroscience, and is the President-Elect of the Pacific Spine & Pain Society. dr.ramonaidu on IG; Ramo Naidu MD on LinkedIn ramonaidu@me.com This podcast is powered by Pinecast.

What is artificial intelligence (AI)?

Play Episode Listen Later Feb 17, 2021 32:29

With special guest V. “Juggy” Jagannathan, PhD, researcher of artificial intelligence and computer science for 3M Health Information Systems. Today's show is co-hosted by Sharme Brodie, RN, CCDS, CCDS-O, a CDI education specialist at HCPro/ACDIS in Middleton, Massachusetts. Today's show is supported by 3M Health Information Systems. 3M Health Information Systems, now with M*Modal, delivers innovative software and consulting services designed for a wide range of healthcare environments. From closing the loop between clinical care and revenue integrity, to computer-assisted coding, clinical documentation integrity and performance monitoring, 3M can help you reduce cost and provide more informed care. Featured solution: Today's featured ACDIS solution is the Live Virtual CDI Boot Camp®! The Live Virtual CDI Boot Camp is ACDIS' premier training for CDI specialists. Trusted by hundreds of CDI specialists as the go-to source for CDI education, this course defines the role of CDI specialists and provides comprehensive training on their responsibilities. Improve your CDI know-how with ACDIS-endorsed best practices for medical record review and compliant physician querying. This class is taught live in a convenient virtual setting. Get the same small classes and personal touch and interaction we provide in the classroom! Specifically, participants learn about MS-DRG methodology, including how MS-DRGs are assigned and how documentation affects code assignment and sequencing. This is a rich, deep experience that includes discussion with CDI boot camp instructors regularly featured on the ACDIS Podcast. To learn more or to register, click here! (http://ow.ly/7gbK30rvtrZ) In the News: The Healthcare Innovation Group's 2021 State of the Industry Survey (http://ow.ly/1NRs30rxjn9) ACDIS update: Respond to the 2021 ACDIS Membership Survey (even if you're not currently a member!) and be entered to win a prize! (http://ow.ly/THyp30rxjnr)

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Denials management and education at Henry Ford

The Healthcare Leadership Experience Radio Show

Play Episode Listen Later Feb 3, 2021 30:46

With special guest Frank Levanduski, BBA, RHIT, CEMC, the manager of the documentation and coding education development and delivery teams, and Patty Vitasinski, RN, CCDS, the manager of CDI quality improvement for the Henry Ford Health System in Detroit, Michigan. Today's show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, a CDI education specialist at HCPro/ACDIS in Middleton, Massachusetts. Featured solution: Today's featured ACDIS solution is the Live Virtual CDI Boot Camp®! The Live Virtual CDI Boot Camp is ACDIS' premier training for CDI specialists. Trusted by hundreds of CDI specialists as the go-to source for CDI education, this course defines the role of CDI specialists and provides comprehensive training on their responsibilities. Improve your CDI know-how with ACDIS-endorsed best practices for medical record review and compliant physician querying. This class is taught live in a convenient virtual setting. Get the same small classes and personal touch and interaction we provide in the classroom! Specifically, participants learn about MS-DRG methodology, including how MS-DRGs are assigned and how documentation affects code assignment and sequencing. This is a rich, deep experience that includes discussion with CDI boot camp instructors regularly featured on the ACDIS Podcast. To learn more or to register, click here! (http://ow.ly/7gbK30rvtrZ) ACDIS update: Register for ACDIS' free “ACDIS insights: Second surge impact of COVID-19” on Thursday, February 11, 11 a.m. to 12:30 p.m. eastern. (http://ow.ly/Cnle30rvs2j)

High Performing Healthcare & Hospital Contracting with Ray O'Kelley | Ep.6

Play Episode Listen Later Jan 25, 2021 42:12

In Episode 6 of The Healthcare Leadership Experience, Lisa is joined by Ray O'Kelley, CEO & Founder of Healthy Contracts and Business Data Applications (BDA), Inc. Ray has 25 years of experience in healthcare software leadership, and helped to build MediTract to a $300 million division. Ray is a Veteran, and retired United States Marine. He served ten years of active duty during the Persian Gulf War. Today's episode is sponsored by Invoice ROI™, the only patented purchased services and indirect spend technology to manage, monitor and benchmark line item details. In this episode of The Healthcare Leadership Experience you'll hear: Identify the three steps to establishing the foundations of a healthy contract for hospitals and healthcare organizations. Discover the true definition of a contract review. (Hint: It isn't sending a 30-page contract out to four different people and asking them to read it). Why the open source innovative technology behind the Healthy Contracts and BDA healthcare contract system is highly important and why it has to be the technology of today, not the past. "If you have a payer you want to reconcile, a bank of CBTs, DRGs to analyze, this technology can support it." Discover the three steps to determine the renewal type of a hospital healthcare contract and when "interpretive extraction" is vital. Why there's no total AI solution for contract management — and why integrity is essential. "When we look at AIs and robotics, we ask ‘'Can it make a legal interpretation?.... and 50% of the time it can't." Discover the four primary goals for working with hospitals and their contracts — and why in software as a service (SAAS) the data must be accurate and simple to use. Why your hospital must understand what's really happening in your healthcare contracts. "There's waste … but most hospitals don't have the resources to identify, mitigate, remediate and renegotiate it." Resources:

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News Update: New Monoclonal Antibody Infusion Underway

Play Episode Listen Later Dec 8, 2020 32:39

Out in the West Texas “town” of El Paso, a number of COVID-19 patients are being treated with a new monoclonal antibody infusion called bamlanivimab. Now in the second week of the operation being conducted in the El Paso Convention Center’s makeshift hospital, Dr. Edward Michelson, Chair of the Department of Emergency Medicine at Texas Tech University Health Sciences Center, reports that while treatments are underway, there hasn’t been enough time to gather data on the effects and outcomes. Dr. Michelson, who appeared on Talk Ten Tuesdays in October 2017, will return to the live broadcast this coming Tuesday with a live update on the new therapy. Also on tap for the broadcast:Tuesday Focus: New COVID-19 Codes: The Centers for Disease Control and Prevention (CDC) recently announced further additions to ICD-10-CM related to COVID-19. Additionally, the Centers for Medicare & Medicaid Services (CMS) has posted new guidelines for ICD-10 CM/PCS coding and an updated MS-DRGs, Version 38.1. Updates include new ICD-10-CM and PCS codes for COVID-19. Reporting our Tuesday Focus will be Susan Gatehouse, founder and CEO for Axea Solutions. RegWatch: Stanley Nachimson, former CMS career professional-turned-well-known healthcare IT authority, will report on how healthcare and politics are inextricably entwined. News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk. The Coding Report: Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC, will report on ICD-10 coding relative to infusion services. TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on another thought-provoking topic that has captured her attention.

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Analysis of the Immune Response to Sciatic Nerve Injury Identifies Efferocytosis as a Key Mechanism of Nerve Debridement

The Hospital Finance Podcast

Play Episode Listen Later Oct 24, 2020

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.10.23.352872v1?rss=1 Authors: Kalinski, A. L., Yoon, C., Huffman, L. D., Duncker, P. C., Kohen, R., Passino, R., Hafner, H., Johnson, C., Kawaguchi, R., Carbajal, K. S., Jara, J. S., Hollis, E., Segal, B., Giger, R. J. Abstract: Sciatic nerve crush injury triggers sterile inflammation within the distal nerve and axotomized dorsal root ganglia (DRGs). Granulocytes and pro-inflammatory Ly6C high monocytes infiltrate the nerve first, and rapidly give way to Ly6C negative inflammation-resolving macrophages. In axotomized DRGs, few hematogenous leukocytes are detected and resident macrophages acquire a ramified morphology. Single-cell RNA-sequencing of injured sciatic nerve identifies five macrophage subpopulations, repair Schwann cells, and mesenchymal precursor cells. Macrophages at the nerve crush site are molecularly distinct from macrophages associated with Wallerian degeneration. In the injured nerve, macrophages "eat" apoptotic leukocytes, a process called efferocytosis, and thereby promote an anti-inflammatory milieu. Myeloid cells in the injured nerve, but not axotomized DRGs, strongly express receptors for the cytokine GM-CSF. In GM-CSF deficient (Csf2-/-) mice, inflammation resolution is delayed and conditioning-lesion induced regeneration of DRG neuron central axons is abolished. Thus, carefully orchestrated inflammation resolution in the nerve is required for conditioning-lesion induced neurorepair. Copy rights belong to original authors. Visit the link for more info

MS-DRG changes in 2021 [PODCAST]

Play Episode Listen Later Oct 21, 2020 7:03

In this episode, we are joined by Mary Devine, Senior Director of Revenue Cycle services at BESLER, to discuss changes to MS-DRGs in 2021. Learn how to listen to The Hospital Finance Podcast® on your mobile device. Highlights of this episode include: A review of the new DRGs that were added for 2021. Notable additions Read More

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Newsworthy MS-DRG Changes for FY 2021, Trusty Tip for Split-Care Billing During the Global Surgical Package, and Mark Twain's Spark

Paint The Medical Picture Podcast

Play Episode Listen Later Oct 7, 2020 23:27

Welcome to the Paint The Medical Picture Podcast, a Nexsen Pruet, LLC series, hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Episode 5 provides Newsworthy details in FY 2021's Final Rule for the Inpatient Prospective Payment System (IPPS), highlighting some changes in MS-DRGs. Trusty Tip touches on my best practice recommendations for split-care billing. Spark recounts the wise words of our beloved American author, Mark Twain. Go ahead and listen, subscribe, rate and review! Now on: Anchor: http://anchor.fm/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw If you would like to reach out for Sonal's consulting services, please contact her directly at: sonalpatel@nexsenpruet.com Find Sonal at Nexsen Pruet at: https://www.nexsenpruet.com/professionals/sonal-patel Find Sonal's Services at: https://www.nexsenpruet.com/about-us/npcoding360 Find Sonal on LinkedIn at: www.linkedin.com/in/sonapate Find Nexsen Pruet Healthcare on LinkedIn at: https://www.linkedin.com/showcase/nexsen-pruet-health-care/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/sonal-patel5/message Support this podcast: https://anchor.fm/sonal-patel5/support

The Infinite Game in Healthcare Innovation, with Dan McMaster

The Race to Value Podcast

Play Episode Listen Later Oct 5, 2020 49:09

Most people know that 3M as a massive industrial conglomerate, a Fortune 500 company with 60,000 products that include Post-It notes, Scotch tape, sandpaper, hanging hooks, band-aids and more. A lesser-known division, but the one that is paramount to our focus on value-based care, is their Health Information Systems division: a $1billion+ dollar enterprise built over the last 35 years and focused on healthcare data aggregation and analysis. 3M's Health Information Systems business works with more than 8,000 healthcare organizations worldwide, including 250,000 physicians, health plans, and 80% of US hospitals, as well as local and national governments in the US and 25 other countries. They deliver software and services across the continuum of care and combine clinical documentation systems and risk assessment methodologies to capture, analyze, and advance patient information in value-based care. Dan McMaster is our guest for this episode. He is the Director of Strategy and Business Development for 3M Health Information Systems. Dan's leadership and vision have served 3M for over 16 years – his in-depth knowledge of the organization reveals a compelling origin story and unfolds a future of innovation that ensures 3M will be a winner the race to value. http://www.3mhis.com/ http://www.3mhiscer.com/ https://www.3mhisinsideangle.com/podcast/ 5:46 The need for analytics and business intelligence in the transition from volume to value 6:12 Potentially Preventable Readmissions (PPR) – identifying acute care hospital readmissions to improve the quality of care 6:37 Clinical Risk Groups (CRG) – “a FICO score for your health” 7:27 Providing key population measures to health plans all over the country and CMS for improving health outcomes 8:26 Using AI to surface real-time insights when completing the medical record 11:00 3M's journey in health information technology from when the healthcare company first started 35 years ago 13:40 Clinical and Economic Research at 3M HIS and the development of DRGs related to Rich Averill's health-related research at Yale University 15:10 Collaboration with payers to develop capitation models 15:30 3M's and M*Modal launch of AI and natural language understanding CDI tool for real-time alerts at the point-of-care 17:00 The story of the challenging new product development of the Post-It note and how this experience shaped the current culture of innovation at 3M 20:23 Developing innovation for HCC coding for Medicare Advantage risk adjustment 22:08 Partnership with payers, providers, government, and EHR companies is key for innovative solutions in healthcare 26:18 How to sift through all of the noise, buzzwords, and rhetoric when evaluating new and emerging technologies 26:53 The potential for AI and NLP to enhance the capabilities of providers in order to improve health outcomes 29:27 AI can reduce the intense documentation burden that contributes to physician depression, anxiety, and suicidality 31:40 Innovation with Medicare Advantage and how advancement in health informatics systems for this population can be leveraged for the bigger whole 37:10 Dan speaks to 3M's involvement in the ACLC and how Michael Leavitt has led with the need for collaboration in value-based care 39:30 Leveraging technology appropriately can free up time for physicians so they can better address patient care needs 41:48 The need for an “Infinite Game” mindset in healthcare innovation

Loss of Prdm12 during development, but not in mature nociceptors, causes defects in pain sensation.

Felipe Torrealba Geopolítica

Play Episode Listen Later Sep 7, 2020

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.07.286286v1?rss=1 Authors: Landy, M. A., Goyal, M., Casey, K. M., Liu, C., Lai, H. C. Abstract: Prdm12 is as a key transcription factor in nociceptor neurogenesis. Mutations of Prdm12 cause Congenital Insensitivity to Pain (CIP) due to failure of nociceptor development. However, precisely how deletion of Prdm12 during development or adulthood affects nociception is unknown. Here, we employ tissue- and temporal-specific knockout mouse models to test the function of Prdm12 during development and in adulthood. We find that constitutive loss of Prdm12 causes deficiencies in proliferation during sensory neurogenesis. We also demonstrate that conditional knockout from dorsal root ganglia (DRGs) during embryogenesis causes defects in nociception. In contrast, we find that in adult DRGs, Prdm12 is dispensable for pain sensation and injury-induced hypersensitivity. Using transcriptomic analysis, we found unique changes in adult Prdm12 knockout DRGs compared to embryonic knockout, and that PRDM12 is likely a transcriptional activator in the adult. Overall, we find that the function of PRDM12 changes over developmental time. Copy rights belong to original authors. Visit the link for more info

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PDVSA Corrupción Colombia DRGS USA Coronavirus 20200302

Play Episode Listen Later Mar 2, 2020 34:19

"La Historia es la Memoria de los Pueblos, por lo tanto es vital estar informado de los diferentes puntos de vista de un mismo acontecimiento, siendo esto indispensable para la formación de una visión más clara de los hechos allí narrados. De allí que un pueblo sin memoria histórica, es un pueblo sin futuro cierto. Si queremos comprender el presente, escudriñemos en el pasado." Felipe Torrealba

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#3 为何核酸检测盒测不准，硅谷最前沿的答案是这样丨疫情中的公司们

What's Next｜科技早知道

Play Episode Listen Later Feb 18, 2020 33:01

主播丨丁教嘉宾丨廖国春后期丨迪卡普里鑫 ShowNotes丨王雅今天的节目依然为大家带来「疫情中的公司们」系列。我们希望能通过这个系列，分享创业者面对黑天鹅时的勇气，灵活，或许还有对这个世界的善意，并通过这些分享和大家一同面对这种不确定性。疫情发生以来，试剂盒困局似乎始终没有完美的解决方案。除了使用试剂盒检测有很高专业门槛外，漏检率高也是无法忽视的一个问题。这期节目我们采访了 IDbyDNA (https://www.idbydna.com)的创始人兼 CEO 廖国春，他为我们介绍了另一种正在蓬勃发展中的微生物感染检测技术：宏基因组检测。本期节目你将听到，为什么核酸检测盒的确诊率不尽如人意，在技术上是否有替代方案；医疗诊断问题在大数据的背景下如何转变为计算问题；更有价值的是，宏基因组检测可能为流行病的防控打开新的局面。另外，硅谷早知道第四季已经上线，需要大家在喜马拉雅、苹果 Podcasts 等各大平台上重新订阅收听。那请大家接着关注声动活泼旗下其他节目。本期主播丁教，声动活泼联合创始人本期嘉宾廖国春， IDbyDNA 的创始人兼CEO The takeaway 宏基因组测序是把样品中所有生物的核酸拿过来不加区分的进行检测。测完之后实际上相当于把病人样品数据化了，这个时候就变成了一个计算问题，我们需要从样品上百万上千万或者更多的DNA序列片段里面找出来，哪些是从人来的，哪些是从微生物来的，哪些是有可能致病的。传统检测方法PCR具有很高的特异性，需要设计一个高特异性的探针，所以它适用于目标明确且非常了解检测对象的情况。核酸试剂盒（PCR）检测效率低有多方面的原因：在疫情早期我们对病毒的基因序列所知甚少，只能根据一些已公开发表的数据来设计探针，无法保证不漏检；当前生产压力大，人手不足，试剂盒的质检无法得到充分保证；上呼吸道和痰液并不是理想的病毒采样点，对病毒核酸的采样构成挑战。宏基因组检测在流行病防控上的优势在于：第一，它可以同时检测很多病菌而不需要专门对某一种病菌采取特别措施，在大规模检测患者的时候可以在早期就发现问题。第二，测序完成后可以不仅可以判断是不是，还可以提供致病病菌的基因信息，有利于制定治疗方案，还能跟数据库里病菌进行比对，追溯传染源。基因库的数据一方面来自于公共数据库，一方面来自于检测病例分析。宏基因组测序想要保证质量，前期准备需要保证样品的制备技术和有效的内标，因为核酸是测序的基础，而内标可以判断实验流程是否完整；后期分析需要完备的数据库来对照分析，同时也要注意DNA序列片段的来自于保守的位点还是特异的位点，后者信息量高，更有分析价值。本期讨论的主要问题传统核酸检测技术在新冠检测中的局限性新的技术如何解决这个问题宏基因组检测的优势宏基因组的商业模式和应用前景宏基因组检测在流行病防控上的意义访谈中提及名词 PCR：即聚合酶链式反应（Polymerase chain reaction），是一项利用DNA双链複製的原理，在生物体外複製特定DNA片段的核酸合成技术，具有较强的灵敏度，准确度和特异性。通过这一技术，可在短时间内大量扩增目的基因，而不必依赖大肠杆菌或酵母菌等生物体。此次新冠肺炎中用于确诊的试剂盒采用的就是逆转录PCR技术（RT-PCR），是聚合酶链式反应（PCR）的一种广泛应用的变形。在 RT-PCR 中，一条 RNA 链被逆转录成为互补 DNA，再以此为模板通过 PCR 进行 DNA 扩增。新型冠状病毒为单链RNA病毒，故采用该方法。宏基因组：宏基因组（Metagenomics）又称元基因组，或称环境基因组，是指同时被研究的整个微生物群落的DNA。宏基因组测序，是对特定环境样品中的微生物群体的基因组（尤其是那些种类众多的难于培养的微生物），进行序列测定。宏基因组检测技术应用在病毒感染研究中，具有可以整体性观察，数据化样品等优点。基因文库：将含有某种生物不同基因的许多DNA片段，导入受体菌的群体中储存，各个受体菌分别含有这种生物的不同的基因，称为基因文库。 DRG：即疾病诊断相关分组(Diagnosis Related Group)，是指以出院患者信息为依据，综合考虑患者的主要诊断和主要治疗方式，结合个体体征如年龄、并发症和伴随病，将疾病的复杂程度和费用相似的病例分到同一个(DRG)组中，从而让不同强度和复杂程度的医疗服务之间有了客观对比依据。在美国按照此制度，对DRGs中各类费用，均有一确定的费率，出院病人按其所属DRGs的费率向医院结帐，医院自负盈亏。这样，医院在提供医疗服务前就已知该组疾病资源消耗的最高限额，从而促使医院为获得利润主动降低经营成本，提高工作效率。也使医疗保险方对受保人每次住院费用都有准确的预算，便于控制费用。 23andMe：一家DNA鉴定公司，可以通过唾液检测DNA来得知你的血统混合情况，也可以选择提交你的DNA数据，用于遗传学研究。 LBT：全称Laboratory developed test，用来指代受CLIA监管的体外诊断。 FDA：即美国食品药品监督管理局（Food and Drug Administration），由美国国会即联邦政府授权，是专门从事食品与药品管理的最高执法机关，寨卡病毒（Zika Virus）：一种通过蚊虫进行传播的虫媒病毒，非洲，美洲，亚洲以及太平洋均有发生疫情的记录。它会引发类似温和的形式的登革热的症状，目前还无法通过药物或疫苗来预防。 BGM If I Only - So Vea Eye of the Newscaster - Out To The World 微博：@声动活泼微信公众号：@声动活泼网站：shengfm.cn 支持/打赏我们：http://shengfm.cn/donation Special Guest: 廖国春.

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Beyond CCs and MCCs: Say Hello to HCCs and APR-DRGs

Play Episode Listen Later Dec 3, 2019 28:34

There was a time when the coin of the realm in the world of coding was knowledge of complications or comorbidities (CCs) and major complications or comorbidities (MCCs).But 10 years later, the industry has changed rapidly, and to avoid going the way of the dinosaur, coders today need to embrace all patients’ refined diagnosis-related groups (APR-DRGs) and hierarchical condition categories (HCCs). A coder’s staying power lies beyond MS-DRGs, according to Kristi Pollard, who reports our lead story during this edition of Talk Ten Tuesdays.The live broadcast will also feature these other segments:The Coding Report: Laurie Johnson reports on the latest coding news that has been making headlines. Johnson is a nationally recognized coding authority and senior healthcare consultant at Revenue Cycle Solutions, LLC.Tuesday Focus: A recent meta-analysis of studies published by the Journal of the American Medical Association (JAMA) on the effects of nutritional support on clinical outcomes is a trending topic in healthcare’s social media universe. We will have two reports on this topic: Molly Hegarty, founder and CEO of Junum, reports on possible revenue loss when the presence of a malnutrition diagnosis is not documented appropriately, and Dr. McClain Blanton, a physician advisor with the Brundage Group, reports on the clinical aspects of the study.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on another thought-provoking topic that has captured her attention.

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Ökonomisierung im Gesundheitswesen - Teil 3

Heile Welt

Play Episode Listen Later Nov 14, 2019 55:22

Fehlende emotionale Betreuung, Verringerung der Pflegestellen, bis eine adäquate Versorgung kaum noch geleistet werden kann oder zu frühe “blutige” Entlassungen - das alles berichten Pflegekräfte und Ärzt*innen aus dem Krankenhausalltag heutzutage immer häufiger. Das Fallpauschalensystem, mit dem seit 2003 stationäre Behandlungen in deutschen Krankenhäusern abgerechnet werden, setzt wirtschaftliche Fehlanreize, die zu Personalabbau, Krankenhausschließungen und -privatisierungen sowie Über- bzw. Unterversorgung in verschiedenen Bereichen führt. Passend zu der immer größer werdenden Bewegung, die die Politik zu einem Kurswechsel auffordert, veröffentlichen wir unsere mehrteilige Podcastreihe. Darin rollen wir von ganz vorn auf, was es mit dem Fallpauschalensystem auf sich hat. Im ersten Podcast sprachen wir darüber, wie es zur Einführung des DRG-Systems kam. Danach haben wir uns das DRG-System genauer angeschaut und überlegt wie die Versorgungslandschaft in Deutschland aussieht und von was sie motiviert wird. In dieser dritten Podcastfolge besprechen wir gleich drei große Themen mit Herrn Dr. Achim Teusch: Personalabbau, Krankenhausschließungen und -privatisierungen. Wir wollen die Fakten wissen: Wie viele Stellen wurden seit Einführung der DRGs abgebaut? Wie wird in privaten Krankenhauskonzernen gewirtschaftet? Was für Auswirkungen haben niedrige Pflegeschlüssel bei hohen Patient*innenzahlen für alle Beteiligten? Außerdem kommt wieder Krankenschwester Silvia Habekost zu Wort und berichtet aus ihren Erfahrungen – zum Beispiel welche skurrilen Neuerungen eine Unternehmensberatungsfirma in ihrem Krankenhaus einführen wollte.

Avoiding Confusion over Critical Care Services

Play Episode Listen Later Jul 23, 2019 29:42

What may seem relatively straightforward to some coders has been a headache, presenting confusion and ambiguity, for others, when it comes to charging for critical care services. During this edition of Talk Ten Tuesdays, nationally recognized professional physician coder and auditor Terry Fletcher will focus not only on coding but also documentation compliance when reporting such services.The broadcast also features these other segments:The Revenue Cycle Report: Bonnie S. Cassidy, nationally renowned health information management (HIM) authority, reports on the importance of ICD-10 coding in the revenue cycle.Dateline Washington: Leslie Krigstein, vice president of congressional affairs for the College of Health Information Management Executives (CHIME), reports on the latest healthcare news coming out of Washington, D.C. News Desk: Timothy Powell, compliance expert, and ICD10monitor national correspondent anchors the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, discuss' the need for physicians to take care of the whole patient, without a preoccupation with DRGs and CC/MCCs.

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Auditors Will Target SNF Patient Condition, Not Services and Time Rendered

Monitor Mondays

Play Episode Listen Later Jul 22, 2019 31:13

There was a time when therapy documentation was the focus of Recovery Audit Contractor (RAC) audits. Under the Patient-Driven Payment Model (PDPM), however, reimbursement for Medicare Part A patients being treated in skilled nursing facilities (SNFs) will be driven by patient condition, rather than therapy minutes. And this creates a target-rich opportunity for auditors, because certain documentation can easily lead to higher reimbursement – and the likelihood of audits leading to claim denials. Reporting on this development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Other segments to appear during broadcast include:Court Report: The Reckitt Benckiser Group has agreed to pay $1.4 billion to resolve its potential criminal and civil liability related to a federal investigation of the marketing of the opioid addiction treatment drug Suboxone. Whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on how an addiction specialist filed a False Claims Act (FCA) motion leading to the largest settlement in U.S. history related to the opioid crisis.Monday Focus: Senior healthcare analyst Frank Cohen returns to Monitor Mondays with a unique perspective on artificial intelligence (AI). Cohen reports on how the more accurate term for the ubiquitous AI should be “augmented intelligence,” as it relates to non-clinical areas of healthcare.SDoH Report: Ellen Fink-Samnick, nationally recognized expert on the social determinants of health (SdoH), will have the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

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2020 Changes in Risk-Adjusted Reimbursement