My practice is IVI guidance. Good question about high pressure NC. There is just no good reason to do high pressure NC balloon on 100% of lesions. That is a carry over from non IVI days. Predominant lipid plaque— appropriate sized NC and nominal. Calcified— high pressure.

Here an interesting case. How would you approach this wide base LM bifurcation aneurysm? Pt with severe calcific CAD and angina

Single payer will never need 218 votes in the House. State-backed academic systems are constructing it through vertical integration. They acquire hospitals, employ physicians, control referrals, operate pharmacies and, in several markets, own insurance businesses. Tax exemption and public capital subsidize the expansion. Regulatory privilege constrains whoever might compete with it. Multiple insurance companies can survive inside this arrangement. Their continued existence creates administrative pluralism, which looks remarkably similar to consumer choice from a sufficient distance. Then every insurance card leads to the same medical empire. Payer count becomes irrelevant after one institution controls the supply.

Today's the 49th anniversary of Andreas Gruentzig doing the 1st coronary angioplasty. Watch this extended version of the story, told by those who were there: Adolph Bachman (1st patient) Bernhard Meier (his doctor) & Maria Schlumpf (Gruentzig's assistant). Next year's the 50th: surprises coming! #AngioHistory

Mandating computer physician orders entry is one of the most destructive policies in healthcare. It’s the biggest factor that tethered the physician to the computer. If a patient needs a CT scan, the doctor can’t just put it in the note or tell a nurse. The doctor has to take the time to click through the cumbersome order entry. It creates a culture where doctors are admonished and pestered about orders, even when the intent is perfectly clear and documented in the record. Patient decided they want their CT scan at another location? “Doctor, you need to re order the scan.” Patient wants to change their surgery date? “Doctor, you need to put in a new order.” “You ordered this lab wrong. You need to fix it.” “There is a new order set for this medication. You need to use that.” “Speech therapy says the patient can eat. You need to put the order in.” This adds up to a huge burden on doctors. Every little thing requires many clicks in the computer. It all adds up. We researched this at ucsf and found the neurosurgeons were spending 2 hours a day just on order entry. Not notes, imaging review, or in the OR. Just orders. And that doesn’t count the time it takes to find an open (and working) computer, log in, and find the chart. Other studies have estimated between 15-30 full workdays are consumed annually just in order entry. That’s an entire month of doctor time gone just to click through the computer. I’m not saying we go back to chicken scratch on a pad of paper. But if the doctor note says “patient needs CT of the head” why do we require another 40 clicks? If a doctor is running to the OR, why cant a verbal order suffice? If a surgery was already booked correctly once, why does the doctor need to re enter it completely? Imagine how much more time doctors would have to treat patients if we simply reversed that rule.

Presented today and published in NEJM, our PADN-HF-PH trial in which 264 pts with left-heart failure (HFrEF or HFpEF) and pulmonary hypertension (mPAP >20 mmHg and PCWP >15 mmHg) were randomized at 25 centers to pulmonary artery denervation (PADN) + GDMT vs GDMT alone.

Thank God. Simple and straightforward! Fifth Universal Definition of Myocardial Infarction (2026): On Behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)

onlinelibrary.wiley.com/doi/… Interesting. Congrats to the authors. Would love to see some bench work to mechanistically describe this 🧐

ahajournals.org/doi/10.1161/… Not surprising results but now we have data. Congrats to the authors!

CMS requires a day-of-surgery pre-surgical assessment (the "update note"). For ASCs (42 CFR 416.52(a)(2)): Upon admission, document an exam for any changes in condition since the last H&P (within 30 days), including allergies. If no changes, a simple note works: "H&P reviewed, patient examined, no change." It must be prior to surgery. The immediate pre-anesthesia risk eval by a physician is separate. Hospitals have parallel rules under the Conditions of Participation. Your hospital's specific template/fields likely exceed the federal minimum and come from internal policy or accreditation.

"If you're a physician reading this, take a Valium before the next paragraph. The budget neutrality constraint that governs the PFS — where every dollar increase in one service must be offset by a dollar decrease somewhere else — applies only to the physician fee schedule. It does not apply to Medicare spending as a whole. Congress can and does appropriate additional money for hospitals, for MA plans, for drug coverage, for post-acute care — all outside the zero-sum straitjacket that governs physician payment."

LOL

“Indiana really sold me on developing me.” Now the owner of the richest rookie contract in NFL history, Fernando Mendoza says he took a “huge pay cut” to play for Indiana vs. richer NIL offers from other schools. #iufb Story from @Jared_Kelly7: 247sports.com/college/indian…

Do you agree? "Gen Z isn’t here to save medicine by being tougher. They may save it by forcing leadership to confront what it has long avoided. American health care doesn’t need harder clinicians nearly as much as it needs to stop grinding them down."

Do you really think doctors were doing a thorough ROS because of a CMS mandate? Or do good doctors do a thorough history and physical because it's good medicine?

Just 250 years ago, America didn’t exist. Let that sink in. Within three generations of people, this country has accomplished the impossible > first country to send human to the moon > invented the internet and core infrastructure behind it (ARPANET, TCP/IP) > invented airplanes > invented the telephone > invented electricity distribution > invented reusable rockets > invented the polio vaccine and mRNA technology > invented the GPS > built the deepest capital markets in history > won 34% of all nobel prize awards, more than the next two countries combined > annually spend a third of the world’s entire R&D budget > led the Genome project that sequenced human DNA > hold just 4% of the population but contribute 25% to the world’s GDP > hold the oldest written national constitution that still remains in force The birth of America was not just a win for Americans. It was a win for the entire world. God bless America. Greatest country on the planet.