PEB - Pacific Edge Ltd

[Minerbarejet]

Just what is it you know that the AUA do not Miner?

Nothing to do with what I know and what they know.
Its the length of time taken to make decisions.
A good case in point is CMS and also Kaiser taking 5 years to get a handle on it.
It has been a major programme getting sufficient clinical evidence out there.
CMS and Kaiser seem to think it sufficient at this point, AUA havent quite got there yet.

[psychic]

Nothing to do with what I know and what they know.
Its the length of time taken to make decisions.
A good case in point is CMS and also Kaiser taking 5 years to get a handle on it.
It has been a major programme getting sufficient clinical evidence out there.
CMS and Kaiser seem to think it sufficient at this point, AUA havent quite got there yet.

The thing is, we don't know anything of the Kaiser deal do we? I know KP is keen to reduce the frequency and reliance on cystoscopies, cost savings and all that, but there is significant risk in adopting Cxbladder outside what is accepted as the gold standard of care. How often and when will they use Cxbladder? We won't know until PE evidence uptake with sales, its all fluff otherwise.

Likewise, the CMS LCD is not a nod to use the test. But it will cover the cost when medically necessary, which the AUA says it is not.

Blind faith?

[Minerbarejet]

https://www.pacificedgedx.com/news-a...-of-cxbladder/


Kaiser Permanente has approved the commercial use of Cxbladder by their urologists for patients being evaluated for bladder cancer.

Does this not mean that KP are happy to have their urologists utilize cxbladder when appropriate and they are prepared
to stump up the cash regardless of what AUA or any other mob of bureaucratic dingbats decide?

If it doesnt mean that then what does it mean?

[psychic]

https://www.pacificedgedx.com/news-a...-of-cxbladder/


Kaiser Permanente has approved the commercial use of Cxbladder by their urologists for patients being evaluated for bladder cancer.

Does this not mean that KP are happy to have their urologists utilize cxbladder when appropriate and they are prepared
to stump up the cash regardless of what AUA or any other mob of bureaucratic dingbats decide?

If it doesnt mean that then what does it mean?

What does it mean indeed! We will have to wait and see but at current m/cap the market certainly seems to agree with you that KP and Medicare are or will be using Cxbladder flat out.

I'm not convinced.

I think it means what it says. That KP (and CMS for that matter) have approved the test for payment when used.
I don't think as you do that KP or CMS have included it in their clinical pathway. I am pretty sure that if this were true PE would have been absolutely clear about this and shouted it from the rooftop!

In NZ, PE went as far as to say that the tests were being included in the clinical pathway by majority DHB's (although did not say when or how), this was back in 2018. You'd expect hockey stick growth from that quarter wouldn't you? It was up 7% in the 12 months to March 2020.

We will see but the bureaucratic dingbats as you refer to those sitting on the AUA may be better informed. Some things are not as they seem and PE has a long history of puffery imo.

[gravityegg]

Just want point out the simple question: if u had cancer, will u consider the easy but not accurate (even with 95% accuracy)method, or the harder but 99.99%accurate way. If cxbladder can’t increase its accuracy, then....

[Minerbarejet]

What does it mean indeed! We will have to wait and see but at current m/cap the market certainly seems to agree with you that KP and Medicare are or will be using Cxbladder flat out.

I'm not convinced.

I think it means what it says. That KP (and CMS for that matter) have approved the test for payment when used.
I don't think as you do that KP or CMS have included it in their clinical pathway. I am pretty sure that if this were true PE would have been absolutely clear about this and shouted it from the rooftop!

In NZ, PE went as far as to say that the tests were being included in the clinical pathway by majority DHB's (although did not say when or how), this was back in 2018. You'd expect hockey stick growth from that quarter wouldn't you? It was up 7% in the 12 months to March 2020.

We will see but the bureaucratic dingbats as you refer to those sitting on the AUA may be better informed. Some things are not as they seem and PE has a long history of puffery imo.

Lets get one thing straight and work from there.
CMS do not have a clinical pathway.
CMS are insurance providers and are OK with paying for any Medicare/Medicaid patient whose urologist decides that cxBladder is ok to go with.
PEB may submit a claim to CMS based on the status of the patient.

KP have a clinical pathway as they have the hospitals/ urologists and physicians and also provide Medicare policies for those with disabilities and also those over 65 years of age.

OK, so you have a Kaiser patient who is over 65 and will be automatically on their Medicare list, has had an operation and requires monitoring for recurrence.

Who Pays??

Medicare I reckon.

[psychic]

Lets get one thing straight and work from there.
CMS do not have a clinical pathway.
CMS are insurance providers and are OK with paying for any Medicare/Medicaid patient whose urologist decides that cxBladder is ok to go with.
PEB may submit a claim to CMS based on the status of the patient.

KP have a clinical pathway as they have the hospitals/ urologists and physicians and also provide Medicare policies for those with disabilities and also those over 65 years of age.

OK, so you have a Kaiser patient who is over 65 and will be automatically on their Medicare list, has had an operation and requires monitoring for recurrence.

Who Pays??

Medicare I reckon.

Agree. Sorry, I wrote poorly, CMS does not write the Clinical pathway. As I said in an earlier post, this is decided upon by the AUA.
CMS follow the advice of the Urologist and so imo we can forget about significant sales from this quarter until the AUA strongly recommend the use of CxBladder.

And yes, KP are free to build the use of the test into its clinical pathway, any lawsuit stops with them. I would have thought that Urologists in the US were bound to follow the guidelines of best medical pratice regardless of where they worked but you may be right. And I agree that if KP are at odds to the AUA and can demonstrate that the use of Cxbladder is "best practice" (I don't thnk they can..) then sure, CMS will likely cover the cost of the test.

But again. We have nothing from KP to confirm that they will be using the tests outside the recommendation of the AUA.

[drcjp]

As someone who knows these things because I deal with it every day, can i just inform about clinical guidelines.
they are guidelines. Docs are not BOUND to follow them to the letter, they should conform to them though.

Private insurers in the USA can use any test they like, provided it has FDA approval and LCD coverage.
Using the test does not need clinical guideline approval, so long as the doc does 95-99% of what the guidelines recommend.
There are many, many tests that docs use outside of guideline recommendations to answer other questions as not all patients are created equal.

If Kaiser and others have accepted the use of CxBladder as useful (which they have), then its not a guideline issue, its a marketing issue.

We shall see how that pans out.

[sunnysleeper11]

@drcjp - Thanks for the insight - more please!
Great discussion on this forum but it all seems like a lot of well intentioned guess work.
A question on a Docs mindset please drcjp
Can you see the use of CX being quickly accepted over invasive cystoscopy by US Docs?
Can their mindset be changed fairly rapidly or do you see CX implemention to be gradual over the next 10 years or so?
Cheers

[Poverty]

We've already come so far Hang in tight?

The next announcement is going to make or break peoples confidence