Quest Diagnostics CMO Dr. Yuri Fesko joins Value Health Voices to decode the Clinical Laboratory Fee Schedule, the impact of PAMA and SALSA, and the future of precision medicine.

Episode Resources:

• Learn more about Quest Diagnostics
• Explore Quest's Consumer-Initiated Testing

How does a flawed government policy threaten the very foundation of modern medicine? Nearly every clinical decision, from a routine check-up to advanced cancer treatment, begins with data from a lab test. But the system that determines the value and payment for these critical services is under threat. In this episode, we explore the complex world of clinical laboratory services policy and payment with an unparalleled expert, Dr. Yuri Fesko, Chief Medical Officer of Quest Diagnostics. We uncover how a poorly designed law could cripple patient access to testing, especially in rural communities, and stifle the life-saving innovation happening in diagnostics.

This deep-dive conversation with Dr. Yuri Fesko breaks down the most pressing issues facing clinical laboratories today. We start with the Clinical Laboratory Fee Schedule (CLFS) and the disastrous impact of the Protecting Access to Medicare Act (PAMA). Dr. Fesko explains how PAMA’s flawed data collection, which surveyed only the largest, most efficient labs, has led to proposed reimbursement cuts of up to 15% annually, threatening the viability of smaller hospital and independent labs across the country. We then discuss the bipartisan RESULTS Act, a proposed solution to create a more accurate and equitable system. The discussion also tackles the immense administrative burden of prior authorization for lab testing, a major friction point for clinicians that delays diagnoses and care. We explore how technology, like Quest’s adoption of the Epic EMR system, aims to streamline this broken process. A significant portion of our conversation focuses on the challenges surrounding reimbursement for advanced diagnostics. Dr. Fesko provides a fascinating look into cutting-edge innovations like Minimal Residual Disease (MRD) testing in oncology, a revolutionary tool that can detect trace amounts of cancer DNA in the blood to help guide treatment decisions and avoid unnecessary, toxic chemotherapy. We also navigate the intricate landscape of laboratory-developed tests (LDT) regulation, weighing the pros and cons of proposed FDA oversight versus the existing accreditation framework. Finally, we touch on patient-centric improvements like price transparency, the power of lab data in public health initiatives, and the critical importance of interoperability in ensuring patients own and control their health records. This episode is an essential guide to understanding the policy, payment, and innovation that will define the future of diagnostic medicine.

About Our Guest:

Dr. Yuri Fesko is the Chief Medical Officer of Quest Diagnostics. With a background in internal medicine, hematology, and oncology, Dr. Fesko leads Quest's medical groups, payer access and reimbursement strategies, and research activities. He brings a unique perspective from the front lines of both clinical practice and the leadership of one of the world's largest laboratory services companies, offering deep insights into the regulatory and financial pressures impacting patient care and diagnostic innovation.

Timestamps:

(00:00) Why Lab Testing is the Foundation of Medicine

(05:43) The Clinical Laboratory Fee Schedule (CLFS) Explained

(09:22) PAMA: A Flawed Law Threatening Lab Services

(14:51) The RESULTS Act: A Bipartisan Fix for PAMA

(18:24) The Burden of Prior Authorization for Lab Testing

(26:07) Improving the Patient Experience with Price Transparency

(30:56) Innovation: Reimbursement for Minimal Residual Disease (MRD) Testing

(41:52) The Complex Regulation of Laboratory-Developed Tests (LDTs)

(46:15) Big Data: How Lab Results Shape Public Health

(55:49) Future Risks & Opportunities for Clinical Labs

Dr. Roger Seheult makes the clinical case for sunlight therapy. Discover the evidence for using infrared light to reduce hospital stays by 30% and cut costs.

Episode Resources:

• Learn from Dr. Seheult on his YouTube Channel
• Explore MedCram's Health Optimization Courses (CME available)
• Watch the Guy Foundation's Autumn Series on Light & Health
• Read the Glen Jeffery study in Nature Scientific Reports
• Explore the Swedish study on sun exposure and all-cause mortality

Could a simple, free resource dramatically reduce hospital stays and save the healthcare system billions? In this episode, we explore the powerful clinical case for sunlight therapy with one of the most respected medical educators online, Dr. Roger Seheult. He begins with the astonishing story of a 15-year-old boy given two days to live due to a flesh-eating fungal pneumonia, who made a miraculous recovery after one simple request: to go outside. This episode confronts the "magical thinking" skepticism head-on, presenting a data-driven argument that hospitals and policymakers can't afford to ignore.

We're joined by Dr. Roger Seheult - a quadruple board-certified physician in pulmonary, critical care, and sleep medicine, and the founder of Medcram - to dissect the science behind sunlight and infrared light. Dr. Seheult breaks down the groundbreaking randomized controlled trials, including recent studies in Nature, that demonstrate the profound link between infrared light and mitochondrial function. Learn how specific wavelengths of light can pass through the human body, making our cellular batteries (mitochondria) more efficient, boosting ATP production, and impacting the root cause of many chronic diseases. This robust photobiomodulation evidence suggests we've overlooked a fundamental element of human health.

The discussion pivots from cellular mechanics to systemic impact, focusing on the staggering potential for reducing hospital length of stay. Dr. Seheult cites multiple studies showing that patients exposed to more sunlight or targeted infrared light are discharged 3-4 days earlier - a reduction of over 30%. We analyze the immense financial implications, calculating potential savings of $5,000-$7,500 per admission for hospitals operating on bundled DRG payments. The episode tackles the practical and bureaucratic hurdles, from the inertia of hospital administration to the need for a new light therapy reimbursement policy. We explore actionable pathways for change, including updates to CPT codes, integration into CMMI value-based care models, and the power of the HCAHPS patient satisfaction survey to drive adoption. This conversation makes a compelling case that adopting light therapy isn't just good medicine; it's a financial and ethical imperative.

About Our Guest:

Dr. Roger Seheult is a quadruple board-certified physician (Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine) and an Associate Clinical Professor at the UC Riverside School of Medicine and on faculty at Loma Linda University. As a critical care doctor, he sees the sickest patients in the hospital, which pushed him to explore foundational health principles that could pull patients back from the brink. He is the co-founder of MedCram, a leading online medical education platform with millions of viewers, where he excels at explaining complex medical topics in a clear and accessible way.

Timestamps:

(00:00) A Miraculous Recovery: The Case of the Boy with a Flesh-Eating Fungus

(02:49) The Science and Finance of Light Therapy

(03:55) Deep Dive: A 15-Year-Old's Fight Against Fungal Pneumonia

(11:10) The Clinical Case for Light Therapy: Examining the Evidence

(15:22) How Infrared Light Boosts Mitochondrial Function

(19:51) Sunlight Exposure, All-Cause Mortality, and Global Health Patterns

(26:40) The Financial Impact: Reducing Hospital Length of Stay by 30%

(31:28) Practical Implementation: How to Prescribe Light Therapy in a Hospital

(34:40) Overcoming Barriers: The Financial and Logistical Case for Change

(44:14) Pathways to Reimbursement: New Policy and Payment Models

(47:35) Rediscovering Old Wisdom: The History of Heliotherapy

(56:21) Actionable Resources & How to Get Involved