EP411: Getting Paid (or Paying) for New Innovations Used in Hospitals as Part of a Procedure or a DRG—Also Bloodstream Infections and Dialysis, With Secretary David Shulkin, MD, and Erin Mistry

If a hospital patient develops a central line infection that turns into sepsis, their odds of readmission within 30 days are nearly 99% — not a small cohort, and not a small problem. In this episode, Stacey Richter talks with Secretary David Shulkin, MD, former US Secretary of Veterans Affairs, and Erin Mistry, chief commercial officer at CorMedix, about a new innovation aimed at keeping dialysis patients from dying of bloodstream infections, and about a much bigger structural question: why hospitals often have a financial disincentive to adopt expensive new innovations at all, even when those innovations demonstrably improve outcomes. WHAT YOU'LL LEARN ✅ Why bloodstream infections in dialysis patients with central venous catheters (CVCs) are a major, underappreciated driver of hospital readmissions, and why preventing them is such a clear-cut economic case for preventive care ✅ How DRG (Diagnostic Related Group) payments work: Medicare pays hospitals a flat sum for roughly 13,000 diagnoses and 5,000 procedures, regardless of what's actually used to deliver the care — which means a hospital that adopts a more expensive but better innovation simply eats the cost difference ✅ Why that flat-payment structure can push purchasing decisions toward the cheapest available option, even when it's not what clinicians or patients actually need ✅ What an NTAP (new technology add-on payment) is, and how CMS created it specifically to give hospitals a financial reason to adopt certain new, qualifying technologies instead of avoiding them ✅ What a QIDP (Qualified Infectious Disease Product) designation is, and why infectious disease innovations currently get prioritized status in the NTAP process WHY THIS MATTERS When a hospital's payment for a procedure or diagnosis doesn't move regardless of what's used to deliver the care, the hospital's purchasing incentives and a patient's actual best interest can quietly diverge — and it's the hospital, not the innovator or the payer, left to eat the cost of doing better by the patient. Programs like NTAP exist because CMS recognized that gap and tried to close it with real money. Understanding how that mechanism works matters for anyone trying to get a genuinely better technology adopted inside a payment system built around flat, DRG-based reimbursement. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X