Barry Rosen

Another important position statement from Association of Healthcare Value Analysis Professionals (AHVAP). As value analysis evolves, it is vitally important to ensure that those who are entrusted with the process understand what is expected of them in terms of professionalism. Please feel free to share this important document.

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🚨 40% of Hospitals Are Losing Money! (Source: Kaufman Hall) 🚨 https://lnkd.in/eEenrkWG While many will shrug and say it is not a big deal because it is the smaller hospitals that are unprofitable, but the reality is much more significant. These hospitals often serve as the largest employers in their communities. When a rural hospital closes, it doesn't just impact healthcare; it devastates local businesses, the broader economy, and the health of that community. Moreover, the presence of a nearby hospital is a critical factor for businesses scouting new locations. Companies know they can't attract top talent if the nearest hospital is in the next county or town. Unfortunately, these hospitals are frequently overlooked by vendors, making it harder for them to thrive. At VantageHealth.ai (and our sister company CompliantHealth.com), we are committed to addressing these challenges. Our value-added solutions aim to move hospitals from red to black through improved revenue streams, reduced costs, increased compliance, and enhanced patient engagement. Let's work together to support these vital institutions and ensure they continue to serve their communities effectively. #Healthcare #RuralHealth #HospitalManagement #CommunityImpact #HealthcareInnovation

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Independent physicians are the best value in healthcare

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***Partnership Announcement*** Pediatric Resource Group (PRG) is excited to partner with Libman Education, one of the most trusted resources for training of hospital coding, CDI, and HIM professionals, to offer our Pediatric CDI Educational Series. The Pediatric CDI Educational Series has over 35 on-demand videos created by CDI expert pediatricians and geared towards coders, CDI professionals and clinical staff with the following objectives: -Understand inpatient pediatric conditions to identify all query opportunities -Describe documentation’s impact on severity adjustment, quality metrics, expected length of stay (LOS), & hospital payment -Review CDI processes, policies, metrics, and the CDI physician champion role This tool is a great supplement to our "Pediatric by PRG" module in the Pinson & Tang CDI Pocket Guide. #CDI #pediatrics #clinicaldocumentation https://lnkd.in/gewSdrAr

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🧠 As a neurosurgeon deeply committed to patient care, I'm compelled to shed light on the challenges we face within hospital settings. The trend of consolidation and the rise of non-physician administrators, bring both opportunities and obstacles. While these roles aim to streamline operations, too often, decisions made by the administration prioritize financial gains over patient well-being and medical expertise. It's crucial to maintain a balance that upholds the integrity of healthcare, ensuring decisions align with the best interests of both doctors and patients. Let's advocate for a system where healthcare decisions are driven by compassion, expertise, and patient outcomes. #HealthcareAdvocacy #PatientFirst #MedicalIntegrity 🏥💡

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Share your latest healthcare experience research and projects as a "Pocket Presentation" at The Patient Experience Symposium, Boston, MA Sept 16 -18, 2024. This unique interactive presentation format enables conversations with colleagues to generate and share ideas as we strive for better experiences for all. Submit "Pocket Presentation" abstracts: https://lnkd.in/eT_UuzWR Explore Symposium agenda: https://lnkd.in/eNKSpJ8G Additionally, The Patient Experience Symposium agenda also features an impressive list of dynamic experts and patient representatives. Hosted roundtable interactive discussions enable connections. Breakout session topics include: equity and inclusion, workforce engagement, measurement, value-based care, and there is a special track for primary care and ambulatory settings. Hosted by The Journal of Patient Experience, "Pocket Presentations" highlight the voice of the patient, consumer, member, family, caregiver, clinician, staff, payor, provider, and leader. "Pocket Presentation" Format: 💡Presenters are positioned in a “pocket” of the room to share their concise presentation ( 5 minutes). 💡Participants visit each “pocket presentation”, and engage in the discussion following the presentation (10 minutes). 💡Participants rotate to a new pocket every 15 minutes during the session (enabling presenters to share with 3 small audiences). SUBMISSION DEADLINE: June 24, 2024 11:59 PM EDT (decision notifications by June 30, 2024).

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#FAST24 kicked off with a keynote Scott Weingart focused on inspiring providers to always ensure we maximize the care we provide. Here are a few of his messages: -we must never allow a patient to die because of a hospital geography issue. Never say “we don’t provide that here.” -if we are going to provide ICU level care, you must bring it to the patient; don’t let yourself believe you can wait for someone else to provide care later. -Amateurs talk strategy, experts talk logistics. Focus on the underlying causes of the illness/injury not just the symptoms. -If you know a procedure kit doesn’t have all the tools you need to do the job, and you don’t talk how to work through the steps, you’re not ready to provide the care. -Never accept believing a skill/procedure is someone else’s job to know. Knowing all the equipment and skills empowers you to help teach others when they struggle and ensures patient care does not suffer. -Love and embrace your team and let them do what they are trained to do. -Don’t resuscitate by story. -You don’t need permission to act. If you know a patient is in a critical situation, perform the skill you know is needed. Always error on the side of over-treating. -Experts still make mistakes and have their care fail, the difference is Experts prepare themselves with plans B, C, D, E, F, and G. They have their back-up plans. -Don’t just plan to win, plan to not lose. This means you can’t just plan to succeed; you must also plan for complications and have plans for when they occur. -Slow is smooth and smooth is fast. Fast might seem faster, but the increase in the risk for bad things to happen. Rushing increases your risk and you being to lose control. You increase speed by mentally training where every item is so you can set up and without thinking about it. -Be relentless in your pursuit of excellence. Look at every case, good and bad, for opportunities to improve. Seek out new skills, new knowledge, and apply them on your next patients. -There needs to be laughter in our jobs and work environment. You must have fun. Fun and laughter instill joy in the workplace. Make our worlds more enjoyable for others and this will in turn make it more enjoyable for yourself. -

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There is plenty of evidence pointing to this fact: provider prices are driving the majority of the increases in premiums and costs, especially in Massachusetts where health care costs are among the highest in the nation. Moreover, the existing health system is not designed to advance health or wellness, but rather sick care. At Wellpoint Massachusetts (formerly UniCare State Indemnity Plan (becoming Wellpoint)) we will continue to partner with physicians and providers to advance models of payments and health services that incentivize our members to engage in their whole health, live healthier lives, and access health services affordably- as best as we can. However, it's crucial that employers and taxpayers actively demand a more transparent and competitive health system that's fair to premium payers in the private market.  Ultimately, it's premium payers who subsidize government health programs and pay for exorbitant provider prices. Get engaged and demand better. #healthnotsickcare #health #affordablehealth #competition #employers #benefits #incentiveswork #lessismore #lowercosts #demandbetter #engage https://lnkd.in/eUGQapJV?

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The inferiority of the American Illness Profit System becomes clearer day-by-day, here is just the latest in an endless sequence of reports showing a factual basis proving its inferiority. Yet nothing happens in Congress to correct any of this because the Congress members are so corrupt, and in the pocket of the corporations that control health care in this country. The only thing that is going to change this is how you vote in what may be the last real election in which you will ever be able to vote.

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We are receiving a lot of great feedback on the new "Pediatrics by PRG" module in the Pinson & Tang CDI Pocket Guide, which is the preeminent resource in the CDI space. If you haven't checked it out yet, take a look at the detailed review of over 40 topics that provide guidance to CDI specialists, coders, & clinicians on pediatric and neonatal conditions. This partnership is a key element of how Pediatric Resource Group (PRG) can help hospitals understand the CDI opportunity in the peds/neonatal space and tackle it confidently. If there are other topics you'd like to see, let us know, we can develop and publish those quickly. #CDI #pediatrics #Clinicaldocumentation

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Mark your calendars! The 2024 Association of Healthcare Value Analysis Professionals (AHVAP) Value Analysis Week is just around the corner. Join us from July 15-19 as we gather healthcare professionals from around the world to explore the latest advancements and strategies in value analysis. Don't miss out! To learn more: https://lnkd.in/eJZSWUVa. #AHVAP2024ValueAnalysisWeek #HealthcareValueAnalysis #HealthcareEvent

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Superb work in NEJM Catalyst from colleagues to further enhance patient-centric care through an ED in Home model with net savings of $1250/encounter. https://lnkd.in/edUJFAAp As an emergency physician doing similar work at Massachusetts General Hospital, I can attest to their experience and that of our patients who are absolutely delighted with such patient-centric care. Excellent clinical pathway especially for our seniors for whom it is often difficult to get to the ED and don't do as well once there. Common reasons for referral often include symptoms of lower clinical risk (safe for home eval) but still requiring same-day diagnostics +/- therapeutics, such as: mild shortness of breath, urinary symptoms, potential skin infection, generalized weakness, leg edema. Great description of the team/model in the article...in short, it consists of remote triage nurses and EDiH coordinators, community paramedics in the patient home obtaining diagnostics and administering therapeutics, and an emergency physician directing the care through a synchronous video-visit. The key for sustainability of these programs is of course meeting patient volume requirements to offset costs (15 encounters/day for this study). Great work Evan Berg, M.D. Gregory Snyder Meghan McGrath, MD and the entire team for further advancing our understanding of EDiH and the home-based care ecosystem. #futureofhealthcare #emergencycare #healthcaretech #mih #homebasedcare #homecenteredcare #telemedicine #virtualcare #health #pointofcare #pointofneed #careredesign

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We’re still feeling the impact of the pandemic on patient safety, as recent federal reports highlight a significant downturn in care quality. However, there’s a silver lining: Efforts are underway to not only restore but enhance pre-pandemic safety levels by 2030. This commitment involves expanded safety measures and innovative quality improvement programs, demonstrating our resilience and dedication to achieving zero harm in healthcare. #HealthcareSafety #PatientCare #PatientSafety #ZeroHarm

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We need to keep learning and improving in #healthcare. We need to share (and publish) creative care models that work well, and work #together across teams, historic silos, and locations to help our patients, communities, and each other. 📌 This is a fantastic overview of a virtual care connection model with specialists and local teams working together to care for patients. ➡️ “The clinical consultation took place in the local clinic facility, with the support of the on-site team.” ➡️ “Laboratory testing and imaging studies were coordinated through community settings, and tertiary site–based surgical, health psychology, and nutritional teams also followed up with this patient via virtual care clinic visits.” ➡️ “By providing these clinical services closer to the patient’s home through a clinical facility, numerous objectives were achieved: (1) patients received thorough clinical assessment and care plans; (2) patients were less likely to use the hospital or ED; (3) patients were more likely to remain in the workforce; and (4) community health care was off-loaded, reducing burnout and improving workforce retention.” ➡️ “This approach combines virtual care with a cooperative care delivery model, where the aim is not to shift patient care from one provider to another, but to expand access for patients and to create both new and clinically appropriate care for each care participant, with the aim that improved access will lead to enhanced care outcomes and more efficient care utilization.” #StrongerTogether #CrossTeamCollaboration #PatientCenteredCare

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A total of 342 OP cardiology clinics were acquired by PE-backed firms over the past decade. 95% of the acquisitions occurred between 2021 and 2023, coincidentally corresponding with the CMS approval of PCI in the ASC setting. In this study concerns arose as "nearly one in four PE-acquired cardiology clinic sites were acquired more than once over the 10-year study period." #Cardiology #PrivateEquity #Acquisitions

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Want to elevate your marketing with a Leapfrog produced webinar about your product, service or technology? Join the Leapfrog Partners Advisory Committee or PAC and we will! Learn why more than 30 companies have joined! palper@leapfrog-group.org

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Thank you Robert Oubre, MD (The Doctor of Documentation) for posting this information. The CDI professional can contribute to oversights in physician documentation through collaboration with physicians, physician advisors, and Case Management/Utilization Review. Collaboration is the key to achieving true "documentation integrity" from a quality of care and reimbursement perspective. The limiting factor is the current Key Performance Indicators CDI is expected to achieve that are nothing more than task-based activities that do not correlate with documentation integrity. CDI plays a vital role in physician documentation for all the right reasons including patient care, quality measures, and support of the revenue cycle in that order. Quality documentation supports optimally sustainable net patient revenue less prone to clinical validation and medical necessity denials and level of care downgrades. I have always believed and supported measures of denials as defects in physician documentation that CDI can address provided it is an expectation of the CDI profession. I call on ACDIS and AHIMA to take the lead in advocating for and promoting transformation in current CDI processes as Dr. Oubre's post suggests. Time to reject the notion that CDI stands for CMI increase through CC/MCC Capture as the main focus of CDI activity. #cdiprofession, #chasingthediagnosis, #chasingmoneythatnevermaterializes, #qualitydocumentation https://lnkd.in/eJYuS-gf

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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