Jody McGinnis

Regardless of the weight the CMS places on a healthcare facility — be it an ambulatory surgical center, long-term care facility, hospital, etc. — complying with the agency’s preparedness standards is a must. Learn how Veoci can help. https://lnkd.in/ecd3PC-r

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Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.

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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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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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🌟We are thrilled to announce our two AdventHealth clinically integrated networks in Florida are merging into a singular, state-wide network.🌟 This strategic move is not just about growth; it's about enhancing the quality of care we provide to every community we serve. As we embark on this journey, I am reminded of a powerful quote: "When the winds of change blow, some people build walls, others build windmills." This resonates deeply with our commitment to evolution and innovation. By embracing change and harnessing the power of unity, we are setting a new standard for healthcare excellence. This evolution signifies our dedication to innovation, ensuring that every patient receives the best possible care. It's a testament to our team's hard work and the trust placed in us by the communities we serve. Here's to a future where healthcare knows no boundaries, and innovation leads the way to better health for all. 💡🏥 #Innovation #populationhealthmanagement #valuebasedcare

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#healthcon 2024 @aapc. Last breakout session on Observation Care and Condition did not disappoint. Key takeaway: Hospitals changing the patient’s status during observation to inpatient should be robust in their documentation for the change to inpatient status. This is important for compliance with utilizition review when CMS and state Medicaid agencies are ramping up their #RAC #audits

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Here's a shocker -- the AHA and the FAH are pushing back against Medicare's mandatory hospital-based bundled payment program. The hospital associations are asking for more time to get ready for a program that will start in 19 months.... It's laughable, of course, but what else should we expect from the agents of the status quo? For those who hadn't kept up, Medicare announced the Transforming Episode Accountability Model several months ago and it's finally going through the end of the rulemaking process. So what's TEAM? A slimmed down version of the Medicare Bundled Payment Model (BPCI and its successor BPCIA) that has been in place for over a decade. There's nothing new about TEAM except that it only covers a handful of inpatient stays and the accountability is reduced to 30 days post discharge instead of 90. Four years ago a dozen or so highly respected leaders in the industry recommended that CMS institute a "DRG+30" across the board. Not just for five DRGs, but all DRGs. And here we are, four years later, and TEAM is set to start in 2026....yes, 2026, not 2025. The first cohort of the original program launched in April 2013, more than 11 years ago. By the time TEAM starts it will have been close to 13 years. Isn't that enough time to get ready Chip Kahn???? All of the published analyses on the Medicare Bundled Payment program showed the same source of savings -- post-acute care. And the savings never negatively impacted outcomes. So it's logical that Medicare makes this mandatory. What's not logical is that it's taken so much time to get to this decision. So let's just get on with it because the taxpayers deserve it and so do Medicare beneficiaries. #TEAM, #BundledPayments, #CMMI

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HHS has released its final rule on disincentives for information blocking. This includes considerations for each of hospital/CAH providers under the Promoting Interoperability Program, individual providers through MIPS, and for ACOs under the Medicare Shared Savings program. From the following press release, “This final rule is designed to ensure we always have access to our own health information and that our care teams have the benefit of this information to guide their decisions." #hhs #interoperability #informationblocking #ONC https://lnkd.in/gNQm69CC

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Late today (4/26) Friday afternoon (of course) HHS issued final rule regarding Section 1557 of the Affordable Care Act (ACA). Now on display for public inspection and will be published 5/6/2024. One of my favorite compliance and training topics. (Remember Lynn McGivern, JD, LLM, CHC and Laura Riddell, CHC?). Still retired, but now updating a next week's presentation for Kara Welke's Geriatric Summit. A lot of small PT, OT & SLP practices will get informed on new and updated obligations under Section 1557. #Section1557 #CivilRights #ACA #nondiscrimination https://lnkd.in/gYQH8Pf4

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To lead effectively amid the 2025 Medicare Advantage and Part D Final Rule changes, leverage data-driven compliance measures, employing predictive analytics to anticipate and prevent regulatory breaches. Champion ethical marketing practices, employing sentiment analysis to ensure transparency and authenticity in communications. Forge partnerships with community organizations to enhance access to behavioral health services, utilizing geospatial analysis and machine learning to optimize resource allocation. By pioneering these strategies, healthcare analytics leaders can navigate regulatory complexities while ensuring equitable care delivery. #DataDrivenCompliance #EthicalMarketingr #EquitableCare #PredictiveAnalytics. https://lnkd.in/eq3vf6qs

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🚨 Important Update for Healthcare Providers 🚨 Between 2017 and 2021, Medicare Part A improperly paid $23.9 billion for inpatient hospital stays, with $7.8 billion attributed to non-qualifying short stays. The OIG's recent report, published on June 13, 2024, has highlighted critical weaknesses in Medicare billing practices leading to these overpayments. 🔍 Key Findings: 1. Insufficient Information for Two-Midnight Rule Exceptions: CMS needs more data to identify when exceptions apply accurately. 2. Ineffective Prepayment Edits: The current prepayment edits process does not prevent improper payments. 3. Inadequate Claims Review and Overpayment Recovery: CMS policies must be revised to review claims and recover overpayments thoroughly. 💡 The Two-Midnight Rule: This rule helps determine whether hospital stays are classified as inpatient or outpatient. If a stay is expected to last two midnights, Medicare Part A covers it. Shorter stays should be covered by Medicare Part B unless specific criteria are met. 🛠️ Recommendations for Improvement: 1. Enhance claims with data on unforeseen circumstances. 2. Develop procedure codes for inpatient-only procedures. 3. Implement prepayment edits for short stays. 4. Update policies for more focused post-payment reviews. #HealthcareConsulting #MedicareCompliance #BillingPractices #HealthcareFinance

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This is fascinating. Clearly clinicians won’t be able to review the tsunami of data that could flow in. This is why nurses and doctors must have AI and data analytics literacy as new clinical decision support tools are developed to analyze this data.

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IT'S ABOUT TIME! How many healthcare professionals recognize the almost unlimited opportunities in the leveraging of SDOH data and information, but don't know where to start? Your solution is here and available! In her new book "The Shift: SDOH Program Design & Operations," Dr. Shannan Swafford provides a comprehensive and insightful guide that is essential for any healthcare organization looking to effectively address the social determinants of health (SDOH). As someone who believes in "a little less talk and a lot more action", Dr. Swafford cuts to the chase in both style and content. This book stands out for its clear and actionable approach to help organizations navigate the intricacies of SDOH program design. Her deep expertise and proven strategies provide readers with the guidance needed to operationalize SDOH initiatives. One of the key strengths of "The Shift" is its focus on the critical importance of SDOH in healthcare and its impact on patient health. Dr. Swafford's expertise and insights into health policies and reimbursement structures are particularly valuable. She outlines how to support SDOH initiatives within existing healthcare frameworks while focusing on improving health equity and patient outcomes. She also emphasizes the need for data analytics while reminding us that behind every piece of data is a person. Overall, "The Shift: SDOH Program Design & Operations" is a must-read for anyone involved in healthcare who is dedicated to making a meaningful difference in addressing the social factors that influence health outcomes. The Shift: SDOH Program Design & Operations https://a.co/d/6oRzMoB #Healthcare #SDOH #HealthEquity #HealthcareInnovation #DrShannanSwafford #NewRelease #HealthcareLeadership #AHIMA #HILeadersareneededhere

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Exciting news! Susan Maupin and I will be presenting an ACHCU webinar on Hospital Outpatient Strategies on May 23rd. Stay updated on the latest hospital outpatient strategies and related regulatory updates by registering now! Don't miss out on this opportunity to gain valuable insights. #ACHCUwebinar #hospitaloutpatientstrategy #healthcareupdate

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🚨 Top 10 #PatientSafety Concerns for 2024. 📌 Have significant changes been made over the last decade? An important question is to reflect on what has been done, what we are doing, and what remains to be done.

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Is CMS trying to kick their best Medicare Advantage plans down a peg? The end of a rule called Hold Harmless would only affect plans scoring five stars in a measure. What does Hold Harmless do? If you have a Five Star rate for a measure two years in a row, but the second year is a little lower, it prevents the possibility of being penalized while maintaining high performance. The rule recognizes that sometimes there can be fluctuation from year to year even in the most successful programs. But the rate went down, so shouldn’t they be penalized? In a large plan, a change from 99% of members getting a routine screening to 98% can meet the significance standard to trigger that penalty. It’s not a direct hit to their ratings but instead makes it harder to get improvement measure credit by turning a neutral (harmless) result into a significant decline. Nearly every member is still getting that screening and it’s really difficult to know the reason behind that small drop. It also means that it gets harder to receive Improvement Measure credit for hard work in other areas. Doesn’t that devalue high performance? I think the unintended message is that there is less value to consistent top performance, year over year, in any one measure. Medicare beneficiaries should be steered towards the plans with consistent high performance. Maybe someone at CMS noticed. In the latest rule, the removal of Hold Harmless was not finalized after its earlier announcement. It is still out there without a start date. Hopefully there will be a clarification soon. In the meantime, STARSTrack does use the Hold Harmless rule in modeling future performance for our clients. Please let me know your comments on this topic. You can also send me an InMail if you’re interested in how we predict future Stars performance. #ingeniahealth #cmsstars #medicareadvantage #CMS2025 #MedicareAdvantage #HealthcarePolicy #RateAnnouncement #HoldHarmless Image generated by AI

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1 in 3 Doctors report serious adverse events linked to prior authorization. A recent survey reveals that prior authorization has led to serious adverse events for patients. These events included ⚠️Hospitalization ⚠️Life-threatening situations ⚠️Disability or permanent bodily damage ⚠️Congenital anomalies ⚠️Birth defects ⚠️Death Physicians expressed concerns that prior authorization requirements led to greater use of health care resources. This resulted in unnecessary waste rather than cost savings. Specifically, about two-thirds of physicians reported that resources were diverted to ineffective initial treatments (64%) or additional office visits (62%) due to prior authorization policies. Additionally, 46% of physicians reported that prior authorization led to urgent or emergency care for patients. The AMA has advocated for reforming the prior authorization process to reduce waste, delays, and disruptions in care delivery. The survey highlights the need for reform in the prior authorization process to improve patient care and reduce administrative burden. What do you think? Let me know in the comments. Dave Worachek Ray Berry Derek Smith Linda Finkel #RevenueCycle #RevenueCycleManagement #PriorAuthorizations

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54 metrics related to patient outcome, value of care, health equity were assessed. 2,700 acute care hospitals and 800 critical access hospitals were evaluated. Lown Institute https://lnkd.in/eAnbUKHi #hospital #healthcare