Asif Saberi, MD, MBA, CPE, FCCP

Great meeting today and more work planned over the coming weeks to bring some interesting research insights as to what makes PNS effective and how we can design future systems that are consistently effective for our patients in order to drive greater payor coverage and improve patient access. Looking forward to crafting a really interesting presentation for this interactive presentation at NANS and cuing up Dr. Evan Peskin to share data on functional outcomes with PNS #innovation #PNS #neuromodulation #research #patientoutcomes #understandhowitworks #NANS

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Sharing key takeaways on the CMS Hospital Inpatient Quality Reporting program for FY2025. - Seven new measures are added (which are welcome, with the caveat of let's see how they work out) -> Patient Safety Structural Measure beginning CY 2025 with payment determination in FY 2027 -> Age Friendly Hospital CY 2025/FY 2027 -> Catheter-Associated Urinary Tract Infection Standardized Infection Ratio Stratified for Oncology Locations (CAUTI- Onc) CY 2026/FY 2028 -> Central Line-Associated Bloodstream Infection Standardized Infection Ratio Stratified for Oncology Locations (CLABSI-Onc) CY 2026/FY 2028 -> Hospital Harm – Falls with Injury (eCQM) CY 2026/FY 2028 -> Hospital Harm – Postoperative Respiratory Failure (eCQM) CY 2026/FY 2028 -> Thirty-day Risk-Standardized Death Rate Among Surgical Inpatients with Complications July 1, 2023–June 30, 2025/ FY 2027 - Five existing measures are removed (which is a breath of fresh air) - the unpopular PSI-04, and measures related to 30-day episode payments for acute myocardial infarction, pneumonia, total hip/ knee arthroplasty, heart failure - Two existing measures are modified (Global malnutrition composite score expanded from seniors over 65 to anyone older than 18 - this is very positive; and Refined HCAHPS measure - will post details on this next week.)

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The Medicare Advantage star ratings system is designed to evaluate the quality of Medicare Advantage plans. These ratings range from 1 to 5 stars, with 5 being the highest, and are based on several factors, including customer service, member satisfaction, and health outcomes. Higher star ratings lead to better reimbursement rates from CMS and can help attract more enrollees. UnitedHealthcare’s lawsuit claims that its downgrade was based on a single customer interaction, which could negatively affect its reimbursement and market competitiveness during the open enrollment period https://lnkd.in/erKQy7Ge #MedicareAdvantage #StarRatings #UnitedHealthcare #CMS #HealthcareLawsuit #HealthInsurance #MedicareNews #OpenEnrollment #HealthcareUpdates #MedicareAdvantagePlans #InsuranceRatings #HealthcareFinance #PatientCare #MedicareReform

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It’s Sepsis Awareness Month! Are you looking for peer inspiration to get started on improving Sepsis practices? Check out our 2023 Sepsis Honor Roll hospital journey posterboards, compiled in this Excellence in Practice Hospital Journey virtual booklet. https://hubs.ly/Q02MWxGn0 #SepsisAwarenessMonth

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Attending the upcoming ACMA Leadership and Physician Advisor Conference in CA? Stop by the Optum booth (#30) to explore our latest innovation, Case Intelligence – an AI-powered case stratification and workflow solution. Don't miss our pre-conference session (Pre-Con Session 1), "Optimizing UM Operations: Proven Strategies for Improving Efficiency, Collaboration, and Revenue," where Kurt Hopfensperger, MD, JD, will share best practices and successful outcomes from combining process improvements, automation, and AI.

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The burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia.

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Attending the upcoming ACMA Leadership and Physician Advisor Conference in CA? Stop by the Optum booth (#30) to explore our latest innovation, Case Intelligence – an AI-powered case stratification and workflow solution. Don't miss our pre-conference session (Pre-Con Session 1), "Optimizing UM Operations: Proven Strategies for Improving Efficiency, Collaboration, and Revenue," where Kurt Hopfensperger, MD, JD, will share best practices and successful outcomes from combining process improvements, automation, and AI. #acma #ai #automation #workflow #healthcareinnovation #healthtech

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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New urgent update from Medicare Codes G0463 and G2211 G0463 Represents hospital outpatient clinic visits for the assessment and management of patients. • Modifiers: • PO: For excepted off-campus provider-based departments. • PN: For non-excepted off-campus provider-based departments. • Usage Examples: • GI Clinic: Follow-up on GERD management. • Orthopedics: Evaluation of knee pain and treatment planning. • Podiatry: Diabetic foot ulcer care with procedures like debridement. • Vascular Surgery: Comprehensive vascular assessment for leg ulcers. Important Notes: G0463 is specific to hospital outpatient settings and does not apply to regular office E/M codes like 99202-99205 or 99211-99215. G2211 Designed for outpatient office visits to reflect visit complexity. No changes in its usage for outpatient settings. Cannot be paired with G0463. G2211 is intended for office visits only, while G0463 is strictly for hospital outpatient visits with the required PO/PN modifiers. #CMSGuidelines #HealthcareUpdates #MedicareBilling #BillingAccuracy #HealthcareProfessionals #RevenueCycleManagement #HealthAdmin #MedicalEducation #OutpatientCare

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Mark Your Calendar: December 17th! Join me at 10:00 AM PST | 1:00 PM EST for the Medicare Quarterly Updates Webinar - 4th Quarter hosted by McVey Seminars. Stay informed with the latest Medicare updates! Register today: https://lnkd.in/gmgzbjSg Let’s navigate these updates together! #McVeySeminars #TerryTuesday

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A couple of thoughts regarding balancing access to healthcare and quality in delivery. Value-based assessment in healthcare revolves around patient-centered outcomes tied to the cost of care delivery. This model incentivizes efficiency, effectiveness, equity, and patient satisfaction, fostering better healthcare quality at lower expenses. Transitioning to Value-Based care entails significant cultural and operational changes, yet with a focus on patients and data-driven strategies, it presents achievable benefits beyond enhanced outcomes and reduced costs. Check out: https://lnkd.in/eMShzBzd #valuebasedcare #innovation

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Health care organizations face an inflection point. With operating margins hovering at historically low levels, organizations urgently require funds not only to invest in core needs like physical plants, technology and clinical programs but also to fuel growth, to drive care transformation and to address expanding priorities around social drivers of health, access, equity and well-being. This makes it critical for all of the health care organization’s financial resources to be deployed to their most effective and best use; yet many organizations still diminish the potential impact of philanthropy by using charitable dollars for initiatives outside their strategy. Given how philanthropy deployment can significantly influence a health care organization’s ability to invest in future opportunities and outcomes, organizations should pursue alignment between strategy and philanthropy. Read more in the lastest issue of Trustee Insights from American Hospital Association in the attached or here: https://lnkd.in/dE5E8fCu This article is shared with the permission of the American Hospital Association. Thank you so much to the exceptional executive leaders who graciously shared their time and perspectives for this article. #Healthcare #Leadership #Philanthropy

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Clinical decision support innovators check out this report

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The value and impact of any AI technology in healthcare depend significantly on collaboration with clinical teams, including nurses. As AI's role in healthcare evolves, it is essential to ensure that nurses are part of these conversations. The more hospitals and healthcare technology companies involve nurses in decision-making, the better the outcomes for everyone involved. If you have thoughts on this topic, please share them in the comments. It's an important issue to discuss. #Nurses #AIinNursing #HealthcareInnovations

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Are your MIPS scores not looking good? Do you practice in FL, GA, SC? Even if your don’t before you take an additional Medicare Reimbursment hit (that is in additional to the 5th consecutive physician pay cut in the setting of record inflation) consider checking out the 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application. Between the Change Health Care Cyberattack, a tropical storm early this year causing record flooding in my area and then a Hurricane causing more than a week of power outages it’s impressive if anyone in my area had amazing MIPS scores. It has been a year of considerable challenges. Check out the link below if you are in Tx, FL, GA, NC, SC, or TN as some counties are eligible https://lnkd.in/eJiH7g7z https://lnkd.in/eHyp8qh7

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☝ Don't Miss the Application Deadlines for the ACO Primary Care Flex Model! CMS is accepting applications for the ACOs Primary Care Flex Model until August 1, 2024. Interested organizations must apply as new or renewing ACOs to the Medicare Shared Savings Program (MSSP) by June 17, 2024. The ACO PC Flex Model will launch on January 1, 2025, and run for five years. Low-revenue ACOs participating in the Shared Savings Program can apply to the ACO PC Flex Model. This innovative model aims to increase the number of low-revenue ACOs and enhance primary care payment through a Prospective Primary Care Payment (PPCP) option, shifting payment from fee-for-service to a predictable, monthly payment. 💲 Enhance primary care payment and innovative care delivery  📉 Narrow Disparities in health care outcomes  🔻Reduce program expenditures while preserving the quality of care  💪 Strengthen participation incentives for new and low-revenue ACOs 💰 Base Rate and Payment Enhancements  💴 One-time Advanced Shared Savings Payment Health Equity Strategy to drive accountable care and advance health equity #ACOPrimaryCareFlexModel #HealthcareInnovation #PrimaryCare #AccountableCare #Medicare #HealthEquity #SustainableHealthcare #ValueBasedCare #VBC #RiskAdjustment #PPCP #SharedSavings #CMS https://lnkd.in/gmiKZsHM

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