Daniel Wolsk

Let's keep hospice focused first and foremost on the PATIENT. After all, we only get one chance to do it right... "There are six primary trends that are influencing consolidation and professional practices: regulatory complexity. technology and integration, private equity ownership. demographics, economies of scale and consumer expectations,” Henderson said. “So many of these things that we see that are influencing health care consolidation need to be pointing toward the patient." #patientsfirst #hospicecare #youonlygetoneshot https://lnkd.in/gbbgV-YF

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Great defense of “private equity medicine” from former CMS administrator Leslie Norwalk. Though few clinicians fully understand it, PEM has become a popular bogeyman for a wide range of complaints about US health care. A few key takeaways: ·      All health care organizations require working capital. They should be judged on their behavior, rather than their source of capital. ·      Pushing health care organizations to more expensive sources of capital (e.g,, high interest loans) doesn’t serve anyone’s interests (except the banks). ·      The financial successes of private equity-backed companies accrue to everyone with a 401K or a mutual fund, not just a small number of wall street elites. ·      Reducing competition in health care (based on investment class) only accelerates market consolidation by integrated health systems, and the higher prices that come with it.

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What is the bottom line if you have financial responsibility for a provider group? Your competitors have the ability to know your contracted rates for everything you do. That's the bad news. The good news is that you can know theirs to help you in your next negotiation.

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More interesting #news today on #carecoordination and transitions of care, this time specific to bundled payments for hospitals and the #TEAM model. #CMS #Healthcare #reimbursement

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**CMS 2025 Final Rule & Key Implications** -Payment Rates: A 2.93% reduction for 2025 (conversion factor: $32.25). Your focus on efficient care delivery and accurate coding is essential to offset reductions. -KX Modifier: Therapy thresholds increased to $2,410 for PT/SLP and $3,000 for OT, making documentation critical to avoiding denials. -Telehealth Adjustments: Congress may determine whether current flexibilities continue. New allowances include audio-only telehealth and expanded billing for caregiver training services (CTS). -Therapy Assistant Supervision: General supervision replaces direct supervision in outpatient settings, offering greater flexibility and improving access to care. -Therapy Plan Certification: Physician orders can now act as signatures, reducing delays in therapy initiation and administrative burdens. Check out the HealthPRO Heritage comprehensive overview of the latest changes and their potential impact on your organization by reading our detailed summary of the Final Rule updates. #CMSFinalRuleUpdates

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Recent projections from Jefferies indicate a significant shake-up for insurers: - Humana: Faces the largest hit, with an expected $2.5 billion reduction in EBITDA and a staggering $16.37 EPS drop, marking an 83% decline compared to 2025 projections. - UnitedHealthcare: Set to lose $1.6 billion in EBITDA, alongside a $1.39 EPS decline (4%). - CVS/Aetna: A relatively modest gain of $100 million in EBITDA and a $0.05 EPS bump (1%). - Elevance: A $100 million reduction in EBITDA with a $0.30 EPS decline (1%). - Centene: A positive outlier, expected to increase EBITDA by $100 million and boost EPS by $0.10 (1%).

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The healthcare industry is in the grip of an inflationary whirlwind. Since 2022, providers have been relentlessly seeking to expand profit margins and offset ballooning operational costs by tightening the screws on health plan contracts. This trend shows no signs of abating, casting a long shadow into 2025. Like a relentless tide, the cost of GLP-1 drugs is rising, sweeping up overall medical expenditures in its wake. The convergence of groundbreaking prescription drugs for chronic ailments and the surging demand for mental health services is creating a perfect storm of cost inflation. While the promise of biosimilar medications offers a glimmer of hope, it is not enough to stem the rising tide. Health plans are scrambling to find cost-savings within their own operations. This perfect storm of escalating costs demands immediate action. Plan Sponsors must embark on a radical overhaul of their cost management strategies. This is no mere financial challenge; it is a moral imperative. As we know, affordability—the delicate balance between healthcare costs and a family’s income—is the ultimate measure of our system’s success. We built Revive to help employers navigate access and affordability while lowering the total cost of care for Plan Sponsors. Our Whole-Person Care Model and our soon-to-launch Weight Health Program addresses primary care, mental health, medication spend and GLP-1 costs. We'd love the opporutnity to share how this can work for your company. #health #selfcare #healthcare #employer #benefits #healthbenefits #CFO

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As 2024 concludes, healthcare leaders have gained critical insights amidst rapid advancements and challenges. Here's a glimpse of the year's key lessons: 🔍 Data as a Strategic Ally: Harnessing real-time analytics transforms operations and patient care. 💻 Telehealth’s New Era: Virtual care isn't just an option—it's expected. 🩺 Workforce Resilience: Supporting staff well-being is pivotal for quality care. 💡 Personalized Patient-Centered Care: Building trust through tailored approaches ensures loyalty and satisfaction. 📜 Adapting to Regulations: Proactive compliance safeguards growth and quality. 🚀 Tech Integration: Innovations like AI show promise but demand careful execution. 💰 Value-Based Care's Rise: Aligning rewards with patient outcomes reshapes operations. As we step into 2025, the focus remains on resilience, innovation, and care. These takeaways set the stage for a robust and adaptable future. What 2024 lessons resonate most with your healthcare journey? Let’s connect and discuss! #HealthcareLeadership #InnovationInCare #2024Lessons #FutureOfHealthcare

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CFOS ARE SHIFTING ATTENTION TO THESE 4 MAKE-OR-BREAK TRENDS This article from HealthLeaders caught my attention for the following- CFO's take note, if your CDI vendor pitches their software as a tool that enhances CDI efficiency in reviewing records that have the best opportunity for documentation improvement, i.e, securing a CC/MCC and raising the CMI, do not take that sales pitch on face value. If your CDI software vendor sends you reports indicating a jump in CMI and CC/MCC from using their AI software, please validate the data. You must analyze your own financial data and determine if your CDI program and its use of technology are generating net patient revenue. My personal experience time and time again is that CMI is a warm fuzzy feel-good number unless you factor in clinical validation denials and missed CDI opportunities to improve physician documentation and alleviate the steadily increasing costly payer denials and financial takebacks. These add up and impact the bottom line. Watch this short 1-minute video and learn if your CDI program is as successful as your CDI vendor and CDI leadership is leading you to believe. https://lnkd.in/eHGXaYSK Attendees agreed that CFOS must assess the true ROI of their technology solutions and initiatives, especially since many vendors don’t come armed with any data. Implementing technology that streamlines workflows and enhances patient care may lead to shorter LOS, but CFOs must evaluate the financial impact of these efficiencies. “At our hospital, we implemented new technology that reduced our LOS, but I had to add 20 other FTEs to accommodate for the tech,” Wallace said. “So, CFOs need to be aware that a reduced LOS does not always equal an increase in revenue.” By conducting thorough financial analyses and performance evaluations, finance leaders can ensure that their technology investments are generating sustainable revenue growth and improving overall financial performance. #technology, #ROI, #returnoninvestment, #donotbelieveyourCDIvendor, #vendorsstretchthetruth, #validatedenials

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What Sets a Truly Turnkey CCM/RPM Partner Apart? When considering a Chronic Care Management (CCM) or Remote Patient Monitoring (RPM) partner, it’s important to look beyond the surface. While many solutions claim to be "turnkey," the reality often tells a different story. Here's how a fully integrated partner truly stands out: 1. True Turnkey Billing   Many programs provide billing support—offering guidance, resources, or templates to help practices manage the process. However, a true turnkey partner takes full responsibility for billing after reimbursement is received. This eliminates financial risk, reduces administrative complexities, and allows the practice to focus on delivering care rather than chasing reimbursements. 2. Seamless Workflow Integration   Leading programs work directly within your existing EMR and practice workflows. This means no added portals, apps, or disruptions for staff. What’s more, these solutions significantly reduce administrative burden by taking over patient communications, from outreach to follow-up, so your staff can concentrate on in-office care and not the logistical grind. 3. Reducing Staff Workload   Patients no longer need to call the practice for questions about their chronic care program—they reach out directly to the care management team. This shift not only decreases inbound calls but also lowers stress for staff, improving job satisfaction and ensuring your team has more time to focus on patient care. 4. Focusing on Patient Outcomes, Not Transactions   Too often, CCM/RPM programs center around checking boxes: calling, documenting, and billing. A meaningful program goes deeper, working with patients to identify the root causes of non-compliance or poor health outcomes and addressing them proactively. Whether it’s finding affordable medication options, providing real-time feedback from monitoring devices, or guiding patients through small lifestyle changes, the focus is always on improving health—not just meeting quotas. 5. Scalability and Engagement   A high-performing program achieves rapid patient engagement without adding strain to your team. Enrolling 50% of eligible patients within 90 days is a reality when the process is fully managed by the partner, not the practice. When you choose a partner that genuinely operates as an extension of your practice—handling everything from billing to patient engagement to device management—it not only drives financial growth but also enhances staff efficiency and, most importantly, improves patient outcomes. That’s the power of a truly turnkey solution.  If you're ready to explore what a partner like this could mean for your organization, let’s connect.

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Cost analysis in isolation lacks depth. Consider comparing costs - or cash shortfalls - from multiple angles: -Procedure codes -CPT codes -Payers -Aged A/R A record of CARCs and RARCs can be used to map shortfalls and denials, getting you closer to the root causes. This is what my team calls an RCM Health Check and I’m covering the concept in a webinar this Thursday. Join me here: https://lnkd.in/epuhRSn7 

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Most sales pitches overemphasize the benefits of the shiny new object while minimizing the frictional cost (financial and otherwise) of implementing the shiny new object. But that change friction is real. In the pursuit of savings, you can easily burn out your team and leave employees feeling overwhelmed or confused by something new which was intended to "help". For companies large or small, switching health insurance carriers isn’t just a minor tweak—it’s a complex, often disruptive process that can create significant operational headaches and employee frustration. And let’s be honest: maybe you like your current health plan carrier. Your employees are satisfied with the coverage; they’re just frustrated by the rising costs. New alternative health plans are emerging, with many promising savings—but most requiring a complete platform overhaul, essentially a full “chassis change” to your entire benefits structure. Some of these plans might save on paper, but they often come with a steep learning curve and operational disruption that impacts both your team and employees. So why not take a different approach? Instead of replacing a health plan carrier that already works for you, imagine staying with your preferred plan but simply guiding employees to the highest-quality, most cost-efficient care options available within your existing health plan network. It’s about maximizing value where you are, leveraging smarter care choices that reduce costs and improve outcomes—without costly disruption or forcing employees to navigate a new system. Garner Health doesn't ask you to reinvent the wheel. Garner sits on top of any plan network and surfaces the top performing doctors from a cost and quality view in a simple and elegant way. Zero disruption. Garner works within your current health plan to achieve real savings, improve member care and deliver value without the friction. For companies that want true impact minus the operational upheaval, Garner is the way forward. Curious how you can make the most of your existing benefits and improve care for your employees while still driving down costs? Let’s connect. https://lnkd.in/d7Rm5JVB

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Great article from Katie Adams from MedCity News interviewing Lee Schwamm, MD. These are three great nuggets. I've built for clients the digital front door wrapper he's referencing. Depending on the maturity and budget availability of an organization, I would argue it's possible to do this even without the software development kit. Unfortunately, those can be cost prohibitive and inaccessible for many health system teams with limited expertise and bandwidth. I do wonder about how an LLM could work to overcome both a wide range of ways a patient might describe their condition and looming challenge information asymmetry between clinically trained knowledge and patient knowledge? Would it be trained to be so risk averse to still always default to an overrun primary care system? Would it really enable to bypass to a specialist when there might be access issues or referrals needed for that specialty? I really like the insight from Lee about the "mid-level, consistent, reliable experience." He talked about this at the Reuters Events Healthcare in San Diego a few weeks back and I still like it! Overall - great article Katie and Lee! https://lnkd.in/gyMRaMKh

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Managed Care Negotiation Best Practices - 2025, Class 2. Negotiating Targets and Rebalancing •Know the facts, not the nonsense the insurance cartels and the academics/think tanks report. According to Millman, national commercial reimbursement rates for states range from 136% of Medicare to 266%. You are being underpaid if your rates are below the national average and/or below the average for your state. https://lnkd.in/gJn8xF6y •The average commercial inpatient reimbursement for each state ranges from 152% of Medicare to 261%, with a national average of 202% •The average commercial outpatient reimbursement for each state ranges from 137% of Medicare to 357%, with a national average of 252%. Note: these rates apply to ASCs as well •The average commercial professional reimbursement for each state ranges from 115% of Medicare to 252%, with a national average of 147% - Health systems need to do a better job negotiating professional rates for their affiliated physicians. •Again, the rates you NEED are based on your mix, i.e., Medicare, Medicaid, Commercial, and Self Pay, and the management effectiveness and efficiency of your organization – it is a straightforward calculation •Like hospitals, the insurance cartels must publish their rates. However, they have made it very difficult to analyze their files. If you want assistance with a local rate comparison, contact John and Pete at After Transparency https://lnkd.in/gHDVBEtS •You can’t fight gravity; GI, Orthopedics, Imaging, and several other procedure-based specialties are (and should be) moving to the outpatient setting. Counting on HOPD rates for these outpatient services is a fool’s errand. •Rebalance the commercial fee schedule so that service revenues migrating to the freestanding outpatient setting are priced below traditional HOPD rates but significantly higher than the commoditized rates being offered by the insurance cartels (i.e., At a minimum, target rates of at least 200% of the outpatient Medicare fee schedule) •The revenue reductions in the outpatient rates should be rebalanced to hospital-centric services such as neurosurgery, ED, and NICU. Ultimately, your organization must base its commercial pricing on:  Revenues-Expenses= Survival So it goes n8 Stay tuned for Class 3 - Preparing for the Unwillingness of the Insurance Cartels to Pay Physicians and Hospitals Fairly #hospitals #healthsystems #healthinsurance #healthinsurance

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"Among the key trends.....rising rate of claims denials across the healthcare sector. Denial rates have steadily increased, with providers seeing rejection rates as high as 10 to 15%. This not only complicates revenue collection, authors said, but also leads to administrative overhead as healthcare organizations spend more resources on appealing and resubmitting claims...... Experian attributes this increase to several factors, including tighter regulatory scrutiny, complex billing requirements and payer policies that are continuously evolving. Coding errors, incomplete patient information and authorization issues are among the top reasons for denied claims, according to the report..... To address these growing challenges, the analysis suggests that healthcare providers explore partnerships with THIRD-PARTY VENDORS who SPECIALIZE in revenue cycle management. Outsourcing claims processing to experts who possess the necessary technology and expertise can help reduce denial rates and improve financial outcomes." https://lnkd.in/eaC9QeR8 #revenuecyclemanagement #medicalbilling #practicemanagment

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3 of the biggest problems in healthcare benefits right... 1. Managing high-cost claimants 2. Managing cost of specialty drugs 3. Enhancing benefits without tanking quality Find out how to directly solve 1 & 2 -> https://lnkd.in/grFn778m #HR #EmployeeBenefits #Health #COE #Surgery #Spend #SelfFunded #SelfInsured

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GASTROENTEROLOGY QUARTERLY UPDATES - 3rd Quarter - Live Webinar - July 10, 2024 - 1 hr web - 10am PT - 1 ceu from AAPC. SPECIAL DISCOUNT ADDITIONAL ATTENDEES - sign up first person at regular price - each add'l attendee(s) goes for $99 a person (includes their own connection, materials & ceu's) - limited spaces available at this rate, so signed up soon! Here's link to download registration and fax to (415)892-1271 or register online at McVey Seminars website - https://lnkd.in/g4SAuyic WANT AN AMAZING DISCOUNT? (for a short time this below discount has an extra $50 off for this week only - so take advantage of double savings for a limited time) TO GET THE NEXT 4 GI QUARTERLIES AT THE LOW PRICE OF $735.00 (BRINGS THE COST FROM $230.00 EACH TO $183.75> here's link to do all 4 sessions for 2024/2025 - https://lnkd.in/gNXFUe8 / #gastroenterology #gastroenterologist #gastrointestinal #gastro #gidoc #healthcare #medicalbilling #medicalcoding #medicalbillingandcoding #coding #billing

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