Ken Carr, MSL

The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Purchased services are vital to healthcare, but they can also become financial drains if not managed properly. A mature purchased services strategy includes insight into all expenses, reduction in unnecessary variation, and prioritized patient care, outcomes, and experience. By focusing on these areas, health systems can lower costs, improve clinical care, and enhance patient experiences. Learn more in Advantus Health Partners article about how to create a mature purchased services strategy: https://lnkd.in/g4UwCjCW #HealthcareSupplyChain #ValueBasedCare #SupplyChainManagement

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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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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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Some encouraging data showing hospital finances have continued to strengthen. Through April 2024, results show a continued improvement in hospital operating margins. Much of these gains are tied to growth in patient volumes and top line revenue. This is good news for hospitals, but expenses are also increasing, and hospitals must stay vigilant in their cost management strategy. Financial health and stability will require keeping an eye on both the top and bottom line. Do you have the best information to navigate to the best results? https://lnkd.in/gxy5d8nv

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A great article from Glenn Krauss on the 10 key required components of an effective CDI program that provide the structured framework for long-term success. Also, right in time for CDI week as the industry recognizes and celebrates all CDI professionals and the work they do. #CDIWeek #healthcarenews #healthcarecoding #revenueintegrity #icd10monitor

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This Thursday the Energy and Commerce Committee will hold a hearing on the Centers of Medicare and Medicaid Improvement (CMMI). Members of the Committee are expected to raise concerns and praise for the agencies' efforts to test and achieve savings in value-based payment models over the years. Since its inception in 2010, CMMI has tested many new payment models including bundled payments, multiple accountable care organization offerings, and the making care primary model. The agency continues to face challenges, such as finding ways to engage rural providers and solo or small physician specialty practices. Reps. Michelle Steel and Susie Lee and Sens. Markwayne Mullin, Kyrsten Sinema and Thom Tillis introduced the EASE Act (HR 7149 / S.4078) to encourage CMMI to create a new payment model for rural and underserved communities to reduce long wait times that many seniors and residents face in these communities when seeking care from a specialist. The bill was developed based on years of data collected and reviewed by OCHIN to help community health centers and rural hospitals improve care integration and create a new value-based payment model. While Congress looks for ways to improve outcomes and reduce costs; and medical schools continue to look for ways to grow the physician workforce, one pathway that would fill the needs of communities (especially rural areas) and prevent avoidable hospital admissions is the EASE Act which looks to utilize telehealth or e-consults to help our most vulnerable populations receive timely care

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Margins and volumes declined slightly in March, which may signal more challenges ahead. Hospital outpatient revenue also fell 5%, reflecting the competitive challenges of providing outpatient care. The median Kaufman Hall Calendar Year-To-Date Operating Margin Index reflecting actual margins for the month of March was 3.9%. The April issue of the National Hospital Flash Report covers these and other key performance metrics. Read Kaufman Hall's latest report here: https://gag.gl/TAAJ1U via Kaufman Hall #Hospitals

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Is incomplete documentation costing your healthcare facility? With the CDI market hitting $1.4B, now's the time to optimize your documentation process! 📋 From physician education to advanced analytics, we'll help you capture the revenue you deserve. Ready to transform your clinical documentation? Visit revcureconsultants.com today! #revcure #cdianalytics #healthcarecoding #revenuemanagement #kansas

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Not fair and balanced Advertorial for Private Equity A total conflict of interest Immoral to destroy healthcare for opportunity to work for companies that profit on ultimately destroying USA 🇺🇸 healthcare as we knew it. People that worked for CMS should be banned from working in industries that profited from the decisions and have connections for future decisions to destroy the healthcare fabric No discussion of the negatives only the positives Consolidation leads to fewer choices for patients The cons for patients outweigh the pros for the investors. Profits over care ultimately leads to rationing of the care that is not profitable Management of PE selects doctors to interface that benefit from a hard line approach over providers that see quality issues and patient safety as important Cheerleaders 📣 for the profiteers

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Dan Toomey from AirLife for commitment to excellence in the specialty of healthcare value analysis! Dan has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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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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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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Are you prepared for the coming additions to The Centers for Medicare and Medicaid Services (CMS) Medicare Advantage (MA) Star Ratings Measures? Beginning January 1, 2025, CMS is implementing additions and changes that will impact 2027 Star Ratings. MA Plans and providers must ensure they are fully prepared to identify beneficiaries for which these new measures apply and develop strategies to address their care needs — and time is ticking. Learn more: https://lnkd.in/eee7bAvu #FTIHealthcare Key Contacts: Mark Van Ert and Krunal Patel

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Centers for Medicare & Medicaid Services 2023 ACO REACH Model results highlight substantial progress in improving healthcare access, quality, and equity for underserved populations. By fostering collaboration and reducing costs, the model delivers positive outcomes for Medicare beneficiaries. However, challenges remain, such as care coordination complexities and the financial burden on smaller providers. Discover how Ensure Data Solutions can support your ACO REACH initiatives with our powerful tools—ENSUREQUAL©, ENSUREXCHANGE©, and ENSURECM©—designed to streamline operations, optimize care, and improve financial and clinical performance. Learn more today! ⤵️

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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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🚨 Update on Baptist Health and Florida Blue Negotiations 🚨 Negotiations between Baptist Health and Florida Blue are ongoing and remain tense as the September 30 contract deadline approaches. Discussions have been underway since February 2024, but no agreement has been reached. The core issue is payment rates: Baptist Health seeks increases to cover rising costs, arguing that current rates are below market, while Florida Blue contends that these demands are excessive and significantly above inflation. With the potential for Baptist Health services to become out-of-network for Florida Blue members on October 1, many patients in Northeast Florida are left uncertain about their healthcare options. Both sides are committed to finding a resolution, but time is running out. 🔗 Sources: Action News Jax, Baptist Health, Health News Florida

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