MELISSA URREA, M.D.

🚨 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.

6

5 Comments

During the recent AMA Annual Meeting, Beau Raymond, MD MMM FACP, Chief Medical Officer of Ochsner Health Network, shared compelling data on the impact of Ochsner Connected Health's Digital Medicine program for managing cardiometabolic diseases. His presentation highlighted the strategic use of digital tools to enhance patient outcomes and reduce overall healthcare costs. Dr. Raymond detailed how the program's success is underscored by its impressive impact on healthcare costs and member outcomes. Annually, enrolled members experience an average savings of $2,200 per person. Within just six months, four out of five members achieve hypertension and diabetes control, including a reduction in emergency department visits and hospital admissions. Leveraging data from connected Bluetooth devices and medication management from licensed clinicians, the program’s data-driven patient management extends beyond mere monitoring, embodying a transformative shift in cardiometabolic healthcare delivery.   We invite you to learn more about our innovative program: - Read the Full AMA Article: https://lnkd.in/gVjmxkDa - Discover how Ochsner's solutions can be part of your health strategy: https://ochsner.cc/4c0BvdZ #OchsnerConnectedHealth #DigitalHealth #ValueBasedCare #HealthcareInnovation #CardiometabolicHealth #Type2Diabetes #Obesity #Hypertension #GLP1

40

☝ 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

5

📢 Reminder to Texas Providers: The Dec. 13th Deadline is Approaching! 📢 HHSC has released a notice regarding nursing facilities (NFs) that have not met the QIPP Year 7 (SFY 2024) Conditions of Participation. Facilities have until Friday, December 13, 2024, to submit the required documentation. ⚠️ Failure to comply will result in removal from the program for SFY2024 and recoupment of all funds previously paid this program year. ✅ Action Steps: 1️⃣ Check the LTSS Provider Finance QIPP webpage under “QIPP Year 7 (SFY2024)” to confirm your facility’s status. 2️⃣ Review and submit required Performance Improvement Project (PIP) templates if needed. 3️⃣ Respond to HHSC emails as soon as possible. 📧 Questions? Contact [email protected]. 🔗 We know how important every dollar is when it comes to Texas reimbursement rates. Stay compliant, meet the deadline, and protect your funding! We're here to help. #TXQIPP #CrestmarkCares https://lnkd.in/g3Xs8V9p

3

1 Comment

Are you inundating your patients with messages❓ Are they receiving the right information at the right time❓ Download "Your Guide to Governance," a comprehensive resource designed to help you effectively manage your patient communications strategy enterprise-wide. 𝐓𝐡𝐢𝐬 𝐠𝐮𝐢𝐝𝐞 𝐢𝐧𝐜𝐥𝐮𝐝𝐞𝐬 𝟓 𝐛𝐞𝐬𝐭 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞𝐬 𝐭𝐨 𝐡𝐞𝐥𝐩 𝐲𝐨𝐮: ✅ Understand the risks of over-messaging and digital fatigue ✅ Break down silos and establish a governance committee ✅ Measure, iterate, and improve your enterprise-wide communication strategy ➡️ Download the full governance guide and workbook here » https://lnkd.in/gGHjjExa #healthcare #patientexperience #digitalhealth #medtech #healthtech

14

We have to do better than this for both our providers and our patients. Removing documentation burden from providers isn't just good for them, it is good business sense in all the ways that matter...clinical outcomes, patient safety, availability and satisfaction. If this is an area of focus for your organization, our virtual documentation solutions are an effective and cost efficient way to move this needle. Documentation does not have to get in the way of patient care. From the article: The TrendBurden Pulse Survey from AMIA (American Medical Informatics Association)'s 25x5 Task Force was designed to collect data and insights on how clinicians are experiencing documentation burden and charting within electronic health record workflows. This April, AMIA received more than 1,250 responses from healthcare professionals – physicians/surgeons (36%), registered nurses (25%), licensed social workers, educators and others – across 49 states and the District of Columbia. Across all respondents, nearly 75% of respondents said "the time required for documentation impedes patient care," says AMIA.

2

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

22

9 Comments

If over 50% of the births in Mississippi are financed by #Medicaid and over 75% of Medicaid recipients are in #managedcare, it makes sense to review contract requirements for managed care organizations. The organizations play a fundamental role in assuring timely, equitable, quality care and improving maternal health outcomes. In this article, Milbank Quarterly offers a close review of managed care contracts and shows that the absence of a national set of #maternalhealth standards has caused challenges in setting expectations for managed care performance. Table 1 in the study offers a summary of contractual findings, including in #Mississippi. Twenty-five contracts require perinatal risk assessments by the MCO or a provider, but most of these contracts do not require risk assessments throughout the full continuum of care. Only two states require risk assessment in the postpartum period (California and Louisiana). Yet nearly half of pregnancy-related deaths occur one week to one year after delivery, when most individuals would have left the hospital. All MCOs are required to include obstetrician gynecologists (OB-GYNs) in network, and seven states explicitly require high-risk obstetrician specialists (maternal–fetal medicine). Mississippi is not one of those states. Full article: https://lnkd.in/gF-45tJ2

4

What excites one to travel from coastal Maine to Dallas in the summer? My partnership with Guy Culpepper, MD, and the Jefferson Physician Group IPA in North Dallas as we engage employers in the DFW metroplex is what! The direct-to-employer (DTE) contracting market for independent physicians is not just growing, it's thriving, especially with the rapid growth of the Texas population. What are we accomplishing in the DTE market? 🔥 Price Transparency - employer and employee discounts 🔥 Simplified and Immediate Payment Processing - no RCM 🔥 Improved Access to Care - primary care and specialists 🔥 Care Navigation 🔥 Point Solutions for RX and Labs 🔥 Strategic Partnerships - benefits design, compliance, digital platform, analytics, and point solution SMEs Employers' payment models vary, but ultimately, independent physicians can improve their payer mix with direct payments. Improving the independent physician practice payer mix helps to ensure viability as more move away from the BUCAs over time. We are engaging other IPAs and independent physicians to grow the network and better serve the employers we are contracted with today. What a great time to be in the DTE market as we prepare for the 2025 plan year. 🌟 #dte #primarycare #specialtycare #digitalinnovation #analytics #dfwmetroplex #pricetransparency #benefitdesign #pointsolutions

42

31 Comments

OIG ALERT- Another targeted condition review, the 5th this year, was released this week. While the penalty is only $297k, the risk found was 51X the penalty. I repeat... 51 times. In addition to the settlement with a health plan announced by the DOJ yesterday, the OIG also posted its most recent targeted review of conditions for a Medicare Advantage plan. These targeted reviews focus on conditions the OIG has identified as having an extreme likelihood for overpayment. Nothing is necessarily new in this report, especially since the dates of service were 2015 and 2016 dates of service. The details: -9 different clinical conditions were reviewed for potential over-capture. All 9 of these have been on prior reports. However, this is the first time vascular claudication has shown up in a 2024 report. I suspect that is because the dates of service are older and not representative of an increased emphasis on the condition. -73% of conditions reviewed failed to have supporting documentation. This number is consistent with prior reviews by the OIG. -Interestingly, depression and vascular claudication were supported in 93% of the reviews. This is on the high end and also one of the reasons the OIG has decreased emphasis on these conditions. -90% of heart attack, stroke, and cancer patients reviewed failed to have supporting documentation. The OIG found that in total the overpayment was $297k. However, this is due to the sampling was limited by condition and extrapolated payment penalties were not allowed for these dates of service. Had they been, the penalty would likely have been 51X higher since the OIG identified $15.3M of risk for these conditions. I expect that now that extrapolation is allowed we can expect to see more OIG reviews with larger penalties. Additionally, with yesterday's DOJ settlement with Independent Health and in particular the $2M penalty to former DxID CEO, I expect 2025 will bring more review findings. If you aren't reviewing your risk then you are susceptible for takebacks. https://lnkd.in/e_Sae-79

64

12 Comments

Introducing CDIQ Consulting - Education Empowering Healthcare Our services empower allied healthcare professionals and the organizations they serve to achieve excellence in patient care and operational performance. We specialize in transforming clinical documentation integrity (CDI) into actionable strategies that enhance severity reporting, risk adjustment, and quality metrics. Under the leadership of Tarman Aziz, MD, CCDS, our CEO, and Anna Rusinowski, our COO, we deliver innovative solutions grounded in expertise and a commitment to elevating healthcare standards. Together, they guide a team dedicated to operationalizing intelligent insights into documentation accuracy, financial outcomes, quality metrics, and career excellence. Our Physician Advisor Solutions focus on training Documentation Champions to more comprehensively prevent DRG downgrade denials, mentoring custom strategies that sustainably improve provider assessment documentation. The Comprehensive CDI Apprenticeship Program builds future CDI specialists using real-world practical training, preparing them for faster onboarding to readily exceed management expectations. HIM and CDI leaders leverage our CDI training modules to enrich their programs with enhanced team productivity and query scope. We design middle revenue cycle consulting initiatives featuring both efficient assessments and immediate solutions strengthened by policy creation to optimize CMI and risk adjustment metrics. For professionals pursuing CCDS certification, our CCDS Exam Preparation course offers a custom curriculum to each enrollee, based on a diagnostic assessment. Our hourly and subscription-based Professional Coaching sessions deliver personalized support to foster leadership skills, professional growth, and adaptability to industry trends. Discover how we can transform your plans into positive outcomes! Empower your success by visiting cdiqconsulting.com today. #EducationEmpoweringHealthcare #ClinicalDocumentation #CDI #RiskAdjustment #HealthcareConsulting #CDIQ

7

Proof of Purpose; PDPs kept afloat Good for Manufacturers, too? The intricacies of IRA Part D benefit redesign dramatically reshape the OOP for millions of beneficiaries, reducing financial toxicity and raising utilization (I will post to past non adherence figures in comments) Unlike MA PDPs, freestanding PDPs can’t shuttle money over from the medical benefit to moderate premium increases, so some speculated that PDPs would fail. I commented several times that given this administrations view of the private market exemplified by MA that was highly unlikely. And after all PDPs are holding up half the benefit. CMS moves forward. “CMS is also announcing a voluntary demonstration program for standalone prescription drug plans (PDPs). The Part D Premium Stabilization Demonstration is designed to test whether additional policy changes stabilize year-over-year changes in premiums for participating standalone PDPs, leading to more predictable options for beneficiaries during the initial implementation of the IRA’s) benefit improvements, creating more gradual enrollment changes… Under the voluntary demonstration, there will be a reduction in the base beneficiary premium of $15 for all participating PDPs, combined with a year-over-year plan premium increase limit of $35 and narrowed risk corridors..” Thanks Tom Thoughts on implications, such as spillover from reducing headwinds, moderating adoption of narrower formularies and networks? If so possible plus for Phrma —not to mention if it slows down MA train with attendant Part B drug prior auths. #PartD #PDPs

5

2 Comments

Here’s your recap of last week’s health IT news 🗞️ 👇 🖊️ AI Ambient Scribes • CHRISTUS Health + Abridge: The 15,000 provider Texas health system adopted the ambient scribe enterprise-wide.    • Tampa General Hospital + Nuance Communications DAX Copilot: Over 500 providers at the health system will begin utilizing the AI ambient scribe.    • Texas Oncology + DeepScribe: The statewide oncology practice adopted the AI ambient medical scribe. (ed. note: scribes continue to be hot!) ☎️ AI Contact Center • Clearstep: The AI conversational chat vendor launched a new feature allowing patients to self-schedule specialist visits. 📊 Data & Analytics • InterSystems + CLEAR: The cloud-based patient data service is integrating the identity technology to expedite access to patient records.    • WakeMed + Bamboo Health: The health system is adopting the data interoperability and encounter notification service. 🥼 Clinical Decision Support • University Hospitals + Aidoc: The Cleveland-based health system is implementing the AI clinical decision support platform across 13 of its hospitals and additional outpatient locations. 🧑‍💻 Virtual and At-Home Care • University of South Carolina School of Medicine + Rimidi: The hospital group and an affiliated multispecialty clinic are adopting the remote patient monitoring platform to reduce complications from postpartum hypertension.    • Mount Sinai Health System + HealthSnap: The medical center announced a new remote patient monitoring and chronic care management program in partnership with the virtual care management platform.    • Wheel: The telehealth company released a new AI-driven virtual care platform designed to enhance the patient experience and offer resources to help partners scale their virtual care services. 💬 Patient Engagement • CipherHealth: The patient engagement solution focused on patient rounding released a new AI summary tool.    • DexCare: The care orchestration platform completed a $75M series C funding round 🩼 Durable Medical Equipment • Better Health: The medical device and peer support network completed a $14M funding round. 🧠 Food for Thought: • Silicon Valley Bank released an interesting report on the state of investment in AI in healthcare, including stats on AI usage at healthcare organizations and the impact of leveraging AI on startup valuation. https://lnkd.in/em7AfivT    • The journal Critical Care Medicine published an editorial on an “in clinico” evaluation of a machine learning-based early warning system to predict in-hospital deterioration. We found it to be an interesting look at the actual impact of a model’s deployment on care processes and patient outcomes in a critical care setting. https://lnkd.in/eQhZbVKu

47

3 Comments

Check out this article on our #journal provided by The University of Texas Health Science Center at Houston (UTHealth Houston). "The Centers for Medicare & Medicaid Services (CMS) Medicare Promoting Interoperability Program for calendar year (CY) 2023 Hardship Exception application opened on May 1, 2024." Links provided in the article. Don't forget to subscribe. #eligiblehospitals #CAH #interoperability #hardship #applications #CCSQ #medicare #hospitals #healthcare #facilities

2

6% is not enough! We need more Latinx physicians to serve the growing Latino population and to mentor the next generation. On October 1st, we celebrate the National Latinx Physician Day. #nationallatinophysicianday #nationallatinaphysicianday #nationallatinxphysicianday #mentorship #latinosinmedicine #NLPD24

31

🚀 CMS Unveils Strategic Initiatives to Enhance Healthcare Services and Accessibility 🏥 The Centers for Medicare & Medicaid Services (CMS) has announced a groundbreaking series of initiatives aimed at improving healthcare quality and expanding access for beneficiaries. Key highlights include: 🌟 Nursing Home Staffing Campaign: Addressing staffing shortages to elevate care standards in long-term facilities. 🧠 Innovation in Behavioral Health Model: Selected states will focus on enhancing care for adults with mental health conditions and substance use disorders. 💰 Healthcare Spending Insights: The 2023 National Health Expenditures Report reveals a significant rise in healthcare spending, emphasizing the need for sustainable funding strategies. 🏡 Acute Hospital Care at Home Program: Demonstrating the feasibility of delivering inpatient-level care in home settings while maintaining quality and reducing costs. 🌍 Health Equity Conference 2025: A platform to discuss advancements in health equity, encouraging community involvement and research contributions. 💡 CMS is also focusing on maternal health, rural healthcare support, hospice quality improvement, and updated hospital price transparency requirements. These initiatives are set to create a more efficient, equitable, and resilient healthcare system that benefits all stakeholders. 👉 Click the link to learn more about these transformative efforts! #CMSInitiatives #General #HealthEquity #HealthcareInnovation #MedicareMedicaid #RegulatoryAgencies #MarketAccess #MarketAccessToday

1