Neil Bedi

🚨 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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Baptist Health's collaboration with Mica AI Now is addressing the problem of detecting cancer in dense breast tissue. Amazing work and care at the Christine E. Lynn Women's Health and Wellness Institute in Boca Raton. Read the article below which was featured in The Boca Raton Tribune. Katie Couric

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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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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

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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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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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Hospital and Health System Transactions The volume of announced transactions grew significantly in Q3 2024. With 27 announced transactions, Q3 had the highest level of activity thus far in 2024 and in line with pre-pandemic activity levels. Announced sales resulting from the Steward Health Care bankruptcy represented a significant amount of this volume, with 11 of the 27 announced transactions involving Steward hospitals.

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For those looking to understand how data analytics and targeted provider education can transform documentation practices, this article is for you.

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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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Key Metrics a Virtual Hospital Manager Should Monitor In the rapidly evolving landscape of healthcare, virtual hospitals are at the forefront of leveraging technology to provide accessible and high-quality care. For a virtual hospital manager, monitoring key metrics is crucial to ensure smooth operations and optimize resource allocation. Appointment and Patient Flow Management Completed Appointments: Track successfully completed appointments. Cancelled Appointments: Monitor cancellation rates. Pending Appointments: Keep an eye on appointments awaiting confirmation. Geographic Distribution Patient Distribution Map: Visualize patient numbers from different regions. Service Coverage Areas: Identify high-demand regions. Service Performance Average Service Time: Measure service completion times. Patient Satisfaction Scores: Analyze feedback to improve services. Resource Utilization Staff Workload: Track patient numbers seen by healthcare professionals. Equipment Status: Monitor availability and functionality of medical devices. Emergency Management Emergency Calls: Track number and nature of emergency calls. Response Times: Measure emergency response times. System Health and Security Server Performance: Monitor IT system health. Data Security: Track security incidents. Financial Performance Revenue and Expenditures: Monitor income and operational costs. Insurance Claims: Track processed claims and billing accuracy. AI and IoT Integration Diagnostic Accuracy: Measure AI-based diagnostic tools' accuracy. Remote Monitoring: Ensure IoT devices are properly connected. By prioritizing these metrics, virtual hospital managers can create a responsive, patient-centered healthcare environment that meets the needs of a diverse and dispersed patient population.SEHA AL RAHBA HOSPITALSanalBeePudena Health Consulting Co.Mustafa Köroğlu

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My next Signal takes a closer look at the latest antitrust probe into large dialysis companies and the shifting role of non-competes in kidney care. A recent POLITICO article provides helpful background around topics like NCAs in dialysis and impacts on the adoption of home dialysis technologies. This is an important discussion, so I'd love to hear from you. If you have something you'd like to share, whether it's an anecdote, comment or question for other readers, please leave a comment or send me a message. H/t to Tom Mueller for sharing the article last week. https://lnkd.in/e95a23JF

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[#ProFoundCaseStudy] iCAD is proud to partner with GE HealthCare and Dr. kathy schilling in this newly released clinical white paper. The team at Boca Raton Regional Hospital Baptist Health in South Florida compared their real-world breast cancer screening performance with DBT before and after implementing #ProFoundAI coupled with GE HealthCare’s Senographe Pristina™ Mammography system. The Results? They saw an impressive improvement in its cancer detection rate (CDR) without impacting recall rates. With AI, the CDR saw a statistically significant increase of 23 percent from 5.77 to 7.08 per 1000 without a statistically significant change in false positives and recalls. Read more: https://bit.ly/4f3OJYX #BreastAI #RadiologyAI #EarlyDetection #ClinicalResults #ScreeningSavesLives  

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Radiologists are achieving payments 500% above the Qualified Payment Amount (QPA) in surprise billing disputes, thanks to the No Surprises Act. This figure is staggering and highlights an important reality: many providers might not realize the tremendous potential of this opportunity. When the No Surprises Act (NSA) was enacted in 2022, the rates at which providers were reimbursed took a major hit, often cut in half. Payors exploited the QPA to justify lower payments, essentially giving themselves the green light to underpay claims. If a provider disagreed with the payment, they had to navigate the cumbersome claims process to recover what they deserved. But here’s the good news: By participating in the IDR process, radiologists are claiming up to 5 times their initial payments. This result is a powerful incentive for payers to engage in a meaningful negotiation and ensure fair compensation. Providers should leverage the NSA to their advantage - and capture every dollar they’re owed.

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Full Medicaid expansion needed to retain Georgia’s physicians Georgia was ranked 5th worst place to practice in a recent Medscape article (“Best and Worst Places to Practice 2024”), using five criteria: physician compensation, cost of living, malpractice premiums, the health of the state’s residents, and physician burnout levels. As current and future physicians and health advocates, this column will add context by detailing our experiences practicing in Georgia. It is no surprise that three of the five worst-ranked states for practicing are among those that have not expanded Medicaid. In Georgia, refusal to expand Medicaid means that nearly 12 percent of residents (well over a million people) are uninsured, significantly limiting their access to healthcare. Only in Texas is coverage worse. Due solely to political concerns, Georgia chose to submit a Medicaid waiver and develop its own Medicaid expansion program, Pathways to Coverage. The governor’s office projected that the program would cover an additional 100,000 Georgians in its first year. But it has been an utter failure, with fewer than 3,500 covered at a cost to taxpayers of $26 million. Full Medicaid expansion would have added over 350,000 Georgians while cutting state spending by $710 million. These three states that refused to expand Medicaid are not surprisingly red. It is also unsurprising that the states with the greatest percentage of unhealthy residents are red. Hopefully, Georgia who thought they had a better way of expanding access to care with their own plan that squandered $26 million to cover 3,500 residents will realize that retaining physicians requires a more sensible approach to expanding access to care. #expandinghealthacess, #accesstocare, #limitingcoveragetoresidents https://lnkd.in/eefqH-9Y

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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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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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At Ardent, I'm proud of the way we are leveraging technology to make healthcare better. Take our partnership with Qventus, Inc, which uses AI to make operating rooms across our system run more smoothly, for example... Navigating OR logistics to schedule surgeries can be a slow and complicated process, too often resulting in wasted blocks of surgical time and delays for patients. Qventus makes this process more efficient by using AI to predict surgeon schedules, expected case volume and OR space, and sharing this information with surgeons and schedulers to ensure the right surgeries happen in the right rooms at the right times. As a result, patients can get their procedures sooner, surgeons' time is better managed, and the OR team can spend more time on patient care instead of coordinating schedules. There's no doubt AI has the potential to improve healthcare. But it isn't a magic bullet. It's up to us to identify ways we can use it to improve broken processes or bridge time-consuming, inefficient gaps. And, most importantly, we have to answer the question: Does this make healthcare better for the people at the heart of it - the patient and caregiver? This one is a win-win and I'm grateful for our teams' willingness to embrace it! https://lnkd.in/eMzzFmBD #AIhealthcare #healthcare #innovation

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