Samuel Bauer, MD, MBA, FACHE, CPE, FACOG

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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A message from ACPA's Government Affairs Committee Chair, Dr. Ritu Prasad, MD, The Centers for Medicare and Medicaid Services (CMS) and United States Department of Health and Human Services (HHS) have requested 𝐜𝐨𝐦𝐦𝐞𝐧𝐭𝐬 related to 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞 (𝐌𝐀) 𝐩𝐥𝐚𝐧 𝐝𝐚𝐭𝐚 𝐜𝐨𝐥𝐥𝐞𝐜𝐭𝐢𝐨𝐧 𝐚𝐧𝐝 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞𝐬 𝐝𝐮𝐞 𝐛𝐲 𝐭𝐨𝐝𝐚𝐲, 𝟓/𝟐𝟗/𝟐𝟒.   This request comes particularly timely given the recent final rule 4201-F impacting MA and year-after-year increasing enrollment in MA. The American College of Physician Advisors’ Government Affairs Committee seeks to offer CMS comments to help inform CMS and HHS of our experience with current MA practices, concerns regarding data collection, and to ensure that MA plans provide services to Medicare beneficiaries that are at least as generous as those provided to Medicare fee-for-service (FFS) in a transparent fashion and with decreased administrative burden. 𝐖𝐡𝐲 𝐬𝐡𝐨𝐮𝐥𝐝 𝐲𝐨𝐮 𝐜𝐚𝐫𝐞? ・ More than 50% of Medicare-eligible beneficiaries are enrolled in MA plans and this enrollment is anticipated to continue to rapidly increase. ・ There are ongoing concerns that MA plans continue to offer benefits that are more restrictive than Medicare FFS (via not complying with the Two-Midnight Rule, clinical validation denials, using opaque proprietary restrictive criteria, re-defining coverage benefits as “payment disputes,” laborious prior authorization, etc.). ・ Underpayment occurs frequently for services provided, with significant delays in payment to hospitals. ・ Administrative burden to fight inappropriate denials is at an all-time high. ・ Improved transparency and data reporting from MA to the public is imperative. 𝐀 𝐟𝐞𝐰 𝐡𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬 𝐨𝐟 𝐨𝐮𝐫 𝐜𝐨𝐦𝐦𝐞𝐧𝐭𝐚𝐫𝐲 𝐢𝐧𝐜𝐥𝐮𝐝𝐞: ・ Improved accountability for plans with regards to 4201-F, the Two-Midnight Rule and use of internal coverage criteria. ・ Enhanced transparency and timeliness of prior authorization processes. ・ Proposed guardrails around skyrocketing Clinical Validation Denials by MA plans. ・ Request for a clear centralized process to submit comments to CMS regarding MA plan behavior that is publicly accessible. 𝐏𝐥𝐞𝐚𝐬𝐞 𝐜𝐨𝐧𝐬𝐢𝐝𝐞𝐫 𝐚𝐬𝐬𝐢𝐬𝐭𝐢𝐧𝐠 𝐮𝐬 𝐢𝐧 𝐜𝐫𝐞𝐚𝐭𝐢𝐧𝐠 𝐜𝐨𝐦𝐦𝐞𝐧𝐭𝐚𝐫𝐲 𝐭𝐨 𝐂𝐌𝐒 𝐢𝐧 𝐬𝐮𝐩𝐩𝐨𝐫𝐭 𝐨𝐟 𝐭𝐡𝐞 𝐩𝐫𝐨𝐩𝐨𝐬𝐞𝐝 𝐫𝐮𝐥𝐞 𝐚𝐬 𝐟𝐨𝐥𝐥𝐨𝐰𝐬: ・ ACPA has provided a template to utilize for comment to CMS on this proposed rule, which is attached to this post. ・ Insert your name, organization, a brief description of your experience with MA plans, and closing signature. ・ Go to this website: https://lnkd.in/gQ7S6Gyt to the view the proposed rule and click the option to “𝐒𝐮𝐛𝐦𝐢𝐭 𝐚 𝐅𝐨𝐫𝐦𝐚𝐥 𝐂𝐨𝐦𝐦𝐞𝐧𝐭” to add your comment. 𝐂𝐨𝐦𝐦𝐞𝐧𝐭 𝐩𝐞𝐫𝐢𝐨𝐝 𝐞𝐧𝐝𝐬 𝐭𝐨𝐝𝐚𝐲, 𝐌𝐚𝐲 𝟐𝟗𝐭𝐡, 𝟐𝟎𝟐𝟒. #ACPA #ACPA10 #WeArePhysicianAdvisors #GovernmentAffairs #PhysicianAdvisors

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Key takeaways from yesterday's Association of Schools and Programs of Public Health (ASPPH) webinar: "What the US Presidential Election Outcome Means for Public Health." Speaker Ali S. Khan, MD, MPH, Dean, University of Nebraska Medicine Medical Center College of Public Health: 1) "Public health can be political... We cannot be perceived as partisan." 2) "There are 39 credited public health schools and 77 credited programs in red states. It is possible to do really good public health...if you're in a red state." 3) U.S. Department of Health and Human Services (HHS) priorities in 2025 may include: child health, substance abuse, mental health, obesity, rural health, preparedness (#H5 Bird Flu). "We'll see, time will tell." 4) "Public health has long been viewed as an invisible safety net - we cannot be invisible anymore." 5) "We're all scientists. We should have a sense of curiousity." Speaker: Mark Mioduski, Principal and Director, Cornerstone Government Affairs: (1) U.S. Department of Health and Human Services (HHS) funding in 2025 is "a wild card." Funding for inequalities and disparities will "fall out of favor in next year's appropriations." "New threats we've never seen before." You can view the webinar recording: https://lnkd.in/eSu9rRG6

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🌟 Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and save your place here: https://bit.ly/3MkxxT8

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the current data collection mechanisms used for Medicare and proposes ways to improve nationwide data collection efforts for Medicaid. https://ja.ma/4dJuqzJ

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On Ep.16 I was joined by Dr. Jared Dashevsky, MD, MEng: Physician, Innovator, and the Mind Behind Healthcare Huddle Ever wonder how healthcare, business, and technology collide? Enter Dr. Jared Dashevsky, MD, MEng, a practicing physician, healthcare systems engineer, and founder of Healthcare Huddle. His newsletter has become a must-read for over 30,000 healthcare professionals, breaking down the complexities of medicine and healthcare innovation. Check out my full conversation with Dr. Dashevsky on Youtube, Spotify & Apple Podcast Full Episode Link: https://lnkd.in/e6NKS6Cy #Pharmacy #Pharmacist #PharmD

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The @AmericanTelemed announced the Center of Digital Excellence initiative to drive the development and implementation of best practices prioritizing patient-centered care, equitable access, and improved clinical and operational outcomes in digital care. @Elissa-baker @annmondjohnson https://lnkd.in/dkiejV3r #TelecareLeadership #DigitalExcellence #DigitalCare #InnovationInHealthcare

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We're excited to showcase an #innovator who's pushing boundaries and shaping the future of healthcare. Meet Juliana (Jewel) Kling, MD, MPH, FACP, MSCP, IF! Q. What sparked your interest in medicine and why did you choose to work at Mayo Clinic? A. My parents were my role models and were committed community advocates. I wanted to be like them by making a positive difference and chose to do so through medicine. When I rotated at Mayo Clinic as a sub internship, I experienced the value system that sets us apart from other institutions. I took care of a kind man who was dying from cancer. I was surprised to see that everyone on his care team made time to meet and develop a plan together, and then meet with his family to assure we were all on the same page. I knew I wanted to train (and then work at) an institution that prioritized patients through teamwork like this. And I did. I completed Internal Medicine residency, followed by a chief year in 2014 and have been on staff since that time. Every day I witness the teamwork and patient centered care that impressed me during my medical school rotation. Q. What problems are you trying to solve and how will your solutions impact humanity? A. I remain committed to advocacy and making a positive impact on people’s lives. As a women’s health internist, I have dedicated my career to studying and improving care related to menopause, female sexual health and LGBTQ health. Our study team has evaluated how important factors, such as intimate partner violence and sleep, may relate to menopausal symptoms and female sexual functioning. We are also working to assure that the core variables of sex, as a biologic variable, and gender, as a social construct are incorporated into all of medicine. This will assure the most precise and comprehensive care for all individuals. Additionally, as the Arizona campus Mayo Clinic Alix School of medicine Dean, I am dedicated to training the best and brightest future physicians. They will lead and innovate the future of healthcare. Q. What excites you about #DiscoveryOasis? A. The opportunity to collaborate with innovative organizations and technologies both in our women’s health practice, as well as in the education space. So many questions still exist in medicine and having the opportunity to answer them through tools and technologies that we haven’t traditionally had access to is exciting. We will be putting our patients first in new ways by breaking down barriers and thinking outside the box to accelerate getting necessary answers. Q. What is the most rewarding part of your job? A. Truly hearing and understanding my patients. It’s incredibly fulfilling to be able to listen to their concerns, address their needs, and provide care that not only treats their conditions but also respects their individual experiences and emotions. Building that trust and connection can make a real difference in their overall well-being and recovery. What an honor. #InnovatorSpotlight

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the complexity of the US health care system. https://ja.ma/3NJYmku

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#Didyouknow community health networks reduce the burden on healthcare systems and improve overall well-being? In this clip from our recent #webinar, "Screen, Refer, Resolve: A Toolkit for Addressing Patients’ SDOH Needs," Alesia O'Daniel, Patient Outreach Manager at Northwestern Medicine, discusses the importance of fostering a human connection with patients to improve care outcomes and build stronger communities. 👀 Watch the full webinar here: https://lnkd.in/gKkNSN_g

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Will a new wave of physician unionization counteract the consequences of #hospitalconsolidation? Can #unions help satisfy physicians’ interest in governance and restore some professional autonomy? The latest paper by BAHM President Kevin Schulman, Stanford CERC, and Barak Richman, Duke University School of Law: https://lnkd.in/gfxniKPV Or see the PDF: https://lnkd.in/gDFCx5b6 #healthcaremanagement

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➡️ Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and register here: https://bit.ly/4fVBYRC

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Team-based care is associated with improved patient outcomes, better collaboration among health care professionals, and reduced professional burnout. It is also a crucial component to meeting the most persistent health care challenges. https://lnkd.in/eS-786XQ #patientcentriccare #teambasedmedicine #patientinclusion

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