Steve Carbonara

Tornado chart.. Tornado chart.. Tornado chart.. Check out this dynamic, interactive dashboard that enables healthcare providers to analyze patient`s costs from provider perspective. Utilizing the add-in featured tornado chart, we can effortlessly compare incurred costs Vs charges. The tornado chart allows for real time parallel comparison between costs and charges among different patient age groups or different diseases. Applying business intelligence in healthcare.. #healthcare #healthcaredata #datanalytics

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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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Great Post Bob ... I have said a few times... "The role of Supply Chain in healthcare is evolving significantly, shifting from a transactional role to a strategic function with a direct impact on financial performance. Supply Chain now has a presence at the C-level, underscoring its importance in driving margins and supporting sustainable financial models. By adopting a holistic approach to expense management and overseeing all non-labor spending, Supply Chain leaders can create substantial value.And its not all created equal. Exmaple: reducing costs by just 5% can yield the same profit impact as increasing revenue by 100%, highlighting the efficiency of cost management over revenue initiatives in improving profitability. This transformation aligns closely with strategic imperatives around delivering higher value with fewer resources, supporting revenue generation, and enhancing competitive advantage. Moving towards clinically integrated, population health-focused, and value-based contracting models is critical for the future."

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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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The recent AMA update sounds like big news for RPM providers. How will it impact the cardio-renal space? Starting January 2026, providers will no longer need patients to transmit 16 days of data to bill for remote physiologic monitoring (RPM) services, according to the AMA CPT Editorial Panel. This change addresses longstanding challenges for providers, who found it difficult to ensure patients submitted enough data for reimbursement. While some stakeholders raised concerns about fraud in RPM billing, this new rule is expected to simplify access and increase adoption of RPM technologies, allowing providers to focus more on patient care and less on meeting data thresholds. Reimbursement levels for the adjusted codes will be reassessed in 2025. Recent evaluations from the Peterson Health Technology Institute (PHTI) and the HHS Office of Inspector General (OIG) add critical context to this decision. PHTI’s recent report questioned the overall effectiveness of many RPM solutions, particularly those focused on behavior change rather than medication management, suggesting that some remote monitoring tools add little value for patient outcomes. Additionally, the OIG flagged potential billing misuse in RPM, noting that 43% of enrollees in some programs did not receive all three components of the intended monitoring. These reports underscore the need for clearer rules and sustainable RPM models that balance cost-efficiency with clinical efficacy. The AMA's updated billing approach aligns with efforts to streamline RPM adoption while addressing some of these broader industry challenges. By lowering the reporting burden, the change may help providers offer RPM services more consistently and encourage companies to refine their tools for greater clinical impact. However, stakeholders will need to ensure these services are used appropriately to avoid further scrutiny from watchdog agencies. *** Does this change impact you? What should we know or keep in mind? How will this impact patients / providers? -- Sources: [1] Fierce: https://lnkd.in/eE6gWgkJ [2] AMA: https://lnkd.in/ewwVFJGF [3] PHTI: https://lnkd.in/eVQ8wyF8 [4] OIG: https://lnkd.in/eMjxh5gc

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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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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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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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If you're worried about building trust in AI maybe quit (obsessively) talking about it so much in your marketing/messaging/positioning. Seriously, the only people who truly care about your tech stack are VCs....customers/users sure don't. Tell me how your solution helps me and quit wasting my time telling me how you built it and what's under the hood. #ai #generativeai #healthcareai #medicalai #software #applications #saas #cloud #marketing #messaging #positioning #strategy #gotomarket https://lnkd.in/gWuf8Yc9

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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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Allocating a marketing budget and maximizing return on investment (ROI) are critical for hospital marketing success, ensuring efficient resource utilization and measurable outcomes. Check: https://lnkd.in/dk8Q_Mpx #hospitalmarketing #hospitalmarketingstrategy #hospital #hospitals #hospitalgrowth #hospitalsoftware #hospitalmanagementsoftware #HIMS #HMIS #hospitalbranding #hospitalmanagement #drlogyplus #drlogy

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Allocating a marketing budget and maximizing return on investment (ROI) are critical for hospital marketing success, ensuring efficient resource utilization and measurable outcomes. Check: https://lnkd.in/dk8Q_Mpx #HIMS #HospitalInformationManagementSystem #Hospitalsoftware #hospitalmanagementsoftware #HMIS #hospitalmanagement #doctor #doctors #hospital #doctor #doctors #hospitals #drlogy #drlogyplus

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I hole heartedly agree Benjamin Schwartz, MD, MBA. Anywhere else in an economic system, innovators who can deliver a better product at lower costs are almost always rewarded with greater market share, and frequently set the direction for the future of a product or industry. Not so in healthcare. I think that Terry Adirim, MD, MPH, MBA (below) hit the nail on the head when she references for-profit health insurers in the mix. Although policies have been enacted with the idea of providing better healthcare at lower costs, they have always given the job of administering those policies to a middleman (insurance companies) whose motives are at odds with the objective they claim to be administering. Profit! Innovation is not in the best interest of the payer. They profit through the inefficiency of the system. Until this lack of alignment between quality patient care at low costs and for-profit health care plans is addressed, process innovation and improvement will only be able to nibble at the edges.

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Traditional EHR systems often fall short in supporting the essential functions of Enhanced Care Management (ECM) under #CalAIM. ECM requires seamless coordination across physical, behavioral, and social determinants of health, proactive member engagement, and real-time data exchange—capabilities that extend beyond the scope of many EHRs. Our Incedo #CareManagement platform is fully aligned with ECM and fills the gap of traditional EHR systems. Incedo offers an integrated whole-person approach to care management and facilitates collaboration across providers and managed care plans to improve outcomes for California’s most vulnerable populations. If you’re looking for a complete #ECM solution, let’s talk about how Incedo can help. https://hubs.ly/Q02RnVwW0 #HealthcareInnovation

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