About
Dr. John Byrnes is a senior healthcare executive with over 25 years of experience leading…
Articles by John
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How to Manage Medicare Advantage Patients in a Primary Care Practice
How to Manage Medicare Advantage Patients in a Primary Care Practice
Managing Medicare Advantage patients in a primary care practice can feel like juggling flaming swords. With an…
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How to Become a Top 100 Hospital
How to Become a Top 100 Hospital
When I started my first quality program, my teams and I only focused on one thing—improving care for our patients—and…
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How To Design a Medication Safety Dashboard
How To Design a Medication Safety Dashboard
Medication errors continue to be the most common errors in medicine. And this is after decades of work trying to fix…
9 Comments
Activity
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Mom and Dad’s life was never about them. It was always about how they could work together to make our world a better place. Their foundation did…
Mom and Dad’s life was never about them. It was always about how they could work together to make our world a better place. Their foundation did…
Liked by John Byrnes, MD, D.ABA
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Proud to work for this organization that earned KLAS recognition!
Proud to work for this organization that earned KLAS recognition!
Liked by John Byrnes, MD, D.ABA
Experience
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Education
Licenses & Certifications
Volunteer Experience
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Contributor
Big Life Foundation
Animal Welfare
One of my favorite charities, The BIG LIFE FOUNDATION is protecting over 1.6 million acres of wilderness in the Amboseli-Tsavo-Kilimanjaro ecosystem of East Africa, Big Life partners with local communities to protect nature for the benefit of all.
Since its inception, Big Life has expanded to employ hundreds of local Maasai rangers—with more than 30 permanent outposts and tent-based field units, 14 patrol vehicles, 2 tracker dogs, and 2 planes for aerial surveillance.
Co-founded…One of my favorite charities, The BIG LIFE FOUNDATION is protecting over 1.6 million acres of wilderness in the Amboseli-Tsavo-Kilimanjaro ecosystem of East Africa, Big Life partners with local communities to protect nature for the benefit of all.
Since its inception, Big Life has expanded to employ hundreds of local Maasai rangers—with more than 30 permanent outposts and tent-based field units, 14 patrol vehicles, 2 tracker dogs, and 2 planes for aerial surveillance.
Co-founded in September 2010 by photographer Nick Brandt, conservationist Richard Bonham, and entrepreneur Tom Hill, Big Life was the first organization in East Africa to establish coordinated cross-border anti-poaching operations. -
Contributor
The Wild Animal Sanctuary
Animal Welfare
The Wild Animal Sanctuary is the oldest and largest nonprofit Sanctuary in the world dedicated exclusively to rescuing captive exotic and endangered large carnivores, providing them with a wonderful life for as long as they live. Located near Denver Colorado and Springfield Colorado, today, The Wild Animal Sanctuary encompasses more than 10,500 acres of space, with over 120 habitats. At TWAS, the animals come first! Providing expert care and rehabilitation, exceptional diets and enrichment, and…
The Wild Animal Sanctuary is the oldest and largest nonprofit Sanctuary in the world dedicated exclusively to rescuing captive exotic and endangered large carnivores, providing them with a wonderful life for as long as they live. Located near Denver Colorado and Springfield Colorado, today, The Wild Animal Sanctuary encompasses more than 10,500 acres of space, with over 120 habitats. At TWAS, the animals come first! Providing expert care and rehabilitation, exceptional diets and enrichment, and large spaces in which to roam makes life for our rescued animals the kind of life they would have if they could choose it.
Established in 1980, The Wild Animal Sanctuary (TWAS), is a state and federally licensed zoological facility and a 501(c)(3) nonprofit organization, and another of my favorite charities.
Publications
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Enhanced Physician Engagement, Tools and Tactics for Success, Chapter 9: Quality, A Cornerstone of Physician Engagement
Health Administration Press
Book Description
Successful physician engagement comes in many shapes and sizes. What works for one healthcare organization may not work for another. And with myriad differences among physicians in terms of age, specialty, work location, and more, multiple approaches to enhancing engagement are needed. The key is exploring different strategies and finding the ones that work for you and your organization.
Enhanced Physician Engagement, Volume 2: Tools and Tactics for Success is a…Book Description
Successful physician engagement comes in many shapes and sizes. What works for one healthcare organization may not work for another. And with myriad differences among physicians in terms of age, specialty, work location, and more, multiple approaches to enhancing engagement are needed. The key is exploring different strategies and finding the ones that work for you and your organization.
Enhanced Physician Engagement, Volume 2: Tools and Tactics for Success is a how-to guide for involving and inspiring physicians. The book examines concrete, practical methods for tackling hot-button issues such as burnout, the burden of electronic health records, and accountability—factors that can cause disengagement. With more than 40 years of healthcare leadership and management experience, editor Carson F. Dye possesses unique expertise in getting physicians more engaged.
Written by recognized physician leaders, each of the book’s chapters stands on its own, allowing you to find practical tips and guidance by topic according to your needs. Chapter authors explain the tactics that have been successful for them and share the lessons they have learned. Topics include:
Assessing physicians for leadership positions
Developing dyad, triad, and quad organization structures
Creating a physician leadership development program
Measuring physician engagement success
In Enhanced Physician Engagement, Volume 1: What It Is, Why You Need It, and Where to Begin, Dye offers a foundation for understanding what physician engagement is and the critical role physician leaders play in healthcare organizations. In this second volume, you will learn step-by-step tips and techniques for developing your own robust action plan for long-term engagement and organizational success.Other authors -
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The Healthcare Quality Book: Vision, Strategy, and Tools, 4th Edition. Chapter 4: Data Collection
Health Administration Press
Every healthcare organization is on its own unique journey, but each one needs a road map to a common destination—quality. Improving the quality of care is an essential strategy for surviving—and thriving—in today’s demanding healthcare environment.
The Healthcare Quality Book: Vision, Strategy, and Tools provides the framework, strategies, and practical tactics that all healthcare leaders need as they learn, implement, and manage quality improvement efforts. With chapters by a group of…Every healthcare organization is on its own unique journey, but each one needs a road map to a common destination—quality. Improving the quality of care is an essential strategy for surviving—and thriving—in today’s demanding healthcare environment.
The Healthcare Quality Book: Vision, Strategy, and Tools provides the framework, strategies, and practical tactics that all healthcare leaders need as they learn, implement, and manage quality improvement efforts. With chapters by a group of leading contributors with significant expertise and breadth of experience, the book offers a detailed exploration of the components of quality, while incorporating techniques to continuously improve and transform healthcare organizations.
The book is organized into four parts. Part I establishes the foundation for healthcare quality and examines the history of the quality movement. Part II speaks in depth about tools, measures, and their applications in the pursuit of quality. Part III focuses on the intersection of leadership and culture—which is central to the pursuit of quality and safety. Part IV concludes the book with a series of chapters that discuss many of the emerging trends that are shaping the contemporary quality landscape.
Building on the success of the first three editions, this new edition has been significantly redeveloped and reimagined, with content strategically refined to focus on what is most essential for healthcare managers. It features new and expanded information on:
Community health quality improvement
Quality measures and leadership
Provider profiling and registries
Culture-of-safety and high-reliability organizing
Health information technology
The Healthcare Quality Book is designed to be both an instructional guide and a conversation starter for all students of healthcare quality—all healthcare professionals, current and future.Other authors -
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The Safety Playbook: A Healthcare Leader’s Guide to Building a High-Reliability Organization
Health Administration Press
Each year, more than 200,000 patients die as a result of medical errors—the third leading cause of death in the United States.
Although the numbers are staggering and the challenges great, this national healthcare crisis is solvable—and fixing it has become a personal mission for John Byrnes, MD, and Susan Teman, RN.
Byrnes and Teman have a proven track record in helping hospitals and health systems transform into high-reliability organizations that aim to deliver error-free care…Each year, more than 200,000 patients die as a result of medical errors—the third leading cause of death in the United States.
Although the numbers are staggering and the challenges great, this national healthcare crisis is solvable—and fixing it has become a personal mission for John Byrnes, MD, and Susan Teman, RN.
Byrnes and Teman have a proven track record in helping hospitals and health systems transform into high-reliability organizations that aim to deliver error-free care at an affordable cost. In The Safety Playbook: A Healthcare Leader’s Guide to Building a High-Reliability Organization, they lay out their process for building a safety program that can eradicate preventable medical errors.
Written in a clear, conversational style, the book applies to all types of healthcare organizations and speaks to leaders across the spectrum—from board members and C-suite executives to clinical leaders; managers; and staff of quality, safety, and risk management departments.
Readers of The Safety Playbook will:
• Review the current rate of medical errors and explore proven solutions, including high reliability
• Discover how transparency about errors and their causes makes a successful safety program possible
• Learn how developing internal safety experts saves time and money
• Examine safety tools and practices used effectively in high-reliability industries
• Understand why communication is the top cause of medical errors and how to improve it
• Explore guidelines used in other healthcare organizations that create a culture of safety
• Study a sample project plan and timeline for implementing a safety program
Filled with compelling case studies and practical tools and strategies, this groundbreaking book can be a catalyst for transforming an organization’s culture, delivering safer care to patients, and ultimately saving lives.Other authors -
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The Quality Playbook: A Step-by-Step Guide for Healthcare Leaders
Second River Healthcare
See publicationThe Quality Playbook and the companion Workbook are about creating great clinical outcomes and safer care for patients, families, and communities; creating healthcare organizations that rank at the top of the nation’s rating lists; and doing what most organizations have been unable to do: deliver top quality at an affordable cost—true healthcare value. If one is embarking on a new quality program or wanting to improve one’s quality program, this Playbook will help in both situations.
The…The Quality Playbook and the companion Workbook are about creating great clinical outcomes and safer care for patients, families, and communities; creating healthcare organizations that rank at the top of the nation’s rating lists; and doing what most organizations have been unable to do: deliver top quality at an affordable cost—true healthcare value. If one is embarking on a new quality program or wanting to improve one’s quality program, this Playbook will help in both situations.
The Playbook has been divided into five parts that will guide the reader through the construction of a solid, effective, quality and safety program.
In part one, “Winning the Playoffs,” one will discover what’s possible when putting an effective program in place. The Playbook will review what it takes to become a 100 Top Hospital, how outcomes are now connected to an organization’s financial survival, and how quality can provide a competitive advantage and grow market share.
Part two, “Your Game Plan,” covers what to put in a quality plan, how to focus one’s efforts, and how to use techniques from finance colleagues to drive change and accountability.
In part three, “Your Winning Team,” the Playbook covers the nitty-gritty of the people side of the equation. Topics include everything from assembling a “kitchen cabinet” to building an effective physician infrastructure.
Next, in part four, the Playbook moves into “Your Tools, Tactics, and Plays.” It contains the most important tools and strategies to use in a quality and safety program, proven methods honed by the author in his twenty-plus years in quality.
In part five, the Playbook wraps up with “The Front Office and Owners (The Board).” The Playbook reviews how to mobilize the board and the C-suite—two groups that can add a lot of momentum to a program. Support and active participation by these groups is a key element of success in almost every high-performing program. -
The Physician's Guide to Disease Management, Chapter 6: Disease Management: Making it Work-A Study in Implementation Strategies and Results in an IDS
Aspen Publishers Inc
This text is designed to provide the physician with a working knowledge of disease management. Providers and managed care organizations are expected to deliver high quality care to defined populations efficiently, therefore knowledge of disease management is crucial. Included are discussions of evidence-based medicine, clinical practice guidelines and outcomes management.
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Global Fees for Episodes of Care: New Approaches to Healthcare Financing. Chapter 8: Disease Management and the Episode of Care
Healthcare Financial Management Association
Organizations
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American Association for Physician Leaders (formerly ACPE)
Board of Directors - Faculty Advisory Council & national faculty in quality & patient safety
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American College of Healthcare Executives
Member & Presenter at ACHE Congress
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Healthcare Financial Management Association (HFMA)
National Board of Directors
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LinkedIn User
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CDIQ Consulting
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
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Nicolas Ferreyros
In a move to streamline care, LA Care Health Plan which managed Medi-Cal and several other plans for low-income Californians is cutting back 24% of its prior authorization requirements. "This change aims to reduce administrative burdens and speed up patient access to necessary treatments," the article explains. This is good to see. Could significantly benefit patient care by removing unnecessary delays in treatment approvals. Devil is in the details but still good progress, particularly for the most vulnerable. Check out the article by Nona Tepper in Modern Healthcare at https://lnkd.in/evVP3eqP
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Artera
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
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John Whyte
Healthcare has made improvements but there's still a long way to go to become truly digital-first. While we've seen advancements in telemedicine, electronic health records, and AI-driven diagnostics, the journey to fully integrate these technologies into everyday practice is far from complete. And the “door” to care – patient navigation – needs a lot of work. If we don't evolve, patient's will find others who do! https://lnkd.in/eSJKiHSR #patientcentricity #digitalfirst #digitaltransformation #patientnavigation
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Shirlivia Parker MHA,RHIA,CDIP, BS
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
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Malie Maysilles
Recent regulatory changes provide hospitals a unique opportunity to reassess their reimbursement practices and strategy, showing the value of completing three reporting types in tandem rather than one at a time. By understanding how reimbursement programs like Medicare DSH, Worksheet S-10 Uncompensated Care, and Medicare bad debts are related, hospitals can save time, alleviate strain on their IT departments, free up staff to focus on high-priority work, and potentially improve their financial health. Learn more in this Moss Adams article by Heather Keser, Jonathan Mason, Jesse Vo and Josh Stewart.
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Reeham Neshiwat PhD CPCI
Starting April 1, 2025, Rural Health Clinics (RHCs) can include CPT Category II codes on Medicare claims. This advancement enhances quality reporting and aligns with value-based care initiatives, as these codes offer detailed insights into patient care. Previously, such submissions led to claim rejections; now, they aim to improve reporting accuracy without altering payment policies. Integrating these codes into the revenue cycle offers several benefits: 1. Accelerated Claims Processing: Detailed documentation reduces the need for additional payer audits, leading to quicker payments and less administrative burden. 2. Improved Quality Metrics: Tracking performance in areas like diabetes management aligns with programs such as Medicare’s Quality Payment Program, potentially resulting in higher reimbursements or bonuses. 3. Error Reduction: Precise coding minimizes errors in claims submissions, decreasing rework and payment delays. 4. Enhanced Negotiation Leverage: Demonstrating high-quality care through data enables better terms with private insurers, leading to higher payment rates or inclusion in premium networks. 5. Alignment with Value-Based Care: Participation in value-based contracts, where outcomes and quality metrics drive revenue, can unlock shared savings and incentive payments. While CPT Category II codes themselves are not reimbursable, their strategic use supports faster payments, fewer denials, and operational efficiency, positively impacting cash flow and the revenue cycle. #Medicare2025 #RuralHealthCare #CPTCodes #QualityReporting #HealthcareUpdates #ValueBasedCare #HealthTech #RHCUpdates #MedicalCoding #HealthPolicy #RevenueCycle #HealthcareInnovation #PatientCareQuality #HealthCareReform https://lnkd.in/etXFK3UG
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Virsys12
Discover how the largest not-for-profit health plan in the mid-Atlantic region transformed its provider lifecycle management with V12 Network. This powerful change has revolutionized their operations, leading to a more efficient, compliant, and future-ready system. Dive into the full success story and see how innovation made all the difference: https://bit.ly/3ANmL5o #Virsys12Success
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Value Health Innovations
Specialty participation in APMs, 4 strategic focus areas: 📌 Formation of Integrated APM Provider Networks 📌 Episode Payment Models 📌 Care Coordination and Collaboration 📌 Alignment with Advance Primary Care Want more details and insights, check out our 2 pager APM Specialty Care Insights.
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MDabstract
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.
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Angelica Landers
☝ 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
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Chuck Rackley
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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Cesar M Limjoco MD
An Outpatient Clinical Documentation Improvement (CDI) program offers substantial advantages to healthcare organizations by elevating patient care and operational efficiency. By integrating risk stratification with chronic conditions, enhancing quality measures, addressing social determinants of health, and establishing a collaborative team empowered by technology, such strategic initiatives result in improved patient outcomes and streamlined operations.
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Richard Ponder, MBA, CMRP, CPhT
Interested in the CMS Medicare Shared Savings Program (MSSP), but not sure where to start? Check out this helpful blog post by a value-based care expert on how MSSP provides a structure for intentional strategic exploration and learnings, even for systems not fully committed to value-based care.
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Luke Hansen
There’s no question that AI is transforming healthcare, and understanding where industry leaders perceive opportunities is important. The latest research report from Arcadia is revealing. 63% of healthcare leaders say AI can analyze large patient data sets to identify trends and create population health intervention strategies 58% say AI can analyze individual patient data to identify opportunities to improve health outcomes 47% say AI can optimize the management and analysis of electronic health records Dive into the report to gain insights from top tech leaders and see where the industry is headed! https://lnkd.in/gf_wkWij
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Hospital Association of Southern California (HASC)
#HASC2024AM 12:45, Laviana: Hear how Zephyr Healthcare Advisors & Altius Healthcare helped a CA hospital address post-pandemic workforce issues and save $12 million yearly. Zephyr is now assisting a SoCal hospital with these challenges. #workforce #performanceimprovement
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Aprille Ruckman
Interested in the CMS Medicare Shared Savings Program (MSSP), but not sure where to start? Check out this helpful blog post by a value-based care expert on how MSSP provides a structure for intentional strategic exploration and learnings, even for systems not fully committed to value-based care.
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Denroy Rodrigues
One in three doctors report that prior authorization has led to serious adverse events for patients, including: ⚠️ Hospitalization ⚠️ Life-threatening situations ⚠️ Disability or permanent bodily damage ⚠️ Congenital anomalies ⚠️ Birth defects ⚠️ Death Physicians are concerned that prior authorization processes often lead to inefficient use of healthcare resources, resulting in unnecessary waste rather than cost savings. About two-thirds of doctors noted that prior authorization led to ineffective initial treatments (64%) or extra office visits (62%). Additionally, 46% of doctors reported that it caused patients to need urgent or emergency care. The AMA is advocating for reform to reduce waste, delays, and disruptions in care. This survey underscores the urgent need to improve the prior authorization process to enhance patient care and reduce administrative burdens. What are your thoughts on this issue? Share your insights in the comments below. #RevenueCycle #RevenueCycleManagement #PriorAuthorizations
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