Renee DeSilva

What is the bottom line if you have financial responsibility for a provider group? Your competitors have the ability to know your contracted rates for everything you do. That's the bad news. The good news is that you can know theirs to help you in your next negotiation.

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Great defense of “private equity medicine” from former CMS administrator Leslie Norwalk. Though few clinicians fully understand it, PEM has become a popular bogeyman for a wide range of complaints about US health care. A few key takeaways: ·      All health care organizations require working capital. They should be judged on their behavior, rather than their source of capital. ·      Pushing health care organizations to more expensive sources of capital (e.g,, high interest loans) doesn’t serve anyone’s interests (except the banks). ·      The financial successes of private equity-backed companies accrue to everyone with a 401K or a mutual fund, not just a small number of wall street elites. ·      Reducing competition in health care (based on investment class) only accelerates market consolidation by integrated health systems, and the higher prices that come with it.

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Really interesting article. ASC operations are proving crucial for the successful adoption of value-based payment systems and evolving healthcare as we know it. Strong operational foundations inherently lead to economic success and greater flexibility in adopting new care models, which in turn improves patient outcomes. #ASCs #Healthcare #PatientCare

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GASTROENTEROLOGY QUARTERLY UPDATES - 3rd Quarter - Live Webinar - July 10, 2024 - 1 hr web - 10am PT - 1 ceu from AAPC. SPECIAL DISCOUNT ADDITIONAL ATTENDEES - sign up first person at regular price - each add'l attendee(s) goes for $99 a person (includes their own connection, materials & ceu's) - limited spaces available at this rate, so signed up soon! Here's link to download registration and fax to (415)892-1271 or register online at McVey Seminars website - https://lnkd.in/g4SAuyic WANT AN AMAZING DISCOUNT? (for a short time this below discount has an extra $50 off for this week only - so take advantage of double savings for a limited time) TO GET THE NEXT 4 GI QUARTERLIES AT THE LOW PRICE OF $735.00 (BRINGS THE COST FROM $230.00 EACH TO $183.75> here's link to do all 4 sessions for 2024/2025 - https://lnkd.in/gNXFUe8 / #gastroenterology #gastroenterologist #gastrointestinal #gastro #gidoc #healthcare #medicalbilling #medicalcoding #medicalbillingandcoding #coding #billing

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This article from Forvis Mazars US Healthcare Practice offers takeaways from the Centers for Medicare & Medicaid Services calendar year 2025 #OPPS Final Rule, impacting HOPDs and ASCs: https://lnkd.in/gy-mu5MV

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As 2024 concludes, healthcare leaders have gained critical insights amidst rapid advancements and challenges. Here's a glimpse of the year's key lessons: 🔍 Data as a Strategic Ally: Harnessing real-time analytics transforms operations and patient care. 💻 Telehealth’s New Era: Virtual care isn't just an option—it's expected. 🩺 Workforce Resilience: Supporting staff well-being is pivotal for quality care. 💡 Personalized Patient-Centered Care: Building trust through tailored approaches ensures loyalty and satisfaction. 📜 Adapting to Regulations: Proactive compliance safeguards growth and quality. 🚀 Tech Integration: Innovations like AI show promise but demand careful execution. 💰 Value-Based Care's Rise: Aligning rewards with patient outcomes reshapes operations. As we step into 2025, the focus remains on resilience, innovation, and care. These takeaways set the stage for a robust and adaptable future. What 2024 lessons resonate most with your healthcare journey? Let’s connect and discuss! #HealthcareLeadership #InnovationInCare #2024Lessons #FutureOfHealthcare

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Improving healthcare profitability by broadening your focus across Strategic growth, Revenue growth, Cost reduction and Capital deployment. Read the attached describing how Healthcare CFOs are approaching profitability efforts. #TinaWheeler #BillLaughlin #MarkBethke #GnanaKanisan #HowardDrenth #DavidVeroff #DorrieGuest #DonaldWallace #BradleyTate #JaclynChapman #ChristiSkalka #OliveORourke

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Join us for a crucial session where we delve into the Health Equity Index. Learn how it's calculated and its significant impact on quality and Star metrics for Medicare Advantage plans. View the SOA Health Meeting agenda here: https://optumin.co/ssw6cc #Optum #SOA #HealthEquity #Medicare #Payer

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AdventHealth is a healthcare organization with nearly 97,000 employees. The 250-person TA team is responsible for hiring more than 27,000 external employees each year and about 9,000 internal transfers. VP of TA Cathy Henesey explains how they became an employer of choice, and shares insights on her career, TA challenges at the top of her radar, technology, the future talent landscape and much more: https://lnkd.in/eHFETQBx #Talent #TalentTechnology #AI #ArtificialIntelligence #AMSVerified #Radancy #HireVue #HiredScore #Workday

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AdventHealth is a healthcare organization with nearly 97,000 employees. The 250-person TA team is responsible for hiring more than 27,000 external employees each year and about 9,000 internal transfers. VP of TA Cathy Henesey explains how they became an employer of choice, and shares insights on her career, TA challenges at the top of her radar, technology, the future talent landscape and much more: https://lnkd.in/eHFETQBx #Talent #TalentTechnology #AI #ArtificialIntelligence #AMSVerified #Radancy #HireVue #HiredScore #Workday

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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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Transparency and empowerment are the cornerstone of what HWL provides healthcare organizations every day, and our reporting and analytics suite is the foundation on which we are built. Whether you are seeking clear knowledge of where you spend on contingent labor, want to have detailed rate analysis, desire better forecasting, or are seeking a larger strategic view to help with hiring decisions; our tools put you in the drivers seat.

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As healthcare providers transition to value-based care, the significance of CDI cannot be overstated. Effective CDI capabilities and resources are crucial for ensuring medical record accuracy, completeness, and consistency, resulting in optimal reimbursement and enhanced compliance.    At AGS Health, we’ve made substantial investments in clinical technology and resources to help ease the CDI burdens on your valuable clinical resources. We’ll handle the documentation so your clinicians can focus on care delivery. 

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Thank you to our wonderful participants this afternoon in the HCT Consulting Group Healthcare Transformation Executive Roundtable. Brian D. Washburn, DHA, MHA, FACHE, FACMPE, CHFP, PMP Chris Saxman Elizabeth Crawford Restat Elya Prystowsky, MS, PhD Mark Korth. I was encouraged by several insights from this amazing group: 👉 #Transformation - we know it when we see it! 👉 #Valuebasedcare - we know it when we don't! 👉 #Valuebasedcare means different things to #patients and #providers but we should not lose sight that like or not, we have to play by the language and definitions being proposed by the Centers for Medicare & Medicaid Services 👉 #Transformation towards #VBC should be keeping healthcare simple, local and well-coordinated - what 99% of people are trying to do today. Organizing to stop the despicable 1% is adding 30% of costs to everyone - especially #ruralhealth 👉 #EMR Transformation has put some hospitals out of business and in some communities, when the hospital closes, the whole community shuts down 👉 #Transformation this group sees on the horizon includes demand for change only intensifying, doing more with fewer providers, addressing #documentation challenges, #AI should focus on removing the hassle of the little things 👉 MAJOR RISK AHEAD - Will #transformation defined by CMS + #BigTech lead to a loss of simplifying the provider-patient experience? Will documentation to meet #VBC demands only escalate due to the 'potential' of what technology offers? And therefore, will health disparities only expand due to the inability of #ruralhealth to keep up? Ultimately - will we eventually have to unwind many of the current technology investments to one day return to a simpler provider-to-patient connection? Thanks again to our amazing participants. DM me if you'd like to be on our roster to participate in the next one!

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💡💡Great insights from our #MDaudit #2023Benchmarkingreport Case accuracy in professional and hospital billing present significant revenue opportunities.... With national staffing shortages impacting the field of healthcare; technology, automation, and analytics have become important catalysts for billing compliance departments as leaders look to increase productivity despite fewer staff members. Operational efficiency and coding accuracy become key drivers for financial effectiveness. Billing compliance teams are doubling down on auditing coders and tracking case accuracy rates for E&M and procedure services across professional and hospital billing. As you will see in subsequent pages, a single percentage increase in accuracy rates will mean cleaner claims during initial submission and in turn millions of dollars in reimbursement in a timely manner. 1. Case accuracy describes the accuracy of the total claims being audited 2. Code accuracy describes the accuracy of codes (E&M, CPT/HCPCS or DRG) in the claims being audited

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This Thursday the Energy and Commerce Committee will hold a hearing on the Centers of Medicare and Medicaid Improvement (CMMI). Members of the Committee are expected to raise concerns and praise for the agencies' efforts to test and achieve savings in value-based payment models over the years. Since its inception in 2010, CMMI has tested many new payment models including bundled payments, multiple accountable care organization offerings, and the making care primary model. The agency continues to face challenges, such as finding ways to engage rural providers and solo or small physician specialty practices. Reps. Michelle Steel and Susie Lee and Sens. Markwayne Mullin, Kyrsten Sinema and Thom Tillis introduced the EASE Act (HR 7149 / S.4078) to encourage CMMI to create a new payment model for rural and underserved communities to reduce long wait times that many seniors and residents face in these communities when seeking care from a specialist. The bill was developed based on years of data collected and reviewed by OCHIN to help community health centers and rural hospitals improve care integration and create a new value-based payment model. While Congress looks for ways to improve outcomes and reduce costs; and medical schools continue to look for ways to grow the physician workforce, one pathway that would fill the needs of communities (especially rural areas) and prevent avoidable hospital admissions is the EASE Act which looks to utilize telehealth or e-consults to help our most vulnerable populations receive timely care

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Providers who are in casemix states, as you’re improving the accuracy of your MDS assessments, be certain to consider the implications will do to adjusted staffing

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"...Hospitals and health systems can generally expect improvement in their operating margins in 2025, though margins aren't likely to recover to pre-pandemic levels, said Erik Swanson, senior vice president of data and analytics at consulting firm Kaufman Hall. He said 2% margins wouldn't be out of the question for health systems..." 

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