Sandip Godambe

🌟 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

35

"However, these savings—as much as $50 billion annually1—are unreported and not shown to improve care access for patients without adequate insurance.2,3" ---Well, the financial design is so bad that it has closed over 600 hospitals since DRG and the era of cost cutting. The financial design is the reason for closures and compromises. The 50 billion distributed to hospitals serving vulnerable populations (40 - 50% of US pop) would be some help due to the Era of Cost Cutting 1983 to 2030 or longer. "Per CMS’s budget neutrality principle in the Outpatient Prospective Payment System (OPPS), the $9 billion repayment must be offset by $7.8 billion of cuts to nondrug reimbursements." ---Budget neutrality and regulatory capture prevent any true reform to add support to the hospitals and practices serving most Americans most behind. Once again CMS is not accountable and must be reigned in even if it takes 50 years as it did for physician accountability over the last half of the 19th century and for human subject researchers over the last half of the 20th century. Medicare and Medicaid have failed for 2621 counties (40% of US) most behind and has primary care and basic health access except 1965 to 1978. What about the Belmont Principles and numerous violations? What about protection of vulnerable populations, informed consent (which requires prior study of consequences poorly done by CMS), or beneficent intent - especially with all three lining up consistently against the majority of the nation most behind time after time! Strike 1 for ethical and moral violations - CMS has demonstrated time and again the inability to protect their charges - vulnerable Americans. CMS most fails where there are concentrations of elderly, poor, disabled, and their worst public plans. Strike 2 - CMS has failed to do adequate studies of consequences prior to the implementations of policies since 1983 and including Medicaid Waivers which will steal more from team member support and give more for team members to do - with worst impacts on Community Health Centers with 50% Medicaid and in the most vulnerable populations highest in concentrations of Medicare, Medicaid, and Dual plans. Studies are done more to justify what CMS is doing rather than to protect most Americans most behind from consequences such as their providers rated poorly or penalized just for caring for these populations inherently lower in outcomes and drivers of outcomes (Readmissions, ACO shared savings, Star Ratings, others) Strike 3 - CMS fails for beneficent intent. The intent is cost cutting. CMS harms tens of millions with designs that have killed hundreds of hospitals and countless practices, delivery team members, and local leaders in health and other community areas. We know about some economic and access impacts from these losses, but the full impact and cascades of impacts are never studied. See comments for losses of jobs, income, leadership, and better health insurance

A 2021 report by the The National Academies of Sciences, Engineering, and Medicine found that while more than 35% of health care visits in the U.S. are to primary care physicians, only about 5% of health spending is on primary care. That’s compared with about 13% for some other developed nations. #primarycare #prevention #publichealth #california https://lnkd.in/g37iugjS

1

Now available - Bundled Payments for Care Improvement (BPCI Advanced) Model Year 4 evaluation findings: go.cms.gov/bpci-adv-ar5 and At a Glance report: https://lnkd.in/e49jD3YM BPCI Advanced aims to provide patients high-quality, coordinated care, support successful recovery and reduce the frequency and length of preventable hospital stays and emergency department use during a clinical episode: go.cms.gov/bpci-advanced.

32

Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the responsibilities of public health agencies that overlap with those of the CDC and argues that the role of the CDC could be redirected to better meet the needs of its core mission. https://ja.ma/40jMUU6

3

"A one-year analysis of 21 Kaiser Permanente Northern California Oncology practices presented at the 2023 American Society of Clinical Oncology Annual Meeting found that each of its oncologists respond to an average of 19 secure patient-physician portal messages per day, including weekends (Abstract 1503). The unseen value of these messages was estimated to be more than $11 million, including roughly $3.8 million in avoided out-of-pocket patent copayment costs and $7.7 million in missed billing. Major cancer centers are increasingly billing for some nonurgent patient portal messages, including Johns Hopkins Medicine, Michigan Medicine, Cleveland Clinic, and the Fred Hutchinson Cancer Center. In addressing the ethics of billing, Dr. Nazha said that health systems need to create an approach that, “1) is efficient and equitable, 2) ensures patients receive valuable and timely access to medical services, and 3) protects the well-being of healthcare providers.”" https://lnkd.in/eYgsKy_x

6

Fascinating new research from Dr. Jeralyn Bernier Jacobs, a physician research scholar at Mid-Atlantic Permanente Medical Group | Kaiser Permanente, shows a significant rise in the incidence of #prediabetes and #TypeIIDiabetes in children and adolescents early in the COVID-19 pandemic. As Dr. Jacobs says, “The pandemic's impact on our children’s health was notable and has potential longstanding implications.”   I look forward to Dr. Jacobs’ future research on pediatric diabetes. #PermanenteResearch https://lnkd.in/gfW2M2S5

29

In recent years, several Health Systems and Payers have started offering Housing Programs / support to patients with complex care needs. While searching for evidence that such programs make meaningful, measurable impact on outcomes and cost, I have often wondered about the variability in study designs and execution strategies with an eye toward scalability. For those of you who have worked in Medicaid, you have certainly felt the challenges when designing and implementing programs at scale! You will enjoy this ! The study evaluated California’s Whole Person Care (WPC) Pilot Program, a Medicaid Section 1115 waiver initiative aimed at addressing health-related social needs (HRSNs) among vulnerable populations through care coordination and cross-sector collaboration. Results showed that while most pilots reduced emergency department (ED) visits, only four (out of 16) also reduced hospitalizations. Key success factors included : 1. Strong partnerships with public housing entities, 2. Field-based outreach, 3. Robust electronic data-sharing infrastructure, 4. Adequate program investment (i.e. don't skimp on investing in 1-3 above!!) Conversely, pilots with low program intensity or weak public housing partnerships were less effective. These findings highlight the importance of well-resourced, integrated approaches to addressing HRSNs in improving health outcomes and reducing acute care utilization. And, I whole heartedly agree with the Authors' conclusions that we need more evidence to start identifying most effective interventions and execution strategies. We will get there! Data stories are always the best ones! #PopulationHealth, #SocialDeterminantsOfHealth, #CareCoordination, #HealthEquity, #SupportiveHousing, #DataDrivenHealth, #HealthTech, #HealthcareIsights, #Medicaid https://lnkd.in/eAUTsjuW

11

🚀 Transform Your Hospital with the CDI MasterClass! 🚀 Are you ready to elevate your hospital's Clinical Documentation Integrity (CDI) practices? Join the ultimate resource for adult acute inpatient care teams, including physicians, CDI specialists, coders, and all stakeholders! ☀️ What We Offer: Unlock a year-long subscription to 50 engaging 30-minute on-demand webinars, rolled out every week! These sessions are designed to ensure that all team members are on the same page while revolutionizing your approach to CDI. Regardless of your shift, take a moment to enhance your skills and knowledge -- just log in and learn at your convenience throughout the contract year! 🏥 Why Choose the CDI MasterClass? The CDI MasterClass program is tailored not only for CDI specialists but also for all stakeholders involved in the process, including medical staff, coders, the CDI team, quality assurance, utlization/case management, appeals/denials management, risk management and compliance. The success of a CDI program relies on collaboration and cohesive efforts among all these groups, as operating in silos rarely leads to effective outcomes. Our comprehensive curriculum empowers your teams to adopt a proactive approach to CDI, leading to: - Improved patient care - Optimized coding accuracy - Enhanced net financial outcomes for your organization 👌🏽 Don’t Miss This Opportunity! Transform your hospital's operations and elevate your CDI practices. Encourage your hospital or health system to sign up today! The path to financial success lies in effective and resilient revenue optimization.  How can you achieve revenue optimization? By accurately capturing the patient's story through concise documentation and precise coding. The key is to enhance revenue with integrity while reducing denials through authentic storytelling. A proactive approach is essential to mitigating risks associated with malpractice and payment denials. ℹ️ Ready to Learn More? For more information about our CDI MasterClass program and to receive a copy of the curriculum principles, email us at [email protected]. Take the first step towards a successful and cohesive CDI strategy! Join us today and make a lasting impact on your healthcare team’s performance! AHIMA American College of Physician Advisors (ACPA) American Medical Association American Hospital Association Healthcare Financial Management Association (HFMA) Health Care Compliance Association (HCCA) American College of Healthcare Executives

11

1 Comment

Viewpoint discusses recent study findings that emphasize mail-order pharmacy dispensing improves access to medication abortion, especially via primary care, where it would not be practical to store medications for dispensing. https://ja.ma/46AjC4E

2

The fee schedule, administrative burdens and inflation are putting a strain on physicians. The Centers for Medicare & Medicaid Services finalized cuts to the 2025 physician fee schedule for the fifth year in a row. The final rule was adjusted “to strengthen primary care, expand access to preventive services and further access to whole-person care for services such as behavioral health, oral health and caregiver training,” the #CMS press release states. Unfortunately, while these cuts lift primary care practices, specialists are floundering. There was a really good Definitive Healthcare survey in 2023 that found over 70,000 physicians have left the #healthcare #workforce over the last 2 to 3 years. This is because of unsustainable rising costs in maintaining a practice combined with administrative burdens which ultimately lead to #physician #burnout. Patients are most affected! Insightful WORKING HEALTHCARE #podcast episode with Emily L. Graham, MSHIM, RHIA, CCS-P of Hart Health Strategies Inc. and key legislative affairs expert for Coalition of State Rheumatology Organizations (CSRO) and Florida Society of Rheumatology: 🍎 Apple #Podcasts: https://lnkd.in/ecvm6VGH 🎙️ Spotify: https://lnkd.in/eapjJyU5 American College of Rheumatology American Medical Association American College of Healthcare Executives MGMA PodPopuli Association of Women in Rheumatology (AWIR) Rheumatology Advance Practice Providers (RhAPP) RPPA - Rheumatology Private Practice Alliance FAU College of Business Florida Atlantic Executive Education https://lnkd.in/exHPAYUj

12

1 Comment

Please help the Association of Healthcare Value Analysis Professionals (AHVAP) in welcoming the newest member, Robin Lundrigan, MS, RN, CVAHP to the Association of Healthcare Value Analysis Professionals (AHVAP) family. Welcome Robin! To learn more about Association of Healthcare Value Analysis Professionals (AHVAP) membership, visit: www.ahvap.org. #AHVAP #membershipmatters #valueanalysis #valuebasedcare

3

3 Comments

Earlier today, #CMS issued a #Medicaid Final Rule codifying existential Quality, Access and Accountability requirements. Among other things, these new rules improve #AccessToCare and #HealthEquity by: ⏩ Creating a mandatory MCD Quality Ratings System (#QRS) containing 18 required #HEDIS & #CAHPS measures which mirrors #MedicareAdvantage & #Exchange #StarRatings programs and requires public display of ratings online  ⏩ Requiring 10- or 15-day maximum wait time standards for routine appts for OP MH/SUD, #primarycare, OB/GYN & 1 add’l state-chosen service ⏩ Requiring MLR reporting, and minimum 85% MLR if states set a minimum MLR target ⏩ Expanding/encouraging #VBP, #VBC and #APMs and codifies Provider Incentive requirements ⏩ Adding guardrails and clarity for use of ILOS, including enrollee rights/access and oversight (the MCD version of #SupplementalBenefits in #MA) ⏩ Codifying #QualityImprovement expense criteria  ⏩ Expanding/strengthening network adequacy and benefit/service availability requirements These rules require Medicaid MCOs to ensure actual access exists for the care and services beneficiaries are entitled to. Just as we've seen recently with CMS changes to #MA, #PartD and #Stars, today’s FR change the game. Especially in combination with the 2027/2030 #DSNP Alignment rules in the 2025 MA FinalRule, these new requirements represent the most change in MCD accountability in decades. Here are 3 practical things Medicaid plans can do immediately for success: 1️⃣ Identify a silo-buster. CMS is aligning programs to minimize burden. It will be hard, if not impossible, to be profitable and highly rated if MA and MCD use separate processes, vendors, provider incentives, etc. It will be even harder to pass along product-specific provider accountability via risk/VBC without cross-program synergy/alignment. #Silobust relentlessly! 2️⃣ Educate, re-educate, re-skill & up-skill. These 284 pages, combined with the 182 in this week’s Nondiscrimination FR and last month’s 1,327 page MA FR can’t be understood or operationalized in your team’s ‘spare time.’ Every person in every team needs to understand the #NewNeedsOfFederalFunding so daily decisions meet new regulatory requirements. 3️⃣ Know your communities, know your providers and know your members. #NextGen solutions in both MA and MCD will require us to know and understand the communities and patients we have the privilege of serving. CMS understands the seismic impact of these rules, and is giving multiple years to come into compliance with the #NewNeedsOfMedicaid. Adaptation will require every bit of the long runways, though it will be tempting to slow-roll transformation since the timeline is long. #WhatGotYouHereWontGetYouThere #Transformation > #TinyTweaks #LetsRoll ⭐ ⭐ ⭐ ⭐ ⭐

114

14 Comments

Join an #EN24 health equity engagement activity in the Experience Hall! Review four distinct patient scenarios and determine the ESI using your expertise. Then, discuss your decisions, delve into the "why" behind them, and reflect on what health equity truly means in the ED. #ENADEI

11

Viewpoint discusses the importance of researcher access to federal health care data following a CMS decision to limit the use of physical data and proposes solutions to maintain access and security. https://ja.ma/3Rh7uzg

3