Seth Ciabotti

➡️ 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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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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If you serve or sell to the #healthcare industry, you owe it to yourself to follow and listen to Eric Bricker, MD's posts. Whether or not you agree with everything he says, he's shedding light on the opacity and complexity of healthcare systems that has made changing/improving healthcare so difficult. #meddevice #healthtech #healthcareinnovation

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CarePoint Health System's most recent bankruptcy reflects years of financial struggles, legal disputes, and attempts to salvage its healthcare operations. Ironically, it was formed in 2013 when three hospitals—Bayonne Medical Center (BMC), Hoboken University Medical Center (HUMC), and Christ Hospital— were purchased out of bankruptcy. Financial strain and management controversies plagued the network, particularly after reports surfaced in 2019 that former CEO Vivek Garipalli and other leaders funneled millions through shell companies, casting a shadow over CarePoint’s financial integrity. In recent years, CarePoint’s financial troubles deepened, with operating losses reaching 14% and significant debt accumulation, prompting the state to appoint a fiscal monitor. CarePoint repeatedly requested state subsidies to maintain operations, cut employee hours, and faced over $11 million in lawsuits from unpaid vendors. An intense rivalry with Secaucus-based Hudson Regional Hospital and its owner, Yan Moshe further complicated CarePoint’s stability. Moshe acquired the land beneath BMC in 2019, spurring legal battles over property control. Bayonne’s city council attempted to safeguard BMC’s future as a hospital through zoning protections, leading to a prolonged court dispute that recently concluded with a ruling in favor of preserving the hospital's function. Despite their adversarial history, CarePoint and HRH recently forged a tentative partnership to create a unified healthcare network, a deal brokered by Jersey City Mayor Steven Fulop. However, just weeks after this announcement, newly appointed CarePoint CEO Dr. Jawad Shah abruptly resigned, leaving CarePoint without a clear leader and triggering renewed uncertainty. Following Shah’s departure, HRH promptly offered $25 million in interim funding to help CarePoint avoid liquidation. HRH proposed to integrate HUMC, Christ Hospital, and BMC into its network, which includes its existing facility in Secaucus, with hopes of forming a stable, regional healthcare system. The Hudson County community and union representatives have since called for a state investigation into CarePoint’s financial management. To keep this story very "New Jersey" its also worth noting that HRH’s recent public image suffered a blow due to the arrest of its marketing director, Reuven Alonalayoff, who was found with an arsenal of weapons and ammunition in an unlocked hospital office. This prolonged crisis raises a pressing question for New Jersey’s state leadership: why wasn’t more done to prevent this unfolding catastrophe? For years, warning signs were not only apparent—they were glaring. Mismanagement, spiraling debt, and questionable practices were well-documented. As a critical safety-net system, CarePoint’s facilities serve some of the most vulnerable populations in Hudson County. When we have a crisis in leadership, patients and communities suffer. Full stop. Kevin Lyonsjeff lestonJohn TozziAnna Mathews

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Have you registered for our HFMA Region 7 Midwest Conference? Here are a few reasons why you don't want to miss this event: Unparalleled Networking Opportunities: The conference will bring together a diverse group of healthcare leaders from across the Midwest. This presents an excellent opportunity for you to connect with like-minded professionals, exchange ideas, and build valuable relationships that can benefit your career and organization. Engaging Educational Sessions: The conference agenda is packed with thought-provoking sessions and panel discussions led by industry experts. You will have the chance to gain insights into the latest trends, best practices, and innovative solutions shaping the healthcare landscape. These sessions will provide you with actionable knowledge that you can apply to your own organization. Collaborative Learning Environment: The conference fosters a collaborative learning environment, encouraging open dialogue and the exchange of ideas. You will have the chance to engage in discussions, and learn from the experiences of your peers. This collaborative atmosphere will inspire new perspectives and innovative approaches to the challenges facing the healthcare industry. This Week's Featured Session: Medicare Advantage Plans: How CMS Final Rules Are Making An Impact Speakers: Terrence Cunningham, Director of Administrative Simplification Policy American Hospital Association Session Description: In this session, Terrence Cunningham from the American Hospital Association will provide an overview of the CY2024 and CY2025 Medicare Advantage rules, including an analysis of the potential impact of key provisions contained within the regulations.   https://cvent.me/W8wlZZ

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💡Interesting recent stat from Beckers! A consistent (3% to 5%) margin of revenue opportunity is lost due to the complexity of documenting and coding for complex inpatient cases. This uncaptured revenue is significant to a hospital's bottom line, with a 5% loss in a mid-size hospital potentially equaling $22 million to $38 million in lost revenue annually‼️ MDaudit can help with our Hospital and Coder audit workflows. Check out this short demo!

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The path to high performant specialty care starts with the referral—ensuring the patient sees the right doctor, at the right time, the first time, and every time. What I’ve been most impressed with in my early days on the Conduce Health team is the ability to accurately and consistently make this possible and personalized at the patient level. Interested in learning more? Let’s connect!

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Progress Note Showing Progress I finished a successful CDI program reset with the help of Keith Stokes, MD at a hospital in the Chicago area. Open Source MD, Inc. and @David Rosen hospitalist's group really put their best foot forward in listening to and becoming more proficient in charting within the EHR. The focus of the CD initiative was upon improving the quality and completeness of the physician's documentation starting with the ED note. This included ED documentation, H & Ps, progress notes, and discharge summaries. Our approach embraced the notion that all CCs/MCCs and CMI increases do not impact net patient revenue if the claims do not convert to money the CFO can use to finance hospital operations. ERNIE DE LOS SANTOS says it so well- "The CFO cannot pay this year's bills with next year's CMI. Without medical necessity clearly delineated and described in the medical record, there simply is no need for CDI. I am noticing progress notes are particularly problematic with excessive copy and paste that contains outdated information, diagnoses that are resolved and should be documented lower in the sequence of diagnoses. Interval histories are not documented to explain why the patient still needs to be hospitalized, the documentation does not clearly show whether the patient's clinical conditions are improving, worsening, or staying the same. This is only the tip of the iceberg when it comes to documentation oversights and incomplete documentation Check out the tool I have shared here called the PNAPE instrument. I encourage all CDI to use this tool as part of the daily chart process. You will undoubtedly find tremendous opportunity for progress note improvement that can be proactively addressed with real meaningful physician documentation training. Time to reject the status quo in CDI, it has reached its shelf life, much like a loaf of bread that becomes outdated on the grocery store shelf. #progressnotes, #betterdocumentation, #effectivedocumentation, #proactivepreemptivedocumentation

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Join Eric Lucas, Jonathan Mason & Georgia Green, MS, CHFP for a webcast on 8/27 - Medicare Regulatory Update: 2025 IPPS Final Rule. We’ll discuss the latest updates for hospitals and cover topics including an evaluation of the IPPS final rule key areas, reimbursement shifts and data trends identified in the IPPS final rule data, and next steps and factors to consider because of the final changes, including the mandatory TEAM model. #healthcare #hospitals

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Proof of Purpose; PDPs kept afloat Good for Manufacturers, too? The intricacies of IRA Part D benefit redesign dramatically reshape the OOP for millions of beneficiaries, reducing financial toxicity and raising utilization (I will post to past non adherence figures in comments) Unlike MA PDPs, freestanding PDPs can’t shuttle money over from the medical benefit to moderate premium increases, so some speculated that PDPs would fail. I commented several times that given this administrations view of the private market exemplified by MA that was highly unlikely. And after all PDPs are holding up half the benefit. CMS moves forward. “CMS is also announcing a voluntary demonstration program for standalone prescription drug plans (PDPs). The Part D Premium Stabilization Demonstration is designed to test whether additional policy changes stabilize year-over-year changes in premiums for participating standalone PDPs, leading to more predictable options for beneficiaries during the initial implementation of the IRA’s) benefit improvements, creating more gradual enrollment changes… Under the voluntary demonstration, there will be a reduction in the base beneficiary premium of $15 for all participating PDPs, combined with a year-over-year plan premium increase limit of $35 and narrowed risk corridors..” Thanks Tom Thoughts on implications, such as spillover from reducing headwinds, moderating adoption of narrower formularies and networks? If so possible plus for Phrma —not to mention if it slows down MA train with attendant Part B drug prior auths. #PartD #PDPs

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NAIC is pushing #CMS to allow members to leave their #MA plan if their provider terminates their MA plan contract. If this is successful, what would you do? ⏩ Would you rethink Provider contracts, payments, engagement or incentives? ⏩ Would it change your UM/MM, denials or #PriorAuthorization strategy? ⏩ If member retention was suddenly on the line, would you change your approach to provider contracting vis-à-vis #CAHPS and #memberexperience to protect #StarRatings? As more providers leave #MedicareAdvantage and the industry outcry grows, this is a great time for reflection: Could your plan adapt fast enough to not only survive, but thrive, if NAIC is successful? The future of member trust, satisfaction, and retention could depend on it. H/T to Amy Lotven for this great find! #ItTakesAVillage to keep up with all of the moving pieces now that 50% of seniors are in MA!

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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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Through an independent review organization and patient feedback, the Ohio Department of Medicaid provides a managed care plan report card each year. The 2024 report card was just released rating each of the seven Medicaid managed care plans. See how Ohio Medicaid’s health insurance plans compare in key performance areas: https://lnkd.in/gXRtKKMn #OhioMedicine #Physicians #Ohio

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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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Healthcare investment market is interesting yet challenging…

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Are you prepared for the coming additions to The Centers for Medicare and Medicaid Services (CMS) Medicare Advantage (MA) Star Ratings Measures? Beginning January 1, 2025, CMS is implementing additions and changes that will impact 2027 Star Ratings. MA Plans and providers must ensure they are fully prepared to identify beneficiaries for which these new measures apply and develop strategies to address their care needs — and time is ticking. Learn more: https://lnkd.in/eee7bAvu #FTIHealthcare Key Contacts: Mark Van Ert and Krunal Patel

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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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Healthcare organizations that have strong lateral communications can “turn on a dime,” adapting quickly when new challenges or opportunities emerge. Learn more about how you can leverage lateral communication for better team cohesion and patient experiences. https://bit.ly/4fyWCa4 #OrganizationalEfficiency #HealthcareLeadership #CommunicationStrategy

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