J. Mark Debnam

Interoperability standards continue to shape the #healthcare industry from #CMS regulations to #HEDIS reporting. To set themselves up for continued success, payers must anticipate the coming shifts, and stay ahead of the ever-evolving landscape. 💭 A recent byline in DOTmed.com, Inc from our client Cotiviti dives into the necessary steps payers must take to ensure these standards are met for seamless #dataexchange: https://lnkd.in/ghGB_txj #interoperability #datasharing #FHIR 

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"Are You Prepared for Your Electronic Health Record Upgrade?" Upgrading to a new version of an EHR (Electronic Health Record) software application is a significant task that requires careful planning and execution. Here are some best practices that Fivebase employs to ensure a smooth transition: ✔️ Understand Benefits: The organization must complete all due diligence on the upgrade and its benefits for clinical, revenue cycle, frontline, quality, and administrative leadership. This will give all team members an elevator pitch of the system's top “X” improvements. ✔️ Define and Prioritize Goals: Clear leadership and governance are crucial to aligning the upgrade with your organization's strategic goals. Defining the exact future state will keep the team focused on the end goal, ensuring a successful upgrade aligned with the organization's strategic direction. ✔️ Understand Current System: Document your current EHR workflows and core reports. You want to make sure you can discuss and review any updates that will be happening and let the team know the benefits of moving forward. This understanding will prepare you for the changes and make you feel more comfortable and knowledgeable about the process. ✔️ Review Project Plans: Your EHR vendor will provide a project plan for every implementation. Your team must thoroughly understand all timelines and their interconnections, especially if other projects are running in parallel. This understanding will ensure smooth coordination and successful implementation. ✔️ Review Upgrade Team: Software vendors constantly add and train new staff. This is core for any company. The main thing to focus on is coordination and training. You must have senior staff on the team to help and direct any upgrade. It’s okay to ask what type of experience people have regarding your upgrade. By following these best practices, you can minimize disruptions and maximize the benefits of your electronic health record system. The goal is to reduce electronic health record frustration and maximize quality time with clients. Fivebase is your partner for clinical process optimization. With a strong focus on integration and database reporting solutions, Fivebase aims to connect customers to their clients and data through innovative technology solutions. Let's connect today! #BehavioralHealthEHR #MentalHealthTech #DigitalHealthRecords #BehavioralHealthIT #EHRIntegration #CuresAct #EHRinteroperability

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Looking to improve patient outcomes and boost revenue? Aylo Health in Metro Atlanta implemented a Chronic Care Management program with ChartSpan, resulting in increased preventative care for Medicare patients, generating new revenue annually, and empowering patients with resources and remote care coordination. If you're interested in learning more about Aylo's success with a CCM partner, check out their free case study here: https://lnkd.in/eE-7wV29 and then lets talk. #healthcare #chroniccaremanagement #ccm #patientcare #casestudy

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Prior authorization continues to be a point of contention in the healthcare industry, especially within Medicare Advantage plans. Recent terminations between healthcare systems and MA plans highlight deeper challenges around #PriorAuth processes, contributing to payer-provider friction. Both payers and providers face financial pressures, and misunderstandings about utilization management add to the strain. While 90% of prior authorization requests are ultimately approved, the drawn-out process, largely due to insufficient documentation, causes frustration. Automated prior auth systems and clearer documentation practices could ease tensions. Read the full article here: https://hubs.la/Q02WdFt30

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Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.

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Curious about the benefits of TEFCA policy changes? Join our upcoming webinar with Home Health Care News as leading industry experts discuss the evolution of exchanging health data on a national scale. Save your seat for this session on Oct. 17 at 2 pm ET: https://shorturl.at/WByRS

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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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Last month, HHS released a final rule establishing disincentives for healthcare providers who have engaged in information blocking. Read more on the final rules below 👇 https://lnkd.in/ejRupHZS #Healthcare #HealthcareCompliance #HHS #InformationBlocking #IT

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Join home health regulatory expert and advocate Cindy Campbell RN, MHA Healthcare Informatics for an important webinar on the latest CMS proposal for CY 2025, which includes significant payment cuts and adjustments that may affect your home health agency’s future. #WellSky #homehealth #proposedrule #CY2025 #CMS #paymentcuts #webinar Register today!

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Here is a summary of CCHP's latest update on Out-of-State Telehealth Provider Policies: Provider licensure exceptions for telehealth across state lines remain a key issue, with frequent inquiries from providers and patients. Providers often seek a list of states allowing out-of-state care via telehealth. Generally, telehealth is governed by the patient's state, requiring providers to hold an in-state license or approval, with some limited exceptions. Limited licensure exceptions vary widely by state and profession, making a comprehensive list difficult. Common exceptions include provider-to-provider consultations, continuity of care, infrequent interactions, emergencies, and specialized care. Currently, 29 states have such exceptions, with 9 states also having a telehealth registration process. Telehealth registration processes exist in 21 states, aiming to ensure oversight of out-of-state providers, often with restrictions on in-person care. Interstate licensure compacts also facilitate out-of-state telehealth, with only 5 jurisdictions not participating in any compact. There are twelve compacts, each varying by provider type, aiming to streamline multi-state practice. Providers should always check with state licensure boards for compliance, as state policies and insurer coverage requirements vary. As of June 25, 2024, CCHP's data shows: - 29 states with limited licensure exceptions - 21 jurisdictions with telehealth registration processes - 9 states with both exceptions and registration - 12 jurisdictions with no specific exceptions or registration, 9 of which are compact members - 5 jurisdictions with no compacts - 3 jurisdictions with no exceptions, registration, or compact https://lnkd.in/gspndAWG

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New Blog Post! ✨The Cost of Redetermination - The Heart of the Matter Discover the cost of Medicaid redetermination on patients & clinic staff and how coverage management solutions, like PointCare's, can improve outcomes. https://bit.ly/3M3mygJ

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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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Discover how Care Management transforms healthcare by coordinating services and enhancing patient outcomes. Learn about the imapct of this proactive, personalized approach and how it can meet evolving needs by reading the article below. https://t.ly/Co7JF #CareManagement #HealthcareInnovation #IntergratedCare #MPCareSolutions

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Rhode Island's 2.4.17(c) regulation sets the stage for personalized resident assessments and service plans in healthcare. It's not just about compliance; it's about ensuring each individual receives the best care possible. Check out our blog for helpful guidance on navigating these standards. https://hubs.la/Q02vCr1C0 #ResidentAssessment #RhodeIsland

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Tune in to this podcast featuring Eric Alper, UMass Memorial Health Senior Vice President, Chief Clinical Informatics Officer, and Chief Quality Officer, to learn more about Hospital at Home and its future growth, and the potential AI brings to improve safety and quality while enhancing the patient and caregiver experience. In addition, Dr. Alper shares his career journey and how combining informatics, technology and expertise enhance care. Listen now!

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EMS Connect facilitates potential hospital return on investment (ROI) through reimbursement optimization. It eliminates the reduction in care reimbursement that the health system may incur due to missing EMS care records by automating EMS care record transmission. This is particularly relevant in areas where justification for activating high-cost care teams and systems is crucial. Examples include trauma team activations, interventional cardiology activations, and neuro/stroke team activations. Learn more: https://zurl.co/AGP5 #EmsConnect #SAFR #SDHC #HIE #HospitalROI #ReimbursementOptimization

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New Online Course! CMS-HCC Risk Adjustment Model Version 28: Be Proactive What can you do to mitigate the impact of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Codes (CMS-HCC) risk adjustment model Version 28? This online course reveals a proactive approach to mitigating the potential negative impact of Version 28 through proper identification of diseases and conditions coupled with addressing, assessing, and properly treating those diseases. It follows clinical and coding guidelines to address diagnoses and conditions for which the risk adjustment factor has been eliminated or reduced. It does this through a disciplined approach of reviewing co-morbid conditions, alternative diagnoses, and improved specificity. In all cases, the primary purpose is to treat the patient's diagnoses and conditions to improve the quality of life for the patient. Learn more about this course at https://lnkd.in/eVmECiEs. #CMS #hcquality #patientcare

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Implementing a new EHR? This episode of The Better Care Podcast is a must-listen! Brian Fengler, MD, sat down with Stacey Johnston, MD, MHA, CHCIO, VP and Chief Applications Officer at Baptist Health to learn about their successful Epic implementation that landed them an Epic Gold Star Level 10 award in just 11 months! Listen tomorrow on all podcast platforms! #epicimplementation #ehrimplementation #healthcaretechnology #healthcarepodcast #epicgoldstar

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