Bryan Webb

Last month's Vistage meeting highlighted the complexities structure examining work levels and the importance of defining cross-functional relationships with clear accountabilities. Tom Foster outlined seven key types of these relationships: service getting, prescribing, audit, monitoring, coordinating, collateral, and advisory, essential for an organization's overall functionality. The discussions emphasized the importance of "testing" team members with special projects to evaluate for advancement readiness, preparing them for future roles or promotions. This strategy enhances operational efficiency and prepares the team for dynamic growth and adaptability. I'm looking forward to diving into some of this with my team! #Vistage #FosterLearning #Relationships

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This is interesting to me. Lawsuits are occurring between employers and health plans based on runaway healthcare costs. Every large employer wants the largest network though with every hospital and provider in network. Leading network teams for way too many years, even when I would make the case to take a stand, we had very little support from employers as it relates to involvement even when we asked. If one plan took a stand, employers would just go to another carrier. This creates a never ending cycle of continued health care cost increases. Only way I see this ending is employers contributing a set amount and then providing numerous network options. Broad networks cost the most, narrowed local networks less. Let consumers decide like they do anything else. Some large employers have started offering 2 types of networks side by side but uptake small. I'm bullish on the concept of IHCRA's

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I don’t get scared easily, but there is something that scares me. Listen to your Minute with Mark to find out what that is. #strategy #strategicleadership #leadership #ahca #leadingage #snf #skillednursingfacility #leadingageca #demandmetric #snowcanyonstrategies

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🌟 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

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New Podcast Episode! In this episode, Jerry Gentile, EdD, MEd, MSHA, MPH, MBA, BSRT, BSHA, RRT discusses mechanical ventilation and its importance in critical and emergency settings. Mechanical ventilation applies positive pressure breaths to patients with impaired ventilation, compromised airways, or respiratory failure. Respiratory therapists need a thorough understanding of mechanical ventilation, airway mechanics, and human anatomy to effectively manage intubated or tracheostomized patients. Link in comments. What would you like to hear about on the podcast?

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Report after report continues to show how the big plans are raking in huge profits by owning large numbers of physician practices, pharmacies and many other service lines in the healthcare industry. https://lnkd.in/eiFwAVTa

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There is a lot of excitement in Washington (& around the country) around new healthcare policy possibilities. Of course we are ready with our own wishlist of changes and updates at the federal level to enhance access to trusted medical care and drive down the bloated healthcare industrial complex. Here's a snapshot: Expand Tax Benefits: Make all health plan payments, including individual contributions to DPC, tax-deductible. Enable HSAs for all Americans without requiring high-deductible health plans. Empower Physicians: Simplify Medicare opt-outs and give states authority over Association Health Plans (AHPs) to promote autonomy and flexibility. Enhance Transparency: Mandate public disclosure of insurer-negotiated rates to level the playing field for patients and independent practices. Address Workforce Shortages: Increase residency funding and loan forgiveness for independent physicians to sustain innovative care models like DPC. Support Medicaid Reform: Enable Medicaid voucher programs, similar to EBT or SNAP to allow recipients to pay directly for healthcare and DPC memberships, reducing reliance on costly emergency services. Caution: The government can't get in the middle of the financial or care transaction. 🔑 Leveraging tools like budget reconciliation and agency rulemaking, we can achieve these transformative changes to create a patient-centered, efficient healthcare system. #HealthcareInnovation #DirectPrimaryCare #PolicyReform #DPC #TaxBenefits #Transparency #PhysicianAutonomy https://lnkd.in/gSmndNXG

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JJ Part A and Part B Targeted Probe and Educate Active Medical Review List All CDI professionals must sign up for their Medicare Administrative Contractor list-serve to stay informed of updates to Medicare regulations & specific announcements geared towards the local region where the hospital operates. Pertinent relevant updates impacting the CDI profession include additions to the CMS Traegt Probed and Educate Program. From the Palmetto GBA website regarding TPE: "The Centers for Medicare & Medicaid Services (CMS) Targeted probe and Educate (TPE) program is designed to help providers and suppliers reduce claim denials and appeals by identifying provider errors, helping correct them, and preventing future errors. Medicare Administrative Contractors (MACs) have been tasked by CMS to identify high denial rates or unusual billing practices and work one-on-one with those providers to reduce claim errors and payment denials; MACs are also expected to review items and services that have high national error rates and are at a financial risk to the Medicare program." Notice in Palmetto GBA's JJ Part A and Part B Targeted Probe and Educate Active Medical Review List several common MS-DRGs DRG 470 - Major Joint Replacement DRG 291-293 Heart Failure and shock with or without CC/MCC DRG 682- 683 Renal Failure DRG 870–872-Septicemia or Severe Sepsis Greater than 96 hours These reviews incorporate elements of medical necessity, proper coding, & clinical validation. CDI must embrace the importance of situational awareness. Situational awareness requires a mindset beyond CC/MCCs, number of records reviewed, CMI, physician query rate, physician query response rate, etc. CDI must be aware of medical necessity denials, and clinical validation denials, taking a proactive preemptive denial avoidance approach to chart review. This approach by its very nature includes awareness of published MAC TPE Reviews & MAC published Medical Reviews. Being proactive entails conducting proactive audits of specific DRGs under review, ensuring documentation supports medical necessity, principal & secondary diagnoses are validated, and coding is accurate and compliant. Why wait to be a target for MAC review when proactive activity is more effective, warding off continued inaccurate/missing documentation, coding, and billing. Review payer denial letters involving clinical validation, incorporate payer-specific clinical criteria into physician documentation training, & consider creating dot phrases that contain payer-specific clinical criteria. An example is sepsis, subject to frequent denial due to "not meeting" Sepsis 3 criteria CDI- it is critical to be proactive versus reactive- stop chasing diagnoses and work with providers to become better documentarians, supporting diagnoses & warding off medical necessity & clinical validation denials. #CDI, #TPE, https://lnkd.in/eVHCtq3Q

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Pretty simple, help those that need guidance for health coverage with explaining what is available

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I had an amazing time at the inaugural Southeast Regional Urgent Care Association conference in Atlanta last week. J. Bernie Short, MD, FAAFP, FCUCM and Tracey Davidoff, MD, FCUCM, kudos for pulling this off. I was impressed by how smoothly everything went and the high quality of the speakers and content. I’d like to share some TAKEAWAYS from the conference: 1.       Chirag Patel shared a near future where patients with chronic conditions are monitored at home using smart devices. AI will alert healthcare providers to any concerning changes, allowing them to determine if a telemedicine visit, urgent care, or emergency care is needed. This shift means urgent care providers will need to handle more complex cases. 2.       John J. Koehler MD, ABPM(OM), CIME highlighted shifts in urgent care, where the push to see higher patient volumes led to core procedures (laceration repair, treatment of simple fractures) being redirected to the ED or specialists. This has led to 2 unintended consequences: loss of skills and stagnant reimbursements. There is room to grow as a specialty, and I see POCUS as one of the ways to get there. 3.        Members of the Urgent Care Association advocacy team (Kristin Rastatter, Cassandra Barnette Donnelly, J. Bernie Short, MD, FAAFP, FCUCM, and Patrick O'Malley) shared about their efforts in the Southeast and on the Hill. A high-priority item is to get approval for an “enhanced” place of service code for urgent care to improve reimbursements. This code would reflect the enhanced services that are already being provided, such as treating patients outside of normal business hours and performing X-rays.   4.       From Brad Laymon's session, I was surprised to learn that an average provider in UC under documents and under codes, resulting in a $50K loss for the practice per year. 5.       Martha Williams talked about the importance of emergency preparedness as a risk mitigation tool for the organization. This is a continuous process that needs to be reevaluated regularly. Practical training with assessments (get the providers to actually use that fire extinguisher and do the CPR!)  and building in redundancies in the supply chain are key to success. Bonus takeaway #6:  Outside of the conference hotel, there was a beautiful park. The Atlanta trees captivated me (and those were the only photos I took other than those of the presentation slides). What a way to recharge!  Friends, don’t forget to look up at the trees when you have a chance. #urgentcare #patientcare #meded #emergencypreparedness #medicaldocumentation

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Please reach out to your legislators to pass the Emergency Care Improvement Act to benefit seniors and members of the military. ONE STEP CLOSER TO BEING FEDERALLY RECOGNIZED TO ACCEPT MEDICARE / MEDICAID AND TRICARE Physicians Premier ER Supports the Emergency Room Improvement Act (S. 3531) Introduced to Congress in October 2018 PHYSICIANS PREMIER asks for your support of the recently introduced Emergency Care Improvement Act (S.3531)- a major step toward granting Freestanding Emergency Medical Center benefits to Texas Medicare / Medicaid patients, and our hero veterans with Tricare. Physicians Premier is hopeful that Congress will vote to pass this important legislation. “Our patients have the perception that Physicians Premier ER doesn’t want to accept Medicare / Medicaid and Tricare patients which is absolutely not the case,” states Dr. Lonnie Schwirtlich, Chief Medical Officer of Physicians Premier ER. “The fact is Freestanding Emergency Medical Centers (FEMCs) such as Physicians Premier ERs have not been recognized or authorized to accept Medicare / Medicaid or Tricare from CMS. This is an important bill for Congress to pass. This could mean accessible, cost-effective emergency health care for all Medicare / Medicaid and Tricare patients.”

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This is still true, even more so now, after a global pandemic. #Navigators in both the federally facilitated marketplace states and states with their own marketplace are a stabilizing workforce for their community when it comes to understanding when to enroll in coverage, how to choose a plan, what the plan changes are each year, how out of pocket costs vary, which networks to choose, when to appeal decisions, what preventive benefits are, how to read billing statements, translate in multiple languages, unpack complicated insurance jargon, and more. Please share! #Outreach #Enrollment #Medicaid #ACA #Healthcare

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Measuring Quality of Care Quality matters. Better health for everyone should be America’s goal. Where you live and receive your healthcare services makes a difference in your health.   Fortunately, objective understandable quality metrics are now easily available at https://lnkd.in/eVQyZ2E6. This easy-to-use website created by the federal government to help potential patients facilitate comparisons among hospitals is based on a variety of the more than 100 measures CMS publicly reports, divided into 7 measure groups or categories: Mortality, Safety of Care, Re-admission, Patient Experience, Effectiveness of Care, Timeliness of Care, and Efficient Use of Medical Imaging. Adding rationality to decision-making in determining where to go for care has the added benefit of improving performance for all hospitals because every healthcare system will have the extra motivation to improve its “grades.”   Better performance also translates system-wide to fewer complications, decreased waste, and lower costs. All these attributes contribute to a healthier America and the ability to transfer resources previously regarded as “waste” in healthcare to other worthwhile endeavors such as education, infrastructure, safety, and environmental protection.         Healthcare is the largest industry by far in America, consuming 18.3% of the GDP at $4.5 trillion dollars and growing. If the U.S. healthcare industry were considered a country, it would be the fifth largest in the world behind the U.S., China, Japan, and Germany. U.S. healthcare is larger than the United Kingdom. U.S. healthcare perennially ranks last in healthcare of the eleven most developed nations.     Healthcare systems living off a past reputation and perceived greatness, embellished and polished by extensive marketing, are no longer rational, effective, or fair to a naïve, stressed sick person. The most venerable institutions are now the most vulnerable.   Clear metrics such as heart failure, heart attack, pneumonia, and post-operative mortality rates objectively differentiate potential outcomes based on where you go for care. All this data is adjusted for age and severity of illness and, although the system is not perfect, it is the best we currently have, with all institutions having the same grading system.   Additionally, and arguably, even more important than being a repair shop, alert healthcare systems should be focused outside the four walls of their institutions. Sadly, our nation’s life expectancy has decreased in the last few years. This decline hasn’t happened since 1963.   Life has changed. Where you get care matters. Do your homework and add to your life expectancy. America can have better care for everyone now using accessible digital transparency.

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I’ve encountered this situation hundreds of times, almost to the point that in some hospital cultures, it’s the norm to constantly squeeze and stretch nurse leaders to cover for another vacant role. We’ve seen span of control stretch far beyond what is safe, typical, and effective for our RN leaders, patients, and staff, and ultimately deterioration occurs. It’s done as a perceived cost saving measure, as a means to not “disrupt,” or in thinking that an external Interim will do more harm than good. You know what I think? [Sure, Cassie, I’d love to hear what you think! 😜] I think, they’ve likely not been introduced to how HealthLinx® #TransitionalLeadership and #Interim process is different, and truly guards against the negative impact that so often results with less effective, stretch-covering interims or external staffing model interims! Read this short, powerful message and Brad Robinson’s take on the matter! If this is you now, let’s talk. Let us at least help you make an informed decision as to whether a stretch-covered interim is the right move for your hospital, or if there is a better, more cost effective, quality-driven, and proven method! Because there is! 😉

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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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#Hospitals and health systems are facing mounting #AdministrativeCosts due to the growing #AdministrativeBurden of #PriorAuthorization and #Denials by commercial health insurers. If you don't believe me, the American Hospital Association reported that hospitals’ labor costs alone increased by more than $42.5 billion between 2021 and 2023. That's nearly $6M per hospital in additional costs. Additionally, the overall administrative costs in the U.S. healthcare system are estimated to be around $496 billion annually! This burden makes us the most wasteful healthcare system in the world. These rising administrative burdens are unsustainable. Period.

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