Geraldine McGinty MD, MBA, FACR

In my latest interview with Becker's ASC Review, I shared that One of the most important leadership lessons I have learned is the value of resilience and strategic adaptability. Building an Ambulatory Suregery Center from the ground up comes with many challenges, from regulatory hurdles and staffing complexities to financial constraints and operational setbacks. Resilience is essential for navigating these obstacles and is not just about having a vision. It is about being determined to push through difficulties while staying focused on the end goal. The ability to adapt strategies when circumstances change is equally important. In the dynamic healthcare environment, being flexible and open to new approaches is crucial for overcoming unforeseen challenges and capitalizing on emerging opportunities. I firmly believe in adopting an entrepreneurial mindset, allowing flexibility, and fostering innovative problem-solving. I believe that leadership is about empowering a team to remain motivated and aligned with the vision, particularly during challenging times. It involves cultivating a culture of trust, collaboration, and continuous improvement, where every challenge is viewed as an opportunity for growth and innovation. 

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A drumbeat about the acute burnout faced by clinicians continues to plague the healthcare industry — and rightly so. Today, 49% of physicians say they are burned out. Further, one in five physicians indicate they are likely to leave their practice within two years. Burnout harms individuals and encompasses a variety of injuries including chronic stress, depression, exhaustion, and loss of joy in work as well as increased substance abuse and suicide. Clinician burnout clearly presents a wicked problem to address. However, the negative impacts of burnout in healthcare extend far beyond clinician well-being. As Dr. Thomas L. Schwenk said in a recent article in JAMA, physicians have effectively been the "proverbial 'canary in the coal mine.' While the canary may be sick, it is the mine that is toxic. Caring for the sick canary is compassionate, but likely futile until there is more fresh air in the mine." Therefore, it is imperative to usher fresh air into the mine by pulling up to understand and address burnout in a more holistic and comprehensive manner.” Burnout is a critical issue…to read more about the issues, please continue reading in the latest issue of Wharton Healthcare Quarterly.   Linda Roszak Burton and I are honored Z. Colette Edwards, MD MBA has once again invited us to be part of her amazing publication with this latest article “Executives Face a Moral and Business Imperative to Address Burnout”

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For decades, healthcare organizations were able to ignore their supply utilization misalignments (i.e. wasteful and inefficient consumption, misuse, misapplication, and value mismatches) in their supply streams with better pricing. However, we believe that those days of putting a band-aid on supply utilization misalignments are gone. As professionals, supply chain leaders have a responsibility to address this price gap with vigorous SUM programs to offset the meager savings they will be obtaining on their GPO contracts going forward.

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Health care spending in the US is projected to have grown 7.5 percent in 2023, much faster than the nominal GDP growth rate of 6.1 percent, according to the wonks at CMS. About 17.6% of the share of the nation’s economy is now devoted to health spending or about $4.8 trillion. The entire GDP if the UK is about 2.3 trillion pounds or just shy of 3 trillion dollars. https://lnkd.in/eg_yK8yK

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Health plan strategist and executive coach Dominick Bizzarro believes that an agile approach to strategic planning can help turn regulations like the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) from something done TO you to something done FOR you. #Interoperability #digitalhealthinnovation

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Clinical trials need to be representative if we expect the results to be applicable to ALL cancer patients. Let's double down to help address this imperative by carefully designing trials that optimize patient access. Let's all commit to taking a data-driven approach to defining eligibility criteria, and reducing site burden by focusing data collection on only those elements absolutely critical to study objectives!

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In the 1980’s a team of researchers at Harvard College, led by William Hsiao, MD began researching how government health systems and commercial insurers should compensate physicians for their services. For more than a decade they worked on a concept that ultimately became known as the Resource-Based Relative Value Scale (RBRVS). Due to rising health care costs, the federal government was taking an increased interest in this work and the United States Congress had directed the Physician Payment Review Commission (PPRC) to develop a fee schedule based on resource costs for physician payment under Medicare. In 1988, Dr. Hsiao and his team published their observations and recommendations in a JAMA article titled “Resource-based relative values. An overview” (https://lnkd.in/e6q4inue). In this historical article, Dr. Hsiao and his team discuss the “underlying elements that are necessary to constructing an RBRVS, each of which is described more fully in subsequent articles: measuring the work (intraservice work) of performing medical services and procedures, estimating preservice and postservice work, comparing work across specialties, measuring practice costs, extrapolating from surveyed services, and establishing an RBRVS for evaluation/management services and for invasive procedures.” The concepts outlined in this article, ultimately became the foundation for Medicare physician payments in 1992. Since 1992, Medicare has paid physicians through a fee schedule according to a resource-based relative-value scale (RBRVS). As noted by Paul Ginsberg, PhD and Robert Berenson, MD in their 2007 New England Journal of Medicine article “Revising Medicare's Physician Fee Schedule — Much Activity, Little Change” (https://lnkd.in/eB4FixBG) the RBRVS approach was “intended to address distortions produced by basing payments on prevailing charges, which had resulted in relatively low payment rates for evaluation and management services, as compared with procedures and technical services, as well as in large geographic variations not explainable by cost variation. The distortions were thought to discourage physicians from practicing in primary care specialties and in rural areas and to encourage a procedurally oriented style of care.”   So the logical questions we should ask ourselves are – what has happened since 1992 and did the RBRVS deliver on its stated goal of decreasing distortions in payments between evaluation & management and procedural/technical services? Join Primary Care for America for #PrimaryCare24 May 22-23, 2024 to discuss this and many other important issues impacting primary care in the United States. Registration is free https://lnkd.in/e5ZGUWJJ  

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S&P: Medicare Advantage's growth a bad omen for hospitals - n8: and Many Health Systems Continue to Participate Under the Terms Dictated by the MA plans, Enabling this Abuse “Even beyond rates, MA adds more administrative and liquidity hurdles for providers. S&P pointed to MA plans’ “key strategy” of prior authorization requirements, which force providers to absorb associated refiling costs and sometimes keep patients locked in a longer hospital stay. That burden is exacerbated by insurers’ generally “high” denial rates, S&P wrote, which have led to instances where smaller providers without the resources to fight claim denials terminate their MA plan contracts and become more vulnerable to closure…. The report also notes that many MA plans have longer pay cycles than traditional Medicare. Combined with claims denials and payment uncertainty, the delayed reimbursement “can hurt cash flow and liquidity,” according to the report.” https://lnkd.in/g3-drT-S So it goes n8 #healthsystems #hospitals #valuebasedcare #medicareadvantage #valuebasedscam

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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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We are receiving a lot of great feedback on the new "Pediatrics by PRG" module in the Pinson & Tang CDI Pocket Guide, which is the preeminent resource in the CDI space. If you haven't checked it out yet, take a look at the detailed review of over 40 topics that provide guidance to CDI specialists, coders, & clinicians on pediatric and neonatal conditions. This partnership is a key element of how Pediatric Resource Group (PRG) can help hospitals understand the CDI opportunity in the peds/neonatal space and tackle it confidently. If there are other topics you'd like to see, let us know, we can develop and publish those quickly. #CDI #pediatrics #Clinicaldocumentation

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McKinsey & Company Report: The healthcare industry is anticipated to undergo significant shifts, with government segments expected to outgrow commercial segments by 65% by 2027. This shift, driven by rising Medicare Advantage penetration and growth in duals segments, will impact payer profit pools. Health systems are facing substantial pressure due to inflation and labor shortages, but transformation efforts and cost containment, particularly in labor, are expected to help EBITDA margins recover. Healthcare technology is also predicted to experience rapid growth, with an estimated 12% compound annual growth rate (CAGR) from 2022 to 2027. https://lnkd.in/g4MfPH99

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⏳ Just 2 weeks to go until the Clinical Pathways Congress + Cancer Care Business Exchange in Boston! The event brings together industry leaders, healthcare professionals, researchers, payment reform experts, and innovators to discuss and showcase transformative oncology delivery, payment, and business models.​ ​ I am excited to participate in this panel with James Hamrick, Jeff Hunnicutt, and Will Shapiro. These are important topics, and these guys know their stuff. By exploring innovative strategies and solutions, we aim to transform the current cancer care landscape, ensuring better access, higher quality care, and improved patient outcomes. ​ ​ Together, we will delve into complex topics such as the role of AI in oncology, the significance of and barriers to effective clinical trial recruitment in the community setting, the power and impact of vertical integration, trends in practice consolidation, the EOM outlook from diverging perspectives, and so much more.​ We invite you to refine your approach in Boston on September 6–8, 2024.​ 🔑 Use code VIP to save 15% on registration. https://lnkd.in/gmCpcGgW #pathwaysexchange #clinicalpathwayscongress #cancercarebusinessexchange #TensorBlack AI in Precision Oncology TensorBlack

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Are you ready to stay the course, even when the finish line keeps moving? I want to share a story about a journey that took nearly two decades to complete. I represented a group of New York hospitals facing a complex Medicare payment issue. Our strategy required us to pivot between regulatory and legislative avenues multiple times, highlighting the importance of adaptability in any long-term plan. It took: ✅Patience ✅Tenacity ✅And unwavering confidence In our evolving strategy to ultimately succeed after 20 years. Remember, real change takes time. But with a resilient mindset, you can navigate any challenge and achieve your objectives. Stay confident and adaptable in your pursuits! #PersistencePays #LeadershipLessons #StrategicPlanning #AdaptAndOvercome

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Second medical opinions: Patients want them; doctors (even surgeons) endorse them; science supports them. Despite the many benefits, patients often forego getting a second opinion because of the challenge in getting access to experts. In this episode of Speak Up For Your Health, Frank McGillin, CEO of The Clinic by Cleveland Clinic talks about how they’ve simplified the process so that patients can quickly get second opinions by experts at the Cleveland Clinic – virtually. Here's a link: https://lnkd.in/g5tZVUq9 #virtualcare, #patientadvocacy, #healthcareaccess, #telehealth, #patientempowerment

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As #AI marches ahead in healthcare, some centers are investing significantly in their infrastructure and collaborations to support model development, application, and evaluation. Breaking down silos among clinical care, basic science, data science, IT, and healthcare data management is essential for the success of these centers. However, the approaches to achieving this vary widely. It will require significant financial investment: Mount Sinai Health System recently opened the Hamilton and Amabel James Center for Artificial Intelligence and Human Health, backed by a $100 million investment. This highlights the level of commitment needed to build robust AI ecosystems (https://lnkd.in/ghH_y-XC). It will require forward thinking: Washington University School of Medicine in St. Louis and BJC Health System have launched the joint Center for Health AI (https://lnkd.in/gXFwiGFt) incorporating opportunities for medical residents and students to gain skills in AI-driven care delivery. Integrating AI education into medical training is a key step forward. It requires collaboration across disciplines: The Department of Biomedical Informatics (DBMI) at Vanderbilt University Medical Center has launched its center for health Artificial Intelligence (AI) – ADVANCE (AI Discovery and Vigilance to Accelerate Innovation and Clinical Excellence). This center, Co-directed by Peter Embí, M.D., M.S. and Brad Malin (https://lnkd.in/gja4fcra) emphasizes the need to break down silos among clinical care, basic science, and data science. Centers like these set a standard for interdisciplinary teamwork. It may require collaboration between large healthcare systems and academic/scientific institutions with significant resources: Hartford HealthCare has launched The Center for AI Innovation in Healthcare and was created through collaboration with University of Oxford and Massachusetts Institute of Technology (https://lnkd.in/gZRGgRSi). Bringing together such institutions with significant technological resources and healthcare systems may be an effective model-- leveraging economies of scale (in this case technology know how and clinical care know how). The Google and Mayo Clinic partnership to advance generative AI applications in healthcare represents another promising model.(https://lnkd.in/gD4gfmcu). It will be fascinating to see which of these models thrives, the lessons learned, and how they shape the future of AI in healthcare. What do you think will drive the most successful outcomes? #UsingWhatWeHaveBetter

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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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Predictive risk modeling is not new. Here Guillermo Garcia-Garcia, MD, MACP, FASN, FNKF, FERA, FISN and the University of Cincinnati team discuss how they built and applied in patient care a multivariate ( Cox hazard ) approach to better identify and address the needs of ESRD patients in the early 1980's. How could they do so? The foundation was their unique and readily analyzable home grown regional computer-based patient record system (DEC VAX based) which, sadly, was more advanced for patient care than many systems deployed today. === Garcia-Garcia, G., J. A. Deddens, R. D’Achiardi-Rey, M. R. First, S. J. Samuels, K. S. Kant, and V. E. Pollak (1985) Am J Kidney Dis 5(1):10-18. 10.1016/s0272-6386(85)80129-3 (3881016) Results of treatment in patients with end-stage renal disease: a multivariate analysis of risk factors and survival in 341 successive patients. "Factors that affect survival in patients with end-stage renal disease (ESRD) are still only partially understood. We report an analysis on a cohort of 341 successive patients who started ESRD treatment in one institution. Survival was calculated from the start of ESRD treatment, whether initial treatment was by dialysis (335 patients) or transplantation (6 patients). Analysis of factors affecting survival was done using the Cox multivariate hazard analysis. Relative risks were calculated for several demographic factors, the primary renal disease, the presence or absence of various high-risk co-morbid factors, and for a first transplant from a living-related or cadaver donor. Older patients, patients with no prior health insurance, those with diabetic nephropathy, and those with small kidneys of unknown cause had statistically significantly higher risks of dying. The risk of dying decreased by year of start of ESRD treatment. Living related donor transplantation was associated with a decreased hazard to age 45 years and older; whereas cadaver donor transplantation was associated with a hazard that increased with age and was significantly increased by age 45." #kidneyhealth #predictiveriskanalysis #healthcare

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Valuable discussion with lawmakers, government officials, and experts at POLITICO's Transforming Health Care event this week on policy solutions to expand access to innovative therapies and digital health technologies. 🏥 Digital health and medical diagnostics were in the spotlight as innovations that could meet urgent needs for a healthcare system facing staffing shortages, a burnout epidemic, growing access gaps, and rising costs as demand grows. 🏥 "The user interface should be a priority for development of digital health tools. Ease of access and ease of use are all factors in promoting adoption and addressing health disparities with these innovations." 🏥 AI in healthcare was a hot topic as panels weighed regulations to ensure patient safety and privacy while supporting health system ability to adopt the technology to alleviate administrative burden and improve outcomes 🏥 Several sessions focused discussion on reimbursement reform, the need to rework Medicare Advantage (MA) quality ratings, and how payment systems can be improved to keep up with innovations. 🏥 "I try to be more prudent" in using diagnostic imaging to treat patients, because it's not covered like other medical options. "We're well aware patients must pay out of pocket...new tech is "not cheap..." 🏥 Panelists, including U.S. Rep. Ami Bera, MD considered how government incentives could support medtech innovation and advancement of digital health to expand access and advance health equity. Good insights from Paul Blanchfield, Lantheus, Susan Coller Monarez, Advanced Research Projects Agency for Health (ARPA-H), Dartmouth Health, and Alexander Ding, MD, MBA. #POLITICOHealth #digitalhealth #diagnostics #healthtech #medtech #healthcarepolicy #healthcareregulation #healthcareinnovation

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