James Merlino, MD

🚀 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

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Another important position statement from Association of Healthcare Value Analysis Professionals (AHVAP). As value analysis evolves, it is vitally important to ensure that those who are entrusted with the process understand what is expected of them in terms of professionalism. Please feel free to share this important document.

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Let’s be honest – healthcare is fragmented and facing multiple critical issues. In order to harmonize healthcare across America, we must address our most pressing challenges. One of these issues is labor management, which is essential for a health system’s operational success. I enjoyed reading this recent article in Becker's Healthcare highlighting 4 key workforce innovation strategies to future-proof your organization. From technologies to successful partnerships, round-table discussants at Becker's 14th Annual Meeting shared insights into solutions that are helping retain and recruit their current workforce and prepare future workers. Managing staffing to benefit the organization, individual staff and, most importantly, the patient is essential to effectively achieve the ideal workforce scenario. Read their tips: https://lnkd.in/eFivXzm3

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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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I looked again at the at the Association of Healthcare Value Analysis Professionals (AHVAP) website. Not to my surprise, the Board membership remains unchanged. Nine Board members, and one "Ex-Officio Board Member. Of the nine Board Members, seven remain organizationally attached to one GPO. In my opinion, this remains a serious conflict of interest, and feels like an ethical concern. Those who care about conflicts of interest and unethical practices know what they look like. That this Association is unconcerned about their lack of independence should be a concern not only for the membership of this organization, but for any prospective members and for all health systems who have employees looking to this Association for value analysis leadership. Value Analysis is broken. It's not working. The evidence is available in the many metrics easily attainable that relate to continually rising supply costs, and quality of care reductions. "Proposed savings" are not "Realized savings". What I see from the AHVAP are illustrations of "proposed savings" to indicate their success. Open the books and show it's realized savings! It's appropriate that the AHVAP would be tied to a GPO in that they both are responsible for taking health systems money to provide a service that is failing our healthcare cost and quality structure. On a funny note, look at the AHVAP website. The Ex-Officio Board Member is listed as: Executive Director & Executive Vice President  AHVAP Dr. J. Hudson Garrett Jr., Ph.D., MSN, MPH, MBA, FNP-BC, IP-BC, PLNC, VA-BC, BC-MSLcert™, MSL-BC, CPPS, CPHQ, LTC-CIP, CIC, CPHRM, ICE-CCP, CVAHPTM, CPXP, CDIPC, FACDONA, FAAPM, FNAP, FACHE, FAOM, FSHEA, FIDSA, FAHVAP Twenty-seven certifications, education initials, qualifications. Dr J Hudson Garret Jr wins the award for the most time spent with his nose in a book, and the least time spent owning a profit-loss statement. These are the academics we're allowing our health systems and employees to take direction from. When I was in the military, we called what Hudson Garrett illustrates on the AHVAP website an "I Love Me" wall. Sorry Hudson, just recognizing what you put out there for me to see.

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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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🚀 Are you ready to transform patient care and operational efficiency in your healthcare organization? In our latest episode of "Excellence in Healthcare," I share game-changing strategies that are setting industry benchmarks. Tune in as I unpack the incredible insights from Chapter 5 of my book, "Mastering Healthcare Excellence." 🎙️ Episode Highlights: 🔹 The importance of empowerment in healthcare teams 🔹 How the Ideal Talent Alignment Tool can enhance job satisfaction and team performance 🔹 The Role Optimization Framework to adapt dynamically to healthcare needs 🔹 Best practices for fostering open communication, professional development, and recognizing contributions Gain actionable knowledge and hear about a case study from a mid-sized hospital that successfully reduced staff turnover by 40% and boosted patient satisfaction by 25%! Empowerment in healthcare is not just a concept—it's a necessity for achieving excellence. 🌐 Listen to the latest episode here 🔖 #HealthcareExcellence #PatientCare #TeamEmpowerment #HealthcareInnovation #LeadershipInHealthcare #ProfessionalDevelopment 🌟 Join us in redefining healthcare—one empowered team member at a time.

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Pleased to share some new research titled, "When Agency Fails: An Analysis of the Association Between Hospital Agency Staffing and Quality Outcomes" with colleagues Rohit Pradhan, Zo Ramamonjiarivelo, Michael Mileski, and Ramalingam Shanmugam. Introduction: Staffing is critical to hospital quality, but recent years have seen hospitals grappling with severe shortages, forcing them to rely on contract or agency staff for urgent patient care needs. This shift in staffing mix has raised questions about its impact on quality. Consequently, this study investigated whether the increased use of agency staff has affected healthcare quality in hospitals. Given the limited recent research on this topic, practitioners remain uncertain about the effectiveness of their staffing strategies and their potential impact on quality. Methods: Drawing from agency theory, data were obtained from Definitive Healthcare which consolidates information from numerous public access databases pertaining to hospitals such as the American Hospital Association Annual Survey (hospital profile) and the Hospital Value-Based Purchasing Program (quality data). We conducted a cross-sectional study using a multivariable linear regression model (2021–2022) with appropriate organizational and market- level control variables. Quality was measured across eight variables while the independent variable of interest was agency labor cost ratio operationalized as the percentage of net patient revenue consumed by agency labor expense. Results: Our results suggested that the employment of agency staff was significantly and negatively associated with six of eight quality measures tested, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star rating, Hospital Compare rating, the hospital Total Performance Score (TPS), and three of the four sub-domains that comprise the TPS: clinical domain score, person and community engagement domain score, and the efficiency and cost reduction score. Discussion: Our results indicated that the increased use of agency labor may have a significant negative influence on quality outcomes at the hospital level. Our findings support the premise that interventions that promote full-time staffing may be more supportive of the quality of care delivered as well as patients’ perceptions of care. https://lnkd.in/gtVv3whk

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How long does it take you to get a doctor’s appointment? In 15 of America’s largest cities, it takes a month to see a new physician, and over a month to meet with a specialist. Healthcare access continues to be a pressing concern to millions of Americans today. In addition to long wait times, the healthcare labor shortage is making it difficult for hospitals to meet patient demand. “The latest projections by the Association of American Medical Colleges (AAMC) indicate that the U.S. will face a shortage of as many as 86,000 clinicians by 2036.” Additionally, 81% of current physicians believe that shortages negatively impact the quality of patient care. The burden on the healthcare system to provide is projected to increase over time due to declining rates of physicians, making barriers to access care even higher. AI is one solution to this accessibility crises. AI can provide physician support by supporting clinical decision making, handling logistics, improving supply chain transparency, automating tasks, and managing data. All of these tasks take burdens off physicians and reduce the cost and speed of providing patient care. AI support also has the potential to improve physician engagement, a prospect I am excited to be working towards in my new role. #healthcare #HealthcareAccess #PhysicianEngagement #AI

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Thank you to our wonderful participants this afternoon in the HCT Consulting Group Healthcare Transformation Executive Roundtable. Brian D. Washburn, DHA, MHA, FACHE, FACMPE, CHFP, PMP Chris Saxman Elizabeth Crawford Restat Elya Prystowsky, MS, PhD Mark Korth. I was encouraged by several insights from this amazing group: 👉 #Transformation - we know it when we see it! 👉 #Valuebasedcare - we know it when we don't! 👉 #Valuebasedcare means different things to #patients and #providers but we should not lose sight that like or not, we have to play by the language and definitions being proposed by the Centers for Medicare & Medicaid Services 👉 #Transformation towards #VBC should be keeping healthcare simple, local and well-coordinated - what 99% of people are trying to do today. Organizing to stop the despicable 1% is adding 30% of costs to everyone - especially #ruralhealth 👉 #EMR Transformation has put some hospitals out of business and in some communities, when the hospital closes, the whole community shuts down 👉 #Transformation this group sees on the horizon includes demand for change only intensifying, doing more with fewer providers, addressing #documentation challenges, #AI should focus on removing the hassle of the little things 👉 MAJOR RISK AHEAD - Will #transformation defined by CMS + #BigTech lead to a loss of simplifying the provider-patient experience? Will documentation to meet #VBC demands only escalate due to the 'potential' of what technology offers? And therefore, will health disparities only expand due to the inability of #ruralhealth to keep up? Ultimately - will we eventually have to unwind many of the current technology investments to one day return to a simpler provider-to-patient connection? Thanks again to our amazing participants. DM me if you'd like to be on our roster to participate in the next one!

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America's Essential Hospitals members: Join us next Tuesday, October 1, from 2 to 3 p.m. ET to hear from Jeremiah Headen, Fellowship Program Manager for the Alliance of Nurses for Healthy Environments. Jeremiah will share information about ANHE’s program to train nurses to work with communities to tackle serious environmental issues, with an emphasis on climate and health equity. #Climate #ClimateJustice #Equity

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We expect to see the final specifications on #CMMI #TEAM model in the next couple of weeks. Please check out this short but very substantive guide for hospitals on how to prepare.

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Come join Roy Sittig and I as we discuss strategies for Acute and Post-Acute Collaboration and improving Transitions of Care. https://lnkd.in/g9xKtXwU?

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“The Future of Value-Based Care and Outpatient Joint Replacement” By: Nate Holton, MHA, PHD. Value-Based Care (VBC) represents a transformative shift in healthcare from quantity to quality. Rather than compensating providers per procedure, VBC rewards them for achieving better patient outcomes and delivering high value. This approach is particularly relevant in orthopedic joint replacement, where the success of surgery and recovery directly impact healthcare value. In the coming years, VBC will likely align more closely with outpatient surgery centers for joint replacements. These centers offer a cost-effective environment where quality standards can still be met. With fewer overhead expenses than hospitals, outpatient centers reduce overall costs for joint replacement surgeries, which aligns with VBC’s emphasis on efficiency and high-quality care. Advances in surgical techniques and pain management now make it possible for patients to recover safely at home, making outpatient centers a viable alternative to traditional inpatient care. To support this shift, orthopedic device companies will need to innovate with solutions that meet the needs of outpatient settings. However, it’s not just about speed or quick recovery—innovation must focus on accurate, cost-effective technologies that provide the best outcomes without losing sight of reimbursement structures and bundled care processes. This means delivering precise information and products that enhance the entire care pathway, ensuring every step contributes meaningfully to patient health and cost sustainability. Sources: Health Affairs, CMS.gov, American Association of Hip and Knee Surgeons. Journal of Orthopaedic Research New England Journal of Medicine What are your thoughts, LinkedIn? Do you agree or disagree with these anticipated changes? #healthcare #devicenation #meddevvice #medicaldevice #orthosales #valuebasedcare #vbc #outpatientjointd

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Great article Wayne Altman, Russ Phillips and Zirui Song et al If you want a cost-effective and quality-driven healthcare system instead of a fee-for-service illness industry, then increase your investment in primary care. One key factor tied to savings in the Medicare Shared Savings Program (MSSP) is the presence of more primary care clinicians within an accountable care organization (ACO). A study revealed that MSSP ACOs with a minimum of 75 percent primary care clinicians yielded $281 per capita in net savings, in contrast to $149 for ACOs with fewer primary care clinicians. Higher provision of evaluation and management services also played a vital role in driving these savings. #Medicare #Healthcare #Savings #ACO #PrimaryCare

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There are no single solutions to Length of Stay (LOS) and throughput. Safely moving the needle requires multiple interventions to make an impact. Aubrey Jolly Graham, Alyssa Platt, Kristian Knutsen, Emily Fletcher, and David Gallagher M.D.'s study from Duke University Hospital is a great example of how daisychaining multiple solutions can drive down LOS across a complicated academic medical center. #healthcareleadership #patientoutcomes #hospitalmedicine #bestpractices #hospitalists #patientflow #patientcare #patientsafety #nurses #physicians #hospitals #leanhealthcare #healthcarequality #healthcareleaders #nurseleaders #healthcareinnovation #healthcare

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This topic and these two experienced experts should be on your #Healthcareprofessional development bucket list! Sign up today! DM me and I’ll connect with more details!

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Why big is bad in healthcare: Some interesting comments here on health system consolidation from Andrew Donahue, FHFMA, CPA, HFMA's director of health finance policy. Keep in in mind that this is someone who's extremely sympathetic to the hospital industry. First, he acknowledges that mergers "can lead to less competition, inferior service and higher prices" and goes on to say that the only driver of hospital mergers is private insurance companies giving better rates to bigger systems. In an accompanying interview on HFMA's "Healthcare Blame Game" podcast, Donahue goes even further: "Community healthy systems do not want to be megasystems...growth is not necessarily the strategic imperative...you lose local control." He talks about "megasystems" laying off local staff and cancelling contracts with local suppliers, both of which can be devastating to communities. "The corporate finger can slip off of the pulse of the local community when you have more bureaucratic layers, channels, and processes to navigate." This is a message that needs to be heard across the healthcare industry. Hospitals exist to serve communities, not corporate offices in distant locations. Corollary message: Private insurers, both for-profit and non-profit, have s***-ified the hospital industry with their contracting practices. #ethicalhealthcare #hippocraticcapitalism #hospitals #healthsystems #monopolies #antitrust

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