Robert Whitcomb, MD FASA FAMIA

🎯 Unlocking Healthcare Efficiency with Risk Adjustment 🎯 Thrilled to share my latest article, “Risk Adjustment: Reducing Inefficiencies and Waste,” featured in the third quarter 2024 issue of St. Louis Metropolitan Medicine. In today's healthcare landscape, understanding risk adjustment is more crucial than ever for driving real change in value-based care delivery. 🔍 Key insights include: - How risk adjustment can streamline processes and reduce waste. - The role it plays in enhancing patient care and outcomes. - Practical strategies for implementation in your organization. 💡 I’d love to hear your thoughts! How is your organization leveraging risk adjustment? Let’s continue to innovate and push the boundaries of what’s possible in healthcare. 👉 Check out the full article here: https://lnkd.in/gyQWdRuE A big thank you to St. Louis Metropolitan Medicine and Jim Braibish for the platform to share these ideas. Let’s keep the conversation going and drive forward with impactful solutions! If you find value in this, please share with your network. Together, we can make a difference. 🌍 #HealthcareInnovation #RiskAdjustment #ValueBasedCare #HealthcareEfficiency #Leadership #Innovation

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For 2025, regulators approved the following average increases for health insurers in the individual market: Blue Cross HMO: 11.56% Health Partners: 9.71% Medica: 1.95% Quartz Health Plan: 9.43% UCare: 8.8% Costs of Medical care continue to increase. As a country we spend so much more on heath care compared to others - If we could spend less on health care more could be spent in other areas that has impact. Education and Social determinatives of heath ( Housing,food,transaportation), defense and economic growth. The cost of health care is having negative effect on our culture. Make it a conversation that says it needs to be addressed.

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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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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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Summary: All 900+ survey participants reported having worked in a hospital, physician practice or payer organization where an IT software or outsourcing engagement resulted in a significant financial loss, workflow interruptions, reputational damage, &/or loss of key staff sometime in the past decade. AP News https://lnkd.in/eVUAYni7 #HealthIT #HIE #EHR #Telehealth #RCM #PatientEngagement #Interoperability #ClinicalDecisionSupport #AI

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Value analysis is crucial for optimizing patient outcomes and resource utilization. That's why I'm attending the Association of Healthcare Value Analysis Professionals (AHVAP) Annual Conference and Industry Partner Expo. I am excited to learn from experts, network with peers, and discover innovative solutions in healthcare value analysis. #HealthcareInnovation #AHVAPConference2024 #healthcarevalueanalysis

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It is evident that physician payments skew towards interventionists and proceduralists thereby limiting #primarycare payment, relatively. But a stat in this Health Affairs’ article caught my eye: To increase primary care supply by just 1%, the payments for primary care must increase by 4% or $1.6 Billion. To me, this means: 1. Value over Volume: Despite over two decades of discussion (with plenty of false starts), it's clear that the only sustainable payment model is one that prioritizes value over volume. 2. Re-architecting Care Delivery: There is not a human solution to our primary care workforce crisis, especially with an aging population. The way care is delivered must be re-architected that drives patient autonomy, access, affordability, and quality.

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The following item provides additional insight into physician consolidation

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Managing prior authorizations across all lines of business is easier when you have a single source of truth. PA Checkpoint becomes that source of truth for our clients - listen to BCBS of Minnesota share their experience: #PriorAuthorization #AIinHealthcare #ItilitiHealth

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"Gen AI 'mission-creep' is the biggest health IT and RCM threat I see right now," said Mark Townsend, MD, chief clinical innovation officer at Cincinnati-based Bon Secours Mercy Health. "Don't get me wrong, I believe in the potential of generative AI to help us work smarter and not harder. We are working hard to create new technology using generative AI, we are selectively investing in Gen AI, and Gen AI is not a panacea for patient care or for operational performance." "The mission-creep of gen AI is to oversell its potential and under-deliver on its performance, which absolutely requires a human being in the loop to validate every output," said Dr. Townsend. "Said differently, challenging ourselves to truly quantify the value of gen AI tools is a tall order at this point." https://lnkd.in/euaYzMD6

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Listen Here: https://lnkd.in/gJrqRCB8 In this episode, Amir A. Ghaferi, MD, MSc, MBA, President & CEO of Physician Enterprise at Froedtert & The Medical College of Wisconsin, discusses how leveraging digital health can expand patient reach. He also shares his excitement and enthusiasm for AI advancements in healthcare, highlighting the potential for innovation to improve patient outcomes. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #digitalhealth #leadership #healthcare

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More flexibility for RPM programs!

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CMS is proposing a 2.8% decrease in the conversion factor under the CY 2025 proposed rule. On the blog, #ECGMC’s Jim Donohue, Dave Wofford, and Heather Flynn Kearney explain what it means for physician groups. #medicare #physicianfeeschedule

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The Ascension ransomware attack caused the dreaded DOWNTIME. For over a MONTH. In this week's episode of One Click at a Time, Kelly Nieves and I imagine (and shudder) at such a travesty and think about what downtime actually means, and what organizations should be thinking about when addressing downtime. DOWNTIME IS AN EMERGENCY. Join us on this week's episode! As always, would love to keep the discussion going around downtime best practices and what we need to reimagine. https://lnkd.in/gPh2DBgm

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It’s a big week - I’ve got two new articles out on my website. First, we have the 2022 MIPS results. In this article, I’m answering a variety of questions about the data and results, and more. Secondly, the CMS released the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule. In this article, I will provide you with the proposed changes for MIPS in the 2025 Performance Year for the following topics: 👉 2025 MIPS Performance Threshold 👉 MIPS Performance Category Scores 👉 Topped Out Quality Measures To read the full articles, click below https://lnkd.in/eXBSwFm

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This is the fifth and final episode of the 5 Mistakes article. Many hospitals only consider the CMS payors when considering trauma charges. But a significant portion of trauma patients are covered by commercial insurance. It is imperative that you know the insurers specific billing criteria to maximize your reimbursement.

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Do you know or are you one of the Healthcare Financial Management Association (HFMA) members who earned a certification in Q2 to validate expertise and demonstrate commitment to the profession? Some 2,115 individuals were honored in Q2 with HFMA certifications, with 101 people earning multiple certifications. Check out the story to see a list of all honorees.

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