Christine Leon, MBA, PMP

🚨 Top 10 #PatientSafety Concerns for 2024. 📌 Have significant changes been made over the last decade? An important question is to reflect on what has been done, what we are doing, and what remains to be done.

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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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Any mention of physician shortage, these days, gets linked to the problem of burnout and stress, which in turn gets connected to the documentation burden ("pyjama time"), which then takes us to the problems of #EHRs. As a result, ambient AI scribing, has become one of the fastest emerging use cases of generative AI in healthcare. An ambient AI scribing tool "listens" in the background during the physician-patient encounter and automatically produces the physician's note without the need for the physician to write anything. This is the promise of ambient AI scribing: by eliminating the need to write a note after the visit, physicians will have more time for patients or for themselves/families. I often wonder if the writing of the note is purely "wasted" time. Is note-writing not integral to our cognitive process and therefore to our ability to learn from each patient encounter and improve our 'practice' of medicine? To get some answers, I listened to this 1971 grand rounds by Larry Weed MD who invented the problem-oriented medical record: https://lnkd.in/g-WftXvi. Dr. Weed says at the beginning of the video: "...this record cannot be separated from the caring of the patient. This is not something.....the practice of medicine over here and the record over there. It is intertwined with it. It determines what you do in the long run." Therefore, in addition to studying the accuracy, evidence, and benefits (time, productivity, cost etc.) of these AI scribing tools, we should also consider the impact of the elimination of note-writing on physician's cognitive processes especially trainees - students and residents. #AI #generativeAI #ambientAIscribing #EHR #cognition #medicaleducation

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AI’s Impact on CDI A recent ACDIS Survey of ACDIS members gauging impact of AI on CDI processes and the CDI profession revealed some interesting points and sentiments towards AI. The most common impacts from the implementation of CDI technology are increases in remote work and in productivity (cited by 67% each), followed by identifying “low-hanging fruit” queries (65%) and improving documentation issues with high-volume DRG groups (54%). Additional responses appear in Table 4 below. Remote work is not conducive to effectively providing sustainable measurable physician documentation educational training. One-on-One training or small group training is most effective in ultimately changing overall physician behavioral patterns of documentation. Often, the best form of training is small bit size nuggets provided in a quick conversation specific to a case on the floor. Productivity is not a valid and reliable measure of CDI performance. The mere fact that the CDIS reviewed a record does not necessarily equate to achieved improvement/integrity of the record. Identifying low hanging fruit diagnoses through queries implies CDI has room for improvement in physician documentation education through reinforcement that improves physician's muscle memory of better documentation practices. Electronic querying serves to mechanize the query process and is no substitute for physician documentation training and knowledge sharing. Physicians do not want more queries, they prefer to document right the first time versus more repetitive transactional reactive queries. AI definitely can assist and serve as an effective tool in CDI activity. However, it must be considered as a tool and not a crutch. There simply is no substitute for good old fashioned CDI boots on the ground, helping physicians achieve clinical documentation excellence through documentation training with reinforcement and guidance. AI is the panacea for improving documentation. #AI, #documentationimprovment, #notapanacea

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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The quality of the argument, along with true partnership and data liquidity, is where the real magic happens in #valuebasedcare contract negotiations. It’s easy to get caught up in the economics and risk adjustment discussions, but at the end of the day, the real measure is how do we map out a shared vision to get to X (I.e. #healthcaretransformation) in the long-term.

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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OIG ALERT: Diagnoses reported only on enrollees’ HRAs and HRA-linked chart reviews, and not on any other 2022 service records, resulted in an estimated $7.5 billion in MA risk-adjusted payments for 2023. Before we dive in here I want to say that I have seen HRAs used appropriately and inappropriately during my time in this space. There can be great value for patients, particularly those with limited access to care and or those reluctant to visit their primary care provider. However there is tremendous risk to the system if these visits are a fragmented approach to care and or not aligned with care planning. What the OIG has identified represents the risks and shows care continuity breakdowns. Ultimately organizations and payers must know their vendor partners because there are some really good ones in this space. Earlier this week the OIG released a really interesting look into Health Risk Assessment, or HRAs. These HRAs are often performed in the home by payers or vendor partners. These should be in depth reviews of the patient and include a host of assessments that often are hard to complete in a condensed visit to a provider office. What the OIG found was that 7.5B or about 2% of all Medicare revenue was tied to conditions captured only during these visits. Is that bad? I don’t know. If these are new conditions and then ultimately incorporated into a broader care plan that improves outcomes then they are a great thing. If they are captured, never shared with the care team, and ultimately used to solely drive revenue with little focus on outcomes then it is bad. I suspect there is a mix of both. If I was at the OIG I would want to take a multi-year look at what was captured year over year only in a HRA as a next step. The report recommends CMS take the following actions. CMS subsequently agreed with recommendation number three but not numbers one and two. 1) Impose additional restrictions on the use of diagnoses reported only on in-home HRAs or chart reviews that are linked to in-home HRAs for risk-adjusted payments. 2) Conduct audits to validate diagnoses reported only on in-home HRAs and HRA-linked chart reviews. 3) Determine whether select health conditions that drove payments from in-home HRAs and HRA-linked chart reviews may be more susceptible to misuse among MA companies. I am doing some advanced analytics on information in the report for future posts but this is a nice easy read for folks. https://lnkd.in/ehNzzSWu

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There’s no question that AI is transforming healthcare, and understanding where industry leaders perceive opportunities is important. The latest research report from Arcadia is revealing. 63% of healthcare leaders say AI can analyze large patient data sets to identify trends and create population health intervention strategies 58% say AI can analyze individual patient data to identify opportunities to improve health outcomes 47% say AI can optimize the management and analysis of electronic health records Dive into the report to gain insights from top tech leaders and see where the industry is headed! https://lnkd.in/gf_wkWij

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I sat down with John Lynn on the Healthcare IT Today podcast where we looked at the tension between payers and providers in the healthcare industry. Health systems' revenues are payers' expenses. But beyond this obvious tension, there are opportunities for both sides to lower the admin costs of the back-and-forth. Key highlights: - Strategies for making processes more efficient, benefiting both payers and providers. - Insights on platform modernization for payers and reducing inefficiencies caused by legacy technology. - How providers can better navigate payer denials by understanding and reverse-engineering payer algorithms. - The role of AI in creating better experiences for patients and members, and why it’s crucial for healthcare organizations to prioritize technology modernization. I also shared some success stories, including a member-centric chatbot developed by 3Pillar that streamlined call center operations, improved member experience, and reduced costs. Tune in to the full discussion to learn more about how payers and providers can collaborate for mutual benefit and create great experiences for their patients and members. View/Listen here: https://lnkd.in/e78vFGJZ #Healthcare #PayersAndProviders #HealthcareIT #AI #PlatformModernization #PatientExperience #3PillarGlobal

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Want to know exactly what Medicare will pay your hospital for a specific admission and the impact a CDI query will have on the case? Google your hospital's "CMS provider number" -Systems may use the same number for multiple hospitals so you might need to dig a little Go to this website: CMS.webpricer.gov and click on "Inpatient PPS" Enter the following: Your hospital's provider number that you Googled Admit & discharge date: make them up to a recent time period Total charges: put 10K if unsure, it won't matter except for outlier cases Covered days: put enough days that cover the length-of-stay DRG: Google "MS-DRG Relative Weight table 5" to get a list of all DRGs Click "Estimate" and you'll see your hospital's payment on the right. You can also scroll down and see your hospital's "cost-to-charge ratio", which is a factor in outlier payments. You can click "Edit Claim" and enter higher charges if you want to see when outlier payments start to kick in or try different DRGs If you want to see the impact of a query that takes a case from a "W/O CC/MCC" (without complication/comorbidity, major complication/comorbidity) to an "MCC" (major complication/comorbidity), enter the MS-DRGs that go with each of those, so DRG 379 for w/o cc/mcc and DRG 377 w/MCC in the GI bleed examples in the slides. The attached slides show a snippet of the CMS relative weight table with GI bleed highlighted to show you the different relative weights of the three severity levels for that DRG. Other DRGs may have just one or two severity levels Next slide is a snapshot of the CMS CC/MCC list with "viral pneumonia" highlighted as a major complication/comorbidity (MCC) Last two slides show you how the payment is calculated for a hospital (UCLA in this case) for the GI Bleed MS-DRG and the impact of a query for "viral pneumonia" that increased the severity from a "WO CC/MCC" to "W MCC" This isn't just for adult patients. There are 12 states that pay Medicaid by MS-DRG and plenty of commercial payers in every state that pay by MS-DRG. Contact Pediatric Resource Group (PRG) to help you develop or optimize CDI for your pediatric/neonatal patients. Don't have peds? We have an adult consulting division as well called Physician Resource Group (PRG) #CDI #revenuecycle #hospitalfinance #MSDRG #CFO #clinicaldocumentation

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Enhancing Quality Improvement in Hospitals with ORControl™ Quality Improvement (QI) in healthcare isn’t just about outcomes—it’s about creating smoother, safer, and more efficient processes. ORControl™ empowers hospitals with minute-by-minute coordination, optimized OR utilization, and instant day-of-surgery insights, helping clinical teams stay aligned and proactive. By addressing challenges as they happen, ORControl supports a more streamlined, patient-centered approach to perioperative operations and day-of-surgery workflows. Learn more about how ORControl is transforming QI initiatives and advancing healthcare standards in this article by Becker's Health. View full article below ⬇

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Attention healthcare providers! 👩‍⚕️👨‍⚕️ CMS is changing how we bill for complex patient care. Starting January 2024: → New add-on code G2211 → Recognizes cognitive load in primary care → Accounts for building patient relationships As a quality analyst, I'm excited about this shift. It's a step towards valuing the "invisible" work in healthcare. How do you think this will impact patient care? #HealthcarePolicy #MedicareUpdates #PatientCare

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