Aric Coffman MD, MBA

This is a quick read on how to improve your bottom line with an engaged & experienced partner like Veradigm.  

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Independent physicians are the best value in healthcare

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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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🌟 Major Healthcare News: HCA to Acquire Catholic Health System 🌟 Exciting developments in the healthcare sector! HCA Healthcare is set to acquire a Catholic health system, marking a significant move in the industry. This acquisition could reshape healthcare delivery and expand access to care for many communities. #HealthcareNews #HCACatholicHealthAcquisition #HealthcareExpansion #PatientCare #HealthcareIndustry #BeckersHospitalReview

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It can be all-consuming for medical practices and even medical groups to just run their businesses. Time for process improvement, contract management, and more can be scarce. ➡️ https://smpl.is/97ct3 ☎🏥💊🚑🚨#Affordable #revenuecycle consulting is the answer. 📊 . #revenuecyclemanagement #revenuecycle #sunlitcovehealthcare

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CMS Proposes 2.8% Cut to Medicare Physician Fees for 2025 — One group calls the proposal "critically short-sighted" This summarizes the dire situation of CMS proposed reduction in the yearly decrease in physician payment when all physician practices are experiencing inflationary pressure and increasing expenses year after year. Patients potentially suffer with more and more physician practices limiting the number of Medicare patients in their practice. I see practices indirectly limiting Medicare patients by offering early morning appointments like 7 AM or 5 PM, knowing these patients do not do early appointments, knowing firsthand when I notice scheduling specialist visits for a family elderly parent that these were the times offered or providing a time months out. Here is for Congress to pass the Strengthening Medicare for Patients and Providers Act to implement an annual inflation-based physician payment update tied to the Medicare Economic Index, and modernize Medicare’s antiquated budget neutrality policies by enacting the Provider Reimbursement Stability Act. "A 2.8% reduction to the conversion factor would be alarming in the best circumstances, but to propose doing so at a time when 92% of medical groups report increased operating costs and are otherwise struggling to remain financially viable is critically short-sighted," Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, said in a statement "Medicare physician reimbursement is on a dire trajectory and these ongoing cuts continue to undermine the ability of medical practices to keep their doors open and function effectively -- the need for comprehensive reform is paramount." #paymentreduction, #paymentdecrease, #physiciansworkingforless, #inflatioanrypressure, #diretrajectory https://lnkd.in/eVkGHBeM

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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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Very interesting article. It compares hospital and health plan consolidation in specific markets. Indiana is a market that is deemed a high cost market (7th highest in nation for hospital costs) because of hospital consolidation per studies, yet when you look at the market, plans have more leverage as the top 3 represent 91% of the large group market. A few thoughts: 1) you can look at number of hospitals, but it would be better to compare commercial spend for these systems as I would imagine a lot higher than the counts indicate. Some hospitals may have a higher proportion of governmental business and that needs to be considered. 2) Based on plan leverage, one would think plans would say no to continued commercial price increases. It's important though that employers support plans in these discussions. I have seen many times over the years that employers want access above everything else, which means the plan has little leverage with the hospital to take hard line stands or risk losing large national employers who will just switch to another plan creating a vicious cycle of continued cost increases. 3) Under this environment, there is little incentive to move to VBC like arrangements vs. fee for service. 7. For example, in Indiana, the systems with the largest share of total hospitals are St. Louis-based Ascension (13.9%), Indianapolis-based IU Health (11.3%), Mishawaka-based Franciscan Health (8.7%) and Franklin, Tenn.-based Community Health Systems (8.7%). These four systems own 42.6% of all the hospitals in Indiana combined 8. On the other hand, the three largest payers in Indiana — Elevance Health (68.9%), UnitedHealth Group (17.1%) and Physicians Health Plan of Northern Indiana (5.3%) — represent 91.2% of all privately insured patients with insurance from the large-group market.  

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Be on the lookout for tomorrow’s Medicare Advantage (MA) 2025 final rule dated 4/23/24. Below, you’ll find an overview of the terms “MA unpublished final rule” and “final rule,” and how they differ in the regulatory process: • Publication Status: The unpublished final rule has not yet been made accessible in the Federal Register, while the final rule is already published and available to the public. • Legal Effectiveness: The unpublished final rule lacks legal effect until it is published; in contrast, the final rule holds legal standing and is enforceable from the date specified as its effective date. • Accessibility: While stakeholders cannot officially cite or fully review an unpublished final rule since it is not yet public, the final rule is comprehensively documented and available for public review and compliance. Understanding these distinctions is critical for compliance and operational planning.

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As healthcare providers transition to value-based care, the significance of CDI cannot be overstated. Effective CDI capabilities and resources are crucial for ensuring medical record accuracy, completeness, and consistency, resulting in optimal reimbursement and enhanced compliance.    At AGS Health, we’ve made substantial investments in clinical technology and resources to help ease the CDI burdens on your valuable clinical resources. We’ll handle the documentation so your clinicians can focus on care delivery. 

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🔎 Senators See Possible Conflicts of Interest in Health Care Pricing Tools The chairmen of two Senate committees overseeing health policy, Ron Wyden of Oregon and Bernie Sanders of Vermont, are looking into the practices of data analytics firm MultiPlan. Concerned about companies prioritizing their own profits over patient well-being, the senators are investigating MultiPlan's business model, which recommends lower payments to medical providers. This model could lead to a conflict of interest, as MultiPlan and insurers can collect higher fees when payouts are lower. The senators have called on MultiPlan to discuss their investigation and address concerns raised by a recent New York Times article. Read the full article here: Senators See Possible Conflicts of Interest in Health Care Pricing Tools MultiPlan has stated that they are working with the Senate committees to explain the complexities patients face when choosing high-priced care outside their networks, emphasizing their commitment to making healthcare transparent, fair, and affordable for all. This inquiry reflects the growing scrutiny of MultiPlan, which has faced allegations of anticompetitive behavior and collusion with insurers to fix prices. The Department of Labor also has ongoing investigations into the type of pricing services provided by MultiPlan. The attention on MultiPlan highlights the importance of employer-based health insurance, which is the most common way Americans receive coverage. Employers are increasingly looking into the cost of administering their plans and are frustrated by limited access to claims data. Legislation has been introduced to address this issue, requiring insurers to provide employers with claims data. As the investigation unfolds, it remains to be seen how MultiPlan and insurers will address concerns and ensure that patient well-being is prioritized over profits. #HealthCarePricing #PatientAdvocacy #HealthInsurance #DataAnalytics #SenateCommittees

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Recent regulatory changes provide hospitals a unique opportunity to reassess their reimbursement practices and strategy, showing the value of completing three reporting types in tandem rather than one at a time. By understanding how reimbursement programs like Medicare DSH, Worksheet S-10 Uncompensated Care, and Medicare bad debts are related, hospitals can save time, alleviate strain on their IT departments, free up staff to focus on high-priority work, and potentially improve their financial health. Learn more in this Moss Adams article by Heather Keser, Jonathan Mason, Jesse Vo and Josh Stewart.

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Great defense of “private equity medicine” from former CMS administrator Leslie Norwalk. Though few clinicians fully understand it, PEM has become a popular bogeyman for a wide range of complaints about US health care. A few key takeaways: ·      All health care organizations require working capital. They should be judged on their behavior, rather than their source of capital. ·      Pushing health care organizations to more expensive sources of capital (e.g,, high interest loans) doesn’t serve anyone’s interests (except the banks). ·      The financial successes of private equity-backed companies accrue to everyone with a 401K or a mutual fund, not just a small number of wall street elites. ·      Reducing competition in health care (based on investment class) only accelerates market consolidation by integrated health systems, and the higher prices that come with it.

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Hospital prices surged 7.7% last month, marking the highest increase in 13 years, significantly contributing to U.S. inflation. Rising costs for procedures, labor, and insurance are key factors, affecting patients and insurers alike. #Healthcare #Inflation #Economy

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This Thursday the Energy and Commerce Committee will hold a hearing on the Centers of Medicare and Medicaid Improvement (CMMI). Members of the Committee are expected to raise concerns and praise for the agencies' efforts to test and achieve savings in value-based payment models over the years. Since its inception in 2010, CMMI has tested many new payment models including bundled payments, multiple accountable care organization offerings, and the making care primary model. The agency continues to face challenges, such as finding ways to engage rural providers and solo or small physician specialty practices. Reps. Michelle Steel and Susie Lee and Sens. Markwayne Mullin, Kyrsten Sinema and Thom Tillis introduced the EASE Act (HR 7149 / S.4078) to encourage CMMI to create a new payment model for rural and underserved communities to reduce long wait times that many seniors and residents face in these communities when seeking care from a specialist. The bill was developed based on years of data collected and reviewed by OCHIN to help community health centers and rural hospitals improve care integration and create a new value-based payment model. While Congress looks for ways to improve outcomes and reduce costs; and medical schools continue to look for ways to grow the physician workforce, one pathway that would fill the needs of communities (especially rural areas) and prevent avoidable hospital admissions is the EASE Act which looks to utilize telehealth or e-consults to help our most vulnerable populations receive timely care

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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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If you have started a new GME program in the last seven years you should reciew these and comment.

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Considering opening your own ASC? This was one of Sullivan's most popular blogs in the past year. We're sharing major pitfalls and how to avoid them. How can our experienced ASC consultants guide your organization to success? #ASC

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