Eric Lee

An Outpatient Clinical Documentation Improvement (CDI) program offers substantial advantages to healthcare organizations by elevating patient care and operational efficiency. By integrating risk stratification with chronic conditions, enhancing quality measures, addressing social determinants of health, and establishing a collaborative team empowered by technology, such strategic initiatives result in improved patient outcomes and streamlined operations.

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And why? With the EPIC vs Particle Health debate, the business-side of the situation is just being pushed even more towards the front. TEFCA participation is voluntary. Regional HIE participation is voluntary. Even Care Everywhere is voluntary for EPIC-using systems. You know what is mandatory? Patient access. Why are we depending on competing businesses to make it work? The patient has the most at stake and has the most interest in information flowing and getting the best outcome. Give them the power to participate. The framework is already there. IYKYK, but that's what we do at Primary Record and that's why we do it.

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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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🩺💻 The Achilles Heel of Telehealth: Why Walmart and Village MD Stumbled 🩺💻 Walmart’s recent decision to shutter its entire healthcare division, including 51 physical clinics and its virtual care platform, sent shockwaves through the industry. This news, following the closure of Village MD clinics by Walgreens, begs the question: what went wrong with these seemingly promising ventures? 🤔 The Walmart Case: Walmart cited “a challenging reimbursement environment and escalating operating costs” as the reason for its exit. While convenient and affordable, their model struggled to compete with established healthcare providers and navigate the complex insurance landscape. 🏥💰 What Didn’t Work: Lack of Integration: The clinics operated independently, lacking deep integration with existing healthcare systems, which made patient data sharing and continuity of care difficult. 🔄📊 Focus on Price Over Value: While offering low costs, Walmart may have prioritized affordability over building strong patient relationships and personalized care. 💲🤝 Limited Scope of Services: The clinics primarily offered basic primary care, potentially failing to attract patients needing more specialized services. 🏥🔍 Models that Work: While Walmart’s venture faltered, other telehealth models are showing promise: Value-Based Care: Providers focus on preventative care and managing chronic conditions, potentially lowering overall healthcare costs and improving patient outcomes. 🌿🏥 Integrated Telehealth: Seamless integration with existing healthcare systems ensures smooth patient data sharing and a more holistic care experience. 🔄🔗 Specialized Services: Telehealth platforms that connect patients with specialists in specific fields, like mental health or dermatology, are proving successful. 🌟👩‍⚕️👨‍⚕️ Village MD Closure: Walgreens’ closure of 160 Village MD clinics highlights another challenge: ensuring the financial viability of these ventures. While Village MD focused on primary care, the high cost of acquiring and operating clinics might have outweighed the revenue generated. 💼💔 The Takeaway: Telehealth holds immense potential, but its success hinges on overcoming these critical hurdles. Building a sustainable model requires: Strong partnerships with established healthcare providers. 🤝🏥 Focus on value-based care and patient outcomes. 🌟📈 Integration with existing healthcare systems. 🔄🔗 Offering specialized services alongside primary care. 👩‍⚕️🔍 The recent closures serve as a cautionary tale, but they shouldn’t overshadow the potential of telehealth to revolutionize healthcare access and delivery. By learning from these missteps and focusing on sustainable, patient-centered models, the future of telehealth remains bright. 🌐🏥🌟 What are your thoughts? #telehealth #healthcare #technology #medicine #futureofhealthcare

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"How can you ensure patient data accuracy in your healthcare database?" LinkedIn randomly asked me this question, dangling another community topvoice" badge of questionable value like a topdoc award, in front of me. There are great things about LinkedIn which I love, but I don't like its thought policing algorithms. LinkedIn has two types of top voice badges: 1) "topvoice" and 2) "community topvoice". The "topvoice" badges are "invitation only" which LinkedIn appears to give out to, only powerful, or politically correct members, whose posts are always amplified on its platform. I have seen many ordinary posts from some "top voice" members being amplified. LinkedIn cleverly invented the "community topvoice" for the intellectual coolies to train its AI engine to produce so called community knowledgebase articles. LinkedIn's random question today about the accuracy of healthcare database was one such attempt. The video shared with this post is my answer. Watch till the end :) We still love you LinkedIn. #healthcare #healthcaredata #humanresource

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A CDC Compendium of Effective Fall Interventions. A terrific and multifaceted document outlining the best available evidence for fall prevention and standardization of care. Not sure if this has been updated since 2015. Continues to be a good resource for value-based fall prevention and improvement in quality of care.

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🌟 Upcoming Live Webinar: Enhancing Dialysis Facility Preparedness 🌟 🗓️ Date: June 25 ⏰ Time: 2 PM ET Join me, Kristi Wells, RN from Greenfield Health System, for an essential webinar explicitly designed for nurse leaders in the dialysis industry. Here's why you should attend: 🔍 Insightful Learnings: Gain firsthand insights into state surveyors' crucial findings and perspectives. Understand what they look for during evaluations and how this impacts facility operations. 📈 Improve Facility Readiness: Learn about the latest trends and focus areas identified by surveyors. This knowledge will help enhance your facility's preparedness and compliance, ensuring you meet and exceed regulatory standards. 💡 Actionable Strategies: I'll share key strategies and best practices to prepare your facility for upcoming surveys, helping you avoid common pitfalls and enhance patient care. 🎓 Earn CE Credits: Earn 1.00 Continuing Education credit by attending this webinar and completing the required post-test and evaluation. This webinar is not just a learning opportunity—it's a chance to improve your facility's operations and patient outcomes directly. Stay ahead of the curve by understanding the latest surveyor expectations and industry standards! Register Here: https://lnkd.in/eBpmNXbw ✨ Don't miss out on this chance to elevate your professional practice and facility standards! ✨ #DialysisCare #NurseLeaders #HealthcareWebinar #DialysisPreparedness #StateSurveyors #ContinuingEducation #NursingEducation #DialysisNursing #HealthSystem #PatientCareExcellence

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Natural Language Processing (NLP) enhances mental health care by analyzing text and speech to detect emotional states and mental health issues. It can identify suicidal ideation, depression, and anxiety, often more accurately than traditional methods. This allows for timely interventions and personalized care, improving patient outcomes. Summery: In 2020, Clarigent Health, a spinout from Cincinnati Children’s, launched an app that uses NLP to analyze speech and identify vocal biomarkers of suicidal risk. The HIPAA-compliant listening tool is designed to provide clinical decision support to mental health professionals. That project was built on work by John Pestian, neuropsychiatric AI scientist who runs a research lab at Cincinnati Children’s. Pestian has been developing machine learning methods for identifying patients at risk of suicide for more than two decades. Using speech samples from therapy sessions and notes from people who died by suicide, Pestian and colleagues demonstrated in 2020 that AI algorithms could detect suicidality with up to 90% accuracy. Also at that time, Talkspace was publishing its own research with NYU Grossman School of Medicine researchers. The feature was officially rolled out in 2019. The analysis runs in real time on messages sent by patients in their encrypted virtual therapy room and triggers an alert to the therapist, allowing them to respond with the appropriate intervention. The key is having a human in the loop. #unitedseniorassociation #USA #eldercare #FDA #seniorliving #ADA #AI #NIH #patientcare #compliance #hospitals #OIG #healthcare #HHSOIG #digitalhealth #HSS #CMS #assistedliving #nursinghomes #seniorcare #medicare #seniorcitizen #homehealthcare #caregiver #dementia #inhomecare #seniorhealth #kloekorby #alzheimers #mentalhealth

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From Becker's Healthcare: "95% of physicians said it [prior authorizations] contributes to burnout." And yet, when LLMs hit the scene, we saw all kinds of posts and videos showing clinicians using the tool to automate or streamline the process. Is this an adoption issue or something larger? #physicanburnout #LLMs #genAI #AiinHealthcare #HealthcareonLinkedIn

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I find this trend really interesting. Has there ever been substantiated data to suggest that approvals amongst payers is almost entirely relative to the prevailing winds of the organization? (IE: In January 2024, Inpatient admission picked up for M.A. plans, this led to increasing denials in February which led to the uptick hitting the peak of the wave and then it trended back down). Ronald Hirsch, MD, FACP, CHCQM, CHRI, ACPA-C, do you believe that payers utilize a top-down retrospective analysis of their director's recent productivity in concert with adjacent directors in same role to "peer-pressure" the into changing uphold versus denials? If substantiated, couldn't this be utilized as a bad-faith argument against an organization in that it could then be inferred they aren't objectively reviewing cases one-off, but they are "recognizing upswells in the wave" and nipping them in the bud (both organizationally as well as individually)?

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This article by Heather Landi at Fierce Healthcare is a great start with good insights, but it barely scratches the surface of this new rule by the Office of the National Coordinator for Health Information Technology (ONC). The #HTI2 rule is the first time #payers have a path for certification. In addition, there are requirements for #ai algorithms. If history is any indication, this could really change the game.. There are now certification criteria for: #PatientAccessAPI #providerDirectoryAPI #PayertoPayerDataExchangeAPI #provideraccessAPI and #priorauthorizationsupportAPI

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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Disconnected, fragmented, and intermittent telehealth is certainly dead Sergei Polevikov, ABD, MBA, MS, MA 🇮🇱🇺🇦 We are now seeing #telehealth 2.0, where companies like Rebel Health Alliance are taking direct virtual patient care to the next level. Our care is ❤️ connected ❤️ holistic ❤️ patient-centered ❤️ integrated ❤️ digitally advance - including both synchronous and asynchronous communication ❤️ team based But most of all, there is care continuity. A patient-physician relationship and partnership is formed so that the patient knows they have someone on their team to guide them when they have questions about their health. So Long, Teladoc! Physician-led, patient-centered #healthcare has gone digital!

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Great investigative research by Bill Finerfrock (Movement is Life Board Member) on how methodology to determine medically underserved areas in America has not been updated in 30 (yes, thirty) years and why this matters! "If the federal government revised the HPSA/MUA/MUP methodologies to include the primary care workforce available in 2024, thousands of communities currently designated as underserved would see their shortage area classification removed." We absolutely have medically underserved areas that need support---we should have a process which accurately identifies them! "The failure to update the metrics used to determine eligibility for these programs and the underlying methodology threaten the effectiveness and efficiency of increasing access to primary care in shortage areas." https://lnkd.in/eReeX74r

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For Shame: Government Removes Requirement for Hospitals To Disclose Their ICU Occupancy . Thousands can die as a result in next emergency : https://lnkd.in/ehPpKcJ9 The COVID-19 pandemic demonstrated that US hospital and health care systems were ill-prepared for the surge of patients who overwhelmed available health care resources. The lack of available ICU beds during the COVID-19 pandemic caused likely thousands of deaths that could have been preventable . Researchers estimate that thousands of early-pandemic deaths could have been avoided were it not for this shortage. However, ICU bed supply was not the root of the problem. Although, at the peak of the pandemic, there were many hospitals across the United States with ICU units that were overwhelmingly full, there were also ICUs in the same regions that were under capacity. Rather, load imbalance—a measure of the relationship of hospitals in hospital referral regions (HRRs) that are at or overcapacity while others are under capacity—was a problem. To prevent the needless loss of human life, we recommend that all hospitals disclose their load-balance plans—such as regional transfer agreements, regionally coordinated length-of-stay, and rapid conversion of hospital to ICU beds access—on a regular basis in a public forum, such as the SEC’s risk analysis, regularly disclosed in its EDGAR data site. Although health care agencies can promulgate the disclosure, the best agency for the collection of these disclosures is the Securities and Exchange Commission (SEC) due to its globally lauded expertise in both data collection and transparent dissemination. This disclosure should be mandated for hospitals through government legislation/rules. Sadly, the CDC recently lifted its requirement for hospitals to report their COVID-19 data—including the number of COVID patients being cared for in ICUs (https://lnkd.in/egcNGMaP). As we sift through the aftermath of the COVID-19 pandemic and return to a pre-COVID way of life, government agencies that bow to industry pressure with guidance changes, like this one, open us up to avoidable deaths in future pandemics. If we hope to avoid repeating the outcomes of the COVID pandemic in future health crises, legislation that mandates hospitals’ disclosure of their load-balance plans is a must. #COVID #CDC #SEC #healthcare #transparency#ICU #rural hospitals

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This is very interesting! I am seeing these "divergent" systems emerging of "Have's and the Have nots" The large AI enablement systems are targeting the large Epic and Cerner Corporation to some extent MEDITECH, providing value for the megahealth systems. Independent primary care is becoming dependent on ACO enablement companies like Aledade, Inc. and Privia Health to some extent agilon health to help them contract and decrease total cost of care. I absolutely agree with the notion that: "Upfront payments at the start of model participation would help practices with limited financial reserves invest in resources to improve care delivery and participate in the models." Will the emerging ACO PC FLEX model be compelling enough? Why or why not? https://lnkd.in/eC-ht_xD

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Many of Medicare's COVID-era telehealth flexibilities are set to expire at the end of 2024, including coverage of audio-only telehealth visits, which may improve access for individuals with limited internet connectivity. In a new JAMA Health Forum paper, we examine recent trends in audio-only telehealth use, and find that certain groups may be disproportionately affected, including low-income patients, people with multiple chronic conditions, and members of racial/ethnic minority groups.

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