Megan Gillespie, DNP, MBA, RN, NEA-BC, FACHE

Elevating Chronic Care Management through Nurse Care Managers As healthcare continues to pivot towards value-based care models, the role of #NurseCareManagers (#NCMs) in Chronic Care Management (#CCM) has never been more pivotal. NCMs are at the forefront of identifying eligible patients, developing personalized #careplans, and ensuring seamless #carecoordination. But how does this translate into better Quality Payment Program (#QPP) scores and increased incentive payments? First, by identifying patients eligible for CCM, NCMs ensure that those with multiple #chronicconditions receive continuous, comprehensive care. They not only enroll patients but also provide them with the necessary education about the benefits of such programs, leading to higher patient engagement and satisfaction. Secondly, care coordination is the heart of CCM. NCMs work tirelessly to connect the dots between various healthcare providers, ensuring that the patient's care plan is executed flawlessly. This includes managing medication, scheduling follow-ups, and monitoring the patient's health status. The seamless execution of these plans leads to improved patient outcomes and reduced hospital readmissions, which are critical metrics in determining QPP scores. Lastly, meticulous documentation and correct coding of CCM services by NCMs ensure that providers are reimbursed accurately for the care provided. This not only supports the financial health of the practice but also reflects the quality of care in QPP scores. In essence, NCMs are invaluable in navigating the complexities of chronic care, enhancing patient health outcomes, and steering healthcare practices towards higher QPP scores and increased incentives. Let's acknowledge and support the integral role of NCMs in elevating #chroniccaremanagement. #nursesofLinkedIn #innovation #nurseleaders #patientcenteredcare #valuebasedcare #CMS

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The PACIFIC NORTHWEST HOSPITAL MEDICINE ASSOCIATION, represented by the American Federation of Teachers and the Oregon Nurses Association, accuses Legacy Health of unilateral staffing changes without adequate bargaining. Allegations include refusing to provide relevant information, implementing changes over objections, and altering shift models, staffing, and pay without negotiation. Following a complaint filed with the National Labor Relations Board (NLRB), the union asserts that Legacy's actions include decreasing shift hours, increasing patient care responsibilities without additional staffing, and altering administrative pay. Legacy defends its adjustments as responses to healthcare needs but pledges to collaborate with the union. The union represents hospitalists across six Legacy hospitals in Oregon and Washington, with a recent vote to unionize. Oregon Health & Science University is also in merger talks with Legacy, aiming to create a sizable 10-hospital system, potentially impacting over 32,000 employees and becoming the largest employer in the Portland metro area. Our solution offers comprehensive support to healthcare entities facing labor disputes, ensuring fair negotiations and optimal staffing solutions. By prioritizing collaboration and transparency, we facilitate constructive dialogue between management and staff, mitigating conflicts and fostering a conducive work environment for all stakeholders. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

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Congratulations to Rhafia Bucoy, DBA, MSN, RN, RN-BC, Regional Clinical Practice Consultant, Perioperative Services, NCAL Kaiser Permanente, recipient of The DAISY Foundation DAISY Nurse Leader Award.   Rhafia Bucoy is NCAL Perioperative Services’ clinical practice and financial performance consultant. She serves as an OR nurse informaticist and analyst, and she is definitely everyone’s “go-to person” for everything Perioperative data, clinical staffing, OpTime build, and all other things. Rhafia is the nurse in the background who silently gets things done, from report build to data mining, analysis, and presentations. She is the clinical liaison to the national teams for KPHC, national product council, and revenue cycle. She is responsible for the clinical testing and auditing of electronic med record documentation.   Despite the overwhelming demand for reports and other competing priorities, Rhafia manages them well and always willingly helps others. She has collaborated with revenue cycle in closing out unposted surgical logs and ensuring accurate implant documentation. She has also recently agreed to close out records related to bedside procedure recovery to ensure accurate capture of workload and patient throughout in the post operative space.   Rhafia serves as the clinical lead and resource for all of NCAL’s surgical system administrators as she lends her expert consulting hat in the OpTime domain from case creation to case closure and posting. Rhafia partnered with supply chain on the implementation of Case Pick App in 19 NCAL facilities, 11 of which went live in 2023. This application helps accurate accounting of supplies used in each surgical case leading to cost valuation and eventual supply standardization. With a few more sites going live in 2024, procedure card maintenance is key and Rhafia recognized this gap in some locations. With this information, she took the initiative to reinvigorate and develop training modules on procedure card updates. She partnered with the national training team and launched the first facilitator-led training in January of 2024.   Another important work that Rhafia is leading is the implementation of the Preop and PACU bay assignment to capture both medical and surgical workload in the perioperative spaces to inform staffing decisions. Her collaboration with the workforce and finance teams is critical in this important work.   Rhafia is a self-directed and a silent nurse leader in the Perioperative space. Her contributions to KP NCAL nursing can easily go unnoticed but definitely worthy of a recognition. She is an asset to have in the team.   #DAISYaward #Kpnursing #Kpnurses #YouBelongHere   Janet Jule, DNP RN, NEA-BC, Jason David Unger

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Listen to the latest episode and learn how innovation and compassion for a community is improving oral health in Oregon!

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Innovation thrives not only in generating new ideas but also in effectively integrating them. In our newest podcast episode, Dr. Dan Weberg, PhD, MHI, RN, FAAN, the National Executive Director of Nursing Workforce Development and Innovation at Kaiser Permanente, brings his significant insight into the challenges of leadership in healthcare settings and its impact on innovation and organizational culture. Throughout the conversation, he talks about how toxic leaders can not only demotivate their teams but also drastically hinder necessary advancements in healthcare systems. This discussion also provides practical strategies for dealing with toxic leadership, ensuring alignment with organizational values, and creating a more innovative and supportive workplace. Catch a short clip below, then head to your favorite podcast streaming platform to listen to the full episode. You can also find all episodes on our website and our YouTube channel. 🌐Website: https://lnkd.in/eSps3EqG ▶️YouTube: https://lnkd.in/eD--4HQ6 If you enjoyed this episode, don't forget to rate, review, and share! Thank you so much, Dan, for having a chat with me! #podcast #toxicleadership #leadershipdevelopment #culturechange

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Shifting the financial model alone is not sufficient for the transition - the care delivery, workforce, and many other pieces of the ecosystem with which PCPs interact also need to adjust accordingly. Funding to allow for the startup costs of transformation must be made available. A comprehensive analysis from The Commonwealth Fund: To encourage participation, practitioners say upfront payments, investment in the primary care workforce, and less emphasis on simplistic quality measures are needed, as well as more support for practices to provide accessible, comprehensive care. #primarycare #integratedcare #teambasedcare #healthcare #healthcareonlinkedin

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Value analysis professionals, mark your calendars! The Association of Healthcare Value Analysis Professionals (AHVAP) Annual Conference and Industry Partner Expo is THE event to stay ahead of the curve in healthcare value analysis. Let's come together to learn, share insights, and drive innovation in our field. #AHVAPConference2024 #HealthcareInnovation

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Check out this free webinar!

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Why Nurses are the Real Change-Makers in Patient Care Management Nurses play a pivotal role in the management of patient care, embodying the core values of care coordination, quality improvement, and patient advocacy. Their involvement goes beyond basic care practices, they are integral in creating complex care plans that ensure continuity of care across various healthcare settings. By coordinating care, nurses not only manage the logistical aspects of patient treatment but also ensure that each part of the patient's healthcare team is informed and in sync with their ongoing needs and treatments. Moreover, #nurses are at the forefront of quality improvement. They consistently evaluate care practices, advocate for the adoption of best practices, and implement new strategies to enhance patient outcomes. Their unique position allows them to see the gaps in patient care and push for systemic changes that improve patient safety and outcomes. #Patientadvocacy is another critical area where nurses shine. They stand as the patient’s voice, ensuring their needs and preferences are respected. They educate patients and families, empowering them to make informed decisions and actively participate in their care. While many software companies claim #leadership in care management, it's clear that nurses are the true agents of change in healthcare. The hands-on care and #patientcentric advocacy we provide are irreplaceable by any software. If you're a nurse feeling the strain of bedside duties, consider transitioning to #caremanagement instead of leaving nursing, our skills and compassion are invaluable in this field. I urge both nurses and physicians to collaborate closely to harness the profound impact that skilled, dedicated nurses have in chronic care management. Let's work together to transform patient care for the better. Let’s join the movement towards a more integrated and #nurse-led approach in healthcare. #Chroniccaremanagement #nurseentrepreneur #innovation #changehealthcare

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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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This is why using the We Belong toolkit to standardize the interview process is important.

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This week - during National Nurses Week - we acknowledge the contributions of our 17,000 nurses across Dignity Health California and asked nurses to share their “Why?” As we close the week, I would be remiss if I didn’t share my why. What’s your why? My choice to embark on this path signifies a commitment to making a tangible difference in people's lives, to be a beacon of hope in moments of uncertainty, and to advocate tirelessly for the well-being of those in your care. In the chaotic tapestry of healthcare, you are the steady hand that navigates with wisdom, integrity, and resilience. Being a nurse leader is more than a career; it's a calling—a calling to lead with humility, to listen with empathy, and to act with purpose. It's about fostering a culture of collaboration, innovation, and continuous learning, where every member of the healthcare team feels valued and supported. In a world where compassion often feels scarce, I choose to amplify it. In a profession where challenges abound, I choose to confront them head-on. In a field where leadership is needed, I choose to step up and lead by example. My choice to be a nurse leader is not just about the roles we fulfill or the titles we hold; it's about the lives we touch, the hearts we heal, and the legacy we leave behind. It's about making a lasting impact in our communities, one patient, one nurse, one decision at a time. #nursesweek #nurseleader #leadership #healthcare #HappyNursesWeek

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“It is about patients, but the dollars follow the patients,” #OHSU struggles with a 47% drop in transfers from other #hospitals which are typically #patients seeking more lucrative specialized #procedures. #Hospital beds are really precious in Oregon (49th in the country per capita supply). #ED clogged with non-urgent non-lucrative cases. Better access to #UrgentCare & #CaseManagement might help. It’s a community-wide issue bigger than OHSU alone. What happened to that cadre of patients who were not transferred to OHSU over the last 5 years? Got acceptable care elsewhere? Waited longer in the OHSU specialty inpatient queue? Suffered more from shunted or delayed access? Does anyone know?

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"However, these savings—as much as $50 billion annually1—are unreported and not shown to improve care access for patients without adequate insurance.2,3" ---Well, the financial design is so bad that it has closed over 600 hospitals since DRG and the era of cost cutting. The financial design is the reason for closures and compromises. The 50 billion distributed to hospitals serving vulnerable populations (40 - 50% of US pop) would be some help due to the Era of Cost Cutting 1983 to 2030 or longer. "Per CMS’s budget neutrality principle in the Outpatient Prospective Payment System (OPPS), the $9 billion repayment must be offset by $7.8 billion of cuts to nondrug reimbursements." ---Budget neutrality and regulatory capture prevent any true reform to add support to the hospitals and practices serving most Americans most behind. Once again CMS is not accountable and must be reigned in even if it takes 50 years as it did for physician accountability over the last half of the 19th century and for human subject researchers over the last half of the 20th century. Medicare and Medicaid have failed for 2621 counties (40% of US) most behind and has primary care and basic health access except 1965 to 1978. What about the Belmont Principles and numerous violations? What about protection of vulnerable populations, informed consent (which requires prior study of consequences poorly done by CMS), or beneficent intent - especially with all three lining up consistently against the majority of the nation most behind time after time! Strike 1 for ethical and moral violations - CMS has demonstrated time and again the inability to protect their charges - vulnerable Americans. CMS most fails where there are concentrations of elderly, poor, disabled, and their worst public plans. Strike 2 - CMS has failed to do adequate studies of consequences prior to the implementations of policies since 1983 and including Medicaid Waivers which will steal more from team member support and give more for team members to do - with worst impacts on Community Health Centers with 50% Medicaid and in the most vulnerable populations highest in concentrations of Medicare, Medicaid, and Dual plans. Studies are done more to justify what CMS is doing rather than to protect most Americans most behind from consequences such as their providers rated poorly or penalized just for caring for these populations inherently lower in outcomes and drivers of outcomes (Readmissions, ACO shared savings, Star Ratings, others) Strike 3 - CMS fails for beneficent intent. The intent is cost cutting. CMS harms tens of millions with designs that have killed hundreds of hospitals and countless practices, delivery team members, and local leaders in health and other community areas. We know about some economic and access impacts from these losses, but the full impact and cascades of impacts are never studied. See comments for losses of jobs, income, leadership, and better health insurance

The Nursing Professional Development (NPD) department plays a vital role in fostering clinical excellence, guided by the Association for Nursing Professional Development (ANPD) framework. Beyond training, the NPD department focuses on nurses' professional growth through continuous education, orientation, competency assessments, and leadership development. Aligned with the ANPD framework, NPD practitioners embody six key roles: Learning Facilitator, Change Agent, Mentor, Leader, Champion for Scientific Inquiry, and Advocate for Practice Transitions. These roles ensure enhanced patient care, high staff competency, and ample career advancement opportunities through various workshops and trainings. By cultivating a culture of continuous learning and innovation, the NPD department empowers nurses to tackle new challenges and implement best practices effectively. As a cornerstone of clinical excellence, the NPD department drives nursing practice forward, ultimately elevating the quality of patient care. #NursingExcellence #ProfessionalDevelopment #ClinicalEducation #HealthcareInnovation #PatientCare

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Listen to Mary Beth Lang share insights on Risant Health's strategy of bringing Value Based Care & Coverage (tools, technology and services) to network model healthcare systems like Geisinger Health. Don't miss out on this opportunity to learn how working together; medical facilities and clinicians can better manage costs, utilization, eliminate unwarranted clinical variation, and reduce redundancies and inefficiencies to improve the patient experience and healthcare outcomes! #ValueBasedCare #Healthcare #PatientExperience https://lnkd.in/eRE79CyA

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Are you struggling to understand how AI can fit into your nursing practice? In my latest #blog, I dive into some practical applications for how #AI can be helpful and why #nurses must be at the forefront of this #innovation. #healthcare

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Identifying common conditions affecting penis health: https://ow.ly/fkHR50Rr1Oy

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