Mike Lombard

Three simple steps to build trust among Hispanics. 1. Understanding. 2. Accessibility. 3. Proactive Care. Even though trust is earned one step at a time and can take a while. Applying these small, practical, actionable takeaways will set your #healthcare organization in the right direction. Let’s taco ‘bout it. https://bit.ly/3TTUT6N

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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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Are you inundating your patients with messages❓ Are they receiving the right information at the right time❓ Download "Your Guide to Governance," a comprehensive resource designed to help you effectively manage your patient communications strategy enterprise-wide. 𝐓𝐡𝐢𝐬 𝐠𝐮𝐢𝐝𝐞 𝐢𝐧𝐜𝐥𝐮𝐝𝐞𝐬 𝟓 𝐛𝐞𝐬𝐭 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞𝐬 𝐭𝐨 𝐡𝐞𝐥𝐩 𝐲𝐨𝐮: ✅ Understand the risks of over-messaging and digital fatigue ✅ Break down silos and establish a governance committee ✅ Measure, iterate, and improve your enterprise-wide communication strategy ➡️ Download the full governance guide and workbook here » https://lnkd.in/gGHjjExa #healthcare #patientexperience #digitalhealth #medtech #healthtech

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Great Post Bob ... I have said a few times... "The role of Supply Chain in healthcare is evolving significantly, shifting from a transactional role to a strategic function with a direct impact on financial performance. Supply Chain now has a presence at the C-level, underscoring its importance in driving margins and supporting sustainable financial models. By adopting a holistic approach to expense management and overseeing all non-labor spending, Supply Chain leaders can create substantial value.And its not all created equal. Exmaple: reducing costs by just 5% can yield the same profit impact as increasing revenue by 100%, highlighting the efficiency of cost management over revenue initiatives in improving profitability. This transformation aligns closely with strategic imperatives around delivering higher value with fewer resources, supporting revenue generation, and enhancing competitive advantage. Moving towards clinically integrated, population health-focused, and value-based contracting models is critical for the future."

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☝ Don't Miss the Application Deadlines for the ACO Primary Care Flex Model! CMS is accepting applications for the ACOs Primary Care Flex Model until August 1, 2024. Interested organizations must apply as new or renewing ACOs to the Medicare Shared Savings Program (MSSP) by June 17, 2024. The ACO PC Flex Model will launch on January 1, 2025, and run for five years. Low-revenue ACOs participating in the Shared Savings Program can apply to the ACO PC Flex Model. This innovative model aims to increase the number of low-revenue ACOs and enhance primary care payment through a Prospective Primary Care Payment (PPCP) option, shifting payment from fee-for-service to a predictable, monthly payment. 💲 Enhance primary care payment and innovative care delivery  📉 Narrow Disparities in health care outcomes  🔻Reduce program expenditures while preserving the quality of care  💪 Strengthen participation incentives for new and low-revenue ACOs 💰 Base Rate and Payment Enhancements  💴 One-time Advanced Shared Savings Payment Health Equity Strategy to drive accountable care and advance health equity #ACOPrimaryCareFlexModel #HealthcareInnovation #PrimaryCare #AccountableCare #Medicare #HealthEquity #SustainableHealthcare #ValueBasedCare #VBC #RiskAdjustment #PPCP #SharedSavings #CMS https://lnkd.in/gmiKZsHM

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🙌🏻 Good. Also if you need help renegotiating these types of agreements 👋🏻 We have over 1.5 million benchmarks (and growing), I would love to show you exactly how to save money on joint contracts.

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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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The ability to be compensated for work carried out in the healthcare space has become increasingly difficult and complicated. It is imperative that our industry remains current on trends, changes, and projected challenges, to ensure our readiness in combatting them. The ambulance industry of today is far different from when our organization first opened in 2010, and we have continuously evolved to meet these challenges head-on. This will remain a big talking point for years to come, and/or until significant changes are made to the benefit of providers. In healthcare, you expend a great deal of capital to provide a service, and in return, you "hope" for reimbursement. Try doing that at a local restaurant - order and eat your food, and tell the staff you MIGHT come back with payment in 90-120 days. Let's see if you make it out of there without cleaning some dishes on your way...

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80% of healthcare organizations report only moderate success with current digital tools for patient self-management. Where do they see potential? Find out in this report. https://lnkd.in/gA6RaaTX

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In this article, we interviewed Laura Polson. Laura is the System Services Director of Clinical Quality Value Analysis for UofL Health and the 2020 Past President of the Association of Healthcare Value Analysis Professionals (AHVAP).

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📝 The Importance of Advance Directives: Planning for Your Healthcare Future Have you thought about what kind of medical care you want if you can't speak for yourself? Advance directives are crucial for ensuring your healthcare wishes are known and respected. Here’s why they matter: 1️⃣ Empowerment: Take control of your healthcare decisions by outlining your preferences in advance. 2️⃣ Family Peace of Mind: Spare your loved ones the stress of making tough decisions during difficult times. Clear guidelines help avoid family disagreements. 3️⃣ Legal Protection: Advance directives ensure that your wishes are honored by healthcare providers, reducing the chances of unwanted treatments. 4️⃣ Flexibility: You can update your directives anytime as your preferences or circumstances change. 5️⃣Avoiding Prolonged Suffering: Advance directives can help prevent unnecessary or unwanted medical interventions that might extend suffering or diminish quality of life. 6️⃣ Clarity for Healthcare Providers: Having clear instructions in place helps healthcare providers make timely and informed decisions aligned with your values and preferences. 🌟 Start the conversation with your family and healthcare provider today! Do you have one in place? If so, like this post!  ✨Check out my newest book for more information, “The Roadmap to Hospital Care,” available now on Amazon to purchase! Link below:  https://lnkd.in/ggZGPfAi #AdvanceDirectives #HealthcarePlanning #PatientEmpowerment #HealthcareFuture #LivingWill ##AdvanceDirectives #HealthcarePlanning #LivingWill #HealthcareProxy #DurablePowerOfAttorney #PatientEmpowerment #HealthcareDecisions #PeaceOfMind #MedicalPlanning #InformedConsent #HealthLiteracy #EndOfLifeCare #PatientRights #WishesMatter #LifePlanning #HealthCareAwareness #FuturePlanning #KnowYourOptions #PlanAhead #FamilyHealth #WellnessJourney #HealthcareFuture #EmpowerYourself #LegalDocuments #HealthCareChoices #SelfAdvocacy #PatientAdvocacy #TakeControl #YourVoice #HealthcareSupport

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The Centers for Medicare & Medicaid Services (CMS) has proposed a rule to make Medicare Advantage (MA) plans' prior authorization rules and coverage criteria publicly accessible. This move aims to reduce inappropriate denials, improve patient access to care, and increase appeal opportunities. Currently, only 4% of denied claims are appealed, yet 80% of appealed denials are overturned. The proposal would require plans to publicly clarify coverage criteria and inform enrollees about their appeal rights. Additionally, CMS seeks to enhance Medicare Advantage provider directories by integrating them into Medicare Plan Finder, simplifying provider comparisons across plans. This would empower seniors to make better-informed healthcare decisions. The rule has garnered support, including from Sen. Ron Wyden, who praised its potential to address prior authorization misuse, eliminate "ghost networks," and curb broker exploitation. Public comments are open until January 27, 2025, after which its future depends on policy decisions by the next administration. Our home health and hospice clients will benefit from enhanced transparency in Medicare Advantage rules, ensuring timely access to care and reducing authorization-related delays. Clearer appeal rights and streamlined provider directories empower clients to secure appropriate reimbursements, optimize workflows, and focus on delivering quality care without administrative burdens. Cliniqon is committed to delivering Guaranteed Quality, Ensured Compliance, and Unparalleled Outcomes in Home Health and Hospice agencies. #HomeHealthServices #HospiceCare #FrontEndServices #BackOfficeSolutions #HealthcareManagement #RevenueCycleManagement #HealthcareCompliance #PatientSupport #CareCoordination #MedicalBilling #ClaimsManagement #PatientEngagement #HealthcareOutsourcing #MedicalCoding #ProviderSupport #CliniqonCare #HealthcareSolutions #PatientCareExcellence #HomeHealthRCM #HospiceBilling MedPage Today

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There are good takeaways from this conversation and more to come. - Leaders must fully grasp the intricacies of risk adjustment, including its interconnections with other departments and the optimal staffing model. Stay tuned for more insights!

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AI combined with healthcare compliance sounds tricky until you learn more. This article highlights how AI strategies can be applied without security risks.

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Great article from American College of Emergency Physicians and refreshing to see ED physicians writing about the need to remedy ambulance patient offload delays. The authors offer sensible commentary and suggestions, including: - Yes, patients who arrive by ambulance can be placed in the waiting room; - Hospitals can move patients waiting for inpatient beds to upstairs hallways and not ED hallways; - Assign a hospital practitioner to screen low-acuity patients and order appropriate routine tests. - And this nugget: "a hospital that is so overwhelmed that it must hold ambulances for hours...should be activating its disaster plan." As I've said often, EMS serves the community, not the hospital, so I applaud the authors for including the phrase "release EMS personnel back to the community" in their article. However, even though I applaud these authors, I must take some issue with the word "release," for it implies that EMS staff are not free to leave an ED unless ED staff permit them to. When clinically appropriate, it is legally and operationally valid for EMS clinicians to tell hospital staff "the patient is stable and we're returning to service" and leave the hospital even without being "released" by ED staff. EMS staff aren't hospital staff (as the authors correctly note), so they are not the hospital's to command. And federal law (EMTALA) clearly imposes the legal duty of care on the hospital once the patient is on their property. Finally, for what it's worth, data tell us that a large percentage of the patients brought by ambulance do not clinically require constant monitoring by EMS personnel while awaiting hospital care and would derive no clinical benefit from being watched by EMS clinicians during the EMS-ED handoff interval. Again, kudos to ACEP and to these authors for their helpful contribution to this conversation. #pww #emslaw #emtala #apot

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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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Interim leadership in healthcare presents a unique set of challenges and opportunities that can significantly impact the organization's stability, efficiency, and patient care quality. The role of interim leaders is critical, particularly during periods of transition, crisis, or organizational change. Understanding these challenges and opportunities is essential for leveraging interim leadership effectively. 🔷 Challenges in Interim Leadership in Healthcare 🔷 🔹 Time Constraints and Immediate Impact: Interim leaders often have limited time to make an impact. They must quickly understand the organization’s culture, operations, and immediate needs. This rapid assimilation can be daunting, particularly in complex healthcare environments where patient care and safety are paramount. 🔹 Resistance to Change: Resistance from staff and stakeholders can be a significant hurdle. Due to their temporary status, employees may be wary of interim leaders, fearing instability or unwanted changes. Gaining trust and buy-in from the team is crucial but can take time to achieve swiftly. 🔹 Maintaining Continuity of Care: A critical challenge is ensuring that patient care remains uninterrupted and high-quality during leadership transitions. Interim leaders must balance the need for quick, decisive actions with maintaining continuity and consistency in patient care services. 🔷 Opportunities in Interim Leadership in Healthcare 🔷 🔹 Fresh Perspective and Objectivity: Interim leaders bring an outsider's perspective, which can be invaluable. They can identify inefficiencies and areas for improvement that may need to be noticed by permanent staff. Their objectivity can facilitate unbiased decision-making and innovative solutions. 🔹 Accelerating Change: Interim leaders can act as catalysts for change. Without the long-term political entanglements that permanent leaders might face, they can implement necessary changes more swiftly. Their temporary status allows them to make tough decisions that might be unpopular but are crucial for the organization's health. 🔹 Building a Bridge: Interim leaders can effectively bridge the gap between outgoing and incoming permanent leaders, ensuring a smooth transition. They can maintain momentum on critical projects and initiatives, providing continuity and stability. Conclusion While fraught with challenges, interim #healthcareleadership also offers numerous opportunities. The key to maximizing the benefits of #interimleadership lies in selecting the right individuals with the appropriate skills, experience, and temperament. Healthcare organizations can navigate transitions smoothly, maintain high standards of patient care, and implement necessary changes effectively. Embracing interim leaders' fresh perspectives and specialized expertise can lead to a more resilient and adaptive healthcare organization. Moab Healthcare #Healthcarestaffing #heatlhcareprofessional

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