TED Talks-Searching for knowledge across disciplines-The new power of collaborationnHoward Rheingold talks about the coming world of collaboration, participatory media and collective action — and how Wikipedia is really an outgrowth of our natural human instinct to work as a group.
nThis talk was presented at an official TED conference, and was featured by TED editors on the home page.n
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Rural hospitals are suffering and it is scary to those of small communities who rely on them for health care. Studies show that they are closing at a rapid rate because they just don’t have the funds. Read more below on these closings and how people are coming up with solutions for this concerning issue. nnMore than 20% of rural hospitals are at a “high risk of closing” due to wobbly finances, a Navigant analysis of publicly available data shows.nnThe study, released Wednesday, also shows that 64% of these at-risk rural hospitals are considered essential to the health and economic well-being of their communities.nnThe analysis examines the financial viability and community essentiality of more than 2,000 rural hospitals nationwide. It found that 21% of the rural hospitals are at high risk of closing based on their total operating margin, days cash on hand, and debt-to-capitalization ratio. This equates to 430 hospitals across 43 states that employ 150,000 people.nn”Our analysis shines a new light on a rural hospital crisis that must be addressed and could significantly worsen with any downturn in the economy,” study co-author David Mosley, managing director at Navigant, said in a media release.nn”Local, state, and federal politicians, as well as health system administrators, need to act,” he said.nnThe study also reviewed of the “community essentiality” of these cash-strapped rural hospitals, measuring factors such as trauma status, service to vulnerable populations, geographic isolation, and economic impact.nnThey determined that 64% or 277 of these hospitals are considered essential to their community’s health and economic well-being. In 31 states, at least half of these financially distressed rural hospitals are considered essential.nnSouthern and Midwestern states, including Mississippi, Alabama, Kansas, Georgia, and Minnesota, are projected to be impacted the most, the data shows.nnThe study blamed “multiple factors” for the ongoing crisis with rural hospitals, including low rural population growth, payer mix degradation, excess hospital capacity due to declining inpatient care, and an inability for hospitals to leverage technology due to a lack of capital.nnOne possible solution involves collaborations between rural hospitals and academic and regional health systems, that leverages the larger systems’ resources for telehealth, revenue cycle management, human capital, electronic health records, physician training, and clinical optimization.nnThe study also supports supporting legislation that advances telehealth reimbursements, such as the bipartisan Rural Emergency Acute Care Hospital (REACH) Act.nnReintroduced in 2017 by Sens. Chuck Grassley, R-Iowa, Amy Klobuchar, D-Minn., and Cory Gardner, R-Colo., the REACH Act would create a new Medicare classification under which rural hospitals would offer emergency and outpatient services but no longer have inpatient beds.n
“OUR ANALYSIS SHINES A NEW LIGHT ON A RURAL HOSPITAL CRISIS THAT MUST BE ADDRESSED AND COULD SIGNIFICANTLY WORSEN WITH ANY DOWNTURN IN THE ECONOMY.” DAVID MOSLEY, MANAGING DIRECTOR AT NAVIGANT.
nOriginal article posted on Healthleadersmedia.com.
Welter Healthcare Partners is excited to present our new Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders. Today, we focus on two new codes, 99451 & 99452 related to inter-professional Telehealth consultations.nn99451 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative timenThe code covers assessment and management services via telephone, Internet, or electronic health record (EHR) and includes a written report to the requesting or referring provider. Report 5 minutes or more of medical consultative time by a consulting physician, typically a specialty physician who receives a written or verbal request from a physician or other qualified healthcare provider to offer an opinion on a case.nn99452 — Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.nReport 30 minutes of time spent on interprofessional telephone, Internet, or electronic health record (EHR) referral services by a requesting or treating provider, that is, a physician or other qualified healthcare professional who is providing a consulting physician with background information regarding a patient’s condition.nnKeep in mind that in addition to these two new codes that codes 99446-99449 have also been revised. Reporting similar services with a verbal and written report, see 99446, Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5-10 minutes of medical consultative discussion and review and add-on codes +99447, +99448, and +99449 for additional time.nnClick the links below to learn moren
nnMedicare accountable care organizations (ACOs) are not happy that they have a little more than a month to decide on whether to take on more risk or leave the program.nnThe CMS on Wednesday gave new ACOs a Feb. 19 deadline to apply to the Pathways to Success program, which forces them to take on more risk than they did in the Medicare Shared Savings Program. But the National Association of ACOs said on Thursday that the deadline is far too short, coming only two months after the CMS published a final rule for Pathways to Success.nn”ACOs barely have time to understand the new rules, and organizing an application is very complicated and for some it is now a high-risk decision,” NAACOS President Clif Gaus said in a statement.nnThe association, which has fervently fought the changes to the risk-sharing program, wants the deadline moved to late March.nnThe CMS published the Pathways to Success rule on Dec. 19. But CMS did not provide the application deadline when it posted the rule.nnThe CMS told Modern Healthcare there will be two application cycles for ACOs in 2019, and this first deadline is for the July 1, 2019 start date. ACOs joining the second round that starts Jan. 1, 2020 will have a summer deadline.nnThe Feb. 19 deadline only applies to new ACOs that want to join the program or ACOs that have an existing agreement that has expired. An ACO that has a three-year agreement that expires in either 2019 or 2020 can finish that contract before moving to the new program.nnPathways to Success represents a radical departure from the prior Shared Services Program.nn
An ACO entering the new five-year program can only be in a one-sided risk track for two to three years depending on how much they earn, with ACOs that generate a low amount of revenue staying in the track longer. After the initial period, they must start to pay the federal government if they don’t save enough money in healthcare costs or meet quality requirements.nnUnder the previous program, an ACO could be in a one-sided risk track for the duration of the five-year contract and not have to pay the federal government anything if they don’t meet quality benchmarks or cost metrics.nnExisting ACOs also will have to participate in programs that require them to take on more risk in subsequent years.nnThe NAACOS said that ACOs won’t be able to make “several critical decisions,” before the Feb. 19 deadline, such as what physicians will participate and signing agreements.nn”Setting an application deadline two months after passing the final rule does not give ACOs that have expiring agreements the necessary time to vet the decision internally,” Jennifer Moore, chief operating officer at MaineHealth ACO in Portland, Maine, said in a statement.nnThe CMS told Modern Healthcare that it is providing ACOs with documents and sample applications.nnOnly a third of ACOs will be subject to the February deadline, according Ashley Ridlon, vice president of health policy for the consulting firm Evolent Health.nnThere are 561 ACOs that are responsible for 10.5 million Medicare patients, according to data from the CMS.nnRidlon conceded that “the timeline is indeed very tight.”nnThe short turnaround means that hospitals and providers are going to not have a lot of time to think through the pros and cons of whether to apply, said David Muhlestein, chief research officer for the firm Leavitt Partners.nn”The timeline is quite short, though doable,” Muhlestein said. “Potential participants will need to prioritize this and get their boards, leadership and physicians aligned in a hurry.”nnOriginal article published on modernhealthcare.
As most medical practices are aware, not all cases are easy to navigate using the latest medical standards. The information below highlights a complicated surgical case along with the correct CPT and ICD-10 codes. Do you have a complicated surgery case need help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected.nn— Click Here To Submit Redacted Surgery Case Study —nn
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32652-RT J94.2, J98.4nnSurgeon: Surgeon(s) and Role:n* XXXXX, XXXXXXX, MD – PrimarynnCase Length: 3 Hr 2 Min 20 SecnnPre-Operative Diagnosis: right retained hemothoraxnnPost-Operative Diagnosis: SamennOperation Performed: Right Video Assisted Thoracic Surgery (VATS) and total lung decorticationnwith removal of large retained old hematomannFindings (Normal + Abnormal): Large amount of old organized thrombus in the right hemithorax with trapped and scarred portions of the lung. Hematoma removed, trapped lung was released. At the end the lung was completely expanding. Good hemostasisnnOperation Description:nThe patient was brought into the operating room and was placed in a supine position. A time out procedure was carried out identifying a correct patient and site. Then general endotracheal anesthesia with a double lumen tube was placed. The patient was placed in a left lateral decubitus position. Then, the first port was placed along the posterior axillary line. A laparoscope was placed the lung was down. Then the second 5 mm port of was placed in a 5th intercostal space in the posterior axillary line. The third incision was placed in the anterior axillary line in the 5th intercostal space. All the ports were placed under a direct visualization. The soft adhesions were carefully released with a blunt laparoscopic grasper. There were soft clots in the apex that were suctioned. There was an area of the lung that was attached to the chest wall which was gently released with blunt dissection. The chest cavity was irrigated with a warm saline. Then we inspected the right chest for bleeding and meticulous hemostasis was obtained. Then a 36French chest tube was placed through the incision on the 7th intercostal space. The chest tube was secured with a #1 silk sutures. The other incisions the muscle was closed with a silk suture. Then the 2-0 Vicryl for a deep dermal tissue and a 4-0 Monocryl for skin was used. Then, glue applied. All the sponge and instrument counts were correct. The patient was extubated and was transferred to the post operative anesthesia care unit.nnRapid Frozen Section Telephone Diagnosis: NonennSpecimens Removed: NonennWound Classifications: Clean Contaminated