Changes and Ways to Stay up to Date

Health Care is a revolving door of changes and unlike most professions, some of our biggest changes happen on a yearly basis. The plus side to this is that we can anticipate most these changes and start preparing for them. How can you make the most out of these changes and make sure you’re ready when they happen? The quick answer is to be prepared, but sometimes that is easier said than done.nnThe important thing to remember, is that these changes are typically finalized months in advance. You start to see industry buzz about proposed changes and this is the time so start paying attention. As we continue to move forward, there are great resources out there to take advantage of and not all of them come with a price tag. Podcasts have come a long way and are not just This American Life, and you don’t need a smart phone to access them. Often times you will end up finding a voice that you can really connect with. Best part is that we are not talking about 2+ hour long webinars. Often times these are quick, 30 minute conversations about key take a ways. With a 30 minute run time they can be great items to listen to while driving, on lunch breaks or even while doing those mindless household tasks.nnOne great weekly option is Talk Ten Tuesday. Click here to see more about the podcast!

Denver Provider Market at ‘Tipping Point,’ Study Finds

The Denver provider market is huge, and it is at a tipping point currently with rates and increases due to the economic development in the area. Some of these providers are merging with others, but there are strict regulations to this. Read the article below to find out more about this “tipping point”.nnHealth systems and physician groups have dominated the Denver healthcare market in recent years, but a new study indicates that employer-purchasers and health plans are poised to disrupt that dynamic.nnSupported by existing legislation, activism from local businesses, and the efforts of Gov. Jared Polis, the Denver market is at a ‘tipping point,’ according to a Catalyst for Payment Reform (CPR) and the Colorado Business Group on Health (CBGH) report released Thursday morning.nnThe study specifically referenced the RAND report from May which found that payers were paying rates to providers well above Medicare levels, noting that employers have an opportunity to pressure insurers to engage providers in contract arrangements that better align with care rendered.nnResearchers believe that payment reform is achievable in Denver, suggesting six policy recommendations to business groups, lawmakers, and insurers, including the expansion of price transparency measures and promotion of benchmarking prices relative to Medicare.nnCorralling healthcare prices has been a primary issue in Colorado this year, with the state most recently pursuing a reinsurance program that Polis expects to lower premiums by 18%.nnThe study found that four major health systems, HCA Holdings, Centura Health, UC Health, and SCL Health, accounted for 85% of patient admissions in 2017. On the Herfindahl-Hirschman Index, this level is considered “moderately concentrated” but the report highlights that it also means the market is “concentrated enough to stifle price competition.”nnWhile providers have concentrated in the market through continuous merger activity, the study found that insurers are governed by strict regulations. The result has been Coloradans facing 13% higher prices compared to the national average and 5% high utilization rates.nnTwo of the recommendations offered by the study were to align two-sided risk arrangements with Medicaid and the Polis-Primavera “Roadmap to Affordability,” the governor’s strategic initiative to make care more affordable, as well as to implement benefit designs to “encourage consumers seek higher value care.” The study also urges that employer-purchases to pursue value-oriented programs that hold providers accountable to the listed targets.nnHowever, in an interview with HealthLeaders earlier this year, Centura Health CEO Peter Banko said the system was going to “pause on the mad rush” to value-based care models, citing the direction the market was taking on the issue.nnAs highlighted in the RAND report, CPR and CBGH believe that building on purchaser momentum through a statewide purchase cooperative can be an effective method at changing the market dynamics in Denver.nnSimilar to the Employers’ Forum of Indiana, an employer-led healthcare coalition which collaborated on the RAND report, the Peak Health Alliance, a Summit County-based purchaser cooperative, has sought to combat rising healthcare prices in the Denver area. The report states that Peak Health, which represents 6,000 covered lives, has already negotiated a “very aggressive” reduction in rates with Centura.nnBob Smith, MBA, executive director of CBGH, said that the report gives employer-purchasers “the tools to make changes” to the Denver healthcare market and stem the tide of rising prices.nn”Healthcare costs, primarily driven by high prices and seemingly unwarranted increases, are edging out salary growth and economic development,” Smith said in a statement. “These trends are taking a toll on every employer from school districts to manufacturers and are simply not sustainable.”nnSmith urged lawmakers to act on the report’s suggested reforms but also said that employers now have “the responsibility to act.”nnOriginal article published on healthleadersmedia.com

Learn to Love Networking

It’s hard to believe that we are already in the last full week of September which means another holiday season is upon us. With all the upcoming social events, personal and professional, it is a perfect time for you to start thinking about making some new connections. Personally, the thought of networking sparks both fear and anxiety, which inevitably leads to excuses about why I am unable to attend. Luckily, as it turns out, I am not alone and there are plenty of professionals who also avoid these situations. Bad news is that this could be hurting your career and keeping you from achieving your goals. Harvard Business Review has an article from 2016 with some great tips for all my fellow introverts, read it below to find out more.nn“I hate networking.” We hear this all the time from executives, other professionals, and MBA students. They tell us that networking makes them feel uncomfortable and phony—even dirty. Although some people have a natural passion for it—namely, the extroverts who love and thrive on social interaction—many understandably see it as brown-nosing, exploitative, and inauthentic.nnBut in today’s world, networking is a necessity. A mountain of research shows that professional networks lead to more job and business opportunities, broader and deeper knowledge, improved capacity to innovate, faster advancement, and greater status and authority. Building and nurturing professional relationships also improves the quality of work and increases job satisfaction.nnWhen we studied 165 lawyers at a large North American law firm, for example, we found that their success depended on their ability to network effectively both internally (to get themselves assigned to choice clients) and externally (to bring business into the firm). Those who regarded these activities as distasteful and avoided them had fewer billable hours than their peers.nnFortunately, our research shows that an aversion to networking can be overcome. We’ve identified four strategies to help people change their mindset.nn1. Focus on LearningnMost people have a dominant motivational focus—what psychologists refer to as either a “promotion” or a “prevention” mindset. Those in the former category think primarily about the growth, advancement, and accomplishments that networking can bring them, while those in the latter see it as something they are obligated to take part in for professional reasons.nnIn laboratory experiments we conducted in the United States and Italy with college students and working adults, and in an additional sample of 174 lawyers at the firm we studied, we documented the effects of both types of thinking. Promotion-focused people networked because they wanted to and approached the activity with excitement, curiosity, and an open mind about all the possibilities that might unfold. Prevention-focused people saw networking as a necessary evil and felt inauthentic while engaged in it, so they did it less often and, as a result, under performed in aspects of their jobs.nnThankfully, as Stanford University’s Carol Dweck has documented in her research, it’s possible to shift your mindset from prevention to promotion, so that you see networking as an opportunity for discovery and learning rather than a chore.nnConsider a work-related social function you feel obliged to attend. You can tell yourself, “I hate these kinds of events. I’m going to have to put on a show and schmooze and pretend to like it.” Or you can tell yourself, “Who knows—it could be interesting. Sometimes when you least expect it, you have a conversation that brings up new ideas and leads to new experiences and opportunities.”nnIf you are an introvert, you can’t simply will yourself to be extroverted, of course. But everyone can choose which motivational focus to bring to networking. Concentrate on the positives—how it’s going to help you boost the knowledge and skills that are needed in your job—and the activity will begin to seem much more worthwhile.nn2. Identify Common InterestsnThe next step in making networking more palatable is to think about how your interests and goals align with those of people you meet and how that can help you forge meaningful working relationships. Northwestern University’s Brian Uzzi calls this the shared activities principle. “Potent networks are not forged through casual interactions but through relatively high-stakes activities that connect you with diverse others,” he explains. (See “How to Build Your Network,” HBR, December 2005.) Numerous studies in social psychology have demonstrated that people establish the most collaborative and longest-lasting connections when they work together on tasks that require one another’s contributions. Indeed, research that one of us (Tiziana) conducted with INSEAD’s Miguel Sousa Lobo showed that this “task interdependence” can be one of the biggest sources of positive energy in professional relationships.nnConsider the approach taken by Claude Grunitzky, a serial entrepreneur in the media industries, when he set out to meet Jefferson Hack, founder of the underground British style and music magazine Dazed & Confused. As described in a Harvard Business School case study by Julie Battilana, Lakshmi Ramarajan, and James Weber, Grunitzky—then 22 and preparing to found his first business, an urban hip-hop magazine in London—learned everything he could about Hack.nn“I read every one of his magazines, noticed what he was writing about and what kinds of bands he reviewed,” Grunitzky recalled. “I did so much of this I felt I could almost understand his personality before we met.” Armed with that knowledge and convinced that he and Hack had similar worldviews and aspirations, Grunitzky felt much more comfortable approaching the industry elder.nnWhen your networking is driven by substantive, shared interests you’ve identified through serious research, it will feel more authentic and meaningful and is more likely to lead to relationships that have those qualities too.nn3. Think Broadly About What You Can GivenEven when you do not share an interest with someone, you can probably find something valuable to offer by thinking beyond the obvious. Of course, this isn’t always easy. We’ve found that people who feel powerless—because they are junior in their organizations, because they belong to a minority, or for other reasons—often believe they have too little to give and are therefore the least likely to engage in networking, even though they’re the ones who will probably derive the most benefit from it.nnThis problem was highlighted in two studies we conducted at the law firm mentioned above, which involved different groups of lawyers at different points in time. We found that senior people were typically much more comfortable networking than junior people were because of their greater power in the organization. This makes sense. When people believe they have a lot to offer others, such as wise advice, mentor-ship, access, and resources, networking feels easier and less selfish.nnA controlled experiment confirmed this finding: People in whom we induced feelings of power found networking less repulsive and were more willing to do it than people assigned to a condition that made them feel powerless.nnHowever, even those with lower rank and less power almost certainly have more to offer than they realize. In their book Influence Without Authority, Allan Cohen and David Bradford note that most people tend to think too narrowly about the resources they have that others might value. They focus on tangible, task-related things such as money, social connections, technical support, and information, while ignoring less obvious assets such as gratitude, recognition, and enhanced reputation. For instance, although mentors typically like helping others, they tend to enjoy it all the more when they are thanked for their assistance.nnThe more heartfelt the expression of gratitude, the greater its value to the recipient. One young professional we know told us that when she turned 30, she wrote to the 30 people she felt had contributed the most to her professional growth, thanking them and describing the specific ways each had helped her. The recipients no doubt appreciated the personalized update and acknowledgement.nnWhen gratitude is expressed publicly, it can also enhance an adviser’s reputation in the workplace. Think of the effect you have when you sing your boss’s praises to your colleagues and superiors, outlining all the ways you’ve progressed under his or her tutelage.nnPeople also appreciate those who understand their values and identities and make them feel included. Juan, an Argentinian executive based in the Toronto office of a Canadian property management company, told us about Hendrik, a junior hire from Germany who rallied everyone in the office to join a series of soccer games that he single-handedly organized. His fellow expats—and there were many, because the company’s workforce was internationally diverse—finally had something fun to do with their colleagues, and Hendrik’s status and connections immediately shot up. In spite of his low-power position, he had brought something new to the table.nnYou might also have unique insights or knowledge that could be useful to those with whom you’re networking. For example, junior people are often better informed than their senior colleagues about generational trends and new markets and technologies. Grunitzky is a prime example. “I knew I could bring something to [Jefferson Hack], which was expertise in hip-hop,” he said. The relationship ended up being a two-way street.nnWhen you think more about what you can give to others than what you can get from them, networking will seem less self-promotional and more selfless—and therefore more worthy of your time.nn4. Find a Higher PurposenAnother factor that affects people’s interest in and effectiveness at networking is the primary purpose they have in mind when they do it. In the law firm we studied, we found that attorneys who focused on the collective benefits of making connections (“support my firm” and “help my clients”) rather than on personal ones (“support or help my career”) felt more authentic and less dirty while networking, were more likely to network, and had more billable hours as a result.nnAny work activity becomes more attractive when it’s linked to a higher goal. So frame your networking in those terms. We’ve seen this approach help female executives overcome their discomfort about pursuing relationships with journalists and publicists. When we remind them that women’s voices are underrepresented in business and that the media attention that would result from their building stronger networks might help counter gender bias, their deep-seated reluctance often subsides.nnAndrea Stairs, managing director of eBay Canada, had just such a change in perspective. “I had to get over the feeling that it would be self-centered and unseemly to put myself out there in the media,” she told us. “I realized that my visibility is actually good for my company and for the image of women in the business world in general. Seeing my media presence as a way to support my colleagues and other professional women freed me to take action and embrace connections I didn’t formerly cultivate.”nnMany if not most of us are ambivalent about networking. We know that it’s critical to our professional success, yet we find it taxing and often distasteful. These strategies can help you overcome your aversion. By shifting to a promotion mindset, identifying and exploring shared interests, expanding your view of what you have to offer, and motivating yourself with a higher purpose, you’ll become more excited about and effective at building relationships that bear fruit for everyone.nnOriginal article published on hbr.org

Celebrating Our 25th Anniversary!

Welter Healthcare Partners is excited to celebrate our 25th anniversary.  We couldn’t have done it without all of you! To celebrate this special occasion, please join us for a night of fun, cocktails and snacks on Wednesday, September 25th.  See below invitation for more information.nnA message from Todd Welter, our CEO on the past 25 years at Welter Healthcare Partners:n

Twenty-Five years ago, we started this company to help our clients succeed and thrive in a competitive marketplace which had constantly changing government rules and regulations.  Twenty-Five years later I am proud that we continue to fight this good fight.  We are a lot more sophisticated now than we were way back then. We have a lot more tools, services and capabilities; some I wouldn’t have even of dreamed of twenty-five years ago.  I am grateful and blessed to be surrounded by so many great and dedicated employees, colleagues, friends and especially clients who believe as we do:  Health care is about people and we should do everything we can to help them to be successful.

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Our next twenty-five years will see unprecedented change.  (I remember buying a fax machine, the ones which used that curly heat sensitive paper and thinking we were all that!) The world of health care is turning itself upside down (again).  Compliance, cost, efficiency and effectiveness will be our challenge.  We are on pace and plan to develop even more sophisticated, interactive, and real-time tools to help our clients continue this good fight to be successful, profitable, and capable of supplying the best health care.

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–          R. Todd Welter, CEO

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Colorado NPI Law

nnThe Colorado Department of Health Care Policy & Financing now requires new and currently enrolled organization health care providers to use an NPI for service location and provider type. Read the article below to get more information on the new implementation of HB 18-1282.nnHB 18-1282 requires newly enrolling and currently enrolled organization health care providers (not individuals) to obtain and use a unique National Provider Identifier (NPI) for each service location and provider type enrolled in the Colorado interChange.nnThe Department of Health Care Policy & Financing (the Department) is responsible for implementing Section 3 of HB 18-1282, which added 25.5-4-419 to the Colorado Revised Statutes. The Department’s proposed draft regulations are related to Section 3 of HB 18-1282 and resulting statutes. Please note that Section 2 of HB 18-1282 is not within the Department’s authority and adds language to the statutes for the Department of Public Health and Environment. The Department’s proposed draft regulations are not related to Section 2 of HB 18-1282, and can only answer questions related to our proposed draft regulations implementing Section 3 of HB 18-1282.nn

nOriginal article published on colorado.gov

Operative Report | Vertical Humeral Osteotomy

Do you have a complicated surgery case that needs 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 –nnDATE OF SURGERY: 06/10/2019nnPREOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPOSTOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPROCEDURES:n

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  1. Left shoulder open exploration with capsular contracture and extra­ articular scar release.
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  3. Left revision reverse total shoulder arthroplasty.
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  5. Vertical humeral osteotomy for removal of implant with subsequent ORIF with intramedullary stem and cerclage suture/wire.
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nESTIMATED BLOOD LOSS: 300 cc.nnFLUIDS AND URINE OUTPUT: Per Anesthesia record.nnINDICATIONS: This is a very pleasant 56-year-old female, who has had significant pain and dysfunction of her left shoulder refractory to conservative care with the aforementioned diagnoses. Options were discussed at length, and she wished to proceed with the above-mentioned operative procedures. After a lengthy discussion of the risks and benefits involved, full informed consent was obtained to proceed with the above preoperatively.nnCOMPONENTS REMOVED: Tornier Aequalis cemented humeral stem and Achilles tendon/soft tissue allograft glenoid surface.nnCOMPONENTS PLACED: Wright Medical Aequalis PerFOrM Plus reverse total shoulder system with half wedge augment baseplate 25 mm x 35-degree, 39 mm +3 mm lateralized glenosphere, 9 mm PTC proximal body, Aequalis Flex revised stem with 9 mm x 90 mm PTC distal stem, standard locking cap +0 mm reverse tray, eccentricity 3.5 mm placed at approximately 5.5 mm, and a +9 mm reversed insert for 39 mm glenosphere angle C 7.5 degrees. Total neck shaft angle 140 degrees.nnOne central locking/compression screw, one superior compression screw, and 2 additional locking screws.nnDESCRIPTION OF PROCEDURE:nnThe patient was brought to the operating room, where general endotracheal anesthesia was induced by Dr. H. after interscalene block was administered.nnThe patient was carefully placed in beach chair position with hips flexed 45 degrees, knees flexed 30 degrees. All bony prominences were padded well, and the head was held in a near neutral position by McConnell head holder. The left shoulder was prepped and draped in standard sterile fashion using a Betadine scrub and paint. The left iliac crest region was also prepped and draped in case an iliac crest bone graft would be required. After prep and drape of the left upper extremity, examination under anesthesia revealed stiffness in all planes with 100 degrees forward flexion and abduction, external rotation of 30 degrees with the arm at side, and internal rotation of 20 degrees with the arm abducted. Ioban sticky drape was applied. Antibiotics were held until appropriate cultures were obtained. Previous scar was incised for a length of approximately 15 cm extending it slightly distally. Full-thickness skin flaps were elevated and deltopectoral interval fully explored proximal to distal.nnCephalic vein was not encountered. The dense scar in the subdeltoid space was released revealing the humeral scapular interface superiorly laterally and anteriorly underneath the coracoid. There was dense scar between the coracoid and the remaining rotator cuff and anterior scar. Multiple soft tissue specimens were sent for pathology and microbiology including multiple sutures. The rotator interval was opened. The subscapularis was essentially completely deficient with only a thin layer of scar in the anterior shoulder taking place of the original subscapularis tendon. The scar was removed and capsular contracture released from the inferior glenoid. Scar was released superiorly and posterolaterally and laterally. The proximal humerus was dislocated revealing significant proximal humeral bone loss from the metaphysis. Soft tissue and bony samples were sent for pathology and microbiology. Osteotomes and rongeur were used to remove cement, and soft tissue and bone from around the prosthesis. A thin bur was used to remove bone and cement from around the lateral prosthesis to allow disimpaction of the prosthesis and removal.nnInitially, attempts were made to lightly disimpact the prosthesis to remove cement mantle, but these attempts were unfruitful. The decision was made to proceed with a vertical osteotomy of the humeral shaft to facilitate removal of the implant and removal of cement.nnOsteotomy was made at the location of maximum bone loss and distally just lateral to pectoralis and latissimus dorsi/teres major insertions and medial to the deltoid insertion. This was carried on just to the level of the deltoid insertion and carried out horizontally medially with direct retractor protection of the soft tissues. The osteotomy was opened and the Ultra-Drive used with a flat tip to remove cement from around the osteotomy and from around the prosthesis itself. The prosthesis was then disimpacted without difficulty. Proximal humerus was irrigated with pulse lavage. The Ultra-Drive was then used to remove additional cement to allow diaphyseal fitting component. The 6.5 and 9 mm discs were used to remove cement using Ultra-Drive under continuous irrigation to prevent overheating.nnThe cement plug was penetrated using the Ultra-Drive and the canal enlarged to allow the smallest revive component to be placed. The trial was placed at 25-30 degrees of retroversion and humerus retracted posteriorly. The wound was irrigated with pulse lavage. Significant amount of scar was removed circumferentially around the glenoid and scar released from the inferior glenoid along with capsular contracture. The wound was irrigated with pulse lavage.nnSmall guide pin was placed followed by reaming the inferior glenoid flat followed by reaming the superior glenoid with a 35-degree reamer for the half wedge component. This would fit well with the half wedge placed superiorly and posteriorly. The wound was irrigated with pulse lavage. 2g of Ancef had been given after obtaining adequate bone and soft tissue samples. The center hole was overdrilled followed by drilling for the central screw measuring 35 mm in length. The final component was placed into position and set screw tightened with excellent compression of the baseplate against the bone. The wound was irrigated with pulse lavage and the shoulder trialed with above-mentioned components trialing well. There was slight rotational instability of the humeral component, so decision was made to cement proximally. The wound was irrigated followed by placing the final component which was fixed with a central set screw. The proximal humerus was redislocated followed by removing the trial component. It should be noted that 2 NiceLoop sutures had been placed in modified racking hitch fashion and one 18-gauge wire placed proximally in standard fashion to close the vertical osteotomy.    This opened slightly with placement of the press-fit component. The press-fit component would engage the distal aspect of the humerus distal to the osteotomy as well. The wound was irrigated with pulse lavage.    One batch of DJO surgical cobalt G cement was mixed, and when reached the appropriate consistency, the humerus was irrigated, suctioned, and the cement was allowed, applied in doughy fashion to the proximal aspect of the component.    It was impacted into position and excess cement removed. The wound was irrigated further. The cement was allowed to fully harden. Prosthesis was approximately 25 degrees of retroversion. A 2 cc aliquot of H-GENIN Wright Medical allograft DBM putty was then placed into the vertical osteotomy site to facilitate and expedite healing. This was after copious irrigation with pulse lavage.    The pectoralis major was closed to the deltoid insertion covering the bone graft. A deep 3/16-inch Hemovac drain was placed followed by irrigating the joint further. Small bleeders were coagulated with electrocautery. The deltopectoral interval was closed using running O PDS Stratafix suture.    Skin was closed using buried O and 2-0 Monocryl sutures followed by 3-0 Monocryl subcuticular and Steri-Strips.    A 4 x 4 Tegaderm dressing was applied. The patient’s arm was placed in a well-padded, well-fitting UltraSling. She tolerated the procedure well.nnIt should be noted that 2 skilled surgical assistants, PA-C and SA-C, were absolutely required in order to perform procedure to the current standard of care in timely fashion. Total skin-to-skin operating time was approximately 3 hours and was prolonged due to the complex nature of this revision procedure.nnPOSTOPERATIVE PLANnnTo start early gentle passive range of motion program per protocol. Maximum forward flexion and abduction 90 degrees, external rotation of 30 degrees, internal rotation to the abdomen with active assisted motion allowed at 4 weeks postop, active motion allowed at 8 weeks postop. At 6-8 weeks postop, maximum forward flexion and abduction allowed would be 130 degrees, external rotation of 50 degrees, internal rotation to L3 with no aggressive end-range stretching. The patient will be admitted for standard postoperative medical and orthopedic care. Her culture results will be followed.nn