D.C. Could Learn A Lot From Healthcare Accomplishments in State Legislatures

Jul 25, 2019 | Uncategorized

While it is said D.C. is slow to make progress on healthcare, individuals are stepping up with a plan noting that “The health of our nation is more important than any political party.” With changes and advancements in healthcare, the state of Colorado is implementing a new law that gives Colorado officials the authority necessary to pursue related federal waivers as needed. The rural areas of our state are experiencing a problem of unaffordable coverage due to insurer competition and limited/nonexistent coverage and state officials are ready to overcome these issues.nnUnited States of Care is a nonpartisan, 501(c)(3) organization dedicated to the goal of every American having access to quality and affordable healthcare.nn”The health of our nation is more important than any political party or partisan victory. United States of Care will chart a path toward a long-term healthcare solution, starting by checking allegiances at the door and putting the patient—our citizens—first.” Dr. Bill Frist, former U.S. Senate majority leader and current USofC board member, said these words at our founding just one year ago. We continue to live by them.nnWith Washington, D.C., slow to make progress on healthcare, we have looked to the laboratories of our democracy—the 50 state governments—to lead our nation and help us chart a path advancing healthcare for everyone. Recently, we have seen significant progress in state legislatures across the country. Acting as a resource, facilitator, convener and technical expert, USoC has connected with healthcare leaders, advocates and others in over 30 states and has formally engaged with partners in Connecticut, Minnesota and New Mexico to support advances in healthcare delivery—learning best practices to share with other states.nnThroughout America and across income groups, Americans say affording healthcare is their most important financial problem. The majority of Americans, across party lines, are concerned about surprise medical bills, prescription drug prices, and coverage for those with pre-existing conditions. This is why state leaders are responding to their constituents’ concerns and seeking policies to make our healthcare system work better for everyone.nnThis unifying feeling—that healthcare is out of reach and unaffordable to many even when one has insurance—eclipses political party and is moving state legislatures across the country to address it. Each state is different, however, and the way lawmakers fix issues—ranging from skyrocketing prescription drug costs to finding ways to make additional coverage choices available and protecting people from financial devastation due to surprise medical bills—is unique in every state.nnThe progress being made state-by-state is a promising march toward the ultimate goal of every single American having access to quality, affordable healthcare regardless of health status, social need or income. Our 2019 State Health Policy Progress analysis hows examples of meaningful progress in 14 states across the country.nnThese state successes are emerging from across the country and from all types of states.nnnnColorado enacted bipartisan legislation directing two state agencies to develop a plan for creating a competitive state insurance plan by Nov. 15, 2019. This new law gives Colorado officials the authority necessary to pursue the federal waivers required to implement the plan. The main goal is to take on the problem of unaffordable coverage in regions of the state, overwhelmingly rural, where insurer competition and affordable coverage is limited or nonexistent.nnColorado also entered 2019 as one of six states with a “C” grade on enforcement of mental health parity. To remedy this, Colorado passed bipartisan legislation to step up requirements for mental health and physical health services to be covered equally. The legislation also increases much needed enforcement and oversight of mental health parity laws.nnMinnesota, the only state with legislative chambers controlled by opposite parties, showed that state leaders can come together across party lines to address pressing problems. Policymakers were faced with the expiration of the state’s provider tax, which helps pay for MinnesotaCare, Medicaid and other vital services that provide care to over 1.2 million Minnesotans.nnLeaders from both parties came together to maintain this crucial funding source and extend the state’s reinsurance program for an additional two years. In Minnesota, reinsurance has reduced premiums by 20% in the individual insurance market. The state also reached a consensus on laws to improve mental health access, lower prescription drug costs, expand access to telehealth, address the opioid crisis, and strengthen elder care protections.nnComplete and original article published on modernhealthcare.com.

Adaptability: Change Your Relationship to Change

Jul 25, 2019 | Uncategorized

As difficult as it may be, embracing change is essential to growing as an individual, being a better employee and a better person than you were yesterday. Focusing on a positive perspective when faced with difficult challenges or changes can help us adapt when we are pushed out of our comfort zones. The following article focuses on this subject and includes great examples of situations that require adaptability and excercises to help you improve your acceptance to change.nnScientists tell us the adaptive ability of any system is usually gauged by its response to disruptions or challenges. In the case of the human system, a.k.a. you and me, adaptive abilities mean you are a person who is flexible in handling change, juggling multiple demands, and navigating new situations with innovative ideas and approaches.nnIs This Me? nnThink about these statements, and choose A or B:n

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• A) I tend to think of change as bad. B) I tend to see change as an opportunity.

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• A) I dislike change. B) Some change can be worthwhile.

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• A) I feel uptight when plans change at home or work. B) I find changes in plans energizing.

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• A) I hate making adjustments in my routines. B) I make adjustments to routines easily.

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• A) I feel threatened when a challenge arises. B) I like a challenge.

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• A) I often get “locked in” to an idea or approach to solving a problem. B) I’m open to new information when solving a problem.

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nIf you find yourself agreeing with most of the A statements, you may be someone who is uncomfortable with change. If you find yourself agreeing with more of the B statements, you may be more able to adapt as changes demand.nnLooking at your own beliefs and judgments can be an important first step toward greater adaptability. If you are fixed in your thinking, you may struggle against change rather than turning it into an opportunity. Learning to sit with discomfort amidst uncertainty is something every human can benefit from.n

An agile mindset is one that recognizes that adapting to change is the price of admission for living a meaningful life.

nLet’s face it, any time you try something new, you face uncertainty and there is risk involved. You never know exactly how things will turn out. For example, you may have to make a decision about whether to take a new job or stay where you are. There are no guarantees the job will be a good fit.  If it is, great! You took the leap and it paid off. If the new job isn’t great–you chalk it up to learning. You are wiser, you gain new skills, new connections, and you’re able to translate that into a better decision next time. The bottom line: change is difficult, uncomfortable, and at times downright painful. Our ability to effectively handle the discomfort of change improves through experimentation and repetition.nnas become an unconscious habit, triggered by any suggestion of change, which results in his automatically coming up with reasons the new idea won’t work, rather than why it might. Such a habit keeps things as they are and squelches innovation. This lack of adaptability keeps inefficient practices in place, and, maybe worse, sends a message not to question the status quo. Over time, this results in stagnation, reduced passion, and energy and weaker financial results.nnHowever, imagine if that executive had been more adaptable and asked the rest of the team how they feel about the new idea and whether it’s worth trying. If they express enthusiasm, the adaptable executive might give it a chance to see how it goes. If it works, progress is made. If it doesn’t, something useful could still be learned. There is acknowledgement that innovation and change carry emotional and financial outlays. And the emotional outlay can be lessened with an emotionally agile mindset.nnAdaptability is at the heart of innovation in any environment.nnPeople who demonstrate adaptability combine curiosity and problem solving skills to achieve their goals. Persistence leads them to try new behaviors or methods of getting things done. They are resourceful and creative, especially when budgets are tight. These key building blocks to adaptability–agility, persistence, and trying multiple strategies–are vital skills for success.nnIncreasingly, adaptability is a key differentiator of effective leadership in highly tumultuous industries, such as technology and finance. Leaders who show strong adaptability recognize that their industry is continually changing and are better able to evolve. They realize they can’t be stuck doing the same old thing over and over. They think creatively and take calculated risks.nnThere are numerous case studies of once-thriving companies whose leaders were unable to embrace change, such as Blockbuster, Sears, and Kodak. Alternatively, we all know companies that make phenomenal examples of adaptability, including Apple and Google, who created new products we didn’t even know we needed. They were attuned to shifting trends and feedback from customers.nnConsider current workplace norms: teams are no longer fixed and steady, they form and disassemble; work is increasingly meted out in short-term contracts. And leaders are attempting to prepare a workforce for jobs that don’t yet exist. It should not be surprising then that employers are putting a high priority on the skill of adaptability.nnAdditional information and helpful tips can be found on original article published on keystepmedia.com.n

Colorado’s Health Exchange Premiums Expected to Drop 18% – if Feds Approve Reinsurance

Jul 19, 2019 | Uncategorized

Health insurance premiums have been an ongoing topic of discussion for Colorado government leaders, medical professionals, insurance companies and patients. With continuous changes throughout the industry, the latest development includes the drop of health exchange premiums. Read the article below for more information recently released and the expectations to come.nnWestern Slope families could save nearly $9,000 a yearnnFor the first time since Colorado started its health insurance exchange, the prices people pay for coverage are expected to drop — by a statewide average of 18.2% — next year if the federal government approves a new state program called reinsurance.nnFor families on the Western Slope, who pay some of the highest insurance premiums in the country, the savings is expected to be nearly $9,000 a year. The Colorado Division of Insurance projects the average savings for Pueblo County at $6,696 annually and $3,369 for metro area residents.nn“I mean, that’s just transformational in terms of saving families money,” Gov. Jared Polis said at a press conference Tuesday.nnReinsurance is basically a pool of $260 million in state and federal money that Colorado plans to use in 2020 to help cover some of the most expensive medical bills among the 250,000 people in the state’s individual market. The idea is that this alleviates some of the burden on insurance providers, which in turn lower their premiums.nnMinnesota’s reinsurance program, for example, dropped its individual premiums by 11.3% and Alaska’s declined by 26%.nnColorado’s reinsurance program is still waiting on final approval from the federal government, but Colorado Insurance Commissioner Mike Conway said he’s all but certain that will happen this fall. Seven states already have federal waivers.nnThe final rates for 2020 health insurance premiums will be released in late September or October.nn“We’ve been working on this for years … ,” said Sen. Bob Rankin, R-Carbondale. “But my caution on this is this doesn’t do anything to really lower the cost of health care.”nnThe news that insurance premiums on the exchange could see a double-digit drop received praise from both the Colorado Hospital Association and Colorado Consumer Health Initiative.nn“We are pleased that the Insurance Commissioner is projecting a decrease in premiums on the individual market for 2020, as it reflects the many efforts by hospitals and providers to take ownership of their portion of the total cost of care,” said Steven Summer, president and chief executive officer of the hospital association, in a prepared statement.nnThe Consumer Health Initiative “expressed cautious optimism” at the expected drop in premiums while warning thatif the Affordable Care Act — also known as Obamacare — is struck down in its latest legal challenge, it could “destabilize everything” by removing health insurance coverage for many Coloradans.nn“We hope the federal Department of Health and Human Services will quickly approve Colorado’s reinsurance program, which is basically insurance for insurance companies that ultimately helps reduce insurance premiums for consumers,” said Adam Fox, director of strategic engagement, in a statement. “Without reinsurance, consumers will face average increases of 0.5 percent and continue to face very high premiums.”nnOriginal article published on denverpost.com.

Changes to Timely Filing Requirements

Jul 11, 2019 | Uncategorized

Changes to timely filing requirements for commercial and Medicare Advantage plans for all claims submitted to plan on or after October 1, 2019

nAnthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.nnEffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*nnFor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)nnNOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL. nn*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.n

Payment methodology change / reimbursement adjustment – Consult codes and Laboratory Services done in the Provider’s Office

nAnthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem) would like to make you aware of changes to our payment methodology / reimbursement adjustment that will be effective for dates of service on or after October 1, 2019.nnConsult CodesnAnthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.nnLaboratory Services done in the Provider’s OfficenAnthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)nnAnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.nnPathology codes are excluded from this adjustment.nnAnthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.nnInformation from Anthem Blue Cross Blue Shield and HMO Colorado.

Ortho Procedure Operative Report

Jul 11, 2019 | Uncategorized

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 PROCEDURE:  04/17/20XXnnPREOPERATIVE DIAGNOSIS: Left degenerative peritalar subluxation and deformity with contracted peroneal tendons and attenuated and tom tibialis posterior tendon, gastrocnemius contracture. nnPOSTOPERATIVE DIAGNOSIS:  Same.nnPROCEDURE: Left Strayer gastrocnemius resection, subtalar and talonavicular joint arthrodesis, peroneal tendon lengthening, tibialis posterior tendon repair, cotton cuneiform osteotomy.nnSURGEON:  K., MD.nnASSISTANT FOR THE CASE: M. nnANESTHESIA:  General.nnBLOOD LOSS: Minimal.nnBRIEF HISTORY: The patient had chronic pain secondary to above.  This was refractory conservative treatment. This was causing her severe difficulty and pain with her knee. Risks and benefits of the above procedure were explained to the patient at length which included pain, bleeding, infection, stiffness, swelling, nerve injury, nonunion, painful hardware, recurrence of deformity, blood clots, a possible need for further surgery, and complications. Informed consent was obtained.nnDESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed on the table in supine position. After a popliteal block was performed, general anesthesia was induced. A well-padded thigh tourniquet was applied.   She was prepped and draped in the usual sterile fashion.nnEsmarch bandage and tourniquet elevated to 300 mmHg. An incision was made centered over the gastrocnemius aponeurosis posteriorly. Sharp dissection was carried out down to the distal aponeurosis. A linear incision was made. Care was taken to avoid injury to the sural nerve or the small saphenous vein. Excellent correction of the contracture was achieved with dorsiflexion well past neutral with the knee extended. Thorough irrigation was carried out using saline. Subcutaneous was closed using inverted 2-0 Vicryl stitches followed by staples for the skin.nnAttention was then turned to the subtalar joint. An incision was made over the sinus tarsi. Sharp dissection was carried out down to the subtalar joint. The peroneal tendons were identified. Z lengthening of the peroneus longus and brevis tendons were then carried out using a 15 blade. This allowed easier correction of the hindfoot valgus. The subtalar joint was entered. This was held open using a lamina spreader. Joint was prepped by removal of cartilage along with perforation of the subchondral bone, surfaced multiple times using a drill bit and chisel. In a similar manner, an incision was made over the talonavicular joint between the tibialis anterior and tibialis posterior tendon. This joint was exposed using a laminar spreader and the joint was prepped in a similar fashion Severe deformity of this joint was seen in a large bone fragment that was non-united from the navicular was present which was excised. The tibialis posterior tendon was obviously lengthened and attenuated. 3 mL of Trinity Elite graft was then thawed and prepped in the standard fashion. A Wright Medical augment was prepped in the standard fashion as well. The augment was first placed on the bone surfaces of both joints with the joint space then filled with the Trinity Elite graft. The talonavicular joint was then first reduced with con-ection of the forefoot abduction. Good co1Tection of the deformity was achievable. This was provisionally held using a K-wire. Once C-mm confirmed a reasonable reduction of the joint and reasonable clinical foot alignment was felt to be present, a single Paragon 28 4.5 mm partially threaded cannulated screw was then placed over the wire with good reduction and fixation.nnNext, attention was then turned to the subtalar joint. Subtalar joint was reduced with correction of the valgus deformity and held in a reduced position with the assistance of the surgical assistant. Through a small posterior incision, a single Paragon 28 7.0 mm partially threaded headless cannulated screw of appropriate size was then placed with good compression  and fixation across the joint achieved and good screw placement confirmed bynnC-a1m.nnNext, a 2-hole compression plate was then applied to further supplement fixation on the talonavicular joint with good fixation achieved.   Next, the forefoot varus was assessed. There was a significant forefoot varus still present and therefore the Cotton osteotomy was performed. A separate incision was made with sharp dissection down to the cuneiform bone dorsally. A TPS saw was then utilized to perform the Cotton osteotomy in the mid-portion of the cuneiform bone.  An osteotome was then used to complete the osteotomy plantarly. Paragon bone wedge trials were then utilized to determine the appropriate size of the bone wedge to be used. A 5mm bone wedge was felt to be appropriate. This was then placed in saline for 5 minutes. The graft was then inserted with the deformity corrected with the aid of the surgical assistant.   The correction of deformity was felt to have been achieved.nnNext, attention was then turned to the tibialis posterior tendon. The tendon was advanced and repaired onto the navicular bone using 2 Arthrex corkscrew anchors.  Good fixation was achieved. Good stability of the ankle was present. Good correction of deformity was present. Irrigation of all wounds was carried out using saline. Subcutaneous was closed using inverted 2-0 Vicryl stitches followed by staples for the skin. Wounds were dressed using Xerofo1m, 4 x 4s, cast padding followed by a well-padded plaster splint followed by an Ace wrap.nnThe patient tolerated the procedure well. There were no complications. She was transferred to the recovery room in good condition. M was used for assistance for the case. Their service was essential for safe time for this case as were proper maintenance of alignment of all articulations while arthrodesis and fixation were performed.nn 

Wishing You A Happy 4th Of July!

Jul 3, 2019 | Uncategorized

“We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.” -Thomas Jeffersonnn Welter Healthcare Partners would like to wish you a Happy 4th of July! Our dedicated staff wants you to remember to relax and have a safe holiday.nnAccording to ADT, firework, grilling and water safety are collectively very important for the 4th of July. More than 50,000 fires are caused by fireworks every year and fun water activities have serious risks if the proper precautions aren’t taken! Please make sure to review safety procedures to keep you and your family safe.nnFrom all of us at Welter Healthcare Partners, we hope you take the opportunity to enjoy this day with loved ones and celebrate your freedom.nn