May 14, 2019 | Uncategorized
The CMS Primary Cares Initiative, being rolled out by officials in the Centers for Medicare & Medicaid Services, spell changes on the horizon for healthcare providers. The initiative is poised to kickstart value-based care, offer five voluntary payment model options, and some significant increases in competition from unlikely places.nn
Even as some important questions remain unanswered, the CMS Primary Cares Initiative is generating a lot of excitement. Observers say it opens the door to more competitors for healthcare incumbents.nnThe shift to value-based care has sputtered a bit in the past two years, as hospitals and health systems have waited to see what innovative reforms the Trump administration would push across the healthcare policymaking finish line.nnDespite a litany of attempts—and two years of a Republican-controlled Congress—the administration has neither repealed nor replaced the Affordable Care Act and the value-based payment provisions embedded within it. Even with its individual mandate neutralized and its constitutionality under judicial review, the ACA remains law, and officials in the Centers for Medicare & Medicaid Services are using the ACA’s authority to roll out a potentially transformative undertaking: the CMS Primary Cares Initiative.nnThat initiative, industry stakeholders say, is poised to kickstart value-based care in Medicare and beyond, ushering in a new wave of consumer-centric competition that could help to shake off some healthcare providers’ risk aversion.nn”There was a sense that things were flattening out. It wasn’t going backwards. It wasn’t going down. It just was not progressing as fast as we all had hoped,” says Norman H. Chenven, MD, founding CEO of Austin Regional Clinic in Texas and vice chairman of the Council of Accountable Physician Practices.nn”With this announcement for Medicare—again, with the caveat that the devil is in the details—there is a sense that this is going to be a shot in the arm and we’re going to see some real new energy, innovation, and evolution of the value-based movement,” Chenven tells HealthLeaders.nnThe initiative, which CMS announced last month, has a total of five voluntary payment model options split between two paths. There are two options under the Primary Care First (PCF) path and three options under the Direct Contracting (DC) path. The idea behind all five options is to demonstrate how risk and reward can lead to investment in primary care that ultimately reduces overall healthcare spending and boosts quality outcomes.nnWhile there are still key details we don’t know about how the new models will operate, they appear to present opportunities for healthcare providers that are strategically positioned to make big moves in value-based primary care.nnBut there also seem to be significant threats, including potential competition from some unlikely sources.nnComplete and original article published on healthleadersmedia.com.
May 14, 2019 | Uncategorized
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 nn
nnDATE OF OPERATION: 11/12/2018nnNEUROSURGERY OPERATIVE REPORTnnPREOPERATIVE DIAGNOSIS: Right frontotemporal dural-based tumor with skull base and orbital invasion.nnPOSTOPERATIVE DIAGNOSIS: Right frontotemporal dural-based tumor with skull base and orbital invasion, probable meningioma with atypical features.nnPROCEDURES: Right frontotemporal craniotomy, resection of dural based tumor, suture of bovine pericardial dural graft, Synthes facet bone putty, subtemporal drain, titanium mesh cranioplasty, intraoperative microscope, ICG fluorescence visualization, lateral orbitotomy, and extradural clinoidectomy.nnCO-SURGEONS: Dr. Z, who performed the right frontotemporal craniotomy, resection of dural based tumor, sutured bovine pericardial dural graft, Synthes facet bone putty, subtemporal drain, titanium mesh cranioplasty, intraoperative microscope, and ICG fluorescence visualization.nnCO-SURGEON: L. M., M.D., who performed lateral orbitotomy and extradural clinoidectomy.nnASSISTANT SURGEONS: Dr. M was the assistant surgeon for Dr. Z’s portion of the surgerynnSECOND ASSISTANTS: A. P., MD and C. B., PAnnINDICATIONS: The patient is a 55-year-old left-handed female, with a positive history of left handedness, who presented with a complex past medical history including hypertension and uncontrolled diabetes, with problems of headache, nausea, vomiting, and vertigo. She had a proximally 6 month history of diabetic retinopathy with blood in her eye and was followed closely by her eye doctors for vision changes. She subsequently developed proptotic changes and blurring of the right vision like a film such that her visual acuity was finger counting in the right eye, with the ability to read with retain on the left. Imaging studies were initially performed that demonstrated a complex skull base meningioma with orbital invasion, particularly at the lateral orbital region. She was initially scheduled for surgery, however, because of uncontrolled diabetes, anesthesia colleagues wanted her under better control prior to the procedure. Thus, she was admitted to the medical service for optimization of glucose control and surgery was performed 72 hours later. The patient and her family underwent detailed informed consent, which is documented elsewhere in the electronic health record.nnPROCEDURE DESCRIPTION: Following the attainment of general anesthesia, all performance measures were and had been accomplished including a preoperative time-out, the administration of antibiotics and approved shave and Betadine preparation. The patient’s head was secured in Mayfield-Kees pin fixation and the stealth was registered. The patient’s head was positioned supine with a bump in a vertex down 30 degree facing to the left approach so that the zygoma was at the highest point in the presentation. A modified Yasargil designed flap to include more temporal and frontal lobe exposure was fashioned entirely behind the hairline with the preservation of the anterior hair in a rubber band for cosmesis. After the stealth registration and the designing of the skin incision to the zygoma, a Betadine preparation was performed and local anesthetic was infiltrated in the subcutaneous tissue. The 10 blade knife was utilized to incise the skin and Raney clips were used to secure the drape. The Bovie was used to reflect the pericranium in the anterior portion of the incision and Metzenbaums were used to dissect inferiorly. The fascia was reflected forward using sharp dissection, and the temporalis muscle was reflected inferiorly down to the level of the zygoma with a superb sphenoid wing exposure. The bone flap was designed with the understanding that the tumor in the sphenoid wing region preoperatively was seen to erode through the bone with hyperostosis and direct bony invasion as there was evidence of tumor in contrast-enhanced regions inferior to the temporalis muscle on the outside of the bone. It was also recognized that there was tumor that had transcended the bone of the lateral orbit and was impacting the lateral rectus muscle. Given that, the bone flap was fashioned in a conservative way outside the area of obvious invasion, first using the Codman perforator and the Midas Rex drill. After this, the pineapple bur was used to primarily remove the region of the sphenoid and lateral orbit involved directly with tumor. A specimen of tumor underneath the temporalis and involving the pericranium was removed, and dissection was performed at that level to minimize the amount of observed tumor. With that, multiple specimens were obtained. Hemostasis was obtained by coagulating the dura primarily. The extradural clinoidectomy was performed expertly by Dr. M., who provided his special training in skull base to address the lateral clinoidectomy and the lateral orbitotomy. The dura was gently mobilized and reflected in order to accomplish both of these procedures safely. The dura was then opened until the tumor was identified and a Sonopet was used to remove portions of the tumor. IC-Green was used under the operating microscope to identify the middle cerebral vessels and identify, which vessels were emphasized and which vessels were going directly to the tumor. This technique worked expertly and was useful in safe dissection. The lateral wall of the orbit was removed and the dura was left intact. Some of the superior orbital roof was also reflected. Every aspect of the dura that was clearly involved with tumor was then removed in an en bloc fashion after the tumor had been safely reflected from the sylvian fissure and sylvian vessels. There was a question of brain invasion at the right frontal lobe, which was very limited. Otherwise, there was intact pia over the temporal and frontal lobes abutting the tumor. Once the dura was resected and the bone areas of tumor removed, as well as some of the infratemporal tumor, a bovine pericardial dural graft was then fashioned and secured using 3 mm MRI compatible Synthes screws as well as Tisseel as a tissue glue to prevent drainage through the inlay dural graft. The superior aspects of the graft were closed primarily with running and interrupted 3-0 Nurolon sutures. The bone that was not involved with tumor was replated using Synthes plates and screws, and a mesh was secured over the area of the lateral sphenoid that had been primarily drilled and resected due to involvement with tumor over that. A fast setting bone putty was used for cosmesis with a superb closure and cosmetic result. The wound was irrigated copiously at many stages through the procedure with antibiotic solution including through the dura prior to the placement of the Tisseel. A subgaleal drain was used and remained in place for a prolonged period of time with the tip underneath the temporalis muscle and curvature underneath the galea, so that there were holes picking up any subgaleal fluid and also CSF to serve as a CSF diversion, successfully allowing the dura to close over for a period of several days postoperatively. The alternative would have been to place an external ventricular drain or a lumbar drain; however, this subgaleal drain placed under the temporalis worked superbly as a diversion for CSF to allow excellent healing. The temporalis muscle was secured using 2-0 Vicryl pop-offs. The fascia was secured using 2-0 Vicryl pop- offs. The galea was closed using 2-0 and 3-0 Vicryl interrupted sutures, and the skin was closed with staples with a 3-0 Prolene stitch at the drain exit site, and a Vicryl buddy stitch at the drain exit site. Sterile dressings and a full head wrap were placed. Sponge, needle, and cottonoid counts were correct at the conclusion of the case.nnFINDINGS: The pathology was consistent with meningioma and given the erosion through structures, the final results were consistent with atypical or grade 2 features as expected from the preoperative imaging studies and the findings intraoperatively. The unplug tumor was biopsied and there were also areas of focal probable brain invasion along the right anterior and inferior frontal lobe. There was confirmed involvement of the pericranial aspect of the temporalis muscle with extradural invasion of the lateral orbit and presumed positive bone.nnSPECIMENS: Multiple frozen and permanent section specimens were sent.nESTIMATED BLOOD LOSS: Between 500 and 700 mL.nANESTHESIA: Performed expertly by general endotracheal intubation with Dr. T., Dr. B., and Dr. W.; all contributing to the patient’s care.nnCULTURES: None.nnDRAINS: One 10-French subtemporal subgaleal drain was placed.nnBLOOD REPLACEMENT: Two units of packed cells were placed for intraoperative hematocrit of 24, as I recall.nnThe patient has continued to do well with preserved vision in her right eye and an excellent postoperative resection with no evidence of stroke and no evidence of new deficit.nnDr. Z. was the surgeon for the right frontotemporal craniotomy, resection of dural based tumor, sutured bovine pericardial dural graft, Synthes facet bone putty cranioplasty, subtemporal drain, titanium mesh cranioplasty, intraoperative use of microscope, ICG fluorescent visualization. Dr. M. was the surgeon for the lateral orbitotomy and extradural clinoidectomy. The 2nd surgeon was required due to his particular expertise in training in skull base approaches, which was not otherwise available at our facility.
May 9, 2019 | Uncategorized
As we head into the future, more and more employers are going to be more proactive about the health of their employees, according to a new survey. This means that by 2020, almost 40% of employers are looking at opening a health center at their offices, hoping to increase employee productivity, health, and on-the-job satisfaction. Here at Welter Healthcare Partners, we understand that employee health is essential to your company’s productivity, and we applaud this progress. nn
Employers are increasingly focused on improving access and quality of care for their workers, according to a new survey.nnWithin the next three years, nearly half of employers plan on implementing high-performance networks (HPN), centers of excellence (COE), onsite or nearby health centers and accountable care organizations (ACO) as ways to provide quality and affordable healthcare options, according to a Willis Towers Watson (WTW) survey released Wednesday morning.nnEighty percent of respondents intend on having COEs within a health plan, a 29% jump year-over-year, and the number of employers who plan on including HPNs more than doubled to 65%.nnBy 2020, almost 40% of employers are looking at opening a health center at their offices, while more than 25% plan to offer one near their facilities.nnThese trends have gained momentum in recent years, as more than 80% of employers with an onsite or near-site health center reported that the move has “succeeded in improving employee access to convenient health care services,” “enhancing employee productivity and bringing absenteeism under control,” while also “delivering and promoting preventive health screening and services, getting ahead of medical issues through early detection and by instilling healthy habits.”nnThe survey also shows that employers are increasingly more concerned with quality of care provided than cost savings as the “most important feature” when considering an HPN.nnSandy Ageloff, managing director, west region health and benefits consulting leader, told HealthLeaders that the survey results indicate that the shifting thought process among employers is being driven by four major paint points.nnThese include the need for better care access, especially around mental health services for employees, providing high quality care, making care cost effective, and concerns about system complexity.nn”I think employers have done a lot to try to improve cost and quality, but what we’re realizing is that employees and their family members are challenged to understand all of the various pieces of the puzzle,” Ageloff said. “Employers are now embracing the need to say, ‘You need to help people navigate through what we’ve done to create beneficial, high-quality programs that provide affordable costs.'”nnComplete and original article published on healthleadersmedia.com.
May 9, 2019 | Uncategorized
Now that we are all familiar with ICD-10 it’s time that we start focusing more on specificity when it comes to diagnosis. It’s not just import for patient charts, with HCC becoming the new standard and payers tracking things like readmissions it’s becoming more important than ever for Coders to capture as much in their code selection as possible.nnICD-10 includes a classification system implemented to capture data, which previously was not tracked. Classifications such as “underdosing of drugs” can prove to be vital when readmission rates are not only tracked but also could affect a practice’s reimbursements. As coders, it’s not only important that we extrapolate this information from the documentation but also code why the drug was not taken correctly or, in some cases, not at all. Classification codes T36-T50 (utilizing a fifth or sixth character of “6”), deals with specific drug underutilization while Z codes Z91.12- Z91.19 classifies the patient’s non-compliance with medical treatment and regimen. Z codes should, when known, be accompanied by the correct underdosing code to help account for intent.nnThe Journal of AHIMA wrote about this back in 2016, however this topic will continue to become more relevant as Risk Adjustment Models are adapted by more practices and payers.nnCLICK HERE to read the full article, “Potential Impact of the ICD-10 Underdosing Classification System” in the Journal of AHIMAnn
Apr 30, 2019 | Uncategorized
Colorado Governor, Jared Polis, has been in the news for his “roadmap” to reduce healthcare costs for all Coloradans. In this article, we dive into the latest developments: which bills are still on the table, how they plan on lowering health care costs, and whether there’s still enough time and money to make this a possibility. nn
Colorado Gov. Jared Polis stood outside of Denver Health Medical Center almost a month ago laying out his “roadmap” to save people money on health care.nnAs the Boulder Democrat ticked off his list of plans, both short term and long term, it quickly became apparent that most of the governor’s ideas to lower health care costs in Colorado weren’t possible unless state lawmakers passed a series of bills.nnDemocrats and Republicans have come together to create the beginnings of a public option health plan and make hospitals turn over more of their financial data. But with a week left in the 2019 session, several items on the governor’s list still haven’t passed and the big question remaining is whether there’s enough time, money and political will to get the rest of them across the finish line.n
Reinsurance
nA high-priority bill that might not make it through in the final days of session is one that has lowered people’s premiums in other states by essentially providing an insurance plan for health insurance companies to help offset the costs of their most expensive patients.nnIt’s called reinsurance, and its sponsors basically rewrote House Bill 1168 for a third time Thursday afternoon.nn“It’s always been an issue of how to pay for it,” said Sen. Bob Rankin, R-Carbondale, as he presented the latest changes to a Senate committee.nnColorado wants to get matching dollars from the federal government for its reinsurance program. The first version of the bill was unlikely to win approval from the Trump administration, and the funding mechanism on the second jeopardized other federal dollars.nnRankin and Sen. Kerry Donovan, D-Vail, were frank with their colleagues that the new way to fund the program isn’t ideal, but Donovan said it’s the best way they could find with time running out on the 2019 legislative session.nnThe new plan is to have Colorado hospitals contribute $40 million, take $26 million from a premium tax that would otherwise go into the general fund and potentially take another $15 million to $40 million from a fee that was originally meant to raise money for affordable housing.nn“We don’t want the program to die,” Rankin said. “We want to use every possible avenue to get this program moving.”nnReinsurance is waiting on a vote by the full Senate.n
Prescription drugs from Canada
nPolis and other Democratic lawmakers see our neighbors to the north as a potential cure for the high drug prices Coloradans pay every day.nnThat’s why Democrats introduced Senate Bill 005 on the first day of the 2019 session. It directs the Department of Health Care Policy and Financing to create a program to buy prescription drugs from from licensed Canadian suppliers and then distribute them to pharmacies and hospitals across the Centennial State.nnThe bill passed the Senate a month ago, but it has yet to clear the House.nnColorado would need a waiver from the federal government to legally bring those drugs across the border, and it’s unclear whether the White House would allow that. Both the Bush and Obama administrations rejected requests from other states.n
Prescription drug transparency
nAnother bill aimed at lowering the price people pay at the pharmacy is running out of time.nnHouse Bill 1296 would authorize the state Department of Insurance to collect data from every part of the prescription drug supply chain, analyze it and report annually to lawmakers on ways to reduce costs. It also would require drug companies to publish certain price increases on the DOI’s website 30 days before they go into effect.nnThe bill has yet to get a vote from either chamber.n
Out-of-network billing
nTwo different bills — one from each chamber — would limit how much money patients can be charged for out-of-network services they likely unknowingly received during an in-network hospital visit.nnThey’re called surprise or balance bills, and this is the fifth time lawmakers have tried to pass some kind of legislation to address them. House Bill 1174 appears to be on its way to becoming law; it’s awaiting a final vote in the Senate.nnOriginal article published on denverpost.com.
Apr 24, 2019 | Uncategorized
Todd Welter has some opinions when it comes to the upcoming Colorado State Bill HB19-1174 Out-Of-Network Health Care Services Provided To Covered Persons. Read it for yourself to see why he believes that the government should not be in the process of setting prices, and why health insurance companies should keep their patients’ best interest in mind by keeping prices low for the future.nnOur very own Todd Welter has been invited to the Colorado State Senate hearing on HB19-1174 Out-Of-Network Health Care Services Provided To Covered Persons.nnIn his own words, “The government should not be in the business of setting prices, there are too many unintended consequences. A free and transparent market should set prices.”
nnThis bill would require “health insurance carriers, health care providers, and health care facilities to provide patients covered by health benefit plans with information concerning the provision of services by out-of-network providers and in-network and out-of-network facilities; outlines the disclosure requirements and the claims and payment process for the provision of out-of-network services; requires the commissioner of insurance, the state board of health, and the director of the division of professions and occupations in the department of regulatory agencies to promulgate rules that specify the requirements for disclosures to customers, including the timing, the format, and the content and language in the disclosures; establishes the reimbursement amount for out-of-network providers that provider health care services to covered person at an in-network facility and for out-of-network providers or facilities that provider emergency services to covered persons; and creates a penalty for failure to comply with the payment requirements for out-of-network health care services.nnRead the rest of the bill here. (PDF)nnIf the state government sets prices for out-of-network services the health plans will be encouraged to use this as a ceiling rate. Any provider who has a higher rate (specialists in rural areas, very unique services, new procedures, etc.) will simply get their contracts terminated allowing the payers to use the state imposed ceiling rate.nnPlease contact your government representatives and make your opinion known!
