Sep 30, 2019 | Uncategorized
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!
Sep 23, 2019 | Uncategorized
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.nn
As 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
Sep 23, 2019 | Uncategorized
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.nn
3. 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
Sep 20, 2019 | Uncategorized
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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Sep 11, 2019 | Uncategorized
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The 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.nn
HB 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
Sep 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 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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- Left shoulder open exploration with capsular contracture and extra articular scar release.
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- Left revision reverse total shoulder arthroplasty.
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- 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
Sep 6, 2019 | Uncategorized
Colorado emergency charges vary in price across the state, which prevents patients from seeking care due to the price of their treatments. The article below gives more insight to the unusual healthcare prices that many people are looking to fix. Read below to find out more on this dive.nnDive Brief:n
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- The cost of emergency department visits in Colorado vary enormously depending on facility and condition severity, according to new data from the state’s all-payer claims database analyzed by the Center for Improving Value in Health Care.
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- Colorado’s EDs were paid an average of $3,115 for the most severe life-threatening cases in 2018. The largest single charge was $47,779, and the smallest was $190.
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- But Denver-based CIVHC, which administers the database, only looked at reimbursement from commercial payers to the facility directly, meaning the entire cost of care for a Colorado patient — including common add-ons like lab tests, imaging services, surgical procedures or other physician fees — is likely much higher.
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nDive Insight:nnColorado’s data provides the U.S. an unusual glimpse into healthcare prices, albeit in one state and one type of provider setting.nnThough national ER use remained largely unchanged over the past decade according to the Health Care Cost Institute, ER clinicians are using high severity codes more frequently. Previous research from the CIVHC found that trend held true in Colorado as well, with a decrease in coding for all other lower-tier severity levels across commercial payers between 2009 and 2016.nnLast year, the median statewide facility payment for a low severity visit was approximately $290 and high severity level claims were paid at almost $3,000.nnAs ER costs continue to rise, some payers are taking controversial steps to try and blunt the trend. Anthem faced lawsuits and backlash from a slew of providers in Connecticut, Georgia and Missouri around its cost-cutting policies, including paying patients directly for emergency care and having them reimburse their providers, and no longer reimbursing for non-emergency services given in the ER.nnIf widely adopted, that latter policy from the Indianapolis-based payer could deny payment for as many as one in six ER visits, according to a study in JAMA.nnProvider critics, wary of insurer policies that could further endanger their bottom lines, argue such measures could prevent patients from seeking care in the first place.nnOver a dozen individual states along with Washington, D.C. have put forward proposals to try and mitigate the practice. The Trump administration backs legislation to ban surprise billing, which lawmakers are set to debate after the summer recess. Often, patients hit with surprise medical bills for care not covered by their insurer get them after receiving care in the ER.nnBig hurdles remain to appease both the payer and provider lobbies, which stand diametrically opposed on the way forward to fix the problem.nnOriginal article published on healthcaredive.com
Aug 30, 2019 | Uncategorized
Banner Health is planning to acquire the North Colorado Medical Center which has been in operation since 1995. This new plan would bring great healthcare opportunities to the area. Read below to find out more about the deal.nnPhoenix-based Banner Health plans to acquire North Colorado Medical Center in Greeley, which it has operated since 1995.nnUnder the proposed deal, which requires regulatory approval, Banner would pay $328.4 million to acquire the land, assets and equipment associated with the hospital from Weld County (Colo.).nnA large portion of the proceeds from the transaction will be used to pay off $209.5 million in existing hospital debt, according to a press release from Weld County.nnOriginal article posted on beckerhospitalreview.com
Aug 21, 2019 | Uncategorized
Pinnacol recently announced that Nurse Practitioners could pursue DOWC accreditation to receive higher reimbursement. Also, Pinnacol announced the use of interpretation services to meet contract obligations and the Division of Workers Compensation requirements for injured workers. Read the article below to find out more about these two new regulations.nnDOWC Accreditation for Nurse PractitionersnnNew Colorado Division of Workers’ Compensation regulations that went into effect Aug. 2 impact nurse practitioners.nnHouse Bill 1105 allows nurse practitioners to obtain DOWC Level I accreditation solely for the purpose of receiving the higher reimbursement associated with the designation. It does not allow them to declare maximum medical improvement for an injured worker, the key component of Level I accreditation.nnNurse practitioners may begin pursuing DOWC Level 1 accreditation now via an online course. The next in-person training session will be offered via DOWC in September in Denver, and registration is open.nnBeginning on Aug. 2, Level 1 accredited nurse practitioners with prescriptive authority will be allowed to bill for 100 percent on the DOWC Medical Fee Schedule.nnReference nnWorkers’ Compensation Rules for NPs and PAs nnUse of Interpretation ServicesnnEffective Sept. 1, Pinnacol will implement procedures to meet contract obligations and the Division of Workers’ Compensation requirements for scheduling interpretation services for Pinnacol’s injured workers. These procedures comply with 2019 DOWC Rule 18-6(Q).nnPinnacol Assurance is committed to aligning all parties to provide uninterrupted, quality service for our non-English-speaking injured workers.nnThe following are the guidelines to ensure quality care.n
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- Interpretation must be authorized for patients during office visits, diagnostics, injections, therapy and psychological services.
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- The treating provider will call Pinnacol for authorization for interpretation services.
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- Pinnacol will determine whether the requested provider is contracted with Pinnacol. If contracted, the request will be approved. If the vendor is not contracted,
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- Pinnacol claims reps will refer the requester to the list of approved, contracted providers.
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- Pinnacol may change the interpretation vendor at any time during the life of the claim — with or without cause — after notifying the current vendor and the primary care provider.
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nIf issues arise in the process of assigning an interpreter or with the services provided by an interpreter, please contact the Pinnacol claims representative immediately.nnPinnacol does not intend to direct the type or duration of medical treatment that may be prescribed. Prescribing providers must exercise independent medical judgment in these matters.nnIf you have any questions or need additional information, please contact Pinnacol Assurance at provider_management@pinnacol.com or 303.361.4945.nnReferences nColorado Division of Workers’ Compensation, Rules of Procedure, Rule 18-6(Q)nUse of Interpretation ServicesnPinnacol’s Contracted Interpretation and Translations Service ProvidersnnOriginal article published by pinnacol.com
Aug 21, 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 –nnSubjective:nnChief Complaints:n
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- Bilateral L5/Sl TF Epidural PRP. Nosed. No ABX/AC. PM.
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nMedical History:nnMedications: Taking Baclofen 10 MG Tablet TAKE ONE-HALF TO ONE TABLET BY MOUTH AT BEDTIME , Taking Celecoxib 200 MG Capsule TAKE ONE CAPSULE BY MOUTH TWICE DAILY, Taking Belbuca 150 MCG Film 1 film to the gum Buccally every 12 hrs, Notes: DNF: 07/29/19, next due 08/28/19, Taking Oxycodone-Acetaminophen 5- 325 MG Tablet 1 tablet as needed Orally every 12 hrs, Notes: DNF: 07/29/19, next due 08/28/19nnObjective:nnVitals: BP 122/78 mm Hg, HR 92 /min, Ht 71.0 in, Wt 195 lbs, Oxygen sat% 95 %, BMI 27 .19 Index.nnAssessment:n
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- Lumbar spondylosis – M47 .816 (Primary)
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- Lumbar radiculopathy – M54.16
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- Degeneration of lumbar intervertebral disc – M51.36
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nAt this point, patient has failed conservative therapy, has undergone imaging and physical examination which demonstrate facet mediated pain.nnThey also have undergone dual diagnostic MBB with over 80% relief on DOS and the duration of effect was consistent with the local anesthetic used.nnThey have had prior RFA of the same levels (over 6mo ago) with >60% relief for 4mo and, by their report, had improvement in performance of ADLs of home, work and family.nnPlan:n
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- Others
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nNotes:nnFAILURE OF CONSERVATIVE MANAGEMENT OF OVER 4 WEEKSn
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- Prescription strength anti-inflammatory medications and analgesics
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- Adjunctive medications such as nerve membrane stabilizers or muscle relaxants
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- Physician-supervised therapeutic exercise program or physical therapy
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- PAIN SEVERITY IS 3/10 OR GREATER
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- UNABLE TO PERFORM AOL’S of WORK, HOME,and RECREATION,
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nProcedures:nnCPS Procedures:nnPre-op, Diagnosis: Lumbar Radiculopathy and disc degeneration.nnPost-op. Diagnosis: same.nnInformed Consent: The risks and benefits per the informed consent were discussed with the patient.nnAlthough risks are theoretically possible, they are remote. We specifically discussed infection, bleeding, nerve damage, spinal cord damage and paralysis. Patient understands risks and benefits and wishes to proceed. All questions answered..nnProcedure: Bilateral LS/S1 TRANSFORAMINAL EPIDURAL, LS/S1 FACET and LEFT APPROACH Discogram and INJECTION of PLATLET RICH PLASMA .nnSedation : None.nnDetails of Procedure: First 60mL of the patient’s blood was sterll collected from the LEFT AC and processed per Celling Biosciences PRP kit instructions. Strict aseptic technique was maintained. 500 mg ancef was given IV. The patient was placed prone on the fluoroscopy table. after sterile prep and drape with chlorhexidine, C-arm fluoroscopy was used to visualize the lumbar spine. The skin puncture sites were anesthetized with cold spray. Pt placed in the prone position on procedure table. Monitors were applied.nnThe patient’s back was prepped with chloraprep and draped with sterile towels. Using AP, lateral, and oblique fluoroscopy, the neuroformina were identified. After anesthetizing the skin with bicarbonated 1% lidocaine, a 22 G 5 inch quincke needle was advanced into each neuroforamen. Needle tip position was confirmed on lateral view and with the injection of 0.5 cc of Isoview 200. The left needle was then advanced into the disk and confirmed with omnipaque/ancef mixture. Then each needle was redirected to the LS/S1 facet. The inferior aspect of the joint was accessed. ‘ After negative aspiration, injectate of PRP iML was injected through each needle without difficulty at each location ‘ ‘The patient tolerated the procedure very well..nnComplications: None.nnSpecimens: None.nnImpressions: The patient stayed in the recovery room without motor and sensory deficits and was discharged home with an escort.nnTechnically successful block. Follow up in 30 days,
Aug 15, 2019 | Uncategorized
The residents of Colorado are working hard to improve our healthcare system throughout the state. A recent study ranked Colorado number 11 in the US based on several different variables, however, health care costs in Colorado were ranked 47. Read the article below recapping the results from the survey and other placement factors.nnA new study places Colorado’s health care system just outside the top 10 in the nation.nnThe study, released Monday by financial website WalletHub, ranked Colorado No. 11 on its list of best and worst states for health care.nnMinnesota, Massachusetts and Rhode Island took the top three spots, with Mississippi, North Carolina and Alaska coming in at the bottom of the list.nnThe report compared the 50 states and the District of Columbia across 43 measures of cost, accessibility and outcome, using data sets ranging from average monthly health insurance premium costs, hospital beds per capita, cancer and heart disease rates, and percentage of insured people ages 19 to 64.nnColorado ranked No. 47 in terms of health care costs for its residents, which considered factors such as average hospital expenses per inpatient day at a community hospital and average monthly health insurance premium costs.nnThe Centennial State ranked 12th in access to health care — which took into account the number of hospital beds per capita and the quality of the state’s public hospital system — and No. 3 in health care outcomes, which included life expectancy and infant, child and maternal mortality rates.nnToday, the average American spends more than $10,000 per year on personal health care, or about 17.9 percent of the U.S. GDP, according to the most recent estimates from the Centers for Medicare & Medicaid Services.nn“But higher costs don’t necessarily translate to better results. The U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden,” the study states. “However, the U.S. has improved in giving more healthcare access for people in worse health, and health care cost growth has slowed somewhat.”nnOriginal article published on csbj.com.
Aug 8, 2019 | Uncategorized
MLNConnects, the official news of CMS, recently proposed 3 new payment rules. CMS released these proposed rules on July 29, which include payment updates for outpatient and physician services and also expanded price transparency initiatives. Read below to find out more information on these proposed rules. n
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- PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020
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- Medicare OPPS and ASC Payment System CY 2020 Proposed Rule
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- ESRD and DMEPOS CY 2020 Proposed Rule
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n1. PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020n
On July 29, CMS issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. This proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. It also includes proposals to streamline the Quality Payment Program with the goal of reducing clinician burden. This includes a new, simple way for clinicians to participate in our pay-for-performance program, the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways.
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The proposed rule also includes:
nn
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- CY 2020 PFS rate setting and conversion factor
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- Medicare telehealth services
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- Payment for evaluation and management services
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- Physician supervision requirements for physician assistants
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- Review and verification of medical record documentation
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- Care management services
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- Comment solicitation on opportunities for bundled payments
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- Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
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- Bundled payments for substance use disorders
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- Therapy services
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- Ambulance services
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- Ground ambulance data collection system
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- Open Payments Program
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- Medicare Shared Savings Program
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- Stark advisory opinion process
n
n 
2. Medicare OPPS and ASC Payment System CY 2020 Proposed Rulen
On July 29, CMS proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Health Care to Put Patients First,” that lay the foundation for a patient-driven health care system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.
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The proposed changes also encourage site-neutral payment between certain Medicare sites of services. Finally, the proposed rule proposes updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency, (including proposals for requirements that would apply to each hospital operating in the United States), strengthening Medicare, rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility and patients have what they need to become active health care consumers.
n
In accordance with Medicare law, CMS is proposing to update OPPS payment rates by 2.7 percent. This update is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for Multi-Factor Productivity (MFP).
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In the CY 2019 OPPS/ASC final rule with comment period, we finalized our proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023). CMS is not proposing any changes to its policy to use the hospital market basket update for ASC payment rates for CY 2020-2023. Using the hospital market basket, CMS proposes to update ASC rates for CY 2020 by 2.7 percent for ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for MFP. This change will also help to promote site neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting.
n
The proposed rule also includes:
nn
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- Proposed definition of ‘hospital,’ ‘standard charges,’ and ‘items and services’
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- Proposed requirements for making public all standard charges for all items and services
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- Proposed requirements for making public consumer-friendly standard charges for a limited set of ‘shoppable services’
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- Proposals for monitoring and enforcement
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- Method to control for unnecessary increases in utilization of outpatient services
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- Changes to the Inpatient Only list
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- ASC covered procedures list
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- High-cost/low-cost threshold for packaged skin substitutes
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- Device pass-through applications
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- Addressing wage index disparities
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- Changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
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- Hospital Outpatient Quality Reporting Program
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- Ambulatory Surgical Center Quality Reporting Program
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- CY 2020 OPPS payment methodology for 340B purchased drugs
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- Partial Hospitalization Program rate setting and update to per diem rates
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- Revision to the organ procurement organization conditions for certification
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- Potential changes to the organ procurement organization and transplant center regulations: Request for Information
n
n
3. ESRD and DMEPOS CY 2020 Proposed Rulen
On July 29, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also:
nn
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- Proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI
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- Proposes changes to the ESRD Quality Incentive Program
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- Includes requests for information on data collection resulting from the ESRD PPS technical expert panel, on possible updates and improvements to the ESRD PPS wage index, and on new rules for the competitive bidding of diabetic testing strips.
n
n
In addition, this rule proposes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services and making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts. This rule would also:
nn
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- Make amendments to revise existing policies related to the competitive bidding program for DMEPOS
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- Streamline the requirements for ordering DMEPOS items, and create one Master List of DMEPOS items that could potentially be subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements
n
n
The proposed CY 2020 ESRD PPS base rate is $240.27, an increase of $5.00 to the current base rate of $235.27. This proposed amount reflects a reduced market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.7 percent) and application of the wage index budget-neutrality adjustment factor (1.004180).
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The proposed rule also includes:
nn
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- Annual update to the wage index
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- Update to the outlier policy
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- Eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA)
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- Basis of Payment for the TDAPA for calcimimetics
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- Average sales price conditional policy for the application of the TDAPA:
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- New and innovative renal dialysis equipment and supplies
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- Discontinuing the application of the erythropoiesis-stimulating agent monitoring policy
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- Impact analysis:
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nOriginal and complete article published on cms.gov
Aug 8, 2019 | Uncategorized
New changes are coming regarding evaluation and management guidelines. Some of these new changes include updates on medical decision making and code selection. We will be seeing these much needed updates in 2021. Read the article below to get updated on all the other changes that are coming.nnIn an ongoing effort to reduce clinician burden, the “counting” of qualifiers in history and exam will soon be a thing of the past. Exciting changes are on the horizon for evaluation & management guidelines, including updates to how medical decision making (MDM) is determined. Although E/M codes will no longer be selected based on how much history or exam is documented, clinicians should still expect to document when the medically necessary pieces of work was done to fully address the patients presenting problem(s).nnStarting in 2021, code selection will be determined by the number/complexity of presenting problems, data reviewed and the risk of complications. Time will also be another method for appropriate E/M selection. With the new coding guidelines, clinicians will be able to count DAY OF face-to-face time AND non-face-to-face time they personally spend on a patients care. Reviewing tests, other records, ordering medications performance of medically necessary exam can all be used for time calculation.nnOffice visit codes will have new time ranges when the implementation takes place. Fine-tuning clinically relevant documentation, telling clear stories about patient encounters and getting better at time-based capture/reporting now will help prepare for these much needed changes we will be seeing just around the corner in 2021.
Aug 6, 2019 | Uncategorized
Welter Healthcare Partners has successfully completed yet another important project for the State of Colorado. We were asked by the Colorado State Innovation Model (SIM) to create a curriculum to help primary care practices better understand how to integrate behavioral health services into their commercial payer contracts such that these services will be reimbursed and as a result remain sustainable.nnThere are six chapters for this curriculum, made up of both workbooks and webinars to help guide you through the program. This content was developed and produced using funding from the Colorado State Innovation Model, a federally funded, Governor’s Office initiative. Click here to learn more.nnYou may follow this link to the Welter Healthcare Partners website where you can view the videos and workbooks for this curriculum and you can also check out our YouTube channel.
Aug 6, 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 exercises to help you improve your acceptance to change.nn
Is 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.
n
- A) I feel threatened when a challenge arises. B) I like a challenge.
n
- 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.nnAn agile mindset is one that recognizes that adapting to change is the price of admission for living a meaningful life. Let’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.nnHere’s how rigidity, the opposite of adaptability, can show up at work: Imagine an executive who quickly shuts down an idea suggested by a team member for a more tech-based system of project management that could increase productivity. The executive may not realize this “shut-down” reflex has 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.nnBy staying adaptable and open-minded, you continue to reinvent yourself and experience significant growth along the way.nnKeep in mind, there are times when there’s a good reason not to change, like preserving quality standards or time-tested effective strategies. The trademark of an adaptable leader, however, is the ability to balance core values with responsiveness in the face of a changing world.nnTry this exercise for developing your adaptabilitynnThink of a change in either your personal or professional life you have recently experienced or are currently experiencing. How do you feel about the change? How are you responding to the change?nnHere are some examples of situations that require adaptability:nnWe are launching a new service line. I’m excited about the possibilities it creates, but a little nervous about whether we’ve thought of everything. I’m doing significant research to position myself as an expert.nnMy daughter just turned 12 and is suddenly becoming moody and withdrawn, spending lots of time in her room and not talking to me or her Dad. I’m scared something might be going on that she’s not telling us.nnNow, ask yourself a series of questions to help find a positive perspective on that change:n
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- What opportunities does this change represent?
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- What positive outcome could I find in this change?
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- What is outside of my control?
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- What is within my control?
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- What is the next (small) action I can take to move in a positive direction?
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- What is the best outcome that might result?
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nAvoiding change is impossible. Instead we can change our relationship to change. We can learn to turn toward what scares us, and in turn, we gradually adapt and grow amidst uncertainty and discomfort in life.nnOriginal article posted on keystepmedia.com
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.nn
nnColorado 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.
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
n
- A) I tend to think of change as bad. B) I tend to see change as an opportunity.
n
- A) I dislike change. B) Some change can be worthwhile.
n
- A) I feel uptight when plans change at home or work. B) I find changes in plans energizing.
n
- A) I hate making adjustments in my routines. B) I make adjustments to routines easily.
n
- A) I feel threatened when a challenge arises. B) I like a challenge.
n
- 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.
n
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
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.
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
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Anthem 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 Codesn
Anthem 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.
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
