Colorado Health Exchange Premiums Dropping – by a Lot

With the development of the health insurance exchange, prices for coverage for those in Colorado are going to drop. This will give families an average of $600-$700, back in their pockets. Read the article below to see when and how this new change will take place.nnFor the first time since Colorado opened its health insurance exchange, the prices people pay for coverage will drop — by a statewide average of 20.2%.nnAnd for families in western Colorado — who face some of the highest health insurance premiums in the nation — the savings could total more than $10,000 per year, according to final numbers for 2020 released by the Colorado Division of Insurance.nn“Just imagine: What could you do with that in your life?” Gov. Jared Polis said. “What could your family do with an extra $600 to $700 a month?”nnThe biggest reason for the price drop — which was higher than projected — is reinsurance, a bipartisan program created by state lawmakers during the 2019 session.nnThe program 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 from the 250,000 people who buy plans through the state’s individual market. In exchange for the help, insurance companies lowered their monthly premiums.nn“It’s the same plans,” Polis said. “It’s just lower prices.”nnThat means problems such as people not using their insurance because of a high deductible will still exist, but the governor is hopeful that the lower monthly costs will lower the state’s uninsured rate.nn“We think this prices it into the market for many more families,” Polis said, though he didn’t commit to a specific number.nnDetails on the plan options can be found at connectforhealthco.com, with 2020 enrollment beginning Nov. 1.nnThe state lawmakers behind the reinsurance bill told The Denver Post they’re not done working on health care costs, either.nn“We have to attack the basic underlying costs,” said Sen. Bob Rankin, R-Carbondale. “This bill does not address why health care costs so much.”nnHis counterpart in the Colorado House, Rep. Julie McCluskie, D-Dillon, is optimistic about programs such as a public option and something called an alliance model that’s just starting in Summit County.nnPeak Health Alliance is a group of big employers that banded together to negotiate lower prices from their local providers and used those prices to get better rates from health insurance companies. When combined with the reinsurance reduction, McCluskie said, alliance members will see their premiums cut up to 50% next year.nnThe governor hopes that by 2021, many more of these alliances will exist, including a statewide group with state, county and city public employees.nn“There’s absolutely significant upside to an alliance model everywhere in our state, both the regional models and statewide,” Polis said. “We’re aggressively pursuing those opportunities to save people money.”nnOriginal article published on denverpost.com

ICM Coding

In this code spotlight, Welter Healthcare Partners is providing new information regarding ICM Coding. Read below to find out more information on Insertable Cardiac Monitor codes!nnnOne of the hardest parts of coding is the revolving door of code changes.  2019 saw a change to Insertable Cardiac Monitors or ICM. Codes 33282 and 33284 were deleted and replaced with 33285 and 33286.  In addition to revisions to the guidelines and monitoring codes there is a lot to read. Here is a great chart to help you get through your next ICM encounter.nn

Wasteful Spending in U.S. Healthcare Estimated at $760 Billion to $935 Billion

For 2019, the U.S. is projected to have spent $3.82 trillion on healthcare. No other country in the world spends this much on healthcare. Below we assess the data and see what the research is saying regarding healthcare prices in the United States. Continue reading to find out more on this wasteful spending.nnnWaste accounts for about 25% of U.S. healthcare spending, new research indicates.nnNo other country spends more on healthcare than the United States, with the gross domestic product share of healthcare spending estimated at nearly 18% and rising. Earlier research on U.S. healthcare spending has estimated that waste accounts for about 30% of the spending total.nnReducing wasteful spending is a promising avenue to curb annual increases in the country’s healthcare spending, according to the co-authors of the new research, which was published today in the Journal of the American Medical Association. “Implementation of effective measures to eliminate waste represents an opportunity reduce the continued increases in U.S. healthcare expenditures,” the researchers wrote.nnThe researchers examined data from 54 published reports. They tallied waste in six categories identified in 2010 by the Institute of medicine (IOM): failure of care delivery, failure of care coordination, over-treatment or low-value care, pricing failure, fraud and abuse, and administrative complexity. Pricing failure includes medication pricing, payer-based health services pricing, and laboratory-based and ambulatory pricing.nnIn 2019, total U.S. healthcare spending is projected at $3.82 trillion.nnThe JAMA researchers generated several key data points:nnAnnual wasteful spending on healthcare is estimated from $760 billion to $935 billion.nnInterventions to reduce waste in the six IOM categories would result in annual savings from $191 billion to $282 billion.n

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  • The annual cost of wasteful spending from administrative complexity accounts for the highest category of waste, estimated at $265.6 billion.
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  • The annual cost of waste from pricing failure is estimated from $230.7 billion to $240.5 billion.
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  • The annual cost of waste from failure of care delivery is estimated from $102.4 billion to $165.7 billion.
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  • The annual cost of waste from overtreatment or low-value care is estimated from $75.7 billion to $101.2 billion.
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  • The annual cost of waste from fraud and abuse is estimated from $58.5 billion to $83.9 billion.
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  • The annual cost of waste from failure of care coordination is estimated from $27.2 billion to $78.2 billion.
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nThe impact of likely interventions to reduce wasteful spending are significant but limited, the researchers wrote.nn”The best available evidence about the cost savings of interventions targeting waste, when scaled nationally, account for only approximately 25% of total wasteful spending. These findings highlight the challenges inherent in rapidly changing the course of a health system that accounts for more than $3.8 trillion in annual spending, 17.8% of the nation’s GDP.”nnAssessing the datannThe highest amount of wasteful spending was associated with the administrative complexity category. The development and adoption of value-based payment models has the most potential to impact this category of wasteful spending, the researchers wrote.nn”In value-based models, in particular those in which clinicians take on financial risk for the total cost of care of the populations they serve, many of the administrative tools used by payers to reduce waste (such as prior authorization) can be discontinued or delegated to the clinicians, reducing complexity for clinicians and aligning incentives for them to reduce waste and improve value in their clinical decision-making.”nnReducing spending the second-highest wasteful category—pricing failure—poses daunting challenges because of the rising prices of pharmaceuticals, the researchers wrote. “New high-cost specialty drugs, which will soon exceed 50% of pharmaceutical spending, are raising new questions about how to maintain affordability. This topic has thus received considerable attention from policy makers, and numerous proposals are currently under consideration.”nnThe researchers say strategies to ease cost pressure in pharmaceuticals include increasing market competition, importing drugs from countries with lower medication prices, and reforming price transparency.nnThe big picture viewnnAn editorial accompanying the new research says the findings are a significant contribution to the ongoing effort to rein in the country’s healthcare spending.nn”At a time when the United States is once again mired in a great debate about the future of its healthcare system, the data reported in the article … should become part of the national discussion. It would be nearly impossible for all waste to be eliminated in any healthcare system, just as it is impossible to know the true cost of any change in the delivery and financing of healthcare without understanding possible savings, and recognizing that there is complexity in knowing the savings,” the editorial says.nnConcentrating on wasteful spending is crucial, the editorial says. “While no single solution will solve the continuous increases in U.S. healthcare spending, identifying, reducing, and eliminating waste are important and appropriate places to start.”nnOriginal article published on healthleadersmedia.com

Operative Report | Converted Laparoscopic

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: October 2017nPREOPERATIVE DIAGNOSIS: Acute diverticulitis.nPOSTOPERATIVE DIAGNOSIS: Acute diverticulitis with obstruction.nESTIMATED BLOOD LOSS: Minimal.nCOMPLICATIONS: No immediate complications.nnDESCRIPTION OF PROCEDURE: After obtaining informed consent, the patient was taken to the operating room and laid in supine position. General endotracheal anesthesia was induced. Pre-op antibiotics were given. An infraumbilical incision was made. This was carried down through subcutaneous tissue and fat until I arrived at the fascia. Incision was made in the fascia. A 10-12 port was inserted into the abdomen. The abdomen was insufflated with CO2. I placed 3 other 8 nun ports. The robot was then docked. I then proceeded with an extensive lysis of adhesions. I dissected out the sigmoid colon. There was a large amount of chronic inflammation. I dissected down to just above the rectum and I dissected up toward the descending left colon. Once I had completely dissected and freed out the majority of the diseased portion of the sigmoid, I used the robotic stapling device and I fired this proximal and distal to the diseased portion of the colon. An incision was made in the suprapubic area. The colon was removed out of the abdomen. I checked to make sure I had adequate hemostasis. I then proceeded to dissect down the descending colon attachments so I could bring this down toward the remaining Hartmann pouch. I dissected as much as I could of the lateral peritoneal reflection. However, I did not have adequate length in order to provide a tension-free anastomosis. Therefore, I had to convert to an open procedure, making a lower abdominal incision. I was then able to dissect out the remaining lateral peritoneal reflections up to the splenic flexure. This gave me adequate length in order to bring down my descending colon for my anastomosis. I used a pursestring device on the very end of the left descending colon. I placed an anvil after sizing the anus and rectum with the EEA. The EEA device was then placed from the anus into the rectum. The pin was fired just anterior to the staple line. The anvil was placed down with the descending colon. The EEA was fired. I did reinforce portions of my circular anastomosis with 3-0 silk suture. I checked to make sure that I had adequate complete donuts, which I did. I irrigated out the abdomen. I approximated and closed the fascia using a running #1 PDS suture. I irrigated out the subcutaneous tissue. I approximated and closed all incisions with staples. The patient tolerated the procedure well.nn10/2017 – Lab Report: SURGICAL PATHOLOGY EXAMnnNote: All result statuses are Final unless otherwise noted.nnTests: (1) SURGICAL PATHOLOGY EXAM (SURG)nnSpecimens: A) – Large Intestine, Sigmoid ColonnB) – Large Intestine, Sigmoid Colon, ANASTOMOTIC RINGSnnFinal DiagnosisnColon, sigmoid, segmental resection:nnDiverticular disease complicated by acute diverticulitis, diverticular abscess, and acute serositis with adhesion formationnNo dysplasia or malignancynnColon, sigmoid, anastomotic rings, resection:nnTwo fragments of colon wall without significant pathologic abnormalitiesnNo dysplasia, acute inflammation or malignancynnClinical Information Diverticulitis with abscessnnGross DescriptionnReceived in formalin and labeled with the patient’s name and medical record number are two specimens.nnReceived is a portion of the sigmoid colon measuring 20.5 cm in length and varying from 2.0 to 4.0 cm in diameter. Serosa coating the segment of bowel is showing focally yellowish discoloration, fibrin adhesions and hemorrhage. Definitive perforation site is not grossly identified.nThe specimen is opened and reveals numerous diverticular openings.nLocated in the center of the specimen is an area of marked stenosis with only about l cm of open luminal diameter. Sectioning through the segment reveals numerous diverticular openings. Several of the diverticular openings extend to close proximity of free serosal surface that is coated with fibrin and hemorrhage. Definitive microabscesses are absent.nMultiple representative sections in total of five.nnReceived are two anastomotic rings measuring 2.5 x 2.2 x 1.7 cm and 1.4 x 2.0 x 1.5 cm. Representative section of each submitted in two.nnMicroscopic DescriptionnA, B. Microscopically examined.

Does Value-Based Pay Have a Future?

Private payers have begun to embrace the possibilities of value-based care. Many are not including value-based incentives, which allows the patient to save money. Read the article below to find out more on how this value-based pay system has a future.nnValue-based care has created a conundrum: pretty much everyone in healthcare likes the idea of paying for outcomes, but no one is sure how to fairly implement it.nnThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) introduced a new world of value-based care to many physicians and was a major step away from fee-for-service. Gone was the Sustainable Growth Rate, replaced with a program that was supposed to drive costs down by reimbursing for quality patient outcomes.nn“Congress had revised the Sustainable Growth Rate many times over the past 20 years, and everyone was fatigued by it,” says Larry Kocot, JD, head of KPMG’s Center for Healthcare Regulatory Insight and a former CMS official. “Physicians were willing to take something new to not have to go through that exercise again.”nnDoctors suddenly found themselves trying to navigate new MACRA acronyms like MIPS and APMs to figure out where they fit as Medicare started moving away from fee-for-service in a bid to contain costs and improve care quality.nnAt the same time, more private payers began to embrace the possibilities of value-based care, working incentives into contracts that rewarded physicians who could use data to show patients were healthier and avoiding unnecessary hospitalizations. But fee-for-service contracts are still the norm.nnMeanwhile, physician organizations began to push back against MACRA as their members rebelled against the cost of the technology needed to comply and the complexity of the reporting measures. CMS responded by exempting hundreds of thousands of physicians, causing some to question the value of the program and if it was improving patient care or saving money.nnWith MACRA now a few years old, experts are looking at how it might be reformed, and what value-based care might look like in the future.nnMACRA: a misstep toward valuennMACRA has not worked to the extent policymakers hoped, says Frederick Southwick, MD, a practicing internist and healthcare researcher at University of Florida Health.nn“The goal was to drive a significant wedge in payments between those willing to step up and use Alternative Payment Models and those who remained on the sidelines,” says Southwick. “We’ve seen physicians take a shot on some things they might not have done in the past to get a bonus payment, but they have not reached the point where they’ll feel pain if they don’t. The MIPS side of this was supposed to be painful to physicians, but it’s mostly a big nothing-burger because so many have been excluded.”nnAs a result, there isn’t much money in the budget-neutral program to move from the poor performers to the good performers, eliminating much of the incentive. According to CMS, in the 2019 payment year (based on 2017 performance data), 71 percent of MIPS participants received a positive payment adjustment with a bonus for performance, 22 percent received a positive payment without the bonus, 2 percent didn’t receive a positive or negative adjustment and only 5 percent received a negative adjustment.nn“The more physicians that are excluded, the harder it is for those in the program to win,” says Kocot, noting that the maximum payment adjustment anyone received was 1.88 percent, while the maximum penalty was 4 percent.nnMIPS was intended to be the incentive to get physicians into some form of risk-sharing APM, but MIPS isn’t accomplishing that and the 5 percent positive payment adjustment APM participants can earn expires in 2024.nn“What is the incentive to get people into MIPS and into an APM as we move further down the line?” asks Kocot.nnMIPS also faces the problem of how to define “quality”.nn“Healthcare is so complicated, that’s hard to do,” says Chris Dawe, vice president of Evolent Health, which helps providers and health plans transition to value-based care, and a former health policy adviser in the Obama administration. “The best way would be through knowledgeable consumers who would ask questions about the cost-benefit and is it worth it to their health and wellbeing. The problem with that is patients don’t go to medical school.”nnEven if patients were making decisions, they would still have difficulty determining who the best doctor is because of the lack of objective information, and in many regions, the absence of choices in hospitals or physicians.nnMIPS participants have scored well on quality measures, but many doctors argue that the measures don’t have any connection to real-world medicine. The time spent reporting on quality has also proven burdensome for many, who say it takes more time away from patients and redirects money toward IT projects.nn“All of these initiatives require a tremendous amount of data accumulation and manipulation,” says William Spratt, Jr., JD, partner in the healthcare practice of Akerman LLP, in Miami. “There are so many different metrics and different ways to modify and manipulate the data in order to determine whether they are meeting various criteria or not, it’s challenging.”nnFor physicians without the support of a larger organization, the challenges are even greater. “It’s introduced an awful lot of complexity into the practice of medicine,” says Spratt. “It’s hard for them to change their practice administration in order to measure and hit those targets.”nAn unintended consequence of that difficulty has been an increase in physicians affiliating with health systems and hospitals so as to shift the reporting burden.nn“It’s probably strengthened the hand of the health systems and offers them another carrot for the primary care physician,” says Southwick. “They aren’t necessarily acquiring them, but at least getting them in the network. I don’t think this is what Congress had in mind.”nnHe adds that a lack of vision has hampered the success of programs like MACRA, because no one understands the end goal.nn“I’ve never heard anyone from the White House articulate what this should look like in five to 10 years,” says Southwick. “Doing so would help the market work toward that and be ready for this new world. Instead, we are just going from one program to the next. It would be a benefit if CMS would say what this would look like at the end.”nnThe future of value-based carennStill, while MACRA may not be working out as envisioned, many experts say it is an important first step toward implementing value-based care. “MACRA started the conversation,” says Spratt. “It has started moving medicine toward more value-based payment and away from the traditional fee-for-service model, which I think most policymakers realize is a good approach.”nnDespite the struggles of MACRA, experts say physicians should understand that their revenue from fee-for-service will continue to decline.n“From what I have seen, the transition to value-based care is a given,” says Andrei Gonzalez, MD, assistant vice president at Change Healthcare, a company that helps payers and providers move to value-based care. “It’s more about what are the right models and how are we going to get there?”nnWith CMS rolling out its new Primary Care First initiative, Gonzalez says their intent is clear. “They want to blow up fee-for-service, and the primary care initiative is a big step in that direction.”nnThe initiative encompasses a variety of models. It is expected to cover about 25 percent of Medicare beneficiaries, and include removing coding requirements for primary care physicians by paying a monthly per-patient fee or a flat per-visit fee.nnPrivate payers are creating similar programs, and large employers are asking commercial plans to use some of CMS’s strategies to save money. As a result, more private payer contracts are including value-based incentives.nn“I do think the private sector push will make it easier as clinicians see value-based care as the new normal and are subject to quality and cost targets that are not fee-for-service,” says Kocot. “That’s absolutely essential to the transition.”nnBoth public and private payers realize they need multiple plans in order to succeed, says Gonzalez.nn“Our research has shown that different models work for different conditions and different regions,” he says. In areas where there is a lot of consolidation among providers and health systems, ACOs or full capitation—where physicians receive a flat monthly fee for each patient— will make the most sense. In less-consolidated areas, models like the Patient-Centered Medical Home may be the primary option.nnWhile capitation was tried in the early days of HMOs, Gonzalez says the industry is a lot savvier on how to do it now. Payers and providers both are going in with more caution. Physicians are managing a patient population, but understand they will need to meet quality and cost metrics, although not the full risk burden like in the past.nnSpratt says smaller practices may need to affiliate with a hospital or health system, because payers see value in partnering with organizations with large numbers of physicians, ancillary services and even urgent care centers, because it gives them more control over the insured and better management of the premium dollar.nn“At the end of the day, it’s all about integration and the coordination of care,” says Spratt.nnCare coordination includes practices being more proactive with helping patients to lead healthier lifestyles and not just waiting for the patients to reach out to them.nn“A lot of practices already have this mentality, but it creates the need for a different set of aptitudes within the practice,” says Gonzalez. This could include, for example, having a nurse monitor COPD patients and ensuring they come in for regular visits.nnFuture value-based care models will also have a greater focus on the social determinants of health.nn“One thing value-based care leads us toward is a sort of untethering of the physician from historical medical tools and allowing them to think more holistically,” says Spratt.nn“Physicians will need to start figuring out how to help patients manage their conditions, how to navigate the health system and manage the social determinants of health,” says Gonzalez. “It’s not as big of a change as it seems, because not every patient requires assistance, but practices need the ability to identify who needs extra help.”nnThe role of the primary care doctornnNo matter what models emerge, experts see the primary care physician as the team leader. Dawe says the patient-centered medical home, with a primary care physician working with one or two NPs or PAs, a nursing staff and someone that goes into the community to help educate patients on how to manage their diseases is a good model, as is an ACO.nn“I think the basic structures for a good model are already in place,” says Southwick. “You can go a long way to creating a new payment ecosystem just on the basis of a primary-care based model, which is basically an ACO.” If that is combined with bundled payments for specialists, Southwick says, those two models work very nicely together.nn“The primary care physician has to be central to any aligned payment and care coordination working with the patient from start to finish,” says Kocot.nnBut primary care doctors should also expect to take on more risk-sharing with payers, whether it’s through an ACO or some other payment model. He warns the transition must come with assistance.nn“There’s a lot happening that primary care physicians have to process on a daily basis,” he says. “The transition needs to be moderated so we don’t lose them in the process. The CMS burden reduction program is very positive, but we have to strike the right balance of incentives and push, and I don’t know that we have yet.”nnExperts say that value-based care will continue to become more prominent in contracts, even though programs like MIPS might be revised or replaced in the future. But one thing is for sure: there is no hiding from it.nn“The move to value is alive and well,” says Kocot.nnOriginal article published on medicaleconomics.com

Changes and Ways to Stay up to Date

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

Denver Provider Market at ‘Tipping Point,’ Study Finds

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

Learn to Love Networking

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

Celebrating Our 25th Anniversary!

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

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

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

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–          R. Todd Welter, CEO

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Colorado NPI Law

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

nOriginal article published on colorado.gov

Operative Report | Vertical Humeral Osteotomy

Do you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected.nn– Click Here to Submit Redacted Surgery Case Study –nnDATE OF SURGERY: 06/10/2019nnPREOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPOSTOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPROCEDURES:n

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

$190 or $47,779? Colorado Emergency Charges Vary Wildly Across State

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

Banner Health to Acquire Colorado Hospital

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

DOWC Accreditation for Nurse Practitioners and Use of Interpretation Services

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

Operative Report | Bilateral L5/Sl TF Epidural

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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  1. 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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  1. 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,

Study Ranks Colorado 11th for Health Care

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.

3 Proposed Payment Rules

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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  1. PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020
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  3. Medicare OPPS and ASC Payment System CY 2020 Proposed Rule
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  5. 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:

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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
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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.

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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.

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The proposed rule also includes:

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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
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n3. 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:

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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.
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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:

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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
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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:

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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

E/M Coding, Guideline and MDM Changes

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.

Welter Healthcare Partners Associates Successfully Completes SIM Curriculum for Primary Care Practices

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.

Adaptability: Change Your Relationship to Change

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.nnIs This Me?nnThink about these statements, and choose A or B:n

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  • A) I tend to think of change as bad. B) I tend to see change as an opportunity.
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  • A) I dislike change. B) Some change can be worthwhile.
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  • A) I feel uptight when plans change at home or work. B) I find changes in plans energizing.
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  • A) I hate making adjustments in my routines. B) I make adjustments to routines easily.
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  • A) I feel threatened when a challenge arises. B) I like a challenge.
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  • A) I often get “locked in” to an idea or approach to solving a problem. B) I’m open to new information when solving a problem.
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nIf you find yourself agreeing with most of the A statements, you may be someone who is uncomfortable with change. If you find yourself agreeing with more of the B statements, you may be more able to adapt as changes demand.nnLooking at your own beliefs and judgments can be an important first step toward greater adaptability. If you are fixed in your thinking, you may struggle against change rather than turning it into an opportunity. Learning to sit with discomfort amidst uncertainty is something every human can benefit from.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