Matthew Baker, PhD’s Post

The new family medicine payment model (PCCM) is a powerful option to stabilize practices and support lifelong comprehensive care. It demonstrates the value of the AMA agreement’s robust provisions to accommodate evolving needs of patients and physicians. https://lnkd.in/gjJYm4Xv

CT Perfusion Analysis Gains Policy Ground for Medicare A Triumph for Patient Advocacy   In the ever-evolving landscape of healthcare, navigating the intricacies of payor policy is a constant challenge. Most Medicare Administrative Contractors (MACs) continue to deny coverage for CT Cerebral Perfusion Analysis in cases where patients present with stroke-like symptoms but are later found to be negative for stroke on imaging. Kim Snyder, CPC, successfully petitioned for a significant Local Coverage Determination (LCD) and Billing and Coding Article change to the Noridian Healthcare policies in June 2022. Noridian agreed to include specific clinical indications such as sudden visual loss and slurred speech in their list of covered indications. This victory marked a significant step forward. Likewise, in April 2024, Palmetto GBA, representing states including Alabama, Georgia, Tennessee, North Carolina, South Carolina, Virginia, and West Virginia also agreed with the petition policy change request, and published their updated Billing and Coding Article A58354, that will be effective June 2, 2024 and will include the addition of fifty three ICD-10 codes for stroke symptoms. “I am optimistic about the successes for policy changes with the Medicare Administrative Contractors and I will continue to leverage these victories to advocate for the benefits of CT Perfusion and other valuable radiology services,” says Kim.  #radiology #ctperfusion #cpt0042T #documentationintegrity #https://lnkd.in/gm-Scax8

🚨 Action Alert: Protect Access to Specialty Care! 🚨 As leaders in ambulatory outpatient-based services, we know firsthand the value of delivering innovative, minimally invasive care to patients in a setting that’s accessible, efficient, and patient-centered. However, proposed Medicare reimbursement cuts threaten the sustainability of these services, which are vital for advancing healthcare and improving patient outcomes. A new bill has been introduced in Congress that seeks to reverse these cuts and ensure fair reimbursement for specialty providers, including those in interventional radiology. This legislation has the potential to significantly strengthen the future of outpatient care, ensuring we can continue to provide high-quality, cost-effective treatment options for patients. Why this matters: 💡 Outpatient-based services reduce costs while improving patient convenience. 💡 Specialty providers rely on sustainable reimbursement to invest in innovation and enhance care delivery. 💡 These cuts could jeopardize access to essential procedures, especially for underserved populations. We urge our colleagues, partners, and stakeholders to support this critical effort by voicing your support for the bill and sharing this message within your networks. Take action here: Action Alert: Stop the 20% Reimbursement Cuts to Medicare Specialty Providers https://lnkd.in/gBtqd9KY Together, we can protect the future of outpatient specialty care and continue delivering the innovative treatments our patients deserve. #HealthcareAdvocacy #InterventionalRadiology #MedicareReform #OutpatientCare #IRCenters Society of Interventional Radiology OEIS Society #irad #Urology

Medical care SHOULD NOT be a for-profit endeavor. "Brown University School of Public Health and Brookings Institution researchers have conducted a longitudinal and cross-sectional study investigating trends in hospital and private equity affiliation among primary care physicians and the associated impact on negotiated service prices. The study revealed that, compared to independent primary care physicians, both hospital and private equity-affiliated physicians commanded higher negotiated prices for equivalent services. The consolidation of medical care has been accelerating, driven by hospitals and private equity firms seeking to optimize market power and payment rates. Primary care has experienced significant corporate interest due to its fragmented structure, demands for coordinated care, and a perceived opportunity for unrealized gains." #medicalcare #medicalcosts

Results from Latest Medscape Physician Survey: Physicians Lament Over-Reliance on Relative Value Units: Survey ICYMI … the latest from Medscape on what physicians think about RVUs. Based on just over 1,000 responses. Interesting but not surprising. Yes, these Medscape survey methodologies may not be flawless, but they provide a reasonable snapshot of clinicians' thinking. Most respondents felt that the RVU methodology was unfair and were unhappy with how their workplace used RVUs. Key Takeaways: 1. Over half of clinicians said alternatives to the RVU system would be more effective. 2. The system encourages volume over value. 3. Almost 75% felt pressure to take on more patients. 4. Increased patient volume is tough on physicians and makes patients feel rushed. 5. More than 50% are occasionally or frequently compelled by their employer to use higher-level coding, which one respondent noted interferes with their ethical responsibility to patients. https://lnkd.in/ePnnDstb #physicians, #Medicare

A new report shows Minnesota, Massachusetts, and Wisconsin as the top states for physicians in 2025. See why at https://loom.ly/4HGN_QA or read on for more physician news. In our latest edition of In the Interim, our monthly roundup of the latest news for locum tenens providers, we explore how physician assistants are redefining career flexibility by changing specialties, highlight the DEA’s extension of telehealth prescribing rules for controlled substances, share insights on how hobbies can combat physician burnout, discuss innovative solutions to address the growing primary care physician shortage, and more. Read In the Interim: https://loom.ly/ta5BtdA

https://lnkd.in/gNGsr7F7 There are some eye opening stats in this article. Among them: - 2 in 3 physicians said they are now spending more time on prior auths, as compared to 3 years ago - 89% of physicians think that too many services and medications require prior auth - Most importantly, 86% of physicians think that prior auths are harming patient care. In short, the prior auth situation is getting worse. Not all is lost, however. For worker's comp claims, using a pharmacy like EZ Scripts can greatly reduce the amount of and time spent on prior auths. Why wait for an prior auth issue, when you already have a proactive solution for that issue? #PriorAuthorizations #PriorAuth #PreAuths #UtilizationReview #EZScriptsPharmacy #PatientCare #Physicians

We are moving forward with reductions to administrative and clinical services to comply with Vermont state budget orders and enforcement actions issued by the Green Mountain Care Board (GMCB), the health care regulator in Vermont. These actions will have both an immediate and long-term impact on patients served in the region and, based on current information, will ultimately result in a workforce reduction estimated to be as many as 200 people who currently serve the health care system, including both employed staff and temporary/travel staff. Changes will take place both immediately and over the next several months. Patients will be informed when the timelines and care transitions for impacted services are clear. Below are the decisions we’re announcing today: - Reduce the number of patients who stay overnight at University of Vermont Medical Center from approximately 450 to 400 and limit regional incoming non-emergency patient transfers. - Eliminate Surgical Renal Transplants at University of Vermont Medical Center and collaborate with Dartmouth Health on care alternatives. University of Vermont Medical Center performed approximately a dozen kidney transplants this year. -End University of Vermont Health Network staffing and operation of kidney dialysis clinics outside of our primary service areas in Vermont, impacting approximately 220 patients across three clinics. - Consolidate Some Family Medicine and Rehabilitation clinics that are part of Central Vermont Medical Center (CVMC), which should not impact access to CVMC-run primary care services for existing patients. - Close the Inpatient Psychiatric Unit at CVMC, which has had an average daily census of approximately eight patients, due to capacity challenges. - More than $18 million in administrative expense cuts, with reductions in expenses, open positions and employees. For more information, please read the full press release on this subject: https://lnkd.in/ef5hG3YQ

We are moving forward with reductions to administrative and clinical services to comply with Vermont state budget orders and enforcement actions issued by the Green Mountain Care Board (GMCB), the health care regulator in Vermont. These actions will have both an immediate and long-term impact on patients served in the region and, based on current information, will ultimately result in a workforce reduction estimated to be as many as 200 people who currently serve the health care system, including both employed staff and temporary/travel staff. Changes will take place both immediately and over the next several months. Patients will be informed when the timelines and care transitions for impacted services are clear. Below are the decisions we’re announcing today: - Reduce the number of patients who stay overnight at University of Vermont Medical Center from approximately 450 to 400 and limit regional incoming non-emergency patient transfers. - Eliminate Surgical Renal Transplants at University of Vermont Medical Center and collaborate with Dartmouth Health on care alternatives. University of Vermont Medical Center performed approximately a dozen kidney transplants this year. -End University of Vermont Health Network staffing and operation of kidney dialysis clinics outside of our primary service areas in Vermont, impacting approximately 220 patients across three clinics. - Consolidate Some Family Medicine and Rehabilitation clinics that are part of Central Vermont Medical Center (CVMC), which should not impact access to CVMC-run primary care services for existing patients. - Close the Inpatient Psychiatric Unit at CVMC, which has had an average daily census of approximately eight patients, due to capacity challenges. - More than $18 million in administrative expense cuts, with reductions in expenses, open positions and employees. For more information, please read the full press release on this subject: https://lnkd.in/ef5hG3YQ

Physician progress notes are generally diagnosis-oriented, and since many diagnoses can be treated in the hospital and as an outpatient, they leave the door open for payor denials. There's also the issue of long stays in which a new attending is taking over and seeing a long list of problems and interventions (note bloat) and not being able to differentiate what remains an acute issue that needs to be addressed. One sentence by the attending physician about why the patient requires hospital care, is not medically stable, and/or medical reasons why they cannot and cannot be discharged can have significant downstream benefits. Not only does it tell an oncoming hospitalist what needs to be addressed, but it also allows the care management team to better coordinate discharge plans and work in parallel instead of in series. Most importantly, it tells payors why the patient needs to be in the hospital, which reduces denials and helps overturn them on appeal.