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This episode features Alan Condon, Editor-in-Chief at Becker's Healthcare. Here, he discusses ProHealth Care shifting 835 employees to Optum then highlights some big mergers & acquisitions going on across the country.
Guest: Dr. Mike Mazzone, ProHealth Care
Today's guest is Dr. Juliet Ugarte Hopkins, MD, CHCQM-PHYADV, FABQAURP, a physician advisor for case management, utilization, and CDI at ProHealth Care, Inc., a three-hospital health system based in Waukesha, Wisconsin. Today's show is co-hosted by Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, interim director, both at ACDIS, based in Middleton, Massachusetts. Our intro and outro music for the ACDIS Podcast is “medianoche” by Dee Yan-Kay and our ad music is “Take Me Higher” by Jahzzar, both obtained from the Free Music Archive. Featured solution: Today's show is brought to you by the 2022 ACDIS Conference. Imagine the possibilities and join your CDI peers in Orlando, Florida, May 2–5, 2022, at the Gaylord Palms Resort & Convention Center! As we reconnect after the COVID-19 pandemic, we all need a little magic in our lives, and we all need to Imagine what might be in store for us professionally. The ACDIS national conference provides countless opportunities to engage personally and professionally with like-minded individuals across the healthcare spectrum. The educational offerings are unparalleled. The networking opportunities are extensive. Our exhibitors are waiting to share their national knowledge. The only necessary ingredient remaining is you. This year we are offering dedicated outpatient CDI content, a masterclass track to improve your interpersonal skills so critical to CDI success, a location with shuttle busses running to the major Disney theme parks, and more! Learn more or register by clicking here. (http://ow.ly/rG5Y30s7Pzt) ACDIS update: Meet the 2022 ACDIS Scholarship Award winners (http://ow.ly/j4b630sfNHB) To listen to the audio-only version of this episode, head to Apple Podcasts, Google Podcasts, Spotify, or your favorite podcast app.
It's estimated that 40% of all Medicare patients go into post-acute care and of those, nearly 23% are readmitted to the hospital within 30 days. This podcast highlights what one organization plans to do to reduce their readmissions. Guests: Heidi Young, RN Senior Quality Project Manager ProHealth Care Jessica Zuercher, MS, MBA, RN Director, Continuum of Care ProHealth Care Moderator: Lindsay Mayer, MSN, RN Senior Director, PI Collaboratives Programs Vizient For more information, email picollaboratives@vizientinc.com Show Notes: [00:45] ProHealth Care has a multidisciplinary all-cause readmission team for post-acute patients [1:00] ProHealth Care has shifted their focus to look at anywhere along the continuum of care for opportunities to prevent readmissions [2:52] Earlier efforts to reduce readmissions were ineffective because of lack of follow up [3:35] ProHealth joined the Vizient Patient Transitions to Post-Acute Care Collaborative [4:00] They developed plans with facility partners, medial directors and sepsis team, making it collaborative and connected with all parties. [4:36] Worked as a group to detail how to fully operationalize their preventive strategies [6:30] Embedded medical directors and Advanced Practice Providers [7:03] Plans for follow up Subscribe Today! Apple Podcasts Amazon Podcasts Spotify Google Podcasts Android Stitcher RSS Feed
The COVID vaccine is intended to make it harder for the virus to make you dangerously sick. But it also might help folks who got sick before and still have long-lingering symptoms. On Today's Show:Daniel Griffin, MD, PhD, infectious disease clinician and researcher at Columbia, chief of the division of Infectious Disease for ProHEALTH Care medical group, talks about what we know about vaccines and treatment, in and out of the hospital and the anecdotal evidence that vaccines help some of those suffering from "long COVID." Dr. Griffin offers a weekly clinical update on the podcast This Week in Virology.
Daniel Griffin, MD, PhD, infectious disease clinician and researcher at Columbia, chief of the division of Infectious Disease for ProHEALTH Care medical group, talks about what we know about vaccines and treatment, in and out of the hospital and the anecdotal evidence that vaccines help some of those suffering from "long COVID." Dr. Griffin offers a weekly clinical update on the podcast This Week in Virology.
The longstanding barriers to data sharing between healthcare organizations have been breaking down over the past decade, removing a major obstacle to partnerships between payers and providers. But major challenges remain, as data management only continues to grow in complexity and healthcare organizations try to make sense of a flood of information. Jamie Gardiner joins the podcast to discuss better data management in healthcare.Jamie LinkedIn: https://www.linkedin.com/in/jamie-gardiner-97008a24/The Data Standard LinkedIn: https://www.linkedin.com/company/the-data-standard/
As the U.S. hits the half-million death mark from COVID-19 -- a grim milestone that is equal to roughly the entire population of Atlanta and more than that of Miami -- a new weapon is being added to the COVID-19 vaccine arsenal. Johnson & Johnson is seeking emergency use authorization for what would become the U.S.'s first one-dose and non-mRNA COVID vaccine. It employs adenovirus vectors, a technology that has been used in labs for decades and was approved for the Ebola vaccine by the FDA in December 2019. It's the same technology that AstraZeneca/Oxford and Sputnik V use. Still, questions remain on how these vaccines may be different than mRNA or similar enough to other existing shots to encourage vaccine uptake. To explain how adenovirus vectors work and what to expect from the new products, Daniel Griffin, MD, PhD, chief of infectious disease at ProHEALTH Care, an Optum unit, joins us on this week's episode.
This episode features Ian Leber, Chief Medical Officer at ProHEALTH Care. Here, he discusses his top priorities in the coming months, the shift he’s seeing towards value based care, and more.
The Complete Show from 4/23/2020
In this episode Scott Becker interviews Dr. Zeyad Baker. Zeyad Baker, MD is President and Chief Executive Officer of ProHEALTH Care, the largest, independent, physician-run healthcare organization in the Northeast. Dr. Baker previously served as Co-President of Riverside Medical Group, where from 2010 until 2018, he built the practice to almost 300 providers with 100 locations. Under Dr. Baker’s leadership, Riverside Medical Group was recognized as the best deliverer of value-best care in the state of New Jersey, winning extensive awards and commendations for quality of care, patient access and measurable improvements in the health of the patient population. Riverside Medical Group became an Optum Partner in 2016. Prior to joining the Riverside Medical Group, Dr. Baker was an attending physician in Pediatrics at Hackensack University Medical Center. Coupled with his responsibilities as a physician, Dr. Baker was the Clinical Assistant Professor of Pediatrics at the University of Medicine and Dentistry of New Jersey (UMDNJ), teaching medical students and pediatric residents. In addition to his teaching role at Hackensack University Medical Center, he has also held teaching positions as the Associate Professor of Pediatrics at Rutgers Medical School and Columbia University. Dr. Baker has taught over 1,000 medical students and residents in primary care. After graduating from Georgetown University, Dr. Baker attended medical school at Ross University. He completed his residency in pediatrics at UMDNJ, receiving the highest honors and recognition given to pediatricians in residency training through the Arnold P. Gold Foundation Award for Humanism and Excellence in Teaching, and twice receiving the prestigious Golden Apple Award, an honor bestowed by a medical school’s student body upon the doctors most recognized for their excellence in teaching. Dr. Baker has been asked to present at numerous prestigious speaking engagements including the Harvard Club at “The Future of Healthcare Transformation”. He is also the youngest physician to be appointed to the highest governing board in New Jersey, The New Jersey State Board of Medical Examiners. Dr. Baker has received multiple awards while a practicing physician including the New Jersey Top Doc award, the Compassionate Doctor Award, and the Patient Choice Award. Throughout his career, Dr. Zeyad Baker has managed over 1,000 physicians and has brought together a rare combination of clinical, academic and operational experience to successfully lead two substantial organizations, where the patient is the top priority. Since taking the helm of ProHEALTH Care in July, 2018, as the new President and CEO, Dr. Baker has launched a bold agenda of patient-centered reforms destined to transform the healthcare system. In his first year, he has brought forward plans, which include a forward-thinking schedule of key initiatives designed to dramatically improve patient care, create an entirely new paradigm for the healthcare and patient experience, and make healthcare significantly more accessible than ever before. Some of these innovations already launched include: - Creating the longest hours open for primary care services in the northeast through the Extended Hours Center, which along with ProHEALTH Care’s primary care services, provide continual access to medical care 365 days a year, 7 days a week - Creating the Care Coordination Center, a telemedicine approach that will provide patients with access to their providers on critical matters such as appointments, referrals, prescription refills, and medical questions answered 7 days/week, 24 hours a day. - Launching The Parenting Lounge, the first health system integrated, free prenatal and post-natal series of family educational programs in the Northeast dedicated to providing all families with the critical knowledge to support their children’s healthy beginnings.
Under siege by policymakers, the controversial 340B drug discount program appears to be widely embraced by its 1,300 member hospitals that participated in a recent national survey. Moreover, the survey revealed that members are using savings to provide critical services and access to care to patients with low incomes and those living in under-served rural communities. Reporting on this survey results and the import of its findings during this edition of Monitor Mondays Maureen Testoni, president and CEO for 340B Health. Other segments to appear during the live broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group. SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Monday Focus: A recent study by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has revealed a concerning series of findings related to the under-reporting of instances of potential abuse and neglect of elderly Medicare patients. Reporting on this developing story is Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., a telemedicine company providing psychiatric care to patients throughout the United States. Case Managers at Risk: Complaints associated with discharge planning can involve allegations that a patient was discharged before they were medically stable enough to leave the hospital, or that services or supplies required in the outpatient setting were not provided. These and other incidents point to the legal liability of case managers. Reporting this developing story is Juliet Ugarte Hopkins, MD, physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.
Many procedures in the CPT® codebook are designated "separate procedures," but that doesn't mean you can report those procedures "separately" in every case, according to nationally recognized professional coding expert Terry Fletcher, who returns to Talk Ten Tuesdays to offer insight into this topic.Join Dr. Erica Remer and Dr. Juliet Ugarte Hopkins as they host the podcast, which also features these other segments:The ICD-10 Coding Report: Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports on latest coding news.News Desk: Timothy Powell, a compliance expert, and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.The Dunn Report: National health information management (HIM) expert and past American Health Information Management Association (AHIMA) President Rose Dunn returns to the podcast with a series on how HIM can play a role in other areas of the revenue cycle.Guest Talk: Juliet Ugarte Hopkins, MD, CHCQM, physician advisor for case management, utilization, and clinical documentation at ProHealth Care, co-hosts the podcast along with Dr. Erica Remer, who is substituting for Talk Ten Tuesdays publisher and host Chuck Buck.
“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place," President Donald Trump told members of Congress during his State of the Union address on Wednesday. "This is wrong, unfair, and together we will stop it. We will stop it fast," the President warned. During his address, the President also pledged to end the HIV epidemic in the nation.Both issues will be discussed during this edition of Monitor Mondays, when Maureen Testoni, president and CEO for 340B Health, returns to the broadcast. Testoni is considered to be one of the nation’s leading experts on the 340B drug pricing program and was recently was recognized as one of the “100 Most Influential People in Healthcare” by Modern Healthcare.The broadcast rundown also will include:Medicare Advantage: Are managed care beneficiaries being deprived of an important benefit? Enrolling in MA plans, beneficiaries expect to receive the same benefits as in traditional Medicare. But as providers move toward DRG payments, MA plans decline authorization for long-term acute care (LTAC) for patients with prolonged respiratory requirements and those with prolonged needs. MA plans feel that these patients should remain in the hospital under the original DRG payment. Reporting on this developing story is Howard Stein, MD, associate director of medical affairs and physician advisor in care management at CentraState Medical Center in Freehold, N.J.Anthem Lawsuit: Nationally renowned whistleblower attorney Mary Inman reports on the recent class action lawsuit filed against Anthem Health.Monday Focus: RACmonitor investigative reporter and New York attorney Edward Roche reports on a scientific breakthrough in DNA sequencing.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, returns to report on all the latest hot topics.Monday Rounds: Juliet Ugarte Hopkins, MD, Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin makes her Monday rounds while substituting for Dr. Ronald Hirsch.
Social determinants of health (SdoH) are swamping hospitals like rising rivers following a storm. A reported $1.7 trillion in healthcare costs are now attributed to 5 percent of the nation’s population, with a majority of that sum related to the SdoH. And while the focus has been largely on the most vulnerable and disenfranchised members of populations, the new face of SDoH is evolving as a consequence of an increase of natural and manmade disasters, as well as new attention being given to longstanding issues such as rural health, human trafficking, business closures, and loss of pensions for an increasing number of older adults.Returning to Talk Ten Tuesdays to report on this developing story is nationally recognized SDoH authority, author, and educator Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, the founder of EFS Supervision Strategies, LLC.Other segments to be featured on the broadcast include:Coding Report: Coders will be dealing with new payment models in 2019, including one for skilled nursing facilities (SNFs) expected to be released on Oct. 1. Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports this developing story.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.RegWatch: Leading healthcare technology consultant Stanley Nachimson returns with his popular segment, RegWatch, through which he reports on the latest regulatory changes coming out of Washington, D.C.DocTalk: Talk Ten Tuesdays guest co-host Juliet Ugarte Hopkins, MD, CHCQM, physician advisor of case management, utilization, and clinical documentation at ProHealth Care, reports on the collaboration between coding, clinical documentation integrity, and physician advisors when facing clinical validation denials.
Case managers being situated in the emergency department (ED) appears to be a trend that is gaining traction nationwide, as results indicate that such a move helps determine appropriate status while also identifying patients who are appropriate for placement into a skilled nursing facility (SNF) directly (instead of placing them into the hospital while searching for a facility). We have two reports on this trending topic during this edition of Monitor Mondays. Leading our report is Juliet Ugarte Hopkins, a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. Dr. Hopkins will also report on structured interdisciplinary bedside rounds (SIBRs), an emerging practice that allows collaboration with the care team on a daily basis. Providing a first-person perspective on the role of case managers as registered nurses in the ED will be Kathleen K. Borchard, an RN case manager at Waukesha Memorial Hospital, also in Wisconsin. The broadcast rundown also will include: RAC Report: Healthcare attorney Knicole Emanuel, a partner at the Potomac Law Group, has the latest news on the Recovery Audit Contractors (RACs). Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on the 2019 Proposed Medicare Physician Fee Schedule’s impact on outpatient therapy. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, reports on the 2019 Proposed Medicare Physician Fee Schedule released by CMS on Thursday. Monitor with us™
Ted Lindner chats with Melani Benedetto and Dr. Dana Lustbader from ProHEALTH Care about National Healthcare Decisions Week, where ProHEALTH can help approach and determine a health care plan and name decision makers.
The recent Doximity research study that revealed an average national wage gap between male and female physicians of $105,000 was greeted by some healthcare professionals as "old news," while to others it seemed one more thread in the national fabric of the discussion on women's rights in the era of #metoo. Yet this income disparity could also contribute to physician burnout—a diagnosis that is higher among female physicians than their counterparts. In 2017, the national gender gap for physicians increased, as female doctors earned 27.7 percent less than their male counterparts—an even bigger gap than the national average, according to the Doximity survey. This news comes at a time when the topic of women's rights both in and out of the workplace has never been more volatile, and women's voices are being heard as never before. There has even been movement toward reviving the Equal Rights Amendment, with the Nevada Legislature last year becoming the first to ratify the ERA after the expiration of the original deadline—45 years after Congress submitted the amendment to the states. New ERA legislation is currently pending in several other states. Discussing the gender gap and wage disparities in medicine during this episode is Dr. Juliet Ugarte Hopkins, a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. Other segments featured in this episode include: News Desk: Gloryanne Bryant, past president of the California Health Information Association and an ICD10monitor contributor, reports on coding Parkinson's Disease, which is in the nation's spotlight as April is National Parkinson's Awareness Month. Women's Health Report: LeAnn Thieman, former nurse and nationally acclaimed author who co-authored the New York Times best-seller Chicken Soup for the Nurse's Soul, returns to Talk Ten Tuesdays to report on burnout among nurses. Thieman is the founder and president of SelfCare for Healthcare. Mental Health Report: Nationally renowned psychiatrist and Talk Ten Tuesdays contributor H. Steven Moffic, MD, reports on burnout among female physicians. TalkBack: Co-host Erica Remer, MD, herself a former emergency medicine physician turned healthcare consultant, relates her own experience in a gender wage discrepancy dispute with a former employer. Talk Ten Tuesdays. More than just talk.™
"The peer-to-peer (P2P) process is a particularly abhorrent chore for physicians," reports Juliet Ugarte Hopkins, MD, a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. "These phone conversations are generally offered by commercial and managed insurance plans when their clinical case manager or medical director does not feel that inpatient status is supported for a particular patient." During this episode of Monitor Mondays Dr. Hopkins makes the case for abandoning your P2P process if the results are not satisfactory. Might the pressure of P2Ps even be contributing to some physicians considering opting out of Medicare? Duane Abbey, PhD, president of Abbey and Abbey Consultants, Inc., will review the complexities of compliance facing physicians and practitioners who might consider throwing in the towel. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, has all the latest developments on the therapy caps as well as the Monitor Mondays Listener Survey. Hospice Report: Theresa Forster, BA, vice president for hospice policy and programs for the National Association of Home Care and Hospice, reports on changes to the CMS Hospice Compare program announced Thursday. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on a recent memo from the U.S. Department of Justice offering good news for some providers. Monitor with us™
Kathy Heffernan, director of physician relations with ProHealth Care, discusses the changes in the relationships between physicians and healthcare organizations. Takeaways for healthcare executives include the changing role for organizations as physicians have become an integrated part of health systems.