Tammy Grygar

As healthcare providers transition to value-based care, the significance of CDI cannot be overstated. Effective CDI capabilities and resources are crucial for ensuring medical record accuracy, completeness, and consistency, resulting in optimal reimbursement and enhanced compliance.    At AGS Health, we’ve made substantial investments in clinical technology and resources to help ease the CDI burdens on your valuable clinical resources. We’ll handle the documentation so your clinicians can focus on care delivery. 

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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Are operational inefficiencies hindering your organization's progress towards it objectives? If you are among the EHR users seeking optimal functionality, while the EHR vendor may offer solid capabilities, it may not cover all of your needs. That's where Pivot Point Consulting steps in. We go beyond the basics of the EHR, meticulously analyzing its features and drawback, and tailor its functionality to seamlessly align with your organization's core objectives. Let us empower your organization to reach its goals and fulfill its mission effectively! Reach out today to let me know how we can support your mission! #eCW #athena #NextGen #Epic https://lnkd.in/gYhQSjkm

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https://lnkd.in/epGSYUbR #EHR support for #healthcare providers is transforming thanks to the Clinical #ServiceDesk. Read how in this Becker's Healthcare article. #WeAreCereCore

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Such a great article, I just had to share! Congratulations Cuero on your implementation. Is your organization going through the same thing and it is challenging? Let our expert EHR Strategy Advisors help, whether it's maintaining the legacy so your staff can focus or to help implement your strategy, we can help. It's what we do. #pivotpoint #ITStrategy #EHRSupport

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The new U.S. Acute Care EHR Market Share 2024 report from KLAS shows one electronic health record vendor, Epic, pulling well ahead of the pack as it continues to add new hospital and health system clients. #Healthcare #KLAS #HealthRecord

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Years ago, CMS forced health systems and ambulatory providers to ONC-Certified EHR technology through Meaningful Use (but also paid for it). Post-Acute and Behavioral Health Providers were not included in this. Today, through payment models being released into the industries (such as GUIDE), CMS is forcing the adoption of Certified EHR technology by requiring it for these models. This is so that organizations can share information and collaborate on patient care in payment models that reward them for doing so. This trend continues for home health with Transforming Episode Accountability Model (TEAM), which provides a new model of care for home health organizations to participate in for 5 of the most expensive surgical procedures that require post-acute care (launches in 2026). From a technology standpoint, an EHR's Certification is only the first step. There are clinical scales, tools, and content to be licensed plus built. Changes to billing functionality. Reporting on measures to create workflows and analytics around the capture on numerators and denominators. Make sure any vendor partners you work with has actually prepared for these things, on top of certification, in the models of care you're pursuing. GUIDE has a profound impact for hospice/palliative care providers by allowing them to be properly reimbursed for taking care of some of nation's most elderly and vulnerable populations. Proud that Netsmart has taken multiple providers on this list LIVE in the last two weeks on the model, operationalizing GUIDE through all of the above in a way that takes care of one of our most vulnerable populations.

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Dr. Donald Rucker, Chief Strategy Officer at 1upHealth, Inc., and Jocelyn Keegan, Program Manager for the HL7 Da Vinci Project, presented at the 2024 WEDI Spring Conference on FHIR Implementation Guides for CDex and PDex. Data and Data Liquidity are Extremely Important "It’s in this current state of play – where the goals of improving care quality while decreasing care cost are paramount – that data has become the currency of care. To be successful, we need to be able to exchange clinical data and payer data, combine it, and compute it. We must continue to move away from manual, analog processes and digitally transform, just as almost all other industries have." https://lnkd.in/eafqMr6C

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Why do Healthcare Systems Need Policies and Tools for CMS and OIG Updates in CDI Programs? To ensure the success and sustainability of Clinical Documentation Improvement (CDI) programs, healthcare administrators, CDI professionals, and compliance officers must play a pivotal role in implementing robust policies and utilizing effective tools. This is how they can stay updated with CMS (Centers for Medicare & Medicaid Services) and OIG (Office of Inspector General) regulations. 📊 Ensures Consistency: Clear policies and reliable tools guarantee that all staff members follow the latest guidelines, promoting uniformity in documentation practices. 🛡️ Enhances Compliance: Policies combined with advanced tools help prevent compliance issues by ensuring that regulatory changes are systematically tracked and implemented. 🏥 Enhances Patient Care: Proper policies and tools ensure accurate and up-to-date documentation, directly improving patient care quality and leading to better health outcomes. 💼 Safeguards Revenue: Well-defined policies and efficient tools reduce the potential risk of claim denials and penalties, protecting the organization's revenue stream. 📚 Supports Training: Policies provide a framework for continuous education, while tools ensure CDI professionals can access the latest information and resources. 🔄 Facilitates Adaptability: Having policies and utilizing tools allows for swift adaptation to regulatory changes, maintaining operational efficiency and compliance. By integrating comprehensive policies and leveraging the right tools for CMS and OIG updates, healthcare systems can ensure their CDI programs' ongoing success and effectiveness. 🌟 #CDI #HealthcareCompliance #PolicyMatters #CMS #OIG #PatientCare #HealthcareManagement #TechInHealthcare

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Exciting news from Epic Systems and Microsoft! They have announced that they are integrating generative AI technology into Epic's EHR for the first time! According to Seth Hain, Senior VP of R&D at Epic, this integration has the potential to increase productivity for physicians & staff. The integration will allow health systems using Epic's EHR system to run generative AI solutions through Microsoft's OpenAI Azure Service. The first use case will be through Epic's In Basket communication software system. Here clinicians can use generative AI to create a draft response when communicating asynchronously with patients. This has already been rolled out to a limited number of users at UW Health and UC San Diego Health, with Stanford Health Care expected to follow soon. The second use case will allow providers to use generative AI to source recommendations from Epic's Slicer Dicer data visualization tool. While there is excitement around its potential benefits, there are also concerns about its influence on clinical diagnosis and decision-making. However, this move could provide a welcome respite to physicians suffering from burnout due excessive administrative burden. What do you think about the integration of generative AI into healthcare? Share your thoughts in the comments below. #EpicSystems #Microsoft #GenerativeAI #EHRIntegration #Productivity #HealthcareTechnology #OpenAIAzureService #InBasket #ClinicalCommunication #UWHealth #UCSanDiegoHealth #StanfordHealthCare #SlicerDicer Oron Afek Braedan Russell Justin L. Neece Tom Liddell Christopher Blackerby

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As we chat with payers and providers, one of the common challenges facing program and revenue integrity is turning enormous amounts of data into useful insights and automating ways to increase effectiveness of the program. Looking forward to sharing some ways you can make the data work for you without having to work for the data! If you aren’t able to attend HPRI East, please connect with me. #dataanalytics #programintegrity #revenueintegrity #HPRIEast #CGI

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Automation and Artificial Intelligence are revolutionizing the process by which healthcare providers secure referrals and prior authorizations from highly efficient Medicare Advantage Plans. This transformation is streamlining administrative tasks, reducing time-consuming paperwork, and improving the overall efficiency of healthcare delivery. By leveraging advanced technologies, providers can now access real-time data, analyze patient information quickly, and make informed decisions promptly. For example, AI algorithms can identify patterns in patient data to predict health outcomes and recommend appropriate treatments. This not only saves time but also ensures that patients receive the most effective care possible. Additionally, automation tools can facilitate communication between providers and insurance companies, leading to faster approvals and fewer denials. According to recent statistics, healthcare organizations that have embraced automation and AI have witnessed a significant reduction in administrative costs and an increase in revenue. Overall, the integration of Automation and Artificial Intelligence in the healthcare industry is enhancing patient care, optimizing processes, and ultimately transforming the way providers interact with Medicare Advantage Plans. #Medicare, #Healthcare, #Automation, #AI

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Staffingly, Inc #clinicalcustomerservice #ccs #ushealthcare #rcm ****Enhancing Patient Care: The Benefits of Clinical Customer Services in US Healthcare In the intricate landscape of healthcare, the role of clinical customer services is paramount. From doctors' offices to hospitals and pharmacies, these services play a pivotal role in ensuring seamless patient care while also offering numerous benefits to healthcare providers. Let's explore how clinical customer services positively impact doctors, hospitals, and pharmacies in the US healthcare system. The Benefits of Clinical Customer Services in US Healthcare In the realm of US healthcare, clinical customer services offer numerous advantages to doctors, hospitals, and pharmacies: >Enhanced Patient Experience: Personalized attention and prompt assistance lead to higher patient satisfaction. >Streamlined Operations: Outsourcing tasks like appointment scheduling and insurance inquiries frees up time for healthcare providers to focus on patient care. >Improved Communication: Clear and concise communication between providers and patients results in better treatment outcomes. >Reduced Workload: Delegating non-clinical tasks alleviates the burden on healthcare professionals, allowing them to dedicate more time to patient care. >Cost Savings: Outsourcing clinical customer services leads to significant cost savings compared to maintaining in-house staff. >24/7 Accessibility: Round-the-clock availability ensures patients can access healthcare services whenever needed. >Compliance and Documentation: Expertise in healthcare regulations and documentation reduces legal risks and maintains reputation. >Customized Support: Tailored assistance meets the unique needs of each patient, enhancing the overall patient experience. Hire extended professional staff to support your healthcare business operations 24/7 for clinical customer service, prior authorisation, pharmacy coding, billing and rejections. Save 70% on staffing cost guaranteed! To request services, email info@staffingly.com, call 24/7 (800) 489-5877 or visit https://staffingly.com/

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This is an interesting article because EHR companies, like Epic and Oracle's Cerner, have made siloing data a major part of their business model. Overall, I like EPIC’s ability to review records from other EPIC shops. It also has a nod to interoperability with its “Care Everywhere“ feature. However, this is often a disorganized and outdated collection of information. Using it requires a ninja level of both tech expertise and medical knowledge possessed mainly by younger physicians and chief residents. I am a fan (and advisor) of companies like Zus Health focused on user-friendly, comprehensive, and up-to-date interoperable health care data tools.

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Want to help your providers reducing burnout? IRIS is the answer! Reach out with questiions or for a demo.

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At the KLAS K2 Collaborative Payer/Provider Summit in Salt Lake City tomorrow, I'll be talking about how data partnerships and interoperability developments are changing the dynamics between health plans and provider organizations. If fragmented healthcare is a problem for you and you want to do something about it, let's connect. #KLASK2Summit2024, #K2Collaborative, #Interoperability, #payer, #provider, #KLAS, #klasresearch

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Transforming Healthcare: The Rise of Prior Authorization Technology Platforms In the ever-evolving healthcare landscape, prior authorization (PA) processes have long been a source of frustration for providers and patients alike. However, innovative technology platforms are now revolutionizing this space, making prior authorization faster, more efficient, and less burdensome. Why Prior Authorization Technology is Growing 1. Efficiency and Speed: Automated PA platforms streamline the approval process, reducing the time providers spend on manual paperwork and enabling quicker patient access to necessary treatments. 2. Accuracy and Compliance: These platforms minimize errors and ensure compliance with ever-changing regulations, providing peace of mind for healthcare providers and insurers. 3. Improved Patient Care: Faster approvals mean patients get timely access to medications and treatments, enhancing their overall care experience and outcomes. 💡 Leading PA Technology Platforms 1. CoverMyMeds: One of the pioneers in the PA space, CoverMyMeds leverages real-time data to expedite the approval process, connecting providers, pharmacies, and payers seamlessly. 2. Surescripts: Known for its comprehensive electronic prescribing solutions, Surescripts also offers robust PA capabilities, ensuring accurate and efficient processing. 3. Availity: By integrating with various Electronic Health Records (EHR) systems, Availity provides real-time PA solutions that reduce administrative burdens and improve turnaround times. 4. PriorAuthNow: Focused on automating the entire PA workflow, PriorAuthNow enhances efficiency and transparency for providers and payers, simplifying the authorization journey. 5. Change Healthcare: With its extensive network and advanced analytics, Change Healthcare offers a comprehensive PA solution that accelerates approvals and ensures compliance. The Future of Prior Authorization As these platforms continue to evolve, the prior authorization process will become even more streamlined, reducing delays in patient care and allowing healthcare providers to focus on what they do best—delivering high-quality care. Let’s embrace these technological advancements and work towards a future where prior authorization is no longer a bottleneck but a smooth, efficient process that benefits all stakeholders in the healthcare ecosystem.

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