Haleem Mohammed MD MBA

#CMOs need their physicians to be addressing prescription overload. Why? Not only does it affect patient care and quality, but because medication management is a component of #valuebasedcare, according to Karna Patel MD, MPH, vice president at Tampa General Hospital and president of Tampa General Medical Group.   "We are focused more on patient experience, quality, outcomes, and cost of care," Patel says. "Medication management is an important area for CMOs and health systems because if we are aiming for all of those things, we want to make sure patients are getting the medications that are needed—not multiple medications that are duplicated or are interacting."   There are other reasons CMOs should be concerned about patients with multiple medications, he told us.   "The side effects that can result from multiple medications can lead to increases in #healthcareutilization, risk of going to the emergency department, hospital admissions, or ICU stays," Patel says. "There are other risks such as impacting the quality of life from falls or other injuries."   Don’t miss the full story: https://lnkd.in/edxxrPnN HealthLeaders

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CMS has a 41 year track record of abuses very specific to the 2621 counties lowest in health care workforce where hospitals have been closed by the hundreds along with countless practices. The new cuts will be a minor impediment to most providers, but it will mean termination or major compromise in more of these counties with 40% of the population in 2010 and growing to 50% by the 2060s as CMS accelerates the decline of what health care remains. The 2621 counties include 37 million rural people (75% consistent in behind) and 90 million urban people (32% fastest growing). These rural and urban populations are both behind in outcomes and drivers of outcomes. This means that CMS micromanagement is costly, burdensome, and discriminatory. There is no value to compromise and terminations of hospitals, practices, team members, jobs, and local leaders. There is no validity of volume to value in what remains of health care services in these counties that have half enough of all basic health access specialties, access barriers, underutilization, and inappropriate utilization. The CMS one size fits all designs have very specifically caused harm to vulnerable populations. heir designs have not had supportive or beneficent intent. They reveal their true colors by cost cutting again and again. They fail to properly study the consequences or listen to critique. Therefore they cannot give informed consent to legislators, leaders, and people left behind. They violate the Belmont Principles and must be held accountable - same as physicians and human subject researchers. The string of steady abuses across DRG, RBRVS, manage care, Readmissions, Star Ratings, and value based designs continues. Millions of excess deaths are by design based on the same calculations used in African American populations and the 2621 counties have 2.7 times more people. CMS plans pay less than cost of delivery and pay 15 - 30% less in these counties. The better employers with their better paying private plans that bail out CMS deficits by design, are missing from the 2621 counties. Even worst the government, health care, and education jobs that did have better insurance, are being cut or centralized away. Only Hill Burton 1946 to 1997 and the first decade of Medicare and Medicaid with inflation related higher payments have helped these counties. Since the 1980s and in reaction to runaway health care costs engineered by those doing best, there have been cost cutting designs that abuse those politically weaker, distant, and poorly understood - the most. They have never spared basic health access or most Americans most behind who will not be writing letters

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For Shame: Government Removes Requirement for Hospitals To Disclose Their ICU Occupancy . Thousands can die as a result in next emergency : https://lnkd.in/ehPpKcJ9 The COVID-19 pandemic demonstrated that US hospital and health care systems were ill-prepared for the surge of patients who overwhelmed available health care resources. The lack of available ICU beds during the COVID-19 pandemic caused likely thousands of deaths that could have been preventable . Researchers estimate that thousands of early-pandemic deaths could have been avoided were it not for this shortage. However, ICU bed supply was not the root of the problem. Although, at the peak of the pandemic, there were many hospitals across the United States with ICU units that were overwhelmingly full, there were also ICUs in the same regions that were under capacity. Rather, load imbalance—a measure of the relationship of hospitals in hospital referral regions (HRRs) that are at or overcapacity while others are under capacity—was a problem. To prevent the needless loss of human life, we recommend that all hospitals disclose their load-balance plans—such as regional transfer agreements, regionally coordinated length-of-stay, and rapid conversion of hospital to ICU beds access—on a regular basis in a public forum, such as the SEC’s risk analysis, regularly disclosed in its EDGAR data site. Although health care agencies can promulgate the disclosure, the best agency for the collection of these disclosures is the Securities and Exchange Commission (SEC) due to its globally lauded expertise in both data collection and transparent dissemination. This disclosure should be mandated for hospitals through government legislation/rules. Sadly, the CDC recently lifted its requirement for hospitals to report their COVID-19 data—including the number of COVID patients being cared for in ICUs (https://lnkd.in/egcNGMaP). As we sift through the aftermath of the COVID-19 pandemic and return to a pre-COVID way of life, government agencies that bow to industry pressure with guidance changes, like this one, open us up to avoidable deaths in future pandemics. If we hope to avoid repeating the outcomes of the COVID pandemic in future health crises, legislation that mandates hospitals’ disclosure of their load-balance plans is a must. #COVID #CDC #SEC #healthcare #transparency#ICU #rural hospitals

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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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The healthcare system is full of acronyms: CMS, ACO, and many more. For this month’s edition of my Care Made Clear explainer series, I will be covering a lesser known acronym: I-SNPs, also known as Institutional Special Needs Plans. I-SNPs are a unique type of Medicare Advantage plan for those with chronic or disabling conditions who need a high level of care. Standard I-SNPs cater to people in long-term care settings, like nursing facilities and inpatient psychiatric facilities. There are also community equivalent I-SNPs (Institutional Equivalent plans (IEs)) that offer benefits for individuals who require institutional-level care but continue to live either at home or in assisted living facilities. These plans aim to provide the same level of comprehensive care and support as I-SNPs, ensuring that members receive the necessary services regardless of their living arrangements. I-SNPs prioritize coordinated, comprehensive care that meets the special needs of institutionalized individuals. Teams of healthcare professionals – including primary care physicians, specialists, nurses, case managers and other caregivers – work together to manage patient health. This integrated approach helps address complex health needs, improve overall patient outcomes, reduce hospital readmissions, manage chronic conditions effectively and ensure that patients aren’t navigating the complex healthcare system alone. I-SNPs cover everything that Original Medicare covers, as all Medicare Advantage plans do. In addition, they often include benefits like vision, dental, transportation, care coordination, prescription drug coverage, mental health counseling and hearing services, which are important for aging individuals but not always covered by traditional Medicare. To qualify for an I-SNP plan, individuals must currently have or need the level of services provided in a long-term care facility for 90 days or longer. Eligibility may also depend on specific health conditions and the recommendation of a healthcare provider to ensure appropriate care. If you or a loved one could benefit from the specialized care that I-SNPs offer, consider exploring whether this type of plan is the right fit for your needs. #CareMadeClear #ISNP 

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Physicians face a looming pay cut again next year as CMS proposes to cut the conversion factor for the 5th straight year in 2025! But there's a potential silver lining for ACO participants. CMS is proposing a new advance payment system to reward high-performing providers. This could transform how providers, especially safety-net providers invest in clinical care. Here's how it works: ☑ Early Shared Savings ↳ High-performing ACOs can claim a share of savings early. ↳ This provides immediate financial relief. ↳ Encourages investment in clinical improvements. ☑ Boost for Safety-Net Providers ↳ Targets providers with limited resources. ↳ Enables them to join ACOs and share in savings. ↳ Promotes more comprehensive patient care. ☑ Whole-Person Care ↳ Funds can cover hearing, vision, and dental care. ↳ Supports behavioral health and social determinants. ↳ Integrates various aspects of patient well-being. ☑ Operational Improvements ↳ Advance payments to support hiring and improved operations. ↳ Enhances care coordination and preventive measures. ↳ Aims to reduce hospitalizations and associated costs. _This is the story they are selling but tough to buy given the 5 straight years of cuts to professional services._ ☑ CMS's Funding Approach ↳ Funded by reallocating existing Medicare savings. ↳ Savings generated from reduced hospitalizations and efficient care. ↳ Reinforces the focus on cost-effective healthcare. ☑ Measuring Cost Savings ↳ CMS will track healthcare spending and hospital admissions. ↳ Detailed reports will analyze savings from ACOs. ↳ Benchmarks and performance metrics will gauge success. ☑ CMS's Long-Term Goals ↳ CMS wants all Medicare beneficiaries in value-based care by 2030. ↳ This proposal could reverse the trend of dwindling provider ACO participation. ↳ Focuses on improving health equity and cost management. Will this policy reshape Medicare ACO participation and improve patient outcomes? Time will tell. But a point of contrast from years' past is increasingly health systems have built or bought the capabilities necessary for success in these programs. And all of this occurs in a background of increasing frustration on the part of lawmakers with the dismal results of the experiments emerging from the Center for Medicare and Medicaid Innovation (CMMI). Congress also has grown intolerant of years of annual Medicare cuts for professional services. This has prompted consideration of a wider-scale overhaul to reimbursement under the program for US seniors. How do you think this advance payment approach will impact providers? Another dud or something worth paying attention to?

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Healthcare's siloed and often useless data comes from leaders failing to focus on what's measured ACROSS services and partners, including how data will be used to compare services and attribute both clinical and financial outcomes. Nerd alert! 🤓 This issue is oddly rarely discussed as per Andy's post, given those of us who understand how data is collected, analyzed, monitored, and used see this gap all the time. It's true for public health systems too (maybe more so). Lack of clarity around measuring collective impact is one of the main gaps Just Whole Care fills for clients, many of whom have no choice but to ask these questions because of limited funding and being treated as fringe CBO's (they're the 'partner' or 'grantee' health systems want, though not as a their measured driver of impact, no. That's to be saved for the health system's value-based contracting credit.). This issue also keeps the State of California and its Medi-Cal managed care plans from true population health management, which we know we're pumping hundreds of millions into through CalAIM. Today the term "data governance" largely focuses on policies and procedures for WHO CAN ACCESS data, HOW and WHEN, as well as how data will be managed technologically.  The WHY and WHO ELSE are barely discussions, short of what payers and funders demand (see California's field-leading Data Exchange Framework: https://dxf.chhs.ca.gov/). Reasons being, the main goal of today's data governance is to ensure the 'right' people get the 'right' data at the 'right' time for the 'right' reasons. It's basically about a single clinician's use to not screw up + CYA for HIPAA and other laws. Not about patients or collaboration. Reactivity and greed over planning and sharing...BORING! As noted by Effie Andrikopoulou, MD MBA FACC FASE, investments in digital health solutions are failing for this very lack of data governance that addresses WHO IS RESPONSIBLE AND ACCOUNTABLE for selecting metrics, and monitoring them across service lines for the quality of collection (accuracy, volume, and impartiality of information), as well as their impact...not just the impact of each service, but also the impact of the measurement process on patient and workforce wellbeing (often more negative than executives accept). There's clearly no one responsible and accountable to address Graham Walker, MD's concern that digital health vendors may be piling the burden of proving their value proposition onto clinical staff -- a big no no. A lot seems pretty in labs and VC meetings, but in the real world, if staff feel put upon by greed and a lack of evidence, they'll silently revolt. In the end, it's all another version of healthcare's myopic, binary thinking: it's either my measure or yours, it can't be both. Digital's just good until proven bad. Either no one's accountable or everyone is...huh? Health drivers aren't binary. Let's stop acting like our data should be. #digitaltransformation #datascience

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CareMax and Steward Health Care are besties What is CareMax you ask? But of course a value based care provider that went public via SPAC in 2021 $297 open price at IPO $487 high price post IPO $3.00 current trading price Notably, CareMaxbought Steward's Medicare VBC business in 2022 for $135M As part of that transaction, double yacht owning Ralph de la Torre became a board member of CareMax Solid foreshadowing Here's what CareMax recently said in it's 10-Q related to its business: "These conditions raise substantial doubt regarding the Company’s ability to continue as a going concern..." Meaning, it may file for bankruptcy if it can't turn things around Some numbers from the quarter: $156M current assets $507M current liabilities $232M revenue ($21.7M) op loss ($23.8M) cash from ops 1:30 reverse stock split recently issued Translation, you had 30 shares and now you have 1 Some more numbers: 55 centers 218,000 covered members 99% under VBC arrangements And last interesting bit of info: "Our principal sources of liquidity have been cash generated by our centers and MSO operations, and borrowings under our credit facilities." When your third key source of liquidity is borrowing, that's an issue Sorry, sorry, one more thing... Apparently, after the acquisition of Steward's VBC business, Steward doctors continued to serve these patients, though they would then be paid from CareMax... which didn't happen What's going on at CareMax? P.S. If you liked this mystery breakdown, you'll love The Healthcare Breakdown, where I breakdown the business of healthcare and all these wheelings and dealings so you can see what's really going on Check it out here: https://buff.ly/47NeASx See you out there!

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With changes in the Medicare Advantage risk model, slowed increase in Medicare Advantage county base rates, and downward pressure on Medicare star ratings—we are seeing broad evidence of retraction. Altogether, these changes amount to a significant cut to industry revenue. National carriers are announcing major cost cutting initiatives, withdrawals from unprofitable markets, and markedly slashing member benefits in an attempt to stay profitable. And some health systems are taking the unprecedented step of exiting Medicare Advantage (many of them non-profit) altogether despite the fact that 50+% seniors now use the program to access healthcare services. Taken together, some are calling these cuts “the great disruption.” Some observations: 1) Benefit “innovation” had gotten out of hand. To stay competitive and grab share, plans (including ours) were introducing unsustainable benefits that caught attention of members only to pull them back. This is going to stop. At least for now. (Traditionally unsexy) Benefit stability will win the hearts and minds of beneficiaries who will be tired of the yo-yo benefits they have experienced in our previously inflationary environment. If it’s too good to be true, it usually is and startups that funded growth through investment capital can’t do it forever. 2) Organizations that succeeded in Medicare Advantage risk through maximizing revenue capture will actually have to learn how to effectively manage care for older adults. This means providing rapid access to patients to help them avoid emergency rooms and hospital admissions. This means more proactive management of chronic conditions. This means managing their own utilization of low-value services. It’s a worthy challenge and time for put so-called high value healthcare organizations to the test. 3) As benefits come down to earth and there’s more parity, competition will be increasingly focused on effectiveness and service. Do you actually do what you say will do? Does your rhetoric match action? And this is a good thing. Service excellence along the value chain is what matters most to beneficiaries. It just hasn’t been what they valued most at point of purchase. Organizations that commit to radical consumer focus will win. 4) Brokers will be more important than ever to guide people to make good decisions about their plans. In an increasingly complicated marketplace (made more complicated by the IRA and changes to drug benefits), people who can help seniors truly understand their options and true out of pocket exposure will be critical. 5) Everyone partnering with everyone (brokers, plans, provider partners) is not a winning strategy. Deeper, narrowing partnerships will win the day. The “great disruption” will begin to play out this Annual Enrollment Period. Let’s just not forget that at the other end of everything we do is an older adult who relies on our service and care.

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Thank you Robert Oubre, MD (The Doctor of Documentation) for posting this information. The CDI professional can contribute to oversights in physician documentation through collaboration with physicians, physician advisors, and Case Management/Utilization Review. Collaboration is the key to achieving true "documentation integrity" from a quality of care and reimbursement perspective. The limiting factor is the current Key Performance Indicators CDI is expected to achieve that are nothing more than task-based activities that do not correlate with documentation integrity. CDI plays a vital role in physician documentation for all the right reasons including patient care, quality measures, and support of the revenue cycle in that order. Quality documentation supports optimally sustainable net patient revenue less prone to clinical validation and medical necessity denials and level of care downgrades. I have always believed and supported measures of denials as defects in physician documentation that CDI can address provided it is an expectation of the CDI profession. I call on ACDIS and AHIMA to take the lead in advocating for and promoting transformation in current CDI processes as Dr. Oubre's post suggests. Time to reject the notion that CDI stands for CMI increase through CC/MCC Capture as the main focus of CDI activity. #cdiprofession, #chasingthediagnosis, #chasingmoneythatnevermaterializes, #qualitydocumentation https://lnkd.in/eJYuS-gf

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Should we pay physicians a flat salary rather than volume based payments? to resist the temptation to do the bare minimum have quality metrics each physician agrees to at the individual physician level. For 1 person it could be metrics around hypertension and someone else diabetes. The more metrics you agree to, the higher the incentive payment. Everyone starts w a “bonus” score of 100 and works down vs starting at 0 and working up. The more patients you see the less impact each individual patient has on your metrics. We have the technology to monitor and measure. Earlier in our careers maybe we weight volume higher and as we mature and gain experience we transition to quality based incentives? One size fits all probably doesn’t work. We need to find appropriate incentives with attention to unintended consequences to keep us motivated to improve. how much does a physician who is high quality and high volume deserve to make? then back into how to structure the compensation package. First posted in my #docsocial group

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"For the three oncology/hematology products selected for this analysis, providers are projected to face a 39% to 64% decrease in Medicare fee-for-service add-on payment, along with a 13% to 21% reduction in commercial and Medicare Advantage add-on payment. Across both markets, this amounts to a $12 billion to $19 billion projected reduction in add-on payments to providers from 2028 to 2032. ... “A financial hit of this magnitude to cancer practices’ reimbursement is staggering and may well limit practices' ability to offer life-saving treatments to patients with cancer, regardless of their coverage types.” Ted Okon, executive director of Community Oncology Alliance." Coverage of the #IRA #InflationReductionAct ticking time bomb for #oncology #hematology providers, by Denise Myshko for FormularyWatch Managed Healthcare Executive https://lnkd.in/eCpr6NCi

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Main Point of Value-Based Care Value-based care is a healthcare model that ties the amount providers earn to the quality and cost-effectiveness of the care they deliver to patients. Unlike the traditional fee-for-service system where providers are paid for each service rendered regardless of outcome--value-based care rewards providers for improving patient outcomes while keeping costs down.

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🌟 A Shocking Reality Check on Obesity & Ozempic 🌍💊 Yesterday, we had an insightful lecture at Baptist Health South Florida as a part of Jose 'Pepe' Alvarez, MD annual lecture. Dr. Herbert Aronow's presentation on the current landscape of GLP-1 RAs was a true eye-opener. But what really stuck with me was the staggering price differences for Ozempic across the globe. I decided to do some digging into the data myself, and here's what I found: 📝 Countries with higher obesity rates seem to be paying a hefty premium for Ozempic. In the U.S., where obesity rates are the highest, we're shelling out a whopping $936 a month – almost 10x more than countries like the U.K. Why? It all boils down to supply and demand. Higher demand = higher prices. But there's hope on the horizon! The patent for Ozempic expires in 2031. However, until then, we could be stuck with these sky-high prices unless governments step in. The Future of GLP-1 Agonists 📈 The global market for these medications is expected to explode, reaching a staggering USD 133.35 billion by 2030! This means that addressing affordability and accessibility is more crucial than ever. My Challenge to You: As healthcare professionals, we have a responsibility to advocate for our patients and find solutions to these complex issues. How can we improve access to affordable treatments? How can we address the root causes of obesity on a global scale? What role should policymakers play in regulating drug prices? Let's start a conversation! Share your thoughts, insights, and solutions in the comments below. 👇 #Healthcare #Obesity #GLP1RA #Ozempic #Jyokti #BaptistHealthSouthFlorida Herb Aronow, MD, MPH Barry Katzen, MD Baptist Health CME

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