The attached document includes summaries of attended sessions as well as links to session slides. The first 2+ pages of the document has a Table of Contents so that you can quickly review topics covered. While many of the sessions focus on homeless populations, the information presented is often more generally applicable.
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- Medical Cannabis
- Starting January 1, 2025, licensed dispensaries will be allowed to sell medical cannabis, and patients can apply for medical cannabis cards. This indicates a shift in legislation towards the acceptance of medical marijuana, despite it still being illegal at the federal level.
- Vape Products Regulation
- New laws will prohibit retailers from selling vape products that do not have FDA approval or a “safe harbor certification.” As of now, the FDA has only approved a small fraction of vape product applications, suggesting potential limitations for retailers.
- This legislative cycle saw more health-related bills proposed than in previous years, including:
- HB 809, aimed at allowing local health departments to collaborate with schools to implement health curricula, which did not pass.
- HB 309, focusing on hospital price transparency by mandating clear public posting of pricing information by facilities.
- SB 153, concerning prepayment review processes, which was almost passed but shifted to HB 423 focused on Medicaid prior authorizations.
- SB 30 faced challenges related to privacy issues in recovery residences.
- Varying Success Rates: Although many bills were introduced, fewer passed compared to earlier years, indicating potential challenges in legislative agreement or prioritization.
- Midwives and Access to Care: Legislative efforts are ongoing to improve Medicaid coverage for midwifery services and enhance accessibility for birthing facilities.
Safeguarding The Revenue Cycle: Cyber-Resilience Strategies and Lessons from the Front Lines
- The average downtime from cyberattacks is increasing and was 18.7 days in 2023.
- AHA urges hospitals to be ready to run on paper for up to 30 days.
- A 15-hospital Midwest health system was attacked in late 2023, causing:
- 2 weeks of downtime
- Disruption to Epic EHR, internet, and phones
- $4M–$6.5M in remediation costs
- Major issues included:
- Medical record and documentation failures
- Gaps in charge capture and revenue cycle
- Need for additional staffing and consultants
- Financial Impact
- Estimated revenue loss up to $112 million for 4 weeks of downtime
- Charge recovery is slow; coders can review only 15-20 charts/day
- Key challenges:
- Incomplete clinical documentation
- Unstandardized provider records (esp. levels of care)
- Poor backup systems for billing and charge capture
- Underdeveloped continuity plans and disaster recovery
- Recommendations:
- Conduct Cyber Resiliency Assessments: Review disaster recovery, billing, and financial continuity
- Standardize Documentation: Real-time backups and provider training
- Improve Clinical Documentation: Audit compliance, automate and validate
- Strengthen Financial Resiliency: Crisis management teams and updated contingency plans
- Key Takeaways:
- Cyberattacks cause massive disruptions and financial loss
- Gaps in preparedness and documentation systems worsen impact
- Investments in resilience, documentation, and continuity planning are essential
HIPAA Security Rule Gets a Makeover: Let’s Break it Down
- Proposed changes to HIPAA Security Rule update the rule to address changes in the healthcare environment, address common deficiencies, incorporate changes that resulted from court decisions, and clarify elements of the rule.
- All implementation specifications are required. There is flexibility in how they are addressed, but not whether they are met.
- Slide 8 shows an overview of all HIPAA Security Safeguards as they are now, Slide 9 shows them as they are in the proposed rule. Updates include:
- Technology Asset Inventory (Slide 11)
- Patch Management (Slide 15)
- Security Incident Procedures (Slide 16)
- Contingency Plan (Slide 17)
- Compliance Audit (Slide 18)
- Business Associate Contracts and Other Arrangements (Slide 20)
- Access Controls (Slide 22)
- Encryption and Decryption (Slide 23)
- Configuration Management (Slide 24)
- Multi-Factor Authentication (Slide 25)
- Vulnerability management (Slide 26)
- Data Backup and Recovery (Slide 27)
- Information Systems Backup and Recovery (Slide 28)
- The rule is effective 60 days after publication. Organizations must be in compliance 180 days from the effective date.
Winning the Payer Game by Identifying Your Risks in Coding and Billing
- The "Payer Game" Is Complex
- Payers often deny claims even when accurately coded.
- Multiple appeal levels may be required for payment.
- Payment amounts often don't match contracts, requiring follow-up.
- Success Requires Teamwork
- Involves collaboration among providers, coding, billing, CDI, legal, and finance teams.
- Each plays a role in ensuring documentation and coding meet payer standards.
- Common Pitfalls
- Coding inaccuracies (e.g., unspecified diagnoses, missing modifiers).
- Payer-specific quirks (e.g., preference for certain modifiers or codes).
- Missing or ambiguous documentation.
- Failure to meet administrative deadlines (e.g., filing, appeals, re-billing).
- Strategies for Improvement
- Build payer rules into claim scrubbers.
- Understand the top denial reasons and address high-impact ones first.
- Monitor external audit trends (e.g., CMS CERT data).
- Develop provider education, audit tools, and appeal templates.
- Audit Example: DRG 266 (TAVR Procedures)
- Frequent denials due to unclear documentation on heart failure acuity.
- Solution: Education, queries, and targeted coder/provider training.
340B Threats and Next Steps: The Importance of 340B and the Challenges Ahead
- Purpose and Importance of 340B:
- The 340B program provides drug discounts to safety-net providers to support care for uninsured and low-income patients.
- It improves financial stability for FQHCs like FHC, enabling expanded services and access to medications.
- At FHC, 340B revenue supports operations, reduces expenses, and helps provide care for 40,000+ vulnerable patients.
- Challenges Facing 340B:
- Manufacturer Restrictions: Since 2019, 32 manufacturers have limited 340B drug replenishment, especially for contract pharmacies.
- Criticisms: Concerns include rapid program expansion, lack of transparency, and claims that savings aren't passed to patients.
- Political and Media Campaigns: “Dark money” anti-340B campaigns aim to influence state legislation restricting contract pharmacies.
- Legislative Activity: Several states have passed or are considering pro-340B pharmacy access laws; others face heavy lobbying.
- Emerging Threats:
- Manufacturers propose shifting from discounts to rebates, which would increase upfront costs and reduce flexibility for providers.
- This shift threatens the sliding-fee scales and affordability for patients.
- Call to Action:
- FHC urges advocacy at federal and state levels—inviting legislators to see firsthand the impact of 340B and engaging patients and staff in outreach efforts.
Flying at the Intersection: HIM Meets Public Health Through SDOH
- Health is shaped not just by clinical care but also by upstream factors such as housing, income, education, and social support.
- The presentation distinguishes between upstream (root causes) and downstream (symptom-focused) interventions in public health.
- SDOH Screening & Guidance:
- As of January 2024, Medicare-reimbursed providers (hospital) must screen for SDOH in five domains: food insecurity, interpersonal safety, housing, transportation, and utilities.
- Tools like the SIREN screening comparison tables help evaluate and implement effective screening practices.
- Integration with Annual Wellness Visits and HCPCS coding (G0438, G0439) facilitates structured documentation and reimbursement.
- Intersection with Public Health & Accreditation:
- Public Health Accreditation Board (PHAB) standards (e.g., Domain 7) emphasize equitable access to services and continuous quality improvement, aligning HIM work with population health goals.
- Population-level outcomes are tracked via the PHAB Data Portal, which includes data on mortality, social environment, and health-related quality of life.
- Case Study – Martin County, Kentucky:
- EKU supported a Local Needs Assessment (LNA) required by state law (HB 129) to evaluate the health of the community.
- Community forums collected insights on health outcomes, behaviors, clinical care access, and social/economic conditions.
- Top concerns included mental health, substance use, poverty, and food insecurity; key barriers were access to providers, broadband, affordable care, and childcare.
- Social Vulnerability & Community Risk Factors:
- Martin County showed medium-high vulnerability (SVI = 0.6869).
- Risk factors with greatest impact included poverty, lack of job opportunities, substance use, and mental health.
- Community strengths were schools, local clinics, churches, and family support systems, though often underutilized due to communication gaps or systemic barriers.
- The integration of SDOH data and public health principles into HIM practice is essential for advancing equity and improving community outcomes. Structured screening, local data, and cross-sector collaboration are key tools for transforming insight into impact.
- Key Themes
- Patient-Centered Care & Autonomy
- Emphasizes respect for patient preferences, shared decision-making, and personalized communication.
- Autonomy supports better outcomes and more efficient use of resources.
- Length of Stay (LOS) as a Key Metric
- Patient-Centered Care & Autonomy
- LOS impacts hospital efficiency, patient outcomes, and healthcare costs.
- Ideal LOS balances:
- Too short: risk of readmission
- Too long: increased costs, complications
- Value-Based vs. Fee-for-Service Models
- Value-based care focuses on outcomes, not volume.
- LOS optimization aligns with quality-based reimbursement (e.g., Medicare VBP, ACOs).
- Data Methods for LOS Analysis
- Traditional methods (regression, stratification) have limitations.
- Propensity Score Matching (PSM) corrects for confounding variables, enabling more accurate comparisons between patient groups.
- Key Findings
- Prolonged LOS is associated with higher costs and morbidity.
- Shorter, well-managed LOS can improve outcomes and reduce expenses.
- ARMC vs. National Data: ARMC generally aligned with national trends, but improvements are possible in care coordination and fragmentation.
- Advanced Tools & Innovations
- AI and predictive analytics support LOS management and discharge planning.
- Health Information Exchange (HIE) reduces care fragmentation and redundant services.
- Blockchain enhances HIE security and patient data control.
- Equity & Disparities
- LOS disparities exist across race, insurance type, and socioeconomic status.
- Vulnerable populations may face longer stays, worse outcomes, or delayed discharge.
- Recommendations
- Use flexible, personalized LOS guidelines.
- Improve care coordination and discharge planning.
- Promote value-based reimbursement and invest in AI tools.
- Address social determinants of health and disparities.
Less Clicking, More Caring: AI’s EHR Revolution
- The Promise of AI in EHRs:
- AI has the potential to automate medical documentation, diagnostics, and treatment planning, significantly alleviating clinician burnout and enhancing patient care by streamlining workflows.
- Historical Context:
- The evolution of EHR systems has gone through distinct phases, from early experiments in the 1960s to widespread adoption and focus on interoperability in the 2020s.
- Challenges in Healthcare:
- Issues like preventable medical errors, rising costs, and clinician burnout remain prevalent. EHR systems are often cumbersome, with physicians spending around 50% of their time on EHR-related tasks.
- Ethical and Operational Concerns:
- The document discusses important ethical considerations regarding AI's role in decision-making, including:
- The risk of over-reliance on AI reducing human intuition and critical thinking.
- Concerns about bias in AI models, particularly when trained on non-representative datasets.
- Questions around data ownership and patient autonomy concerning AI-driven processes.
- AI Implementation Guidelines:
- AI-powered EHRs must ensure:
- Patient data protection and compliance with regulations.
- Reduction of bias to provide equitable care across demographics.
- Support for, rather than replacement of, human decision-making.
- Technological Benefits:
- Specific features of AI in EHRs highlighted include:
- Automated documentation and voice/NLP-driven charting.
- Predictive analytics for early risk detection and improved patient engagement.
- Patient-Centered Approach:
- Emphasis on integrating self-reported data and improving care recommendations, which fosters a more patient-first approach.
- Need for Trust and Accountability:
- Transparency and accountability in AI recommendations are crucial for gaining the trust of both clinicians and patients, along with secure handling of sensitive medical records.
AI in Medical Coding: The Evolution, Impact and Best Practices in 2025
- Current Challenges in Medical Coding:
- Staffing shortages, inconsistent quality, and changing payer rules are driving delays, denials, and compliance risks.
- Offshore and manual coding methods often result in variability and inefficiency.
- Evolution of Medical Coding:
- Transition from manual coding to Computer-Assisted Coding (CAC) and now to Autonomous Medical Coding, which uses AI technologies like Natural Language Processing, machine learning, and large language models to code medical records with minimal human involvement.
- Technology Overview:
- Nym’s platform provides high-accuracy coding across specialties such as Emergency Medicine, Radiology, and Outpatient Surgery.
- Coders only review flagged charts, dramatically reducing time and improving consistency.
- Ensuring Accuracy:
- Best practices include:
- Customer alignment on coding philosophy
- Technology education to build trust and understanding
- Ongoing auditing to validate performance and compliance
- Case Studies:
- Inova Health: Reduced costs by $500K+, eliminated overtime, and decreased revenue backlog by 50%.
- Genesis Healthcare: Achieved 96%+ coding accuracy, improved job satisfaction, and reduced operational strain.
- Limitations & Best Practices:
- AI tools are not yet a 100% solution—coverage is limited to select specialties and a portion of charts.
- Success depends on organizational readiness, IT infrastructure, cross-functional teams, and governance.
- Checklist for 2025:
- Evaluate technical readiness
- Align coding standards across payers
- Define performance metrics and audit procedures
- Engage stakeholders across HIM, IT, and revenue cycle teams
- Best practices include:
Maximize Impact: Empower CDI and Uncover Every Diagnosis with AI
- AI as a Tool for Clinical Documentation Improvement:
- AI is presented as a powerful resource for CDI teams, aimed at capturing opportunities and alleviating administrative burdens without replacing existing staff or processes. It complements current workflows, especially in a challenging, low-margin healthcare environment.
- Financial Risk Minimization:
- The use of AI can help in second-pass reviews, identifying additional revenue opportunities while managing costs and minimizing financial risks. This ensures that CDI teams can remain effective amidst staffing constraints.
- Augmentation of Existing Workflows:
- AI augments current CDI operations rather than substitute personnel, thereby improving the accuracy and quality of healthcare data
- Comprehensive Review Process:
- The integration of AI facilitates a thorough examination of charts—scanning 100% for revenue and quality issues, which can lead to higher identification rates of key findings
- Educative Functions of AI:
- AI not only aids in operational tasks but also assists CDI teams in learning new clinical concepts and understanding complex situations, ultimately enhancing their expertise and effectiveness.
AI in Prescribing: Navigating Ethics, Risk, and the Physician’s Role
- Enhancement of Physician Role: AI should support and enhance the physician’s role rather than replace it. Physicians must retain control over clinical decisions, using AI as a tool for assistance in decision-making.
- Decision Support: AI in healthcare has the potential to identify risks, optimize treatments, and streamline administrative tasks, particularly in managing controlled substances and reducing misuse. However, AI must support rather than substitute physician judgment.
- Concerns about Bias: AI algorithms risk perpetuating healthcare biases due to limitations in data, including incomplete or biased information, affecting marginalized populations disproportionately.
- Risk Assessment Limitations: AI systems may flag patients as "high-risk" based on historical data, leading to decisions that overlook patient-specific factors and the physician's clinical judgment. This raises liability issues for physicians who may feel pressured to follow AI recommendations over their expertise.
- Need for Thoughtful Use: The rapid development of AI technologies necessitates informed and thoughtful prescribing practices, emphasizing AI as a supportive rather than definitive decision-maker.
- Healthcare Data Interoperability: Effective use of AI in patient care requires improved healthcare data interoperability to ensure that data flows freely between providers, patients, and agencies.
Ethical and Practical Implications: The presentation highlights the ethical, practical, and legal challenges posed by AI in prescribing controlled substances, emphasizing the need for a balance between AI capabilities and physician responsibilities.
Reliable Connectivity for Expectional Care: WiFi Implementation for a Large Health System
DRG Integrity: Common Documentation and Coding Opportunities in DRG Audits
Health Equity and SDOH
Bridging the Gap Leveraging Heatlh Information Technology to Address Healthcare Inequities
- This poster presentation examined disparities with a focus on The R4P (Remove, Repair, Restructure, Remediate) tool for designing equitable HIT solutions.
- The presentation highlighted 2 case studies. The first demonstrating bias in pulse oximetry due to higher readings on patients with darker skin tones, which in turn leads to delays in care. The case study supports the need for redesigning devices with diverse skin tone datasets, and AI driven corrections. The second case study highlighted disparities in radiology care and supported AI assisted scheduling, mobile radiology units, and improved insurance options to reduce the disparity.
Building Healthier Communities Strategies for Prioritizing Equity and Culturally Competent Care
- This presentation reviewed the importance of addressing equity and social risk factors, strategies to improve outcomes and reviewed the process of applying for Healthcare Equity Certification from the Joint Commission.
- The presentation showed the impact of broad approaches compared to targeted approaches for increasing breast cancer screening and lunch cancer screening.
Automated Extraction of Social Determinants of Health To Improve Patient Outcomes
- The presenter is in the process of developing an AI tool that reviews patient charts and extracts social determinants of health data from non-standardized fields (ie free text). The tool then can convert unstructured SDOH data into structure data fields.
- Currently, they are testing pattern matching approaches, Bidirectional Encoder Representations from Transformers (BERT) based models, and Large Language Models. Then working with the results to create predictive graphs for 30-day unplanned readmissions.
SDOH Program Design Technology Data and Evaluation that Drives ROI
- ROI needs to consider cost savings, efficiency, quality, satisfaction, and insights gained from programs.
- The presentation reviewed 2 case studies where health systems used Unite Us to address social needs:
- North Carolina Health Opportunities Pilots: program testing non-medical interventions for high needs Medicaid enrollees. Services include housing, food, transportation and toxic stress interventions. Participation led to an estimated $85 PMPM in Medicaid savings.
- Sarasota Memorial Health Care System/First 1,000 Days: The program included a community collaboration to improve care access for pregnant mothers and families with young children. The program connected participants to social care services. Saw a reduction in postpartum-related and all-cause 30-day readmission for Medicaid/Medicare patients.
Clinical and Community Data Initiative Data Linking for Food Security.
- Food insecurity significantly raises healthcare costs and ED visits.
- Nutrition services help reduce hospitalization and improve chronic disease outcomes.
- Clinical providers and community-based organizations operate in disconnected systems and CBOs cannot share or access clinical data due to technical and regulatory barriers.
- The goal of the project was to establish a common data model for clinical and social data, enable cross organizational data sharing, measure outcomes, and build dashboards for reporting and analysis.
- Outcomes:
- About 75% of CBO participants were successfully matched with clinical data.
- Roughly 45% of matched patients had diabetes
- A1C control improved modestly in 3 and 6 months after service delivery.
Artificial Intelligence
AI in Healthcare Avoiding Pitfalls and Driving Project Success
- AI projects are only as good as the data used for the model.
- Data quality and quantity both matter. Proof of concepts often don’t prove anything because the data does not reflect real world variables.
Las Vegas Cardiff Project AI Models Map Violence and Overdoses
- The Cardiff Model of Violence Prevention focuses on ER data providing solutions.
- One study in two police jurisdictions found that 83% and 93% of violent injuries seen in the ER were not reported to law enforcement.
- Using ER data, participants created a heat map of violent crime then using AI models mapped probability of violent crime and overdoses by location. Using the map, participants developed community driven interventions in the predicted crime hotspots. Interventions included Narcan training and street pastors.
Developing a Solid Foundation for AI Governance in Healthcare Organizations
- 45% of those surveyed through HIMSS are using AI/Machine Learning and 55% are not. Reasons for not using AI tools include:
- Lack of funding to purchase technology (45%)
- Technology does not fit in workflow (41%)
- Lack of organization policy/governance framework to implement technology (39%)
- Lack of and/or perceived lack of accuracy (27%)
- Ethical concerns about development and use (20%)
- Mass General Brigham shared their governance structure which includes:
- AI Governance Committee
- AI Implementation Oversight Working Group
- Individual Project Teams
- Slide 17 shows their phased approach to implementing AI.
- AI tools in use include using AI to summarize patient visits into clinical documentation and basket draft messages.
- Getting started: work to solve a particular problem, make sure everyone agrees on the terminology and technology, create an inventory of AI tools in use.
- Types of lability for Health AI
- Privacy
- Consumer protection and non-discrimination
- Tort Liability
- Medical malpractice
- Institutional liability
- Direct liability
- Vicarious liability
- Emerging Theories of Liability
- AI personhood
- Common enterprise liability
- Products Liability:
- Defects
- Failure to warn
- Strict malfunction
- Breach of warranty
- FDA approval and manufacturer liability
- ONC Certification Program
- False Claims Act
AIML Driven Clustering of Diabetes and Hypertension Populations
- The presenters conducted a retrospective analysis of patients with diabetes and hypertension over three years. The clustering analysis was used to identify patient groups based on social and clinical characteristics.
- 8 distinct clusters emerged from the analysis, two of which were identified as vulnerable (Latina with language barriers and middle aged, black males with high social risk).
- The two vulnerable clusters had the highest ED visit rate, lowest outpatient visit rates, and lowest digital engagement.
- 25% of patients with diabetes and 11% of patients with hypertension had not had a visit in the past 12 months.
- Using this data the health system will create targeted interventions to address care opportunities and engage patients in services.
Generative AI Security Essentials
- GenAI can be weaponized by cybercriminals:
- Phishing: highly targeted, scalable attacks.
- Identity Theft: deepfakes, voice cloning.
- Exploitation: reputational and financial harm.
- Disinformation: fake but convincing media content.
- Top Gen AI User Risks
- Security & Privacy: AI tools may learn from your input and leak sensitive data.
- Bias & Fairness: Models can reflect and amplify societal biases.
- Overreliance: Users may trust inaccurate or overly confident AI outputs.
- Miscommunication: AI struggles with nuance and can misinterpret vague prompts.
- Risk mitigation strategies:
- Do not enter sensitive data into public AI systems
- Audit AI output for bias and errors
- Cross check results with subject matter experts
- Establish AI use policies for ethics, security, and transparency.
- Organization AI Policies define approved tools, acceptable uses, data security practices, and transparency requirements.
Virtual Care
Unlocking Virtual Care A Collaborative Approach to Expansion and Success
- Valley Health (VA) shared their experience scaling and maturing their virtual care program. Their goal was to create a mature digital health strategy that is best in class, consistent, effective, and prepared to serve multiple clinical programs simultaneously.
- Valley Health created a steering committee to guide the rollout of services and developed a scorecard for their goals. They had one common virtual platform (previously had multiple platforms across their health system). Ambulatory virtual health services included virtual medical visits, school visits, community paramedicine and virtual urgent care.
- Starting on Slide 16, there are images of their equipment and set up for different services.
Interoperability
Pioneering Bidirectional Data Exchange for Mandatory Compliance and Beyond
- The presentation reviewed CMS Interoperability rules and challenges with payer-to-payer data exchange. Requirements include the ability to:
- Retrieve data from a prior health plan for all new members and at current member request
- Exchange data via FHIR API
- Integration of data into a longitudinal health record
HL7 AI Standards Provenance Fraud detection Prevention and Health Equity
- The presentation reviewed HL7 FHIR standards, AI in healthcare, collaboration for health equity, and addressing bias in AI.
- FHIR has evolved since its first proposal in 2011, with significant milestones in 2014, 2018, and upcoming releases. The FHIR community includes implementers, standards developers, and various stakeholders working towards interoperability and healthcare improvements.
- The FHIR Accelerator Program supports implementers in creating guides for public-private sector solutions in healthcare.
- Da Vinci Project: A multi-stakeholder initiative focused on value-based care, improving prior authorization processes, and enhancing clinical data sharing.
- CodeX Initiative: CodeX aims to improve cancer care and research through FHIR-enabled workflows, expanding to cardiology and genomics.
- FAST Accelerator: The FAST initiative identifies scalability gaps in FHIR resources and proposes solutions to accelerate FHIR adoption.
- Vulcan Project: Vulcan connects clinical research and patient care, focusing on standardized data exchange and improving clinical trial outcomes.
- Ethical concerns include bias, interoperability, and the balance of risk and reward in AI applications in healthcare.
- AI developers should ensure transparency and establish guidelines for monitoring bias in algorithms to promote equity.
- Strategies include partnering with equity organizations, ensuring accessibility, and prioritizing tools that address health gaps.
Cybersecurity
Proactive and Reactive Strategies to Minimize Data Disruptions in Healthcare
- The presentation discusses strategies to minimize data disruptions in healthcare through proactive and reactive governance measures.
- Challenge of Healthcare Data
- American hospitals generate an average of 2600 terabytes of data daily.
- 98% of healthcare leaders prioritize improving data quality to achieve organizational goals.
- Poor-quality data affects various areas, including scheduling, EHR, enrollment, and claims.
- Proactive and Reactive Strategies
- Proactive measures include planning, preventing issues, and understanding data needs.
- Reactive measures focus on detecting problems, containing issues, and restoring data integrity.
- Strategies include automating tasks, clear documentation, and defining expected input/output.
- Opportunities for Generative AI
- Generative AI can assist in anomaly detection and validating data accuracy.
- It can fill in missing data and promote consistency across systems.
- The effectiveness of AI depends on the quality of training data.
On February 20, Facktor and Associates hosted a webinar, Strengthening Financial Foundations: Resilience Strategies for Health Centers. Webinar objectives were to share key strategies for navigating financial uncertainty, communicating effectively, and preparing for potential funding changes. Strategies and resources were provided for navigating financial challenges and diversifying revenue streams, fostering strong collaboration between finance and operations teams, managing and adapting to change, and communicating effectively and retaining staff in times of uncertainty.
Webinar Questions & Answers:
Q: In this case, would the center (in scenario planning example) need to budget for upfront increased costs to boost capacity to welcome in more of the previously unserved Medicaid? One of the assumptions was that Good Deeds was already at capacity?
A: The assumption in the scenario we shared is that patient volume did not change (they were at capacity) but payer mix changed, so no additional operating costs were incurred. There may be a budget needed to boost outreach to Medicaid eligible patients. And, the health center should determine if they can increase staffing/capacity as a result of any increased demand.
Q: Prediction question: Many states and counties discontinued or decreased their uninsured programs or like in California moved CHIP, emergency medicaid and other programs into Medicaid. Do you think there will be time to get these programs back at the State and County level?
A: States will be facing similar budget constraints with a possibly lower federal match, so the biggest barrier could be cost, in addition to time, to preserve programs for the uninsured. For a good rundown of all the potential Medicaid changes, please see this excellent Health Affairs article by Sara Rosenbaum and Alison Barkoff, trusted colleagues in the health center movement.
Q: Any updates on 340B programs changes?
A: Your primary care association is your best and most current source of information on 340B program changes and the status of the proposed 340B legislation. We recognize that 340B has been targeted as a revenue-generator that enables health centers to provide services (e.g. gender affirming care) that are out of alignment with a new Administration's policies. For now health centers should be sure to recertify for 340B before the deadline of Monday March 10. As of today, about 40% of health centers (e.g. 96 in California) have not re-certified yet.
Additional Q&A from the Webinar can be found in the healthpod forum. Sign up today at: www.healthpod.co
*New MGMA Memo Increased Immigration Enforcement: Implications for Medical Group Practices
Health Care Providers and Immigration Enforcement: Know Your Rights, Know Your Patient's Rights: Updated December 2024 and includes suggested actions for health care providers.
Department of Homeland Security's "Sensitive Locations" Policies: The new administration has revoked these policies in a statement from the Department for Homeland Security that you can access here: Statement from a DHS Spokesperson on Directives Expanding Law Enforcement and Ending the Abuse of Humanitarian Parole.
Guidance for Staff: If Federal Immigration Agents Visit a Public Health Site - This presentation is for King County but includes a good example of training for health center staff. Topics include:
- Warrants
- Private Areas
- Role Specific Tasks (front desk staff, providers etc.)
Immigration Enforcement Guidance to Nonprofits from the Lawyers Alliance of New York and New York Lawyers for the Public Interest dated 12/23/2024
Printable "Red Cards" which review constitutional rights:
NACHC Summary Resources:
Medicare - Two Changes to Care Coordination Coding eff 1-1-25
Vironix Health Presentation (more detail re: new Advanced Primary Care Management, Digital Mental Health Treatment, and Remote Patient Monitoring)
340B Consultants Factsheet on Medicare PrEP Coverage
CMS 'Mental Health Visits via Telecommunications for RHCs and FQHCs' mln matters
You can review the full Medicare Physician Fee Schedule here: CY25 Medicare Physician Fee Schedule
Each of these are PowerPoint presentations, and you should see any available notes for each slide. If not, adjust the setting in the lower right hand corner to see notes. I have consolidated the slides so that they contain the most pertinent information, but feel free to let me know if you'd like the full slide deck.
AI Slides from Partner and MGMA Conferences
Clinician Well Being from MGMA
Culture of Accountability from MGMA
Cybersecurity from NACHC (also shared with IT listserv)
Developing Physician Leaders MGMA
IT Vendor Contract Negotiations MGMA (also shared with IT listserv) This is just a couple of slides with areas that are open to negotiation in vendor contracts.
Provider Recruitment and Retention MGMA
I'm also adding the KY Telehealth Consortium partner, HealthConnect Networks, presntation from the December Board meeting:
2023 MGMA Better Performers Report
This MGMA Keys to Medical Practice Excellence Report provides benchmarks for AR, practice revenue and expenses, staffing, physician compensation, and practice operations.
MGMA provides this information on benchmarking: MGMA polls from 2019 showed that most healthcare leaders have used benchmarking data to improve their operations (84%) and address business issues (82%) in areas such as productivity, financials, human resources and patient access. Although healthcare leaders are using benchmarking to improve their operations, it might come as a surprise that they aren’t doing so more often.
A Dec. 12, 2023 MGMA Stat poll found that most medical group leaders (41%) benchmark their organization’s data versus external data annually, compared to nearly one in four (24%) who are benchmarking at least monthly and another 15% benchmarking quarterly. Another 15% noted they never benchmark versus external sources, and 4% responded “other” — most of whom noted they benchmark every two to three years. The poll had 332 applicable responses.
WHY BENCHMARK? Benchmarking is crucial in helping healthcare leaders make optimal strategic choices, reducing risk in decision-making and justifying their actions or inactions. In other words, “If you don’t measure it, you can’t manage it. If you don’t value it, you won’t change it.”
Benchmarking facilitates organizational growth and development by improving operations, boosting efficiency, and reducing operating costs. It also enables leaders to compare with competitors across multiple metrics, identify and adopt effective practices from high-performing organizations and eliminate unnecessary costs by streamlining positions, activities, policies and procedures that were previously ineffective.
Top-performing medical groups (such as those identified in the MGMA DataDive Better Performers data set) reach their goals because they “transform data into action” and implement best practices based on key performance indicators (KPIs) and benchmarking against other medical groups. Better Performers review their benchmarking data regularly — every month, according to a 2022 interview with Martin Shehan.
Consistent, continual benchmarking can help organizations see the forest through the trees — showing change and consistency over time within individual practices, larger medical groups and entire specialties.
Telehealth
- Continued payment for telehealth furnished by FQHCs as allowed during PHE though December 31, 2024. This includes payment for audio only telehealth services.
- Delay of in person requirements for mental health visits until January 1, 2025.
- CMS will continue to allow providers to list their work addresses on their Medicare enrollment form while billing telehealth services from their home until December 31, 2024.
Providers
- Licensed Marriage and Family Therapists (LMFTs) and Licensed Mental Health Counselors (LMHCS) are included as distant site practitioners for purposes telehealth. They are added to the list of core Medicare FQHC clinicians and will generate a billable (PPS) visit.
- Addiction counselors who meet the requirements of MFCs are eligible to enroll as Medicare providers.
- The change in provider applies to Medicare and Medicaid.
- Nurse Practitioners are no longer required to have primary care certification to work in an FQHC.
G0511 Final billing amount: $72.98
Remote Patient Monitoring/ Remote Therapeutic Monitoring
- FQHCs will be able to bill for RPM/RTM under the general management HCPCS code G0511.
- Monitoring must occur over a minimum of 16 days over a 30-day period (reported only once during a 30-day period and only one practitioner can bill CPT codes 99453 and 99454 or CPT codes 98976, 98977, 98980 and 98981 during a 30-day period). This does not apply to treatment management codes.
- Practitioners can bill RPM or RTM concurrently with Chronic Care Management (CCM), Transitional Care Management (TCM), Behavioral Health Integration (BHI), Principal Care Management (PCM), and Chronic Pain Management (CPM), but not both RPM and RTM.
- If a patient receives RPM and RTM together and multiple devices are used:
- Services associated with all the medical devices can be billed by only one practitioner or provider only once per patient, per 30-day period,
- Only when at least 16 days of data have been collected, and
- The services must be reasonable and necessary
- May only be furnished to established patients
- Consider patients who received RPM only through the PHE as established patients.
Community Health Integration (CHI)
- CHI services performed by certified or trained auxiliary personally (including CHWs), incident to the professional services under the general supervision of the billing practitioner in the bundle G0511 code will be covered.
- A CHI visit must follow an initiating E/M visit in which the practitioner identifies the presence of SDOH needs that significantly limit the practitioner’s ability to diagnose or treat the problems addressed in the visit.
- Requires patient consent prior to providing CHI services (can be obtained verbally if documented in record, or a written – cost share may apply).
- Two codes:
- G0019 (main code): 60 minutes/month
- G0022: additional 30 minutes
- No frequency limitation for G0022
Principle Illness Navigation (PIN) Services
- Certified or trained auxiliary personnel under the direction of a billing practitioner (general supervision), which may include a patient navigator or certified peer specialist provide navigation as part of the treatment plan for serious, provide services to patients with a high-risk disease expected to last at least 3 months that places the patient at significant risk of hospitalization or nursing home placement, acute exacerbation or decompensation, functional decline or death.
- Must follow E/M visit by billing practitioner.
- Requires patient consent prior to providing PIN services (can be obtained verbally if documented in record, or a written – cost share may apply).
- PIN is added to general care management code G0511
- G0023 – 60 minutes/month
- G0024 – additional 30 minutes
Chronic Care Management
- Informed consent must be received prior to start of the services
- Consent can be obtained verbally if documented and includes notification of the required services and can be collected while CCM is initiated by auxiliary staff.
SDOH Health Risk Assessment in the Annual Medicare Wellness Visit
- Risk assessment is added as an optional element of the AWV
- Tool used for the risk assessment must be standardized, evidence-based (ex: PRAPARE)
- There is no additional payment for this screening as part of the AWV unless provided through telehealth (bill with telehealth service)
- When SDOH assessment is furnished with another qualifying visit (non-AWV) on the same day in an FQHC, only the visit will be paid under the FQHC PPS, and coinsurance will be applicable to the patient.
- More guidance is coming for furnishing SDOH screening outside of AWV.
- While CMS has created a G-Code for SDOH Health Risk Assessment that is a standalone code, this code is not applicable for FQHCs.
You can download a copy of this information here: 2024 Medicare Physician Fee Schedule Quick Reference Guide
Below are resources from the Kentucky Voices for Health Conference - The slides include an update from Medicaid starting on Page 6 and details about CHW billing status on slide 18.
- Slides from the event
- Annual Meeting Agenda
- KVH's 2024 Legislative Priorities
- Medicaid in Crisis and Recovery Snapshot
- KY Statewide CHFS Impact Report 2022 & all counties
- Serious Mental Illness (SMI) 1915i SPA/Waiver Town Halls:
- Monday, Dec. 11, 1-2:30 EST. St. Elizabeth Training Center (Banquet Room A): 3861 Olympic Blvd. Erlanger, KY 41018
- Wednesday, Dec. 13, 1-2:30pm EST. UofL Mary & Elizabeth Hospital (Assembly Room): 1850 Bluegrass Ave. Louisville, KY 40215. Virtual session available at bit.ly/KY1915iSPADec13Session
- Thursday, Dec. 14th, 1-2:30pm CST. Daviess County Fiscal Court (Second Floor) 212 St. Ann St. Owensboro, KY 42303
- KVH's SMI Waiver Video
Upcoming Events:
- ThriveKY Virtual Roadshow - 12/15/23 1-3pm. Register here
- Dr. Schuster's Advocacy 101 Training (zoom) - 1/8/24 11am-2pm. Register here
- ThriveKY January webinar - 1/22/24 2-3:30pm. Register here
- Health Literacy For The Win! training (zoom) - 1/23/24 10am-11am. Register here
- ThriveKY & CHFS February webinar - 2/12/24 2-3:30pm. Register here
- To stay up to date on KVH news and events, be sure to subscribe to KVH's newsletter.
KVH has handful of explainers compiled by KVH and our ThriveKY partners near the registration desk.
- Medicaid Renewals (English & Spanish)
- The Family Fix (English)
- CCAP (English & Spanish)
- Immunizations through the Lifespan (English & Spanish)
- KTAP (English & Spanish)
- Mental Health (English & Spanish)
- Non-Emergency Medical Transportation (English & Spanish)
- Special Enrollment Periods (English & Spanish)
- SNAP (English & Spanish)
- SNAP Work Reporting Requirements (English & Spanish)
The National Digital Inclusion Alliance recently hosted a webinar on advocacy and lobbying. This webinar presents in depth what counts as lobbying and how to appropriately track lobbying. While the NDIA's focus is on digital inclusion, the resources shared apply to all 501c3 non profits. I highly recommend checking out the "Lobbying Flowchart".
A recording of the webinar can be found here, using the password: 11/7NDIA. This training will be available until February 6th, 2024.
A PDF of the presentation is attached. In addition, below is a list of resources that Sarah thinks you will find helpful after the training:
- Public Charities Can Lobby: Guidelines for 501(c)(3) Public Charities
- Bolder Advocacy’s Practical Guidance – What Nonprofits Need to Know About Lobbying
- Being a Player: A Guide to the IRS Lobbying Regulations for Advocacy Charities
- Lobbying Flowchart
These episodes from Rules of the Game: the Bolder Advocacy Podcast can also be helpful:
