This document outlines the structure and terms for outsourcing the operations and management of community health centers in Uttarakhand, India to private partners through a public-private partnership model. Key aspects include a 10-year concession period, provision of capital grants for equipment purchases, monthly operating grants, responsibilities of the private partner for clinical services, staffing, maintenance and more. Performance will be monitored based on key indicators like staff attendance and equipment downtime.
Aridis Pharmaceuticals is a late-stage clinical development company, leading the creation of transformative, first-in-class anti-infectives for life-threatening viral and bacterial respiratory infections. The company’s lead drug candidate for acute pneumonia met all endpoints for its phase 2 clinical trial and the Company is now preparing for a phase 3 study. Its pipeline of novel mechanism antibacterial and antivirals, sprung from its proprietary technology platforms, are designed to combat the growing public health threat of viral pandemics and antimicrobial resistant (AMR) bacteria. Its anti-toxin monoclonal antibody approach is a proven Mechanism of Action and has shown efficacy as a combination therapy in reducing acute pneumonia patients time in ICU as compared to the current standard of care, which is antibiotics. In addition to its phase 3 program, ARDS also has a phase 2 asset for the treatment of Bacteria HAP/VAP LPS 011. It also recently began enrolling for a phase 2 clinical trial for the treatment of Cystic Fibrosis patients with acute pneumonia, a program funded by the Cystic Fibrosis Foundation for $7.5 million. Importantly, ARDS is also preparing to launch a Phase 1/2 clinical trial in the second half of 2021 with its novel inhalation antibody technology for emerging COVID-19 mutated variants. The expansion of COVID virus strain coverage, combined with the product's self-administered, at-home treatment modality, further differentiates the company's AR-712 COVID treatment offering.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
Implementation of a Perioperative Surgical Home (PSH)Wellbe
The PSH is a patient-centered, physician-led system of coordinated care that guides patients through the entire surgical experience. From the decision for surgery to 30-90 days post discharge from a medical facility, the PSH model of care is re-engineered to improve patient care and outcomes while decreasing total cost. Learn how your physicians can earn financial incentives from both the PSH and the new CMS requirements for Alternative Payment Models (APMs).
What does SGR Reform and PSH have in common? Dr. Mike Schweitzer, a national leader in PSH, will show you how physicians can leverage a PSH to meet the new APM requirements. The Medicare Access and CHIP Reauthorization Act (MACRA) replaces SGR with a new performance-based payment system and financial incentives for participation in alternative payment models. The law requires that major changes occur by January 1, 2017 – the measurement year for penalties and rewards in 2019. Dr. Schweitzer will describe how to develop a PSH program in your organization. He will share strategies to engage physician leaders to prepare for MACRA or Value Based Payments through PSH.
This webinar will enable you to:
- Identify the burning platform for a PSH
- Define the elements of a PSH
- Outline the infrastructure needed to implement a PSH
- Build and sustain the metrics to support a PSH
- Learn how to engage physician champions
About the Speaker:
Dr. Mike Schweitzer is the Vice President of Healthcare Delivery Transformation at VHA Southeast in Tampa, FL. Mike is also the Medical Director guiding the ASA-sponsored Perioperative Surgical Home Collaborative involving 44 healthcare organizations across the nation. Dr. Schweitzer is a nationally recognized speaker and has published many articles on the Perioperative Surgical Home.
Dr. Schweitzer previously served as the Chief Medical Officer for Northeast Baptist Hospital in San Antonio, TX where he was involved in the CMS Pilot for Acute Care Episodes, ACO development, and co-management programs.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Using the Perioperative Surgical Home as a Model to Implement CJRWellbe
Watch the webinar on youtube: https://youtu.be/rNaU_P2mHXE
The transition to value-based care models has increased pressure to deliver high quality and cost effective care. The medical home concept has gained traction in the primary care setting, and now, the perioperative surgical home has the potential to improve patient satisfaction, outcomes, and cost-effectiveness in the acute setting.
Dr. Zeev Kain, Chancellor’s Professor of Anesthesiology and former Associate Dean of Clinical Operations at University of California at Irvine Health, will share challenges and lessons learned implementing their Joint Replacement Surgical Home to provide more coordinated, standardized care.
What you’ll learn:
– An overview of the Perioperative Surgical Home model, and how it can improve outcomes while reducing cost
– Lessons learned from UC Irvine’s implementation of a Joint Replacement Surgical Home
– Considerations for implementing a Perioperative Surgical Home in your organization
About the Speaker:
Zeev N. Kain is a Chancellor’s Professor of Anesthesiology & Pediatrics & Psychiatry and the Chair of the Department of Anesthesiology & Perioperative Care at UC Irvine Health. Dr. Kain completed residency training in Pediatrics and Anesthesiology, a fellowship in Pediatric Anesthesia and was received an MBA from Columbia University. After 19 years at Yale University he joined UC Irvine Health in 2008. Dr. Kain has had continuous NIH funding since 1996 and had published over 200 publications in the peer-reviewed literature. His main research focus was stress in children undergoing surgery and invasive procedures.
Dr. Kain established the annual summit on the Perioperative Surgical Home and is a member of the steering committee of a 43 hospital collaborative on this topic. His training in Lean Six Sigma and his MBA and his management background have enabled him to embark on the quest to make the Perioperative Surgical Home ubiquitous at UC Irvine Health and to help bring this care model to institutions nationally.
Aridis Pharmaceuticals is a late-stage clinical development company, leading the creation of transformative, first-in-class anti-infectives for life-threatening viral and bacterial respiratory infections. The company’s lead drug candidate for acute pneumonia met all endpoints for its phase 2 clinical trial and the Company is now preparing for a phase 3 study. Its pipeline of novel mechanism antibacterial and antivirals, sprung from its proprietary technology platforms, are designed to combat the growing public health threat of viral pandemics and antimicrobial resistant (AMR) bacteria. Its anti-toxin monoclonal antibody approach is a proven Mechanism of Action and has shown efficacy as a combination therapy in reducing acute pneumonia patients time in ICU as compared to the current standard of care, which is antibiotics. In addition to its phase 3 program, ARDS also has a phase 2 asset for the treatment of Bacteria HAP/VAP LPS 011. It also recently began enrolling for a phase 2 clinical trial for the treatment of Cystic Fibrosis patients with acute pneumonia, a program funded by the Cystic Fibrosis Foundation for $7.5 million. Importantly, ARDS is also preparing to launch a Phase 1/2 clinical trial in the second half of 2021 with its novel inhalation antibody technology for emerging COVID-19 mutated variants. The expansion of COVID virus strain coverage, combined with the product's self-administered, at-home treatment modality, further differentiates the company's AR-712 COVID treatment offering.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
Implementation of a Perioperative Surgical Home (PSH)Wellbe
The PSH is a patient-centered, physician-led system of coordinated care that guides patients through the entire surgical experience. From the decision for surgery to 30-90 days post discharge from a medical facility, the PSH model of care is re-engineered to improve patient care and outcomes while decreasing total cost. Learn how your physicians can earn financial incentives from both the PSH and the new CMS requirements for Alternative Payment Models (APMs).
What does SGR Reform and PSH have in common? Dr. Mike Schweitzer, a national leader in PSH, will show you how physicians can leverage a PSH to meet the new APM requirements. The Medicare Access and CHIP Reauthorization Act (MACRA) replaces SGR with a new performance-based payment system and financial incentives for participation in alternative payment models. The law requires that major changes occur by January 1, 2017 – the measurement year for penalties and rewards in 2019. Dr. Schweitzer will describe how to develop a PSH program in your organization. He will share strategies to engage physician leaders to prepare for MACRA or Value Based Payments through PSH.
This webinar will enable you to:
- Identify the burning platform for a PSH
- Define the elements of a PSH
- Outline the infrastructure needed to implement a PSH
- Build and sustain the metrics to support a PSH
- Learn how to engage physician champions
About the Speaker:
Dr. Mike Schweitzer is the Vice President of Healthcare Delivery Transformation at VHA Southeast in Tampa, FL. Mike is also the Medical Director guiding the ASA-sponsored Perioperative Surgical Home Collaborative involving 44 healthcare organizations across the nation. Dr. Schweitzer is a nationally recognized speaker and has published many articles on the Perioperative Surgical Home.
Dr. Schweitzer previously served as the Chief Medical Officer for Northeast Baptist Hospital in San Antonio, TX where he was involved in the CMS Pilot for Acute Care Episodes, ACO development, and co-management programs.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Using the Perioperative Surgical Home as a Model to Implement CJRWellbe
Watch the webinar on youtube: https://youtu.be/rNaU_P2mHXE
The transition to value-based care models has increased pressure to deliver high quality and cost effective care. The medical home concept has gained traction in the primary care setting, and now, the perioperative surgical home has the potential to improve patient satisfaction, outcomes, and cost-effectiveness in the acute setting.
Dr. Zeev Kain, Chancellor’s Professor of Anesthesiology and former Associate Dean of Clinical Operations at University of California at Irvine Health, will share challenges and lessons learned implementing their Joint Replacement Surgical Home to provide more coordinated, standardized care.
What you’ll learn:
– An overview of the Perioperative Surgical Home model, and how it can improve outcomes while reducing cost
– Lessons learned from UC Irvine’s implementation of a Joint Replacement Surgical Home
– Considerations for implementing a Perioperative Surgical Home in your organization
About the Speaker:
Zeev N. Kain is a Chancellor’s Professor of Anesthesiology & Pediatrics & Psychiatry and the Chair of the Department of Anesthesiology & Perioperative Care at UC Irvine Health. Dr. Kain completed residency training in Pediatrics and Anesthesiology, a fellowship in Pediatric Anesthesia and was received an MBA from Columbia University. After 19 years at Yale University he joined UC Irvine Health in 2008. Dr. Kain has had continuous NIH funding since 1996 and had published over 200 publications in the peer-reviewed literature. His main research focus was stress in children undergoing surgery and invasive procedures.
Dr. Kain established the annual summit on the Perioperative Surgical Home and is a member of the steering committee of a 43 hospital collaborative on this topic. His training in Lean Six Sigma and his MBA and his management background have enabled him to embark on the quest to make the Perioperative Surgical Home ubiquitous at UC Irvine Health and to help bring this care model to institutions nationally.
ICD-10 Transition Presentation: What Health Lawyers Need to KnowPYA, P.C.
PYA Consulting Principal Denise Hall, along with co-presenter Julie Chicoine, recently updated health lawyers about ICD-10 transition readiness at the American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, held March 26-27, 2014.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
Coordination of Benefits and its implications to Health PlansCitiusTech
Coordination of Benefits (COB) allows plans that provide health and/or prescription coverage with Medicare to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). Member’s primary plan has the responsibility of paying claims first, followed by coverage by remaining plans. This process of splitting the costs across multiple coverage is called COB. This document introduces COB and how health plans and members benefit through COB regulations.
ICD-10 Transition: What Health Lawyers Need to KnowPYA, P.C.
PYA Principal Denise Hall, along with Senior Corporate Counsel Julie Chicoine of Ohio State University Wexner Medical Center, presented “ICD-10 Transition: What Health Lawyers Need to Know” at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues.
The Uncertain Future of Medicare Add-Ons and Pass-ThroughsBESLER
With so many changes resulting from the Patient Protection and Affordable Care Act (ACA) and other potential initiatives under consideration, a significant amount of your organization’s future Medicare revenue may be at risk. The trend to reduce and/or revamp payment methodologies comes at a time when hospitals face shrinking or non-existent margins. Revenue sources potentially on the chopping block include Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and transplant, to name a few. Additionally, the Office of Inspector General (OIG) continues to add reimbursement-related topics to its annual Work Plan, expanding the areas for potential paybacks or penalties.
Uncertain future of medicare pass throughs and add-onsBESLER
Very few items are still settled on your cost report. With so many changes resulting from the ACA and other potential initiatives being discussed every day, your organization should be acutely aware of the total amount of Medicare Revenue that is at risk. There is talk of eliminating, greatly reducing or completely altering payment methodologies that hospitals have become so reliant on for so long. Revenue potentially at risk includes Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and Transplant.
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact ...marcus evans Network
Troy Trosclair, HCA MidAmerica Division - Speaker at the marcus evans National Healthcare CNO Summit, held in Hollywood, FL, April 26-28, 2012, delivered his presentation entitled The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
Medicare reimburses acute care hospitals under the inpatient prospective payment system or (IPPS). The slide presentation below provides an overview of IPPS including exemptions, prospective vs. hospital specific components, and reimbursement methodologies.
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
ICD-10 Transition Presentation: What Health Lawyers Need to KnowPYA, P.C.
PYA Consulting Principal Denise Hall, along with co-presenter Julie Chicoine, recently updated health lawyers about ICD-10 transition readiness at the American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, held March 26-27, 2014.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
Coordination of Benefits and its implications to Health PlansCitiusTech
Coordination of Benefits (COB) allows plans that provide health and/or prescription coverage with Medicare to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). Member’s primary plan has the responsibility of paying claims first, followed by coverage by remaining plans. This process of splitting the costs across multiple coverage is called COB. This document introduces COB and how health plans and members benefit through COB regulations.
ICD-10 Transition: What Health Lawyers Need to KnowPYA, P.C.
PYA Principal Denise Hall, along with Senior Corporate Counsel Julie Chicoine of Ohio State University Wexner Medical Center, presented “ICD-10 Transition: What Health Lawyers Need to Know” at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues.
The Uncertain Future of Medicare Add-Ons and Pass-ThroughsBESLER
With so many changes resulting from the Patient Protection and Affordable Care Act (ACA) and other potential initiatives under consideration, a significant amount of your organization’s future Medicare revenue may be at risk. The trend to reduce and/or revamp payment methodologies comes at a time when hospitals face shrinking or non-existent margins. Revenue sources potentially on the chopping block include Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and transplant, to name a few. Additionally, the Office of Inspector General (OIG) continues to add reimbursement-related topics to its annual Work Plan, expanding the areas for potential paybacks or penalties.
Uncertain future of medicare pass throughs and add-onsBESLER
Very few items are still settled on your cost report. With so many changes resulting from the ACA and other potential initiatives being discussed every day, your organization should be acutely aware of the total amount of Medicare Revenue that is at risk. There is talk of eliminating, greatly reducing or completely altering payment methodologies that hospitals have become so reliant on for so long. Revenue potentially at risk includes Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and Transplant.
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact ...marcus evans Network
Troy Trosclair, HCA MidAmerica Division - Speaker at the marcus evans National Healthcare CNO Summit, held in Hollywood, FL, April 26-28, 2012, delivered his presentation entitled The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
Medicare reimburses acute care hospitals under the inpatient prospective payment system or (IPPS). The slide presentation below provides an overview of IPPS including exemptions, prospective vs. hospital specific components, and reimbursement methodologies.
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Анализ чувствительности вариаций модели оценки эффективностиAnatoly Simkin
Описание результатов проведенного анализа чувствительности разработанных моделей оценки эффективности деятельности национальных исследовательских университетов. Проведенный анализ определил объективный и соответсвующий требованиям вариант модели рейтинга вузов.
Description of the results of the sensitivity analysis of the developed models performance evaluation national research universities. The analysis identified the objective requirements and the correct version of the model ranking of universities.
The system of flexible automation of Web StoresAnatoly Simkin
This presentation was presented at the MIPT english class under the theme "Sales presentation". It is a translation of the presentation for competition “Egghead”. This theme is dedicated to the design of the modern approach, called "compliance management", which provides a flexible description of business processes at the user level.
På Randstad arbetar vi varje dag med att läsa en mängd cv:n och vi vet både vad ett bra cv ska innehålla och vad det inte ska innehålla. Här får du en checklista att följa när du ska skriva ett konkurrenskraftigt cv.
Insurance new business process diagramabhinayverma
This slide gives a high level overview of the New Business Acquisition process for Insurance companies. Exact process may vary based on firm, line of business etc. but at a high level, this process overview should suffice.
As health centers strive to provide high quality comprehensive care, whether by contract or MOU
arrangement, each document type must contain certain provisions in order to be compliant with the HRSA
Compliance Manual and Site Visit Protocol (SVP). This webinar will provide participants with a non-legal perspective on contracts and MOUs, identify “must haves” within contracts, and finally identify best practices to assist with maintaining compliance.
How Israel reimburses hospitals based on activity: the Procedure-Related Grou...OECD Governance
This presentation was made by Ruth Waitzberg, Israel, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
2023 — Focus on the Margin (Vitalware by Health Catalyst)Health Catalyst
In this webinar, we will look at pressures exerted in 2023 on the margin and explore how cost management and complete charge capture can protect and enhance the margin. We will provide details on patient activity costing versus the cost-to-charge ratio (CCR), looking at common themes for lost charges and providing an example of where patient activity cost management was able to provide insight into cost containment and practice patterns of a system provider.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Chc in ppp mode general presentation
1. Operations & Management of
Community Health Centres
under PPP Mode
Community health Centers & District Hospitals
outsourced in public private partnership
2. Project Structure
S No Particulars Description
1 Project Owner Department of Medical Health & Family Welfare
2 PPP Model Operation & Maintenance
3 Number of CHCs a) Minimum Number of CHC’s outsourced should be 4
4
Concession
Period
10 years
5
Financial Grant
by The
Government
a) Capital Grant for equipments above Rs 5.00 Lakhs
on one time basis
b) For any subsequent purchase of more than Rs. 2.00
lakh, 100% Grant subject to approval by DOMH&FW
c) Operating Grant : Fixed Plus Variable
6
Identified
Services
a) Diagnostics : X-ray, ultrasound, ECG & Pathology
b) Maternity cases
c) Surgeries /Orthopedic
d) Minor Injuries
e) In Patient Services
7
Monitoring
Arrangement
a) Expert Committee like PwC or E&Y etc.
3. Clinical Staff
Sr.
No.
Clinical Staff Number
1 General surgeon 1
2 Physician 1
3 Obstetrician & Gynaecologist 1
4 Paediatrician 1
5 Radiologist 1
6 Orthopaedic 1
7 ENT surgeon 1
8 Anaesthetist 1
9 Eye surgeon (1 for every CHC) 1
10 Dental surgeon 1
11 General duty medical officer 2
12 Staff Nurse 10
13 Maternity assistant (ANM) 2
14 Total 24
4. Scope of Private Partner
Clinical Services (defined in next page)
Upgrade the facility and manage the same as per the prescribed
standards of Indian Public Health System (IPHS)
Add specialized services / beds for procedures over and above existing
scope as prescribed by the DoMH&FW from time to time
Recruit, retain and manage qualified and experienced medical human
resource
IT-based Management Information Systems to manage the hospitals and
inventory.
Maintenance of all movable and immovable assets of the hospital
Abide by the existing Government laws/ rules and policies
Undertake all statutory responsibilities
Timings - OPD (8.00 AM to 4.00 PM) and Diagnostic (8.00 AM to 8.00 PM).
Emergency 24 X 7
5. Identified Services for PPP Partner
Clinical Services : OPD , IPD, emergency, drug dispensing, diagnostic
(identified radiology and pathology, CT scan etc) maternity cases,
surgeries, Orthopaedic surgeries, replacements, etc.
Catering & Dietary and Linen & Laundry
Hospital Waste Management, Pest Control and Sterilisation Services
Clinical Record Keeping, Security, Patient discharge process
Minor Repairs
Out of Scope for Private Partner
Medico legal cases
Promotion and management of Government health schemes
Ambulance services
Collection of user charges
Major Repairs due to ageing and natural disaster
6. GRANT STRUCTURE EITHER THROUGH FINANCIAL BID
PARAMETER OR ON UTTRAKHAND GOVT RATES
User Charges to be collected by Chikitsa Prabandhan Samiti at
Government Rates
The O&M expenses categorized into
Fixed (Hospital Management, Housekeeping, In patients Human
Resources, financing charges etc) and
Variable based on Diagnostic Procedures, Maternity Cases, Surgeries,
Orthopedic surgeries etc
Government Grant towards Fixed (monthly based on area) and Variable
(based on actual services rendered)
Demand risk is transferred to PPP Partner and Operating Risk is shared
7. Selection Process of PPP Partner
OPTION 1: One stage-two bid process :
Technical
Financial
Basis to evaluate Technical Experience
Number of years of experience in managing similar facilities
Size of facilities managed (based on cumulative number of beds)
Number of Maternity Cases handled (since there are significant
number of maternity cases in CHC’s : 4-6 per day)
Experience of managing multi locations (based on number of centres
managing)
OPTION 2: Nomination basis based on Uttrakhand price bid :
TIRAL OPERATIONS FOR 5 YEARS, IF SUCESSFUL THEN TENDER
8. Financial Bid
Revenue Grant
2 VARIABLE GRANT (actual services rendered)
a) Diagnostic Per procedure as per existing Govt rates or RSBY rates
b) Maternity
Cases/Surgeries
Per procedure as per existing Govt rates or RSBY rates
c) Accidental Cases Per procedure as per existing Govt rates or RSBY rates
2) FIXED MONTHLY GRANT (towards housekeeping, hospital
management, human resources, finance charges etc)
a) Fixed Grant Rs per sq mtr of built up area per month
Present Value of Total Grant = Variable (per procedure bid amount
converted into annual grant based on projected number of procedures) +
Fixed Grant
9. Capital Grant (not part of Financial Bid)
This would be mutually agreed based on “actual equipment gap”
To fulfill “gap” in capital equipment vis-a-vis Government standards
•Government will provide 100% Grant on all new equipments more than
Rs. 5.00 Lakhs on one time basis subject to approval by DOMH&FW
•For any subsequent purchase of more than Rs. 5.00 lakh the
Government will provide 100% Grant subject to approval by DOMH&FW
This would not include any non medical appliances, equipments,
consumables, instruments – measuring or otherwise, furniture,
software/hardware
The requirement, specification and cost of equipment would be
reviewed and verified by the Government
All such Procurements would be guided by Uttarakhand Procurement
Rules 2008
10. ALTERNATE PROCESS FOR OUTSOURCING IN PPP
RETRUN ON INVESTMENT OF THE GOVERNMENT
THE PPP PARTNER RETURNS THE ENTIRE EXPENDITURE WITHOUT INTEREST
INCURRED BY THE GOVERNMENT TO CREATE THE HOSPITAL INFRASTRCUTURE
REVENUE SHARING WITH THE GOVERNMENT
The Private Partner shares revenue with Government in the ratio of
70:30 for the period of ROI of the Government.
After the ROI of the Government is complete, the revenue sharing
becomes 30:70 with the government for a period of 10 years.
The Private Partner has no ownership claim of the hospital
The private Partner can charge only Government rates and RSBY
rates to the patients.
GOVERNMENT GRANT ONLY FOR LIMITED PERIOD
THE GOVERNMENT GIVES GRANT FOR A LIMITED PERIOD TILL THE HOSPITAL
BECOMES FINANCIALLY SELF SUSTAINED 1 YEAR AGAINST BG
11. Key Performance Indicators
Payment based on Key Performance Indicators
S. No KPI Explanation Calculation (in percentage)
KPI1 Attendance
of clinical
staff
Attendance of clinical staff is critical to
delivery of services. The Concessionaire is
encouraged to have proper staff management
plans to ensure that service delivery is not
affected due to planned/unplanned leaves,
replacements etc.
Total number of days the clinical staff
was absent in the quarter / (Total
number of days the centre was open in
the quarter X Total number of clinical
staff (As per Schedule 8))
KPI2 Availability
of critical
consumabl
es/reagent
s
This KPI captures whether proper inventory
management procedures are followed by the
Concessionaire to avoid instances where
service delivery is disrupted due to non-
availability or shortage of critical
consumables/kits/reagents.
Sum of total number of days of stock
out for each critical consumables that
has affected or disrupted service
delivery in a quarter / (Total number
of days the centre was open in the
quarter X Number of critical
consumables)
KPI3 Downtime
of critical
equipment
s
This KPI forces the Concessionaire to engage
the suppliers/OEMs in Service Level
Agreements SLAs and Asset Management
Contracts (AMCs) for maintenance and
servicing of equipments. Reducing equipment
down time increases equipment availability
which increases throughput.
Sum (cumulative value) of difference
in actual downtimes and benchmark
downtimes of the identified critical
equipments (highlighted in PIM) in a
quarter in cases when the actual
downtimes exceed the benchmarks /
Benchmark downtime for all
equipments in that quarter
12. Key Performance Indicators
Scoring Sheet and Payment
S.
No.
Average KPI Score (AKS) Percentage of total
reimbursement to be paid to
Concessionaire for the quarter
1 0 – 5 % 100%
2 6 – 10% 95 %
3 11 – 15% 85 %
4 16 – 20% 75 %
5 > 20 % 60 % (with show cause and
explanation)
13. Termination Payments on DOMH&FW Event of
Default
The Concessionaire shall be entitled to revoke the
Performance Security, if subsisting
14. Project Monitoring
Expert Committee
i. Representative of DOMH&FW not below the rank of Additional
Secretary
ii. Two super specialist doctors from hospital
iii. Representative from patient group – any one or two patients who
are undergoing treatment in this centre since last fifteen days or
their attendant.
iv. Representative of Concessionaire
• The expert committee shall evaluate project deliverables on a
3 monthly basis
