Updates from Washington & Key Strategies to Succeed

©2015
UPDATES FROM WASHINGTON
LHE HFMA Joint Event
April 21, 2017
St. Louis West
Cora Butler, JD,RN,CHC

THE CONTENT OF THIS PRESENTATION IS INTENDED FOR
EDUCATIONAL PURPOSES ONLY, NOT LEGAL ADVICE
OR THE INSIGHTS OF A CRYSTAL GAZER

AGENDA
Discuss what seems to be the current posture of the
Trump Administration and Republican Party leadership
relative to expected healthcare policy changes.
Identify key distinctions between the Affordable Care
Act (ACA aka ObamaCare) and the American Health
Care Act (AHCA aka TrumpCare).
Recognize key strategies for future success regardless
of changes to US healthcare policy and law.

Why Repeal?
The Republican Rationale

True Impact on employment: 2 million FTE will be out of
work force by 2025- Congressional Budget Office
Increased health care premiums by 25% in 2017-
New York Times
True 19.2 million taxpayers chose to pay a penalty/seek
exemption rather than enroll in ACA exchange- IRS
True Lack of options- ⅓ of US Counties have only 1
insurer- Time.com
True Individual Mandate- American taxpayers paid $3
billion for individual mandate penalties affecting 8 million
people in 2016- Investor’s Business Daily
True ACA cost Americans over $1 trillion in taxes-
Congressional Budget Office
Penalty for a family- Maximum $2085- Healthcare.gov
CLICK
HERE
Source: QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11,
2017, from https://housegop.leadpages.co/obamacare-fails-quiz/

Washington, What’s going on!
Glimpse of the Rollercoaster ride

Jan 12, ‘17 Jan 20, ‘17Nov 9, ‘16
’
Donald Trump wins the election
(304-227)
Senate voles allowing the repeal of the
ACA through the budget reconciliation
process; disallows a filibuster
Noon: Trump takes the Presidential
Oath of Office
2:00 pm: Trump signs the Executive
Order
‘Minimizing the Economic Burden of
the PPACA Pending Repeal’
Source: Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11, 2017, from
https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act

Mar 23, ‘17 Mar 24, ‘17Mar 6, ‘17
Scheduled vote for the GOP bill,
later postponed to March 24,2017
House Republicans publicly release
‘The American Health Care Act’
Introduced the ‘Phase One’ of the 3-
phase plan to repeat ACA
The AHCA bill was withdrawn- failure
to gain sufficient House Republican
support

Apr 4, ‘17 Apr 6, ‘17Mar 28, ‘17
House Speaker Paul Ryan- “still
moving
forward with health care” with no
scheduled timeline
House Speaker Paul Ryan-
“Proposal under conceptual stages”
Republicans add a new amendment to the
AHCA- ‘Federal Invisible Risk Sharing
Program’ adding $15 billion fund to help
insurers pay claims for the sickest
customers

Apr 24, ‘17 FutureApr 7, ‘17
WHO (Donald Trump) picks up the healthcare policy ball
and throws it to WHAT (Paul Ryan).
WHAT throws it to I DON’T KNOW (House Republicans)
and
I DON”T KNOW (House Republicans) throws it to Spring
Recess
A bona fide triple play!

#RepealAndReplace
The American Health Care Act

AIMS
Dismantle the Obamacare taxes
Eliminate the individual and employer
mandate penalties
Prohibit health insurers from denying
coverage/charging more money
Help young adults access health
insurance and stabilize market place-
allow coverage until age 26
Modernize and strengthen
Medicaid- Transition to ‘per capita
allotment’
Establish a Patient and State Stability
Fund- provide states with $100 billion to
design programs that meet their unique
population
Empower individuals and families-
enhance and expand Health Savings
Accounts
Help access affordable, quality health
care- providing a monthly tax credit
between $2000 and $14,000
APPROACH
Step I- RECONCILIATION
The American Health Care Act:
Introduction of the Bill, Consideration
by the House, Pass legislation through
regular order
Step II- ADMINISTRATIVE
ACTION
HHS Secretary Tom Price will
deregulate the marketplace to stabilize
it, increase choices and lower costs
Step III- ADDITIONAL
LEGISLATION
Pass conservative-minded bills to
allow shopping across state lines,
medical liability reform, and more.
Source: Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/healthcare/#top

ACA vs AHCA
Differences & Similarities

ACA AHCA
Insurance Mandates Individual mandate
Employer mandate on larger
companies
No individual or employer mandate
Insurers can impose a one year 30%
surcharge on consumers with a lapse
in coverage
Aid for insurance
consumers
Income-based subsidies for
premiums that limit after-subsidy
cost to a percent of income
Tax credits for out-of-pocket
expenses
Age-based refundable tax credits for
premiums, phased out for higher
incomes
No tax credit for out-of-pocket
expenses
Medicaid Matching federal funds to states for
anyone who qualifies
Expanded eligibility to 138% of
poverty level income
Federal funds granted to states based
on a capped, per-capita basis starting
in 2020
States can choose to expand
Medicaid eligibility, but would
receive less federal support for those
additional persons
Premium age differences Insurers can charge older customers
up to three times as much as younger
customers
Insurers can charge older customers
up to five times as much as younger
customers
Health Savings Accounts Individuals can put $3,400 and
families can put $6,750 into a tax-
free health savings account
Individuals can put $6,550 and
families can put $13,100 into a tax-
free health savings account
Source: American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017

ACA AHCA
Cadillac tax Cadillac tax on high-cost employer
plans implemented in 2020
Cadillac tax on high-cost employer
plans implemented in 2025
Other taxes 3.8% tax on investment income
0.9% tax on individuals with an
income higher than $200,000 or
families with an income higher than
$250,000
Repeal of both taxes
Essential Health Benefits Insurers are required to offer ten
essential health benefits
Private plans are required to offer
the ten essential health benefits.
Some Medicaid plans are not
required to offer mental health and
substance abuse benefits
Pre- existing conditions Insurers are banned from denying coverage for pre-existing conditions
Dependents staying on
plan
Dependents can stay on health insurance plan until age 26
Annual and lifetime limits Insurers are prohibited from setting annual and lifetime limits on individual
coverage
Risk sharing Federal risk sharing program
Source: American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017

Congressional Budget Office
Estimates about AHCA

Federal Budget (2017-2026)
• Federal deficits: Reduce by $337 billion
• Outlays: Reduce by $1.2 trillion
• Revenues: Reduced by $0.9 trillion
Health Insurance Coverage
• 2018: 14 million more people would be uninsured due to penalty repeal
• 2020 to 2026: 21 million and 24 million respectively would be uninsured due to the
changes in subsidies for insurance purchased in the nongroup market and to Medicaid
program
• 2026: 52 million people would be uninsured compared to 28 million under ACA
Health Insurance Market: Key factors to maintain stability under AHCA
• Subsidies to purchase insurance: maintain sufficient demand for insurance by low
health care expenditures
• Grants to states from Patient and State Stability Fund: reduce the costs to insurers of
people with high health care expenditures
Source: American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486

Premiums
• 2018 and 2019: Average premiums for single policyholders in the non group market
would be 15-20 percent higher than under ACA
• 2020: increase in average premiums from repealing the individual mandate penalties
would be more than offset by the combination of grants to states from the Patient
and State Stability Fund, elimination of the requirement for insurers to offer plans
covering certain percentage of the cost of covered benefits, and a younger mix of
enrollees
• 2026: Average premiums for single policyholders in the non group market would be
10 percent lower than under ACA
• Although, changes in premiums relative to those under current law would differ
significantly for people of different ages because of a change in age-rating rules
Uncertainty
• Estimates are difficult to predict
• Depends on the ways in which federal agencies, states, insurers, employers,
individuals, doctors, hospitals, and other affected parties would respond to the
changes made by legislation
• These estimates are in the middle of the distribution of the potential outcomes, and
hence still uncertain
Source: American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486

Remarks: Republican Leaders
Before Vote, After AHCA Pulled

Donald Trump
President
Paul Ryan
House Speaker
Tom Price
DHHS Secretary
Seema Verma
CMS Administrator
“After seven horrible years
of ObamaCare (skyrocketing
premiums & deductibles, bad
healthcare), this is finally
your chance for a great
plan!”
March 24, 2017
“That’s called a death spiral.“-
talking about soaring premiums
and fewer choices under
Obamacare
“This is the closest we will ever
get to repealing and replacing
Obamacare. It really comes
down to a binary choice.”
March 9, 2017
“Coverage is not the
measuring stick we should
be using. What we should be
using is care.”
“ Obamacare just destroyed
the individual market. Don’t
listen to me, listen to the
insurers.”
March 17, 2017
“One-third of counties and five
states only have one choice of
health plan. And so that tells us
we are not getting the choices
that Americans deserve.”
“The other thing that concerns
me is hearing from providers.
Many providers are faced with
dealing with regulations and
mandates instead of focusing on
high-quality care and spending
time with their patients.”
March 22, 2017
Before Vote

Donald Trump
President
Paul Ryan
House Speaker
Tom Price
DHHS Secretary
Seema Verma
CMS Administrator
“If the Democrats — when it
explodes, which it will soon
— if they got together with
us and got a real health-care
bill, I’d be totally open to it,
and I think that’s going to
happen.”
March 27, 2017
“Talks on Repealing and
Replacing ObamaCare are,
and have been, going on, and
will continue until such time
as a deal is hopefully
struck.”
April 2, 2017
“We’re not going to just all of a
sudden abandon health care and
move on to the rest. We are
going to move on with rest of
our agenda, keep that on track,
while we work the health-care
problem. It’s just that valuable,
that important.”
March 27, 2017
After AHCA Pulled

Remarks: Democratic Leaders
Before Vote, After AHCA Pulled

Bernie Sanders
US Senator for Vermont
Nancy Pelosi
House Minority Leader
for California
Charles Schumer
US Senator for New York
“It is immoral. And it should not see
the light of day. Let’s be clear —
and I have no hesitation in saying
this — if this legislation is passed,
millions of people are thrown off of
health insurance, not able to get to a
doctor when they must. Thousands
of Americans will die. That’s what
this legislation is about.”
March 13, 2017
“Tonight, Republicans revealed a
Make America Sick Again bill
that hands billionaires a massive
new tax break while shifting huge
costs and burdens onto working
families across America.
Republicans will force tens of
millions of families to pay more
for worse coverage- and push
millions of Americans off of
health coverage entirely“
March 07, 2017
“Don't repeal the Affordable
Care Act and replace it with a
threadbare health insurance
plan that puts insurance
companies back in charge.
Keep the law and work with
Democrats on reasonable
fixes.“
February 27, 2017
Before Vote

Bernie Sanders
US Senator for Vermont
Nancy Pelosi
House Minority Leader
for California
Charles Schumer
US Senator for New York
“The defeat of the disastrous
Trump-Ryan health care bill is a
major victory for working families
and everyone who stood up in
opposition.”
"Nobody really cares that it's a
failure of Trump or a failure of
Ryan. What the American people
are asking is how does it happen
that we are the only major country
on Earth not to guarantee health
care to all people as a right?“
March 24, 2017
“Today is a great day for our
country, it's a victory -- what
happened on the floor is a victory
for the American people, for our
seniors, for people with
disabilities, for our children, for
our veterans”
March 24, 2017
“Ultimately the #Trumpcare bill failed
because of two traits that have plagued
the Trump presidency: incompetence &
broken promises.“
“They can’t get their story straight, and
today we’ve learned they can’t count
votes and they can’t close a deal.”
March 24, 2017
After AHCA Pulled

Reactions: Primary Care Physicians
On Introduction of AHCA

• Raju Patnam MD, Family Medicine, Greenville SC
“ It is not addressing tort reform, cost of medications or payments to PCPs”
• Vikki Stefans MD, Pediatrics, Little Rock AK
“We need to go single payer or we need the individual mandate that would have made the ACA
easily able to stand on its own two feet without skyrocketing premiums from some people.”
• Scott Helmers, MD, Family Medicine, Spirit Lake IA
“Trump-Ryan care is quite a step backward… If there is any value to Trump-Ryan care it will be
that in its crashing we may see the country move to single payer, national healthcare.”
• Jeffrey Kagan, MD, Internal Medicine, Newington CT
“ Providers who took in many Medicaid patients under the ACA will be left with deciding to
continue caring at a big discount or dumping them and then having many empty patient slots.”
• Sue Osborne, DO, Family Medicine, Floyd VA
“This is my simple request: whatever the reconstructionist design, they have the same healthcare
policy options, and pay the same premiums as the rest of us, with no exceptions for the wealthy
or the elected.”
Source: Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from
http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react-ahca?page=0%2C9

House Republicans- Renew efforts for repeal
Senate Republicans may take charge
May shift focus to non-ACA legislation
Potential administrative actions may include:
• Reduced enforcement of Individual Mandates
• Delay Cadillac tax
• Eliminate, delay or modify innovation models (e.g. Comprehensive Joint Replacement)
• Limit special enrollment period
• End cost- sharing reduction payments
• Narrow scope of essential health benefits
• Allow some Medicaid work requirements and premiums (1115 waivers)
• Eliminate contraception requirements
Resurrection mode is ON!
Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-
advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook

Medicare Access and CHIP Reauthorization
Act of 2015 (MACRA)
Strong bipartisan support
Delay would be tied to budgetary implications
Bending the Medicare cost curve is not a partisan issue
Move from FFS to value- based care
April 10, 2017
“I believe all options
should be on the table to
ensure MACRA is
implemented in a way that
benefits patients and
keeps providers—
particularly those in small
practices—in the
Medicare program.”
US Rep. Phil Roe, MD, (R-Tennessee)
Source: Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/physician-practice-
roundtable/members/expert-insights/2016/nine-faqs-on-provider-payment-under-macra

MACRA: Tracks & Scores
Source: Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options [SLIDESHOW]. Retrieved April 11, 2017, from
https://www.slideshare.net/MedisolvMarketing/the-basics-of-macra-and-2017-reporting-options-slideshow

Performance: The first performance period opens January 1, 2017 and closes December 31, 2017. During 2017,
record quality data and how you used technology to support your practice.
Send in performance data: To potentially earn a positive payment adjustment under MIPS, send in data about
the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In
order to earn the 5% incentive payment by significantly participating in an Advanced APM, just send quality data
through your Advanced APM.
Feedback: Medicare gives you feedback about your performance after you send your data.
Payment: You may earn a positive MIPS payment adjustment for 2019 if you submit 2017 data by March 31,
2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019.
MACRA: Reporting Timeline

MACRA: Payment Adjustments
Source: E. (2016, May 18). How MIPS, APMs Work Under MACRA to Improve Value-Based Care. Retrieved April 20, 2017, from
https://ehrintelligence.com/news/how-mips-apms-work-under-macra-to-improve-value-based-care

Anytime between January 1 and October
2, 2017. Whenever you choose to start,
you'll need to send in your performance
data by March 31, 2018. You can also
begin participating in an Advanced
APM.
The first payment adjustments based on
performance go into effect on January 1,
2019.
Not participating in the Quality Payment Program: If you don’t send
in any 2017 data, then you receive a negative 4% payment
adjustment in 2019.
On choosing the MIPS path, you have three options.
• Test: If you submit a minimum amount of 2017 data to Medicare (for
example, one quality measure or one improvement activity for any point in
2017), you can avoid a downward payment adjustment.
• Partial: If you submit 90 days of 2017 data to Medicare, you may earn a
neutral or positive payment adjustment.
• Full: If you submit a full year of 2017 data to Medicare, you may earn a
positive payment adjustment.
MACRA: When to start? Expected outcomes?
Source: MACRA. (n.d.). Retrieved April 20, 2017, from https://www.thenationalcouncil.org/macra/

Key Strategies
How can I succeed, no matter what changes!

Reduce cost
structure
Establish
sustainable
Medicare risk
strategy
Establish a
consumer
loyalty
platform
Elevate
Physician
network
performance
Adapt to New Market Realities
NOTE:
The success of these four
elements depend heavily on an
appropriate and scalable Health
IT platform

Raw Data
• Clinical systems
• Billing/Claims
• Patient generated
(e.g., wearables,
portals)
• External data (e.g.
social, financial)
BI Capabilities
• Data acquisition,
aggregation
• Coherent architecture
• Governance
• Tools, staff skills
• Culture,
organizational data
literacy
Goal Optimization
• Clinical outcomes
• Patient experience
• Referral performance
• Financial efficiency
• Regulatory metrics
• Market share
Cut down administrative
costs
Clinical Decision Support
(Evidence based)
Better Care Coordination
Improved patient wellness
Eliminate Fraud and Abuse
Risk
Performance based
referrals
Your data is your best friend!
Source:Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-it-
advisor/events/webconferences/2017/top-ten-health-it-challenges-for-2017/ondemand

NorthShore University Health System
Who
Identify patients at risk for hypertension and control risk of heart
attack and stroke
Why
Through a BI tool which:
How
• Linked practicing physicians with research and quality improvement- eliminate
undiagnosed/at risk hypertension patients
• Flagged patients for additional follow up through algorithms
Identified, tested and diagnosed more than 500 patients with
previously undiagnosed hypertension
Results
Success Story: Business Intelligence
Source:The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10, 2016.
http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf

Define goals for yourself and your practice
Collect performance standards relevant to the goals
Perform a gap analysis between the existing performance with
the goals/ benchmark with competitors
Use basic lean six sigma principles, root cause analysis, and
other similar methods to identify and reduce variation
Establish a continuous quality assurance and performance
improvement program to foster high quality in all areas of care
and services
Quality Assurance & Performance Improvement

Sample PI Tool: Readmissions Performance Tracking

Washington University Physicians at Barnes
Who
‘Percutaneous Intervention’- Improving outcomes
What
Tailoring the following to patient needs:
How
• Equipment
• Access- Brachial vs Femoral
• Dosage of Contrast Media
• Anti-coagulant type- Bivalrudin vs Heparin ($547 vs <$1.22-2009)
Impact seen on:
Results
• Patient Safety & Outcomes
• Costs
• Readmissions
Success Story: Performance Improvement
Source:Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral
Intervention: A Single-Center Experience. J Am Coll Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015.

Do not wait for the legislative
changes
Focus of your strategy should
be on accessibility,
affordability and reliability
Value based payment is here to
stay!
Plan NOW to win tomorrow
Key Takeaways

• QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11, 2017, from
https://housegop.leadpages.co/obamacare-fails-quiz
• Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11,
2017, from
https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act
• Bryan, B. (2017, March 29). House Republicans might take another swing at repealing Obamacare.
Retrieved April 11, 2017, from http://www.businessinsider.com/ahca-trumpcare-obamacare-replacement-
bill-2017-3
• Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from
https://housegop.leadpages.co/healthcare/#top
• American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from
https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017
• American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from
https://www.cbo.gov/publication/52486
• Dinan, S. (2017, March 09). Ryan works to save GOP’s Obamacare repeal. Retrieved April 11, 2017,
from http://www.washingtontimes.com/news/2017/mar/9/paul-ryan-works-save-gops-obamacare-repeal/
• Geraghty, J. (2017, March 17). Tom Price: The Benchmark for Success Is Care, Not Coverage. Retrieved
April 11, 2017, from http://www.nationalreview.com/corner/445880/hhs-secretary-tom-price-benchmark-
success-care-not-coverage
• Remarks by President Trump and Administrator Seema Verma in Women in Healthcare Panel Meeting.
(2017, March 22). Retrieved April 11, 2017, from https://www.whitehouse.gov/the-press-
office/2017/03/22/remarks-president-trump-and-administrator-seema-verma-women-healthcare
References

• DeBonis, M. (2017, March 27). Paul Ryan: House Republicans will continue their push for health-care
reform this year. Retrieved April 11, 2017, from https://www.washingtonpost.com/powerpost/paul-ryan-
house-republicans-will-continue-their-push-for-health-care-reform-this-year/2017/03/27/8e331e86-130c-
11e7-833c-503e1f6394c9_story.html?utm_term=.8af16aabf415
• Weigel, D. (2017, March 14). Sanders and Manchin, at opposite ends of Senate caucus, call ACA
replacement ‘immoral’. Retrieved April 11, 2017, from
https://www.washingtonpost.com/news/powerpost/wp/2017/03/14/sanders-and-manchin-at-opposite-
ends-of-senate-caucus-call-aca-replacement-immoral/?utm_term=.6bf6824b0c32
• Account, N. P. (2017, March 06). The GOP plan to #MakeAmericaSickAgain will do massive damage to
millions. https://t.co/r14nQmKHlI https://t.co/dQGtP9xcSK. Retrieved April 11, 2017, from
https://twitter.com/NancyPelosi/status/838915022176849921/photo/1
• Carney, J. (2017, February 27). Schumer blasts leaked GOP ObamaCare repeal bill. Retrieved April 11,
2017, from http://thehill.com/blogs/floor-action/senate/321344-schumer-blasts-leaked-gop-obamacare-
repeal-bill
• Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from
http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react-
ahca?page=0%2C9
• Hansler, J. (n.d.). Democrats react to collapse of GOP health care bill: 'So much for "The Art of the Deal"'
Retrieved April 11, 2017, from http://abcnews.go.com/Politics/democrats-react-collapse-gop-health-care-
bill-art/story?id=46361649
• Lima, C., Pollack, H., Glasser, S. B., & Grunwald, M. (n.d.). Sanders: Public outcry helped derail GOP
health care bill. Retrieved April 11, 2017, from http://www.politico.com/story/2017/03/bernie-sanders-
obamacare-public-outcry-236493
References

• The proposal under discussion among conservative House Freedom Caucus members, & The White
House would allow states to opt out of two key Affordable Care Act provisions: essential health benefits.
(n.d.). Revived GOP health care talks could hurt those with pre-existing conditions. Retrieved April 11,
2017, from http://money.cnn.com/2017/04/04/news/economy/obamacare-freedom-caucus-pre-existing-
conditions/
• What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from
https://www.advisory.com/research/health-care-advisory-board/events/webconferences/2017/what-you-
need-to-know-about-the-post-ahca-health-policy-outlook
• Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from
https://www.advisory.com/research/physician-practice-roundtable/members/expert-insights/2016/nine-
faqs-on-provider-payment-under-macra
• Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options
[SLIDESHOW]. Retrieved April 11, 2017, from https://www.slideshare.net/MedisolvMarketing/the-
basics-of-macra-and-2017-reporting-options-slideshow
• Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from
https://www.advisory.com/research/health-care-it-advisor/events/webconferences/2017/top-ten-health-it-
challenges-for-2017/ondemand
• The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10,
2016. http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf
• Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus
Unfractionated Heparin in Percutaneous Peripheral Intervention: A Single-Center Experience. J Am Coll
Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015
References

Cora Butler, JD,RN,CHC
cbutler@healthcorevalue.com
573-864-9430 Mobile
573-443-1645 Office
www.healthcorevalue.com

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