For around a quarter of a century, E/M coding guidelines had few revisions, but that has all changed in the last couple of years. This year, E/M codes have a number of key revisions, with 25 deleted codes and many code changes in five categories. On this episode, we review key E/M coding changes important to you and your practice.

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Senior Principal, Clinical Operations and Quality

Vizient

Guest:

Sheila Bowlds, MBA

Senior Consulting Director, Clinical Documentation Improvement

Vizient

Show Notes:

[00:58] Professional fee E/M Codes

[01:30] Overview of changes involving E/M Codes in 2023

[02:00] Observation codes

[03:36] Rationale behind changes

[04:16] Potential results; focus on cognitive effort of provider

[05:33] Patients still in observation status

[05:47] Effect on consultation codes

[06:41] Simplification

Links | Resources:

To contact Modern Practice: [email protected]

Sheila’s email: [email protected]

CPT E/M coding guideline changes in 2023 (AMA pdf): 2023-e-m-descriptors-guidelines.pdf

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Pharmacy Benefit Managers (PBMs) have emerged as a powerful player in healthcare today, and their role has brought value but also controversy. They have  become a negative challenge for many provider practices Yet, there is a different approach that is more provider-friencly, and on this episode, we explore the approach of Alluma as an alternative to PBMs.

Moderator:

Guest:

Show Notes:

[00:51] Role of PBMs: value and controversy

[02:53] Alluma: a different PBM approach

[05:33] PBMs and lagging rebates: a disconnect for health plans

[06:58] Best practice: a provider-led solution

[09:27] PBMs and thwarted access to preferred medications

[10:44] A limited PBM appeals process

[11:19] Alluma’s approach: working more closely with providers

[11:40] Addressing regional prescribing patterns

[15:20] The future: more government regulation

Links | Resources:

To contact Modern Practice: [email protected]

Priyesh Patel’s email: [email protected]

“PBM Impact on Employers & Risk to Health Systems” (Alluma white paper): Click here

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As patients take on more of their medication costs through higher deductibles and coinsurance, Pharmacy Benefit Managers (PBMs) are becoming more and more crucial to the process. PBMs are key to determining the medications available to patients and what patients have to pay for them. Yet, there can be an alternative to PBMs, and on this episode, we explore how health care organizations can find alternative solutions for skyrocketing drug costs, solutions that are at the level of the individual patient and the provider and not at the macro level taken by PBMs.

Moderator:

Guest:

Show Notes:

[01:07] Addressing skyrocketing drug costs – the Alluma solution

[02:04] Pharmacy Benefit Managers (PBMs)

[03:07] 75% of Vizient member organizations are self-employed insurers (8M lives)

[03:51] Health care workers are not healthy

[05:21] PBMs are not health providers – they manage lives at a macro level

[06:42] Working at a clinical level

[09:55] Complex issues around new, complex drugs

[11:21] Controversy around PBMs: the extravagant profits and the rebate issue

Links | Resources:

To contact Modern Practice: [email protected]

Priyesh Patel’s email: [email protected]

“PBM Impact on Employers & Risk to Health Systems” (Alluma white paper): Click here

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The past couple of years revealed issues that had to be faced and glaring needs that hac to be addressed. On this episode, Tom continues his review of the issues and challenges of the past year and what we can do to improve on them.

Moderator:

Show Notes:

[00:23] Increase of addiction, suicides and accidental overdoses

[01:34] Addiction treatment needed

[02:30] Resilience revealed

[03:22] Doing more with less and using better documentation processes

[04:45] Community is essential

[05:09] If you don’t make time for your wellness, you’ll be forced to make time for your illness

[07:02] Be kind to one another and ourselves

Links | Resources:

To contact Modern Practice: [email protected]

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Nearly three years ago, COVID-19 struck and changed the healthcare landscape. It created issues but also pushed issues to the surface that needed to be addressed. On this episode, Tom recaps the issues and challenges of the past year and what we can do to face them and make improvements.

Moderator:

Show Notes:

[00:54] The use of masks

[02:23] Vaccines

[03:37] Booster fatigue is common

[05:09] Be kind to yourself

[06:10] Not everyone is treated equally in healthcare

[07:47] Take mental health seriously – anxiety has nothing to do with character

Links | Resources:

To contact Modern Practice: [email protected]

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This final episode of a three-part series on clinical quality focuses on documentation and the impact correct documentation can make on improving care. Also featured is a discussion on what needs to happen in the future to improve quality.

Guest speakers:

Rick May, MD

Moderator:

Show Notes:

[00:38] Documentation requires critical thinking

[01:37] Providers and documentation

[05:25] What needs to happen in the next few years

Links | Resources:

Advance clinical operations and quality (Vizient): Click Here

AHA Leadership Roundtable: The Future of Health Care Quality (Aug 3, 2022): Click Here

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This episode continues a three-part series on clinical quality: why it is still elusive and what practices and organizations can do to overcome the massive challenges around quality improvement. This program focuses on those challenges but also the benefits in the drive toward quality in health care.

Guest speakers:

Angela Hunt, RN, MBA, CCDS

Principal, Clinical Documentation

Vizient

Rick May, MD

Senior Principal, Clinical Quality Improvement

Vizient

Moderator:

Tomas Villanueva, DO, MBA, FACPE, SFHM

Senior Principal, Clinical Operations and Quality

Vizient

Show Notes:

[00:38] Issues affecting quality

[01:37] Documentation issues – not just finance

[02:55] Thinking differently – prime importance of quality, reduced patient days

[05:06] Other benefits

[06:11] Effect on private payers

[07:07] Workforce – a brewing catastrophe

Links | Resources:

Advance clinical operations and quality (Vizient) Click here

AHA Leadership Roundtable: The Future of Health Care Quality (Aug 3, 2022) Click here

To contact Modern Practice: [email protected]

To contact Angela Hunt: [email protected]

To contact Dr. Rick May: [email protected]

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Since the publication of “To Err Is Human” over 20 years ago, focus on healthcare quality has intensified. Yet, progress has been halting at best, with hospital-acquired conditions, medication errors, and many other issues still prevalent. This episode begins a three-part series on clinical quality: why it is still elusive and what are recommended actions that clinical practices and organizations can take to attain quality improvement.

Guest speakers:

Rick May, MD

Moderator:

Show Notes:

[01:22] The status of clinical quality today

[02:49] The impact of the workforce shortage

[03:42] Areas of concern

[04:54] Process and training issues

[05:43] The impact of financial issues

[08:06] Clinical documentation issues

Links | Resources:

Advance clinical operations and quality (Vizient) Click Here

AHA Leadership Roundtable: The Future of Health Care Quality (Aug 3, 2022) Click Here

To contact Modern Practice: [email protected]

To contact Angela Hunt: [email protected]

To contact Dr. Rick May: [email protected]

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This episode of our award-winning podcast finishes the three-part series on the various drug shortages occurring today and what organizations and practices can do about them.

Guest speaker:

Steven Lucio, PharmD, BCPS

Moderator:

Show Notes:

[00:40] Challenges of dealing with China and the impact of COVID

[03:14] Partnerships to help providers deal with shortages

[07:12] Months of disruption

[07:40] Employing different sourcing strategies and building inventory

[08:38] Recommendations for next steps and a new alliance

[10:00] Need for enduring management to minimize shortages

Links | Resources:

“The one thing you need to know about drug shortage stewardship” (Vizient, Oct 25, 2022): Click Here

To contact Modern Practice: [email protected]

To contact Dr. Sutaria: [email protected]

To contact Dr. Lucio: [email protected]

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On this episode of our award-winning podcast, we continue our series on the various drug shortages occurring today and what organizations and practices can do about them.

Guest speaker:

Steven Lucio, PharmD, BCPS

Moderator:

Show Notes:

[00:33] Challenges dealing with shortages

[01:58] Using shortages as a care opportunity

[04:06] “Anticipatory purchasing”

[06:16] Problem knowing where drugs originate

[08:44] Originating drugs in the US and Europe: pros and cons

Links | Resources:

“The one thing you need to know about drug shortage stewardship” (Vizient, Oct 25, 2022): Click Here

To contact Modern Practice: [email protected]

To contact Dr. Sutaria: [email protected]

To contact Dr. Lucio: [email protected]

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