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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

CMS Policy Changes to Reduce Costs Financial pressures are rising as CMS implements the updated Version 28 Hierarchical Condition Category (HCC) model , which introduces changes aimed at limiting types of codes that are most used for up-coding or over-coding to help rein in spending. MA plans are looking for contradictions in provider notes.

Hospital 130
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Engaging Physicians in Quality Improvement: Strategies for Driving Practice Change

EvidenceCare

Real-time dashboards can also flag length of stay variance, prompting collaboration to streamline processes and free up capacity for higher-acuity admissions. Targeted clinical decision support , such as focusing on same-day discharge rates for low-risk patients, can increase evidence-aligned discharges and reduce readmissions.

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Will New Medicaid Policies Put Hospital Margins at Risk?

EvidenceCare

These improvements reflect stabilization following pandemic-related disruptions and cost pressures. Cost-Sharing: Medicaid recipients earning above the poverty line could face copays up to $35 per visit, capped at 5% of income. and operating margins to 5.2%. Examine differences in utilization and outcomes between subgroups (e.g.,

Hospital 130
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How Denver Health Reduced Length of Stay: A Step-by-Step Guide

EvidenceCare

They often provided data that was delayed by several weeks or aggregated at the service line level, which made it difficult to pinpoint actionable issues or analyze trends in real time by individual provider, DRG, or discharge unit. So Denver Healths internal analytics team built a custom data pipeline.

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How BPCI Enhances Patient Experience and Lowers Costs: A Comprehensive Guide

Guideway Care

Cost reduction strategies in BPCI focus on linking payment to performance, utilizing predictive analytics and interprofessional collaboration to lower expenses while maintaining high-quality care. At its heart, the BPCI program emphasizes strong collaboration between healthcare providers as essential for enhancing patient experiences.

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RAG in Healthcare: Your Complete Guide to Its Implementation

Arkenea

RAG systems can reduce this to minutes by: Instantly retrieving relevant studies from vast medical databases Summarizing key findings in the context of your specific research questions Identifying gaps in current research that align with your organization’s capabilities Comparing treatment outcomes across multiple studies with your patient population (..)

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New Insights on Medicare Advantage Plans and The Two-Midnight Rule

EvidenceCare

The Impact of the Two-Midnight Rule on Denials At the 2024 HFMA Annual Conference, we asked healthcare executives if they’re seeing any changes following the CMS Two-Midnight Rule, particularly in denials. We’re still facing the same types of denials, especially with short stays where payers push back post-discharge.”