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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.

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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. Effective care transitions and follow-up can improve outcomes and reduce unnecessary costs.

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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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A Very Tepid Defense of the Physical Exam

Sensible Medicine

The differential diagnosis includes a rotator cuff strain (probably infraspinatus), osteoarthritis (maybe flared up with the gardening), the beginning of adhesive capsulitis (frozen shoulder), or even Lyme arthritis (again, given the gardening). He discharges the patient with instructions to follow up if necessary.

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Primary care news round-up (4th July – 9th July 2025)

Practice Index

It has pointed to Team Up Derbyshire, which links GPs, social workers, carers and nurses, as an example of what it wants to see. New NHS App could leave practices behind Patients could end up using better NHS technology than practices, GP leaders warned as the Government announced details of a new AI-enhanced NHS app.

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AI is Transforming Healthcare Behind the Scenes

Mobius MD

Having AI check errors gives providers peace of mind while speeding up reimbursements and minimizing costly denials. By predicting admissions and discharge patterns, AI helps prevent overcrowding and reduces wait times. Post-visit, AI can guide patients through recovery by sending reminders to take medications or schedule follow-ups.