Dr. John Zelem, a former hospital surgeon-turned-consultant, is scheduled to begin a new a career assignment at a critical access hospital (CAH).
There was a time in my life when my mother and father bought 80 acres of “raw” land in Southern California, a small parcel in a tiny ranching community in the San Bernardino foothills. All of us in the Buck family were 100 percent “city slickers,” as the term implied, in those days.
But the allure of fresh air and wide-open spaces was too alluring for my parents to turn down. So, we moved up. Or rather, we moved down, from all the conveniences of a modern life in Los Angeles to the rustic setting that we called “the Ranch.” Nonetheless, medical care – a hospital with doctors and nurses – was miles away, and the fastest route was over a dirt road (40 miles over a dusty, cratered dirt road). Getting seriously sick or injured in those days was pretty much a life-or-death situation.
Today, healthcare in the United States is not too much better than it was back then.
So, when I learned that Dr. John Zelem, a member of the ICD10monitor editorial board and a panelist on Talk Ten Tuesdays, was accepting a new gig at a critical access hospital (CAH), I was intrigued.
“In my own consulting career, I have only been involved with medium to large hospitals and multi-hospital systems,” Zelem wrote to me in an email. “This new experience will be with a CAH, which is the Centers for Medicare & Medicaid Services (CMS) designation for hospitals with no more than a 25-patient census.”
Zelem explained that the CAH designation is given to eligible rural hospitals by CMS with the express purpose of reducing the financial vulnerability of these facilities, and improving access to healthcare by keeping essential services in these communities.
“CAHs provide this essential access to high-quality healthcare in rural communities and represent more than two-thirds of all rural hospitals, (making them) vital for ensuring the health of communities that may not have access to larger facilities,” Zelem said.
The founder and president of Streamline Solutions Consulting, Zelem told me that one of the most exciting parts of this venture will be assisting in ensuring the continued success of such a hospital, as CAHs make up approximately 20 percent of all hospitals in the U.S.
When asked about the role he will assume at his new post, Zelem explained that he will be a physician advisor, something that aligns with his consulting business, which is focused on “streamlining” efficiencies and interaction among various departments (such as utilization management, compliance and revenue cycle).
“This will be a physician advisor role, which can involve administrative and clinical revenue cycle roles,” Zelem wrote in his email. “There will be interaction with elements of utilization review, case management, and CDI (clinical documentation integrity). I will also have a chance to work with various physician areas for improving documentation – which, as we know, is so well-needed – and appealing denials. It is important to do everything possible to ensure the survival of these rural healthcare facilities.”
As a news and information service, we have been reporting on the plight of rural hospitals consistently for years, so naturally, I was concerned about the constant rumor I hear that rural hospitals are on the “endangered species list” – so I asked Dr. Zelem for his take on the notion.
“Yes, and here are some of the concerning statistics,” Zelem wrote: “This designation of a critical access hospital, through the Balanced Budget Act of 1997, was in response to over 400 rural hospital closures during the 1980s and early 1990s. Even today, more than 180 rural hospitals have closed since 2005.”
Closures, according to Zelem, were already occurring at an accelerated rate over the last decade, noting that 21 more such facilities have shut down since the start of the COVID-19 pandemic.
“Close to half of rural hospitals in the United States are now operating at a loss,” Zelem said. “One needs to keep in mind that we have an obligation to provide quality healthcare to all, regardless of location.”
Especially when that location is hard to reach.
Recently, I attended the American Health Lawyers Association (AHLA) annual conference in San Francisco. Attorneys must attend a certain number of continuing legal education (CLE)
In 2019 Medicare released the following statement: “It appears that hospitals in a limited number of states have used urban-to-rural hospital reclassifications to inappropriately influence
Please log in to your account to comment on this article.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
đź‘»Spooky Sale is Back!đź‘» Get 31% off all three Medlearn brands, using code SPOOKY24.
