Latest / Becker’s Healthcare Podcast / Navigating CMS Changes and Clinical Documentation in Rural Orthopedics with Dr. Sylvester Youlo

Transcript

Navigating CMS Changes and Clinical Documentation in Rural Orthopedics with Dr. Sylvester Youlo · Becker’s Healthcare Podcast

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  Every year, Becker's annual meeting brings health care
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  leaders together to unpack the most pressing issues
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  facing the industry.
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  And every year, those conversations shift in profound
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  and unexpected ways.
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  This April, more than 3,500
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  healthcare executives will return to Chicago
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  for Becker's sixteenth annual meeting.
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  Seven ninety five elite speakers will offer new
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  lessons,
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  new case studies, and predictions about what comes
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  next. Join us April 13 through the sixteenth.
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  For the agenda and event details,
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  visit beckershospreview.com
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  and click on the events tab in the
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  upper right.
• 0:37
  Hello, and welcome to the Becker's Healthcare podcast.
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  My name is Chanel Bonger. And today I
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  have the pleasure of speaking with doctor Sylvester
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  Yulo, an orthopedic surgeon at Phelps Health who
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  joins the podcast today to share insights into
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  his background, healthcare trends he's keeping an eye
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  on a bit more. Doctor Yulo, thank you
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  so much for joining me today. Thank you
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  for having me, Chanel. Perfect. Well, to get
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  us started out, could you please introduce yourself,
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  tell us a bit about your background and
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  Phelps Health?
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  Okay. Well, my name is doctor Silvesta Yulo.
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  I'm an orthopedic surgeon.
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  I'm employed by Phelps Health, a rural hospital
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  in, in Missouri.
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  We actually are located about 90 miles from
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  Saint Louis
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  and 90 miles from Springfield. So we are
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  kind of in the middle. We service about
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  250,000
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  people,
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  and our hospital mostly service a
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  US military installation around here called Fort Leonard
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  Wood. So we take care of the family
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  there and the service members.
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  Our practice is general orthopedics,
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  cover up joint replacement trauma,
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  and I have a special niche in post,
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  sports surgery.
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  I also have two, master degrees,
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  an MBA and and a master in health
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  administration,
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  because I I strongly believe that physician must
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  must understand how health care works, financially
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  to be able to serve serve patients long
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  term.
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  Got it. Got it. Thank you so much
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  for the introduction. And now moving forward,
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  what health care trends are you currently watching
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  in your role today, either in orthopedics or
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  just health care overall?
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  Well,
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  really, the the the biggest thing really I'm
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  watching out for is how things have changed
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  with CMS almost, you know, every few months.
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  Recently, there have been changes to
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  everything going to most most surgeries going to
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  outpatient
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  only, at least leaving the inpatient only list
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  to the outpatient list. And and, also, there
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  there are multiple regulations that have been that
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  have come out and then change changing physician
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  reimbursement, hospital reimbursement.
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  Those are actually biggest trends we're watching out
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  for right now.
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  Absolutely.
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  And so kinda looking forward into the rest
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  of the year, what are you most focused
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  on and excited about? And then kinda looking
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  back at last year,
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  can you talk about an initiative or a
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  project that you're most proud of?
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  Yes. So so here so most things started
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  changing, especially with,
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  the, inpatient only list being changed.
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  We, we designed our organization to focus on
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  a little different
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  differently than most people are doing on clinical
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  documentation.
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  So so, you know, when I went to
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  medical school, documentation was about, you know, if
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  you didn't write it down, you didn't perform
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  it.
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  It was about, you know, documenting so patients
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  would know what happened
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  for medical legal purposes. But what really is
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  happening now is that,
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  documenting,
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  the the the care that is performed
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  is very important. So about a year ago,
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  almost two years ago,
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  we decided to,
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  to start a CBI
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  initiative
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  at our institution.
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  And what we decided to do was
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  have buy in from physician and everybody else
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  to understand the nuances about documenting the care
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  that we provide
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  so that once CMS got to know what
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  we did, all insurance companies figured out what
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  we did.
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  Getting reimbursed was a little easier.
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  The the initial purpose of that that initiative
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  really wasn't about reimbursement, really.
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  It was about increase increasing our TMI.
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  TMI is really case mesh index.
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  That number is very important
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  in documenting how sick the patient we treat
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  her, and that's what we're trying to to
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  go after. But once we did that,
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  what we did realize was
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  overall, it benefit of patients.
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  It benefited the system. It decreased,
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  you know, how much,
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  your bills were in our it decreased our
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  our denials.
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  It increased our our reimbursement rate, and those
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  things changed. That was the biggest thing we
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  did. We started, though, we started with inpatient,
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  and we saw a tremendous
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  improvement
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  in multiple
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  microcysthesis.
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  And then after that, we decided this year
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  to study for, you know, outpatient
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  clinics and all that, and it's going pretty
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  well.
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  Well, that's amazing to hear. And, obviously, you're
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  a lifelong learner with,
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  being a provider that went back and got
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  two master's degrees. So I'm curious to hear
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  from your perspective what advice you'd give to
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  evolving emerging leaders that are looking to have
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  the same drive and success in their careers
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  as you have.
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  Well, so the you you hit a point
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  re really, Chanel. I think life's long learning
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  is important.
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  Medical school is long. You know, you gotta
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  go to school, get a bachelor's degree, and
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  then take the MCAP, go to medical school,
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  go to residence, and sometimes go to fellowship.
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  And and most most doctors are just eager
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  to be done with all the training so
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  they can go to work. What happens once
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  you get practicing, you get busy. And so
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  most doctors just check boxes for CMEs. You
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  need a CME to continue practicing instead of
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  just do a couple of CMEs and check
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  boxes.
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  What I think most physicians
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  need to realize is that we've gotta provide
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  care for patients.
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  We cannot forget
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  that the financial aspect of, medical care in
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  The United States and the rest of the
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  world is very important.
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  There's no money to run the system.
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  There's no way to care for patients.
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  So understanding the financial part of business and
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  understanding how high health care is run is
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  very important. So the advice I give to
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  young I give to young doctors is
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  don't be content to just be a doctor
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  and serve patients.
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  Learn about the system. Learn how to improve
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  health care outcomes. Learn how to improve health
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  care delivery so it's a little cheaper,
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  without sacrificing patient outcome.
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  Excellent advice. Well, doctor Hilo, I enjoyed our
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  time today. But before I let you go,
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  is there anything else that listeners should know?
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  Well, yes. A couple of things to know
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  is what I what I alluded to about,
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  clinical documentation.
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  When I'm one of the advisers,
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  for for the, the system here, the physician
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  adviser for our clinical documentation program.
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  Documenting,
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  I think, change will be very important
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  because, you know, the biggest thing I'm I'm
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  watching out for is this taking patient off
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  of the inpatient
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  only list to outpatient list. And what will
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  happen
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  is that eventually and this is gonna happen.
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  Probably the next
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  two to three years,
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  there will be a time that some patients
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  you cannot meet them
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  because they are they'll become only outpatient. You
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  can't meet them. The only way you can
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  meet a patient will be to document properly
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  why you are keeping the patient in the
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  hospital. For example,
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  I performed joint replacement.
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  Most joint replacement is not gonna be sooner
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  or later outpatient only. The next thing is
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  gonna be
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  in the surgery.
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  But most people are required during replacement at
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  older patients.
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  As we get older, we do have medical
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  comorbidities.
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  And so if you have a patient that
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  needs a joint replacement
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  and you do not take the time to
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  document
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  the entire patient's profile,
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  they will be you know, you have difficulty
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  improving
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  or at least
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  asking insurance companies
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  to pay you back if the patient had
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  to stay in the hospital for maybe one
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  or two days
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  because they can always argue that this procedure
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  is supposed to be outpatient only, and you
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  are keeping the patient for a few days.
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  So I think clinical documentation is very important.
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  Instead of just believing that documentation is for
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  medical legal purposes, I think physicians need to
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  step back and understand that documenting is very
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  important,
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  for health care delivery overall.
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  Absolutely. Well, doctor Iulo, that's a great note
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  to end our time with, and I wanna
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  thank you once again for sharing your insights
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  with me today on the Becker's Healthcare podcast.
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  Thank you so much.
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  Thank you for having me. I appreciate it.