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Welcome to the Fall edition of the Leading Edge. Our feature articles begin with a look at telemedicine: is it at a “tipping point?” Many think so despite the barriers that remain.

Next we look at Medicare Advantage. This below-the-radar version of Medicare insures nearly a third of Medicare patients in what otherwise look like commercial plans. But increasingly, we see MA adopting narrow networks. And debates over MA costs and quality have not been resolved.

Healthcare exchanges are highlighted in our next feature. Everyone has seen the news about insurers dropping out. But exchanges aren’t going away so expect to see more narrow networks and expanded efforts to attract younger and healthier consumers.

In our final feature, we describe current industry efforts to improve population health. It is clear that managing a population’s health is hard but we are beginning to see early success stories. A lot has been learned about how to implement population health programs from the experience to date.

In the Compliance Corner, you will learn why OIG exclusion checking is so important and about a new AdvantEdge offer to assist clients with exclusion testing.

In our specialty sections, anesthesia includes new codes, colonoscopy coding guidelines, the most costly emergency surgery procedures and patient selection criteria for ambulatory anesthesia.

For pathology, we summarize what is being called “Laboratory 2.0,” highlight 2018 risks for independent and hospital labs and, with near-term import, talk about potential cuts to 2017 reimbursement and how to survive MIPS.

In the Behavioral Health world, we describe how population health starts with whole person care, the changing role and reimbursement for case management, the implications and opportunities in the new CARA legislation and the challenges involved with integrating physical and mental health.

For Emergency Medicine, we describe recent growth in free-standing EDs, remind providers about Attestation documentation requirements, highlight the continued pressures on OON reimbursement and describe the requirements for billing for critical care services.

Our radiology section provides an update on “Radiology 3.0,” the ACRs roadmap to the future of radiology, describes how patients use online access to radiology reports, barriers to widespread use of LDCT for lung cancer screening and the latest on CDS requirements.

In the ASC section, we start with recommendations to allow total knee replacement surgery in an ASC setting, describe colonoscopy best practices, how ambulatory surgery is being used for breast cancer treatment, and how ASCs reduce outpatient procedure costs.

There is always a lot going on around AdvantEdge! Check out Office news to see recent news and accomplishments about and by your colleagues.

A reminder that any article in the newsletter can be printed as a nicely formatted PDF. And if you use the client version(s) of the newsletter (which will be published around October 7) there is a PDF “button” that you can use to download the entire newsletter for email or printing.

A last, personal, note. This is my last issue of the LeadingEdge. As most of you know, I am retiring in October. But rest assured that the LeadingEdge and the other AdvantEdge newsletters are in good hands. Hannah Paoletti does most of the heavy lifting and Mike Krivich is on board to take over my end of things. I’m sure the quality of articles will continue to improve, which has always been our objective.

As always, we need your feedback and topic suggestions. Please call or email Mike with comments and suggested topics for the next issue: and (630) 874-2525.


Bill Gilbert