Terry Loftus

$556 MILLION. That’s what Kaiser Permanente is paying to settle Medicare claims — and this isn’t noise, it’s a warning shot. Federal prosecutors say Kaiser affiliates inflated Medicare Advantage diagnoses to make patients look sicker, triggering higher payouts from taxpayers. More risk codes = more money. Kaiser denies wrongdoing, but the settlement is one of the largest Medicare Advantage recoveries ever. Why it matters: over HALF of all seniors are now in Medicare Advantage. If aggressive coding boosts profits without real medical need, the system bleeds billions — and trust collapses. This isn’t paperwork. It’s how Medicare money gets quietly rerouted. And Washington is done looking away. #Medicare #MedicareAdvantage #HealthcareFraud #KaiserPermanente #BreakingNews #HealthCare #TaxpayerMoney #SeniorCare #MedicalBilling #FraudInvestigation #DOJ #CMS #HealthPolicy #CorporateAccountability #BigHealthcare #PublicFunds #HealthNews #Regulation #Oversight #Insurance #WallStreet #Hospitals #MedicalIndustry #USNews #FYP #ForYou #ViralNews

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💡 What’s Next for Healthcare Leaders? Warner Thomas, FACHE, president/CEO of Sutter Health, shares invaluable insights on navigating the future of healthcare and leading effectively amid rapid change. 🎧 Listen to the full Healthcare Executive podcast wherever you get podcasts.

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Through the partnership between Healthway QualiMed Hospital San Jose del Monte and Valenzuela City, we’ve made free dialysis accessible to patients who need it most. In this video, we hear from Evangeline, one of many beneficiaries of the Valenzuela City Hemodialysis Center. Her story is a powerful reminder that healing is possible when care is within reach—and that partnerships like this are what bring it closer to home. This is the heart of what we do at AC Health: working together to ensure every Filipino has access to the care they deserve. Healthway Philippines #CareBeyondCure #Sampulso #OneACHealth

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Imagine you're an ER doctor trying to manage hundreds of patients—then someone comes in with sudden vision loss. Your only tool? A direct ophthalmoscope — a 170-year-old instrument even retina specialists find challenging. At Kaiser Permanente, we tackled this problem by deploying fundus cameras in every ER and linking them to our Eye PACS system, thanks to the efforts of many including Naveen Chandra, Gregg Gayre and Smita Rouillard MD AGAF. For the first time, ER physicians could capture diagnostic images, and our on-call ophthalmologists could remotely review them and give real-time input. The results? Our ER doctors could diagnose with more confidence, and our patients got faster, better care — ED length of stay dropped by 10%, saving on average 36 minutes per visit (p < 0.001). Excited for Nikita Vora — Emory University graduate, future Emory University School of Medicine student, and research team member —who presented our research last week at the prestigious Society for Academic Emergency Medicine conference in Philadelphia. Big podium. Big moment. Big future ahead. 👏 Thanks to Douglas Corley and the Division of Research for supporting the work, and special thanks to team members Timothy D., Dana Sax, Mubarika Alavi, mary reed, Adrian Dokey, Tova Mannis, Aubrey Gilbert for their tremendous expertise and assistance. #ophthalmology, #retina, #AAO, #ASRS The Permanente Medical Group, Inc. Permanente Medicine

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EMS leaders and pediatric champions, download this paper and scroll straight to Table 2. You'll find 24 evidence-based quality measures covering the full scope of pediatric prehospital care. ✅ Airway management. ✅ Trauma. ✅ Pain control. ✅ Respiratory emergencies. ✅ Cardiac arrest. ✅ Seizures. ✅ Anaphylaxis...and more. 𝐀𝐬𝐤 𝐲𝐨𝐮𝐫𝐬𝐞𝐥𝐟: 𝐡𝐨𝐰 𝐦𝐚𝐧𝐲 𝐨𝐟 𝐭𝐡𝐞𝐬𝐞 𝐜𝐚𝐧 𝐲𝐨𝐮𝐫 𝐚𝐠𝐞𝐧𝐜𝐲 𝐦𝐞𝐚𝐬𝐮𝐫𝐞 𝐭𝐨𝐝𝐚𝐲? Over half apply to BLS. Nearly all are process measures that can plug directly into your NEMSIS data. This isn't theoretical, it's a practical starting point for any agency looking to build or strengthen pediatric QI. Kudos to my friends and colleagues who published this paper Caleb Ward, MB BChir, MPH, Kathleen Adelgais, Rachael Alter, Robert Chaplin, Tabitha Cheng, Mark Cicero, Ann Dietrich, PATRICIA FROST RN,MS,PHN,PNP,  Andrea L Genovesi, MA, Matt Hansen, Hilary Hewes, Lindsey (Jaeger) Dumond, Kathryn Kothari, Christian Martin-Gill, Sheree Murphy, Katherine Remick, Theresa Walls & Kathleen Brown.

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Complete insanity. Insurance companies are trying to tie "contracting" and physician fees issues to physician licensing by imposing a ceiling on what physician fee can be, determined by "insurance companies!". How about we put a "cost" ceiling on insurance company executives? Limit their salaries to 100% of Medicare rates (which is more than they pay physicians)? American Medical Association Kai Sternstein

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From PCP E&M and/or AWV to PT success--a low-friction and high-value step you can take right at the primary care visit to asses risky loss of power 👇 Loss of power is one of the greatest risks for falls, injuries, and loss of independence. An easy way to check it and treat it at the same time? Watch them get up from an armchair without giving them any verbal prompts. Do they hesitate? Do they need to push with their arms? Do they need assistance? Do they appear unsteady? How many can they do without effort or at all? Note what you see. And compare them to a "normal" elderly patient, who should not have difficulty doing this activity 10 or more times with little effort. You can give them one simple therapeutic exercise that most can do safely in a stable chair with armrests. It treats the power they have lost. Here's the other reason I like it--it's only ONE thing. Follow-through is hard, patient engagement is hard. You can ask them to get up and down from a chair X number of times every time a t.v. commercial comes on, or every hour, or every time they get up to use the bathroom...whatever they will commit to. And if they are there with a care partner or loved one, teach them, too. If they can't do it? Put a pillow or two on the seat and try again. Document their starting point, whatever it is. Want to standardize it? Use the five times sit to stand test (5XSTS Test) on all elderly patients at every visit, and especially at their Annual Wellness Visit (AWV). Partner closely with a PT practice? Ask that when they evaluate any of your practice's patients, they share the results of the test and any recommendations or concerns. (Therapists--If the practice's providers are in an ACO or other VBC payment model, this is crucial information. They want to know!) Oh, and if they can't do one sit to stand without much effort and they live alone, there may is likely a safety issue--a prompt evaluation in the home by a PT is likely in order and likely other steps should be taken promptly. And ask for the "sale" when you teach them the exercise. Ask them to commit to doing the exercise. One exercise a few times per day. Then help them book an appointment to re-evaluate them in two weeks. Let them know you will be re-evaluating them and what you will be looking for. Tell them why this is so important. Gold star for calling them in a few days to see how they are doing! 🌟 Here's a great next step for patients with impairment in sit to stand: coordinate with your high-value PT practice in the area to either make a home visit or see them at their follow-up visit in two weeks right in your own practice. A direct hand-off from PCP yields the greatest chance of your patient accessing the PT they need when they need it. You can make a real difference in one PCP visit and a follow-up appointment! Link to the 5XSTS test in the comments. *This is not medical advice and is for informational purposes only. My content reflects my own ideas and opinions.*

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Medicare doesn't audit randomly. They audit patterns. I can spot one in 15 minutes—can your team? 🔍 Excessive use of one code 🔍 Missing modifiers 🔍 No proof of time-based services 🔍 Copy-paste notes 🔍 High-level E/M visits with vague diagnoses It doesn’t matter how “great” your documentation looks. If it doesn’t support why and how a service was medically necessary—it won’t survive an audit. ✨ What you need is a strategy: ✅ Internal compliance review ✅ Education for providers ✅ Audit-proof documentation workflows Medicare will audit you. It’s not if—it’s when. #MedicareAudit #Compliance #MedicalPracticeConsulting #PainManagement #MedicalNecessity

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Physician Recruiting: A High-Stakes Game of "Medical Monopoly" ​Recruiting a doctor isn't "human resources." It’s an event that combines the tension of a hostage negotiation with the theatricality of a Las Vegas magic show. If you’ve ever tried to fill a call schedule, you know the "vibe" is less professional networking and more desperate survivalism. ​Here is the reality of what it takes to land a "Great Crested Specialist" in the wild. ​1. The "Golden Child" Scouting Report ​The search begins with the Board of Directors handing you a wishlist for a "Unicorn." They want a candidate who: ​Finished residency at Mayo but has the humble soul of a country doctor. ​Is board-certified in three sub-specialties. ​Is excited to move to a town where the cultural landmark is a statue of a guy holding a giant fish. ​You then have to break the news: "That person exists, but they currently live on a private yacht and only work four hours a week via tele-health from the Mediterranean." ​2. The CV Speed-Dating Game ​When the resumes finally hit your desk, it’s a masterclass in creative storytelling. You’ll encounter: ​The "Nomad": Has worked in eight states in five years. Claims they "just love regional geography," which is doctor-speak for "I’ve burned every bridge east of the Mississippi." ​The "Academic Titan": Has published 600 papers on the molecular density of specialized proteins but hasn't touched a living human patient since the mid-nineties. ​The "Negotiator": Hasn’t even seen the hospital yet but wants to know if the "relocation package" covers their collection of vintage pinball machines. ​3. The Site Visit ​When a viable candidate finally lands at the airport, the hospital enters "Code Smoke and Mirrors." The Camouflage: You hide the "Out of Order" signs on the elevators. You tell the nursing units to "look joyful" for exactly 48 hours. ​The Secret Weapon: You pair the candidate with the one physician on staff who hasn't filed a formal grievance this month. You whisper to that doctor: "If you mention the EMR, I’m taking away your reserved parking spot." ​The Spouse Factor: You spend 10% of the time talking to the doctor and 90% of the time convincing their spouse that the local mall isn't "abandoned," it’s "undergoing a minimalist reimagining." ​4. The "Staring Contest" (The Offer) ​If they like the coffee and the spouse likes the schools, you move to the contract. This involves seven lawyers and a stack of paper thick enough to stop a bullet. This is a high-stakes poker game where your opponent can see your cards and knows your desperate. 4. ​The Victory Lap ​The contract is signed. The credentialing is done. You’ve successfully filled the slot! You feel like a world-class closer. You sit back, take a deep breath, and realize you can finally sleep. ​Then, the Head of Cardiology pokes his head in your office. He’s decided to quit medicine to open an artisanal sourdough bakery in Vermont. ​Back to the trenches. ​

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There’s a lot of debate right now about who can be your doctor. Here’s the clarification. Examples of Who Can Be Your Doctor • Your primary care physician • The specialist you see regularly • Your local health system • The Mayo Clinic • One Medical • The VA • Kaiser Permanente • Doctronic (our nationwide clinic) Examples of Who Cannot Be Your Doctor • Anyone without a medical license • An institution without physicians • A humanoid robot in a white coat • An AI chatbot Doctor is a role. Practicing medicine is a function. AI is a tool.

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I was grateful to help inform this important story. The physician shortage is truly a national crisis, more acutely felt given the recruitment challenges specific to the Monterey Peninsula. Our recruitment support programs and low physician turnover have been critical to doubling the size of our organization in the last 6 years.

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Why is it so hard to hire NPs in California? For years, California has been one of the most restrictive NP practice states in the nation. Even the most experienced NPs—fully capable of managing chronic disease, primary care, and rural health—were required to practice under collaborative agreements. This has made recruitment slow, expensive, and frustrating for employers. But there is hope. Thanks to the leadership of California Association for Nurse Practitioners—and champions like Dr. RON ORDONA, DNP, FNP-BC, GS-C, WCC, FAANP and Dr. Cynthia Jovanov—California is finally moving toward Full Practice Authority.  🙌 AB 890: California’s First Real Pathway to Independence Signed in 2020, AB 890 creates two new NP categories: 🟦 103 NPs – No standardized procedures, but still within a system that has an MD collaborative structure. 🟩 104 NPs – Fully independent. No supervision. Can open NP-owned clinics. Requirements include: - 3-year transition (4600 hours) - National certification - CE requirements - BRN regulatory approval For the first time, California acknowledged what NPs already proved during COVID: they’re essential primary care providers. 2026: 💥 The FIRST group of California 104 NPs becomes fully independent 🏥 NP-owned clinics begin opening 📉 Supervisory barriers finally start to decrease This mirrors the success seen in Oregon, Washington, Arizona, and New Mexico. SB 1451: The 2024 Accelerator SB 1451 “cleans up” AB 890 by: ✨ Fixing confusing regulatory language ✨ Clarifying certification requirements ✨ Ensuring smooth approval for 104 NP applications The result: a clean, workable launch in 2026. How AB 890 Will Transform NP Hiring 1️⃣ NP-Owned Primary Care Clinics - FNPs, AGNPs, PMHNPs, ENPs can: - Open private practices - Bill independently - Expand access to underserved communities 🏥✨ 2️⃣ Relief for the Provider Shortage Many California communities have one provider for thousands of patients. Independent NPs will change that. 3️⃣ Lower Administrative Burden for Employers No more: ❌ Complex standardized procedures Recruitment becomes faster. Retention becomes stronger. Healthcare leaders — how have you navigated California’s collaborative agreement requirements so far? I’d love to learn from your experience. Happy NP Week Everyone! https://lnkd.in/gMDQg8u9

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Interesting assessment by the County – containing many of the potential impacts PWW Advisory Group identified and communicated in our industry education. 𝐀𝐝𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐑𝐞𝐬𝐨𝐮𝐫𝐜𝐞𝐬 Webinar - The Pulse of EMS Finance - 'One Big Beautiful Bill' May Mean for EMS: https://lnkd.in/g2aTZRNK EMS1 Article: https://lnkd.in/g_e-pRQc   Table of Potential EMS Impacts by PWW|AG and National Association of Emergency Medical Technicians (NAEMT) https://lnkd.in/gRMyXNbc What’s interesting is they seem to be focusing on cost increases but did not identify the additional looming revenue hit. "𝐏𝐨𝐭𝐞𝐧𝐭𝐢𝐚𝐥 𝐬𝐭𝐫𝐚𝐢𝐧 𝐨𝐧 𝐞𝐦𝐞𝐫𝐠𝐞𝐧𝐜𝐲 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬 Valentine also warned that the changes could increase pressure on the emergency medical system if residents lose health coverage and delay treatment until medical emergencies arise." "Valentine said a worst-case scenario — such as the closure of a local hospital — could significantly increase emergency room demand at San Joaquin General Hospital and St. Joseph’s Medical Center." "Emergency medical services officials estimate the county hospital could see a 32% increase in emergency medical service deliveries and a 23% increase in emergency room volume in that scenario." "Meeting that demand could require adding four additional ambulances daily, costing roughly $150,000 per week, Valentine said." [Note: Using this estimate, the cost of 1 ambulance 24/7/365 is $1.95 million annually. ($150,000 x 52 = $7.8 million / 4 = $1.95 million] -------------- 𝐒𝐚𝐧 𝐉𝐨𝐚𝐪𝐮𝐢𝐧 𝐂𝐨𝐮𝐧𝐭𝐲 𝐰𝐚𝐫𝐧𝐬 𝐨𝐟 $𝟕𝟔.𝟗𝐌 𝐢𝐧 𝐜𝐨𝐬𝐭𝐬 𝐝𝐮𝐞 𝐭𝐨 𝐓𝐫𝐮𝐦𝐩’𝐬 ‘𝐁𝐢𝐠 𝐁𝐞𝐚𝐮𝐭𝐢𝐟𝐮𝐥 𝐁𝐢𝐥𝐥’ Public health services facing largest losses, and clinics and hospital warn of ripple effects, strain on emergency services Hannah Workman, The Stockton Record March 11, 2026 https://lnkd.in/gUfxq2EG

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As of late 2024, median hospital operating margins (after accounting for system allocations) were roughly 1–2%, placing over half of U.S. hospitals in a fiscal state that challenges their long-term survivability. Furthermore, a deep divide has emerged: while a subset of high-performing hospitals have financially recovered (even improving profitability in 2023–24), a large portion have stagnated or worsened. Analyses reveals that about 40% of American hospitals continue to lose money from operations into 2024. In other words, two out of five hospitals are effectively insolvent if the status quo continues. This is an unsustainable situation that threatens access to care in many communities. Even those with positive margins are often eking out 1–3% – “historically slim” margins that are not yet fully sustainable in the face of future shocks (pandemic, inflationary surges, climate-based, tariffs, legislation, etc.) or capital needs. What’s driving this margin erosion? At DOCSI, as we look across the market and engage with our partners we see five principal factors accounting for the majority of financial strain: -------------------------------------- 1. Labor Costs 2. Declining Reimbursement and Payment Reform 3. Supply and Implant Spend (Implants, PPI, Devices, Drugs) 4. Utilization Inefficiencies and Unwarranted Clinical Variation 5. Suboptimal Revenue Cycle Performance -------------------------------------- - What are you seeing? - Where do you think healthcare systems should focus with respect to expense reduction? - Would you prioritize expense reduction (direct and controllable) or revenue growth (often slower, more uncertain)? Which has been more impactful on your system’s bottom line?

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