By Cheryl Ericson, RN, MS, CCDS, CDIP

Initial denial rates are finally falling. Revenue leakage is not. Kodiak’s March 2026 report found hospitals on its platform lost $48.4 billion in net revenue in 2025 to final denials and bad debt, up more than 25% from $38.6 billion. Clinical denials for prior authorization and medical necessity accounted for virtually all of the increase in denial rates. Medicare Advantage (MA) is where that pressure concentrates. Hospital frustration is leading to a growing number of health systems to drop MA plans due to payment and authorization practices.

MA Denial Rates Run Far Above Traditional Medicare

In Kodiak’s September report, Unyielding Denials, MA inpatient initial denials improved to 9.15% in the first half of 2026 from 10.75%, but remain more than double the 4.21% for traditional Medicare. Prior authorization and precertification denials drive much of the gap: 2.48% for MA versus 0.02%. MA inpatient final denials are 4.54% of net patient service revenue, more than three times the 1.24% for traditional Medicare. As margins remain tight, MA plan denial rates remain significant with payer mix shifting towards a higher percentage of MA beneficiaries due to rising volumes of uninsured patients at many hospitals.   

Post-Acute Denials Are Often Overlooked

KFF reports that HHS Office of Inspector General found MA insurers denied 65% of requests for long-term care hospital stays, 54% for inpatient rehabilitation, and 12% for skilled nursing. Encouragingly the data also shows appeals work with plans approving 95% of appealed skilled nursing denials. Yet only 18% of skilled nursing denials were appealed, along with 31% for rehabilitation and 36% for long-term care hospitals.

From Post-Acute Denial to Revenue Leakage

Kodiak’s data does not isolate post-acute denials, but the mechanism is clear. A denied or delayed authorization leaves a discharge-ready patient in an acute bed. MedPAC’s preliminary findings show median acute stays before transfer of nine days for MA enrollees versus six for fee-for-service before inpatient rehabilitation, and 21 versus 13 before a long-term care hospital. The American Hospital Association attributes the pattern to prior authorization delays. Under case-based inpatient payment, those extra days typically add cost without adding payment. In fact, Becker’s recently cited post-acute discharge delays among the top hospital challenges in 2025.

Now add the clinical denials Kodiak tracks. Clinical initial denials rose to 2.6% in 2025 from 2.4%, and they are hard to overturn with the rate slipping to 42.1% from 42.7%. Denials that are never appealed or never overturned become final denials, and the median final denial rate rose to 2.7% from 2.5%.

Where Physician Advisors Make the Difference

MA plans must follow Traditional Medicare coverage criteria, including inpatient admission rules at 42 CFR 412.3 (see 42 CFR 422.101(b)(2)). Enforcing that takes physician-level work:

• Post-acute authorization: early physician escalation and peer-to-peer review to shorten avoidable days.
• Clinical denials: arguments tied to the regulation, not generic templates.
• Appeal discipline: appeal by default, with opt-outs documented.
• Payer-level tracking: initial and final denial rates reported separately for MA and traditional Medicare.

The Real Question to Ask

The question is no longer only whether your initial denial rate is falling. It is how many denials, including post-acute authorizations, go unchallenged before they become final write-offs.

The post Medicare Advantage Post-Acute Denials Are Feeding Hospital Revenue Leakage appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

With five years at Brundage Group and more than a decade of experience in healthcare, Taylor works closely with hospital leaders to identify opportunities within their utilization management (UM) programs, strengthen Physician Advisor support, and improve financial outcomes. 

His perspective is grounded in an important distinction: a low denial rate doesn’t necessarily mean a hospital is doing everything right. 

Looking Beyond Denial Rates 

In conversations with hospital leaders, Taylor consistently sees the effects of growing friction between hospitals and payers. While denials are often treated as individual reimbursement challenges, payer strategies can influence decisions across an entire organization.

“When organizations focus too heavily on avoiding denials, they can end up playing right into what the payer wants them to do,” Taylor explains. “They’re billing less or not really advocating for the care they’ve been providing.”

This reluctance to challenge payer decisions can create significant revenue leakage. Medicare Advantage plans are a particular concern for many hospitals seeking support, although Taylor emphasizes that these challenges extend across the industry.

Hospitals may interpret a low denial rate as evidence that their UM processes are working effectively. However, they may be overlooking opportunities to appropriately classify patients, defend medical necessity, and capture earned revenue.

Avoiding denials and protecting earned revenue aren’t always the same thing. Recognizing the difference requires hospitals to look beyond familiar metrics and evaluate whether their current processes are supporting appropriate clinical and financial decisions.

Combining Expertise with Technology 

Even experienced internal UM and Physician Advisor teams can reach a point where additional expertise makes a difference. Individual hospitals may not have access to the broader perspective that comes from reviewing cases across hospitals, health systems, and payer environments nationwide.

Brundage Group brings that experience to its work, helping organizations identify trends, recognize opportunities, and strengthen their approach to payer challenges.

Technology also plays an important role. Taylor points to Certus Radar Revenue Cycle Intelligence as a valuable safety net for hospital UM programs, helping identify patients who may benefit from Physician Advisor review.

The solution grew out of a practical challenge raised by a hospital client: how could the organization ensure the right patients were being escalated when utilization review nurses weren’t available around the clock?

Certus Radar helps direct patients to the appropriate clinical resource, supporting internal teams while helping prevent cases from falling through the cracks during staffing gaps, nights, and weekends.

For Taylor, the distinction is that technology should complement clinical expertise rather than replace it.

“We leverage technology to make sure the right patients are getting to the right resource at the right time,” he explains.

By connecting technology with Physician Advisor judgment, hospitals can better identify opportunities for appropriate patient status determinations and reimbursement. The platform also provides ongoing visibility into results through a dashboard, allowing teams to monitor performance without waiting for monthly reports.

Turning Case Reviews into Lasting Improvement 

For Taylor, Brundage Group’s value extends beyond technology and individual case reviews. The team looks for recurring trends in its work, including documentation gaps, denial patterns, and medical necessity decisions, then uses education and feedback to address underlying issues.

“We really work our way out of a job at times by leveraging our work to track those trends and then using education to kind of get past those trends,” Taylor says.

By providing feedback tied to actual cases, Brundage Group helps clinicians and Physician Advisors apply lessons to future decisions. Over time, this can strengthen documentation, improve medical necessity decision-making, and help internal teams become more confident in their approach.

The benefits extend to day-to-day operations, too. When Physician Advisor support helps resolve cases that warrant inpatient status, utilization review nurses can focus more attention on patients who remain in observation. Teams can then investigate whether additional documentation or clinical review is needed or whether a patient may no longer require hospital-level care.

The goal is not simply to improve individual outcomes, but to help hospitals build stronger processes over time.

Standing Behind Clinical Decisions 

Brundage Group’s support doesn’t end when a clinical recommendation is made. When a payer denies a claim despite a determination supported by the team’s Physician Advisors, Brundage Group can provide additional assistance through its peer-to-peer program and appeal letter writing.

For Taylor, this support is essential to helping hospitals feel confident advocating for appropriate reimbursement.

“We don’t want denial to be a scary word,” he says. “You just need a partner that’s going to stand behind your determinations and fight those denials appropriately.”

Hospitals should work to prevent avoidable denials, but fear of denials can become costly when it leads organizations to avoid appropriate inpatient admissions or accept payer decisions without challenge. Having experienced clinical support helps hospitals evaluate those decisions and advocate for the care they provide.

Keeping the Focus on Patient Care

Looking ahead, Taylor sees continued opportunity for hospitals to combine their internal expertise with the resources, technology, and broader perspective of an experienced external team. Maintaining a fully staffed internal Physician Advisor program can be challenging, particularly as payer strategies evolve, and staffing needs change.

Brundage Group helps hospitals address these challenges while allowing their clinical teams to focus on patient care.

For Taylor, that mission is what makes his work meaningful. He has seen how stronger UM processes and appropriate reimbursement can help hospitals improve their financial position, sustain growth, and continue serving their communities.

Ultimately, protecting earned revenue is more than a hospital’s bottom line. It helps support the organization’s ability to deliver care and serve patients and families. Through clinical expertise, technology, and ongoing education, Brundage Group helps hospitals recognize opportunities, make informed decisions, and stand behind the care their patients need.

The post Spotlight: Taylor Smith | Navigating the Changing Landscape of Utilization Management  appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Jonna began her career as a hospital nurse, spending over a decade in the emergency room before moving into nursing leadership and eventually case management. It was through case management that she discovered utilization management (UM), a field that combined her clinical experience, critical thinking, and desire to help patients in a different way.

“I think you’re an investigator,” Jonna said of utilization management. “You’re looking through the record. You’re trying to see what qualifies.”

That investigative side of the work quickly became a passion. For the past 15 years, Jonna has specialized in utilization management, including consulting with hospitals across the country on best practices, staffing challenges, and process improvement. Today, she brings that experience with her as Director of Utilization Management at Brundage Group.

Clinical Experience Meets Critical Thinking

For Jonna, her years in the emergency room continue to shape how she approaches utilization management.

The fast-paced environment taught her how to adapt quickly, while years of clinical experience strengthened the critical thinking skills she now uses to evaluate patient records and apply clinical criteria.

“You’re using your critical thinking skills as a nurse to see what qualifies in this patient’s condition.”

Jonna Mayfield, RN, BSN, CMGT-BC

That clinical perspective is what allows utilization management to go beyond checking a diagnosis against a set of criteria. It requires understanding the patient’s condition, treatment pathway, documentation, and clinical story as a whole.

It also creates opportunities for education. When documentation does not fully support a physician’s decision, Jonna’s team can engage directly with physicians to better understand the case and help strengthen the documentation.

“Over time, we’ll see an improvement just from having those brief conversations with the doctor,” Jonna said.

For her, those conversations are an important part of the work, not just correcting an individual case, but helping improve processes over time.

The Power of Education

Education is a recurring theme throughout Jonna’s approach to utilization management. She believes the strongest results come from helping healthcare teams understand the reasoning behind the work, rather than simply telling them what to do.

“I love that Brundage Group focuses on education,” she said. “We’re trying to educate as we go so that we’re actually improving processes along the way.”

That philosophy is particularly important in a field that Jonna believes is often underrepresented in traditional nursing and medical education. Understanding utilization management, documentation, and the importance of appropriate level-of-care decisions can benefit clinicians throughout their careers.

Technology as a Tool for Expertise

Jonna has watched utilization management evolve throughout her career. Early in her career, nurses relied heavily on physical books and learned many processes through trial and error. Today, technology provides faster access to information, more educational resources, and opportunities to streamline the review process.

She sees AI as another tool that can help clinicians spend less time searching through records and more time applying their expertise.

A tech-enabled review could pull together the most relevant information from a patient’s chart, potentially reducing the time a nurse spends gathering data. But Jonna is clear about where the expertise still belongs.

For Jonna, the future of utilization management isn’t replacing clinical expertise. It’s about giving experienced clinicians better tools to use that expertise more efficiently.

Making a Difference Behind the Scenes

After decades in nursing, Jonna’s motivation ultimately comes back to the same reason she entered the profession in the first place: making a difference.

And that impact doesn’t have to be visible to the patient.

“You don’t have to be at the bedside with that patient to make a difference,” she said.

A well-supported utilization management decision can help ensure a patient is placed at the appropriate level of care, while accurate documentation and review can help prevent unnecessary denials and support appropriate reimbursement for hospitals.

For Jonna, the connection between those two outcomes is what makes the work so rewarding.

“I love to see that we can decrease hospitals’ denials and we can improve their revenue,” she said. “And it’s all because of this expert team that we have that can come in and make a difference.”

After 35 years in healthcare, Jonna’s role may look very different from where she started, but her purpose hasn’t changed.

“I just have a passion for what we do and love to be able to make an impact for hospitals.” At Brundage Group, Jonna continues to bring that passion to her work every day, combining decades of clinical experience with a commitment to helping hospitals and the patients they serve.

The post Spotlight: Jonna Mayfield | Making an Impact Beyond the Bedside appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Then someone checks the net revenue. It’s up, by a lot.

What’s Actually Happening

Borderline two-midnight patients move from outpatient observation services to inpatient status when clinically appropriate and medically necessary. These low-weight Medicare Severity Diagnosis-Related Groups (MS-DRGs) cases are compliant, but they sit at the lower end of the acuity range. You’re adding volume to the inpatient population with cases that are legitimately appropriate under the Medicare Two-Midnight Rule but have lower severity (e.g., no complications/comorbidities or major complication/comorbidities) compared to the rest of the inpatient population. This one shift explains everything below.

Why CMI Falls

CMI is the average MS-DRG relative weight across inpatient discharges over a specific period. Adding lower-weight cases lowers the average. Coding and documentation didn’t get worse; the denominator expanded to include a healthier patient population.

The tell: CMI falling while inpatient volume and overall revenue rise. In contrast, a falling CMI while inpatient volume holds flat, and revenue per case signals decay, is a real problem. A falling CMI must be investigated rather than assumed to be a problem within the revenue cycle.

Why AR Days Climb

Inpatient claims are paid more slowly than observation claims. Higher dollar amounts and complex coding scenarios trigger more scrutiny from payers. Denied claims sit in the receivables aging while they’re being worked. AR days climb as a direct result of the same underlying shift; a higher inpatient population ratio results in more inpatient claims being adjudicated.

A better way to track AR days is to stop looking at one blended AR number. Track inpatient and observation AR days as separate cohorts. If each cohort’s aging is stable and the blended number moved only because the patient status mix moved, that is an artifact of the UM strategy, not a receivables problem.

Why Denials Rise

More inpatient claims mean more claims exposed to inpatient medical necessity review, especially as payer mix shifts towards Medicare Advantage. Adding three hundred inpatient stays to the patient population will increase the raw denial count, making UM efforts appear ineffective.

Instead, track the denial rate (denials per inpatient discharge). More often than not, the rate remains steady or improves. Hospitals must also consider their overturn rate. A high overturn rate means payers are challenging legitimate inpatient stays and losing, which is a defensible-status story, not a UM failure.

Why Net Revenue Wins

Inpatient care generates far more net revenue than observation care for a clinically comparable stay. Net revenue, more than cash collections alone, validates whether accepting slower payment on a much larger claim is the right tradeoff for the organization’s patient-status strategy. And because the cost structure for a given stay is largely similar regarding less patient status, that lift in net revenue generally improves EBITDA, though this could be tempered by increased costs if the change in status also drives a change in length of stay.

Higher AR days, plus higher net revenue, mean the organization is carrying more receivables and converting them into significantly more revenue than before. If net revenue per discharge is falling while CMI falls, that is a failure of the hospital’s revenue cycle. Net revenue per AA
(adjusted admissions) is the number that tells the true story of whether the new UR strategy is successful.

Reading the Four Together

CMI down, denials up, AR days up, net revenue up. That combination is evidence of a mix shift. Real deterioration looks different: CMI falling while revenue per case erodes, denials rising with weak overturn rates, AR aging within a single cohort rather than across the mix, and net revenue flat or falling.

Same four metrics, opposite story. Only segmentation tells you which one you’re in.

The Takeaway

Old benchmarks were built on a case mix that a successful UM program is designed to change. For organizations increasing appropriate inpatient capture, modest CMI dilution may become a natural consequence of changing patient-status mix.

As hospital reimbursement becomes more complex build dashboards around what distinguishes the two stories:

• Case-mix-adjusted views
• Denials per inpatient stay
• Dollars recovered and appeal success rate alongside denied dollars
• Inpatient and observation AR tracked separately
• Net revenue per adjusted admission (NRAA) as the metric that cuts through it all
• Final account write-offs as a check on whether the other metrics are telling the full story

Encourage alignment across UM, CDI, coding, and patient financial services before the quarterly review. If UM is capturing appropriate inpatient volume while finance is independently alarmed by CMI, the organization will inadvertently move back to leaving money and accuracy on the table. The goal is not to improve CMI, reduce AR days, or minimize denial counts. The goal is to maximize appropriate reimbursement while maintaining defensible clinical documentation and sustainable financial performance.

Don’t Let a Healthy Program Get “Corrected” Back into a Problem

If your CMI is dropping and your team can’t yet prove whether that’s dilution or decay, that’s the exact gap we help close. Brundage Group helps finance, revenue cycle, and clinical leaders distinguish between metric deterioration and metric distortion. By integrating UM, CDI, coding, denial, and financial performance data, organizations gain the visibility needed to determine whether a declining CMI reflects true operational weakness or the expected result of a changing patient-status mix.

The post When Good Utilization Management Makes Your Numbers Look Bad appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

As Senior Vice President of IT at Brundage Group, Aaron O’Brien leads the team developing the technology behind our physician-led services. From advanced analytics to workflow automation and client-facing solutions like Certus Radar, Certus Beacon, and Certus Navigator, his work helps hospitals gain greater visibility into their revenue cycle while enabling clinical teams to focus on informed, compliant decisions.

A Career Built on Solving Problems

Aaron’s career in technology began more than 20 years ago as a data analyst.

“I started as a data analyst and progressed from Microsoft Excel into advanced analytics, business intelligence, and technology leadership,” he says.

That experience eventually led him to Brundage Group.

“I really liked what Brundage Group was doing,” Aaron says. “Helping hospitals is meaningful work. My family has relied on hospitals throughout the years, so knowing our technology supports organizations providing patient care was something I wanted to be part of.”

Technology That Supports Clinical Expertise

Since joining Brundage Group nearly three years ago, Aaron has helped advance products that improve workflow efficiency, prioritize reviews, and provide actionable insights.

One of the biggest advancements has been the evolution of Certus Radar.

“We’ve focused on making it valuable not only from a financial perspective for hospitals but also as a complete product solution, from integrating with client systems to helping clients manage work and measure outcomes through Certus Beacon.”

For Aaron, technology isn’t replacing expertise.

“Our goal is to reduce the time our physicians and operational teams spend navigating workflows so they can focus on making the right clinical decision.”

Innovation Starts with Listening

Every product enhancement starts with client feedback.

“Our Business Development, Client Success, Operations, and Clinical teams work directly with hospitals every day, so they understand where the gaps and opportunities are.”

Aaron O’Brien, Senior VP of IT

Those insights, combined with clinical expertise, shape solutions that solve real-world challenges.

“Technology alone isn’t enough. You need the clinical perspective to make sure you’re building something that truly solves a problem.”

Keeping AI in Perspective

Aaron sees artificial intelligence (AI) as a way to improve efficiency, not replace clinical judgment.

Instead, AI can help prioritize records, streamline workflows, and automate routine work while physicians remain central to every meaningful decision.

“We’re big believers in keeping a human in the loop.”

Looking Ahead

Aaron is excited about the future of healthcare interoperability, a vision reflected in Certus Connect, Brundage Group’s latest technology offering.

By securely displaying electronic medical record data within Brundage Group’s workflow, Certus Connect streamlines reviews, reduces unnecessary system access, and shortens turnaround times.

“The goal is simple,” Aaron says. “Help our teams resolve cases faster while making the experience easier for our clients.”

While Aaron spends his days focused on software and product development, his perspective always comes back to people.

“We know what we do positively impacts hospitals,” he says. “I’d like to think those improvements help organizations better support their staff and improve patient outcomes.”

As healthcare technology continues to evolve, Aaron believes success will come from embracing innovation while maintaining a strong focus on security and trust.

As healthcare continues to evolve, Aaron believes organizations must embrace innovation thoughtfully.

“We’re living through one of the most disruptive periods in technology,” he says. “The organizations that succeed will be the ones that embrace innovation while maintaining a strong focus on security and trust.”

That philosophy continues to guide Aaron and his team as they build technology that strengthens collaboration, supports clinical expertise, and helps hospitals navigate an increasingly complex healthcare landscape.

The post Spotlight: Aaron O’Brien | Building Technology Behind Better Healthcare appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Today, as Lead Clinical Coding Analyst at Brundage Group, Robin helps healthcare organizations strengthen DRG accuracy and reduce denial risk before claims are submitted. But her understanding of denial management and DRG integrity was built through a path that was anything but linear.

In fact, much of her expertise was built by working on the opposite side of the table.

From Physician Billing to Revenue Integrity

Robin’s healthcare career began in the late 1990s, providing medical billing services for physician practices while raising her children at home.

“I wanted to have my own business so I could be home with my kids,” she recalled. “This was during the dial-up internet era, so everything took a little longer, but it gave me exposure to a wide variety of specialties and how reimbursement worked.”

As payer requirements became increasingly complex, Robin found herself drawn to the broader challenges of healthcare reimbursement and documentation. After earning inpatient coding credentials, she transitioned into the hospital space and eventually discovered a passion for DRG auditing.

“I thought I was going to love coding,” she said. “What I realized was that I enjoyed auditing much more. I liked identifying problems, finding opportunities, and understanding why things happened.”

That curiosity ultimately led her into the payer world, where she spent years conducting DRG audits, developing recovery concepts, and reviewing provider appeals for some of the nation’s largest health plans.

Learning the Payer Playbook

Robin’s experience reviewing claims and appeals on behalf of payers gave her an uncommon advantage: she learned exactly what auditors look for when evaluating documentation, coding accuracy, and clinical support.

“I was reading the appeal letters hospitals submitted and deciding whether I agreed with them or not,” she explained. “That experience taught me what the auditor on the other side wants to see.”

Over time, Robin became known for her deep understanding of payer tactics and denial trends. Her unique perspective earned her the nickname “Queen of Denial,” which eventually inspired her to develop a denial analytics application.

The tool helped organizations identify denial patterns, track root causes, and uncover documentation gaps that contributed to reimbursement challenges.

“It allowed us to drill down into why denials were happening,” Robin said. “Instead of just looking at the denial itself, we could identify documentation issues, education opportunities, and patterns that needed attention.”

While technology has evolved significantly since then, the experience reinforced something Robin continues to believe today: understanding denial risk requires more than simply reacting to denials after they occur.

Moving from the Payer to Provider Side

After years of working for payers, Robin transitioned to the provider’s side.

“I guess I got a little burned out being on the payer’s side,” she stated.

She joined Brundage Group initially supporting denial management efforts. Around the same time, she began collaborating with Dr. Rao on what would eventually become Brundage Group’s DRG Integrity service line.

“Dr. Rao told me we were going to build a DRG program,” Robin said. “I’ve been involved from the beginning, helping develop the rules, workflows, and processes that support what we’re doing today.”

That work continues to evolve as Robin develops sophisticated review rules designed to identify claims with the highest likelihood of denial risk, documentation concerns, or reimbursement opportunities.

Why Denial Prevention Matters

While many organizations still view DRG reviews primarily as a revenue optimization strategy, Robin believes the industry’s biggest opportunity today is denial prevention.

With clinical validation denials continuing to increase, Robin sees firsthand how payer scrutiny affects hospitals and health systems.

“There’s really no end in sight to the denials,” she said. “The best opportunity is to catch issues before billing and give organizations a chance to address them proactively.”

That proactive approach is one of the reasons she strongly believes in pre-bill DRG review.

“Getting it right the first time is really what we’re trying to do,” Robin explained. “If organizations can identify documentation concerns, coding risks, or potential denial issues before billing, they’re in a much better position than trying to fix everything after the fact.”

A Different Approach to DRG Integrity

When asked what sets Brundage Group apart from other vendors, Robin points to the depth of review and the collaborative expertise behind every recommendation.

That multidisciplinary approach allows Brundage Group to identify risks that might otherwise be missed while helping organizations avoid recommendations that could create future denial exposure.

“We’re not interested in recommending something simply because it increases reimbursement,” Robin explained. “If we know it’s likely to create a clinical validation issue later, we’re going to tell the client that.”

For Robin, success isn’t measured by how many claims are touched. It’s measured by helping organizations submit accurate claims, reduce rework, and strengthen revenue integrity.

Looking Ahead

Even after more than two decades in healthcare, Robin remains energized by solving complex reimbursement challenges and finding new ways to improve the review process.

One area that particularly excites her is the opportunity to combine utilization management insights with DRG expertise earlier in the patient journey—helping identify opportunities before coding is even finalized.

“We’re always looking for ways to be more proactive,” she said. “The goal is to help organizations identify opportunities and risks as early as possible.”

That mindset—always asking what comes next and how processes can be improved—has been a constant throughout Robin’s career.

From physician billing and coding to payer audits, denial management, and DRG integrity, she’s spent more than 25 years understanding every side of the reimbursement process.

Today, healthcare organizations benefit from that experience every time she helps them prevent a denial before it happens.

And if there’s one thing Robin has learned along the way, it’s that sometimes the best way to win an appeal is to never need one in the first place

The post Spotlight: Robin Sewell — Turning Denials into Prevention appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

In 2009, early in his emergency medicine career at Morton Plant Hospital, Dr. Smith met Dr. Tim Brundage.

“At the time, I didn’t think much about it beyond just having a good conversation,” Dr. Smith recalled. “But I always remember him. He was easy to talk to, thoughtful, and clearly cared about people.”

Years later, after building a career that spanned emergency medicine leadership, hospital administration, and the payer side of healthcare, Dr. Smith would once again cross paths with Dr. Brundage, this time as part of the team at Brundage Group.

That full-circle moment reflects much of Dr. Smith’s approach to healthcare today: relationships matter, collaboration matters, and behind every operational challenge are people trying to do meaningful work.

Over the course of his career, Dr. Smith has worked across nearly every corner of healthcare, from paramedic and phlebotomist to emergency physician, department leader, and payer-side physician reviewer. Those experiences gave him something many healthcare professionals never fully see: the perspective from both sides of the system.

Speaking Different Languages, Chasing the Same Goals

After years spent in clinical leadership and administration, Dr. Smith noticed a recurring challenge inside healthcare organizations.

In many cases, teams are not necessarily working against one another. They are simply operating under different pressures, priorities, and expectations.

“Clinical leaders, financial leaders, and operational leaders are often trying to accomplish the same things,” Dr. Smith explained. “But they’re speaking different languages.”

For clinicians, the focus is on delivering quality patient care. For hospital leadership, it maintains operational stability while continuing to serve the community. For financial and utilization management teams, it is ensuring the organization can sustain that care long-term.

The problem, according to Dr. Smith, is that those efforts often become siloed.

Departments can unintentionally end up operating independently, managing their own fires, metrics, and responsibilities without the time or resources to fully align with one another.

That disconnect creates friction, slows decision-making, and often increases the burden placed on already overwhelmed clinical teams.

The Role of a Trusted Advisor

Dr. Smith believes Physician Advisors play a critical role in helping bridge those gaps.

That perspective became even clearer after Dr. Smith transitioned to the payer side of healthcare.

“There were so many things I remember thinking, ‘I wish I had known this earlier,’” he said. “Simple things that could have helped hospitals and physicians tremendously if we had understood how documentation and medical necessity were being evaluated.”

Now working as a Physician Advisor with Brundage Group, Dr. Smith uses those experiences to help hospitals navigate increasingly complex payer expectations, patient status decisions, and documentation requirements.

Rather than adding to the administrative burden clinicians already face, he believes Physician Advisors should function as collaborative partners who simplify complex processes and provide clear, actionable guidance.

“If clinicians have trusted support behind them, they can focus more of their attention on where it belongs, on patient care,” he explained.

Turning Insight Into Action

As healthcare continues to evolve, Dr. Smith sees the need for proactive support becoming even more important.

Hospitals today are balancing staffing shortages, growing payer scrutiny, changing regulations, and increasing operational demands, often all at once. Many organizations are forced into a reactive cycle simply because they do not have the time or resources to stay ahead of every change happening across the industry.

That is where the combination of physician expertise and proactive analytics becomes especially valuable.

Through solutions like Certus Radar, Brundage Group helps hospitals identify patterns, recognize emerging risks, and address issues before they escalate into larger operational or financial problems.

For Dr. Smith, the value is not simply in preventing denials or improving the accuracy of patient status. It is helping hospitals achieve stronger alignment between the people delivering care and the systems that support it.

Building Stronger Partnerships in Healthcare

At the center of Dr. Smith’s philosophy is a simple idea: healthcare works better when people trust each other.

Whether he was leading an emergency department, reviewing cases on the payer side, or supporting hospitals as a Physician Advisor today, Dr. Smith has consistently focused on helping people work together toward shared goals.

Because ultimately, the challenges facing healthcare are rarely solved by one department alone.

They are solved through collaboration, communication, and trusted partnerships that help organizations move forward together.

The post Spotlight: Dr. Gregory Smith – A Career Built on Understanding Both Sides appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Today’s hospitals are operating in an increasingly complex environment, marked by shrinking margins, rising payer denials, and evolving regulatory demands. In response, Utilization Management (UM) has become more than a compliance function; it is now a critical driver of both financial performance and patient access to care. Dr. Simon Ahtaridis, MPH, CHCQM, Lead Physician Advisor for the UM service line, shares how Physician Advisors help hospitals navigate these challenges and where opportunities remain.

Connecting Clinical Care with Reimbursement

As the gap between clinical care and reimbursement continues to widen, hospitals are facing a familiar challenge: delivering appropriate care that isn’t always fully reflected in the medical record. While physicians are highly skilled at diagnosing and treating patients, they are not always trained to clearly demonstrate medical necessity in documentation, an issue that has become increasingly important as payers intensify their review processes.

This is where the Physician Advisor plays a critical role. By working alongside physicians, case management, and Clinical Documentation Integrity (CDI) teams, Physician Advisors help ensure that the patient’s story is accurately captured in real time. These collaborative efforts not only strengthen compliance but also support more accurate reimbursement.

Moving from Reactive to Proactive Utilization Management

For many hospitals, Utilization Management has traditionally been reactive, identifying issues after a patient has been discharged, when opportunities to correct documentation or clarify status are limited. In today’s environment, that approach is no longer sustainable.

Competing priorities, limited resources, and complex electronic medical records can make it difficult to consistently capture patient complexity during the hospital stay. As a result, missed opportunities often translate into avoidable denials and lost revenue.

Leading organizations are shifting toward a more proactive model, focusing on early identification of patient status, stronger alignment across UM, CDI, and case management, and the use of real-time insights to guide decisions during the inpatient stay. This shift allows teams to address issues before they escalate, reduce denials, and improve overall performance.

Helping Hospitals and Communities Thrive

The impact of these challenges extends beyond hospital operations. Financial instability can directly affect access to care, particularly in rural communities where resources are already limited. When hospitals are not reimbursed appropriately, the consequences can ripple outward, impacting staffing, services, and long-term sustainability.

Addressing these challenges requires coordinated effort across clinical, operational, and financial teams. Physician Advisors play a key role in bringing these groups together, aligning priorities, and ensuring that care decisions are both clinically sound and financially supported.

At the same time, many hospital leaders lack the tools needed to fully interpret their data and identify where opportunities exist. As Dr. Ahtaridis notes, having clear visibility into performance is essential for making informed decisions. Advanced analytics can help bridge this gap, turning complex data into actionable insight and enabling a more proactive approach to Utilization Management.

As healthcare continues to evolve, so does the role of the Physician Advisor. Increasing complexity demands deeper expertise, a more proactive approach to Utilization Management, and stronger collaboration.

Ultimately, the goal is clear: ensure hospitals are accurately reimbursed for the care they provide so they can continue delivering high-quality services to the patients and communities that depend on them.

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Pinellas Park, Fla. – April 27, 2026 

Brundage Group, a physician-led leader in revenue cycle management (RCM) consulting and Physician Advisor services, today announced the launch of its newly redesigned Certus Navigator Utilization Management portal—a configurable, workflow-driven platform designed to deliver personalized, role-based experiences and real-time patient and case management. 

The platform represents a major transformation, enabling healthcare teams to manage patient records, track cases, and act directly within the system. Users can leverage Certus Radar to view patient census data, identify actionable items, and execute built-in workflow actions, from submitting cases to updating records, without leaving the portal.

Key enhancements include: 

• Role-based experiences tailored to user responsibilities  

• Real-time patient and case management through Certus Radar with actionable workflows  

• Built-in workflow actions that allow users to submit and manage cases directly from patient records  

• Enhanced dashboards with advanced, configurable filtering for customized insights  

• Built on Salesforce Experience Cloud with Apex-powered data integrations, ensuring seamless connectivity and performance  

The redesigned Certus Navigator portal underscores Brundage Group’s commitment to delivering technology-enabled, physician-led solutions that support the evolving demands of today’s healthcare environment. 

About Brundage Group 
Brundage Group is a leading provider of physician-led, tech-enabled clinical and revenue integrity solutions for U.S. hospitals and health systems. Its team of top-tier Physician Advisors, proprietary analytics, and educational programs empower health care providers with ensuring inpatient care is thoroughly documented, clinically justified, and compliant with regulatory standards. Founded in 2007, Brundage Group is dedicated to enhancing clinical accuracy, regulatory compliance, and financial health for hospitals and health care systems nationwide, so they can focus on providing exceptional care to their patients and communities.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

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Unifying CDI, Coding, and Physician Advisors

The landscape of hospital revenue integrity is rapidly evolving, and the once-separate worlds of Utilization Review (UR), Clinical Documentation Integrity (CDI), coding, and Physician Advisors are now converging into a unified strategy. Cheryl Ericson, RN, MS, CCDS, CDIP’s career journey exemplifies this transformation. With experience in public health, nursing, insurance, and hospital administration, Cheryl witnessed firsthand how siloed functions led to inefficiencies and missed opportunities. Coders, nurses, and physicians often operate independently, unaware of how their work impacts the broader clinical revenue cycle. Claims data (also referred to as administrative data) both directly and indirectly impact hospital revenue as a function of reimbursement and value-based care.

The Power of Collaboration

Today, effective revenue integrity depends on structured collaboration. Cheryl emphasized the importance of regular meetings, case reviews, and open dialogue among UR, CDI, coding, and Physician Advisors. This collaborative approach breaks down barriers, fosters mutual respect, and ensures that each group’s expertise is leveraged toward shared organizational goals. It all begins with physician documentation; without physician support, we can’t achieve optimization. Having physicians actively involved is invaluable; sometimes, when you’re coding or working through cases, their direct input can clarify ambiguities and ensure that the documentation reflects the true clinical picture. Physician Advisors, once seen as peripheral, are now central to bridging clinical and administrative priorities. Their involvement ensures that physician intent is accurately captured; coding reflects true patient acuity, and documentation supports both reimbursement and quality metrics. Cheryl noted, “Physician Advisors have gained a lot more confidence and a lot more knowledge. I think before they used to be very dependent on CDIs and coders, and so they didn’t necessarily express their own opinions as much.” This evolution highlights how Physician Advisors now play a more assertive and informed role, contributing their own perspectives alongside the expertise of other revenue cycle teams.

Adapting to a Changing Environment

Hospitals today face pressures like shrinking margins and staffing shortages. Cheryl emphasizes that achieving sustainable revenue integrity requires integrating UR, CDI, coding, and Physician Advisors into a cohesive reporting framework. At many hospitals, UR, CDI, and coding report to different departments, creating silos and communication barriers. Cheryl notes, “Often departments are so focused on their own silo and trying to meet those metrics instead of considering how their metrics relate to organizational goals.” By integrating these functions into a single clinical revenue cycle structure, organizations can improve coordination, oversight, and accountability. This alignment ensures that committees, such as those focused on sepsis, readmissions, or mortality, make decisions that consider clinical functions and downstream impacts associated with patient status and coding, while supporting organizational goals such as the case mix index, denial prevention, and quality. Cheryl recommends practical steps, including unified leadership, transparent technology, and a shared culture of learning, to help teams work toward common objectives and strengthen both financial and clinical outcomes.

Looking Ahead

As outpatient volumes rise and inpatient cases become more complex, the need for integrated expertise will only grow. The migration of procedures from the inpatient to the hospital outpatient setting will be hastened by the elimination of the inpatient only list, likely resulting in an eventual shift to independent ambulatory surgical centers leading to significant loss of revenue for most hospitals. For example, the National Patient and Procedure Volume Tracker by StrataSphere® for 12/31/24 shows that inpatient primary knee replacement is down 21.2% in 2024 compared to 2023. Inpatient primary hip replacement is down 3.8% when comparing 2024 rates to 2023. The healthcare industry is changing more rapidly than at any other time, as payers fight to maintain profits by challenging hospital billing practices. In contrast, hospitals contend with new regulations designed to reduce fraud and waste. Cheryl’s insights and ongoing thought leadership reinforce a clear message: revenue integrity is a team sport, and success depends on breaking down silos in favor of unified, strategic, measurable action. The future of hospital financial health lies in the seamless integration of UR, CDI, coding, and Physician Advisors, ensuring hospitals remain viable, compliant, and focused on delivering high-quality patient care.

The post Spotlight: Cheryl Ericson – From Silos to Synergy appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Dr. Patel’s Career Journey and Path to Leadership

Dr. Patel’s passion for medicine began early, inspired by a blend of scientific curiosity and a desire to serve his community. After medical school at the American University of the Caribbean and clinical rotations in New York, he completed his residency in Chicago, where he first assumed a leadership role as chief resident. His career then took him to New England, where he practiced as a hospitalist before being tapped for a dual clinical and administrative role. The shift to physician advisory work was motivated by a need for stability as he started a family, but also by recognition of his strong interpersonal skills and attention to detail. As Dr. Patel shares, “It worked out perfectly cause my wife and I were expecting our first child later that year. So that was more stability, and that was one of the primary reasons that I took it.” Eventually, Dr. Patel joined Brundage Group, seeking broader exposure to healthcare systems and the flexibility of remote work.

The Role and Impact of Physician Advisors

Physician Advisors serve as the essential bridge between clinical teams and hospital administration. Dr. Patel describes their role as translating the realities of bedside care into actionable insights for the C-suite, ensuring that both patient care and financial sustainability are prioritized. As Dr. Patel puts it, “The importance of why we need to document this way, and the connection between the clinical side and the financial side is lacking.” Their work impacts everything from documentation practices to regulatory compliance and revenue cycle management. By speaking the language of both clinicians and administrators, Physician Advisors help align hospital operations with the realities of patient care, reducing denials and improving outcomes.

Collaboration Between Physician Advisors and Executive Leadership

A central theme in Dr. Patel’s journey is the importance of strong alignment between Physician Advisors and hospital executives, particularly the Chief Medical Officer. Dr. Patel emphasizes that “when leadership delivers unified messages, physicians benefit from clear and consistent direction, minimizing confusion and allowing them to prioritize patient care.” Productive partnerships are rooted in transparent communication, reliance on data-driven strategies, and mutual respect. Dr. Patel believes, “hospitals that empower Physician Advisors and involve them in strategic planning see measurable gains in critical metrics such as length of stay and denial rates, resulting in positive outcomes for both patients and the organization.” This collaborative approach nurtures a culture of shared responsibility and informed decision-making, ultimately elevating both patient care and overall hospital performance.

Future of the Physician Advisor Role

Looking ahead, Dr. Patel envisions the Physician Advisor role as an evolving career path within the medical profession. As he reflects, “I think that it will possibly become a new career path. You go through your medical schooling, you do your training, some bedside rounds or bedside years and then maybe even during your training there’s some portion incorporated, but I see it almost as a dual business administrative and medical degree. This perspective underscores a future where advisory experience is integrated earlier in training, blending clinical expertise with business acumen to prepare future leaders who can navigate both patient care and hospital operations effectively.

Dr. Patel’s journey illustrates the profound impact Physician Advisors can have, not just on individual patients, but on entire hospital systems. His advice to healthcare leaders is clear: prioritize alignment and collaboration between Physician Advisors and the C-suite to drive better outcomes for all. In Dr. Patel’s words, “the true value of this role lies in helping hundreds or thousands of patients by ensuring hospitals remain strong, sustainable, and patient-focused.”

The post Spotlight: Dr. Dhaval Patel—Bridging Clinical Excellence and Healthcare Leadership appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Breaking Barriers and Leading by Example

Entering medicine in the 1990s, Dr. Geoffrion faced a workforce dominated by men. She quickly learned that respect and equal pay were not freely given to women physicians. Her promotion to chief resident marked a pivotal moment, affirming her place in the field and her ability to lead. Dr. Geoffrion recalls confronting sexism directly, including a memorable incident in which she challenged a colleague’s dismissive nickname in the operating room, earning applause from peers. Throughout her career, she has consistently demonstrated the importance of setting a high standard for others to follow. “I like to be an example. I like to be the person who’s doing the job better than everybody and lead by example,” Dr. Geoffrion said. Her commitment to excellence and leadership has paved the way for others, inspiring colleagues and mentees to strive for their best.

Balancing Career and Family

Balancing a demanding career with family life, Dr. Geoffrion became one of the country’s first hospitalists, working night shifts for 15 years so she could raise her three children. Reflecting on the experience, she said, “I had three children under the age of five, and I was able to work nights and then still be, you know, like a stay-at-home mom for them with a lot of help, family support. So, for me it was a career where I could do two things that I love the most, right? To be a mom and a doctor. As a matter of fact, my license plate is ‘Doctor Mom.’ I just wanted to be able to have a family, but at the same time have a career that was challenging.” Dr. Geoffrion credits her supportive spouse and careful planning to help her prioritize quality family time, even when quantity was limited.

Meaningful Impact and Continued Advocacy

Throughout her career, Dr. Geoffrion found profound meaning in caring for patients during their most vulnerable moments, cherishing the opportunity to comfort families, advocate for patients, and make a difference in critical times. As her journey progressed, she transitioned into the role of Physician Advisor and expanded her advocacy by helping hospitals navigate complex systems and ensuring patients receive the care they needed. Joining Brundage Group in 2022, marked a new chapter, bringing renewed inspiration through collaboration with passionate colleagues. On this environment, Dr. Geoffrion said, “I think it’s great to be around people that all have the same passion to, you know, help hospitals. You know, I think I would say that it inspires me every day. We just learn something new every day at this job.” The intellectual stimulation and sense of shared purpose at Brundage Group continue to motivate her each day.

Progress for Women in Medicine

Dr. Geoffrion has witnessed significant progress for women in medicine, noting that women now outnumber men in medical school classes and are increasingly taking on leadership roles. She has played an active part in building supportive communities, from organizing networking groups to mentoring young physicians. Dr. Geoffrion believes women physicians excel at networking and supporting one another, creating spaces for growth and shared success. She fondly recalls, “We started a women physicians potluck and we did it every other week, and we would all meet and just talk about the challenges of medicine and leadership.” These gatherings offered camaraderie and a valuable space for sharing experiences and supporting one another, helping female physicians navigate the unique obstacles they faced in the medical field.

Advice for Future Generations

Her advice to future generations is clear: pursue medicine with empathy, passion and perseverance. Dr. Geoffrion encourages women not to take shortcuts, and to embrace the challenges and rewards of a fulfilling career. “I love teaching, and so I always encourage women to go into medicine. I don’t tell people not to do it. I think it’s a fantastic career.” Dr. Geoffrion believes medicine is a calling, and those who feel drawn to it will find satisfaction and purpose.

A Lasting Legacy

Dr. Cheryl Geoffrion’s legacy is one of resilience, leadership and unwavering commitment to her patients, colleagues and family. As we celebrate National Women Physicians Day, Dr. Geoffrion stands as a role model and inspiration — showing what is possible when determination meets compassion in the world of medicine.

The post Celebrating Dr. Cheryl Geoffrion: National Women Physicians Day appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

A Career Built on Service and Education

Dr. Deppert’s medical training began at Hahnemann University College of Medicine (now Drexel), followed by a residency and chief residency at the University of Pennsylvania Presbyterian Hospital. He balanced clinical practice with teaching, mentoring future doctors, and holding leadership positions such as Vice Chairman of Medicine and Chief Medical Officer at several major hospitals. Despite the demanding hours and frequent relocations, Dr. Deppert’s focus remained on building relationships with patients and colleagues, always striving to improve healthcare delivery. 

Prevention and the Power of Listening

A central theme in Dr. Deppert’s career, and his writing, is the importance of prevention. Early on, he noticed that many patients arrived at the hospital with advanced, preventable illnesses. This realization fueled his advocacy for early detection, lifestyle changes, and patient education.

“Prevention is really important, but it is a balance,” said Dr. Deppert. His approach emphasizes not only the value of preventive care but also the need to consider each patient’s unique situation, listening closely to their concerns and goals.

He developed innovative programs to address risk factors for heart disease and stroke, emphasizing that it is never too late to make positive changes. Dr. Deppert’s stories highlight the need for doctors to listen deeply, understand the whole person, and address not just physical symptoms but also behavioral and societal factors. 

Writing as Reflection and Legacy

Dr. Deppert’s first book, titled, “NREDOM ENICIDEM: Modern Medicine is Backwards,” distills decades of experience into practical lessons for both patients and physicians. He hopes readers take away that “it’s never too late,” that self-care and open communication with healthcare providers are vital, and that small steps can lead to meaningful change.

Reflecting on his approach, Dr. Deppert remarked, “I kind of forgot maybe on some level that there’s also a role for prevention in terms of the total plan, right, I just focused on the tree in front of me, I forgot about the whole forest. This is a person. It’s not just a stroke or a heart attack.” His words underscore the necessity of seeing each patient as a whole individual, not just a diagnosis.

Looking Forward: A Trilogy of Healing

Dr. Deppert’s commitment to education and advocacy doesn’t stop with this book. He is already working on two more: one delving into spirituality and resilience in the face of adversity, and another focused on the art of truly listening to patients. Together, these works form a trilogy that reflects his holistic vision for healthcare, one that honors the mind, body, and spirit.

As Dr. Deppert discusses the topic of his upcoming third book, “The Unheard Patient: I Know My Doctor Heard Me, but Did He Listen?” he notes, “Hearing is a passive process.” This insight captures the distinction he makes between simply hearing a patient’s words and truly listening to understand their needs and concerns. By emphasizing this difference, Dr. Deppert advocates for a deeper, more empathetic approach to patient care that goes beyond routine interactions.

Personal Stories and Resilience

Dr. Deppert’s journey has not been without challenges—hospital bankruptcies, personal loss, and health struggles have shaped his perspective. He shares candidly about setbacks and the role of faith, family, and perseverance in overcoming adversity. These experiences have deepened his empathy and commitment to supporting others, both in and out of the hospital. 

A Lasting Impact

When asked about his legacy, Dr. Deppert’s answer is simple: he hopes to be remembered as someone who cared, who tried to have an influence, and who shared his vulnerabilities to help others. His story is a powerful reminder that medicine is not just about science, but about compassion, connection, and the courage to keep moving forward.

Dr. Eric Deppert’s book is available now, and his insights continue to inspire both the medical community and the broader public. We are honored to share his story as part of the Brundage Group family.

The post Spotlight Interview: Dr. Eric Deppert – A Life Dedicated to Healing and Humanity appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Nationwide revenue cycle solutions provider helps hospitals navigate the complexities of clinical revenue cycle management.  

Tampa, Fla. – [September 23, 2025] 

The Patient Protection and Affordable Care Act (ACA) of 2010 was designed to reduce the number of uninsured by providing a continuum of affordable coverage options. The ACA increased the volume of low-income adults who qualify for Medicaid coverage beyond those with disabilities through Medicaid expansion to those with incomes 138% of the federal poverty level.  

KFF reports that in 2024, 44 million (16.4%) of the nonelderly U.S. population participated in an ACA program (marketplace, Medicaid expansion or a Basic Health Plan). Enrollment in marketplace plans reached a record high of 21.4 million. Enhanced premiums lower payments for health insurance policies. Some policies are free for those with incomes up to 150% of the federal poverty level.  

Enhanced premium tax credits expire in 2025. If these subsidies are not extended it will increase the volume of uninsured patients beyond projected losses due to changes in Medicaid eligibility.  

• Without the tax credit, healthy people will likely decline health insurance, increasing the uninsured population by an average of 3.8 million annually.  

• Premiums will increase by more than 75% on average for those who remain within the health insurance marketplace, which will contribute to higher levels of bad debt for most hospitals.  

It is estimated that these tax credits allowed 10 million people to gain affordable healthcare coverage through the health insurance marketplace. The American Hospital Association (AHIA) Fact Sheet on Enhanced Premium Tax Credits cite the impacts of these lost subsidies include:  

• An average increase of at least $700 in the price of marketplace health insurance plans.  

• 4.2 million mostly rural and low-income people becoming uninsured by 2034.  

• A reduction in hospital spending of $28 billion over 10 years creating “considerable financial stress on hospitals, health systems and other providers, which will face more uncompensated care and bad debt.”  

What This Means For You: 

The expiration of premium tax credits has the potential to reverse years of progress in reducing the uninsured population, with far-reaching consequences for patients, hospitals, and communities. The financial impact – more uncompensated care, greater bad debt, and reduced hospital resources – will directly affect care delivery, especially in rural and underserved areas.  

Now is the time for healthcare leaders to raise awareness and advocate for policies that preserve access to affordable coverage. Brundage Group encourages Physician Advisors, hospital executives, and clinical leaders to engage in this dialogue to ensure your organization’s voice is heard on an issue that directly impacts patient care and financial sustainability.  

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