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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.

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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, health care trends he's keeping an

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eye on a bit more. Doctor Yulo, thank

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you so much for joining me today. Thank

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you for having me, Chanel. Perfect. Well, to

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get us started out, could you please introduce

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yourself, tell us a bit about your background

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and 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 got to

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provide 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.