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