Pachavit Kasemsap

Criteria for CMS Star Ratings

Certified by the American Board of Surgery, Dr. Pachavit Kasemsap is the former medical director of WellMed Medical Group. In that role, Pachavit Kasemsap, MD, maximized outcome among independent physician groups through collaboration with the operations and provider relations staff, mentoring and maintaining continuous communication with contracted physicians, and recruiting new medical directors. He also raised CMS Star rating to 4.5.

Launched in 2007, the Centers for Medicare and Medicaid Services (CMS) Hospital Star Rating System helps consumers better understand the performance rates of nearby health facilities. The ratings are available on the CMS Hospital Compare website. CMS Star Ratings help give patients a prior knowledge of the quality of care offered at local health facilities and the chance to compare the quality of service offered by one with another.

CMS calculates hospital star ratings from data collected from the hospitals; Outpatient Quality Reporting OQR and Inpatient Quality Reporting. Hospitals have to provide a minimum of three measures within a minimum of three measure groups, which must include one outcome group (readmission rate, patient safety, or mortality) to be eligible for an overall CMS rating. Other performance areas include timeliness of care, patient experience, and effectiveness of care.

Primary Care Practices in Need of Assistance to Stay Afloat

Pennsylvania physician Pachavit Kasemsap, M.D. is a medical director manager in utilization management at Cigna and focuses his work on the efficiency and appropriateness of medical programs at the company. In addition to his work with Cigna, Dr. Pachavit Kasemsap is also a member of the American Medical Group Association (AMGA), an organization that aims to improve health and find ways to care for patients at a lower cost.

Recently, the organization published an article focused on the need for primary care practices to get help in response to the current pandemic. The article predicts a dark future for the entire sector unless funding and support are provided.

Currently, office visits have decreased almost 25 percent since the onset of the pandemic with many struggling to remain open. Moreover, according to the Commonwealth Fund, both virtual and in-person office visits have declined since the outbreak. Because of stay-at-home orders across the country compounded by office closures, revenue sources have dropped significantly.

While the federal government has assisted and the Primary Care First has initiated capitation payments (which will not go into effect until 2021), many practices would have to close their doors. For this reason, the Commonwealth Fund, America’s Health Insurance Plans, and primary care medical societies, in addition to other organizations, have asked Congress to allocate money for primary practices in the next stimulus package.

Areas of focus include telemedicine coverage and contracting strategies. With this funding, the industry organizations are hoping to encourage insurers to provide telemedicine coverage and rewarding primary care providers for providing patients high-quality care.

The alternative to not providing support is quite bleak. The public could potentially face a healthcare system where it would take six months to get an appointment to see a doctor-and simply because many physicians would be forced to close their doors leaving the ones who are still practicing overwhelmed with a patient load.

What Is a Flight Surgeon?

Dr. Pachavit Kasemsap is a general surgeon and a United States Air Force veteran. An accomplished Medical Director and Healthcare Manager, Pachavit Kasemsap, MD, spent nine years as a flight surgeon, a critical role in maintaining the health of airmen.

Flight surgeons are medical specialists who work with Air Force personnel. These surgeons must master a set of skills above that of a typical surgeon since the men and women they treat are often exposed to challenging conditions that can have complex effects on their bodies. The job of a flight surgeon is to prevent, detect, and treat the many physiological responses that can result from those challenges.

Flight surgeons require an MD or DO, and they must complete an American Osteopathic Association-accredited program of specialty training. Further, flight surgeons must pass a course in aerospace medicine and complete a residency program. As commissioned officers, flight surgeons must complete officer courses as well and be board-eligible for aerospace medicine.

How to Improve Current Utilization Management Practices

Pachavit Kasemsap, MD served in the military as a flight surgeon and founded a bariatric surgery program. Today, Dr. Pachavit Kasemsap works for Cigna as a medical director in utilization management.

A 2017 article published in Healthcare IT News reported that even as early as 2013, the healthcare industry has suffered from inefficiencies in terms of utility management. In the years spanning 2011 and 2013, 64 percent of physicians reported having problems determining which tests, procedures, and drugs a patient needed, and 63 percent of physicians reported having to wait several days for authorizations on drugs, procedures, and tests with 13 percent having to wait longer than a week.

These efficiencies added up for both payers and providers. For payers, the costs totaled $74 billion, and for providers, the costs totaled $31 billion, and these were only administrative costs. In total, the loss to the healthcare industry added up to $800 billion in administrative efficiencies, provider error and efficiency, duplicative care, fraud and abuse, and other areas of waste.

However, these inefficiencies can be addressed in a few ways. Even with time and budget constraints, including a 24-hour case manager that can assess efficiencies at all points of care (before, during, and after) improves the likelihood that patient receives effective, high-quality care and reduces healthcare costs. Finally, the use of automation as it relates to storing patient information can reduce duplication of services, i.e. electronic health records.

The Role of EMRs in Increasing Preventive Care Measures

Former flight surgeon Pachavit Kasemsap, MD, possesses extensive experience in healthcare management. In a former role, Dr. Pachavit Kasemsap oversaw clinical outcomes across the network where he was employed.

A key element in clinical outcomes is making sure patients receive preventive care. The push to integrate preventive care into the healthcare platform also translates into reduced costs for healthcare organizations. In recent years, healthcare organizations are recognizing the efficacy of electronic medical records (EMRs) in increasing preventive care outcomes.

EMRs are used to assist in clinical decision support (CDS) that involves providing patients with appropriate preventative care measures. EMRs play a two-pronged role in assisting healthcare providers with centralizing information and a place where patient therapies (and outcomes) can be recorded.

EMRs are important in preventive care for few other central reasons. EMRs serve as tools for tracking patient progress and therapy, which reduces duplication in services and maximizes performance measures. They aid physicians in diagnosing patients sooner, and more importantly, they reduce errors and improves patient safety.

On larger scale, EMRs have the possibility to gather data to make decisions about whole populations. For example, this tool can store information related to a group of patients suffering from the same condition, and search for the patients that qualify for a specific treatment. This data would include current medications a patient has been prescribed. In terms of public health outcomes, this tool is invaluable in healthcare management.

The New Healthcare Shortage – Military Combat Physicians

Former flight surgeon and healthcare administrator Pachavit Kasemsap, MD, previously served as a physician in the United States Air Force. Dr. Pachavit Kasemsap also performed a tour of duty in Iraq, where he served as a combat physician.

A need for physicians still exists in the Middle East. As recently as two years ago (2018), military physicians serving in the Middle East were busy, some seeing patients every day. With existing tensions in the Middle East, the shortage of military physicians is a crucial factor in military defense. Even with this shortage, the Pentagon has reduced the number of physicians and other healthcare professionals by 18,000.

The need for combat physicians is integral, especially with the state of political affairs in the Middle East. Combat physicians are trained in trauma life support care. In war zones, uniformed physicians meet that need. Moreover, military physicians are soldiers trained in combat.

From working with patients in war zones to jumping out of airplanes, physicians trained in these areas engender the trust of their troops. More importantly, they are one of the most significant factors in fortifying troops and playing a critical role in defense.

Advantages of Robots in General Surgery

A medical director manager in utilization management at Cigna, Pachavit Kasemsap, MD has close to 20 years of experience in medicine and has served as both a flight and general surgeon. As a general surgeon, one of Dr. Pachavit Kasemsap’s specialties is bariatric surgeries.

For many physicians, robotics has contributed to the success of surgical procedures. Just three years ago, many researchers found that there were many benefits to relying on robotic-assisted surgeries (RAS).

The adoption of RAS has increased in the years spanning 2008 to 2015. While cost is a major disadvantage, one of its central benefits is that it provides physicians with a three-dimensional view of the operating site. Moreover, the robotic arms allow for more dexterity, and it allows for clearer images of nerves and vessels. Finally, the robot can be used in confined, close spaces without interfering with the surgeon’s ability to work.

Patients also stand to benefit from hospitals that adopt RAS. The surgeries have been akin to what laparoscopic surgeries were 30 years ago in that they allowed minimal invasiveness and less blood loss. Patients experience less pain, infection, scarring, and fewer wound complications. RAS, finally, surgeries can also translate into shorter hospital stays and quicker recoveries.

ACS Urges Congress to Legislate on Surprise Medical Bills

Healthcare administration specialist Dr. Pachavit Kasemsap serves as medical director manager in utilization management of Cigna, where he is responsible for completing utilization management determinations and assisting with appeals when necessary. Board-certified by the American Board of Surgery, Pachavit Kasemsap, MD is a Fellow of the American College of Surgeons (ACS).

ACS has raised concerns about the impact of surprise medical bills on the patient-physician relationship. In urging the legislators for a comprehensive solution to the issue, ACS maintains its position that patients should not be caught up in the middle of payment negotiations between healthcare insurance providers, physicians, and hospitals.

ACS provided lawmakers with the physician’s perspective on the issue since lawmakers have been forging legislative proposals to eliminate out-of-network care surprise medical bills since last year. ACS said that any future bills that will tackle the issue should protect the patients. Legislation should also increase transparency and accountability of insurance plans, and address inadequate networks. Additionally, ACS believes that legislative solutions to the issue should not put reliance on rate-setting based on negotiated in-network rates. Neither should the solution depend on a percentage of Medicare to cover out-of-network care.

These suggestions are important considerations and if the members of Congress do not heed these inputs, ACS expects large-scale effects on the healthcare system. For the solution to surprise medical bills to be sustainable, physicians and insurance providers should implement a fair independent dispute resolution process to negotiate final payment.

Comparing Original Medicare and Medicare Advantage

Based in Pittsburgh, Pennsylvania, Dr. Pachavit Kasemsap serves as Cigna’s medical director manager in utilization management (UM) and oversees the completion of UM determinations and assists in UM appeals. Among Pachavit Kasemsap, MD’s core responsibilities is supporting the firm’s Medicare Advantage business.

A federally mandated program, Medicare offers patients several primary ways of accessing coverage. One is through Medicare Part A (hospital insurance) and another is through Part B (medical insurance), with Part D covering the Medicare prescription drug plan.

Original Medicare combines Part A and Part B, with patients able to join Part D separately. It allows the flexibility of accessing any physician or hospital nationwide that accepts Medicare. Those wanting to cover 20 percent coinsurance and other out-of-pocket costs can purchase supplemental coverage, and add elements such as Medigap and former employer or union coverage.

A preferred route for many is Part C, Medicare Advantage, which bundles the other three forms of Medicare coverage. It reduces out of pocket costs compared to Original Medicare, and typically offers benefits beyond Original Medicare such as dental, hearing, and vision. Medicare Advantage does have greater restrictions, including requiring the use of physicians who are within the plan’s network for care that is non-urgent and non-emergent.

RAF – How It Is Estimated

A member of the American Medical Group Association as well as the American Association for Physician Leadership, Pachavit Kasemsap, MD, worked as a medical director at WellMed Medical Group. While at WellMed, Dr. Pachavit Kasemsap raised the market RAF score and enhanced the combined HEDIS quality metrics.

Also known as RAF, risk adjustment factor is a measure of the probable costs needed to meet the healthcare requirements of an individual beneficiary. A beneficiary’s risk adjustment factor is determined by assessing the individual’s health condition, particularly those conditions that fall within a hierarchical category as well as demographic factors that encompass gender, age, and other parameters including residence and attended institutions. In general, older individuals usually have a higher RAF compared to younger individuals. Individuals with a history of certain medical conditions may also have a high RAF compared to individuals that do not have such history.

The role of RAF is to guide the adjustment of capitated payments for beneficiaries that are enrolled in Medicare Advantage plans as well as some certain demonstration projects. Usually, the payment depends on the report of patient data, which will be provided by a qualified healthcare service provider and further used in estimating the expected cost to maintain the patient’s health. As a result of this, the reports must be complete and accurate since incorrect or non-specific diagnoses in the report can affect the patient’s health care reimbursement.