John Zelem, MD, FACS is principal owner and chief executive officer of Streamline Solutions Consulting, Inc. The company provides technology-enabled, expert physician advisor services.
Dr. Zelem is focused on managing Medicare and Medicaid regulatory compliance, minimizing inappropriate medical necessity denials and achieving appropriate lengths of stay in acute care hospitals and health systems. Read More
A Board-certified general surgeon with more than 26 years of clinical experience, Dr. Zelem managed quality assessment and improvement as a former executive medical director in the past. In addition, Dr. Zelem practiced general surgery for more than 25 years and is a Fellow of the American College of Surgeons. He has served on numerous governing boards and committees and is a renowned industry author.
Dr. Zelem’s career is the perfect example of the concept holism; each part has affected the whole, but no part was more important than the whole of his career. Everything that he has learned and accomplished has led to the progress of the next stage. Not every step was positive, but every step contributed positively.
It started with more than 26 years of clinical practice in general surgery. Yet, it wasn’t just about performing surgery. It involved learning and mastering other skills, such as teaching, training corporate sales staff, product development, providing presentations especially in the motivational speaking arena, gaining people skills, learning and mentoring new surgical procedures around the world, becoming a noted author, and management and leadership principles.
John then made a transition from the clinical side to healthcare executive leadership for the next 15 years. He developed expertise in compliance, contracts and regulations, utilization review, case management, client relations, and physician education. At one point he was responsible for helping clients with new and existing utilization management programs to improve their processes positively affecting revenue cycle while maintaining compliant practices . He was responsible for the development and improvement of existing and newly formed physician advisor programs, with continued mentoring, management, and education.
There are two words that highlight the holistic approach taken:
Without these, sustainability may be challenged.
Dr. Zelem can help you take your organization to the next level. Schedule your free consultation to determine what defines your success.
Streamline Consulting Services, Inc. helps hospitals, physicians, utilization review and physician advisors by providing a holistic solution to successfully achieving a healthy and compliant process in your revenue cycle.Read More
Streamline Solutions Consulting, Inc. has the unparalleled ability to step back and objectively look at your organization; open your mind to different ways of doing and improving processes through gap analysis techniques while breaking down silos. Some of the following components define your processes and culture:
- Documentation improvement
- Compliance and existing processes
Remember this: If you want to make some changes, you need to make some changes.
Let Streamline Solutions Consulting, Inc., utilizing a holistic approach, be part of your change, be your solution, through trust and collaboration.
Taking the holistic approach
Looking at the big picture
Every little change you make affects the whole.
Utilization Management 360®
Breaking Down Silos
Streamline Solutions Consulting, Inc. empowers organizations to improve their revenue cycle by operationalizing a holistic approach to “breakdown the silos” that exist amongst the components of the following functions:
- Utilization Review
- Case Management
- Clinical Documentation Integrity
- Physician Advisors
- Coding and Compliance
Since clinical documentation “cements” these components, it makes total sense to utilize this common denominator providing a team approach where each part affects the whole. It’s back to basics. Extensive data reviews, interviews of key leadership and staff, and best practice application will enable an integrated, collaborative approach with measurable and sustainable results.
Streamline Solutions Consulting, Inc. will provide your solution, fill in the missing pieces of your puzzle to provide the complete picture.
Physician Advisory Services
The use of Physician Advisors has been increasing exponentially over the past years. Streamline Solutions Consulting, Inc. understands the history, development, utilization of the Physician Advisor role for more than just chart reviews for Level of Care Determinations, and can:
- Analyze your present program for compliance, standardization, and accountability
- Ensuring that existing and new program Physician Advisors integrate with UR/Case Management, your physicians, and your leadership
- Through gap analysis techniques evaluate for efficiencies
- Help “break down silos” that may exist linking Utilization Review, Case Management, and CDI in a holistic manner
- Improving physician documentation
- Help to develop and customize new programs for your individual needs unique to your culture and community
- Assist in hiring and training competent Physician Advisors for new programs through a unique onsite training presence and mentoring afterwards
Streamline Solutions Consulting, Inc. is well positioned to help you establish a high quality program through these qualifications:
- 14 years of overall Physician Advisor experience
- 5 plus years of designing and building onsite Physician Advisor programs
- Involved in the interviewing hiring of over 20 Physician Advisors
- Implemented and provided onsite training for 14 Physician Advisors
- Assisted with PA integration with
- Case Management, Utilization Review
- Facility physicians
- Executive level
- Assisted with PA integration with
- Managed and mentored a team of 14 Physician Advisors
Helped set up a program of measurable metrics to hold Physician Advisors accountable
Case Management Repair Services
Case Management repairs often include fixing readmission programs as well as trouble-shooting discharge planning issues. Too often, too many opinions within case management hinder real process improvement. We can fix that. Working in conjunction with case management experts, here are just a few of the problems we can fix at your facility or practice:Read More
- Determining where time is being wasted
- Evaluating team members’ performance. Are they operating at the top of their license?
- Is there enough support staff?
- Problems with care transition and the progression of care
- Difficulty understanding the components of value-based purchasing
- Help with risk-assessment
- Are services being provided that can be set up in alternative settings
- Readmission reduction programs
- Reduce mortality rates
- Discharge planning
Have a problem with your case management? Contact us.
Revenue Cycle Repair Services
Repairing any of the moving parts of your revenue cycle is our specialty. We will analyze your present program for cross-functionality, knowledge-sharing, and integrated responsibilities. We will tackle documentation that is common to all components to make sure the medical necessity is present and for justification and proof that medically necessary services were provided.Read More
In particular, we can help you with your clinical revenue cycle (CRC). Here are just a few of the revenue cycle and clinical revenue cycle problems we can fix:
- Revenue cycle management (RCM) programs so that everyone becomes more aware where CRC resides in RCM and its significant effect on sustainable revenue
- Broken communication bridges with finance, compliance, business operations and technology
- Inconsistent reporting structure among UR, case management, CDI, the physician advisors and coders
- Bottlenecks and constraints that are preventing your clinical revenue cycle teams from having a smooth, efficient, collaborative process through team empowerment
Have a problem with your revenue cycle or your clinical revenue cycle? Contact us.
August 21, 2020
Re: Testimonial for Services of Streamline Solutions Consulting, Inc.
The Sentara Revenue Cycle engaged the services of Streamline Solutions Consulting, Inc., specifically Dr. John Zelem, for an independent review of the Utilization Review processes for Sentara Healthcare. I have been acquainted with Dr. Zelem since the beginning of our business relationship in 2011 with Optum in his prior role as Regional Vice President of Provider Relations and Education.
In this time, I have come to value his experience, professionalism, and wealth of knowledge in the development of best practice programs related to utilization review, physician documentation, and regulatory compliance. We have built a trusting and collaborative relationship over the years which made the selection of John for our project an obvious choice. Read More
The scope of the project included a very comprehensive review of our Utilization Review processes, the Physician Advisor program, the roles and working knowledge of other Sentara physician and non-physician leaders in the review process (Case Management, Clinical Documentation Improvement, Utilization Review, Chief Medical Officer, etc.), policies, opportunities, and outcomes.
The goal of the engagement was to make recommendations for an integrated, collaborative, unified team approach for a what came to be known as a “Utilization Management 360” approach enveloping all intra-operational entities involved decision support for documentation and billing compliance. This was a very comprehensive project that required extensive data reviews, interviews, and best practice research. At the conclusion of the project, John formulated very well thought out recommendations for our system delivered in a thorough executive report.
If you have further questions, I would be happy to assist you.
Karen A. Pelham, MSN, RN
Director, Hospital Clinical Revenue Cycle
- July 5, 2021 11:20 PM
The clinical revenue cycle (CRC) is seldom mentioned and under-reported. The more universally recognized concept, of course, is revenue cycle management (RCM). It is the umbrella of which CRC is an integral part and a crucial revenue driver, accounting for a large portion of the direct and indirect cost of providing care. CRC needs to be recognized for this importance, and also requires improvement from its present status with a more holistic approach.
- May 26, 2021 11:47 PM
When we hear the word hospital or healthcare our thoughts automatically go to patient care which is not unreasonable. Yet, one must remember that there is also a business side to healthcare. If it is not treated as a business there will not be enough revenue to fund it for survival. Learn more…
- March 30, 2021 10:57 PM
The role that the Physician Advisor provides as communicator, facilitator, subject matter expert, and “quarterback” is invaluable. In just performing their intended duties, working with teams and management, managing the silos within Clinical Revenue Cycle can occur.
- March 6, 2021 3:38 PM
It seems that there is now a relatively new concept or program that has come into play in healthcare and it is called “Revenue Integrity” (RI). Is it another silo or is it a solution for clinical revenue cycle? According to an HFMA Survey of 125 hospital and health system CFOs and revenue executives, only 44 percent of respondents say their organizations have established revenue integrity programs.
- December 9, 2020 5:20 PM
Team empowerment is the essential ingredient to the success of any initiative, but it cannot be engaged without thoughtful processes. Teams are composed of individuals with unique skills, personalities, backgrounds, and drive. Utilizing the ingredients provide here will help provide the cement, the glue, the structure to maintain an holistic approach where the whole is greater than the sum of its parts
- September 23, 2020 10:04 PM
Making the Case for Utilization Management 360®. Read how UM360 played a role in a multi-hospital system and will continue to improve Clinical Revenue Cycle Management.
- September 23, 2020 9:29 PM
Hospital revenue is declining. What kind of changes does Revenue Cycle Management need to make? What is the solution? The real question to ask is how much pain needs to be endured for RCM to be motivated to change and not just use temporary patches. What will be the precipitating factor that will cause RCM to make some changes now before significant pain. The solution is “Utilization Management 360®”