Ohtariv0.0.4
OS

Ortho1 Surgical Group

Orthopedic Surgery

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    Front Office

KD

Kristopher Downing

Owner-Partner
Unpublished changes
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Ohtari

Workflow builder

K
We have CJR-eligible joint replacement cases and I want to systematically capture outcomes at 30 and 90 days — pain scores, functional status, readmissions, complications — so we can calculate shared savings. Ohtari should run the outcome surveys, compile the data, and generate the quarterly CMS report. Flag any cases approaching the readmission window.
+ Add BCBS Blue Distinction tracking
⚙ Adjust day 30/90 windows
+ Add physical therapy milestone check
+ Export to partner dashboard
Trigger

Day 30 or Day 90 post-discharge (Athena calendar)

Request made by

Approval required
default

Approved by: Practice manager (report sign-off) · Surgeon on case

Human sign-off required before any patient, chart, claim, or financial action runs.

Athena · Read

Load episode cost and readmission data

episode.cost_to_date, readmissions.count, ED_visits.count, complications.flag, surgeon.name

Survey · Voice

Run structured outcome survey (voice call)

VAS pain · KOOS/HOOS functional score · patient satisfaction (0–10) · return to activity

Channel:

Conditional

Readmission risk or complication flagged?

Alert surgeon's nurse immediately · flag episode for clinical review

Report

Generate shared savings calculation + CMS report

Episode cost vs. target price · quality adjustment · shared savings estimate at 90 days

Athena · Write

Write outcomes and close episode

PROM scores · readmission count · shared savings estimate · CMS submission status