Navigating CMS Changes and Clinical Documentation in Rural Orthopedics with Dr. Sylvester Youlo

Summary

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Podcast Summary

Episode Overview

Podcast: Becker’s Healthcare Podcast
Episode Title: Navigating CMS Changes and Clinical Documentation in Rural Orthopedics with Dr. Sylvester Youlo
Date: February 15, 2026
Main Theme:
This episode features Dr. Sylvester Youlo, an orthopedic surgeon at Phelps Health, discussing crucial updates to Centers for Medicare & Medicaid Services (CMS) regulations, the pivotal importance of clinical documentation, and strategies for healthcare leadership in a rural setting.

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Key Discussion Points and Insights

1. Introduction and Background

[01:02] Dr. Youlo shares his background and the context of Phelps Health:

• Phelps Health is a rural hospital in Missouri, serving 250,000 people and supporting the Fort Leonard Wood military installation.
• Dr. Youlo’s practice covers general orthopedics (joint replacement, trauma, sports surgery).
• He holds two master’s degrees (MBA, MHA) to better understand the business of healthcare.
• Quote: “I strongly believe that physician must understand how healthcare works financially…to serve patients long term.” [01:48]

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2. Major Healthcare Trends: The Impact of CMS Regulatory Changes

[02:06] Dr. Youlo highlights:

• Frequent and substantial CMS regulatory changes, especially regarding the movement of surgical procedures from “inpatient only” to “outpatient” status.
• Ongoing adjustments in physician and hospital reimbursement policies.
• Quote: “The biggest thing really I’m watching out for is how things are changing with CMS…multiple regulations…coming out and changing physician reimbursement, hospital reimbursement.” [02:12]

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3. Clinical Documentation as a Strategic Initiative

[02:49] Dr. Youlo describes a key project at Phelps Health:

• Initiation of a Clinical Documentation Improvement (CDI) program approximately two years ago, in response to evolving CMS documentation and billing criteria.
• Goals:
  • Increase Case Mix Index (CMI) to accurately reflect patient acuity.
  • Educate and gain buy-in from physicians about the broader impact of thorough documentation.
• Outcomes:
  • Improved reimbursement rates.
  • Fewer billing denials.
  • Benefits for both the health system and patients.
• Quote: “Once we did that, what we did realize was, overall, it benefited patients, it benefited the system, it decreased how much bills were in iro, it decreased our denials, increased our reimbursement rate, and those things changed. That was the biggest thing we did.” [03:38]

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4. Expanding CDI from Inpatient to Outpatient

• The initiative, initially for inpatients, expanded into outpatient clinics due to its success.
• Ongoing adoption is showing promising results in quality and financial metrics.

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5. Advice for Emerging Healthcare Leaders

[05:01] Dr. Youlo addresses lifelong learning:

• The importance of continued education after formal training.
• Physicians should learn not just clinical skills but also healthcare economics and management.
• Encourages younger physicians not to be content with only clinical work—understand the system to drive improvements in delivery and cost.
• Quote: “Don’t be content to just be a doctor…Learn about the system, learn how to improve outcomes, learn how to improve healthcare delivery so it’s a little cheaper without sacrificing patients’ outcome.” [05:48]

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6. The Critical Role of Clinical Documentation Given CMS Shifts

[06:22] Dr. Youlo emphasizes future challenges:

• As more procedures are classified as “outpatient only”, inpatient admissions will require strong justification.
• Poor documentation could mean denial of insurance reimbursement, even when medically necessary.
• Documentation must move beyond “medical-legal purposes” and be detailed enough to support patient acuity and the medical necessity of inpatient stays.
• Notable Quote:
  “The only way you can admit a patient will be to document properly why you are keeping the patient in hospital…If you do not take the time to document the entire patient’s profile, … you will have difficulty … asking insurance companies to pay you back.” [06:44]

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Notable Quotes & Memorable Moments

• On the value of business knowledge for doctors:
  “I strongly believe that physician must understand how healthcare works financially, be able to serve patients long term.” - Dr. Youlo [01:48]
• On CMS regulation impact:
  “The biggest thing really I’m watching out for is how things are changing with CMS … going to most surgeries, going to outpatient only.” - Dr. Youlo [02:12]
• On clinical documentation:
  “Documenting the care that is performed is very important.” - Dr. Youlo [02:59]
• On advice to young professionals:
  “Don’t be content to just be a doctor and serve patients. Learn about the system …learn how to improve healthcare delivery so it’s a little cheaper without sacrificing patients outcome.” - Dr. Youlo [05:48]
• On the future of admission criteria:
  “There will be a time…some patients, you cannot admit them…The only way you can admit a patient will be to document properly why you are keeping the patient in hospital.” - Dr. Youlo [06:34]

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Timestamps of Key Segments

• [01:02] – Dr. Youlo introduces his background & Phelps Health
• [02:06] – Healthcare trends & CMS regulatory change impact
• [02:49] – Clinical documentation improvement initiative
• [05:01] – Lifelong learning and advice for emerging leaders
• [06:22] – The coming importance of detailed documentation with CMS policies
• [06:44] – Concrete examples: documenting joint replacements for older patients

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Closing Tone

The conversation is pragmatic, earnest, and focused on actionable advice for clinicians and hospital leaders coping with rapid change in regulation and reimbursement. Dr. Youlo blends the clinical, business, and educational perspectives, underscoring that effective healthcare today requires broader system knowledge as well as clinical excellence.

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Transcript

[A]

Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospitalview.com and click on the Events tab in the upper right.

[B]

Hello and welcome to the Becker's Healthcare Podcast. My name is Chanel Bunger and today I have the pleasure of speaking with Dr. Sylvester Yullow, an orthopedic surgeon at Phelps Health who joins the podcast today to share insights into his background, healthcare trends he's keeping an eye on and a bit more. Dr. Ulo, thank you so much for joining me today.

[C]

Thank you for having me, Chanel.

[B]

Perfect. Well, to get us started out, could you please introduce yourself, tell us a bit about your background and Phelps Health.

[C]

Okay. Well, my name is Dr. Sylvester Yullow. I'm an orthopedic surgeon. I'm employed by Phelps Health, a rural hospital in Missouri. We actually are located about 90 miles from St. 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. So we take care of the families there and service members. My practice is general orthopedics. I cover joint replacement trauma and I have a special niche in sports surgery. I also hold two master degrees, an MBA in Master in Health Administration because I strongly believe that physician must understand how healthcare works financially, be able to serve patients long term.

[B]

Got it, got it. Thank you so much for that introduction. And now moving forward, what healthcare trends are you currently watching in your role today either in orthopedics or just healthcare overall?

[C]

Well, really the biggest thing really I'm watching out for is how things are changing with CMS almost every few months recently there have been changes to everything, going to most surgeries, going to outpatient only, at least leaving the inpatient only list to the outpatient list. And and also there are multiple regulations that have been that are coming out and changing physician reimbursement, hospital reimbursement. Those are actually the biggest trends we are watching out for right now.

[B]

Absolutely. And so kind of looking forward into the rest of the year, what are you most focused on and excited about? And then kind of looking back at last year, can you Talk about an initiative or a project that you're most proud of.

[C]

Yes, so here. So once things started changing, especially with the inpatient only list being changed, we decided our organization to focus on a little differently than most people are doing on clinical documentation. So, you know, when we went to medical school, documentation was about, you know, if you didn't write it down, you didn't perform 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 care that is performed is very important. So about a year ago, almost two years ago, we decided to start a CDI 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, or insurance companies figured out what we did, getting reimbursed was a little easier. The initial purpose of that initiative really wasn't about reimbursement, really, it was about increasing our cmi. PMI is really case miss Index. That number is very important in documenting how sick the patient we treat are. And that's what we're trying to go after. But once we did that, what we did realize was overall, it benefited patients, it benefited the system, it decreased how much bills were in iro, it decreased our denials, increased 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 matrices. And then after that, we decided this year to study for, you know, outpatient clinics and all that. And it's going pretty well.

[B]

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.

[C]

Well, so you hit a point, really, Chanel. I think life's long. Learning is important. Medical school is long. You know, you got to go to school, get a bachelor's degree and then take the mcat, go to medical school, go to residency, sometimes go to fellowship. And 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 practice 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 healthcare is run is very important. The advice 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 healthcare outcomes, learn how to improve healthcare delivery so it's a little cheaper without sacrificing patients outcome.

[B]

Excellent advice. Well, Dr. Hilo, I've enjoyed our time today, but before I let you go, is there anything else that listeners should know?

[C]

Well, yes, a couple of things to know is what I alluded to about clinical documentation. I'm one of the advisors for the system here, physician advisor for our clinical documentation program. Documenting. I think change will be very important because you know, the biggest thing I'm watching out for is this taking patients off of the inpatient only list to our patient list. And what will happen is, is that eventually, and this is going to happen probably in the next two to three years, there will be a time that some patients, you can admit them because they are, they will become only outpatient, you cannot meet them. The only way you can admit a patient will be to document properly why you are keeping the patient in hospital. For example, I perform joint replacement. Most joint replacement is not going to be sooner or later outpatient only. The next thing is going to be same day surgery. But most people are required joint replacement are 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, there will be, you know, you will have difficulty improving or at least asking insurance competence 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're 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 healthcare delivery overall.

[B]

Absolutely. Well, Dr. Yula, that's a great note to end our time with and I want to thank you once again for sharing your insights with me today on the Becker's Healthcare podcast.

[C]

Thank you so much thank you for having me. I appreciate it.