CMS’ Physician QRUR Tables Highlight High-Value Referral Patterns for Medicare Population

William HoldingAmong other data, detail tables in a physician practice’s Quality Use and Resource Reports (QRURs) pinpoint specialist referral networks for Medicare beneficiaries, explains William Holding, consultant, PDA, Inc., which can help physician practices determine their highest value referral pathways.

In this audio interview, Holding explains the benefits of tapping CMS-generated QRUR reports to enhance performance under Merit-Based Incentive Payment Systems (MIPS), one of two payment paths for physician reimbursement under MACRA.

During Physician MACRA Preparation: Using QRUR and Other CMS Data To Maximize Your Performance, a January 2017 webinar now available for replay, Holding and colleague Nancy Lane, president of PDA, Inc., share the critical steps physician practices should take when analyzing their QRUR data, along with details on other CMS data points that can help practices improve MIPS performance.

Length: 3:07 minutes

Hybrid Embedded RN Care Managers Target High-Cost, High-Utilization ‘VIPs’

When Sentara Medical Group determined its embedded RN care managers spent only 25 percent of their time on care management, it revamped its embedded model, explains Mary M. Morin, RN, NEA-BC, RN-BC, nurse executive with Sentara. In the new hybrid model, RN care managers support two to three practices and also visit high-cost, high-utilization patients at home, in the hospital and virtually.

At first, Sentara management balked at a perceived duplication of service between the RNs and home health nurses—until they saw the fruits of these patient encounters, which Ms. Morin describes in this audio interview. Home visits in particular allow RN care managers to assess the patient’s environment and meet the individual on their level, which lifts engagement in self-care, she notes.

Mary Morin will explain the motivation behind Sentara’s hybrid embedded case management model and the model’s impact on its highest risk population during a July 31, 2014 webinar, “A Hybrid Embedded Case Management Model: Sentara Medical Group’s Approach,” a 45-minute program sponsored by The Healthcare Intelligence Network.

Length: 8:28 minutes

Healthcare Trends & Forecasts in 2014: 7 Payor Strategies That Will Reshape Primary Care

From partnering with non-traditional providers like retail clinics to targeting larger physician practices to achieve savings and boost health outcomes, watch for health plans to continue to reshape primary care delivery over the coming year, predicts Catherine Sreckovich, managing director, healthcare, Navigant. Ms. Sreckovich outlines seven ways in which payors will influence primary care, advocates for big data for both payors and providers, and comments on the longevity of the bundled or episodic payment trend in this HealthSounds interview.

Catherine Sreckovich and Steven Valentine, president of The Camden Group, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

Length: 7:37 minutes

Aligning Value-Based Reimbursement with Physician Practice Transformation

In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a “meet the practices where they are” philosophy, reports Julie Schilz, director of care delivery transformation for WellPoint. Each practice is at a different place in the transformation effort and requires specialized supports, she adds.

Smoothing the transformation rollout is the simultaneous participation of 500 WellPoint practices in CMS’s Comprehensive Primary Care (CPC) program, whose goals dovetail with key PCMH principles — as though WellPoint had another partner in its transformation initiative, Schilz notes.

Just as important as practice support is transparency with health plan members, Schilz adds, especially when it comes to explaining the concept of the medical home neighborhood — where care coordination is a collaboration between primary care and the specialist.

Ms. Schilz shared the key features of WellPoint’s transformation initiative, including results from its pilot program that have led to a system-wide rollout, during an October 24, 2013 webinar, Aligning Value-Based Reimbursement with Physician Practice Transformation.

Length: 5:29 minutes

Embedded Case Management in the Primary Care Practice: Program Design and Results

Workflow rehearsals of key practice protocols ensure that the entire care team — including the embedded case manager — is prepared in advance, notes Robert Fortini, vice president and chief clinical officer at Bon Secours Health System. Fortini describes two workflows “rehearsed” by Bon Secours care teams, details the embedded case manager’s contribution to medication compliance in the practice, and explains key steps that precede the case manager hiring process.

Robert Fortini will explain how Bon Secours has adapted the Geisinger Health System embedded case manager model to meet the needs of its own population during Embedded Case Management in the Primary Care Practice: Program Design and Results, a 45-minute webinar on August 10, 2011.

Length: 7:38 minutes

Rewarding Primary Care Practice Reform with Physician Payment Reform: A Medical Home’s Experience

Capital District Physicians’ Health Plan’s (CDPHP) medical home pilot began in 2008, with the dual goals of reforming both the practice of primary care in the CDPHP network and payments to these physicians. Dr. Bruce Nash, CDPHP’s senior vice president of medical affairs and chief medical officer, explains what sets the two-phase CDPHP program apart from other medical home pilots, how participants met the challenge of practice transformation, and why preliminary pilot results mirror what’s going on in the industry today.

Dr. Nash described how CDPHP met the challenge of developing a novel risk adjustment methodology that would drive a global payment combined with a significant bonus structure to attract physician participation and encourage future growth by medical students to enter primary care during Rewarding Primary Care Practice Reform with Physician Payment Reform: A Medical Home’s Experience, 45-minute webinar on February 23, 2011.

Length: 3:39 minutes

Redesigning the Physician Practice for Improved Efficiency and Increased Revenue

In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don’t have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim described how his practice’s team-based approach has changed the nature of the patient visit as well as the nurses’ workload, and provides the secret to a productive patient visit.

Dr Eitrheim shared how his practice made the transformation from a traditional practice to a team-based approach during Redesigning the Physician Practice for Improved Efficiency and Increased Revenue, a 45-minute webinar on December 15, 2010.

Length: 4:25 minutes

Improving Physician Performance and Value-Based Reimbursement Levels Through Meaningful Data Sharing

Along with the transformation to a patient-centered medical home came an acceptance of a model that coordinates care for an entire population, not just the patients showing up each day, notes Dr. Paul Kaye, medical director at Taconic IPA. And even though the 238 Taconic physicians at 11 sites have received Level III PPC®-PCMH™ recognition from the NCQA, Susan Stuard, executive director of THINC, explains that practice transformation doesn’t stop there.

Dr. Kaye and Ms. Stuard described how the sharing of data across its organization is improving physician performance and value-based reimbursement levels during Improving Physician Performance and Value-Based Reimbursement Levels Through Meaningful Data Sharing, a 45-minute webinar on June 23, 2010.

Length: 4:31 minutes