Archive for the ‘Physician Practices’ Category

Infographic: Preparing for MACRA

April 21st, 2017 by Melanie Matthews

Only 35 percent of health systems have a MACRA strategy and are going to be ready to participate, according to a new infographic by Health Catalyst.

The infographic examines the top MACRA concern, preparation levels and potential benefits.

Under CMS's "Pick Your Pace" choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices' performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal--Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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Infographic: Is Adopting a Concierge Medicine Model Right for Your Practice?

April 5th, 2017 by Melanie Matthews

As physician practices face changes in the physician reimbursement environment, many practices are looking to alternative practice models, according to a new infographic by Kareo.

The infographic examines the key differences and similarities between traditional practices and concierge practices.

Under CMS's "Pick Your Pace" choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices' performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal--Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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How a Data Dive Makes a Difference in ACO Care Coordination Efficiency

March 30th, 2017 by Patricia Donovan

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UTSACN used data analytics to trim its home health network from more than 1,200 agencies to 20 highly efficient home health providers.

How does UT Southwestern Accountable Care Network (UTSACN) use information to inform and advance care coordination programming? As UT Southwestern's Director of Care Coordination Cathy Bryan explains, a closer look at doctors' attitudes toward a Medicare home health form initiated a retooling of the ACO's home health approach.

We realized our home health spend was two times the national average. When we reviewed just the prior 12 months, we identified more than 1,200 unique agencies that serviced at least one of our patients. With this huge number of disparate home health agencies, it was difficult to get a handle on the problem.

Our primary care doctors told us they found the CMS 485 Home Health Certification and Plan of Care form to be too long. The font on the form is four-point type; it's complex, so they don't understand it. However, because they don't want a family member or patient to call them because they took away their home care, they often sign the form without worrying about it.

As we began looking at these findings, we wondered what they really told us. Are some agencies better than others, and how do we begin to create a narrow network or preferred network for home care? We knew we couldn't work with 1,200 agencies efficiently; even 20 agencies is a lot to work with.

We began to analyze the claims. My skilled analyst created an internal efficiency score. She risk-adjusted various pieces of data, like average length of stay. For home health, there were a number of consecutive recertifications. We looked at average spend per recertification, and the number of patients they had on each agency. We risk-adjusted this data, because some agencies may actually get sicker patients because they have higher skill sets within their nursing staff.

We created a risk-adjusted efficiency score based on claims. We narrowed down the list by only looking at agencies with 80 percent or higher efficiency. That left us with about 80 agencies; we then narrowed our search to 90 percent efficiency and above, and still had 44. That was still too many, so we cross-walked these with CMS Star ratings to narrow it even more. Finally, after looking at our geographic distribution for agencies that serviced at least 20 patients, we eliminated those with one and two patients. We sought agencies that had some population moving through them.

Ultimately, we reduced our final home health network to about 20 agencies that were not creating a lot of additional spend, and not holding patients on service for an incredibly long period of time.

Source: Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives

advanced care coordination

During Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives, a 2016 webinar available for replay, Cathy Bryan, director, care coordination at UT Southwestern, shares how her organization’s care coordination model manages utilization while achieving its mission of bridging the gap from where patients are to where they need to be to adhere to their care plan.

Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’

March 13th, 2017 by Patricia Donovan

American Health Care ActLast week's unveiling of G.O.P. legislation designed to repeal and replace the Affordable Care Act (ACA) triggered a flurry of concerns and criticisms from healthcare industry sectors.

The proposed American Health Care Act (AHCA) would eliminate Obamacare's individual mandate and put in place refundable tax credits for individuals to purchase health insurance. It also proposes restructuring Medicaid and defunding Planned Parenthood. However, the bill seeks to maintain protections for individuals with pre-existing conditions and to permit children to remain on their parents' insurance plans until they reach the age of 26.

As of last Friday, the proposed American Health Care Act (AHCA) had cleared two committees in the U.S. House of Representatives; a final House vote on the bill is expected the week of March 20.

In a letter to leaders of the House committees that will mark up the AHCA, the American Medical Association (AMA) rejected the ACA replacement bill. In the letter, AMA CEO and Executive Vice President James L. Madara, MD, stated that his organization "cannot support the AHCA as drafted because of the expected decline in health
insurance coverage and the potential harm it would cause to vulnerable patient populations."

In particular, the AMA, the nation's largest physicians' group representing more than 220,000 doctors, residents, and medical students, objected to the bill's proposed restructuring of Medicaid, claiming it "would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes."

The AMA's position was also outlined in a statement issued by Andrew W. Gurman, MD, AMA president.

Meanwhile, the American Hospital Association (AHA), which counts 5,000 hospitals among its members, also opposed the AHCA. In a news release, Rick Pollack, AHA president and CEO, stated that the AHA "cannot support The American Health Care Act in its current form." The AHA stated that it would be difficult to evaluate the bill without coverage estimates by the Congressional Budget Office (CBO).

Echoing AMA apprehension over proposed Medicaid restructuring, Pollack stated that the AHA feared the bill "will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care."

Although Pollack lauded recent Congessional efforts to address behavioral health issues, including the growing opioid abuse epidemic, he stressed that "significant progress in these areas is directly related to whether individuals have coverage. And, we have already seen clear evidence of how expanded coverage is helping to address these high-priority needs."

Also seeking adequate Medicaid funding in the AHCA was America’s Health Insurance Plans (AHIP), a national association whose 1,300 members provide coverage for healthcare and related services to more than 200 million Americans.

In a letter to two key House committees, AHIP President and CEO Marilyn Tavenner stated that "Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts."

However, AHIP commended the proposed legislation for its "number of positive steps to help stabilize the market and create a bridge to a reformed market during the 2018 and 2019 transition period" and "pledged to work collaboratively to shape the final legislation."

"AHIP members are committed to reducing cost growth by using value-based care arrangements and other innovative programs to address chronic illnesses and better manage the care of the highest-need patients," Tavenner concluded.

In a statement on Friday, Secretary of Health and Human Services Tom Price, MD, committing his agency to using its regulatory authority to create greater flexibility in the Medicaid program for states, including "a review of existing waiver procedures to provide states the impetus and freedom to innovate and test new ideas to improve access to care and health outcomes."

5-Part Framework for MIPS Success Under MACRA

March 2nd, 2017 by Patricia Donovan

Before picking MACRA pace, physician practices should construct a framework for MIPS success.

Along with picking a MACRA pace, physician practices should construct a framework for MIPS success.

Regardless of the pace a healthcare organization sets for Quality Payment Program participation, there are some key tactics that should form the framework of any MACRA initiative. Here, William Holding, consultant with PDA Inc., outlines the critical elements organizations need to achieve "MACRA-readiness."

  • The first component for success is perhaps the most important, and that's having a culture of provider support. A willingness to explore new options. This component is free, so if you don't have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you've got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
  • Second is strategic planning. Set measurable goals. That's important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
  • The next piece is strong leadership. If you don't have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.

    I've experienced teams that didn't work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You've got to find the right people to be involved.

  • Next, data analytics is key. This starts with an individual with the right skills. It doesn't mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
  • Lastly, clinical documentation is essential. Doing that well will improve your position in this program.

Source: Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance

social determinants of health

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

Infographic: Navigating the Merit-Based Incentive Payment System

February 17th, 2017 by Melanie Matthews

The goal of the Centers for Medicare and Medicaid Services' new quality program, the Merit-Based Incentive Payment System (MIPS), is to streamline quality reporting to CMS and improve care, according to a new infographic by athenaInsight, Inc.

The infographic examines how MIPS will impact an average clinician this year…and in 2019 when the 2017 reporting will impact a clinician's reimbursement rates.

Infographic: EHR + CRM = Superior Patient Engagement

Under CMS's "Pick Your Pace" choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019: simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices' performance and laying a path toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal--Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you'd like featured on our site? Click here for submission guidelines.

Providers, Patients Outline Healthcare Priorities to New HHS Secretary

February 16th, 2017 by Patricia Donovan

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents' minds.

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents' minds.

As Rep. Tom Price settles into his new role as secretary of the Department of Health and Human Services (HHS), organizations representing physician practices, nurses, patient groups and actuaries are making their healthcare priorities known to the newly confirmed administrator.

Concerns range from the future of the Affordable Care Act, which President Trump pledged to repeal in a January 2017 executive order, to specifics of new physician reimbursement programs resulting from MACRA (Medicare Access and CHIP Reauthorization Act of 2015).

In a news release from the American Association of Nurse Practitioners, America's leading nursing organizations called on the Trump administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. Representing over 3.5 million nurses, the organizations affirmed their shared commitment to advancing patient-centered healthcare and healthcare policies that reflect five key areas ranging from ensuring patients access to healthcare with affordable coverage options regardless of preexisting conditions to creating greater efficiency in the Medicare system.

On the patient side, I Am Essential, a coalition of more than 200 patient groups, asked Price to preserve key ObamaCare protections, including one that guarantees coverage for those with pre-existing conditions.

In its letter, the coalition said certain ObamaCare provisions have provided improved access to care to millions living with chronic and serious health conditions.

"While it is not a perfect law," the letter stated, "The ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized."

The letter concluded with the following statement: "As you make any changes, we urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious health conditions."

Meanwhile, a letter from the Medical Group Management Association (MGMA), which represents more than 18,000 U.S. healthcare organizations in which 385,000 physicians practice, asked the new administrator to "significantly reduce the regulatory burden on physician practices and improve the quality and efficiency of healthcare delivery in this country."

Focused on the federal payor's new Quality Payment Program resulting from MACRA, the MGMA requested the following from Price, who worked in private practice as an orthopedic surgeon for nearly twenty years prior to launching his political career:

  • A reduction in the cost and reporting burden of the Merit-Based Incentive Payment System (MIPS);
  • A careful review of the eligible Advanced Alternate Payment Program (APM) risk standard and contend there is significant inherent risk in moving from fee-for-service to risk-bearing arrangements, including substantial investment and operational costs, as well as misaligned financial incentives between the payment systems; and
  • Legislative relief from the Federal Physician Self-Referral Law, which MGMA referred to as "a regulatory monster of mind-numbing complexity."

MGMA represents physician groups of all sizes, types, structures and specialties, and has members in every major healthcare system in the nation.

And finally, the American Academy of Actuaries released three new issue briefs examining a number of key public policy considerations policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act.

The three papers, which address high-risk pools, selling health insurance across state lines, and association health plans, are available on the academy's site.

"Differences in a reform's structure can have wide implications for stakeholders and for how it interacts with other reforms that have been or may be adopted," said Academy Senior Health Fellow Cori Uccello. "For example, high-risk pools can be structured in different ways, with different implications for access to coverage, premiums, and government spending. Further, how regulatory authority is defined for both cross-state insurance sales and association health plans affects whether insurers would compete on a level playing field."

Physician Supplemental QRUR: Episode-Specific Patient-Level Data Tells Story of High Utilizers

February 7th, 2017 by Patricia Donovan

QRUR reports provide a mirror into physicians' cost and quality performance under MACRA.

As year one of MACRA unfolds, healthcare providers deterred by security hurdles associated with CMS Enterprise Portal access may want to reconsider. The wealth of aggregate quality and cost performance data available through the portal is well worth the trouble of accessing it, advises William Holding, consultant with PDA, Inc.

Specifically, Quality Resource and Utilization Reports (QRURs) downloadable from the portal are essential tools for physician practices that hope to succeed on MACRA-defined reimbursement paths, Holding said—even practices equipped with robust internal reporting systems.

"This is the same system that accountable care organizations (ACOs) use, and that CMS uses for many other things, so it's a good idea to get past those barriers," he explained during Physician MACRA Preparation: Using QRUR and Other CMS Data to Maximize Your Performance, a February 2017 webinar now available for replay.

Originally designed for CMS's value-based modifier, QRURs are good indicators of future cost performance under MACRA, via either Merit-Based Incentive Payment System (MIPS), where most physician practices are expected to fall initially, or Alternate Payment Models (APMs), he said.

After providing an overview of MIPS and APMs, including five essential prerequisites to MACRA preparation, Holding delved into the quality and cost metrics contained in QRURs, from aggregate data in the main report to detailed tables rich with patient-specific information.

The main QRUR report illustrates where a physician practice falls in relation to other practices on the overall composite for cost and quality. The QRUR's Quality portion shows scores for a series of domains, including effective clinical care and patient experience, which offer a great window into how a practice might perform with different selected measures in MIPS.

Next, QRUR cost performance indicates per capita costs for attributed beneficiaries, which will remain a cost measure in MIPS.

Drilling down, Holding characterized seven associated QRUR downloads—including one table on individual eligible professional performance on the 2015 PQRS Measures—as even more useful than the QRURs themselves.

And finally, he termed the downloadable supplemental QRUR "a very powerful tool" that drills down to the beneficiary level, providing a snapshot of some of the highest cost events occurring among a practice's patients.

"For high utilizers, for specific episodes, you can drill right down to the patient to try and understand the story. What's happening to your patient when they're not in your practice, and what can you do about it?" said Holding.

Having presented the available reports, Holding described four key benefits of using QRUR downloads, including as a priority setting tool, and then detailed the myriad of ways QRURs can be analyzed to improve MIPS performance.

However, Holding stressed, even physician practices with the most sophisticated reporting structures will not thrive under MACRA without the right team or culture of provider support in place. He closed his presentation with a formula for determining investment in performance improvement activities and a five-step plan for MACRA preparation.

Listen to an interview with William Holding on the use of QRURs to determine a physician practice's highest value referral pathways.

Infographic: A Survival Guide for Independent Physicians

February 3rd, 2017 by Melanie Matthews

The move to value-based case is making it increasingly difficult for physicians to remain as independent practices, according to a new infographic by Intermedix.

Many physicians are considering alternative practice models, including selling their practice to hospital systems. However, according to the Health Care Transformation Task Force, five out of the top six reasons doctors dislike hospital employment have to do with loss of practice control. Forming a professional partnership is another alternative that provides physicians with group negotiation power and operational support without compromising ownership or management autonomy.

The infographic examines how a supergroup can help physicians maintain independence and achieve practice success.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN's 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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Social Determinants of Health: Does Technology Connect or Isolate?

January 12th, 2017 by Patricia Donovan
social isolation

Only half of Americans with two or more chronic conditions actually go online.

Social determinants are areas of health that involve an individual’s social and environmental condition as well as experiences that directly impact health and health status. Here, Dr. Randall Williams, chief executive officer, Pharos Innovations, examines why, contrary to popular thought, technology advances may actually increase the gap between social connectedness and social isolation for certain populations.

In the age of the Internet, technology itself may become a barrier to being connected with others through social interactions. The Pew Research Center has done some nice work on health and the Internet. It turns out that three quarters of adults in the United States go online. That's probably not all that surprising, but what's more nuanced in this data is that the Internet access of individuals in the United States actually differs, depending on whether or not those individuals suffer from chronic health conditions.

It turns out that of Americans who have two or more chronic conditions, which by the way represents the vast majority of the Medicare population, only half go online. As it turns out, the very same groups that suffer most from social determinants of health, and not just from social isolation, also have the highest rates of chronic disease. And according to this research, they are the ones most likely to NOT have access to the Internet. This is called the Internet Divide.

We might be encouraged by the prevalence and penetration of mobile technologies, and maybe those would be the great bridge over the Internet Divide. Unfortunately, that may not be the case yet. According to this same Pew research, 90 percent of Americans who don't have a chronic condition actually own a cellphone. However, if you do have two or more chronic conditions, that number drops down pretty dramatically to 70 percent. That finding is a bit better than Internet access, but certainly not ubiquitous. If you look at those who have a cellphone, only 23 percent of them actually access text-messaging technologies on their cellphones, and smartphone apps fall well below that.

Source: Social Determinants and Population Health: Redesigning Care Management to Bridge Clinical and Non-Medical Services

social determinants of health

In Social Determinants and Population Health: Redesigning Care Management to Bridge Clinical and Non-Medical Services, care teams will learn that by asking patients the right questions and listening carefully to their responses, they can begin to identify and address social determinants, dramatically impacting patient outcomes as well as their own financial success under value-based care.