Archive for the ‘Physician Practices’ Category

Infographic: Physician Social Media Use

July 25th, 2014 by Melanie Matthews

Physicians have mixed opinions about leveraging social media use in their practices, according to a new infographic by MedData Group.

The infographic looks at the top two social media channels that physicians use, the top five physician specialties that engage in online physician communities and the top concerns preventing physicians from using social media for professional reasons.

Physician Use of Social Media

The growth of social networking has been dramatic, and the applications are quickly finding their way into healthcare organizations. This expanded best-seller provides an overview of the social media tools healthcare organizations are using to connect, communicate, and collaborate with their patients, physicians, staff, vendors, media, and the community at large.

Social Media in Healthcare: Connect, Communicate, Collaborate, 2nd edition describes the major social media applications and reviews their benefits, uses, limitations, risks, and costs. It also provides tips for creating a social media strategy based on your organization’s specific needs and resources. Through real-world examples and up-to-date statistics on social media and healthcare, this book illustrates how social media can improve the efficiency, effectiveness, and marketing of your healthcare organization.

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Infographic: Physicians’ Salaries 2014

July 21st, 2014 by Melanie Matthews

Physicians are becoming more proactive in managing their incomes by being more selective about insurers and patients and providing ancillary services. In addition, a small but growing number of physicians are moving toward cash-only practices.

A new infographic from Medscape looks at these trends, along with details on how the Affordable Care Act is impacting physician practices, the income gender disparity among physicians and physician career satisfaction.

Physicians' Salaries 2014

In today's value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts — models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians' skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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Infographic: The Rising Cost of On-Call Physicians

July 11th, 2014 by Melanie Matthews

Nearly twice as many physicians were paid for time devoted to being on-call this year than last -- with some earning more than $1,000 per day, according to the Medical Group Management Association's On-Call Survey: 2014 Report Based on 2013 Data, reflected in a new infographic.

More than 60 percent of physicians reported receiving a daily stipend for taking call, a stark contrast to last year, when only 35 percent did. Additionally, primary care physicians saw their median daily on-call compensation rate soar in the past year, up to $250 in 2013 from the $150 claimed in 2012. PCPs in the western geographic section of the United States reported making as much as $1,103 per day in on-call compensation.

Even physicians who were not monetarily rewarded for their on-call duties received some sort of benefit. Of the 37 percent of physicians who said they received no additional compensation for taking on-call coverage, 33 percent reported being rewarded with time off.

This infographic looks at on-call compensation by practice size and compensation methods.

The Rising Cost of On-Call Doctors

Shifting reimbursement models are forcing hospital executives to rethink their approach to physician relationships. New cost and quality demands require hospitals to explore all alternatives—including tighter alignment with physicians. The New Hospital-Physician Enterprise: Meeting the Challenges of Value-Based Care provides expert advice on structuring and sustaining hospital-physician relationships in the post-reform environment.

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4 Ways to Pinpoint High-Risk, High-Cost Candidates for Case Management

June 24th, 2014 by Patricia Donovan

case management patients

Doctors don't always know when their patients are in the hospital.

Providers in a physician practice are a good starting point for case managers to identify high-risk or high-cost patients for case management, explains Annette Watson, RN-BC, CCM, MBA, senior VP of community transformation for Taconic Professional Resources (TPR).

The process of identifying high-risk, high-cost patients can be formal or informal. You can use internal sources; when TPR goes in, that is one of the baselines of understanding. We understand who the patients are and what the population is, because if they have not been using data or have not been in an Advanced Primary Care initiative, it is highly unlikely the practice will have a quantitative method in place when we arrive.

We begin by asking the practice providers who the sickest patients are. Second, we can use data available at the practice level, such as registries or reports that can be run from the EHR.

Third, we also look at the kind of data they get from external sources. For example, do they receive reports from payors that show some utilization activity? Many of those reports may be somewhat aged. They are not necessarily timely, which raises actionability questions. However, we found there are reports coming out from payors, particularly about recent ER use or hospital discharges, that are more timely, which allow the practices to look at data—still retrospectively in most cases but much more quickly than they were able to in the past.

And finally, hospital admission and discharge information is important. Depending on the model in a PCP, if a physician is not the admitting physician— that is, if the admission is from a specialist, hospitalist, or through the ER—it cannot be assumed the PCP has the admission and discharge information.

People may think physicians know about their patients being in the hospital, but that is not always the case.

(Note: Taconic Professional Resources offers professional training and practice optimization to organizations aspiring to become a patient-centered medical home and/or join a medical neighborhood.)

Excerpted from: Advancing Primary Care with Embedded Case Management: Lessons from the Taconic IPA Pilot

6 Metrics to Engage Physicians in Value-Based Payments

May 22nd, 2014 by Cheryl Miller

As incentive models change for physicians and their practices along with the industry's move to value-based care, it is key to engage them in the evolving process, says Cynthia Kilroy, senior vice president of provider strategy and business development at Optum. After you find a common value-based vision, you need to spend time with the physicians discussing what value-based care is, including how it is going to impact them, and what it means for their practice, among other things.

When you think about engaging physicians, which is how we typically roll this out across organizations, six key performance metric steps are needed to move this along. This is not something that happens in a couple of months. It takes one to three years to move a compensation model to a large 20 to 25 percent of incentives.

After you find the common value-based vision, you need to spend time with the physicians discussing what value-based care is, including how it is going to impact them, what it means for their practice, how we support them, etc.

Once you have alignment with that, the finding and designing of incentive metrics has to be done by the physicians. This cannot be done in a vacuum. It needs to be physicians from all different types of practices or specialties and different locations within the organizations that you look at. What are the incentives I want to measure?

Then you publish the incentives and blind those incentives so that physicians can digest and challenge them. Something may need to be modified. Therefore, you should give that time and feedback. Once you have that feedback, you can unblind it. Organizations find unblinded incentives to be a very powerful tool, but you need to make sure that you have the alignment and agreement and that people believe in the metrics, because if you put metrics out that are incorrect or not of value, you have lost the opportunity to change that behavior.

Then you create a shadow incentive reimbursement model, letting physicians know where and how it is going to impact them, allowing them to potentially change how they are practicing or leveraging the care team more.

Finally, you implement the incentive compensation model. There are two phases. One is to meet the minimum, which is typically the first way that the incentives compensation is executed. The next is a rating factor around the quartile, and that is something that takes time as well.

Next is the analytics platform. When finding, designing and publishing the incentive metrics, you build them, share them, get feedback and then approve the metrics. You need an analytic platform to understand and measure these new metrics that we are looking at.

Excerpted from 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability.

Care Coordination Compacts: Establishing Accountability, Clarity between Physicians and Specialists

May 22nd, 2014 by Cheryl Miller


It's a scenario that occurs time and time again, and is a deep source of frustration for all involved: a physician refers a patient to a specialist, but hears nothing back from that specialist. In fact, they learn that the visit happened only when the patient returns for his primary care visit, but without any necessary information.

Or, a specialist receives a patient who has none of the pre-work or test results necessary for an effective visit, which ends up delaying care for the patient. Or, on the flip side, the specialist receives patients that had numerous unneeded and avoidable tests done prior to the referral.

The culprit? Lack of accountability and clarity, the foundations of the Care Compact, an agreement between two practices that outlines the roles and responsibilities of each in order to promote patient-centered care, says Robert Krebbs, director of payment innovation at WellPoint, Inc., during Care Compacts: Forming the Foundation of Care Teams with PCPs and Specialists, a May 2014 webinar now available for replay from the Healthcare Intelligence Network.

The Care Compacts (also known as Care Coordination Agreements and/or Referral Agreements) are key to WellPoint’s patient-centered medical home neighborhood (PCMH-N) pilot, Patient-Centered Specialty Care (PCSC). The program was launched in January 2014 with a select number of pilot practices, ranging in size from solo practices to large group practices in markets where there is a strong patient-centered medical home (PCMH) foothold, says Krebbs.

PCSC is a value-based reimbursement program developed for three types of specialties with clear care coordination alignment opportunities with PCMHs: cardiology, endocrinology, and OB/GYN. These specialists work with existing patient-centered medical home partners to improve quality and coordinate care guided by cost and efficiency measures, Krebbs continued, ensuring the following:

  • Effective two-way communication between primary and secondary providers;
  • Appropriate and timely referrals and consultations with prompt feedback of findings / recommendations;
  • Effective co-management of patients when necessary; and
  • Commitment to practice in a patient-centered fashion across all physicians delivering care to a patient.

The reason these care agreements work is because they provide a standard set of processes for roles in care coordination, truly defining what care coordination is between two practices. While many practices across the country agree they need care coordination, they don't always agree on what the concept of care coordination is, Krebbs continues.

At their simplest, they help to clearly outline who's going to do what in a referral or consult situation. By cutting out inappropriate duties and maintaining appropriate ones, they help to curb healthcare spend and improve patient care, Krebbs says.

“The care compact isn't intended to solve all the world's problems. It’s not going to make care coordination perfect, but it's a starting point. Just like the patient-centered medical home (PCMH) provides a foundation for the medical neighborhood, the care compacts provide a foundation for care coordination between practices. It's an essential starting point to further care coordination expectations across that medical neighborhood," says Krebbs.

Listen to an interview with Robert Krebbs.

BCBS Michigan PGIP Value Partnership Translates to Quality Improvement, Cost Savings

May 6th, 2014 by Patricia Donovan

Donna Saxton: BCBSM's PGIP has resulted in primary care-specialist collaborations that improved care coordination and reduced unnecessary utilization and spend.

Blue Cross Blue Shield of Michigan's Physician Group Incentive Program (PGIP) is so studded with acronyms it's almost a separate language, jokes Donna Saxton, BCBSM's field team manager of BCBSM's value partnerships program.

And while not everyone speaks PGIP-tian, it's easy to translate the savings and benefits the medical home reward and incentives program portends for the insurer, its PCMH practices and its health plan members.

Ms. Saxton described PGIP's place in BCBSM's Value Partnerships program during Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures, including the structure of rewards and incentives that have produced results for the plan, which operates the largest network in Michigan.

"PGIP incentivizes providers to enhance the delivery of care by encouraging them to be responsible and proactive in their behaviors, and ultimately driving better health outcomes and also increasing the fee for value that we also desperately need to get to," said Ms. Saxton.

In return, BCBSM provides financing tools and support for the nearly 18,500 primary care physicians and specialists who participate—more than half of BCBSM's physician population.

Aimed at some root causes of high cost healthcare, including a weak primary care foundation, PGIP, which Ms. Saxton described as the organization's "pinnacle" initiative, expects physician organizations (POs) to take responsibility for developing systems of care, motivating its physicians from within and adopting a culture of process improvement. In return, BCBSM places resources and a PGIP field team representative at the POs' disposal.

Some PGIP activities eligible for incentives range from e-prescribing and patient registries to specialist referrals and medical homes' linkage to community services, Ms. Saxton explained. Further, BCBSM has amped up three key medical home initiatives for its organized systems of care (OSC), "putting them on steroids," as Ms. Saxton said, to raise the performance bar and offer more chances for POs to earn incentives.

BCBSM coined the term OSC, which, while conceptually aligned with the goals of an accountable care organization (ACO) is designed to give providers more latitude in detemining their priorities, she noted. "The OSC is where the neighborhood concept comes into play, where you focus on implementation of PCMH neighborhood capabilities in your specialty offices to further address fragmented care." BCBSM specialists are eligible for one-time incentives plus enhanced fees for collaboration with primary care practices.

A counterpart to PGIP incentives is the PGIP PCMH designation program, an opportunity for practices to earn BCBSM's internally developed medical home designation and the added incentives that go with that distinction, such as increased reimbursement for PCMH office visits. The designation comprises 140 capabiities across a dozen areas.

To date, the biggest challenge of PGIP appears to be its extended access initiative, but practices who adopt more open scheduling often have much lower rates of ED and radiology utilization, noted Ms. Saxton.

Connectivity is also an issue for some, especially practices in rural areas of the state or organizations that have not yet adopted EHRs, which will ultimately be required for participation.

Compared to non-BCBSM-designated PCMHs, the organization's medical homes have produced some significant results, including an 11.2 percent decrease in primary-care related ED visits and a 6.7 percent reduction in low-tech radiology usage.

Ms. Saxton shares more on physician incentives and rewards and some outstanding primary care collaborations that have resulted from the engagement of specialists in BCBSM’s medical home program in this audio interview.

9 Things to Know About Patient-Centered Medical Homes in 2014

April 29th, 2014 by Patricia Donovan

Having established a firm foundation by providing over two decades of patient-centered care, the medical home model is poised for a makeover, expanding into medical neighborhoods and opening the door to specialists’ enhanced role in care coordination—two new metrics documented in the seventh comprehensive Patient-Centered Medical Home (PCMH) survey by the Healthcare Intelligence Network (HIN).

Here are nine benchmarks gleaned from the 2014 PCMH survey:

  • The annual percentage of respondents implementing the medical home model continues to rise, with a high of 58 percent reporting PCMH adoption, up from 52 percent in 2012, when the survey was last conducted.
  • The percentage of respondents with at least a fifth of patients assigned to medical homes more than doubled in the last two years, from 27 to 50 percent.
  • Today’s medical home is especially welcoming to Medicaid beneficiaries, who were targeted by only 3 percent of medical homes in 2012 but now are included in 37 percent of respondents’ patient-centered approaches.
  • Prepared to take their medical homes to the next level of care in the year to come, almost half—48 percent—have joined or expect to join a medical home neighborhood, defined by TransforMED℠ as “a strong foundation of transformed primary care practices aligned with health systems and specialists to ensure that care is maximally coordinated and managed."
  • At the same time, 37 percent of 2014 respondents identified practice transformation, or the process of adopting the attributes of the patient-centered medical home model, as the most formidable challenge of medical home creation.
  • In new metrics from this year’s survey, nearly half of respondents (46 percent) include specialists in their patient-centered medical homes.
  • With an eye toward care coordination, the inclusion of case managers in medical homes jumped from 56 percent in 2012 to 76 percent in 2014.
  • Today’s medical homes are a little more crowded, with three-quarters of respondents reporting 21 or more physicians participating, up from 58 percent in 2012.
  • Undaunted by recent studies to the contrary, all 2014 respondents with medical homes believe the model can reduce cost and improve care delivery.

Excerpted from 2014 Healthcare Benchmarks: The Patient-Centered Medical Home.

2 Essential Steps for Embedding Case Managers

April 24th, 2014 by Cheryl Miller

Selecting the right practice for embedded case managers, and then getting physicians to embrace the concept, are key to successfully embedding case managers, say two thought leaders, Irene Zolotorofe, RN, MS, MSN, administrative director of clinical operations at Bon Secours Health System, and Randall Krakauer, MD, national Medicare medical director for Aetna. Here, they discuss how to best implement these steps.

Question: How did you select practices for embedding of case managers, and what were the first steps in preparing the practice?

Response: (Irene Zolotorofe) They were chosen primarily at the recommendation of some of our operations directors; also, we began with the physicians who are absolutely willing to go ‘medical home,’ that are excited about this model of care. We like to go into a practice where they are motivated to do that type of transition with their patient population.

Physicians are the key; as a physician group expresses interest, we work with them first, since they are key to getting a whole team going. We work hand in hand with the physicians and then the practice managers, and then we bring the process down to the rest of the staff. It takes us about three months.

Question: What marketing strategy is employed to encourage the physician groups to collaborate and embrace the concept of embedding health plan case managers in their practices?

Response: (Dr. Randall Krakauer) What doesn’t always work well is to start with ‘I’m here to help you.’ It is a matter of meeting with your physicians and discussing some of your mutual goals and mutual interests. We focus on those aspects of the equation in which we have common interests: quality of care, doing a better job for our members, your patients. We focus on areas in which we have the opportunity to work together. We show them what we have accomplished in the areas of care management on our own. We can show them at this point, since we’re not new to the game now, some results that we have achieved with other physician partners. And we initiate a discussion on how we can support each other, how we can work together to meet our mutual goals and how we can both benefit from this process.

And with a little bit of time and effort in a great many cases, some great things can happen as a result of such discussions.

Excerpted from Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators.

Predictors of PHO Longevity and Financial Success

April 15th, 2014 by Patricia Donovan

Today, value-based payment models encourage hospitals and physicians to work together and make each more accountable for the other's actions in a physician-hospital organization (PHO). But what are predictors of PHO longevity and financial success?

Here, Healthcare thought leaders Travis Ansel, MBA, manager of strategic services, Healthcare Strategy Group, and Greg Mertz, MBA, FACMPE, director of consulting operations, Healthcare Strategy Group, debate the question.

Response (Greg Mertz): It’s pretty evident that no one entity is going to be able to meet the needs of the population. If you’ve got a hospital that employs physicians, there’s an excellent chance that the employed physician network isn’t the total answer for caring for the population. They’re going to have to embrace non-employed physicians, other specialties, larger based primary care. Some entity is going to have to be created to make that happen.

But the PHO is an excellent model. Basically, it creates a collaborative entity that can bring in hospitals, employed physicians, non-employed physicians, ancillary providers. The PHO this time is something that is going to be necessary. Value is inevitable. I don’t see any reason that it would not have great longevity.

Response (Travis Ansel): I definitely agree. I think the biggest predictor of long-term success is the culture, but it’s going to be how the governance of the PHO is set up. It’s going to be giving the physicians, both employed and independent, a real voice in the organization and getting their expertise leveraged going forward. That’s going to be the biggest predictor. Beyond that, a willingness to experiment.

We’re in a situation now where organizations can’t really afford to sit on the sidelines for too long with all the different models that CMS and private payors are putting up in order to encourage shared risk between providers and hospitals. A willingness to experiment would be another key to success in my mind because it’s really the only way to learn how to be successful in this new environment, how to get involved in it and not hang on to the current FFS environment until it withers and dies.

Excerpted from Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success.