Archive for the ‘Primary Care Practice’ Category

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    Infographic: Physician Health and Patient Care Impacted by Practice Demands

    October 6th, 2017 by Melanie Matthews

    The demands of practicing medicine are negatively impacting primary care doctors and their patients, according to a new infographic by MDVIP.

    The infographic examines how stress is impacting physicians and how this affects patients, along with details on what’s contributing most to physician stress.

    UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

    Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

    Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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    Infographic: Measuring Total Investments in Health

    November 21st, 2016 by Melanie Matthews

    Current spending on medical care is increasing, but does not always translate to improved health. Research has, however, shown a positive relationship between spending on social services and improved health and there has been a growing number efforts to measure “total spend on health” or the investments being made to produce health, according to a new infographic by Leavitt Partners.

    To better understand total spend on health, defined as health expenditures that extend beyond traditional clinical care costs or total cost of care measures to include costs related to social determinants of health, Leavitt conducted, with support from the Robert Wood Johnson Foundation, an assessment of related research and initiatives.

    The infographic examines the key challenges of analyzing total spend on health and next steps for healthcare leaders, researchers and other stakeholders in this area.

    Empowered Digital Patients

    The move from fee-for-service to value-based healthcare is driving the need for increased capabilities in population health management, including addressing all of the areas that may impact a person’s health. There is growing recognition that a broad range of social, economic and environmental factors shape an individual’s health, according to the New England Journal of Medicine. In fact, 60 percent of premature deaths are due to either individual behaviors or social and environmental factors. Healthcare providers who adopt value-based reimbursement models have an economic interest in all of the factors that impact a person’s health and providers must develop new skills and data gathering capabilities and forge community partnerships to understand and impact these factors.

    During Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System a December 8th webinar at 1:30 p.m. Eastern time, Dr. Randall Williams, chief executive officer, Pharos Innovations, will share his insight on the opportunity available to providers to impact population health beyond traditional clinical factors.

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    Appointment Data Opens Door to Population Health Management of Rising Risk Patients

    August 9th, 2016 by Patricia Donovan

    The rising risk population represents a healthcare organization’s “low-hanging fruit,” says Dr. Adrian Zai, clinical director of population informatics at Massachusetts General Hospital.

    Sometimes the most powerful population health management intervention is simply to convince a patient to make an appointment.

    This is the first step Dr. Adrian Zai, clinical director of population informatics at Massachusetts General Hospital (MGH), would recommend to any organization hoping to better manage its rising risk population, a group the physician describes as “low-hanging fruit.”

    “The appointment does not require significant investment in any health IT or other resources,” said Dr. Zai during Targeting High-Risk and Rising-Risk Patients: A Multi-Pronged Strategy, an August 2016 webinar now available for replay. “All you need is appointment data. The key is to identify existing data you already have in your organization and start there, so that you impact outcomes.”

    Dr. Zai, whose hospital has been ranked number one in the nation by U.S. News & World Report, likened the notion of an organization acquiring a sophisticated health data analytics system prior to identifying clinical outcomes to “building a house without an architect.”

    However, having done its due data diligence, MGH’s population health management approach embraces technology. The MGH approach, which targets rising- and high-risk patients, has moved far beyond appointment-setting, constructing a safety net program with the goal of improving clinical outcomes for 300,000 patients in its entire primary care network— a network spanning MGH and Brigham and Women’s Hospital.

    To this end, MGH developed a new set of clinically meaningful measures, but not before soliciting physician feedback on its existing set. In response, doctors identified more than 200 challenges to the old measures that MGH addressed in its new decision support system.

    With new measures in place, MGH then created central population health coordinator teams to support primary care physicians in population health management, freeing clinicians to care for patients.

    The selection of technology to support MGH’s primary care safety net presented its own challenges. “Frequently, the tools you end up with—for data aggregation, analytics, care coordination, and patient outreach—don’t actually talk to each other. You need a system to pull all of these functionalities together. That’s the strategy we took,” said Dr. Zai.

    The new MGH population health management system enables clinicians to identify and share gaps in care with MGH care coordinators and population health managers, so they can intervene and try and close those gaps, he continued.

    The system also tracks outcomes. After using the system for only six months, MGH reported improvement in every one of its newly developed performance framework measures. Not only is the ability to review outcomes appealing to payors, but 85 percent of MGH physicians surveyed also expressed satisfaction with the system—as well as its concurrent financial incentives.

    In closing, Dr. Zai reiterated the need for collaboration: between staffers doing the work and the informatics tying those efforts neatly together. “One cannot work without the other. That technology is just a tool. Just as you cannot give a hammer to someone and expect them to build a house, you need the talents working together with technology to make that happen.”

    Click here to listen to an interview with Dr. Zai on reducing the natural inertia of low-risk patients to move into the high-risk stratum.

    MACRA Mantra for Physician Practices: “Chase the Quality, and the Dollars Will Follow”

    July 19th, 2016 by Patricia Donovan

    Physician practices should position themselves to be paid for volume now and value in the future, McKesson’s Eric Levin advised webinar participants.


    If provider discontent doesn’t prompt a delay, the controversial MACRA legislation will become reality in just six months, shaking up traditional physician reporting and reimbursement as healthcare knows it.

    And while the proposed MACRA rule is still in flux, the bones of the law aren’t expected to change, notes Eric Levin, McKesson’s director of strategic services. From this point forward, he says, care coordination will be the ticket to success in eventual MACRA value- and performance-based healthcare models.

    “As clinical alignment and care coordination increase, if you are not participating in some type of value-based care program, most likely you’re not being reimbursed or rewarded for that work,” Levin told participants in The New Physician Quality Reporting: Positioning Your Practice for MACRA’s Merit-Based Incentive Payment System, a July 2016 webinar now available for replay.

    In outlining MACRA’s intent, Levin chiefly focused on the Merit-Based Incentive Payment Systems (MIPS) rather than the second reimbursement path, alternative payment systems (APMs), since the majority—88 percent—of physicians is expected to qualify under MIPS rather than APMs.

    Zeroing in on MIPS, Levin reviewed eligibility, performance categories and data submission options, among other points. He then detailed the plethora of current and planned technical assistance options from CMS—including eventual practice transformation networks to provide peer-level support to physicians—before offering practical ways physician practices can prepare now for MACRA.

    His six immediate action steps for practices included dipping a toe into analytics and data aggregation. “Look at the data. Learn how to risk-stratify. See the gaps in care you currently have and where those can be filled in so you’re not just measuring but actually improving quality,” Levin advised. The CMS Quality and Resource Use Report is useful for estimating a practice’s MIPS score, he added.

    In offering six additional tactics to become MACRA-ready, Levin recommended physician practices acquaint themselves with national benchmarks as a primer in quality measurement.

    And on Levin’s accompanying five-point MACRA implementation checklist is a reminder to stay current on CMS’s proposed and final MACRA rulings. Fostering relationships with technology vendors wouldn’t hurt either, he added.

    His final points covered additional MACRA implementation resources, including education from provider associations, as well as the benefits of Patient-Centered Medical Home recognition and engagement in CMS’s Chronic Care Management initiative in MACRA preparation.

    “These programs will really help you begin the value-based journey if you have not started.”

    Levin emphasized providers should not wait for the final rule. Rather, physician practices should “learn how to focus on quality outcomes and costs, helping focus on the patient as well as that patient-provider relationship. Look at how you can identify ways to increase inexpensive patient encounters.”

    Before concluding, Levin answered participants’ questions on how MACRA and MIPS will impact specialty providers; lessons practices can take from participation in the Physician Quality Reporting System, Meaningful Use and other value-based initiatives to enhance MACRA success; recommendations for small and solo practices; and other key concerns.

    Learn more about Levin’s presentation.

    Infographic: Proven Preventative Healthcare Practices

    July 1st, 2016 by Melanie Matthews

    Adopting simple, proven preventative practices could save Americans billions in healthcare costs per year and allow most to live longer lives. Nurses trained in basic screenings and counseling can have profound impacts, according to a new infographic by the University of San Francisco’s Online Master of Science in Nursing program.

    The infographic highlights 20 proven preventative services and the impact on the number of lives saved and healthcare costs if more people had access to these services.

    Increasing demand for quality-based, pay-for-value healthcare has elevated the health coach’s contribution to chronic care management and population health. From supporting ‘rising risk’ populations telephonically to conducting home visits for recently discharged high-risk, high-cost individuals, health coaching offers an essential care management touch point.

    2016 Healthcare Benchmarks: Health Coaching is the fifth comprehensive analysis of the health coaching arena by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by health coaching programs; risk stratification criteria; prevalence of embedded coaching within care sites; coaching tools and incentives as well as program outcomes and ROI from more than 100 healthcare organizations.

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    Infographic: 12 Physician Practice Models

    January 18th, 2016 by Melanie Matthews

    Healthcare industry challenges and government mandates are changing the way some physician practices operate, according to a new infographic by BillingParadise.

    The infographic outlines how 12 different physician practice models work to help physicians understand and choose a model best suited for them.

    One year after the Centers for Medicare and Medicaid Services began reimbursing physician practices for chronic care management services, Bon Secours Medical Group is now comfortable with the CCM reimbursement requirements and is reporting that it’s unique approach to this revenue opportunity is ramping up nicely. And, the organization’s approach to chronic care management reimbursement is helping to position itself for advance care planning as a new billable CMS event in the upcoming year.

    During Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a January 26th webinar at 1:30 p.m. Eastern, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, will provide an inside look at his organization’s experience with CMS’ chronic care management reimbursement this year and how they are leveraging this experience for CMS’ newest billable event in 2016—advance care planning.

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    Infographic: ACA’s Impact on Primary Care Practitioners

    November 27th, 2015 by Melanie Matthews

    Most primary care practitioners are reporting no change in their ability to provide quality care after the Affordable Care Act’s (ACA’s) major coverage provisions took effect in January 2014, according to a new Visualizing Health Policy infographic. Their opinions about the healthcare law are sharply divided along political party lines. Generally, primary care physicians have a more negative view of health reform’s effect on the cost of patient care, but a more positive view of the law’s impact on patient access to healthcare and insurance.

    The infographic looks at the number of primary care clinicians who say they’re seeing more newly insured patients or patients covered by Medicaid since the ACA’s major coverage provisions took effect in January 2014.


    Dual-Eligibles Demos: Early Results and Their Implications offers timely intelligence about efforts to provide integrated care programs for beneficiaries who are dually eligible for Medicare and Medicaid—so-called “dual eligibles”—a group of 9 million beneficiaries who account for more than $300 billion in annual health care spending.

    Dual-Eligibles Demos: Early Results and Their Implications also includes a case study of the nation’s largest CMS-backed duals demo in California—one that has many insurers participating, including national for-profit firms, large local non-profits and smaller plans.

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    Medicare Chronic Care Management Reimbursement: Clarifying EHR Use and Electronic Requirements

    October 22nd, 2015 by Patricia Donovan

    Just one-fifth of U.S. physician practices participate in CMS's Chronic Care Management Program.

    Nearly 70 percent of physicians nationwide admit they do not fully understand the Medicare Chronic Care Management (CCM) program, according to an August 2015 study by Smartlink Mobile Systems. The survey of 45,000 American physician practices determined that while 20 percent do participate in CCM, there is a great deal of confusion surrounding the CMS program designed to curb the cost of coordinating care for 34.4 million Medicare fee-for-service beneficiaries with two or more chronic diseases—particularly when it comes to meeting CCM’s electronic requirements.

    The CCM initiative pays participating physician practices a monthly fee for twenty minutes of non-face-to-face patient care.

    Earlier this year, Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, delved into CMS requirements and discussed approaches and challenges to meeting the CCM requirements, including a practice’s requirements for electronic health records (EHRs):

    The CCM care plan is all the clinical staff needs to have access to in order to count time toward the 20 minutes. In terms of the EHR itself, the practice is only required for certain specified services within the Chronic Care Management. For example, the practice has to create a structured recording of demographics, problems, medications and allergies within the EHR, and then that information must inform the care plan. The care plan will include that type of information but doesn’t have to include everything that is in the EHR.

    The practice also must put into the EHR a structured clinical summary record, which is discussed at some length in the final rule. In addition, the EHR must document that there’s written consent for the CCM services and all the other things the practice explained to the patient when the patient gave consent.

    In addition, the care plan must be provided to the patient. That could be a hard copy or an electronic copy. The communication to and from home with community-based providers regarding their psychosocial needs and functional deficits also must be in the EHR.

    Essentially, the electronic care plan is a distilled version of the EHR containing the pertinent information clinical staff would need to provide CCM services.

    However, in spite of this interpretation, one Medicare contractor recently suggested that in order to count time toward the 20 minutes, the clinical staff has to have access to the EHR. We believe that is an incorrect interpretation of the rule. We believe the practitioners only need access to the electronic care plan.

    The last thing I would like to mention about the EHR is that use of the EHR to provide care plans and other information to all off-site clinical staff and to other practitioners could theoretically raise privacy concerns. These are not new privacy concerns, but any practice that is going to provide CCM services needs to be cognizant of potential HIPAA issues and make sure they are in compliance. One thing that can be done in this regard is to have the individuals with EHR access sign business associate agreements.

    Source: Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue

    http://hin.3dcartstores.com/Chronic-Care-Management-Reimbursement-Compliance-Physician-Requirements-for-Value-Based-Revenue_p_5027.html

    Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue sets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements. In this 25-page resource, attorneys Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, drill down into chronic care management requirements outlined in the 2015 Medicare Physician Fee Schedule.

    Guest Post: 7 Ideas to Improve Communication and Coordination between Care Sites

    September 22nd, 2015 by Richard A. Royer, CEO, Primaris

    With access to some of the most highly educated and trained medical professionals in the world, providing Americans with the best patient care possible should be simple. Unfortunately, that’s not often the case. Poor communication between specialists, duplicate tests and unnecessary procedures are frequently the norm rather than the exception, leading to costly, dangerous and sometimes deadly consequences. With so many specialists and resources readily on hand, how is this happening?

    The problem is a lack of care coordination. Simply put, care coordination is the idea that all specialists treating a patient should communicate and share information to ensure that everyone acts as a team to meet patient needs. This includes reporting all results back to a primary care practice or to someone coordinating patient care, and ensuring that labs, specialists, hospitals, and long-term care facilities work together to communicate information quickly and appropriately. It’s about primary care physicians, nurses, technicians, specialists, and caregivers collaborating on patient care rather than working as separate entities.

    The average Medicare beneficiary interacts with seven physicians in four different practices during a single year, according to the New England Journal of Medicine. For those with chronic conditions, the numbers can be even higher. And, nearly one-fifth of Medicare patients who are hospitalized are readmitted within 30 days of discharge, and 75 percent of these readmissions could have been prevented by improved care coordination.

    Too often, patients discharged from hospitals don’t get the support and encouragement they need to take their medicine, follow their diets, and adhere to the regimens doctors have prescribed during their stay. Many of these problems can be solved by improving care coordination, and that starts with communication between care sites.

    Here are seven suggestions for improving communication between care sites—as well as across the care continuum:

    • Start the dialog: As a rule of thumb, improving communication between care sites begins with healthcare providers asking themselves what they know that others need to know, and sharing that information with the patient’s care team. What do patients need to know when they’re referred to a specialist? What do the specialists that patients are being referred to need to be aware of, e.g. what tests have already been completed? Has the primary care physician been informed?
    • Create a team and make it accountable: Organizations should start by assigning a team of people to be accountable for managing patient care. Define the extent of their responsibilities for key activities such as following up on test results and communicating information to other physicians. Establish when specific responsibilities should be transferred to other care providers—whether that means specialty physicians, long-term care facilities, or home care providers.
    • Designate care coordinators: Designate staff that will act specifically as care coordinators can help to reduce hospital readmissions. Before patients leave the hospital, care coordinators should meet with them to make sure they understand the treatment plans they need to follow at home as well as any changes to their medication regimens. The hospital care coordinators also must follow up on any pending labs and imaging studies and contact primary care physicians to communicate updated medications, treatment plans, and test results for their patients. The likelihood of readmission drops significantly when patients leave with a clear understanding of their treatment plans and when their primary care physicians know what is necessary during follow-up care.

      This same communication protocol should also apply to patients who leave the hospital for long-term care facilities. In this instance, the hospital care coordinator should communicate discharge instructions to the long-term care staff. As soon as residents return to the long-term care facility, staff there should meet with residents to review their discharge instructions, answer their questions, and communicate with the hospital if any further clarification is needed. Long-term care staff should also follow up regularly with these residents to ensure they continue to comply with instructions the doctor has recommended and intervene if any problems arise.

    • Standardize communication processes: Create a protocol for filling out patient charts in a standard way so they are easy to interpret and key elements aren’t overlooked. You also should standardize communication by using structured forms to ensure primary care providers, specialists, and long-term care providers all have the same and necessary information.
    • Develop a referral tracking system: Creating a system to internally track and manage referrals and transitions— including consultations with specialists, hospitalizations and ER visits, and referrals to community agencies—can go a long way towards improving communication between care sites. It will help to ensure patients are well prepared for their referral visit and know what to expect afterwards. And, it simplifies follow-up with referral providers about findings, next steps and treatment plans.
    • Follow up on referrals: When a primary care physician refers a patient to a specialist, for example, office staff should follow up to make sure the appointment was made and completed. In addition, office staff needs to ensure the specialist shares his findings with the primary care physician so he can be well versed on the patient’s progress and any additional steps to be taken.
    • Notify providers in the patient’s medical neighborhood: Similarly, when patients visit the emergency room or are admitted to the hospital, communication should be a priority. In this instance, hospital staff should notify the primary care practice so the primary care doctor can follow the patient’s progress through discharge and institute a care plan to prevent future admissions. In addition, the practice can reach out to patients when they leave the hospital to make sure they understand discharge instructions and schedule follow-up appointments. When the patient comes in for follow-up care, the primary care physician should have a complete history of specialists seen during the hospital admission, their recommendations, and tests performed, along with the results.

    The healthcare industry can no longer simply “discharge” patients. Providers must now work collaboratively with all others across the continuum of care to transition and coordinate the ongoing care of every patient. That’s what care coordination is all about.


    Richard Royer

    About the Author: Richard A. Royer has served as the chief executive officer of Primaris since 2001. He has extensive administrative healthcare experience and is actively involved in several statewide healthcare initiatives. In 2006 he was appointed by the Missouri governor to the Missouri Healthcare Information Technology Task Force and chaired the resources workgroup. He also serves on the board of directors as treasurer for the Excellence in Missouri Foundation. In his over 35 years of medical business experience he has held positions as chief executive officer at Cuyahoga Falls, Ohio, General Hospital; executive director of Columbia Regional Hospital in Missouri; and founder and president of Avalon Enterprises, a medical financial consulting firm.

    HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.