Posts Tagged ‘physician reimbursement’

Infographic: Chronic Care Management Revenue Opportunities

December 9th, 2015 by Melanie Matthews

The value of gaining experience and proficiency with population management and value-based reimbursement is becoming essential as Medicare shifts a greater portion of its payments to these methodologies. Medicare’s chronic care management reimbursement codes allow practices to get paid while learning about this new shift and gaining confidence and competence with value-based reimbursement, according to a new infographic by McKesson.

The infographic examines the incidence of chronic conditions among Medicare beneficiaries and the revenue opportunity for practices that bill Medicare under the Chronic Care Management codes.

Starting this past January, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

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How Aligned Incentives and Evidence-Based Care Support Patient Engagement

December 8th, 2015 by Patricia Donovan

Best practice care standards and new models of provider compensation round out Intermountain Healthcare's patient engagement framework.

Intermountain Healthcare’s vision of shared accountability among patients, payors, providers and even the community is constructed around three key tenets: engaging patients, delivering evidence-based care and aligning provider assignments. Here, Tammy Richards, corporate director of patient and clinical engagement at Intermountain Healthcare, expands upon the latter two pillars, and how they support her organization’s six-stage patient engagement framework.

Regarding evidence-based care, Intermountain has demonstrated that higher quality often costs less. Patients typically have better health medical outcomes and tend to experience fewer complications and readmissions, and through our extensive data repositories, Intermountain’s clinical programs and services are ramping up developments and consistent use of those best practice standards. Our term for that is “care process models.”

Patient engagement means that patients are in involved in their own health and care choices and they interact meaningfully with caregivers. That’s the key. What does “meaningfully” mean and can it be accomplished through technology? Does it require face to face interactions? What portion of each will make the difference there? We engage patients in wellness and prevention decisions, choices about their care or develop models of care to support patients in their unique circumstances. Population health is most definitely the focus.

We are also looking at electronic tools. We’re aggressively pursuing transparency specifically and publicly reporting star ratings for individual providers and physicians, as well as those comments submitted by patients about those physicians. We’re also addressing the emotional labor of medicine and decision fatigue. By aligning financial incentives, we create a payment system that rewards hospitals and physicians for providing the right care rather than just more care.

Intermountain supports the Institute of Medicine recommendation to address these three types of substandard care: under-treatment, or doing too little; overtreatment, doing too much; and clinical mistakes. All three types of substandard care pose medical risks to patients, and we are addressing decision fatigue with that in mind.

We’re developing new models for compensating hospitals and physicians. These models are based on a combination of productivity, quality, service and total cost of care. In addition to that, SelectHealth, our insurance company, is designing health plan benefits that encourage members to participate in their care and to consider financial impacts of their healthcare decisions. Of course, we also focus traditionally on efficiency, which helps us manage costs.

We know regardless of our circumstances or histories, we also must now acknowledge that assuming full financial risk for patient populations and increasing pressures or reduced cost in healthcare means placing more emphasis on improving patient outcomes.

Source: Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health System

http://hin.3dcartstores.com/Framework-for-Patient-Engagement-6-Stages-to-Success-in-a-Value-Based-Health-System_p_5102.html

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health System details Intermountain Healthcare’s multilayered approach and how it supports its corporate mission: Helping people live the healthiest lives possible.

Infographic: Chronic Care Management Reimbursement Trends

October 23rd, 2015 by Melanie Matthews

Chronic Care Management Reimbursement TrendsPhysician participation in the chronic care management program is expected to grow to 70 percent of all practices by the third quarter of 2016, according to a new infographic by Smartlink Mobile.

The infographic looks at the program’s impact on physician practices and practices’ understanding of the program requirements.

Starting this past January, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance for physician practices to maximize CCM reimbursement.

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Infographic: 4 Key Steps to Increasing Physician Practice Revenue

September 25th, 2015 by Melanie Matthews

There are several key steps physician practices can take to help grow their practice revenue, according to a new infographic by MedLanding News.

4 Key Steps to Increasing Physician Practice Revenue

Lessons from a Leading Pioneer ACO: Value-Based Gains from Physician Engagement, Performance Improvement and Care ManagementFollowing Pioneer ACO Year 3 results released by CMS in August 2015, Steward Health Care Network continues to make good on its Promise to provide coordinated, high-quality and cost-efficient care to its 80,000 Pioneer-aligned Medicare beneficiaries. Promise, Steward’s top-performing Pioneer ACO, has generated $30 million of savings in its first three years of participation, according to recently published data.

Lessons from a Leading Pioneer ACO: Value-Based Gains from Physician Engagement, Performance Improvement and Care Management provides veteran advice from Kelly Clements, Pioneer Program Director, Steward Health Care Network. Steward is one of 20 accountable care organizations remaining in the Pioneer program and one of 15 reporting savings for year 3 (2014).

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Infographic: Physicians on the Front Line of Healthcare

July 31st, 2015 by Melanie Matthews

As the healthcare industry moves increasingly toward a value-based system of healthcare delivery and reimbursement, a growing number of physician practices are delivering care in a more systemized way, according to a new infographic by Bain & Company.

The infographic illustrates this change—with 75 percent of physicians using electronic medical records, up from just 29 percent two years ago and 81 percent of practices using treatment protocols, up from 34 percent two years ago.

The infographic also examines the number of practices using metrics, participating in risk-based contracts and the change in management of physician practices.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: Revenue Cycle Management

March 11th, 2015 by Melanie Matthews

Some 76 percent of physician practices handle their billing function in-house, according to a new survey by NextGen Healthcare.

An infographic by NextGen highlights the survey findings, including key billing metrics, best practices for handling denials and overall physician practice performance as it relates to revenue cycle management.


The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third EditionWritten in plain language using nontechnical jargon, The Business of Medical Practice presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, and regulatory and academic perspectives with Health 2.0 examples, and blog and internet links, as well as charts, tables, diagrams, and Web site references, resulting in an all-encompassing resource.

The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition integrates various medical practice business disciplines-from finance and economics to marketing to the strategic management sciences-to improve patient outcomes and achieve best practices in the healthcare administration field.

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Infographic: Getting Paid for the New Chronic Care Management Code

November 21st, 2014 by Melanie Matthews

Under CMS’ new Chronic Care Management (CCM) program, which takes effect in 2015, physician practices can receive reimbursement for non-encounter based follow up care to coordinate care for those with chronic conditions.

A new infographic by HealthFusion provides details on the physician practice and patient responsibilities for practices to be eligible for this reimbursement.

Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care CoordinationStarting January 2015, physician practices will be eligible to receive reimbursement for chronic care management services provided by physicians, advanced practice nurses, physician assistants, clinical nurse specialists and certified midwives to Medicare beneficiaries with multiple chronic conditions. The 2015 Medicare Physician Fee schedule, which finalized the Chronic Care Management reimbursement, was just released, leaving healthcare organizations with little time to prepare for the final aspects of this new reimbursement opportunity.

During Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination a November 19th webinar, now available for replay, Rick Hindmand, attorney with McDonald Hopkins, will share critical insight into how physician practices can best structure their practice to receive this additional reimbursement. The McDonald Hopkins law firm advises a nation-wide client base extensively on healthcare reimbursement.

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Infographic: CMS’ Value-Based Modifier Program

November 3rd, 2014 by Melanie Matthews

CMS’ new Value-Based Modifier program is designed to assess both quality of care and the cost of that care under the Medicare Physician Fee Schedule. Starting in 2015, all providers who participate in fee-for-service Medicare need to prepare for VBM because their 2017 Medicare payments will be adjusted based on their 2015 performance.

In a new infographic, Health Fusion examines how the value-based modifier is calculated, how physician practices might measure up and what practices will need to do in 2015.

CMS' Value-Based Modifier Program

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market’s new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare’s new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

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Joint Contracting Key Component of Clinical Integration Program

June 20th, 2012 by Cheryl Miller

Joint contracting is the ‘glue’ that keeps the Advocate Physician Partners (APP) clinical integration program together, explains Mark Shields, MD, MBA, APP senior medical director and vice president of medical management for Advocate Health Care.

To put together our clinical integration (CI) program, we have negotiated with all of the carriers in our marketplace. There are 10 clinically integrated contracts with our 10 lead carriers. The funding of the CI programs is based on a percentage of allowable physician billings. That is how we create the cash flow for our pay for performance (PFP) program and key infrastructure. The key component of CI is that our quality, patient safety and cost-effectiveness measures are the same across all of the health plans. Our program covers both risk contracts and FFS contracts. Therefore, both health maintenance organization (HMO) and preferred provider organization (PPO) contracts are covered.

We negotiate both base and incentive compensation for physicians. The key component to drive outcome is that the same measures and thresholds of performance are common across all of these contracts. That allows the providers to overcome what has been referred to as a “Tower of Babel” in the past. Even when different insurance companies had similar measures in their PFP programs, the thresholds and methods to collect and report the data were different. It became so confusing for providers that they were not able to focus on performance improvement. They threw up their hands and said, “Well, let the chips fall where they may.”

By having the common set of measures across all of the payors, we are able to develop tools and common reporting systems to drive change. This is our definition of CI: physicians across specialties working together with hospitals to drive quality, patient safety and cost-effectiveness. Joint contracting is a critical component of CI; it is the key glue to keep the program together. Joint contracting has been a key issue that has engaged APP in discussions with regulators, particularly the Federal Trade Commission (FTC). They have given us approval to continue with this CI program, and that is important for others who are thinking about doing this kind of program. It passes not only market acceptance, but also regulatory acceptance.