| Date post: | 07-May-2015 |
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Healthcare |
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Intermountain User Group
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
• Partner with healthcare systems na0onwide • Individual physician clinics to mul0-‐state organiza0ons
• Consul0ng services and products designed to help clients successfully navigate the ever-‐evolving government programs and industry trends
About Quirk Healthcare Solu0ons
• CEO – Quirk Healthcare Solu0ons
– Quirk Wellness Centers
• Execu0ve Director – Quirk Healthcare Founda0on
• VP of New Prac0ce Acquisi0ons – Leon Medical Network
About Ben Quirk
What are ICD-‐10 Codes?
• Granular code set developed by WHO for: – Increased clinical accuracy – Improved disease tracking – Disease trending
• More ICD-‐10 codes compared to ICD-‐9
ICD-‐9 14,000 diagnosis codes 4,000 procedure codes 5 digit numeric codes
ICD-‐10 68,000 diagnosis codes 87,000 procedure codes
7 digit alphanumeric codes
ICD10 Is A Requirement to Get Paid A\er October 1, 2014 • Just kidding! • Congress pushed ICD10 from October 1, 2014 to no early than October 1, 2015
• Does not mean that October 1, 2015 is the implementa0on date (but in all likelihood will be)
ICD10 Delay – Good and Bad
• Good: – Huge number of compe0ng priori0es already taxing CMS in 2014
– End-‐to-‐end tes0ng not completed by many payors – All systems required an upgrade, and some were delayed
• Bad: – Upgrades s0ll required for MU 2014 requirements – Will they really do it in 2015? Loss of momentum – Keeps the US lagging behind all other developed countries
But Don’t Relax Quite Yet
If you don’t keep your eye on the ball, you could s0ll end up in a world of trouble. (And yes, your daughter will date this guy)
Fee for Service Has A Finite Timeline – The Future is Value
At the HIMSS 2014 Conference, Hillary Clinton declared Fee for Service is dead and the future is value over volume
Fee for Service Has A Finite Timeline – The Future is Value (con0nued) • Healthcare industry upheaval as never seen before
• Use 2014 and the ICD10 delay as opportuni0es to get ahead of compe00on
• Thrive while others struggle to survive.
THE CHALLENGES – AND HOW TO GET AHEAD
Sequestra0on
We are s0ll receiving 2% less on all billed charges.
Sequestra0on – The Plan
Keep the downward reimbursement trend from becoming cumula0ve with other penal0es kicking in this year.
Affordable Care Act
• Poli0cs aside, the Affordable Care Act is wreaking havoc on some providers’ bojom lines: – All new group of consumers who are not used to managed care enrolled in plans.
– Consumers may not know (or care) about out of pocket expenses with complex deduc0ble or copay plans.
– Many states pushing pa0ents on straight Medicaid into managed care plans. • You may be contracted with these plans but not even know it • Yet another group of consumers introduced into your prac0ce who are not familiar with managed care
• May also require new quality reports
Affordable Care Act – The Plan
• Protect your prac0ces’ bojom line. (Now) – Look into pre-‐encounter copays and coinsurance es0mators (eg from Navicure). Collect this money prior to the visit.
– Evaluate your payers and which plans you’re required to accept per the contract. Compare against their websites or your provider rela0ons rep.
– If you are contracted with Managed Medicare plans, determine if there are other repor0ng requirements by discussing with your provider rela0onship rep.
Meaningful Use
• All Medicare providers must have already ajested or do so by September 30, 2014 or face a 1% penalty in 2015. – That percentage is cumula0ve (2% in 2016, etc).
• Medicaid providers? You don’t even need to start un0l 2016 and will receive full reimbursement.
MU 2014
• Both Stage 1 and Stage 2 were modified for 2014: – All EHRs had to be recer0fied for 2014. If you are on an EHR, you must upgrade this year to be MU compliant.
– If ajes0ng for Medicare, you must ajest for a fiscal quarter in 2014.
– Exemp0ons in Menu Measures no longer count as fulfilling the measures
MU Stage 2
• MU Stage 2 is tough – pay specific ajen0on to the HISP requirements in Core Measure 15.
• Hardship Exemp0ons may be the way to go. They’re due by June 30, 2014. – CMS extremely lenient on hardship exemp0ons for hospitals
and the hope is that this will translate to providers (only 6 of the exemp0ons were declined, and this is because the hospitals already had automa0c exemp0ons).
• HIMSS is pushing for an extension un0l April 2015 for the first year of MU2. There has not been any response from CMS.
• Check out our Free solu0on (pay ajen0on to the end!) • Under Medicare, you cannot skip years.
MU Stage 2 -‐ Plan
• Get your applica0on upgrades done as early in Q3 as possible.
• Test out the func0onality before September 30, 2014. This is your trial period.
• You must begin ajesta0on by October 1, 2014 (for Medicare)
PQRS
• Required for all Medicare
• Date is based off of fiscal year • 2 years prior • Results posted on Physician Compare Website
2013 0.5% (performance year for 2015 penalty)
2014 0.5% (performance year for 2016 penalty)
2015 -‐1.5%
2016 -‐2%
PQRS -‐ Plan
• Overlaps with Meaningful Use Clinical Quality Measures
• For registry based repor0ng, 80% of encounters are required
Value Based Modifier – PQRS’ Evil Cousin
• All Medicare Providers are auto-‐enrolled in Value Based Modifier program.
• Incen0ves or penal0es are paid using a complex formula of claims and quality (PQRS and MU data). – 2013 – All groups over 100 providers enrolled – 2014– All groups over 10 providers enrolled – 2015 – All providers enrolled
• Voluntary enrollment or CMS enrolls automa0cally • First year is a demonstra0on period. A\er that, incen0ves and penal0es kick in.
• Results published on Physician Compare Website.
Value Based Modifier – Plan
• Review results from first year to see what scoring would have been.
• Start paying close ajen0on to CQM and PQRS performance – mee0ng the measures is not enough – you need to have the right answer.
• Educate your providers that their quality scores are going to be published.
Increased Visibility Into Value
• Value is defined as cost vs outcomes • MU, PQRS, and Value Based Modifier quality published on the Physician Compare website
• Commercial website also aggrega0ng and displaying this data to their payors.
• Services are well funded, full of your data, and bent on showing pa0ents perceived quality vs cost.
• In addi0on, for the first 0me ever, Medicare has published reimbursement data on providers on the Physician Compare website.
Increased Visibility Into Value -‐ Plan
• Tomorrow, log onto the Physician Compare website and ensure the data is accurate
• Find out what your payors are publishing and ask to validate.
• Share the data with your providers. If possible, include metrics in their report cards.
Recap Challenge Task Deadline
ICD10 Upgrade and test, test, test Q2 2015…ish
Affordable Care Act Understand your market. Collect cash upfront
Now!
Meaningful Use 2014 Upgrade now or look at hardships Now!
PQRS If you haven’t started, you need to do claims submission
Now!
Value Based Modifier Determine where you fall and begin watching quality measures.
Q2-‐3 2014
Increased Visibility into Value
Go on Physician Compare website. Contact payers to see what they have.
Now!
Focus on thriving while others struggle.
Free Stuff
• For NextGen, but applicable to other systems: – Meaningful Use 2014 (1 and 2) Without Upgrading
– Configurable Histories Templates – EPM Recalls in EHR
Available by contact [email protected]
QUESTIONS?
