10/20/2016. Working within the Value-Based World

Transcription

1 Working within the Value-Based World MGMA Annual Conference Roundtable Discussion Orthopedics Urology Surgery Monday, October 31,

2 Learning Objectives Summarize key solutions used by other specialty practice executives List new strategies to address significant issues in your practice Identify colleagues who you can contact after the conference to continue problem solving Today s presenters & round-table facilitators Sandra George MBA, CMPE Urologic Specialists of Oklahoma, Inc. Tulsa OK UROLOGY Donald E. Stumpp, CMPE, CPA McLean County Orthopedics, Ltd, Bloomington, Illinois ORTHOPEDICS Amy LaGrange, MBA, FACMPE, Ellis Medicine, Schenectady, N.Y. SURGERY 2

3 Urology Triple Aim: Care, Health and Cost Sandra George MBA, CMPE Urologic Specialists of Oklahoma, Inc. Tulsa OK Value-Based Healthcare (VBH) The delivery of evidence-based treatment through which providers are compensated based on improved patient outcomes. Volume vs. Value Providers will not be paid on the number of visits/services (as in the fee-for-schedule model) but expected to demonstrate the value of the care (more risk bearing model of fee-for-value) by achieving improved outcomes at a lower cost. 3

4 MACRA MACRA Medicare And CHIP Reauthorization Act - Reforms that have eliminated the sustainable growth rate (SGR) formula - Provides new incentives, penalties and processes APM Alternative Payment Methods - HHS wants 30% of traditional Medicare payments to come from ACOs, bundled payments or other APM models - Physicians meet the requirements of the ACO & are exempt from MIPS - Created to facilitate care coordination and achieve the Triple Aim for patients; improve health, improve quality of care and reduce overall cost MIPS- Merit-Based Incentive Payment System The proposed MIPS payment formula will replace the PQRS, Value Based Modifier (VM) and MU programs. Your current performance under these quality reporting programs can help provide some insight into MIPS. Have you reviewed your QRUR? It compares your practice s cost and quality performance to a national benchmark. 4

5 Transition what about.. What is the impact on your practice? What are you doing or have done to prepare? Are you making changes to your service line? What is the impact on workflow, processes & IT? How and what to measure? Track trends? Dashboards? Compensation structure? Revenue cycle impact? Capital expenditures? Collaboration and sub-specialization? Others?? Challenges. How is your documentation? For independent specialty practices? For academic/hospital owned? More coordination of care within & across specialties? Improve outcomes; how? Reduce overall healthcare costs; how? Patient satisfaction; how will you handle? New technology (which has limited outcomes)? Avoid reimbursement penalties? Receive bonus? 5

6 Inquiring minds. Value-based contracting Specialty Clinics -Advanced Prostate Cancer, Advanced OAB and E/D Provenge, Xtandi, Xofigo & others Nurse Navigator Analytical software Physical Therapy Physician extenders Histology Multi-disciplinary approach ORTHOPEDICS VALUE BASED CARE McLean County Orthopedics, Ltd Bloomington, Illinois Donald E. Stumpp, CMPE, CPA 6

7 McLean County Orthopedics Started in Orthopedic Surgeons 2 Pain Management Physicians 1 Sports Medicine Physician 16 Therapy Providers 1.2 Open Hitachi Oasis MRI McLean County Market Population 175,000 24,000 Medicare lives with 27% MA MA Two Hospitals Advocate BroMenn OSF St Joseph 50% of the Orthopedic Surgeons in county VALUE BASED CARE Clinical Integration with Advocate Health Care, Chicago subhead 7

8 Clinical Integration with Advocate Physician Partners HMO Risk arrangements with Payers BCBS-IL Medicaid Managed Care (Meridian) Shared Savings Arrangements MCO $217k ($27k per MD) $162k ($20k per MD) $198k ($25k per MD) Bundled Payment Care Initiative (BPCI) CMS Model 3 Post Acute Care Bundle Joint Replacements DRG 469 & 470 Convener Illinois Bone & Joint Institute Began April month lag on reconciliation Annual Payment of $600,000 $2500 per episode to MCO $1200 per episode savings to CMS 8

9 Donald E. Stumpp, CMPE, CPA Chief Executive Officer 1111 Trinity Lane, Suite 111 Phone and Fax: General Surgery Amy LaGrange, MBA, FACMPE, CPC Ellis Medicine Schenectady, NY 9

10 Coming Soon to a practice near you MACRA MIPS Payer driven incentive programs Imbedded clinical documentation specialists Patient Centered Medical Home Expanded hours for enhanced reimbursement Points to Ponder Hospital-Physician relationships are they working? Hospital operating room vs. ambulatory surgical center (ACS) Anyone employed physician using both? EMR changes Changing EMR s already? Not using an EMR? EMR s that work for general surgery. 10

11 After Effects of.. American Care Act on practice/service Unlisted code changes Purchasing expensive surgical tools and paying back the investment (robots for surgery) Physician burnout How are the physician dealing with it? How are you as an administrator managing it? Big Data How is it being used to make decision? Decrease readmissions? Discussion The shifting paradigm will bring about changes and opportunities. So what can we do as leaders to help our practices make a successful transition? 11

12 Speaker contact information: Sandra George MBA, CMPE Phone Direct Donald E. Stumpp, CMPE, CPA Phone and Fax: Amy LaGrange, MBA, FACMPE, CPC Phone