Presentation on theme: "2014 PPRNet Annual Meeting August 23, 2014 Oscar F. Lovelace Jr., MD."— Presentation transcript:
2014 PPRNet Annual Meeting August 23, 2014 Oscar F. Lovelace Jr., MD
Quality Improvement Research Return on Investment Medicare 2015 CCM CCM Reimbursement
Pay for Performance is here to stay PQRS (Physician Quality Reporting System) NCQA (National Committee for Quality Assurance) PCMH (Patient Centered Medical Home) ACO (Accountable Care Organizations) MU (Meaningful Use) If we care about quality, we need process & metrics. How much time is available at the end of the day?
Need for more community based research Data drives process improvement – PPRNet Increase in practice / university affiliation AHRQ more focused on primary care research Future offers practice level research opportunities ACOs will require outcomes research Self funded health plans for independent practices
The QI/Research professional An office champion A part-time employee A full time employee in a group practice A department within a larger organization
PQRS$ 5,000 PCMH$ 18,000 NCQA/BCBS$ 26,000 CCI $ 38,000 Meaningful Use $ 95,000 Since 2011
Services are designed to pay separately for non-face-to- face coordination of care New G-Code for Traditional Medicare Patients Payment will be $41.97 per patient per month - Patient responsibility is 20% of this fee = $8.28 Will reimburse one physician within 30-day period
Patients must: Have 2 or more chronic health conditions, expected to: last at least 12 months or until death place the patient at risk of death, acute exacerbation or functional decline Be informed of the program Sign a consent form
Providers must: Ensure patients have had (within the past year) either an: AWV (Annual Wellness Visit) or IPPE (Initial Preventive Physical Examination) Document a minimum of 20-minutes of clinical labor time for non-face-to-face interaction Offer patients access to care 24/7 Use an EMR that meets HHS certification for MU
100 patients x 12 months x $42 = $ 50, patients x 12 months x $42 = $151, patients x 12 months x $42=$504,000
Payment transition from encounter to quality based Benefits of investing in QI / Research staff Additional funding may offset personnel expenses Thinking ahead keeps us from being left behind!