Presentation on theme: "Intermountain User Group Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis."— Presentation transcript:
Intermountain User Group Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.
Partner with healthcare systems nationwide Individual physician clinics to multi-state organizations Consulting services and products designed to help clients successfully navigate the ever- evolving government programs and industry trends About Quirk Healthcare Solutions
CEO – Quirk Healthcare Solutions – Quirk Wellness Centers Executive Director – Quirk Healthcare Foundation VP of New Practice Acquisitions – 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 After 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 implementation date (but in all likelihood will be)
ICD10 Delay – Good and Bad Good: – Huge number of competing priorities already taxing CMS in 2014 – End-to-end testing not completed by many payors – All systems required an upgrade, and some were delayed Bad: – Upgrades still 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 still 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 (continued) Healthcare industry upheaval as never seen before Use 2014 and the ICD10 delay as opportunities to get ahead of competition Thrive while others struggle to survive.
Sequestration We are still receiving 2% less on all billed charges.
THE CHALLENGES – AND HOW TO GET AHEAD
Sequestration – The Plan Keep the downward reimbursement trend from becoming cumulative with other penalties kicking in this year.
Affordable Care Act Politics aside, the Affordable Care Act is wreaking havoc on some providers’ bottom 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 deductible or copay plans. – Many states pushing patients 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 practice who are not familiar with managed care May also require new quality reports
Affordable Care Act – The Plan Protect your practices’ bottom line. (Now) – Look into pre-encounter copays and coinsurance estimators (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 relations rep. – If you are contracted with Managed Medicare plans, determine if there are other reporting requirements by discussing with your provider relationship rep.
Meaningful Use All Medicare providers must have already attested or do so by September 30, 2014 or face a 1% penalty in – That percentage is cumulative (2% in 2016, etc). Medicaid providers? You don’t even need to start until 2016 and will receive full reimbursement.
MU 2014 Both Stage 1 and Stage 2 were modified for 2014: – All EHRs had to be recertified for If you are on an EHR, you must upgrade this year to be MU compliant. – If attesting for Medicare, you must attest for a fiscal quarter in – Exemptions in Menu Measures no longer count as fulfilling the measures
MU Stage 2 MU Stage 2 is tough – pay specific attention to the HISP requirements in Core Measure 15. Hardship Exemptions may be the way to go. They’re due by June 30, – CMS extremely lenient on hardship exemptions for hospitals and the hope is that this will translate to providers (only 6 of the exemptions were declined, and this is because the hospitals already had automatic exemptions). HIMSS is pushing for an extension until April 2015 for the first year of MU2. There has not been any response from CMS. Check out our Free solution (pay attention to the end!) Under Medicare, you cannot skip years.
MU Stage 2 - Plan Get your application upgrades done as early in Q3 as possible. Test out the functionality before September 30, This is your trial period. You must begin attestation 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 % (performance year for 2015 penalty) % (performance year for 2016 penalty) % %
PQRS - Plan Overlaps with Meaningful Use Clinical Quality Measures For registry based reporting, 80% of encounters are required
Value Based Modifier – PQRS’ Evil Cousin All Medicare Providers are auto-enrolled in Value Based Modifier program. Incentives or penalties 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 automatically First year is a demonstration period. After that, incentives and penalties 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 attention to CQM and PQRS performance – meeting 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 aggregating and displaying this data to their payors. Services are well funded, full of your data, and bent on showing patients perceived quality vs cost. In addition, for the first time 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 ChallengeTaskDeadline ICD10Upgrade and test, test, testQ2 2015…ish Affordable Care ActUnderstand your market. Collect cash upfront Now! Meaningful Use 2014Upgrade now or look at hardshipsNow! PQRSIf you haven’t started, you need to do claims submission Now! Value Based ModifierDetermine where you fall and begin watching quality measures. Q 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