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10 Things You Need To Do To Survive in 2010 and beyond…

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Presentation on theme: "10 Things You Need To Do To Survive in 2010 and beyond…"— Presentation transcript:

1 10 Things You Need To Do To Survive in 2010 and beyond…

2 Agenda Trends In Oncology Practice 2010 Practice Objectives 10 Things You Can Do Discussion 2 onPoint Oncology LLC

3 Trends In Oncology Practice 1. Flat or declining reimbursement with increasing drug costs. 2. Increasing patient out-of-pocket costs for oral and injectable therapies. 3. Inefficient and unpredictable revenue cycle. 4. Increasing demand for information in exchange for payment. 5. Audits, audits, and then, more audits. 3 onPoint Oncology LLC

4 Trends in Oncology Practice 6. Patient demand for more clinical information and provider face time. 7. Pressure to automate everything ASAP. 8. Higher overhead with less facility revenue. 9. More regulatory intervention between pharmaceutical companies and providers. 10. Trending towards hospital-physician alliances in Oncology care and coordination of care. 4 onPoint Oncology LLC

5 Trend #1—Less Reimbursement/ Higher Drug Costs 5 onPoint Oncology LLC

6 Trend #1—Less Reimbursement/ Higher Drug Costs 6 onPoint Oncology LLC

7 Trend #1—Less Reimbursement/ Higher Drug Costs 7 onPoint Oncology LLC

8 Trend #2--Higher Patient Costs Employers Cannot Sustain Costs… 8 onPoint Oncology LLC

9 Mean Health Insurance Costs Per Worker Hour for Employees with Access to Coverage, 1999- 2005 Source: Kaiser Family Foundation analysis based on data from the National Compensation Survey, 1999-2005, conducted by the Bureau of Labor Statistics.

10 Trend #3: Unpredictable/ Inefficient Revenue Cycle Causes: 2008-2009: ESAs 2010: Medicare starts and stops Increasing claims intervention by private insurance Prior authorizations Record requests Post-payment denials Claims edits that make no sense MUEs Undecipherable remittance codes High dollar reviews 10 onPoint Oncology LLC

11 Trend #4: Data for Pay Oncology Intermediary Strategies PQRI Reporting for E-prescribing QOPI measures UPMC measures 11 onPoint Oncology LLC

12 Trend #5: Audit Mania RACs MACs CERT 99211 High dollar claims ZPICs, MICs Private payer audits Health Reform push to eliminate waste 12 onPoint Oncology LLC

13 Trend #6: Patient Thirst for Info and “Face Time” Multiplicity of cancer web sites Social networking Complexity of patient out-of-pocket schemes Many therapeutic choices for common cancer diagnoses Health reform has added to the frenzy. The AMA reports that health reform questions take “up to two hours” out of the work day. 13 onPoint Oncology LLC

14 Trend #7: Pressure to Automate The ARRA incentives to automate health records. Physicians can make the lesser of 75% of Medicare fee schedule allowed charges or $44,000 over 5 years. E-prescribing incentives and, then, disincentives. PQRI incentives and, then, disincentives. PQRI direct EMR interfacing starting this year. Constant requests for medical record data. onPoint Oncology LLC 14

15 Year2011 Is First Year 2012 Is First year 2013 Is First Year2014 Is First Year2015 Is First Year 2011$18,000 2012$12,000$18,000 2013$8,000$12,000$15,000 2014$4,000$8,000$12,000$15,000 2015$2,000$4,000$8,000$12,0000 2016$0$2,000$4,000$8,0000 TOTAL$44,000 $42,000$35,0000 Medicare ARRA Physician Payment Maximum Incentives – Must have already implemented “certified” EHR meeting “meaningful use” criteria to qualify. 15 10% more for HPSA areas onPoint Oncology LLC

16 Meaningful Use Timeline First definition of MU (requirements ) 2011 Second definition of MU (new requirements) 2013 Preparation for MU 2009 Third definition of MU (requirements ) 2015 Penalties for not meeting MU >2015 First incentives for MU Second incentives for MU Final incentives for MU Requirements for meeting Meaningful Use will increase over time Incentives run 2011-2015 and penalties begin in 2016 16 onPoint Oncology LLC

17 Trend #8: Less Reimbursement; Higher Overhead Price of branded therapeutics; ASP reimbursement Shortage of nurses, NPPs, physicians, and lab techs. Must have incentives to retain scarce resources. Automation Diversification Debt service Possible inflation onPoint Oncology LLC 17

18 Trend #9: Regulatory Intervention Between Docs and Pharma It’s been proposed in the Senate (“The Sunshine Bill”) that all remuneration to physicians over $10 or cumulatively over $100 need to be reported. Some companies are doing this voluntarily. Many cancer drug companies have Corporate Integrity Agreements with the OIG, which limit what they can do with and for cancer clinics. Will there continue to be indigent drug support by pharma, once Health Reform kicks in around 2015? onPoint Oncology LLC 18

19 Trend #10: Closer Relationships Between Physicians and Hospitals 340B status by 1700+ hospitals make many hospitals “inspired” to acquire cancer practices. For-profit hospitals eyes cancer clinics for “the downstream” revenue Accountable Care Organizations are part of health reform. CMS also testing out “gain-sharing” arrangements for certain diagnoses. onPoint Oncology LLC 19

20 Objectives We set these objectives for our things you should do as you need to know why you are doing what you’re doing… Provide high quality care consistent with best practices, optimal patient care and enhanced patient/family relations and ensure information systems can reflect practice treatment patterns. Maintain enough cash for expected operations and debt service expense. Optimize financial counseling and back office operations for expected or better reimbursement. Ensure capital outlays are consistent with the forecasted needs of the practice. onPoint Oncology LLC 20

21 #1: Have A Strategic Plan Many practices “fly by the seats of their pants”. It is necessary to PLAN for each and every year to do the best you can within the constraints of your market and means. Know your demographics. The Medicare mix will be changing as baby boomers reach Medicare age. How will you deal? Other aspects: Cash needs Capital needs Marketing plan Additional services onPoint Oncology LLC 21

22 #2: Set Patient Expectations Early In Treatment Patients need to know from the outset how your practice operates. This will prevent complaints and questions throughout their relationship with your practice. Patients should do the following BEFORE their first visit: Fill out forms regarding their demographics and insurance information. Sign a condition of treatment, where they commit to paying patient portions, telling you about changes in insurance and employment status, etc. Understand that they will pay at the time of treatment and that you will send folks to collections as necessary. Know a list of web pages and/or telephone numbers they will need during their treatment, if they have questions. onPoint Oncology LLC 22

23 Conditions of Treatment Gives permission to release information in order to get paid Requires patients to get referrals that are necessary. Requires patients to notify at the time of service change of insurance. Requires patients to supply income and asset information if they become uninsured. Allows you to access credit cards. Allows you to perform a credit check for high balances. 23 onPoint Oncology LLC

24 #3: Use Technology Not People Use your web site to intervene between your practice and your patients. Some suggestions include: Allow input of practice forms and agreements on your site with automated faxing and e-mailing. Examples include: demographics, insurance, conditions of treatment, patient histories, etc. Post FAQs for patients on your web site for general questions and by diagnosis. Post your calendar for support groups and other patient events in your practice. Other postings that will decrease phone calls in your practice. Provide patients access to their personal health information to minimize questions, e.g. Altos SEE MY CHART for: Appointment scheduling Lab results and trends Prescriptions and dosing Disease info onPoint Oncology LLC 24

25 #4: Know Your Contracts and Disseminate Info Administrators and Directing Physicians should know the following: Contract basis (RBRVS, Medicare allowables, charges, etc) Contract renewal date Contract re-opener causes Contract opt-out period Front desk should have a Contract Book Back Office should have a Contract Book and know the fee schedule for every major payer. onPoint Oncology LLC 25

26 Make Everyone A FC Have a Contract Book at your Front Desk Pictures of Insurance Cards Pre-Auth, Referrals Needed With E-mails or Telephone Numbers Employers Who Use, if Applicable Contract Copays and Deductibles In-network, Out-of-Network Contracted Rates (for billing) Contracted Pharmacies Discharge Area with scripts, appointments, and charging. Signs in waiting room. 26 onPoint Oncology LLC

27 #5: Get A Certified EMR If you do not have an EMR, you will soon be left in the dust. You need to get on this right now. If you do have an EMR, it must meet these requirements: Be able to generate e-scripts for the incentive. Be able to generate PQRI data. Be certified for ‘meaningful use’ Be able to reflect the protocols and regimens that you use. Be web-based for instant updates. Get after your vendor, if requirements are not met. onPoint Oncology LLC 27

28 #6-Police Yourself Before Others Do Have a Continuous Quality Improvement plan. This can include: E/M auditing Revenue auditing LCD/NCD checks “Incident to” auditing Monitor protocols for physician compliance. Have a regulatory “expert” inside the practice that keeps track of everything going on nationally and locally. This person should be charged with keeping the practice informed at staff meetings. Ensure your patient accounting systems support the kinds of reports you will need to police yourself. You must have a good practice management system to monitor what is going on with your claims! onPoint Oncology LLC 28

29 #7: Avoid COLA Raises While Oncology practices need to be competitive for clinicians and this may prevent your avoiding raises for them BUT… For other staff members… Think of incentive plans related to better operation cash based on more cash per day, lower DSO, higher profit per FTE, collection of high dollar accounts, better contracts, collected cash per hour, call stats, etc. Incentives can include non-cash rewards: Starbuck’s cards, pizza parties, PTO, work from home days, OT, etc. onPoint Oncology LLC 29

30 #8: Be An Intermediary Pharma and payers are paying other people to care for your patients, in terms of of gathering data and/or keeping your patient on oral drugs. Groups like: Oncology-specific intermediaries Specialty Pharmacy Disease Management companies This is money out of your pocket! Your negotiations with payers should include information about the services you offer such as.. Therapy management of oral and pump infused drugs Participation in proven regimens: NCCN, UPMC, ASCO/ASH Participation in quality initiatives such as QOPI, PQRI for common cancers, smoking cessation onPoint Oncology LLC 30

31 #9: Deal With Your Hospital A diplomatic physician should be appointed as a hospital liaison, if you do not have one. Their job might be: To ascertain where positive relations may reside or areas of common interest. To ascertain what services overlap and where competition might cause duplication and friction. To understand whether the hospital is interested in an outpatient acquisition—be it you or someone else. To ascertain what joint efforts you can make to better serve cancer patients as partners. To participate in committees or task forces looking at ACOs, gain- sharing and/or Medical Home initiatives. Bottom line: This is not a good time to tick off your hospital. onPoint Oncology LLC 31

32 #10: Pay Your Distributor Your distributor is not a bank and they are not a lender. They are the supplier for your patient revenue. You cannot afford the following: C.O.D. terms, unless your Days Outstanding from Service are less than 20-25. Interest that will put a majority of your drugs underwater. Loss of a supplier. Therefore, if your cash flow is too low to pay the required amount, you should look at other alternatives such as: Lines of credit A loan from physician partners A working capital loan Sending ‘underwater’ drug patients elsewhere onPoint Oncology LLC 32

33 Biggest Reason for Failures Cannot pay the drug distributor and go into the “Cancer Clinic Death Spiral”

34 CAN Web Site The latest news Forms Regulations Newsletters Presentations 34 onPoint Oncology LLC

35 35 Contact 800-795-2633 Newsletter is free! Send all RAC information to me at the ABOVE E-mails or FAX to 650-618-8621 Sign up for the newsletter--Go to our website: onPoint Oncology LLC

36 36 onPoint Oncology LLC

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