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!