Join Us at The Value Based Health Care Congress 2016

Mark Aquino

Untitled design

The Value-Based Health Care Congress is just a week away and we’re excited to announce we’ll be there, standing alongside industry veterans and learning more about the state of value-based care. Under The Value-Based Health Care Congress are 3 individual tracks for providers, each covering some of the key pillars of the landscape today:

  1. The MACRA Strategy Collaborative Summit
  1. Value-Based Network and Contract Management Summit
  1. ACO Strategy Summit

We went ahead and listed some of the conference sessions around care quality and health care IT that we’ll be looking forward to attending, and hopefully you will too. Be sure to stop by the CareSkore booth in the exhibit hall to see our Personalized Population Management™ platform, and learn how your healthcare organization can improve both clinical and financial outcomes. Without further ado, here are some of the sessions that we’re excited to see (exact times subject to change):

 

1. Measuring for Value – Panel Discussion

Track and Time: Main Summit, Day 1 @2:05pm

Core quality measure sets are in place and we’ve taken a significant leap forward in providing accurate, useful information on healthcare quality that can inform decisions. The next step in this transition to value-based care rests on our ability to integrate quality and resource use performance to ultimately drive better outcomes.

  • Understand the quality-spending relationship and how it promotes provider buy-in and success in risk-based contracts
  • Learn how to incorporate the patient voice to develop meaningful measures
  • Align measures across the continuum of care to reduce burden and improve efficiency

Speakers:

David Introcaso (@HealthcareIssue)

Helen R. Burstin (@HelenBurstin) – Sr VP, Performance Measures at National Quality Forum

Kate Goodrich – Director, Center for Clinical Standards and Quality at CMS

John S. O’Shea – Sr Fellow, Center for Health Policy Studies at The Heritage Foundation

Stephen L. Ondra (@StephenOndra) – Chief Strategy Officer at Amida Technology Solutions

Linda Walker – VP, Health Security at AARP

 

2. Examine the Role of Health IT in Delivery System Transformation

Track and Time: MACRA Summit, Day 2 @10:45am

Healthcare IT is undoubtedly a critical piece to how we advance quality and value. ONC’s Elise Anthony gives us the catch-all on healthcare technologies—from flow of health info to patient data access, and care delivery—required for participating in CMS programs.

  • Understand how health IT is the foundation to better care, smarter, spending and healthier people
  • Learn about new health IT initiatives that can support practical needs of patients and providers

Speaker:

Elise Sweetney Anthony (@Policy2Progress) – Director, Office of Policy at ONC

 

3. Explore the Ingredients of a Health IT Value Strategy

Track and Time: MACRA Summit, Day 2 @11:30am

Implementing health IT does not guarantee success. These technologies—focused on improving care must allow stakeholders to be able to find usability and usefulness that also support processes—both business and clinical—of a value-based reimbursement system.

  • Review the HIMSS STEPS™ model and its five components
  • Identify areas where health IT has proven value and non-technical barriers to IT optimization
  • Explore potential new functions of health IT that should support value-based care

Speakers:

Peter Basch – Medical Director, Ambulatory EHR and Health IT Policy at MedStar Health

Patricia Wise – VP, Health Information Systems, HIMSS

 

4. Engage Physicians in ACO and Other Value-Based Models to improve Quality

Track and Time: ACO Summit, Day 2 @2:15pm

Successfully engaging physicians ensures that ACOs and other value-based endeavors reach potential, but that is easier said than done. It’s especially challenging when physicians continue to receive fee-for-service and value-based payments simultaneously.

  • Understand physicians’ risk-based payment and MACRA, and how to transition to a value-based mix
  • How to coordinate for optimal management of complex patients
  • Utilize integrated and actionable claims data, not multiple EHRs, and learn how to report data that demonstrates the impact of clinical decisions

Speaker:

Abigail Chen – Medical Director, Quality and Clinical Integration at Mount Sinai

 

5. Achieve Better Quality, Less Effort, and Greater Savings – How You Can Have All Three

Track and Time: ACO Summit, Day 2 @3:00pm

Through organizing information and communicating it with providers in addition to focusing on specific efforts such as cardiac and respiratory conditions, providers can improve cost and quality metrics in parallel and demonstrate the value throughout the health care community.

  • Explore feasibility of collecting and tracking patient data to understand quality performance
  • How cutting costs and increasing quality scores can earn shared savings
  • Illustrate examples of payer-provider engagement and alignment around shared objectives

Speaker:

John Haughton (@haughton_md) – CIO at Chautauqua AMP; CQO at Independent Health Plan

 

Beyond MIPS: A Look into the 90+ Clinical Improvement Activities

CareSkore

Header - Look into 90 activities

Under the MACRA, providers will be reimbursed according to a composite score that reflects how well you’re providing value-based care. This composite score comprises of four key categories: the quality of care you provide, the efficiency of your resource use, meaningful use of EHR, and last but certainly not least, clinical practice improvement activities (CPIA).

Image - 90 Clinical Improvement Activities

A rising tide lifts all boats, right? The great part about MIPS—one of the two payment programs as part of MACRA—is that all of these metrics tie-in to improve clinical outcomes and patient engagement. This leads to cost savings, efficient resource use, and improved adoption of your EHR. Maximizing your composite score will not only affect your payments positively, but it will help you provide efficient patient care.

Not all activities are created equal

Certain categories are worth more than others due to their impact on patient care. High-weighted activities are worth 20 points, whereas medium-weighted activities value at 10 points. While these CPIAs only account for 15% of your total score, leveraging the highest-weighted tactics can be easy wins for your practice. Planning, completing and reporting 3 activities is much easier to pull off than 6 different initiatives. During your 90-reporting period (here’s a plan for when should start thinking about it), you must achieve 60 points by completing these clinical practice improvement activities in which there are over 90 tactics across 8 categories, in the combination of your choice.

Here’s a look at some of the types of activities in each category per ASCRS:

Expanded Practice Access: expanded practice hours, telehealth services, and improving access to services

Population Management: chronic care management programs, community and rural healthcare programs

Care coordination: health information sharing, timely communication and follow-up, care coordination training to handle transitions of care, and active referral management

Beneficiary Engagement: EHR to document patient-reported outcome,enhanced patient portals

Patient Safety and Practice Assessment: ongoing practice assessments and patient safety improvements, and use of tools such as the Surgical Risk Calculator

Achieving Health Equity: seeing new and follow-up Medicaid patients in a timely manner, and use of QCDR for demonstrating performance of processes for screening for social determinants

Emergency Response and Preparedness: participate in disaster medical teams or participation in domestic or international humanitarian volunteer work

Integrated Behavioral and Mental Health: tobacco intervention and smoking cessation, and integration with mental health services.

Choosing your activities

With several ways to maximize points in these categories, many activities may overlap and will have a bigger benefit for your patients.

Let’s take the Beneficiary Engagement and Population Management categories for example. You can implement specific programs and protocols to help patients with chronic illness like heart disease and diabetes. Helping patients manage their care at home with blood pressure testing and glucose measurements will help keep them on track and reduce the risk of readmission.

Bonus: Have a tool where patients can electronically share data and communicate with providers.

Convenience is king

Anything you can do to make life easier for your patients will most likely be a highly weighted CPIA. Expanding access to care with extended hours or e-visits can significantly decrease appointment cancellations or no-shows. Also, providing 24/7 real-time communication with care teams and reminders will greatly improve patient engagement and overall outcomes.

Another highly weighted activity is participation in CMS’s Transforming Clinical Practice Initiative which aims to help:

      • Exchange patient data information for the best continuity of care
      • Track patients through the entire process and integrate information from specialists to make sure care is documented
      • Coordinate phone calls, communication, navigation post-discharge
      • Communicate timely results for follow-up
      • Create individualized care plans for high-risk patients to share with other providers

Attaining Full Credit with Reporting

Given that the entire healthcare industry is shifting towards value-based care, reporting will be one of the most critical components within the continuum of care. If you haven’t already, begin to determine what measures you will report on and evaluate your strengths. Identify what gaps can be filled and put in the necessary plans to improve those gaps. Here at CareSkore, we envision providers getting the credit they deserve.

Through CareSkore, providers can:

      • Generate reports for measures including MACRA, PQRS, and HEDIS
      • Manage your patient population with real-time assessments
      • Understand patient data and quality metrics in order to improve outcomes

Whether it’s reporting for Clinical Improvement Activities or any of the mentioned categories, understanding your patient population through reporting is the first step to cultivating the provider-to-patient relationship.

Sources:

MIPS, MACRA & MU - The Next Evolution of Healthcare Payment Reform

MIPS: Clinical Practice Improvement Activities Category

MIPS Program: 2017 Clinical Practice Improvement Category Proposed Rule Guide

Federal Register - Subcategories

Medicare Program; MIPS and APM Incentive Under the Physician Fee Schedule

Transforming Clinical Practice Incentives

Preparing Your Practice for MACRA: A Plan for 2016 and Beyond

CareSkore

Header - Preparing for MACRA

Significant changes are coming to the way physicians are reimbursed through the Medicare Access and CHIP Reauthorization Act (MACRA). As part of a larger initiative to transition from fee-for-service towards value-based care, one of MACRA’s proposed payment programs, the merit-based incentive payment system (MIPS) will help providers focus on improving clinical outcomes by reducing administrative burdens. In the long run, this will offer more financial certainty and a greater potential for bonus payments. As a healthcare organization, there are action items you must take in order to receive credit for the high-quality care you’re providing.

 

Preparing for MACRA in 2016

In 2015, about 56% of physicians said they were unsure whether or not they were ready to participate in MACRA. Ready or not, the following are things you can start doing today to prepare for the newly proposed payment programs.

  • Understand the impact: Review the proposed changes and explore their implications.
  • Know yourself: There is no one-size-fits-all approach given that each and every provider is unique in their own way, so only you—alongside your administrative team—can complete an accurate self-assessment.
  • Develop a success plan: Outline your strategy with target dates to keep you on track.
  • Educate your team: Get in touch with providers and internal stakeholders to make sure everyone is on the same page.

 

What You Can Do Today

Start thinking about which payment track is most fitting for your practice. Unless you’re part of an accountable care organization (ACO), you will most likely begin with MIPS. You’ll need to review your Quality Resource and Use Report (QRUR) to get a baseline of where you can improve.

1. Meet Meaningful Use

If you aren’t already using an EHR or electronic health record system, now is the time. It should allow patients to access and exchange their information across the coordination of their care. Find a solution that enables you to connect with patients and will be easy to adopt.

2. Start Reporting

Determine which quality measures you plan to report on. Since this could differ based on specialty, you’ll want to carefully evaluate your strengths. If you’re part of a physician practice, decide whether you want to report as a group or as an individual.

3. Understand Resource Use

Once you dig into your data and evaluate your benchmarks, you’ll be able to understand how you’re spending your resources. Knowing which of your patient populations are keeping costs up is critical to developing a plan to improve care. Often, these groups include patients with chronic illness that require frequent visits and engagement. Strategize how your practice can deliver care more effectively to these patients.

4. Identify High-Performance Areas

Your practice is probably already performing well in some quality areas. Use this as an opportunity to get credit for the things you do best. Then you can develop a plan and fill in the gaps where you need to improve.

5. Evaluate Your Readiness for MACRA

Whether you follow a MACRA checklist or create your own success plan, gauge your progress and understand the timeline in order to set your practice up for success.

 

What You Need To Do in 2017

In January 2017, CMS (The Center for Medicare and Medicaid Services) will begin collecting data to get a baseline for the rest of your performance metrics. You’ll receive your first feedback report in July of 2017, giving you a better idea of your current quality measures. It’s also a chance to quickly adjust any measures during Q3 and Q4.

In 2017, you should decide on your 90-day reporting period. Many factors can influence your choice such as the timing of major holidays or when providers will be on vacation. Choose a time that will provide the complete, most accurate picture of your practice. Your practice will also need to decide which Clinical Practice Improvement Activities to begin. Getting a jump-start on these can help your overall composite score, and improve the patient experience. Talk with your team about which activities will be the most impactful and cost-effective to facilitate and make both short-term and long-term plans.

Make sure it’s meaningful: it won’t be enough just to meet meaningful use. Your EHR technology will be evaluated for efficacy by CMS and will want to know it’s adding value to the patient experience, not just checking off a box. The following are things to look for when evaluating an EHR:

  • Make sure it is secure
  • Make sure patients are actually using it
  • Make sure patients are using it to access health information and receive secure messages

 

Thinking About 2018

By 2018, the CMS’s goal is to have 90% of Medicare payments shifted to quality or value-based care. When you receive your second feedback report in July of 2018, you can compare your progress and understand where you can improve. From creating improvement action plans you’re positioning yourself to maximize payments.

Understanding how all practice operations work together is great if you can easily synthesize all the data and see trends. That’s where CareSkore comes in, giving healthcare providers the ability to:

  • Get a 360-degree view on patients and patient populations by accurately assessing both patient risks and needs, and improve outcomes.
  • Coordinate and manage the most appropriate and timely care through personalized follow-up with high-risk patients and understanding data that will improve quality measures.
  • Improve patient engagement by connecting with patients even after they have left the premises to reduce both no-shows and cancellation rates.

These simple, yet impactful tactics can enhance the patient experience, improve outcomes and reduce administrative and operational challenges that keep your practice from providing the best possible care to every single patient—which is ultimately what MACRA will be evaluating.

 

Sources

 

MACRA Basics: MIPS vs APM - What You Need to Know About the New Rules

CareSkore

 Header - MACRA MIPS vs APM (1)

What is MACRA?

The MACRA (Medicare Access and CHIP Reauthorization Act) is the new healthcare reform poised to replace all of the different “patchwork programs” for physicians who receive Medicare payments. As part of the shift towards value-based programs proposed by CMS (Centers for Medicare & Medicaid Services), it’s purpose is to set up a new framework that rewards physicians, not on the amount, but the quality of care they provide. As a provider, you have two different options for how you want to get reimbursed: MIPS (Merit-based Incentive Payment System) and APMs (Advanced Payment Model).

 

What is MIPS?

MIPS determines your reimbursement rates by the quality of care. Payment adjustments under MIPS are based on the MIPS Composite Score, which comprises of 4 key areas:

  • Quality (Formerly Physician Quality Reporting System or PQRS)
  • Advancing Care Information (Meaningful Use)
  • Clinical Practice Improvement Activities
  • Resource Use

If your score is above the threshold, you’ll receive a positive payment adjustment. But if you’re below, you’ll have a negative payment adjustment for the following year. Scores will be compared to both year-over-year improvements and other providers.

 

Benefits of Merit-Based Payments

High performers under MIPS receive a positive payment adjustment for up to 3x the adjustment factor, but physicians still have to report on quality measures to make sure standards are being upheld. Providers can maintain a higher score by simply improving patients’ outcomes through care coordination and ensuring patients have easy electronic access to their health information. Many are already using technology to increase patient engagement. By communicating with their patients in real-time, providers can better serve patients who have a higher risks of complication and readmission to the hospital. Through patient engagement and communications, providers receive credit for helping patients through personalized reminders to take their medicines, monitor their performance, and keeping them healthy throughout the continuum of care. Tying clinical practice improvement activities such as improving patient safety, population health, and long-term outcomes together, ultimately makes your practice much more efficient.

 

What is APM?

Aside from MIPS, the other payment track is an Advanced Payment Model or APM. Currently, patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) use this model. CMS, however, anticipates that more individual providers will qualify for this option. APMs will provide a 5% lump sum bonus based on the prior year’s payment beginning in 2019 over a 6 year time period.

To be eligible for APM, participants must:

  • Have serious quality measures comparable to MIPS
  • Use EHR (Electronic Health Record) technology
  • Bear “more than a nominal financial risk” similar to an ACO or PCMH

Physicians who choose an APM have an opportunity to earn more, but run the risk of paying Medicare back if they don’t meet savings goals. Understanding these risks and determining if they outweigh the potential benefits is a decision that providers will have to make individually or with their practice management team.

 

How to Choose the Best Payment Model

Which path do you take? You and your partners can weighout both payment models under the MACRA, but first, you’ll want to get the facts to make an informed decision.

Know yourself - Dig through the quality data. Are you a high performer? Find out why or why not. Know your current quality metrics and create a plan to improve.

Know your patient population - Do you know you take on patients that have multiple health problems or things you can’t control? That could be a factor in your reimbursement rates.

Under MIPS, there are over 90 activities you can choose from to demonstrate how you’re improving your clinical practice. These tactics can give you credit for helping patients overcome challenges like making sure they’re taking their medicine or adhering to a rehab program.

 

How Meaningful is Meaningful Use Technology

Another thing to consider is your meaningful use technology. Now, you’ll be measured on how well patients are making use of their electronic health information. Is it actually providing value? The intent is that providers and patients are actually sharing information and making prevention and high-quality care more accessible to patients.

 

Start Planning Now

The good news is that the current payment programs requiring reporting on quality metrics will be absorbed into the MACRA. Physician practices have until 2019 to choose their payment track, however, it’s never too early to understand your options and have a general idea of what makes the most sense for your practice. In the meantime, you should honestly evaluate your quality metrics and how you’re meeting meaningful use. Take the time to look for ways to improve and implement tactics that can help your patients now.

 

References:

NPRM - Quality Payment Program Fact Sheet

CMS Quality Reporting Programs

Medicare Access and CHIP Reauthorization Act (MACRA) Preview Module

Quality Payment Program - CMS

Quality Payment Program - MIPS and APM

MIPS or APM: Which is better for your practice?

Moving toward improved care through information

MACRA Payment: APM vs MIPS

MACRA Basics: The Method Behind MIPS Scoring

Mark Aquino

cover mips scoring

When the sustainable growth rate (SGR) formula was set in stone in 1997, its sole intent was to better control the cost of healthcare payments to physicians. Payments towards clinicians were and still are predicated on volume of services, not value. If the overall physician costs were greater than Medicare expenditure targets, then physician payments were reduced.

Enter in MACRA, otherwise known as The Medicare and CHIP Reauthorization Act and we’re on our way to repeal the SGR formula and create an entirely new system that physicians must follow.

 

Old to the New

As the torch bearer in this shift towards value-based care, MACRA is proposing two payment systems that eligible physicians can choose to operate under; MIPS, or Merit-based Incentive Payment System and APM, also known as the Advanced Payment Model. The goal of MIPS is to provide physicians with the flexibility to choose activities and measure those most meaningful to their practice. With the introduction of Clinical Improvement Activities, a new performance category that physicians will be scored on, MIPS will consolidate the three categories that physicians already measured by; Quality, Resource Use, and Meaningful Use of Technology, forming the MIPS Composite Score as a result. The MIPS Composite Performance Score takes into account the weight across each performance category, performance factors, group performance, availability and applicability of measures, and special circumstances of nontraditional practices (practices located in rural areas and non-patient).

 

Are You Eligible?

First order of business: how do you know if you’re eligible to operate under the MIPS program? MIPS-eligible clinicians in the first and second year of the program include:

  • Physicians
  • PAs
  • NPs
  • Clinical nurse specialists
  • Certified registered nurse anesthetists

After the third year, the eligibility funnel expands, adding:

  • Physical or occupational therapists
  • Speech-language pathologists
  • Audiologists
  • Nurse midwives
  • Clinical social workers
  • Clinical psychologists
  • Dietitians
  • Nutritional professionals

You’re exempt from MIPS if you are:

  • In your first year of Medicare participation
  • Eligible for APM and qualify for bonus payment
  • Below the low volume threshold (Medicare billing charges less than equal to $10,000 and provides care for 100 or fewer Medicare patients in one year).
  • A hospital or facility

As you prepare your practice for MACRA, it’s critical to keep these four performance categories in mind, how they’re calculated, and how they tie-in together to form the MIPS composite score.

 

The Big Four

 

Quality

The quality performance category replaces the Physician Quality Reporting System, or PQRS, accounting for 50 percent of the MIPS composite score. Under the quality performance category, there will be six measures that doctors can choose to report on that best reflects their practice. In addition, doctors must also report on 1 high priority measure; outcome, appropriate use, patient safety, efficiency, care coordination or patient experience, and 1 cross-cutting measure.

Composite Score Weight: 50% in 2019

Maximum Possible Points: 80 to 90 points

Calculation and Scoring: Each measure equates to 1-10 points in comparison to historical reports. If a measure is not reported, score equals 0. Additional bonus points are awarded for patient experience, patient safety, care coordination, and EHR reporting.

 

Advancing Care Information

In the Advancing Care Information category, formerly known as Meaningful Use, clinicians are rewarded based on their performance of measures most favorable to them, reporting on key measures on interoperability and the exchange of information. The six objectives required to measure, as proposed by CMS include Protection of Patient Health Information, Patient Electronic Access, Coordination of Care Through Patient Engagement, Electronic Prescribing, Health Information Exchange, and Public Health and Clinical Data Registry Reporting.

Composite Score Weight: 25% in 2019

Maximum Possible Points: 100

Calculation and Scoring: A base score of 50 points is granted if the provider reports one or more use cases across each available measure. For each measure, up to 10 additional points are possible.

 

Clinical Practice Improvement Activities

Of over 90 activities to choose from, clinicians have the choice to measure activities best suitable for their practice. Those participating under medical homes earn full credit while APM participants earn half. Activity categories include Expanded Practice Access, Beneficiary Engagement, Achieving Health Equity, Population Management, Patient Safety and Practice Assessment, Emergency Preparedness and Response, Care Coordination, Participation in an APM, Integrated Behavioral, and Mental Health.

Composite Score Weight: 15% in 2019

Maximum Possible Points: 60

Calculation and Scoring: Each of the 90 activities is worth 10 points and “high-value activities” are given double the weight.

 

Resource Use

For clinicians and physicians, the score for the Resource Use or Cost category is based on claims and volume sufficiency. For this category, doctors need not report anything as CMS does the calculations. Clinicians that provide high-quality care for their patients achieve better performance, thus resulting in a higher score through being the most efficient in resource use.

Composite Score Weight: 10% in 2019

Maximum Possible Points: Average score of resources measures that can be attributed.

Calculation and Scoring: 1-10 points based on performance benchmarks.

 

What’s Ahead

As the final MACRA ruling is just a few months away, physicians—and hospitals—must prepare themselves by understanding the implications of MACRA—both MIPS and APM—and have actionable information on what they can do to address the proposed payment systems. While MACRA—if passed—goes into effect in 2019, both 2017 and 2018 performance and payments will be accounted for.  you can, not only improve your processes and workflows but more importantly, enhance how you serve your patients better in the continuum of care.

Are you looking to learn more about MACRA? Join us as we cover how to directly approach the new payment systems in our upcoming webinar, MACRA: Addressing the Transition, this Thursday, August 11th at 11AM PDT.

 

References:

CMS Quality Payment Program NPRM

CMS The Medicare, The Merit-Based Incentive Payment System: MIPS Scoring Methodology Overview

 

Where EHRs Fall Short: 3 Reasons Doctors Need Predictive Patient Relationship Management

Mark Aquino

photo-1465161191540-aac346fcbaff

Look into the center of a hospital’s information technology stack, and you’re bound to find electronic health record systems (EHRs) to be the cream of the crop, costing healthcare providers tens to hundreds of millions of dollars for implementation and use. As the core system of record within a healthcare organization, when it comes to providing the 360-degree view on any given patient or patient population, EHRs fall short on giving the complete picture.

 

The State of Electronic Health Record Systems

It’s no doubt that EHRs are critical to a hospital or health practice. An EHRs’ core capability rests on being able to store significant amounts of patient data records and is used across multiple functions—care quality, finance, and operations—within a health organization. Whether it’s capturing notes on patient encounters, insurance claim information, or data on historical visits, you name it—EHRs are effective in that regard. This, however, is what EHRs were designed to do, and nothing more; to operate as silos of unstructured data.

Storing data and interpreting data are two independent undertakings. It’s important for doctors to be able to distinguish between the two without overspending on time and resources. In order to capture the complete picture on a patient population, clinical and financial departments need a dedicated system that allows for seamless interpretation of patient data, predictability, and personalized patient communication at will. Keep an eye out for the following when looking into a predictive patient relationship management solution:

 

3 Reasons Doctors Need Predictive Patient Relationship Management

 

 1. Predicting no-shows and patient risks

Tracking historical patient data is fundamental. But what about predicting and planning for the future? As healthcare providers continue to amass increasingly large amounts of patient data from socioeconomic to demographic inputs, not leveraging that data is an opportunity missed. Where EHRs lack, a predictive patient relationship management can make up in value, as EHRs were not designed to predict future occurrences from their stored data. Doctors need a solution that not only enables them to manage no-show and cancellation rates but addresses dire questions like, Which patients within my population are at-risk? What are the leading factors for my patients’ risks? How can I improve the health of my patient population?

 

 2. The need to engage patients

Doctors and physicians want to spend more time doing what they do best: caring for their patients, not trying to make sense of high volumes of unstructured data. When relying on EHRs for patient engagement, physicians and nurse practitioners can face barriers; meeting personalized demands, usability issues, unnecessary workload. What doctors and physicians seek is a tool that not only gives back lost time from using EHRs but a tool that enables bi-directional patient communication even when patients leave the premise. This calls for a communication medium to be put in place dedicated to engaging patients and helping doctors get what patients need when they need it.

 

 3. Meeting regulatory reporting requirements

One thing is true. It’s becoming much more difficult for doctors to focus on their population. While the rise of the health IT landscape was meant to automate certain tasks, the reality is it’s taking up more and more of a doctor’s time. With new reporting and payment regulations underway, doctors must have a solution fixated to handling this department. EHRs alone aren’t enough and extracting data from these systems can be a daunting task. Orchestrated in alignment, however, EHRs and predictive analytics make a formidable pair. Together as the bread-and-butter of the health IT stack, EHRs and predictive analytics empower healthcare providers to capture data, interpret it for actionable insights—regardless of complexity or magnitude—and help providers with their patients in the continuum of care.

 

Predictive patient relationship management does not replace an EHR. Rather, predictive patient relationship management complements a robust EHR system. In this new era of healthcare, predictability tied with communication and reporting gives doctors the ability to ultimately improve their financial and clinical outcomes and focus on what matters most, the patient.

 

The Medicare Access and CHIP Reauthorization Act (MACRA) is underway to completely change how healthcare providers approach medicare payments. Are you ready? Join us as we discuss how to approach MACRA in our upcoming webinar, MACRA: Addressing the Transition.

 

MACRA is a Reality Sooner Than You Think – A Law Paved with Good Intentions and Steep Implementation challenges: Face it with the right partner

Aditya Mangal

macra header

 

“For a small practice, it is more critical to embrace MACRA sooner, to avoid the negative impact on your income.”

- Jas Grewal, CEO at CareSkore

 

We took the pain of reading through the 962 page MACRA NPRM document to understand the intricacies of the law.

The good news: MACRA will pay physicians for doing what they already want to do: provide the best possible care for their patients. Hence when a provider does the best thing in the interest of the patient — doing good — they’ll also do financially well.

The bad news: MACRA is soon to be a reality. Experts are calling it the most significant change to clinician reimbursement in more than two decades. And that means you have to be ready.

 

Fast and Furious

The MACRA timeline is aggressive—performance measures go into effect in 2017—and you need to get up to speed on how this complex program will impact your organization.

You have to start now, to ensure implementation of tools needed to baseline your performance and jumpstart the MACRA journey. MIPS payments start in 2019, based on the quality of care starting with 2017. Hence, 2016 an important year for you to understand and strengthen quality benchmarks.

So what should a clinician do as far as technology is concerned?

By 2017, the clinicians should

  1. Use a 2014 or 2015 Edition Certified HER
  2. Decide which track they should choose when reporting to CMS
  3. Report on stage 2 or stage 3 care information objectives and measures
  4. Allow ONC to review of their EHR; provide support for HIE

And, when they get spare time after that, continue to take care of their patients

 

MACRA Implementation Timeline

macra timeline q

 

Financial Impact & Incentives

A major question is how aggressively the MIPS program would redistribute payments from low performers to high performers.

As we combed through the enormous document, we found that CMS’s analysis estimates the impact on providers by practice size in Table 64 (Page 676 of 962), suggesting that 87% of eligible clinicians in solo practices and 70% of practices with two to nine clinicians will have a negative adjustment due to a below average score.

These estimates suggest that in the first year, the average MIPS adjustment (positive or negative) would be several thousand dollars per clinician.

Clinicians working for a practice with 100 or more eligible clinicians, 81.3% will have a positive adjustment, only 18.3% are estimated to receive a negative adjustment.

In total, the solo physician practices with a negative payment adjustment would collectively be getting $300 million less than they would without MIPS. This number is only $57 million for practices with 100 or more eligible physicians.

 

Small Providers

If you are a clinician or group that fall under the low volume threshold that CMS defines as clinicians or groups with $10,000 or less in Medicare charges AND 100 or fewer Medicare patients or in first year billing Medicare, you are excluded from MACRA.

That is only a tiny fraction of the providers.

Smaller providers face steep challenges complying with MACRA metrics, in particular, the EHR and technology-based requirements or some of the qualifying APMs that require greater capital or a patient population.

MACRA will enable provider affiliations will be characterized by tight partnerships through which the entities can share capabilities.

Smaller, independent practices may actually have more agility as the sole authority in crafting their MACRA strategy. Independent medical groups have will have more flexibility in what they do to respond to MACRA that medical groups associated with hospitals or health systems won’t have.

 

Looking Forward

Final MACRA rules are still a couple of months away, and there could be some change in the ruling. However, the proposal gives insights on CMS’s thought process and what to expect with final ruling later this year. Not only the regulatory reporting is going to be substantial, but also the financial incentives are significant. Hence, the clinical and financial outcomes of your practice are very co-related as MACRA gets into effect.

As provider’s address MACRA, they need to address not only MIPS/APMs, but also Medicare Advantage, Medicaid incentives, and commercial insurances. Stay tuned for future posts as we address these concerns.

 

References

  1. The MACRA proposed rule is at: https://www.gpo.gov/fdsys/pkg/FR-2016-05-09/pdf/2016-10032.pdf.
  2. The CMS “Measure Development Plan” is at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Final-MDP.pdf.

I Will Keep Them From Harm and Injustice (Part 2)

CareSkore

Part 2: Preventing No-Shows

 

Being stood up is never fun and it’s disrespectful in professional appointments. Unfortunately, it’s not a matter of if, but when patients will miss appointments. People will get stuck in traffic and priorities shifting throughout the day. No-shows will continue to occur, but there are ways to dramatically reduce patients from disappearing.

The problem with no-shows is that healthcare providers don’t get notice of a patient’s status. It could be because of time constraints, monetary constraints (e.g. insurance deductibles), or even physical constraints. The reasons behind patient no-shows may vary by individual needs.

Healthcare providers have attempted to reduce no-shows with a fee policy. One office placed “problem patients” on probation. Others simply absorb the lost time and income. While the onus ultimately rests upon the patient, doctors cannot provide proper care if the patients do not show up. It hurts a patient more than the physician.

In part two of our Population Health Management series, we explore the problem of no-shows, and how to prevent it from occurring.

 

Challenge #2: Preventing no-shows

No-shows are defined as intended appointments that are not canceled or rescheduled less than two hours before the designated time.

The worst part of patient no-shows is not knowing a patient’s condition. For doctors, this uncertainty is cause for concern because it elevates the risk of pain and suffering. Prolonging a diagnosis and treatment for a medical condition can be both physiologically and financially taxing.

Patient no-shows have been reported to be as low as 5.5% and as high as 30%. Higher rates were particularly apparent for academic practices.

No-show patients may seem harmless since it guises itself as a much-needed break for overworked physicians. But it severely hurts a hospital’s bottom line. Not only does the practice lose revenue, cost per patient increases as well as readmission rates, which may lead to hefty penalties.

 

Opportunity: Reducing Patient No-Shows

Understanding your patients is critical for reducing no-shows. It begins with observing your practice’s no-show rates. Only 63% of healthcare providers tracked missed appointments. The remaining practices are unaware of the severity of their no-show rates, and would be difficult to measure and improve on performance.

In one study, a 47% of patients are habitual no-show patients. The problem is that the 35% of the habitual no-show patients had close ties with the physicians. This makes no-show policies difficult to implement. In fact, 7% of the habitual no-shows are also 15% of the arrived visits. This makes patient management a complex and sensitive challenge.

Understanding the individual patient is as important as knowing the patient population. Each patient is unique and has different reasons for not attending an appointment. The likelihood of patient no-shows can be attributed to their clinical data, claims history, demographics, and socioeconomic status.

 

Recommendations: Nurture your Patients

There are many reasons why patients fail to appear without notice. There are ways healthcare providers can reduce no-show rates by focusing on actively engaging at-risk patients.

Traditional methods such as no-show fees, double bookings, or first come first serve practices, can marginally improve no-shows. However, these techniques can cause friction and are as unprofessional as a discount domestic airline.

To focus on the cause, rather than the symptom, healthcare providers should place more attention on long lead times. Doctor’s appointments are often made weeks in advance, which patients have to be diligent to reserve. As the appointment approaches, reminders are often necessary.

Suum cuique is the latin verb for “To each their own.” Everyone has a personal preference. Using a personalized approach encourages, rather than punishes, patients for showing up. And it’s showing results.

Patients are five times more likely to keep an appointment when they receive a call reminder. By receiving reminders, 17.3% of patients missed appointments, compared with 23.1% of patients who received no reminder call missed their appointments.

However, calling to remind each patient is laborious. Patient Relation Management technologies such as CareSkore, actively engages patients using Short Messaging Service (SMS). Texting a patient not only provides clear communication, it is automated, bidirectional, and asynchronous.

 

Automated

When an appointment is approaching messaging technologies can automatically send reminders to patients without using admin time.

 

BiDirectional

SMS technologies that leverage Artificial Intelligence (A.I.) like CareSkore engages patients in a natural conversation. Unlike push notifications, A.I. is bidirectional, which means the computer understands the language and responds accordingly.

 

Asynchronous

Unlike a phone call, text messages can be received and responded without needing the recipient to be actively engaged in real time.

 

The Patient Lifecycle

No-shows hurt both patients and caregivers. But there are ways to reduce the lost time. Nurturing patients throughout their lifecycle helps avoid no-shows. This does not require a large call center, but the careful implementation of intelligent software. Doctors are here to treat, but they are only as effective as the presence of a patient.

I Will Keep Them From Harm and Injustice (Part 1)

CareSkore

Part 1: Identifying and Reducing Readmissions Rates

Oliver Leung CareSkore

 

It’s no secret that America’s health care system needs intensive care. $180 billion is wasted every year on operational inefficiencies, and the condition is not improving. This is largely attributed to a fee-based system that incentivized volume over value.

In 2010, the Affordable Care Act made health care providers an offer they couldn’t refuse — a mandate to increase efficiency or feel the pain of stiff financial penalties. This ideology shifted the practice from fee for service to value-based care. Loved it or loathed it, health care providers are forced to play with the cards they were dealt with.

As with all illnesses, we begin with identifying the symptoms of a broken health care system, so we can follow through with a diagnosis and treatment. In this ten-part series, we will:

  • Identify the most pressing challenges facing our health care system
  • Address opportunities for improvements, and
  • Make recommendations for enhancements

Finding solutions to fix our health care system won’t be resolved overnight, but it is prudent to focus on the elements that are causing inefficiencies. Then implement noninvasive solutions that are quick, intelligent, and cost-effective.

 

Challenge #1: Readmission

When our vehicle breaks down, we go to the mechanic to get it fixed. We expect our vehicle to function after our visit because it is part of a mechanic’s duty of care.

Similarly, a doctor’s obligation is to treat patients with a level of care that is consistent with the Hippocratic Oath. Unlike a machine, however, humans can’t be recalled. We either heal, deteriorate or perish. Readmissions are a serious threat to not only our health but to our health care system.

By far, Medicare bears the greatest burden of readmission and is the gold standard by which health care providers measure performance on. The three greatest preventable conditions for Medicare readmissions are:

  1. Congestive heart failure (24.5%)
  2. Septicemia (21.3%)
  3. Pneumonia (17.9%)

The conditions above cost hospitals over $4.3 billion. The government (and ultimately the taxpayer) foots 43% of our national health bill. Consequently, hospital reimbursements have recently been restructured under the Hospital Readmission Reduction Program (HRRP) in October 2012. The program focuses on patients who are readmitted within 30 days for high-cost or high-volume conditions and procedures. Specifically, heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), hip/knee replacement, and coronary artery bypass graft (CABG).

The Hospital Readmissions Reduction Program is designed to improve the quality of care by incentivizing the reduction of hospital readmissions and penalizing underperforming hospitals.

 

Oliver Leung CareSkore Readmission Rates

 

Since the initiation of the program, readmission rates have declined 1%, from more than 19.0% to less than 18.0%. Although this is an improvement, 50% of hospitals received readmission penalties of up to 3% for failing to meet the national readmission benchmark.

The financial cost is merely a symptom of the problem. Readmitted patients are preventable and increase demand for doctors who already have long waitlists. It also places a hindrance on society since patients are required to take repeated time off work or home care. In short, remitted patients are not given the proper treatment, which is simply poor quality of care.

 

Opportunity: Preventing Readmission

Readmission rates are calculated using discharge data for each hospital from the three years prior to the year in which the penalty is assessed. According to the Centers for Medicare & Medicaid Services (CMS), The two criteria for evaluating the impact of readmissions are volume and costs. To understand the impact of these variables, we need to look at the data that drives the numbers.

The average readmission rate for the top ten high volume conditions among Medicare beneficiaries is 19.6%. Simply put, nearly 1 in 5 patients return for preventable retreatments.

However, the quality of care is not solely dependent on hospital care. Hospitals serve patients of varying risk profiles. External factors such as socioeconomic status and demographics come into play and should be taken into consideration.

Despite these discrepancies, there are currently no provisions in the Health care Readmissions Reduction Program to account for these external factors. This could adversely (and often unfairly) impact the perception of a health care provider. These external data sets are largely unaccounted for but have a significant impact on patient readmission.

 

Recommendations: Patient-centered care.

There are ways to mitigate the risk of patient readmission. It begins with intimately knowing your patient. This may sound daunting at first, but it can be easier than you think.

The difference between a stranger and a loved one is data. With a friend, you know what appeals to them as much as what repulses them.

In the same way, health care providers can leverage data to determine whether a patient is considered at risk of readmission. But data itself is inert. It can’t predict and won’t prevent readmissions on its own. Therefore, health care providers need to aggregating and normalizing the data in order to understand the probability of readmission. Only then can you make accurate decisions.

Finally, patients need to be nurtured throughout their medical journey. Patient engagement is like following through on your golf or tennis swing. It takes practice, but it will certainly improve your game.

It starts with asking, “How have you been?” It’s simple, but not easy. Engaging your patients is very involving and can take tremendous resources from your admin staff. So new technologies such as CareSkore actively engages patients using artificial intelligence (A.I.) to prevent readmissions from occurring.

“A spoonful of sugar helps the medicine go down…”
Reducing readmissions isn’t a trivial task, but it is one that deserves attention. Readmissions prevent doctors from seeing fresh patients, disrupts the wellbeing of a patient, and drives costs to health care providers. There are early indicators that the health care industry is adopting methods to reduce readmissions. Not only because it is mandated by the government, but because prevention is better than treatment. Solutions are available to transform hospitals from a destination to a journey.