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GE Healthcare Camden Group Insights Blog

This is the MACRA Webinar You've Been Waiting For

Posted by Matthew Smith on Oct 6, 2016 12:06:37 PM

webinar_Clouds_icon-resized-600-2.jpgPlease join GE Healthcare Camden Group for a complimentary, 60-minute webinar, Chart Your Course for MACRA Success, on Thursday, October 20, 2016, at 12:00 P.M., ET.

Background:

In April 2015, the Medicare Access & CHIP Reauthorization Act of 2015 ("MACRA") was passed, ending the Sustainable Growth Rate ("SGR") formula for determining Medicare payments for healthcare providers’ services. MACRA is intended to accelerate moving care delivery toward quality and value-based reimbursement models through the new Merit-Based Incentive Payment System ("MIPS") and incentive payments for participation in certain Alternative Payment Models ("APMs").

This law has a strict timeline to implement strategy to maximize possible incentive payments, improve care delivery and design, and successfully achieve efficiencies improving cost and quality that will go into effect 2019 based on the 2017 performance reporting period. While the final details of the incentives for the new payment models will not be defined until CMS publishes the final rule in November 2016, there are several things you can begin doing to determine optimum strategy and prepare for 2017.

Overview:

In this complimentary webinar, members of the GE Healthcare Camden Group consulting team will deliver an overview of the legislative details of the new payment reform law and the implications of MACRA. They will also provide the necessary tools to successfully navigate through the next phase of participation for the Quality Payment Program, MIPS, and APMs.

Date:

Thursday, October 20, 12:00 P.M., Eastern

Learning Objectives:

  • Learn the timing and timeline for MACRA implementation
  • Review the two tracks for participation, APMs and MIPs
  • Examine the incentives and penalties associated with MACRA
  • Gain insight on MIPs Composite Score:
  • Understand what it will take to be successful under MACRA
  • Master the steps to take to begin the path to APMs

GE Healthcare Camden Group Presenters:


Burnett_new.jpgSabrina Burnett, Vice President

Ms. Burnett is a vice president with GE Healthcare Camden Group. With more than 20 years of professional experience, Ms. Burnett delivers a wealth of skilled leadership in health management processes and solutions-based planning and execution. She has in-depth knowledge of the post-acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, including managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. Ms. Burnett is recognized for her expertise in contract negotiations, solutions-based planning.

Hawkins_New.jpgCami Hawkins, Manager

Ms. Hawkins is a manager with GE Healthcare Camden Group and has more than 20 years of experience in the healthcare provider sector as a management consultant. She specializes in the areas of practice operations, contract negotiations, benefits administration, reimbursement management, and market development. Ms. Hawkins assists a wide range of provider organizations, healthcare systems, and independent and employed physician groups with addressing issues impacting their overall performance and competitive positioning. Her key areas of expertise include strategic planning, population health strategy.

ZielinskiL.jpgLucy Zielinski, Vice President

Ms. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization.

To Register:

To register, simply click the button below, complete a short registration form, and press the "Cick to Register!" button. We will provide dial-in information and a WebEx link via email the week of the webinar.

Webinar, MACRA Questions?

Please contact Matthew Smith at msmith@ge.com.

Topics: Webinar, Lucy Zielinski, MACRA, Sabrina Burnett, Cami Hawkins, MIPS, APM

Operationalize Population Health With a Focus on Consumer Access

Posted by Matthew Smith on Sep 16, 2016 12:53:53 PM

By Lucy Zielinski, Vice President, GE Healthcare Camden Group, and Fran Horner, Managing Partner, Singola Consulting

population_health-3.jpgHealthcare organizations are faced with the reality of value-based care. Many have formed a clinically integrated network (“CIN”) to manage patient populations while focusing on the Triple Aim (improve patient satisfaction, reduce cost of care, improve quality of care). Forming a CIN and setting a strategy is one thing, operationalizing clinically integrated activities is where the rubber meets the road. To succeed, organizations must bend the cost curve while improving quality performance and outcomes.

While in some areas, the opportunities to provide better care are obvious, other areas prove harder to improve. For example, 60 percent of referrals go unscheduled. This alarming statistic demonstrates how healthcare organizations can do better—namely by implementing operational processes that schedule referrals during the initial patient visit. Other examples include 23 percent of scheduled appointments are missed, and 36 percent of patients do not receive follow-up care. This lack of follow up and care coordination to manage patients may lead to complications resulting in increased healthcare costs, not to mention low patient satisfaction scores. Many payors, including CMS, are publicly reporting quality data and consumers are scrutinizing the scores and making decisions based on the scores. As a result, an organization may be negatively impacted from a reputational perspective, as well as a financial one.

To avoid a negative impact, organizations can focus on five strategic areas improve care, thus having an impact upon the Triple Aim.

1. Know Your Consumers

To gain market advantage, organizations must understand their consumer profile. Market segmentation enables organizations to segment consumers with similar needs and wants in an effort to match their expectations. Questions to ask include:

  • Who are your consumers?
  • What is important to them?
  • What services do they need/seek?
  • What are the socioeconomic profiles and physiographic elements?
  • Are they compliant, tech savvy, cost conscious, do they operate online, etc.?
  • How do they best receive messages?

Taking time to study your consumers is the first step.

2. Engage Patients

Patient engagement starts at registration by identifying the channels of communication—phone, email, web-portal and/or text—that the patient finds most convenient to receive appointment reminders, medical advice, and follow-up care. This is reconfirmed during discharge to streamline care coordination. Knowing how to communicate with the patient is key to truly engaging the patient in his or her care and effectively leveraging contact center technology to support outreach.

Knowing your patient population and how best to communicate with the different patient populations improves engagement. For example, if you are targeting medication adherence for your hypertensive patients, you may consider sending patient reminders for medication refills or educational material via the patient portal. You may also consider calling and reminding patients to schedule and complete routine wellness screenings such as mammograms. If patients fail to complete these screenings, then reminders can be sent via portal or text message. 

3. Focus On Outbound Communications

Outbound communications in healthcare include appointment confirmations, payment reminders, wellness updates, prescription refills, and claim status updates. A contact center can also be an efficient way to support outreach by leveraging omni-channel contact center technologies, including outbound communications, to improve care and engagement by contacting patients at the right time, with the right message, using their preferred channel of communication. Using outbound communications and technology, the contact center can play a vital role in reducing preventable readmissions. Many organizations are consolidating and centralizing contact centers to include the acute, ambulatory and post-acute environments to support care coordination.

4. Leverage Technology

As a result of the Affordable Care Act, many organizations have adopted electronic health records and reports from such systems can be leveraged to support care management. For example, using a targeted population list exported from the EHR, the contact center technology can be effectively deployed in both self-service or assisted care models. Case in point, patients who have scored 1-4 on the LACE Index may receive an automated call, voicemail, or text to reiterate their discharge instructions and remind them to call their primary care physician for a follow up appointment. Whereas patients with a score greater than 10 (indicating a high risk of readmission) would receive a phone call from the contact center nurse or care coordinator to personally follow-up on patient discharge instructions, make a follow up appointment, or coordinate referrals. Organizations, including clinically integrated networks, are focusing on the interoperability of technology to give them a leg up on patient safety, quality and cost. 

5. Optimize Change Management

Many healthcare organizations focus on technical change strategy and change management when executing tactical plans and projects. They are concerned with planning, budgeting, organizing, controlling, measuring, and problem-solving. Change management produces predictability and order in the organization. An essential but often-overlooked aspect of change strategy is change leadership—the human or cultural component that provides the spark needed to activate change. Change leadership aligns employees with a shared vision for the future of the organization, then mobilizes and motivates them to make that vision a reality. Organizations need to train their staff on how to best communicate to consumers so that consumers navigate the system with ease and satisfaction, resulting in positive surveys.

Consumers are making decision on a daily basis. Health systems, by focusing on these five strategies, can help consumers navigate their organization to make sure that the right care is delivered at the right time, at the right place and at the right price. Health systems will then be able to experience better outcomes, while attracting new patients and retain existing patients.


ZielinskiL.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization. She may be reached at Lucia.Zielinski@ge.com.

 

horner.jpgWith more than 20 years of experience in contact center operations and 11 of those in healthcare, Ms. Horner is a recognized industry leader who has guided numerous healthcare organizations through development of their patient engagement strategies with a focus on top-to-bottom contact center assessments, workforce optimization, outsourcing, referral management, and revenue cycle management. With extensive experience directing large-scale business operations and strategic initiatives, she is skilled at driving change and implementing cost-effective solutions while enhancing the customer experience.

Topics: Population Health, Patient Access, Lucy Zielinski, Access, Fran Horner

Population Health 2.0: Activate Your Strategy Through a PHSO

Posted by Matthew Smith on Aug 18, 2016 11:12:27 AM

By Graham Brown, MPH, CRC, Vice President, and Lucy Zielinski, Vice President, GE Healthcare Camden Group

population_health.jpgWith the transition to value-based payment, medical practices are aligning with Accountable Care Organizations (“ACOs”) and clinically integrated networks (“CINs”). These enabling business structures, with the new payment models, require a new level of support to medical practices. A true Population Health Support Organization (“PHSO”) is the perfect fit in a dynamically evolving delivery landscape.

Strategically, a PHSO aims to integrate providers, hospitals, payers, and services across the continuum of patient care. The interoperability between each of the entities reduces fragmented patient care and serves as the bridge between healthcare silos. A PHSO is the key platform to help providers transition into the new world of medicine by providing infrastructure for physicians to reshape and drive patient-centered care and engagement via efficient management of patient populations. It is a sound structure for those starting and maintaining a CIN, or simply for those managing medical practices that are evolving to meet the demands of the future delivery system. Much like Management Service Organizations (“MSOs”) of the past, a well-designed PHSO may also support physicians who wish to remain and thrive in private practice but still collaborate with other providers across the continuum.

Setting the Objectives

The objectives of a PHSO are three-fold: support physicians in sound financial management, quality improvement, and infrastructure needed for population health. These include moving the needle on quality measures and outcome performance, controlling total cost of care, and providing improved patient access to medical care. The goal is to improve patient loyalty and experience, ultimately keeping patients in the organized system of care. The PHSO also acts as an aggregator of key patient and administrative data; so it may become the conduit for the transfer of knowledge critical to success in managing the health of populations.

PHSO vs. MSO

So how is the PHSO of tomorrow different from the MSO of the past? The PHSO is a vehicle to connect all the dots for the transformation from the old fee-for-service to the new value-based payment models. There are many benefits to organizing and operating a PHSO to support physicians’ transition to value-based care delivery, including:

  • Integrating physicians with the organized delivery system of care, which supports ACO and CIN initiatives
  • Providing a contracting vehicle that allows and supports providers to assume risk and manage it effectively.
  • Coordinating the care management services across the continuum and managing transitions of care from one setting to another
  • Enhancing system interoperability to exchange and share data among the providers to support care delivery
  • Improving financial performance and managing the complexities of practice management
  • Ensuring compliance with CMS programs, such as MACRA, and avoiding payment reductions
  • Supporting consumerism by creating a unified brand focused on consumer experience and loyalty
  • Managing the revenue cycle and coding processes (i.e., diagnosis coding, chronic care management requirements, Hierarchical Condition Categories ("HCC")/Risk Adjustment Factor ("RAF) to support value-based contracts
  • Providing education to physicians—both employed and independent—on topics such as industry trends, leadership, care redesign, etc.

Whether physicians are employed or independent, the PHSO can support them equally while providing a vehicle for improved operational and financial performance.  

Where to Begin

Systems should begin by assessing their employed medical groups and conducting outreach to independent, affiliated medical groups to determine needs, timing of the value-based transition, and identify the gaps. These become the starting points for core PHSO services. An existing CIN, ACO, or MSO could evolve to become the PHSO. The key to success is either designing a new or adapting an existing organization to fill the identified gaps of support services needed to be successful under changing reimbursement and care delivery models. Lastly, the PHSO can be used to gain new relationships while strengthening existing relationships with physicians. These partnerships will allow the collective organizations to ultimately improve the health of the populations they manage.

The healthcare delivery system and corresponding reimbursement models are undergoing significant change…which is unlikely to slow down. The old ways to practice medicine will no longer work in the world of a value-based payment system. A transformation of current practice structure, business strategy, and partnerships along the continuum of care will play key roles for success in the new healthcare world.

  Population Health Support Organizations, PHSO


BrownG-470185-edited.jpgMr. Brown is a vice president and clinical integration practice leader with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at g.brown@ge.com.

 


ZielinskiL-069442-edited.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization. She may be reached at Lucia.Zielinski@ge.com.

 

Topics: ACO, CIN, Lucy Zielinski, Graham Brown, Population Health Support Organization, PHSO

Top 10 Actions to Take Now to Prepare for MACRA

Posted by Matthew Smith on Jul 29, 2016 10:11:44 AM

By Marc Mertz, MHA, FACMPE, Vice President, and Lucy Zielinski, Vice President, GE Healthcare Camden Group

shutterstock_124411828.jpgMost medical groups celebrated the repeal of the sustainable growthrate (“SGR”) and the associated cuts to the physician fee schedule. The SGR was replaced by the Medicare Access and CHIP Reauthorization Act (“MACRA”), a proposed CMS rule that is designed to encourage medical groups to pursue advanced payment models and accountable care.

MACRA replaces several Medicare reporting systems and creates two new programs: the Merit-Based Incentive Payment System (“MIPS”) and Advanced Payment Models (“APMs”). Both programs have pros and cons, but because they are currently scheduled to begin to measure performance on January 1, 2017, medical groups have little time to prepare.

Here are 10 actions your group should be taking now to prepare for MACRA.

  1. Determine your path. The MIPS program replaces the former EHR Incentive (Meaningful Use), Physician Quality Reporting System, and Value-based Payment Modifier programs with four measures of cost, quality, information technology (“IT”) use, and clinical practice improvement activities. How well your group performs on these measures compared to your peers will determine whether your Medicare payments are increased or cut by up to 9 percent by 2022. The APM path is for groups that are willing to take up- and down-side risk under new payment models, including select ACOs, medical homes, and bundled payments. APMs offer a 5 percent bonus payment.

    Many groups would rather avoid the reporting requirements, uncertainty, and potential payment reductions of MIPS. Unfortunately, qualifying for APM will be a challenge unless your group is already in a qualifying program – especially given the January 1, 2017 proposed start date. This aggressive timeline is one of the criticisms of MACRA, and CMS may push back the start date in the final rule. At this point, a vast majority (some projections are as high as 90 percent) of medical groups are expected to pursue MIPS, at least initially. Groups that start under MIPS can apply to move to APM in subsequent years.

  2.  Educate and engage your providers. Under the current performance based incentive programs, groups are rewarded for simply reporting data. If you start under MIPS, you will receive bonuses or pay cuts based on your actual performance against other groups. Active provider participation and engagement are imperative for improving your performance on the MIPS measures for cost, technology use, quality, and clinical practice performance. Start now by educating your providers on MACRA and the crucial role they play in your group’s success. Inform them that their scores will be published on Physician Compare for public consumption. Evaluate your physician compensation plan to ensure that incentives are aligned with your MACRA objectives.
  3. Assess your current technology. Health IT (“HIT”) is foundational to MACRA, which requires participants to use certified electronic health records technology (“CEHRT”). While the number of meaningful use measures has decreased, groups may have HIT challenges relating to interoperability and the exchange of information. Although vendors have made great advances in recent years, gaps still exist, and the development of new capabilities and analytics continues. To meet MACRA requirements specifically relating to the collecting, monitoring, and reporting measures and scores, groups may require additional IT capabilities beyond the CEHRT. Additionally, there is an increase in the use of Qualified Clinical Data Registries (“QCDR”) to collect clinical data to better manage the delivery of care, ultimately improving the quality.
  4. Know your quality measures. APMs typically have a prescribed set of measures based on the program whereas, under MIPs, providers have the option to select measures. However, MACRA does require that quality measures used in APMs be comparable to those used in MIPS. Knowing your quality measures, and if applicable, selecting the right measures, is key as your group’s performance will be determined based on how you compare to peers. It is important that you identify the measures applicable to your group, considering your provider specialty mix and patient population, and then create workflows to support the data capture of such measures. A good place to start is the Quality and Resource Use Report (“QRUR”) since this report compares your scores relative to your peers by calculating the standard deviations from the national mean for both quality and cost. There is also a high-risk bonus adjustment that is based on ICD-10 coding, so accurate diagnosis coding assignment is critical.
  5. Track provider performance. Monitoring your group’s performance at an individual provider level on a consistent basis is vital since every point matters. Groups need to track performance monthly and compare the values to peers as well as targets. Your exceptional performance scores do not guarantee success since your current performance is compared to future benchmarks, which are unknown at this time. Also, CMS has allocated millions of dollars to reward high performing providers who land above performance thresholds, so aiming high may get you additional dollars.
  6. Form a steering committee. Whether you pursue APM or MIPS, it will be important that your group is strategically aligned and that your efforts are coordinated. Much work will be necessary to ensure that your group has capabilities for measure selection, data capture and reporting, workflow analysis and/or development, training, and performance monitoring. A multidisciplinary steering committee consisting of physicians, management, IT, other providers, and staff can be a powerful way to align the group and to address the broad array of tasks. The steering committee will be charged with creating the MACRA strategy and a high level work plan. Members will oversee the plan’s progress, timeline adherence, and provide direction for resolution of any obstacles impacting the plan.
  7. Implement a change management program. Success under MACRA will require strategic and operational changes; change can be difficult to implement and even more difficult to maintain. Consider using a formal change management program that will combine a well-executed plan for change with the leadership needed to sustain that change over time. When executing tactical plans and projects, many groups focus solely on technical change strategies, while change management, like GE’s Change Acceleration Process (“CAP)” program, focuses on both the technical changes and change leadership. Change leadership is an essential, but often overlooked aspect of change strategy; it addresses the human or cultural component that provides the spark needed to activate change. Change leadership will align, mobilize and motivate all stakeholders with a shared vision to support the MACRA program, making success a reality.
  8. Consider partnership opportunities. APM and MIPS both present challenges, especially to smaller groups, that might be easier to overcome with partners. APMs require a group to take downside risk. Groups that do not have experience with risk or have a small patient population can benefit from joining an independent practice association (“IPA”), physician-hospital organization (“PHO”), clinically integrated network (“CIN”), or ACO that can provide care management capabilities, as well as spreading actuarial risk over a larger population. Success under MIPS will require technology resources, care management, and practice operational capabilities that may not be financially sustainable for small groups. Medical groups that have patient-centered medical home (“PCMH”) status receive full credit for achieving the MIPS Clinical Practice Improvement Activities measure, so groups should consider joining a network or hiring an MSO that can provide resources or capabilities to support a PCMH.
  9. Develop care management capabilities. Success under MACRA will require that groups deliver value by improving quality, outcomes, and patient experience while reducing costs. Use data to understand how your group performs today and where there are specific opportunities to improve. Then work with your physicians and staff to develop and implement care management capabilities that support higher performance. You should also look outside the walls of your group to partner with other providers, community resources, and your patients to more effectively manage the health of your population.
  10. Create a roadmap in 2016. MACRA reporting is scheduled to begin in January 2017; hence, the time is now to create a plan and roadmap. Understanding your group’s current challenges will be important as you develop your roadmap. Once you activate your plan, monitor your progress monthly and make any updates based on the final rule. Even if MACRA reporting is delayed, you will have a head start.

If groups take these 10 actions, they will be in a better position to transform the care that is delivered based on the Triple Aim of better care, better experience, and lower cost. And they will be rewarded financially under MACRA.

MACRA


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at marc.mertz@ge.com.  

 

 

ZielinskiL.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group, with over 20 years of experience in the healthcare industry. She specializes in helping private and hospital-owned medical practices achieve top financial performance by guiding physicians through practice development, strategic planning, coding and revenue cycle process optimization, and electronic health record system implementation. In her health system leadership roles, she has successfully managed the revenue cycle for over 2,000 physicians. She may be reached at lucia.zielinski@ge.com.

 

 

Topics: Medical Groups, Lucy Zielinski, Marc Mertz, MACRA, CAP, Change Acceleration Program

MACRA: How the New Merit-Based Incentive Payment System Will Impact Physician Practices

Posted by Matthew Smith on Jul 14, 2016 4:15:34 PM

By Lucy Zielinski, Vice President, and Nidhi Chaudhary, Consultant, GE Healthcare Camden Group

MACRA_Image.pngHealthcare delivery and its corresponding costs are changing due to recent industry trends. Value-based programs reimburse healthcare providers for the quality of care they provide to patients. To support this, the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) intends to reform Medicare payments to physicians over the next several years. MACRA has two pathways:

  1. The Merit-Based Incentive Payment System (“MIPS”)
  2. Alternate Payment Models (“APMs”), which will take effect starting in 2017.

In order for practices to survive and compete in this value-based environment, specific initiatives must be deployed this year. 

MACRA1.png

Transitioning to the MACRA MIPS model

There are currently multiple quality and value programs for Medicare providers: Physician Quality Reporting Program ("PQRS"); Value-Based Payment Modifier; and the CMS EHR Incentive Program. 

MACRA streamlines those programs into MIPS and adds a fourth category called Clinical Practice Improvement Activities. Below is an example of MIPS Scoring for Year 1:

MIPS1.png

Challenges Faced by Physicians:

  • Uncertainties surrounding the shift from volume-to-value
  • Potential reduced reimbursement for services
  • Tracking of quality and cost management
  • Optimizing electronic health record (“EHR”)/registry use

Key MACRA questions for medical groups:

  • What does the current Quality and Resource Use Report (“QRUR”) tell you?
  • What is the implementation plan for 2016 and 2017?
  • What are the right measures that should be tracked and reported? Are workflow changes required?
  • What clinical practice improvement activities will be added?
  • How will the current infrastructure support the initiatives?
  • Is additional technology required?
  • How will the composite score be optimized?
  • Do we have adequate resources and education opportunities to be successful?

How can GE Healthcare Camden Group help organizations create and navigate a MACRA roadmap for 2017?

We help organizations:

  • Identify gaps and priorities by performing a MACRA readiness assessment
  • Help groups form and facilitate a steering committee with a shared vision
  • Integrate change management methodologies to ensure success
  • Create education and communication plans
  • Develop a tactical MACRA roadmap focusing on strategic and operational objectives   
See our sample work plan and timeline below:

MACRA_Roadmap.png

If you want to get started with your own, personalized MACRA roadmap, click the button below and a GE Healthcare Camden Group MACRA expert will be in touch to start you on your way.

MACRA


ZielinskiL.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group, with over 20 years of experience in the healthcare industry. She specializes in helping private and hospital-owned medical practices achieve top financial performance by guiding physicians through practice development, strategic planning, coding and revenue cycle process optimization, and electronic health record system implementation. In her health system leadership roles, she has successfully managed the revenue cycle for over 2,000 physicians. Additionally, Lucy has led engagements with physician billing companies that involved restructuring operations and development of dashboard reports. She may be reached at lucia.zielinski@ge.com.

ChaudharyN.jpgMs. Chaudhary is a consultant with GE Healthcare CamdenGroup specializing in delivering strategies, working to provide more efficient and lean processes as well as coaching leaders and management. Ms. Chaudhary joined GE Healthcare in 2007 and has extensive experience in Regulatory Affairs and Quality Engineering pertaining to both medical and pharmaceutical devices. Ms.Chaudhary has provided support for strategic and business planning while working within the business and with the medical staff at multiple hospitals. She may be reached at Nidhi.Chaudhary@ge.com.

 

 

 

 

Topics: Value-Based Care, Payment Reform, Value-Based Contracting, Lucy Zielinski, Payment Models, MACRA, MIPS, Nidhi Chaudhary

Final Call for Webinar Signup: Transforming Your Medical Group for Future Success

Posted by Matthew Smith on Nov 11, 2015 12:54:40 PM

A New, Complimentary Webinar From GE Healthcare Camden Group

GE Healthcare Camden Group, WebinarOverview:

Is your medical group positioned to succeed in a value-based, consumer-driven world where access, quality, and cost are the drivers of success?

Will your current business and care delivery models support new payment systems, meet technology requirements, and satisfy consumer demands?

Have you started to transform the delivery of care to respond to competition and changing market forces?

Learn more about what it takes to transform your medical group by registering for GE Healthcare Camden Group’s one-hour webinar, Transforming Your Medical Group for Future Success on:

Thursday, November 12, 2015 at 1:00 PM ET (12:00 PM CT, 11:00 AM MT, 10:00 AM PT).

Practice Transformation, Webinar, GE Healthcare Camden Group

By the conclusion of the webinar, attendees will:

  • Understand the three reasons why practices must be transformed
  • Learn how to construct a high-level roadmap to addresses technology, operational efficiency, financial performance, patient access and satisfaction, and clinical care redesign
  • Discover how to assess a practice in order to identify the gap between where its medical group is currently positioned and where it needs to be for optimum success
  • Cite new-generation key performance indicators to measure performance and successes
  • Determine next steps for transforming the medical group for future success.

Presenters:

Marc Mertz     

Marc Mertz              
Vice President                                    
GEHC Camden Group

Lucy Zielinski, The Camden Group

 

 

 

Lucy Zielinski              
Vice President                                    
GEHC Camden Group

Susan Corneliuson, The Camden Group

Senior Manager                               
GEHC Camden Group

Space is limited. Reserve your webinar seat today by clicking the button below.

Webinar login details will be sent to accepted registrants prior to the November 12th webinar.

Practice Transformation, Webinar, GE Healthcare Camden Group

 


Please Note: This webinar is complimentary for The Camden Group’s clients, industry colleagues, and other interested parties. The Camden Group reserves the right to deny access to those individuals who may pose a conflict of interest to The Camden Group.


 

Topics: Medical Group, Practice Management, Webinar, Lucy Zielinski, Marc Mertz, Susan Corneliuson, Practice Transformation

Chronic Care Management Services: 5 Reasons Physicians Leave Money on the Table

Posted by Matthew Smith on Nov 10, 2015 1:34:39 PM

By Lucy Zielinski, Vice President, GE Healthcare Camden Group

Chronic Care Management ServicesIt has been nearly a year since the Centers for Medicare and Medicaid Services (“CMS”) introduced payment for chronic care management services (“CCM”). As of January 1, 2015, under the Medicare Physician Fee Schedule, physicians who perform CCM can bill for such services using CPT code 99490 and receive a payment of approximately $43 per patient per month. Although CMS estimated that a large majority of Medicare patients would be eligible for such services (as most beneficiaries have two or more chronic conditions), CMS received claims for less than one percent of the estimated eligible population.

So why aren’t physicians billing for CCM when many are performing CCM services? Based on feedback from physicians, professional societies, and vendors, there are five main reasons physicians are not billing for CCM, and this is what your practice should do to correct this.

1. Patient enrollment is difficult and time consuming. Practices are required to have a conversation with patients to inform them of CCM services. Once informed, patients must provide written consent. Most practices are not organized in a manner that they can do this. To address this, practices should develop and implement a marketing and communications plan to introduce this service to eligible patients and educate them on the benefits. Much of the patient education can be done through educational materials, signage, video, and newsletters provided in the office, on the website, or via a patient portal. Education should focus on the benefits of monthly monitoring of the patient’s health. Patients value both high-touch and high-tech approaches. Physician and staff time can be managed if these other tools are used.

2. Copayments create patient dissatisfaction. Patients are responsible for a 20 percent copay for CCM services, which amounts to approximately $8 per month. Since face-to-face encounters are not necessary, it is hard for patients to understand what services they are paying for, and many patients assume this is already a standard part of their care. Thus, the educational process is critical to overcoming this barrier. Patients will pay for services they feel add value to their health. At the same time, it is important to communicate to patients their financial obligations for CCM services. For many, secondary coverage will mitigate their out-of-pocket costs.

3. Electronic Health (“EHRs”) may not effectively support CCM requirements. Although The Health Information Technology for Economic and Clinical Health Act has accelerated the adoption and utilization of electronic health records, and meeting meaningful use requirements fulfills many of the CCM needs, some EHRs may not currently have the functionality to adequately support and/or track CCM services. In the EHR, practices should create a care plan template and a tracker to report monthly CCM activities to ensure requirements are met. Additionally, interoperability challenges exist, including the sharing of patient data among providers. Practices should contact their EHR vendors and inquire about any upgrades or workflow recommendations to support CCM requirements. Also, some EHR vendors offer patient outreach services that supplement the CCM services offered by the practice and, collectively, the services of both meet the billing requirements for the service.

4. Compliance is difficult. To be paid for CCM services, practices must provide 24/7 patient access to care management staff, create a comprehensive care plan for each patient, and document at least 20 minutes of CCM clinical staff time per patient per calendar month, among other requirements. CCM services demand transformation of a practice, including care redesign using a team-based model of care. Practices on this journey or those that implemented medical homes will be better equipped to meet the CCM compliance requirements.

5. CCM services require an investment. Implementing a CCM program creates additional costs, including staffing, technology, marketing, and other general expenses, as well as can increase the physician’s workload. However, the benefits often outweigh the costs. Practices receive new revenue for services they may already be providing, and patients can benefit from more frequent contacts from the practice. By assessing workflows and reassigning certain activities that do not require a physician’s license, practices will gain efficiencies by involving other staff. The practice should perform a cost benefit analysis to understand both the costs and benefits of this service and budget accordingly. Most importantly, the practice needs to consider the strategic advantage of performing such services both in facilitating the move to value-based care and differentiating itself from its competitors.

While cost, implementation, and compliance are challenges, there are many benefits to the practice in pursuing CCM. Practices should not miss the opportunity to use CCM as a driver to position and prepare the practice for future success in a value-based payment environment, while receiving payment in today’s fee-for-service world. Start now! Perform your cost-benefit analysis; identify any gaps in your ability to meet the CCM requirements; implement a plan to address workflows, staffing, and documentation needs. CCM can be a first step in transforming your practice for future success.

Practice Transformation, Webinar, The Camden Group


Ms. Zielinski is a vice president with GE Healthcare Camden Group, with over 20 years of experience in the healthcare industry. She specializes in helping private and hospital-owned medical practices achieve top financial performance by guiding physicians through practice development, strategic planning, coding and revenue cycle process optimization, and electronic health record system implementation. In her health system leadership roles, she has successfully managed the revenue cycle for over 2,000 physicians. Additionally, Lucy has led engagements with physician billing companies that involved restructuring operations and development of dashboard reports. She may be reached at lzielinski@thecamdengroup.com or 312-775-1700.

Topics: Lucy Zielinski, Chronic Care Management, Chronic Care Management Services

Webinar Registration Still Open: Transforming Your Medical Group for Future Success

Posted by Matthew Smith on Nov 5, 2015 9:55:41 AM

A New, Complimentary Webinar From The Camden Group

Webinar, Practice Transformation, The Camden GroupOverview:

Is your medical group positioned to succeed in a value-based, consumer-driven world where access, quality, and cost are the drivers of success?

Will your current business and care delivery models support new payment systems, meet technology requirements, and satisfy consumer demands?

Have you started to transform the delivery of care to respond to competition and changing market forces?

Learn more about what it takes to transform your medical group by registering for The Camden Group’s one-hour webinar, Transforming Your Medical Group for Future Success on:

Thursday, November 12, 2015 at 1:00 PM ET (12:00 PM CT, 11:00 AM MT, 10:00 AM PT).

By the conclusion of the webinar, attendees will:

  • Understand the three reasons why practices must be transformed
  • Learn how to construct a high-level roadmap to addresses technology, operational efficiency, financial performance, patient access and satisfaction, and clinical care redesign
  • Discover how to assess a practice in order to identify the gap between where its medical group is currently positioned and where it needs to be for optimum success
  • Cite new-generation key performance indicators to measure performance and successes
  • Determine next steps for transforming the medical group for future success.

Presenters:

Lucy Zielinski, The Camden Group       Susan Corneliuson, The Camden Group

Lucy Zielinski           Susan CorneliusonMHS, FACHE
Vice President              Senior Manager
The Camden Group       The Camden Group

Space is limited. Reserve your webinar seat now by clicking the button below.

Webinar login details will be sent to accepted registrants the week prior to the November 12th webinar.

Practice Transformation, Webinar, The Camden Group


Please Note: This webinar is complimentary for The Camden Group’s clients, industry colleagues, and other interested parties. The Camden Group reserves the right to deny access to those individuals who may pose a conflict of interest to The Camden Group.


 

Topics: Medical Group, Practice Management, Webinar, Lucy Zielinski, Susan Corneliuson, Practice Transformation

Webinar Registration Open: Transforming Your Medical Group for Future Success

Posted by Matthew Smith on Oct 1, 2015 12:57:28 PM

A New, Complimentary Webinar From The Camden Group

Webinar, Practice Transformation, The Camden GroupOverview:

Is your medical group positioned to succeed in a value-based, consumer-driven world where access, quality, and cost are the drivers of success?

Will your current business and care delivery models support new payment systems, meet technology requirements, and satisfy consumer demands?

Have you started to transform the delivery of care to respond to competition and changing market forces?

Learn more about what it takes to transform your medical group by registering for The Camden Group’s one-hour webinar, Transforming Your Medical Group for Future Success on:

Thursday, November 12, 2015 at 1:00 PM ET (12:00 PM CT, 11:00 AM MT, 10:00 AM PT).

By the conclusion of the webinar, attendees will:

  • Understand the three reasons why practices must be transformed
  • Learn how to construct a high-level roadmap to addresses technology, operational efficiency, financial performance, patient access and satisfaction, and clinical care redesign
  • Discover how to assess a practice in order to identify the gap between where its medical group is currently positioned and where it needs to be for optimum success
  • Cite new-generation key performance indicators to measure performance and successes
  • Determine next steps for transforming the medical group for future success.

Presenters:

Mary Witt, The Camden Group             Lucy Zielinski, The Camden Group      Susan Corneliuson, The Camden Group

Mary Witt, MSW          Lucy Zielinski           Susan CorneliusonMHS, FACHE
Senior Vice President     Vice President              Senior Manager
The Camden Group        The Camden Group       The Camden Group

Space is limited. Reserve your webinar seat now by clicking the button below.

Webinar login details will be sent to accepted registrants the week prior to the November 12th webinar.

Practice Transformation, Webinar, The Camden Group


Please Note: This webinar is complimentary for The Camden Group’s clients, industry colleagues, and other interested parties. The Camden Group reserves the right to deny access to those individuals who may pose a conflict of interest to The Camden Group.


 

Topics: Mary Witt, Medical Group, Practice Management, Webinar, Lucy Zielinski, Susan Corneliuson, Practice Transformation

New Download: Patient Payment Optimization—5 Steps for Improvement

Posted by Matthew Smith on Jun 12, 2015 2:37:32 PM

payments_getty_images.jpegWith the rise of consumer-directed healthcare and high deductible plans, the increase in patient financial responsibility is impacting medical groups. Medical groups are experiencing an increase in patient out-of-pocket payments. For many practices, patients are or will be one of the top 5 largest payers. Effectively managing patient liability and accounts receivable is key to avoiding a reduction in profit margin. Based on recent statistics, if medical groups do not redesign how they manage the patient collections process, they can anticipate a 5-10 percent reduction in their bottom line.

The AMA’s National Health Insurer Report Card examined the portion of healthcare expenses (copays, deductibles, and coinsurance) for which patients are responsible and found that during February and March of 2015, patients paid an average of 23.6 percent of the amount that health insurers set for paying physicians. Essentially, patients paid only 24 cents on the dollar of what they owed. So how can medical groups change patient payment behaviors to optimize this major source of revenue?  

This presentation provides an overview of a "best practice" patient collections process and introduces a five-step approach for improving the process. The objective is for medical groups to:

  • Increase patient satisfaction
  • Decrease their cost to collect
  • Decrease bad debt
  • Increase their patient collections

Strategies to meet these goals are discussed, including process redesign, patient engagement/education, and technology optimization (or automation). An assessment tool and key performance metrics to help medical groups optimize payment are included.

Patient Payment Optimization, The Camden Group

Topics: Lucy Zielinski, Patient Payment Optimization, Patient Collections

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