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Becoming the Practice of the Future Today: 10 Steps to Transform Your Practice and Provide Individualized Care

Posted by Matthew Smith on Oct 6, 2015 11:23:51 AM

By Susan Corneliuson, MHS, FACHE, Senior Manager, and  Mary Witt, MSW, Senior Vice President, The Camden Group

Practice Transformation, The Camden GroupCurrent business and care delivery models, even if combined with innovative or sustainable technologies, will not lead to future success. Practices must create new care delivery and business models while incorporating technological advances to effectively compete today and in the future. New payment models, disruptive technology, and care delivery vehicles (e.g., e-visits, home monitoring, retail clinics), along with changing consumer demands for immediate access and transparency, require medical practice transformation. Here are the top 10 steps you should be taking now to transform your medical practice in order to succeed now and in the future.

1. Create a profile of your current and potential patients

Who are they (e.g., age, sex, payer mix)? What is their health status? What are their priorities for their healthcare (e.g., convenience, access, relationship, continuity of care)? How do they want their care delivered? Perhaps through e-visits, urgent care, face-to-face visits, telemedicine, or e-mail? How do they want to communicate (e.g., e-mail, texting, phone, patient portal, face-to-face encounters)? Identifying who your patients are will allow you to tailor your practice to meet their needs.

2. Assess your market

What are the demographics (e.g., ages, sex, income, health status) of your service area, and how fast is it growing? What do consumers want from their physicians? What do employers want from providers? Where are payers going with their payment models? What are your competitors doing to position themselves for the future? Who else might come into your market? Market knowledge should inform your practice redesign efforts as you move to meet the needs of patients and payers.

3. Examine your practice from your patients’ perspective

Assess your practice from top to bottom as if you were a patient. Use patient shoppers and patient focus groups to understand their perspective and expectations. Scrutinize your patient satisfaction surveys for useful data on patient needs and wants. Identify the amount of value-added time (the amount of visit time spent in actual interaction about the patient’s care) versus non-value added time, and perform cycle time studies to identify reasons for long wait times. Target patient cycle time at 30 to 40 minutes for a routine visit, and value added time at 75 to 80 percent of the visit total. By examining your practice from the patient’s perspective, you will be able to identify the gaps and develop a roadmap to transform your practice.

4. Create process excellence to drive patient, provider, and staff satisfaction

Document and analyze your work flows for all key operational areas, including patient scheduling, check-in, vitaling, exam, check-out, and patient follow-up. Identify waste, duplication, and barriers in each operational function and develop revised workflows that reduce process variability. Focus on process excellence, ensuring that every step in the process is meaningful and leads to better care. This not only will improve patient satisfaction but motivates providers and staff because it eliminates unnecessary steps and increases direct patient care time.

5. Develop patient-directed, convenient access points to your practice

Based on your patient profile, develop the access points your practice requires to meet the needs of your patient population. Be able to offer same day patients appointments so they do not go elsewhere. Implement a robust patient portal with interactive email and scheduling capabilities. Offer e-visits, text messaging, expanded hours, and/or develop relationships with urgent cares. Create an environment that allows the patient to choose the method in which they will access care with convenience and ease.

6. Change your care delivery model to facilitate population health management

With the move to fee-for-value reimbursement and the new demands of patients in this technological age, providers need to use teams more effectively to meet patient needs. Based on your patient’s needs, determine what type of team will be most successful in managing your population of patients. Consider the use of medical assistants, care managers, social workers, and health coaches to create the support network required. For example, if your practice has a high volume of chronic care patients, consider a high-touch, high-contact delivery model with the use of care managers and health coaches to continuously engage patients in their care. For panels with high commercial, healthy populations, increase the use of advanced practice clinicians, offer e-visits, and expand hours to provide easy, convenient access. Ensure that all team members are working to the top of their license and skill sets to maximize efficiency and physician support.

7. Assess your current business model based on what is necessary to succeed in a fee-for-value world

Assess your capabilities to provide high quality, effective, affordable care not only today, but three to five years from now. Analyze your practice’s cost structure, and identify the profit formula that will allow you to compete. Based on the needs of your patients and resources required to manage your population, identify the profit margins, reimbursement, and volumes required to meet your business goals. Analyze your payer contracts and explore fee-for-value payment model options with your payers that build on your strengths as a practice. Understand the total cost of care for your patients so you can be part of the solution in bringing them the care they deserve in a cost-efficient manner. Ensure that your compensation models effectively align with practice goals and critical success factors.

8. Optimize your use of data to enhance care, ensure accountability, and achieve your goals

Create your practice’s value proposition for the future, and use it to guide your practice metrics and dashboard reports. Apply integrated technology and automated dashboards to track and report on practice performance, including quality measures to maximize pay for performance dollars. Use the electronic medical records (“EMR”) to proactively prompt you about a patient’s care needs. Utilize real time prompts to remind physicians of needed preventive and chronic care during the patient visit so needs can be immediately addressed. Implement a patient registry to manage patients with chronic diseases and consider the integration of home monitoring and diagnostic equipment in your care model. Gather data on your use of ancillaries, and assess if you are following best practices and only performing tests and procedures when necessary.

9. Implement strategies to foster patient “stickiness” to your practice

Focus on creating patient loyalty. Use texting, email, and social media to maintain contact outside of the face-to-face visit. Provide your patients with the information they need to stay healthy on a regular basis through texting, email, and phone calls. Develop your patient portal as the “go-to” site when they have questions by making patient education materials readily available on the portal, including the provision of links to reputable internet sites. Explore the creation of a phone application that can provide patients with a ready source to answer their immediate health concerns so they don’t have to go outside the practice’s sphere of influence. For example, the application could be linked to a branded call center which could provide an immediate response to health questions and concerns.

10. Optimize the use of technology

Utilize technology purposefully to allow providers more touch time with patients and make sure your technology works for you, not against you. Assess EMR efficiency by counting the number of clicks, screens, and typing required per task; observe physician and staff as they use the EMR and record extra steps. Work with your EMR vendor to decrease extra steps and streamline the data entry process. Note variations in the use of the system and train providers and staff in the most effective and efficient processes. Implement other technology such as automated appointment reminders and easy payment tools through the use of text, email, and phone. Use your patient portal to decrease call volume by activating patient scheduling, referral management, prescription refills, lab notifications, and pre-registration and check-in features. Consider the cost benefit of each technological feature and ensure that, once the feature is enabled, it is optimized to work for the practice.

Start now: make transformation a priority to ensure you successfully achieve your practice’s value proposition. Do not wait until your payers change how they pay, retail clinics proliferate in your community, your practice is losing patients or physicians, or you are losing money. Practice transformation does not occur over night. It takes time and hard work. To succeed in the future, you need to lay the foundation now.


 A New Webinar From The Camden Group

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?

Register for The Camden Group’s 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, The Camden Group


Ms. Corneliuson is a senior manager with The Camden Group and has over 13 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings. She may be reached at scorneliuson@thecamdengroup.com or 714-263-8200.

 

Ms. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

 

Topics: Mary Witt, Medical Group, Susan Corneliuson, Medical Group Efficiency, Medical Group Transformation

Advanced Access: a Winning Approach for Patients, Providers, and Staff

Posted by Matthew Smith on Oct 5, 2015 3:14:13 PM

By Mary Witt, MSW, Senior Vice President, and William K. Faber, M.D., Vice President, The Camden Group

Advanced AccessAccess to the right medical care at the right time in the right setting improves patient satisfaction. It also attracts new patients, retains existing patients, supports safety, improves outcomes, and reduces cost. So why do so many medical practices still struggle to provide adequate access to achieve these goals?Traditional approaches to improving access have focused on:

  • Recruitment--which may be costly, impossible, or too much of a long-term challenge
  • Partnering with urgent care centers or retail clinics which do not facilitate continuity or an ongoing relationship with your medical practice
  • Managing demand through triage, which has only led to greater patient dis-satisfaction
  • Holding a fixed number of appointments for patients (which are never the right number) needing to be seen the day they call, often called "carve-out scheduling"

Under any of these approaches, physicians and staff struggle to meet the needs of today, as well as those of patients who have waited days or weeks for appointment.

Access may be improved significantly through practice optimization, and by employing the principles of advanced access. Advanced access is appointment availability that reflects the real-time demand of patients and, therefore, reduces or eliminates queuing. It is a philosophy that focuses on “doing today’s work today.” However, it is more than just changing the schedule. It is an innovative way of thinking about patient care. It emphasizes improvement of the total care experience, from the initial telephone call to follow-up care. Advanced access works because it predicts demand and then focuses on maximizing daily capacity so that daily demand can be met. It also does not occur in a vacuum. It requires that the processes in a practice be reviewed and often modified. 

Here are five tried and true principles:

1. Understand Your Demand and Capacity

It is well known that Monday is always the day of highest demand for primary care providers (or Tuesday after a three-day weekend). Tuesday often has the second greatest demand, and demand on Wednesday through Friday is about equal. Most patients would appreciate some early evening and weekend availability too. We also know that winter flu season is the busiest time of year and that if a practice performs school physicals, July and August will have greater demand.

Does your provider capacity match patient demand?  Do you maximize provider availability for your high-demand hours?  You may find that you have too many physicians working mid-day Thursday and not enough on Monday morning. Talk with your providers about the mismatch of appointment availability to the known hours of patient demand. Let them work out a fair distribution within the parameters you give them. Most of the redistribution can often be accomplished voluntarily. Provider vacations can be managed to minimize coverage holes at times of greatest demand.

2. Decrease Appointment Types

Much inefficiency and unnecessary queuing results from the creation of too many appointment types. Many systems try to handle demand by creating more appointment types to “manage” the schedule, but that has only created additional complexity and limited appointment availability. Best practice is to reduce appoint types to two: a short and a long (with the long being twice the length of a short). You may decide to have 15 and 30-minute appointments or 20 and 40-minute appointments for instance. Relegate all patient needs to one of the two. This gives your scheduler much more flexibility to get patients in. Also, if you know that a certain patient always runs over, give them a longer appointment.

3. Manage Your Daily Appointment Inventory

Many providers clog up all their future appointment availability for those who are acutely ill by unnecessarily scheduling follow-up appointments. A protocol change, for instance, of seeing patients for blood pressure checks every quarter instead of every other month immediately creates capacity. The same is true for diabetics or anyone with a chronic disease. Of course, different patients need to be seen on different intervals due to the severity of their disease or their compliance with treatment. The point is to be mindful of that need rather than rescheduling routinely in a pattern that limits future availability.

Use a morning and afternoon huddle with your medical assistant to review the schedule and plan for the day. Identify patients whose needs could be met by a phone call to free up space on the schedule. If someone being seen today has a future appointment, take care of both issues during the first appointment if possible.

4. Create Contingency Plans

Create provider care teams to ensure that vacations, sick time and temporary absences do not significantly impact same-day appointments. Proactively develop plans to handle peak demand such as flu season and school physicals.

5. Measure and Monitor Access on an Ongoing Basis

Unless access is routinely measured (third available appointment), it is easy to fall into old habits and slip into postponing work until tomorrow. When contingency plans are implemented, they need to be monitored to identify what is working and what is not so that problems can be quickly identified and resolved before backlog creep occurs.

Advanced Access Is Win-Win

Everyone wins with advanced access: patients, physicians, staff, and management by:

  • Increasing patient satisfaction
  • Improving clinical outcomes for patients through better continuity of care (patients now see their own doctor) and greater emphasis on prevention
  • Enhancing quality of practice life for physicians and staff
  • Increasing efficiency in patient flow
    • Fewer no shows
    • Less phone calls
    • Minimizes re-work
  • Decreasing costs through decline in ER and urgent care visits
  • Potentially increasing in net revenue
    • More new patients
    • Ability to do more for patient through max-packing
AccuTracker, Workflows

Ms. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

Dr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

 

Topics: William K. Faber MD, Mary Witt, Medical Group Efficiency, AccuTracker, Advanced Access, Medical Group 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

Top 10 Steps to Improve Medical Group Efficiency

Posted by Matthew Smith on Jun 17, 2015 9:25:04 AM
By Mary Witt, MSW, Senior Vice President, and 
Susan Corneliuson, MHS, FACHE, Senior Manager, The Camden Group

medpractice.jpgWith the transition to pay for value, the need for enhanced care coordination, EMR optimization, emphasis on quality reporting, and increasing patient expectations, medical groups are finding that work flow processes developed in a simpler time are no longer delivering the results required for success. Work flow optimization to improve efficiency and drive improved health outcomes is a necessary component of a successful medical group. As such, work flow redesign has become a required skill set for medical group leaders, and a culture of continuous process improvement must be established. Effective work flow redesign requires a formal, defined process to ensure that sustainable gains are maintained and continuously improved over time to stay current with the ever changing healthcare environment. The key steps for successful redesign are described below.

1.  Choose Effective Leaders and Champions

Work flow redesign cannot happen without leaders who understand and can drive the need for change. Leaders chosen must establish a clear and compelling vision and be able to articulate the need for process redesign, in terms that those doing the work can understand and embrace. Leaders should be able to speak reliably about the operations of the medical group in order to establish the credibility of the initiative and should have a clear understanding of the inherent challenges that will need to be addressed if the group is to achieve desired results. Effective leadership is critical to addressing and removing obstacles that arise during the redesign process.

2.  Make the Case for Redesign

Work flow redesign requires transformative change. Given that change is often intimidating and disruptive, it is critical that all involved understand why the status quo is no longer viable, how the process will work, and what the redesign process is going to achieve. Most importantly, the case for redesign needs to answer the question “what is in it for me” so those involved have a reason to buy-in. Buy-in at all levels of the organization is necessary if lasting change is to occur.

3.  Clearly Define Goals, Critical Success Factors, and Baseline Performance Metrics

Do not begin to redesign work flows until there is consensus regarding the expected outcome of the redesign initiative. Without clearly defined goals and agreement around what success looks like, it will be difficult to evaluate if the redesigned work flows are having the desired impact. Goals should reinforce the case for redesign and provide further context for the work that is to take place. It is also beneficial to identify the critical factors for success so they can be integrated into the process and help guide the redesign efforts. Lastly, baseline performance metrics must be established and will serve as the basis by which to gauge the effectiveness of the changes implemented.

4.  Create Cross-Functional Teams

Given the interdependence of all work flow processes in medical group operations, the redesign team should be cross-functional and cross-disciplinary; that is, include representatives from each of the areas that will be impacted by the work flow changes or will provide tools to assist in streamlining work flows (e.g., clinical staff, physicians, front office staff, information technology, human resources). Team members need to be content experts to ensure that the new work flows meet the needs of their area. Also, it is important that they have credibility within their area of expertise so they can serve as champions for the new work flows. Engage staff and physicians from multiple locations in order to ensure that the newly designed work flows can be adapted and applied across all sites.

5.  Describe Your Ideal State

To facilitate creative thinking, create a vision and description of the ideal state before work is started on the actual redesign of the work flows themselves. Rather than building on the current state, start with a clean slate so that the ideal state is not reined in by current practice. Using the current state can often limit thinking and build in biases based on what people think is or is not achievable. Allowing individuals to think beyond what is possible today will break the barriers of traditional thinking and assist in pushing the envelope to achieving the ideal future state.

6.  Create a New Work Flow that Drives Performance to the Ideal State

Mapping the current state is the starting point of the redesign work itself. The current state map identifies waste, duplication, bottlenecks, rework, and inconsistencies in the current process. The gap between the current state and the ideal state provides direction on changes needed in work flow and the challenges and obstacles required to be resolved in order to create a new work flow that successfully achieves the desired goals. Processes should be mapped in as much detail as possible to ensure that all eventualities are considered.

7.  Revise Staff Roles and Responsibilities to Fit the New Work Flow

Redesign of work flows may require that staff roles and responsibilities be re-configured. As the work flows are modified, job descriptions should to be reviewed to identify if changes need to be made to reflect these changes in tasks or responsibilities. Specific performance expectations related to new tasks should be included in the job description to facilitate accountability.

8.  Implement, Measure, and Refine

Upon agreement of the redesigned work flows, implementation begins with the development of the action plan which includes steps, assigned accountabilities, and a timeline. The action plan should address training requirements, the development of new tools, equipment needs, and detailed implementation of the processes themselves. Consider initially implementing the revised work flows in one or two pilot sites. Then refine work flow processes based on the performance to metrics before rolling it out throughout the organization. Choice of pilot sites is important to the success of the redesign process. Characteristics of an ideal pilot site include: an appetite for change, willingness to be flexible, and strong physician and administrative leadership at the pilot site level. Pilot implementation of new work flows should last for at least three weeks before any significant changes to new processes are made. Setting a three week target allows staff and physicians the time to adjust to the changes and ensures that changes are not made as a result of a reluctance or fear of change but are based on performance to identified metrics and end-user feedback. A performance dashboard should be established prior to implementation with ongoing tracking of defined measures and opportunity for end-users engagement and feedback. Daily huddles should be held to track progress and identify issues requiring resolution.

9.  Communication Throughout the Design Process Is a Must

When embarking on workflow redesign, you cannot communicate enough. Physician and staff will be nervous and uncertain about what redesign means for them, and communicating at each step of the process can build support and a comfort level with the changes. Also, it is helpful to utilize a variety of communication methodologies, both written and verbal, to address the differences in how people hear and learn. Depending on the size and complexity of the redesign process, consider creating a regular newsletter to keep people informed of progress. Provide an opportunity for physicians and staff to ask questions and receive feedback through regular meetings. As the new work flows are implemented, the use of dashboards to monitor and track progress can be very helpful in building momentum.

10.  Celebrate Success

Change is hard work and implementing new work flows can be very stressful for all involved. Therefore, it is important to celebrate success. Create opportunities for short term wins and celebrate as they are achieved. This lays the groundwork for creating a culture of continuous learning and improvement which is critical for long-term survival in a changing environment.

Medical Practice Workflow Redesign, The Camden Group,


Mary Witt, The Camden Group, Physician ServicesMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

Susan_Corneliuson.pngMs. Corneliuson is a senior manager with The Camden Group and has over 13 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings. She may be reached at scorneliuson@thecamdengroup.com or 714-263-8200.

Topics: Mary Witt, Medical Groups, Susan Corneliuson, Medical Group Efficiency

SGR is Fixed! What's Next?

Posted by Matthew Smith on May 7, 2015 1:23:00 PM

By Mary Witt, MSW, Senior Vice President, The Camden Group

sgr.pngThe Medicare Access and CHIP Reauthorization Act (“MACRA”) became law last month, and the repeal of the of the sustainable growth rate formula (“SGR”) was official. As important, MACRA reinforces Medicare’s move away from fee-for-service and into pay for value. The major impact on medical groups includes:

  • Provides a 0.5 percent annual update to Medicare rates from 2015 through 2019.
    • The 2015 update will occur July 1, 2015.
  • Moves all providers (physicians, nurse practitioners, clinical nurse specialists, midwives, certified registered nurse anesthetists, and physician assistants) into value-based payments in 2019, either through the Merit-Based Incentive Program (“MIPS”) or through bonuses for participation in an Alternative Payment Methodology (“APM”). All providers will be incentivized through MIPS if they do not qualify for bonuses under APM.
  • MIPS consolidates and streamlines current Medicare quality programs (Physician Quality Reporting System [“PQRS”], Meaningful Use, and the value-based payment modifier and sunsets the penalties associated with each of the current programs in 2018.
    • MIPS will reward providers based on performance in four categories: quality, resource use, meaningful use, and clinical performance improvement.
    • It creates a composite score based on the four categories and, depending on how it compares with a performance threshold (based on the mean composite score of all eligible professionals), eligible providers will receive a bonus, a penalty, or no adjustment in payment. Those scoring in the lowest quartile will receive a penalty and bonuses will be proportional depending upon the score.
  • Provides a five percent bonus for 2019 to 2024 for eligible professionals who are a “qualifying APM participant.”
    • Qualifying APM categories include accountable care organizations, patient centered medical homes, bundled payments, or other models developed by the Centers for Medicare and Medicaid Services (“CMS”).
    • In 2019, a qualifying APM participant must have at least 25 percent of payments attributed to services furnished under an eligible APM. It increases to 50 percent in 2021, and 75 percent in 2023 and beyond.
  • Reverses CMS’ decision to eliminate the use of 10- and 90-day global day surgical codes.

So Does MACRA Mean We Don’t Need to Do Anything Different?

The answer is a resounding "NO!"  

This legislation is another signal that payers have moved away from fee-for-service to pay for value, and medical groups need to assess their readiness and act now. Waiting until the payment methodology changes is too late. Instead, medical groups must begin the work of redesigning their practices now to be successful in the future.

Must Dos

  • Improve patient access to increase patient satisfaction and prevent leakage to new competitors
  • Maximize operational efficiency
    • Analyze your performance on quality and cost and develop a performance improvement action plan now
    • Document and assess your current work flows for all key practice processes:  check-in, check-out, physician visit, and visit discharge to identify waste, barriers, duplication, and missing steps
    • Maximize patient throughput
    • Develop work flows to effectively use team members to maximize physician effectiveness
    • Optimize electronic health records utilization
  • Re-examine your physician compensation plan and add incentives for quality, patient satisfaction, and efficiency
  • Use the current Medicare value-based payment initiatives to help you build the foundation for success under MIPS
    • Participate in PQRS

witt_headshot.pngMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. Ms. Witt leads medical group development, performance improvement, and turnaround projects for integrated delivery systems, medical groups, and academic residency programs throughout the country. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

Topics: Mary Witt, Sustainable Growth Rate, SGR, Medicare Access and CHIP Reauthorization Act, EHR Optimization, MACRA

Calling All Oncology Practices: CMS Extends Oncology Care Model Letter of Intent Deadline

Posted by Matthew Smith on Apr 14, 2015 3:39:32 PM

By Mary Witt, MSW, Senior Vice President, The Camden Group

oncology-salaryIn February, the Centers for Medicare and Medicaid Services (“CMS”) announced the Oncology Care Model (“OCM”) Initiative to improve care coordination, appropriateness of care, and access to care for Medicare beneficiaries undergoing chemotherapy by using appropriately aligned financial incentives. The deadline for submitting a non-binding letter of intent (“LOI”) has been extended from April 23 to May 7, 2015If your oncology practice has not yet considered participating in the OCM initiative, time still remains to consider participation and to submit your LOI.

Participation in the initiative may benefit your practice in the following ways: 

  • Improves how you deliver care
    • Care coordination
    • Quality
    • Efficiency
  • Provides financial resources to strengthen your care delivery model
  • Enhances your competitive position in the marketplace by increasing quality and efficiency (cost), (i.e., assist in the creation of a market differentiator)

The OCM Initiative is episode-based, which is defined as chemotherapy and related care during a 6-month period following the initiation of chemotherapy treatment. The goal of the OCM Initiative is to improve quality through transforming how oncology care is delivered in the medical practice setting. Fee-for-service Medicare beneficiaries are automatically enrolled if they receive chemotherapy at a participating practice.

Under the OCM Initiative, participating practices will continue to be paid Medicare fee-for-service payments. Additionally, CMS is implementing a two-part payment approach:

  • Per beneficiary per month (“PBPM”)
  • Performance-based payment
    • Performance on specific quality measures
    • Total cost of care as compared to established targets

Eligible practices include:

  • Physician group practices and solo physicians providing chemotherapies and currently enrolled in Medicare (multispecialty practices may apply and include only those physicians who furnish cancer chemotherapy).
  • Hospital-owned practices may apply as long as the hospital is paid by Medicare under the inpatient and outpatient prospective payment systems.
  • Practices that partner with a hospital outpatient department for chemotherapy infusion services may participate as well as those that are owned or affiliated with hospitals that participate in the 340B Drug Pricing Program.
  • Practices may participate in other CMS programs including shared savings models such as accountable care organizations. Practitioners participating in the Transforming Clinical Practices Initiative are not eligible to participate.
  • Those owned or affiliated with PPS-exempt cancer hospitals, critical access hospitals, Federally Qualified Health Centers, and Rural Health Clinics can’t apply.

For additional information, please download The Camden Group’s new CMS Oncology Care Model Initiative Overview by clicking the button below. This new overview provides the following details of the initiative:

  • Eligible Practices
  • OCM Practice Requirements
  • Financial Incentives
  • Risk Factors
  • Beneficiary Enrollment and Attribution
  • OCM Initiative Benefit to Physician Practices
  • Sample Payment Projection
  • Timeline for LOI Through Implementation

  Oncology Care Model Initiative Overview


 

witt_headshotMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. Ms. Witt leads medical group development, performance improvement, and turnaround projects for integrated delivery systems, medical groups, and academic residency programs throughout the country. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

Topics: Medicare, CMS, Mary Witt, Oncology Care Model Initiative

Top 10 Trends and Implications for Medical Groups in 2015

Posted by Matthew Smith on Jan 27, 2015 2:23:00 PM
By Mary Witt, MSW
Senior Vice President, The Camden Group


016_healthcare_consultant.juSuccess in 2015 requires clear thinking and decisive action. Whether independent or hospital/system-owned, medical groups cannot continue to do business as usual and expect to succeed in 2015. Increasing financial pressures, the move to fee-for-value, and increased expectations for quality require new ways of doing business. Here are the top 10 trends for 2015 that can provide direction and focus as medical groups plan for the year ahead.

1. A focus on performance optimization is necessary for success. Medical groups can no longer be satisfied with median performance. Medical groups that are not pushing themselves to excel will find themselves left behind as top performers emerge and gain market dominance. Also, as financial pressures increase for hospitals and health systems, they will no longer be able to sustain the high losses experienced by many hospital-owned medical groups. It is critical that medical groups assess their performance as compared to industry best practices and implement a performance improvement plan to address any deficits. To sustain forward momentum, medical groups should establish clear accountabilities for performance throughout the medical group by creating measurable performance standards, continually measuring performance against targets through the use of dashboard reports, developing action plans to address variances, and incorporating performance expectations into job descriptions.

2. Patient collections cannot be ignored. With the increase in high deductible plans and patient copays, medical groups are seeing a significant increase in the dollars owed by patients. Therefore, an effective patient collection process that starts when the appointment is scheduled is critical to ensuring that all revenue owed is collected. When the appointment is scheduled, patients should be informed of copay and deductible amounts as well as outstanding balances, and the expectation that payment is due at the time of the visit should be established. Time of service collections should include collection of all monies owed for the services provided that day as well as any outstanding balances.

3. 2015 brings increasing competition from nontraditional organizations. New, non-traditional competitors are entering the outpatient medical care market. Retail firms such as WalMart, Walgreen’s, CVS, and RiteAid have created primary care clinics; while some have partnered with local providers, more often they have created their own clinics or partnered with national firms. Target and Kaiser Permanente have developed a partnership to provide primary and specialty care in clinics in Target stores that will be open to nonKaiser enrollees. Payers such as Anthem California are marketing e-visits directly to their enrollees bypassing the traditional in person physicianpatient relationship. Partnering with non-traditional organizations is an option that should be assessed as well as considering non-traditional practice locations. It is important to understand what patients want and expect of the practice to retain them. Regularly survey patients about their experience with the practice; consider the use of focus groups to gather more in-depth data on what is important to them.

4. Physician compensation models require redesign. As medical groups prepare for fee-for-value payment, increasing competition, and a focus on quality, there is likely a need to redesign their compensation model to better align incentives with the new environmental realities. What worked in the past is unlikely to work in the future. It is important to understand how quickly the market is shifting from fee-for-service to value-based payment in order to determine what needs to be changed and how quickly it needs to happen. Medical groups will want to develop a road map to broaden compensation incentives to prepare for fee-for-value payments. Consider adding incentives for care coordination, quality, and efficiency in addition to productivity. Initially, it may make sense to devote a small percentage of compensation to these new metrics to prepare for the future if the market is not demanding immediate change.

5. Transparency is becoming increasingly important. The era of transparency in cost and quality is here. Payers are publishing provider charges by Current Procedural Terminology (“CPT”) code; CMS has published Medicare payments made to physicians. Employers are demanding price transparency, especially as they move to high deductible plans and pass more cost on to their employees. States are creating multipayer pricing databases based on payer claims data and providing access to consumers. Many new websites enable consumers to shop price and quality. Quality is being tracked more vigilantly, and quality scores are readily available to the consumer through a variety of websites. With all of this data available, it is important that medical groups understand how their pricing and quality compare to their competitors and take action to ensure that high prices and poor quality do not cost them patients.

6. Mastery of technology cannot be ignored. Medicare demands that medical groups report on quality or face penalties, and payers increasingly link payments to quality reporting or results. Therefore, medical practices need to be able to collect, analyze, and exchange data. Also, as expenses increase, and operational demands become increasingly complex, the ability to automate work is critical to improving efficiency. New care models increasingly rely on real-time access to patient clinical data as well as access to tools such as telemedicine or health monitoring devices. Effective use of technology to improve results is a necessary element for future success. Evaluating current work flows and looking for inefficiencies (e.g., duplicate data entry, multiple handoffs) can lead to identifying opportunities for automation. Explore the use of telephone technology to automate tasks such as appointment and payment balance reminders. Participate in a health information exchange that provides two-way communication and clinical results with hospitals, referring physicians, and other health providers. Use an electronic health record to assist clinicians in the care of their patients; the use of real-time prompts assists physicians in performing preventive services and informs them when test results are outside of normal.

7. Managing a population of patients requires new care delivery models. Managing a population of patients requires a change in how care is delivered. The focus is no longer on episodic care, but instead focuses on managing the total healthcare needs of a population of patients. The emphasis shifts to “providing the right care at the right time in the right place.” Redesigning care involves transforming both how care is delivered and who delivers the care. Re-examine roles within the practice to ensure that everyone is working to the top of their license/expertise. Successful management of a population of patients requires an expanded team approach to care. New care team members can include advanced practice clinicians, care managers, social workers, pharmacists, nutritionists, and health coaches with leadership and direction provided by the physician. Reexamine the workflow in the office to assure that as the care model evolves, the work flow is adapted to facilitate efficient use of space and staff. Explore the feasibility of using e-visits, tele-health, and group visits to improve access, responsiveness, and maximize patient engagement. Consider the operational and financial feasibility of implementing Medicare’s newly reimbursed chronic care management.

8. Patient engagement leads to better outcomes. Patients actively engaged in their care have better outcomes and utilize fewer health resources. In order to maximize patient engagement, medical practices must move from telling patients what to do to assisting them to develop the knowledge, skills, and confidence necessary to be an active partner in their care. Train physicians and staff on communication skills and motivational interviewing and integrate expectations into physician and staff performance expectations. Ensure that patients are actively engaged in discussing their health and developing their care plan. The use of patient portals can be an effective means of maintaining communication with patients and monitoring their adherence to care plans.

9. Patient demand for access is not going away. Thus, ensuring timely patient access has to be a medical group priority if the practice is to have satisfied patients. To understand patient access, routinely monitor third next appointment availability. Calculate the practice’s patient demand versus practice capacity, and implement strategies to increase capacity as needed. Consider allowing patients to schedule their own visits through a patient portal, providing evening and weekend hours, offering e-visits, and communicating by email and text. Practices should also employ strategies to facilitate regular communication with their patients through e-mail blasts, texting, and social media.

10. Physicians will continue to move toward the employment model. As the complexity of medical practice and economic pressures increases, and the demand for capital for practice infrastructure (e.g., electronic health record, care team staffing) grows, more physicians are choosing to become employed, and that trend is likely to accelerate over the next few years. This provides opportunities for existing medical groups and hospitals/health systems to add physicians to their practices as they seek to capture a greater population. To ensure a successful employment relationship, medical groups and physicians both need to clearly define their goals and expected outcomes and then develop a set of criteria to guide decisions as opportunities are considered.

As medical groups grapple with the many challenges of 2015, it is important to focus on optimizing performance and preparing for value-based reimbursement by meeting the needs of patients efficiently and effectively. Concentrate on how to create a strategic advantage by establishing capabilities or attributes that will distinguish your group from competitors. In difficult times like these, superior, nimble, focused performance will lead to success.

Mary Witt, The Camden Group, Physician ServicesMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

Topics: Clinical Integration, Population Health, HIT, HealthIT, Mary Witt, Medical Group, Medical Groups, Clinically Integrated Networks, Physician Compensation, Patient Engagement, The Camden Group, Trends

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