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GE Healthcare Camden Group Insights Blog

Five Focus Areas for Medical Groups in 2017

Posted by Matthew Smith on Jan 26, 2017 12:59:09 PM

For medical groups, the last few years have been tumultuous with the shift to value-based care. In 2017, medical groups will continue to experience change on all fronts, including payment, care delivery, and interaction and communication with patients. Medical groups must contend with new payment models, fierce competition in their markets, increased regulatory requirements, clinical advances, digital and information technology changes, and population health management implementation.

In response to these shifts, medical groups should focus on five key areas to position themselves for the future. As Socrates said, “The secret of change is to focus all of your energy not on fighting the old but on building the new.” And that is what medical groups need to do in 2017: build the new by transforming the old ways of practice management.

To read this article in its entirely, please click the button below to be taken directly to the HFMA website.

Medical Groups, 2017 Trends

Topics: Population Health, Medical Groups, Patient Access, Trends, Medical Group Transformation

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, GE Healthcare Camden Group

Most 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 [email protected].  

 

 

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

Meet the Practice: Physician Services

Posted by Matthew Smith on Feb 18, 2016 3:36:16 PM

This Meet the Practice overview, examining the Physician Services practice, is the second in a series in which GE Healthcare Camden Group shares insights into our five newly aligned practice areas:

  • Care Design and Delivery
  • Physician Services
  • Population Health Management
  • Strategy and Leadership
  • Financial Advisory and Transactions

Physician Services

Practice Lead: Marc Mertz, Vice President

Explain the need and problem solved for clients by your practice

With the passage of the Affordable Care Act and a host of market changes, the challenges physicians and medical groups now face are tremendous. New payment models are emerging, consumerism is increasing, public reporting of quality measures and costs is on the rise, retail clinics and other new providers offer new competition, and EMRs and mobile health are fast becoming “table stakes.” As providers consolidate, find strength in size, and work to redesign care delivery, we make sure physician organizations are poised to succeed in a value-based world.

What are some of the top capabilities or offerings of the practice?

Our top offerings include:

  • Medical group performance assessment and improvement
  • Improving patient access
  • Improved clinic efficiency and work flow (with AccuTracker Software)
  • Physician/ Hospital alignment strategies
  • Physician compensation plan design
  • IPA and Medical group development/ M&A
  • Medical group organizational redesign (governance and management)
  • Revenue cycle management improvement
  • Physician onboarding strategies
  • Medical group performance monitoring and dashboard reports (partnership with dashboardMD)

What is the value or ROI that is provided by solving these challenges?

Our goal is to empower medical groups to better perform financially, clinically, and operationally. To achieve this goal, we work with each group to improve patient, physician, and staff satisfaction and engagement while also improving overall patient access to care. 

What synergies differentiate this practice area (and GE Healthcare Camden Group)?

Nearly all health systems or hospitals utilize employed or closely-affiliated physicians, and many of those groups underperform based on organizational objectives.  Physician Services helps clients improve medical group performance and outcomes.

To this point, our work has historically included assessment and development of implementation plans, but typically stopped short of activation. GE Healthcare Camden Group is now well-positioned to provide Physician Services clients with activation support and change acceleration that ensures long-term success and sustainability.

Another differentiator is our AccuTracker software—proprietary, mobile-enabled software developed by GE Healthcare Camden Group, and designed as an easy-to-use app that helps users time processes and track EMR efficiency. Using AccuTracker, you can track cycle times for clinical processes (e.g., clinics, urgent care centers, operating rooms, emergency departments) as well as non-clinical processes, such as revenue cycle management. Over time as more data is collected and aggregated, it will also allow you to benchmark your results against other organizations (organization names will not be disclosed) so you can identify areas for improvement, all from the convenience of a mobile device. The software is completely customizable; you can either use the pre-defined benchmark processes or create custom processes to track.

An overview video may be accessed here.

GE Healthcare Camden Group, AccuTracker

Topics: Medical Groups, Physician Practice, AccuTracker

Top 10 Steps to Improve Medical Group Efficiency

Posted by Matthew Smith on Jun 17, 2015 9:25:04 AM
By Susan Corneliuson, MHS, FACHE, Senior Manager, GE Healthcare Camden Group
With 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,


Susan_Corneliuson.pngMs. Corneliuson is a senior manager with GE Healthcare Camden Group and has over 14 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.

Topics: Medical Groups, Susan Corneliuson, Medical Group Efficiency

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