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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

Preparing for Value-Based Contracting? Here are 5 Key Questions for Providers to Consider

Posted by Matthew Smith on Jun 7, 2016 2:27:10 PM

By Sabrina Burnett, Vice President, GE Healthcare Camden Group

contracting.pngIn January, 2015, the U.S. Department of Health and Human Services ("HHS") announced it had set a clear goal and timeline for transitioning Medicare reimbursements from volume to value. HHS’s goal is to tie 30 percent of all Medicare payments to quality and cost performance by the end of 2016 and increasing that proportion to 50 percent by the end of 2018. Commercial payers are expected to follow suit and develop their own programs for basing payment on quality or value. Immediately following the announcement from HHS, several major health systems and the nation’s top health insurers announced the creation of the Health Care Transformation Task Force and challenged other providers and payers to commit to their goal of putting 75 percent of business into value-based arrangements by 2020¹.

It is no longer a matter of “if” we are moving to value, but “when." As providers prepare for impending change in reimbursement they must decide if they are going to lead, follow or resist.

5 Considerations

Regardless if providers are planning to engage in shared savings, accountable care organizations, bundled payments, or risk contracts, there are several questions to consider when developing their strategy: 

  1. Are you prepared to participate in value-based initiatives?
  2. Do you understand the healthcare needs in your market?
  3. Have you optimized the technology necessary to support success?
  4. Have you undergone care delivery transformation?
  5. Do you understand the financial implication of new reimbursement methods?

It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful in a value-based world. Conduct an organizational self-assessment to help identify current capabilities and those still needed to achieve status as a value provider. Additionally, catalog the existing payers, products, and value-based programs and know the health care needs in your market and the corresponding services offered. Knowing your capabilities and understanding your market serves as a blueprint or roadmap to develop your strategy and guide successful contracting efforts. As you begin to build the payer strategy, it is important to stay focused on what infrastructure/tools you need to possess or build to effectively manage risk while reducing costs of care and maintaining high-quality outcomes. 

Analytics Drive Positioning

To properly position for value-based care, providers must have progressive financial and clinical data analytics and reporting capabilities. Significant investments in technology and care model redesign are required to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance. Payers have massive amounts of data and an infrastructure to collect, aggregate, and analyze the data. Look for payers that are willing to collaborate and work in partnership to leverage the data and infrastructure.

It is equally important to invest the time to understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where, how individual participants will be incentivized to achieve these objectives and the short-term investment in the infrastructure required to produce improvements in care coordination and quality.

There is not a one-size fits all strategy, so it is important to know the provider’s readiness to participate in value-based initiatives, the different care delivery needs of the community, the scope of risk to be taken, and have relationships with payers and other providers that will be necessary to achieve success.

1. Source: “Major Healthcare Players Unite to Accelerate Transformation of U.S. Healthcare System” Health Care Transformation Task Force, June. 28, 2015.


sabrina_burnett1.pngMs. Burnett is a vice president with GE Healthcare Camden Group. With 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 and post-acute integration within the continuum of care. She may be reached at sabrina.burnett@ge.com

Topics: Value-Based Contracting, Healthcare Data, Provider Contracting, Sabrina Burnett, Healthcare Data Analytics, Volume-to-Value

5 Key Considerations for Providers Preparing for Value-Based Contracting

Posted by Matthew Smith on Nov 6, 2015 9:35:28 AM

By Sabrina Burnett, Vice President, The Camden Group

Value-Based Contracting, PhysiciansOn January 26, 2015, the U.S. Department of Health and Human Services ("HHS") announced it had set a clear goal and timeline for transitioning Medicare reimbursements from volume to value. HHS’s goal is to tie 30 percent of all Medicare payments to quality and cost performance by the end of 2016 and increasing that proportion to 50 percent by the end of 2018. Commercial payers are expected to follow suit and develop their own programs for basing payment on quality or value. Immediately following the announcement from HHS, several major health systems and the nation’s top health insurers announced the creation of the Health Care Transformation Task Force and challenged other providers and payers to commit to their goal of putting 75 percent of business into value-based arrangements by 2020¹.

It is no longer a matter of “if” we are moving to value, but “when." As providers prepare for impending change in reimbursement they have to decide if they are going to lead, follow or resist.Considerations

Regardless if providers are planning to engage in shared savings, accountable care organizations, bundled payments or risk contracts, there are several questions to consider when developing their strategy: 

  1. Are you prepared to participate in value-based initiatives?
  2. Do you understand the healthcare needs in your market?
  3. Have you optimized the technology necessary to support success?
  4. Have you undergone care delivery transformation?
  5. Do you understand the financial implication of new reimbursement methods?

It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful in a value-based world. Conduct an organizational self-assessment to help identify current capabilities and those still needed to achieve status as a value provider. Additionally, catalogue the existing payers, products, and value-based programs and know the health care needs in your market and the corresponding services offered. Knowing your capabilities and understanding your market serves as a blueprint or roadmap to develop your strategy and guide successful contracting efforts. As you begin to build the payer strategy, it is important to stay focused on what infrastructure/tools you need to posess or build to effectively manage risk while reducing costs of care and maintaining high-quality outcomes. 

Analytics Drive Positioning

To properly position for value-based care, providers must have progressive financial and clinical data analytics and reporting capabilities. Significant investments in technology and care model redesign are required to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance. Payers have massive amounts of data and an infrastructure to collect, aggregate, and analyze the data. Look for payers that are willing to collaborate and work in partnership to leverage the data and infrastructure.

It is equally important to invest the time to understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where, how individual participants will be incentivized to achieve these objectives and the short-term investment in the infrastructure required to produce improvements in care coordination and quality.

There is not a one-size fits all strategy, so it is important to know the provider’s readiness to participate in value-based initiatives, the different care delivery needs of the community, the scope of risk to be taken, and have relationships with payers and other providers that will be necessary to achieve success.

  1. Source: “Major Healthcare Players Unite to Accelerate Transformation of U.S. Healthcare System” Health Care Transformation Task Force, June. 28, 2015.

Ms. Burnett is a vice president with The Camden Group with more than 20 years of professional healthcare experience. She specializes in physician services solution-based planning and execution. Ms. Burnett has in-depth knowledge of the post acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. She also has extensive operational experience with credentialing, billing and collections, practice management, assisting billing companies and medical groups in improving their financial performance. She may be reached at sburnett@thecamdengroup.com or 512-792-5600.

Topics: Value-Based Contracting, Provider Contracting, Sabrina Burnett

Live from MGMA 2014: Are You Ready for Revenue Cycle 2.0?

Posted by Matthew Smith on Oct 23, 2014 11:08:00 AM

MGMA, Medical Group Management Association, Revenue CycleHeading to the MGMA 2014 Annual Conference this weekend in Las Vegas? If you are, make sure you join Health Directions President/CEO Daniel J. Marino for his presentation Are You Ready for Revenue Cycle 2.0? on Monday October 27 from 10:15-11:15AM. If you're a media member and would like to schedule a time to talk with Dan either prior to or at the conference, please email Matthew Smith, Health Directions Director of Marketing with your request.

Presentation Description

The session will show how to manage at-risk fee arrangements by coordinating discounted up-front reimbursement with future reconciliation payments. Participants will learn how to manage bundled payment contracts by re-tooling revenue cycle processes to focus on disease state or clinical programs. Harmonizing billing among several care providers will ensure proper claim adjudication with payers and patients. Participants will explore techniques for modernizing the verification process and using a practice management information system to ensure proper reconciliation of patient accounts to performance-based contracts.

Learning Objectives

  • Identify traditional revenue cycle processes that represent weak spots
  • Manage documentation, billing, collections and payment allocation under shared savings contracts and at-risk arrangements
  • Re-engineer revenue cycle processes for value-based contracts by coordinating billing and receivables across providers

Presentation Details

Date: Monday, October 27th

Time: 10:15-11:15AM

Location: N250

CEU Credits: 1

Content Area: Revenue and Cost Strategies

MGMA Link: http://s36.a2zinc.net/clients/mgma/mgma2014/public/SessionDetails.aspx?FromPage=Sessions.aspx&SessionID=525&SessionDateID=18

To download an existing Health Directions Revenue Cycle presentation, please click the button, below.

Revenue Cycle, Key Performance Indicators, KPIs,

Topics: Bundled Payments, MGMA, Value-Based Contracting, Revenue Cycle, Daniel J. Marino

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