is it time for new revenue streams?
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webinar
Is It Time for New Revenue Streams?Presented by Rochelle Glassman June 23, 2016
@GoKareo
Agenda
2
Agenda
2
• Welcome & Introductions• Is It Time to Add New Revenue
Streams?• How Can Kareo Help?• Your Questions
@GoKareo 33
How to Participate Today…
Type your questions
Download today’s resources
View today’s presentation
@GoKareo 44
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@GoKareo 55
Speakers
Rochelle Glassman
President, United Physician Services Nationally-recognized healthcare consultant Former executive-level consultant for Cigna Healthcare business entrepreneur 30 years of healthcare business experience President/CEO United Physician Services, LLC Physician Advocate Trauma-trained RN
@GoKareo
Agenda
6
Agenda
6
• Welcome & Introductions• Is It Time to Add New Revenue
Streams?• How Can Kareo Help?• Your Questions
@GoKareo 77
You Can Make More Money
There are new opportunities: Many preventative services are now
covered!
Environment is changing from fee-for-
service to pay-for-performance.
New advances in medicine can be
added to your practice.
@GoKareo 88
Pay-for-Performance
Payment is based on metrics
HEDIS (Healthcare Effectiveness Data
& Information Set) Used by 90% of health plans
Quality measurements
Focuses on preventative care
More ‘whole picture’ approach
@GoKareo 99
Accountable Care Organization (ACO) Quality Measures
Patient / Caregiver Experience
Care Coordination Patient Safety
Preventative Health
At-Risk Population Diabetes
At-Risk Population Hypertension
At-Risk Population – Ischemic Vascular Disease
(IVD)
At-Risk Population – Heart Failure (HF)
At-Risk Population – Coronary Artery Disease (CAD)
There are 33 Quality Measures encompassing the following categories:
@GoKareo 1010
Merit Based Payment System (MIPS)
Program Performance Year
Medicare Part B Payment
Adjustment Year
Maximum -% Medicare Part B
Payment Adjustment
Maximum +% Medicare Part B
Payment Adjustment
PQRS/VBM 2016 2018 -4% penalty +4%*X incentive
MIPS 2017 2019 -4% penalty +4%*X incentive
MIPS 2018 2020 -5% penalty +5%*X incentive
MIPS 2019 2021 -7% penalty +7%*X incentive
MIPS 2020 2022 -9% penalty +9%*X incentive
Financial Impact
@GoKareo 1111
Screening for Diabetic Retinopathy (currently a HEDIS requirement)
Leading cause of blindness among
diabetics: Somewhere in the world, someone goes blind
every 5 seconds
415 million worldwide have diabetes
86 million have pre-diabetes
28.5% of diabetic patients have diabetic
retinopathy
According to UHC 80% non compliance rate
With early detection, 90% of vision loss can be
prevented.
@GoKareo 1212
Screening for Diabetic Retinopathy
In-house optometrist Increase patient compliance
Improve clinical outcomes
Reimbursement for eye exams AND bonus
from health plan! 92002 $81.63 (Exam; intermediate, New pt)
92004 - $149.66 (Exam; comprehensive, New pt)
92012 - $85.93(Exam; intermediate, Est pt)
92014 - $124.60 (Exam; comprehensive, Est pt) HEDIS Bonus: Based on compliance target met
@GoKareo 1313
Dermatology Care
Most common form of cancer,
but easily treatable
1 in 5 get skin cancer
Bringing in on-site dermatologist Additional revenue
Better detection
Improved compliance
@GoKareo 1414
Urine Drug Testing
Traditionally patients were sent to
the lab
Toxicology down to the nanogram
Better to assess in clinical setting
EHR compatible
Cost of cups, $55 - $75
Reimbursement $150 – $1,650- Medicaid & Medicare CPT (G0477)- Insurance & Work-Comp CPT (80300)
@GoKareo 1515
Drug Testing
Pain Management
Neurology
Anesthesiology
Surgeons (post operative and pre
operative)
Treatment centers
OB/GYN
Internal Medicine
Family Practice
@GoKareo 1616
Depression Research Results
New, clinically valuable
testing strategies
Target depression and
appropriate treatment
Screening for Depression
in Adults & Children
(99420, G0444) $18.26
ICD-10 Dx Z13.89
@GoKareo 1717
Depression Research Results
Primary care doctors misdiagnose depression 53% of the time
First of class blood test Looks at 9 bio markers across 4
pathways Score of 1-9 with sensitivity of 94% and
specificity of 92% overall accuracy of 93%
Score of 1-4 = 95% likelihood of not having major depressive disorder (MDD)
Score of 5-9 = 90% likelihood of having MDD
@GoKareo 1818
Pharmacogenetic Testing
100,000+ die each year due to
medication-related errors
770,00+ are hospitalized yearly for
Adverse Drug Reactions
Prescribe medications through science,
not guesswork!
Zero capital costs to the practice
@GoKareo 1919
Pharmacogenetic Testing
New system of prescribing
according to genetic make-up More accurate
Better results
Less side effects
Potential marketing
Additional revenue stream
@GoKareo 2020
Pharmacogenetic Testing
Remuneration of either $15 or $75
per patient working
Simple 30 second cheek swab
Reimbursed by all plans except
Medicaid
Specialties: primary care, internal
medicine, pain management,
neurology and psychiatry
@GoKareo 2121
Medical Weight Loss
Covered for up to 26 visits per year
(exclusions may apply) for patients
with a BMI >30. 1 visit every week for first month
1 visit every other week for 2-6 months
1 visit every month for months 7-17
CPT code G0447 (15 minutes)
@GoKareo 2222
Medical Weight Loss
Nutritional counseling covered with certain patients with diabetes and renal disease (i.e., CPT code 97802 and 97803)
Partner with specialties to attract patients
Great preventative measure to achieve benchmarks
Happier patients
@GoKareo 2323
Medical Weight Loss
Revenue for your practice B-12 Shots
Appetite Suppressants
Supplements
EKG for patients over 40 (CPT 93000,
12 lead with interpretation).
Reimbursement is $17.19*
(Recommended for patients taking
appetite suppressants over 45).
* 2016 CMS Fee Schedule - National
@GoKareo 2424
Allergy Program
More than 50 million people in the US have allergies.
If you test 8 patients per week for 60 spots (95004), average cost to practice is $28 with a total annual income of $75,400
Spirometry , expiratory flow rate measurement (94010) $36.52
Additional for quarterly visits for E/M code 99213 ($73.40) total of $220.20, per patient per year
Sub Lingual Drops Starter Set cost is $60 - $90 for a total annual revenue of $323 per patient per year
Maintenance Drops $150 - $180
@GoKareo 2525
Smoking Cessation
16.8 percent (40 million) of US adults smoke tobacco
Medicare Part B covers two levels of tobacco cessation per 12 month period
Private / Commercial insurers are required to provide evidence-based
@GoKareo 2626
Smoking Cessation
Symptomatic Patients 99406 (3-10 minutes intermediate counseling) CMS rate: $14.32
99407 ( > 10 minutes intensive counseling) CMS rate: $27.93
Asymptomatic Patients G0436 (3-10 minutes intermediate counseling) CMS rate: $14.68
G0437 ( > 10 minutes intensive counseling) CMS rate: $27.93
Note: 2 diagnoses are needed to support these code sets.
a. Tobacco counseling (Z71.6)
b. Nicotine dependence (F17.2--)
@GoKareo
Agenda
27
Agenda
27
• Welcome & Introductions• Is It Time to Add New Revenue
Streams?• How Can Kareo Help?• Your Questions
@GoKareo 2828
Awards and Rankings
Growth awards The speed at which
medical practices are moving to Kareo and referring it to other
providers.
Best places to work Happy, engaged
employees stay longer, have more experience and
offer better customer service
Analyst reviews 3rd party recognition,
driven by direct customer feedback,
equals trust and credibility
@GoKareo 2929
Kareo Platform
Kareo Billing
• Centralized A/R Management
• Intuitive Billing Analytics • Easy & accurate charge
capture• ICD-10 Ready• Smarter billing/patient
collections• Secure messaging• Powerful scheduler/appt.
reminders
@GoKareo 3030
Kareo Platform
Kareo Clinical
• Comprehensive dashboard
• Simple charting• Easy ePrescribing• Convenient eLabs• Specialty templates• Electronic Superbill• Integrated Patient
Portal • Secure messaging
@GoKareo 3131
Kareo Platform
Kareo Managed Billing• Dedicated team of specialists • Simple scheduling/calendar• Charge Capture (web/mobile)• Nationwide Billing Rules Engine• Claims tracking• Billing Tasks• Billing Analytics
@GoKareo 3232
Kareo Platform
Kareo Marketing• Marketing and front
office automation• Online visibility and SEO • Online appt. scheduling • Email, text & voice
recording appt. reminders
• Post visit patient reviews• Practice analytics for ROI• Patient communications
@GoKareo 3333
Kareo and Chiron Health Make the Perfect Pair
Seamless Scheduling Integration
Automatic Insurance Exchange and Telemedicine Eligibility Verification
HIPAA- Compliant Video Visits
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Discover Kareo’s Role
• PAHCOM has approved 1 CEU credit.• Each attendee will receive an email today
with a link to request certification. Certificates will be mailed within the next few days.
• Attendees must be logged into the webinar to receive credit.
• You’ll be asked at the end of the webinar if you want a CEU certificate.
“…Make Your Practice a Best Practice!”
@GoKareo
Agenda
35
Agenda
35
• Welcome & Introductions• Is It Time to Add New Revenue
Streams?• How Can Kareo Help?• Your Questions
@GoKareo 3636
How to Participate Today…
Type your questions
-- Questions After the Webinar --
888.775.2736 x1sales@kareo.com
Connect with KareoStop by and say hi!
Kareo @GoKareo GoKareo Kareo
3353 Michelson Drive, Suite 400Irvine, CA 92612(888) 775-2736
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