sterling solutions, ltd. how to prepare for next year’s reimbursement cuts

Sterling Solutions, Ltd.

How to Prepare forNext Year’s Reimbursement Cuts

© 2014 Sterling Solutions, Ltd.

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Objectives

Understand how quality measures affect your reimbursement in 2015 and beyond

Identify key quality challenges and EHR resolution strategies

Provide practical methods to get the quality data you need from your EHR


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Technical Assistance

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Advances in Practice Operations Series• “Streamlining Your Practice for Profitability & Success”• “Revenue Cycle Management & EHRs”• “How to Prepare for Next Year’s Reimbursement Cuts”• “Patient Flow & the Bottom Line”

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Today’s Expert

Ronald B. Sterling, CEO of Sterling Solutions, Ltd., is a nationally-recognized thought leader on leveraging EHRs to boost practice revenue through smart selection and implementation of electronic health record and practice management systems.

Ron has advised healthcare organizations and practices across the country. Ron has analyzed software from over 150 vendors.

Ron publishes the popular EHR Blog, Avoid-EHR-Disasters.com and authored the HIMSS Book of the Year Award winning Keys to EHR/EHR Success - Selecting and Implementing an Electronic Medical Record. Ron has contributed hundreds of articles to a wide range of publications including the widely used Marketing Your Clinical Practice.


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Why Quality Matters

Changes to standards of careChanges to standards of care Meaningful UseMeaningful Use

- Track patient needsTrack patient needs- Notify patientNotify patient- Manage patientManage patient

Patient-Centered Specialty Practice & Patient-Centered Specialty Practice & Patient-Centered Medical HomePatient-Centered Medical Home

- Manage patient careManage patient care


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Why Quality Matters (Continued)

Changes to Standards of CareChanges to Standards of Care Clinical ImprovementClinical Improvement

- Define standardsDefine standards- Evaluate resultsEvaluate results- Refine standardsRefine standards

Proposed SGR “Fix”Proposed SGR “Fix”- Dollars for qualityDollars for quality- Moving patients to “alternative payment Moving patients to “alternative payment

models”models”


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Get Ready for Value-Based Payment

CMS to apply value-based payment formulas CMS to apply value-based payment formulas to Medicare fees for all practicesto Medicare fees for all practices 2015: Groups of 100+ eligible providers2015: Groups of 100+ eligible providers 2016: Groups of 10+ eligible providers2016: Groups of 10+ eligible providers 2017: All practices 2017: All practices

Quality/Cost Low Cost Average Cost High Cost

High Quality +2.0x* +1.0x* +0.0%

Medium Quality +1.0x* +0.0% +1.0%

Low Quality +0.0% =1.0% -2.0%


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How your EHR impacts quality

Unprecedented view of performanceUnprecedented view of performance

Significant EHR differencesSignificant EHR differences MessagesMessages Clinical contentClinical content Patient education optionsPatient education options WorkflowWorkflow Treatment managementTreatment management Patient portal featuresPatient portal features


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Your Transition to Quality


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Quality Challenges

Lead time to establish quality focusLead time to establish quality focus EHREHR Staffing modelStaffing model Service strategy (clinical call center)Service strategy (clinical call center)

Building a quality “record”Building a quality “record” Proposed “fix” scoresProposed “fix” scores

Transitioning to Alternative Payment ModelsTransitioning to Alternative Payment Models


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Quality Strategy

Establish standards based onEstablish standards based on Payor and ACO contract Payor and ACO contract

obligationsobligations ServicesServices Sub-specialtiesSub-specialties RelationshipsRelationships

- PCPPCP- Other practices/HCOsOther practices/HCOs


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Quality Strategic Tools

EHREHR Use reporting & display optionsUse reporting & display options Create procedural workaroundsCreate procedural workarounds Discuss needs with vendorsDiscuss needs with vendors

Remote Patient Monitoring Systems (RPMS)Remote Patient Monitoring Systems (RPMS) Consider patient engagement optionsConsider patient engagement options Monitor new developmentsMonitor new developments


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Quality Strategic Tools (Continued)

WorkflowWorkflow

Supporting softwareSupporting software May supplement EHRMay supplement EHR

AnalyticsAnalytics Control mechanismControl mechanism Notification protocolsNotification protocols Move from physician-centric care to Move from physician-centric care to

physician-managed carephysician-managed care


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Potential Quality Measures

ReferralsReferrals Track by stageTrack by stage Time to visitTime to visit Supporting documentationSupporting documentation Follow-up with PCP/referring doctor/HCOFollow-up with PCP/referring doctor/HCO Report to PCP/referring doctor/HCOReport to PCP/referring doctor/HCO Survey PCP/referring doctors/HCOSurvey PCP/referring doctors/HCO

MessagesMessages Messages over portalMessages over portal Incoming calls answered at time of callIncoming calls answered at time of call Time to answer messageTime to answer message Time to patient replyTime to patient reply Follow-up and remediation of messagesFollow-up and remediation of messages


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Potential Quality Measures (Continued)

Clinical call centerClinical call center Monitoring remote patient Monitoring remote patient

information & secure messagesinformation & secure messages Handling scripted situationsHandling scripted situations Completeness of documentationCompleteness of documentation Escalation within practice/call centerEscalation within practice/call center Appropriateness of issues passed to doctorsAppropriateness of issues passed to doctors Coordination with practice locations/unitsCoordination with practice locations/units Additional scripted situationsAdditional scripted situations


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OrdersOrders Patients with go-forward treatment Patients with go-forward treatment

plansplans Treatment plan item agingTreatment plan item aging Percent of compliancePercent of compliance Automatic order managementAutomatic order management On-time surgery/procedure percentageOn-time surgery/procedure percentage Surgery/procedure order aging analysisSurgery/procedure order aging analysis Closure of orders on a timely basisClosure of orders on a timely basis


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Clinical NotesClinical Notes Outstanding services requiring Outstanding services requiring

clinical contentclinical content Notes recorded with clinical Notes recorded with clinical

contentcontent Appropriate use of free text notesAppropriate use of free text notes Proper coding of services & problemsProper coding of services & problems Signed notes within established timeSigned notes within established time Notes outstanding beyond allowed timeNotes outstanding beyond allowed time Aging of note creation-to-signingAging of note creation-to-signing


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Clinical WorkflowClinical Workflow Time statistics on visit stepsTime statistics on visit steps Analysis of workflow deviationsAnalysis of workflow deviations Backlog of To-Do and messages by typeBacklog of To-Do and messages by type Aging of To-Do and messages by typeAging of To-Do and messages by type


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Case: Lack of Standards

A practice does not have a standard way of A practice does not have a standard way of managing clinical servicesmanaging clinical services What effect does lack of standards have on What effect does lack of standards have on

patient service?patient service? How does the use of different clinical How does the use of different clinical

content checklists for the problem affect content checklists for the problem affect quality?quality?


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Case: MU2 Attestation

A practice has achieved Stage 2 of Meaningful A practice has achieved Stage 2 of Meaningful Use.Use. What, if any, additional patient service What, if any, additional patient service

standards should affect their quality standards should affect their quality strategy?strategy?


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Case: Remote Patient Monitoring

A local hospital is using remote patient A local hospital is using remote patient monitoring tools to address excessive 30-day monitoring tools to address excessive 30-day readmission.readmission. What affect does this have on your practice?What affect does this have on your practice? Does the hospital’s decision affect your Does the hospital’s decision affect your

patient care strategy?patient care strategy?


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Quality Strategy Checklist

Implement processImplement process Establish periodic performance Establish periodic performance

tracking (daily, weekly, monthly)tracking (daily, weekly, monthly) Compile statistics for management Compile statistics for management

reviewreview

Track quality & complianceTrack quality & compliance Monitor trends & practice/HCO changesMonitor trends & practice/HCO changes Analysis issues & opportunitiesAnalysis issues & opportunities Update quality measures & toolsUpdate quality measures & tools

- New situationsNew situations- EHR changes & upgradesEHR changes & upgrades- Changes to practice/HCOChanges to practice/HCO- Changes to relationships & servicesChanges to relationships & services


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Key Takeaways

Time is limited due to industry changesTime is limited due to industry changes

Implementation has a long lead timeImplementation has a long lead time Tools require significant workTools require significant work Changes to staffing mixChanges to staffing mix Implement changesImplement changes Refine strategy & operationRefine strategy & operation

Quality requires a change in culture, attitudes Quality requires a change in culture, attitudes & service focus& service focus

QUESTIONS

ANSWERS

RONALD B. STERLING, CPASterling Solutions, Ltd.

[email protected](301)681-4247BLOG: Avoid-EHR-Disasters.com


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Conventus Contact Information

Susan Lieberman, MBAVice President, Risk Management

Conventus Inter-Insurance Exchange877-444-0484, x466

www.conventusnj.com

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