Developing Staff and Resource Infrastructure to Support Value-Based Reimbursement. NCHICA Annual Conference 2016

Transcription

1 Developing Staff and Resource Infrastructure to Support Value-Based Reimbursement NCHICA Annual Conference

2 University Physicians, Inc. (UPI) Faculty Practice Plan for the University of Colorado School of Medicine Supporting over 2,400 providers with outreach to the entire Rocky Mountain Region Major facility partners in care include: University of Colorado Hospital & Health System Children s Hospital of Colorado Denver Health & Hospital System VA Eastern Colorado Health Care #NCHICA2016 2

3 Learning Objectives Baseline understanding of shift toward value-based reimbursement modeling Identification of key staffing competencies and resource infrastructure to support value-based reimbursement Strategies for advanced data capture Strategies for developing leadership buy-in for infrastructure #NCHICA2016 3

4 MACRA The Medicare Access and CHIP Reauthorization Act of 2015 passed in April 2015 Repeals the Medicare Sustainable Growth Rate (SGR) formula and replaces it with a pay-for-performance model Streamlines existing quality reporting programs into the new Merit-based Incentive Payment System (MIPS) Clinicians or groups can participate in MIPS or an alternate payment model #NCHICA2016 4

5 @CUDOCTORS #NCHICA2016 5

6 MIPS Consolidates Quality Reporting #NCHICA2016 6

7 Alternate Payment Models APMs are new approaches to paying for medical care through Medicare that incentivize quality and value. Examples #NCHICA2016 7

8 The Office of Value Based Performance Formally established by University Physicians, Inc. (UPI) leadership in September 2015 Office designed to keep pace with shifts in reimbursement philosophy and related program evolution Central alignment of talent, resources, and program #NCHICA2016 8

9 Key Competencies Regulatory Interpretation & Management Project Management Compliance EHR Architecture & Workflows Analytics & Decision Support Patient-centered #NCHICA2016

10 Regulatory Management Project Management Compliance EHR Architecture Analytics Patient Outreach Regulatory Interpretation & Management MACRA = overwhelmingly complex Ability to digest and prepare executive summaries to inform decision making Your feedback does impact future rule-making Take advantage of legislative comment periods AAMC and EHR vendor should become partner #NCHICA

11 Regulatory Management Project Management Compliance EHR Architecture Analytics Patient Outreach Project Management Coordination and alignment of activities/resources across the enterprise Develop timelines and accountability Tracking of activity and #NCHICA

12 Regulatory Management Project Management Compliance EHR Architecture Analytics Patient Outreach Compliance Heavy auditing of EHR incentive program participation Audit management experience helpful Appropriate balance of content Rule interpretation and documentation strategies Auditing of quality measure reporting and program participation beginning to take #NCHICA

13 Regulatory Management Project Management Compliance EHR Architecture Analytics Patient Outreach EHR Architecture & Workflows Information technology optimization User needs assessments External data aggregation Population health registry development Provider education & training Must find time to foster adoption Connecting quality goals to the front line care #NCHICA

14 Analytics & Decision Support 14

15 Regulatory Management Project Management Compliance EHR Architecture Analytics Patient Outreach Achieving Excellence Through Deeper Dive Data Analysis John Steffen Sr. Epic Clarity Reporting Analyst

16 CMS Data Submission Timeline NOVEMBER Claims-based data submission via 3 rd party vendor Anticipated release of the MIPS/APM final rule will mandate reporting changes UPI begins GPRO option for data submission 2013 MIPS/APM reporting period begins JANUARY #NCHICA

17 Utilizing Epic s Features BPAs Referrals After-Visit Summaries Flowsheets IMPROVED #NCHICA

18 Integrating Outside Data Colorado Department of Public Health & Environment (CDPHE) flu and pneumonia vaccination records Excellera University of Colorado Hospital (UCH) left ventricular ejection fraction results Colorado Regional Health Information Organization (CORHIO) patient visit/stay data at non- UCH #NCHICA

19 Standard Deviations from the Mean CMS Quality Score Results Quality Composite Scores #NCHICA

20 Additional Reporting Born from UPI VBM #NCHICA

21 Point-in-Time Snapshot 21

22 HCC Opportunities Report 22

23 Custom Data Marts Built registries that Epic had not yet developed Depression Registry CV Risk 23

24 Skill Sets Required to Make it All Happen Advanced T-SQL language proficiency in creating queries, stored procedures, functions, etc. Reporting tools Crystal reports, Tableau Business Objects enterprise server Excel 24

25 Future Initiatives Expanded use of Business Objects server InfoView, automated scheduling, and report dissemination Use of project management software (Eclipse) Advancing the use of Tableau 25

26 Regulatory Management Project Management Compliance EHR Architecture Analytics Patient Outreach Patient-Centered Outreach Clinical re-design Define clinical improvement initiatives that create value for patients as well as your organization Team-based coordinated care Heavy emphasis on Care Manager best #NCHICA

27 Coming Together Coming Together 27

28 Payer Relations and Network Development Vice President Associate Dean & Medical Director Adult Health (MD) Operations Vice President, COO (MD) Office of Value Based Performance Medical Director (MD, MSPH) Administrative Director Compliance and Privacy Officer Performance Reporting Performance Analytics Performance Innovation & Patient-centered Outreach Manager Sr. Epic Clarity Reporting Analyst Program Manager (Epic Healthy Planet) Regulatory Lead Epic Clarity Reporting Analyst Pharmacist Program Analyst Program Specialist Outreach Coordinators 4 #NCHICA

29 EHR Incentive Program Payments Total EHR Incentive Payments Issued Through 2015 Eligible Professionals Eligible Hospitals Medicare: $8.3B Medicaid: $4.3B Medicare/Medicaid Combined: $18.9B Developing a re-investment pitch Benefits to the enterprise v. individual Future revenue #NCHICA

30 Penalty Phases of Meaningful Use Eligible Professionals (EPs) failing to demonstrate Meaningful Use in 2013 and beyond are individually subject to Medicare fee schedule penalties Even 1% adjustments can result in significant losses at the EPlevel EHR Incentive Program Penalties Failed Reporting Year Penalty Year Penalty % % % #NCHICA

31 Value-Based Payment Modifier Alternative to individual PQRS submissions GPRO = Group Practice Reporting Option Centralized submission of Quality Data on behalf of all providers under Tax ID Number Central management of data capture and reporting #NCHICA

32 Value-Based Payment Modifier #NCHICA

33 Performance Impacts Payment Failure to successfully report quality data could result in a 4% decrement to Medicare fee schedule across your entire Tax ID Number 2.5-3MM in estimated revenue preservation over the past #NCHICA

34 UPI vs. Other AAMC Practices 2014 Value-Based Payment Modifier #NCHICA

35 Talent Acquisition Emerging degrees & certifications Health Information Technology Health Informatics Professional societies American Health Information Management Assoc. (AHIMA) Certified electronic health record vendors Your own #NCHICA

36 Questions? #NCHICA

37 Contact Information Aaron Van Artsen Administrative Director of Value Based Performance Organizational Compliance and Privacy Officer (303) John Steffen Sr. Epic Clarity Reporting analyst (303) #NCHICA