WHITE PAPER TIME IS MONEY. Specialty practices should act now to avoid costly Medicare payment penalties.

Transcription

1 WHITE PAPER TIME IS MONEY Specialty practices should act now to avoid costly Medicare payment penalties.

2 TIME IS MONEY There are good reasons for the focus on immediacy in every physician practice the patient needs care now, the claim must be coded correctly to ensure payment and fees must be collected to generate positive cash flow. A deadline that is one, two or three years in the future naturally falls to the bottom of a physician s or practice manager s to-do list. Many of these deadlines belong to programs such as the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program (Meaningful Use) and the Physician Quality Reporting System (PQRS). Physician practices must address these mandates or lose potential incentives, face payment reduction penalties, or both. Unfortunately, deadlines associated with these programs are now at the forefront, and failure to begin and continue demonstrating Meaningful Use will result in increasing payment reductions an additional 1 percent for Meaningful Use each year with penalties of 5 percent in 2019 and beyond. A 9% reduction translates to $1,282,500 over seven years for a physician with annual Medicare payments of $2,700,000. And while some may not consider Meaningful Use payment reductions to be significant, there s more that practices need to consider. Penalties for other mandates also continue to increase, with payment reductions for non-compliance with PQRS requirements reducing provider payments by 1.5 percent in 2015, 2 percent in 2016 and each year after. Additionally, in 2013 the Budget Control Act was implemented, requiring $1.2 trillion in federal spending cuts be achieved over the course of nine years. Under this sequestration, physicians face a 2 percent cut across the board in Medicare provider payments on or after April 1 of each year. 1 Nextech.com

3 These increasing payments collectively represent a significant reduction in income to a physician practice growing from a potential 4.5 percent annual payment reduction in 2015 to a total of 9 percent in This translates to $1,282,500 over seven years for a physician with annual Medicare payments of $2,700,000. THERE S STILL TIME Physician practices still have time to participate in the EHR Incentive Program, but there are two critical dates of which physicians need to be keenly aware. The deadline for documenting Meaningful Use and avoiding payment reductions in 2015 is October 1, More importantly, due to the required 90-day reporting period, a physician practice must begin collection of Meaningful Use data no later than July 1, These two critical dates are highlighted on the right. PENALTIES ADD UP QUICKLY The initial penalties for not attesting for Meaningful Use start out fairly low but increase to 5 percent over time. Additionally, physicians should be aware that there are other penalties that will be added to the 5 percent. The chart below illustrates how the total penalties could potentially increase to as much as 9 percent. AVOIDING 2015 MEDICARE PAYMENT PENALTIES Eligible Professionals (EPs) participating in the EHR Incentive Program for the first time in 2014 can avoid the 2015 penalty by successfully attesting to Meaningful Use before this date First time participants must begin their 90-day reporting period no later than this date to meet requirements Practices seeking a hardship exemption must file with CMS by this date to be considered. REPORTING PENALTY MU PQRS erx SEQUESTRATION YEAR YEAR 2013 erx % -2% 2013 MU/PQRS % -1.5% 0% -2% 2014* % -2% 0% -2% % -2% 0% -2% % -2% 0% -2% % -2% 0% -2% % -2% 0% -2% TOTAL PENALTIES COULD POTENTIALLY INCREASE TO AS MUCH AS 9% Nextech.com 2

4 EVADE CONFUSION ON THE TIMING OF REPORTING REQUIREMENTS One of the more confusing aspects of Meaningful Use is the lag time between reporting periods and application of penalties payment reductions are based on full year reports for 2013 along with the 90-day period required in After 2015, each year s assessments will be based on documentation provided two years prior. For example, 2014 reports drive 2016 payment adjustments and 2015 reports determine 2017 reductions in payments. EPs have two years to document compliance with Stage 1 Meaningful Use requirements before moving to Stage 2 criteria. But another crucial detail is that in 2014 all providers must use Stage 2-certified EHR technology, regardless of the criteria reported, or face penalties. CMS has offered some reprieve, however. Although Meaningful Use deadlines can be worrisome, providers who can prove hardship in several categories can request exemptions to avoid 2015 penalties. Lack of infrastructure, such as sufficient Internet or broadband access, new practices that have not had sufficient business to prove Meaningful Use, natural disasters and EHR vendors ability to obtain Stage 2 certification in time are a few of the reasons a hardship exemption will be considered. The filing deadline for a hardship exemption is July 1, UNDERSTANDING DIFFERENCES BETWEEN STAGES 1 AND 2 MEANINGFUL USE FOR SPECIALTY PRACTICES While Stage 1 Meaningful Use criteria focused on capturing and sharing data, Stage 2 requirements set higher thresholds for compliance to promote advanced clinical processes and to heighten the level of patient engagement. A significant challenge for physician practice staff is to understand the scope of changes from Stage 1 to Stage 2 measures, and to implement work processes to ensure capture of appropriate data to produce documentation of Meaningful Use and avoid penalties. CLINICAL PROCESS MEASURES While most objectives and measures are more appropriate for primary care providers versus specialists, there are some specialty-specific measures, such as submission of cases to specialty registries for cancer or other specialty registries, which are not. For measures that are not applicable to specialists, CMS has provided a process for specialists to exclude measures that do not apply to their scope of practice. 1 For some measures, such as blood pressure, providers can use data entered by other physicians if the EHR captures data from other professionals. Only 30% of adults ages 65 and older report using the internet for health information, compared to 67% of adults ages 30 to Nextech.com

5 Having a vendor with deep domain expertise in Meaningful Use 2 and who offers personal training can help physicians review all of their options and make the best selections for their individual practice. For example, a specialty-specific technology partner can customize a solution and workflow so that capturing data such as height, weight and blood pressure for attestation purposes is fast, efficient and can ultimately add clinical value for the practice. The ability to customize software to easily capture patient information that a practice has not traditionally recorded gives physicians more choice and flexibility in selecting certain criteria. STAGE 1 Meaningful Use criteria focuses on capturing and sharing data. PROVIDERS ARE RESPONSIBLE FOR PATIENT ACCESS TO INFORMATION Stage 2 Meaningful Use is heavily focused on improving patient engagement. With one measure requiring that more than 5 percent of unique patients seen during a reporting period view, download or transfer their health information to another party, EPs must not only provide electronic access to individuals but also work to modify the behavior of patients. However, meeting patient engagement measures presents a significant challenge for providers with a large percentage of older patients. According to the Pew Research Institute, only 30 percent of adults ages 65 and older report using the internet for health information, compared to 67 percent of adults ages 30 to STAGE 2 Meaningful Use requirements set higher thresholds for compliance to promote advanced clinical processes and to heighten the level of patient engagement. To meet the so-called 5 percent rule, the EP can offer education, easy access and support to non-tech savvy individuals in order to increase the adoption and use of patient portals or electronic communications. Here again, vendor support and training play a key role in achieving success. Practices striving to meet this measurement should seek a technology provider willing to work directly with all physician clients who often see many older patients to create or customize solutions that are appropriate for their individual needs. 5% RULE requires more than 5% of unique patients seen during a reporting period view, download or transfer their health information to another party. Nextech.com 4

6 CHOOSING THE RIGHT SOFTWARE SOLUTION Providers must use Stage 2-certified technology to meet Meaningful Use requirements, but it s not the only issue to consider when selecting a technology partner. Particularly for specialty practices, a certified solution should be based on a flexible, scalable platform that enables customization to meet the practice s specific needs for clinical care, reporting requirements, process improvement and enhanced productivity. Selecting an EHR and practice management solution that can be fully customized to meet the unique requirements of a specialty practice is an important consideration. One strategy to improve efficiency and streamline workflow in the practice is the use of mobile technology, such as tablet devices, to access patient information. Conversations with patients are more engaging if the physician is facing the patient while entering notes on a tablet as opposed to sitting or standing at a desk with a computer. The less intrusive tablet enhances communication without compromising the clinician s ability to make notes during the conversation. Busy specialty practices also appreciate the functionality, which allows staff to move quickly between patient rooms without having to log in and out of desktop PCs. Physicians are also more productive with mobile solutions that have been fully customized to match their charting and personal preferences for workflow. Having an ONC 2014 Certified EHR. Is required for meaningful use attestation. 5 Nextech.com

7 HOW TRUE VENDOR-PRACTICE PARTNERSHIPS AVOID MOUNTING PENALTIES AND LEAD TO SUCCESSFUL ATTESTATION A significant component of any EHR technology is not only the software solution, but the support and training provided by a vendor. Solution partners offering customized, on-site training that supplements implementation initiatives with ongoing education is invaluable to practices navigating regulatory mandates and industry challenges. The financial investment in an EHR partner goes well beyond the initial purchase decision. The technology capabilities to capture, record and report data in formats that meet regulatory mandates affect the financial sustainability of the practice by ensuring providers can avoid payment penalties for non-compliance. An EHR vendor s expertise can ensure the practice s successful documentation of Meaningful Use if the relationship is viewed as a collaboration rather than a commercial transaction. CONCLUSION The Meaningful Use program was designed to bring greater structure to the way EHRs are used to improve the effectiveness of patient care. Although meeting Meaningful Use measures may seem like a daunting responsibility laden with multiple penalties if deadlines are not met, a specialized, Stage 2-certified EHR vendor can make Meaningful Use reporting a simple and smooth process. When considering a technology partner, it is imperative EPs consider EHR partners that offer one-to-one training and customized support to ensure all deadlines are met and each incentive payment is received. TIME IS RUNNING OUT An EHR vendor s expertise can ensure the practice s successful documentation of Meaningful Use if the relationship is viewed as a collaboration rather than a commercial transaction. PARTNERSHIPS = ATTESTATION 1. Meaningful Use for Specialists Tip Sheet, Centers for Medicare and Medicaid Services, Washington D.C gov/regulations-and-guidance/legislation/ehrincentiveprograms/ Downloads/Meaningful_Use_Specialists_Tipsheet_1_7_2013.pdf. Accessed March Health Fact Sheet. Pew Internet Research Project, Pew Research Center, Washington D.C. health-fact-sheet/ Accessed March 27, Nextech.com 6

8 Nextech deploys specialty-focused healthcare technology for physician practices. As a trusted advisor to thousands of specialty providers since 1997, Nextech delivers consultative guidance, professional services and innovative tools that enable clients to increase efficiencies while meeting their long-term business goals. The company s robust solutions integrate seamlessly with value-added modules to create a single, intuitive platform that streamlines clinical, administrative, financial and marketing workflows. To learn how Nextech s advanced offerings help specialty providers succeed in a fast-changing healthcare environment, visit West Executive Drive, Suite 350 Tampa, Florida p: f: Nextech.com