Developing Staff and Resource Infrastructure to … Staff and Resource Infrastructure to Support Value-Based Reimbursement NCHICA Annual Conference 2016 1 University Physicians, Inc

Developing Staff and Resource Infrastructure to Support

Value-Based Reimbursement

NCHICA Annual Conference

2016

1

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 System

2

@CUDOCTORS #NCHICA2016

Learning Objectives

3@CUDOCTORS #NCHICA2016

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 development

MACRA

4

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 (APM)



MIPS Consolidates Quality Reporting Programs


Alternate Payment Models

APMs are new approaches to paying for medical care through Medicare that incentivize quality and value.

Examples include:


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 management


Key Competencies

Regulatory Interpretation &

Management

Project Management

Compliance

EHR Architecture & Workflows

Analytics & Decision Support

Patient-centered Outreach


Regulatory Interpretation & Management

• MACRA = “overwhelmingly complex”

• Ability to digest and prepare executive summaries to inform decision making

10

• Your feedback does impact future rule-making

– Take advantage of legislative comment periods

– AAMC and EHR vendor should become partner resources

Regulatory Management

Project Management

ComplianceEHR

ArchitectureAnalytics

Patient Outreach


Project Management

• Coordination and alignment of activities/resources across the enterprise

• Develop timelines and accountability

• Tracking of activity and value

@CUDOCTORS #NCHICA2016 11


Project Management

ComplianceEHR


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 shape



Project Management

ComplianceEHR


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 teams



Project Management

ComplianceEHR


Patient Outreach

14

Analytics & Decision Support

Achieving Excellence Through “Deeper Dive” Data Analysis

John SteffenSr. Epic Clarity Reporting Analyst


Project Management

ComplianceEHR


Patient Outreach

CMS Data Submission Timeline


2013

2012

JANUARY 2017

NOVEMBER 2016

Claims-based data submission via 3rd

party vendor

UPI begins GPRO option for data submission

Anticipated release of the MIPS/APM final rule – will

mandate reporting changes

MIPS/APM reporting period begins

Utilizing Epic’s Features


BPAs

Referrals

After-Visit Summaries

Flowsheets

IMPROVED QUALITY

Integrating Outside Data


Colorado Department of Public Health &

Environment (CDPHE)

Colorado Regional Health Information

Organization (CORHIO)

Excellera – University of Colorado Hospital

(UCH)

patient visit/stay

data at non-UCH

facilities

left ventricular

ejection fraction results

flu and pneumonia vaccination

records


Quality Composite Scores

0.09

0.91 0.880.95

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

2012 2013 2014 2015

Stan

dar

d D

evia

tio

ns

fro

m t

he

Mea

nCMS Quality Score Results


Additional Reporting Born from UPI VBM

Solution

Point-in-Time Snapshot

21

HCC Opportunities Report

22

Custom Data Marts

Built registries that Epic had not yet developed

–Depression Registry

–CV Risk

23

Skill Sets Required to Make it All Happen

24

Advanced T-SQL language proficiency in creating queries, stored procedures, functions, etc.

Reporting tools – Crystal reports, Tableau

Business Objects enterprise server

Excel

Future Initiatives

25

Advancing the use of

Tableau

Use of project management

software (Eclipse)

Expanded use of Business Objects server – InfoView,

automated scheduling, and

report dissemination

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 practice



Project Management

ComplianceEHR


Patient Outreach

Coming Together

27

Coming Together


Payer Relations and Network Development

Vice President

Associate Dean & Medical Director

Adult Health (MD)

OperationsVice 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

Regulatory Lead

Sr. Epic Clarity Reporting Analyst

Program Analyst

Program Specialist

Epic Clarity Reporting Analyst

Program Manager (Epic Healthy Planet)

Outreach Coordinators4 FTE

Pharmacist

EHR Incentive Program Payments

• Developing a re-investment pitch

– Benefits to the enterprise v. individual

– Future revenue preservation


Total EHR Incentive Payments Issued Through 2015

Eligible Professionals

Medicare:$8.3B

Medicaid:$4.3B

Eligible Hospitals

Medicare/Medicaid Combined: $18.9B

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 EP-level

30

EHR Incentive Program Penalties

Failed Reporting

YearPenalty Year Penalty

2013 2015 1%

2014 2016 2%

2015 2017 3%

2016 2018 4%


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 strategies


Value-Based Payment Modifier Scoring



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 years

UPI vs. Other AAMC Practices2014 Value-Based Payment Modifier Program


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 organization


Questions?


Questions?

Contact Information


Aaron Van ArtsenAdministrative Director of Value Based PerformanceOrganizational Compliance and Privacy [email protected](303) 493-7620

John SteffenSr. Epic Clarity Reporting [email protected](303) 493-8238

mailto:[email protected]

mailto:[email protected]

Documents

Developing Staff and Resource Infrastructure to … Staff and Resource Infrastructure to Support Value-Based Reimbursement NCHICA Annual Conference 2016 1 University Physicians, Inc