Intermountain User Group

Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.

• Partner with healthcare systems nationwide • Individual physician clinics to multi-state

organizations • Consulting services and products designed to

help clients successfully navigate the ever-evolving government programs and industry trends

About Quirk Healthcare Solutions

• CEO – Quirk Healthcare Solutions– Quirk Wellness Centers

• Executive Director – Quirk Healthcare Foundation

• VP of New Practice Acquisitions – Leon Medical Network

About Ben Quirk

What are ICD-10 Codes?

• Granular code set developed by WHO for:– Increased clinical accuracy– Improved disease tracking– Disease trending

• More ICD-10 codes compared to ICD-9

ICD-914,000 diagnosis codes4,000 procedure codes5 digit numeric codes

ICD-1068,000 diagnosis codes87,000 procedure codes

7 digit alphanumeric codes

ICD10 Is A Requirement to Get Paid After October 1, 2014• Just kidding! • Congress pushed ICD10 from October 1, 2014

to no early than October 1, 2015• Does not mean that October 1, 2015 is the

implementation date (but in all likelihood will be)

ICD10 Delay – Good and Bad

• Good:– Huge number of competing priorities already taxing CMS

in 2014– End-to-end testing not completed by many payors– All systems required an upgrade, and some were delayed

• Bad:– Upgrades still required for MU 2014 requirements– Will they really do it in 2015? Loss of momentum– Keeps the US lagging behind all other developed countries

But Don’t Relax Quite Yet

If you don’t keep your eye on the ball, you could still end up in a world of trouble. (And yes, your daughter will date this guy)

Fee for Service Has A Finite Timeline – The Future is Value

At the HIMSS 2014 Conference, Hillary Clinton declared Fee for Service is dead and the future is value over volume

Fee for Service Has A Finite Timeline – The Future is Value (continued)

• Healthcare industry upheaval as never seen before

• Use 2014 and the ICD10 delay as opportunities to get ahead of competition

• Thrive while others struggle to survive.

Sequestration

We are still receiving 2% less on all billed charges.

THE CHALLENGES – AND HOW TO GET AHEAD

Sequestration – The Plan

Keep the downward reimbursement trend from becoming cumulative with other penalties kicking in this year.

Affordable Care Act• Politics aside, the Affordable Care Act is wreaking havoc

on some providers’ bottom lines:– All new group of consumers who are not used to managed

care enrolled in plans.– Consumers may not know (or care) about out of pocket

expenses with complex deductible or copay plans.– Many states pushing patients on straight Medicaid into

managed care plans. • You may be contracted with these plans but not even know it• Yet another group of consumers introduced into your practice who

are not familiar with managed care• May also require new quality reports

Affordable Care Act – The Plan

• Protect your practices’ bottom line. (Now)– Look into pre-encounter copays and coinsurance

estimators (eg from Navicure). Collect this money prior to the visit.

– Evaluate your payers and which plans you’re required to accept per the contract. Compare against their websites or your provider relations rep.

– If you are contracted with Managed Medicare plans, determine if there are other reporting requirements by discussing with your provider relationship rep.

Meaningful Use

• All Medicare providers must have already attested or do so by September 30, 2014 or face a 1% penalty in 2015. – That percentage is cumulative (2% in 2016, etc).

• Medicaid providers? You don’t even need to start until 2016 and will receive full reimbursement.

MU 2014

• Both Stage 1 and Stage 2 were modified for 2014:– All EHRs had to be recertified for 2014. If you are

on an EHR, you must upgrade this year to be MU compliant.

– If attesting for Medicare, you must attest for a fiscal quarter in 2014.

– Exemptions in Menu Measures no longer count as fulfilling the measures

MU Stage 2• MU Stage 2 is tough – pay specific attention to the HISP

requirements in Core Measure 15.• Hardship Exemptions may be the way to go. They’re due by June

30, 2014. – CMS extremely lenient on hardship exemptions for hospitals and the

hope is that this will translate to providers (only 6 of the exemptions were declined, and this is because the hospitals already had automatic exemptions).

• HIMSS is pushing for an extension until April 2015 for the first year of MU2. There has not been any response from CMS.

• Check out our Free solution (pay attention to the end!)• Under Medicare, you cannot skip years.

MU Stage 2 - Plan

• Get your application upgrades done as early in Q3 as possible.

• Test out the functionality before September 30, 2014. This is your trial period.

• You must begin attestation by October 1, 2014 (for Medicare)

PQRS

• Required for all Medicare

• Date is based off of fiscal year • 2 years prior• Results posted on Physician Compare Website

2013 0.5% (performance year for 2015 penalty)

2014 0.5% (performance year for 2016 penalty)

2015 -1.5%

2016 -2%

PQRS - Plan

• Overlaps with Meaningful Use Clinical Quality Measures

• For registry based reporting, 80% of encounters are required

Value Based Modifier – PQRS’ Evil Cousin

• All Medicare Providers are auto-enrolled in Value Based Modifier program.

• Incentives or penalties are paid using a complex formula of claims and quality (PQRS and MU data).– 2013 – All groups over 100 providers enrolled– 2014– All groups over 10 providers enrolled– 2015 – All providers enrolled

• Voluntary enrollment or CMS enrolls automatically• First year is a demonstration period. After that, incentives

and penalties kick in. • Results published on Physician Compare Website.

Value Based Modifier – Plan

• Review results from first year to see what scoring would have been.

• Start paying close attention to CQM and PQRS performance – meeting the measures is not enough – you need to have the right answer.

• Educate your providers that their quality scores are going to be published.

Increased Visibility Into Value

• Value is defined as cost vs outcomes• MU, PQRS, and Value Based Modifier quality published

on the Physician Compare website• Commercial website also aggregating and displaying

this data to their payors.• Services are well funded, full of your data, and bent on

showing patients perceived quality vs cost.• In addition, for the first time ever, Medicare has

published reimbursement data on providers on the Physician Compare website.

Increased Visibility Into Value - Plan

• Tomorrow, log onto the Physician Compare website and ensure the data is accurate

• Find out what your payors are publishing and ask to validate.

• Share the data with your providers. If possible, include metrics in their report cards.

RecapChallenge Task Deadline

ICD10 Upgrade and test, test, test Q2 2015…ish

Affordable Care Act Understand your market. Collect cash upfront

Now!

Meaningful Use 2014 Upgrade now or look at hardships Now!

PQRS If you haven’t started, you need to do claims submission

Now!

Value Based Modifier Determine where you fall and begin watching quality measures.

Q2-3 2014

Increased Visibility into Value

Go on Physician Compare website. Contact payers to see what they have.

Now!

Focus on thriving while others struggle.

Free Stuff

• For NextGen, but applicable to other systems:– Meaningful Use 2014 (1 and 2) Without Upgrading– Configurable Histories Templates– EPM Recalls in EHR

Available by contact info@quirkhealthcare.com

QUESTIONS?

Quirk Healthcare Solutionsinfo@quirkhealthcare.com888-WE-QUIRK