PYA Monitors Topics on Healthcare Radar at AlaHA
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PYA Monitors Topics on Healthcare Radar at AlaHA

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PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included: ...

PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:

ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?

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PYA Monitors Topics on Healthcare Radar at AlaHA PYA Monitors Topics on Healthcare Radar at AlaHA Presentation Transcript

  • Page 0June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting ICD-10… What Now? The Alabama Hospital Association – Annual Meeting June 12, 2014
  • Page 1June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Agenda • Updated ICD-10 timeline • Managing your ICD-10 project – Planning – Communications – Testing – Training Planning Communications Training Testing
  • Page 2June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting There’s A Code For That! Source: http://www.youtube.com/watch?v=GWJQSmqRLRk View slide
  • Page 3June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting There’s A Code For That! Source: http://www.youtube.com/watch?v=yKYwr31s4bk View slide
  • Page 4June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Updated ICD-10 Timeline PYA May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Planning Identify resources Create project team Assess effects Create project plan Secure budget Communications Inform staff Contact vendors Contact payers Monitor vendor prep Monitor payer prep Testing High-level training for test team Level 1: internal Level 2: external1 Comprehensive Training Documentation Coding 2 October 1, 2015 is the anticipated compliance date for ICD-10. 2014 2015 G O L I V E Confirm ongoing practice schedule to correspond with new "go live"2 date 1 Monitor external testing periods, especially updates regarding CMS limited testing currently CANCELLED for July 21 - 25, 2014 for selected volunteers.
  • Page 5June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting ICD-10 Project Overview Successful Go-Live Training Testing Communications Planning
  • Page 6June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting • Plan for dual ICD-9 and 10 codes for a brief period to address services rendered before October 1, but discharged after October 1. • Monitor physician documentation to ensure ICD-10 compliance. • Monitor impact on claim-processing activity, claim denials, and rejections. • Audit coder productivity and accuracy. • Monitor patient satisfaction. • Post-transition review: – What’s working? – What needs fixing? • Schedule 30-day post-conversion claims assessment. ICD-10 Go Live, The Day After…
  • Page 7June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Questions?
  • Page 8June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Value-Based Payments What’s Up With That? The Alabama Hospital Association – Annual Meeting June 12, 2014
  • Page 9June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting What is a “Value-Based Payment” Model? Value-Based Payment: A payment model which rewards healthcare providers for meeting certain predetermined performance measures related to quality and efficiency. Efficiency: The state or quality of achieving maximum productivity with minimum wasted effort or expense. Quality: The standard of something as measured against other things of a similar kind; the degree of excellence of something “quality of life” also the general excellence of standard or level. Value: The regard that something is held to deserve; the importance or preciousness of something: “Your support is of great value.”
  • Page 10June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Fundamentals Driving Clinical Integration and VBP
  • Page 11June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Summary of Hospital VBP Hospitals are not only encouraged to promote quality of care and patient satisfaction, it is affecting their bottom line! • In FY14, a payment reduction of up to 1.25%. The result of these measures are available to everyone. Better performance equates to better payments (and ideally, better outcomes for patients). Summary of Hospital VBP
  • Page 12June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Physician Value-Based Purchasing Similar to Hospitals Physicians are encouraged to place value and performance above production. Similar to Hospitals Physician payments from CMS will be affected by the reporting and benchmarking of these measures. Similar to Hospitals Physicians are accountable for reporting on quality measures.
  • Page 13June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Why Report? •2015: ̶ Based on FY 2013 reporting. ̶ EPs who do not report under PQRS subject to payment adjustment of 1.5%. •2016 and Beyond: ̶ Based on 2014 reporting and beyond. ̶ EPs who do not report under PQRS subject to payment adjustment of 2.0%. Payment adjustment based on percentage of total estimated Medicare Physician Fee Schedule allowed charges: EP – Eligible Providers
  • Page 14June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting More Reasons to Report Physician Feedback Reports FY15 implementation of physician feedback report adjustments for physician practices with greater than 100 physicians. FY17; physician feedback reports will be sent to all physicians in the country at which point payment adjustments will be made (similar to Hospital value-based purchasing).
  • Page 15June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Why Clinical Integration and VBP? • Today’s volume-based, fee-for-service system is based on independence: each provider is paid for providing a discrete service, without regard to others performance. • Tomorrow’s value-based payment systems, however, will demand interdependence: providers will be rewarded for quality and efficiency achieved through collaborative care
  • Page 16June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Questions?
  • Page 17June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Thank You! Nancy McConnell Principal Pershing Yoakley & Associates, P.C. (404) 266-9876 nmcconnell@pyapc.com www.pyapc.com
  • Page 18June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Hospital-Physician Transaction – The Compliance Wheel The Alabama Hospital Association – Annual Meeting June 12, 2014
  • Page 19June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Alignment Perspectives: Physicians • Financially squeezed • Decline in reimbursement and loss of income • Obtaining malpractice coverage at reasonable rates • Inability or unwillingness to recruit to level that hospitals demand • Quality of life • Increasingly complex government oversight • Overhead and working capital requirements • Quality pressures • Healthcare reform
  • Page 20June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Alignment Perspectives: Hospitals • Increasing payer and public emphasis on standardization, integration, and consolidation of services in order to drive quality initiatives through outcomes and evidence- based medicine • Seeking efficiencies • Diversifying and focusing on outpatient and wellness care • Expanding into rural communities where there are not enough primary care and key specialist physicians to service the community’s healthcare needs • Experiencing physician shortages in key specialties • Competition from physician owned outpatient centers
  • Page 21June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Alignment Perspectives: Hospitals • Healthcare reform and potential for global reimbursement • Increase ability to recruit and retain high quality physicians to the community • Fill gaps in areas such as call coverage, where physicians are increasingly unwilling (due to lifestyle demands and/or practice economics) or unable (due to subspecialization) to provide emergency room call • Negotiate better rates with commercial payers
  • Page 22June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Alignment Perspectives: Payers and Healthcare Reform Payers • Consumers more aware of price and quality. • Baby boomers moving to the Medicare program. • Medicare and other payers expecting “value” for payment. • Commercial insurers under pressure from employers to reduce cost. • Consumers picking up more of the healthcare “tab.” Healthcare Reform • Reimbursement changes accelerating alignment of hospitals and physicians. • Tightening of resources requiring new approaches to the medical staff model. • Quality, safety, and transparency will affect strategic and operational decisions. • Capital and IT investments will be dictated by availability of capital resources and government incentives.
  • Page 23June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Multiple Models for Collaboration • Contracts – Physician employment – Recruitment agreements – Professional service agreements (PSA) – Practice acquisition agreements – Practice support agreements – Clinical research agreements • Non-Clinical Joint Ventures – Facility development/MOB ventures – Space & equipment leasing companies – Management companies – HIT ventures • Contractual Venture Models – Service line co-management – Pay for quality/pay for performance – Block leasing – Foundation model – Centers of Excellence models – Modified under arrangements models • Clinical Joint Ventures – ASCs – Ambulatory facilities
  • Page 24June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Multiple Models for Collaboration Physician Advisory Council Extent of Physician Integration High High Costs Lease Agreement Low Recruitment Assistance Clinical JV Professional Services Agreement Co- Management Arrangements ED Call Pay Medical Director Management Services Agreement Employment Foundation Model
  • Page 25June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting The Compliance Wheel Physician-Hospital Alignment  Strategic/Business Planning  Physician needs assessments  Community health needs assessments  Programmatic  Legal and Regulatory  Transaction structure  Legal opinion  Term sheet/contracts  Due Diligence  Financial  Operational  Regulatory compliance  Documentation  FMV  Commercial Reasonableness  Agreements  Need  Regular Audit & Monitoring  Agreements  FMV  Need
  • Page 26June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Questions?
  • Page 27June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Thank You! Tynan Olechny Principal Pershing Yoakley & Associates, P.C. (404) 266-9876 tolechny@pyapc.com www.pyapc.com
  • Page 28June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting The Osler Circle: Differentiating Physicians for Competitive Advantage The Alabama Hospital Association – Annual Meeting June 12, 2014
  • Page 29June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Today’s Discussion 1. Strategic Coherence – what is it and why does it matter? 2. Current context and limiting factors. 3. Coherence to what end? (Differentiation) 4. Sir William and the Five “A”s. 5. Putting it all together – The Osler Circle. 6. Wrap Up and Questions.
  • Page 30June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Strategic Coherence (And What’s Holding Us Back?) Limiting Factors • In Place: EAs, Non-Competes, Comp Plans, EHR – We’re Done! Wait…we’re not? • Clarity on what remains = continued default defensive strategy. • Demonstrating the Value-Add. Strategic Coherence: “Organization-wide collaboration, coordination and allocation of resources to create unique, valuable and sustainable advantages.” The ability to accomplish as a group, things not possible to accomplish as individuals. The Story of the Blind Men and the Elephant
  • Page 31June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Strategic Coherence (contd.) Coherence Differentiation Value Generation Competitive Advantage STRATEGY Coherence to what end and along what path? • Answer: Differentiation that creates value • Competing to be different as a conscious strategy • If this sounds familiar…it is
  • Page 32June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Competitive Physician Differentiation “Over time, if someone is taking your market share overall, or in a particular specialty…You’ll find there is always a good reason. Most likely it is your poor service, your bad results, or delayed access.” - Fred Loop, Former CEO of the Cleveland Clinic
  • Page 33June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting The “5 A”s of Physician Differentiation 1. Availability - Time vs. patient appointment, vs. waiting room vs. specialist follow up with PCP. - Secure Patient Portal and Next Day Appointment availability. 2. Affability - “When I am your doctor, I try to imagine the kind of doctor I’d like if I were you. Then I try to be that kind of doctor.” – Charles Mayo 3. Ability - Collectively represented by the physician’s experience, training, outcomes, and reputation and extends to and is impacted by perception of institutional reputation. Sir William Osler, 1849 – 1919 Considered by many to be “The Father of Modern Medicine” and creator of the medical residency. Success in practice depends on: “Availability, affability, and ability, in that order” – Sir William Osler
  • Page 34June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting The “5 A”s of Physician Differentiation Contd. 4. Affordability - The cost of care remains obscure and fragmented and healthcare consumers have been insulated from the realities of price for generations. - However, price sensitivity and transparency is increasing on all fronts and organizations are beginning to position physicians on affordability. 5. Accountability - Accountability is not new to medicine, however two new forms are emerging: 1) Accountability on “value” of care delivered (combination of outcome and costs). 2) For hospital sponsored/affiliated physicians, accountability to organization mission, values, and vision. Sir William Osler, 1849 – 1919 Considered by many to be “The Father of Modern Medicine” and creator of the medical residency. A couple of humble suggestions for 2014:
  • Page 35June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Putting it All Together: The Osler Circle
  • Page 36June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Wrap Up and Take-Aways • Ultimately, no hospital asset is as valuable as physician differentiation. • Competitive differentiation of the physician enterprise (employed and independent) ought to be a major strategic consideration. • Osler’s circle can help define where to focus that time and attention. • Only by addressing the creation of unique value will the investments of time, talent and treasure in the physician enterprise provide sustainable returns. * A full article on this subject to be published in Hospitals and Health Networks Online in June 2014.
  • Page 37June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Questions?
  • Page 38June 12, 2014 Prepared for The Alabama Hospital Association Annual Meeting Thank You! Chris Beckham Senior Manager Pershing Yoakley & Associates, P.C. (706) 248-6131 cbeckham@pyapc.com www.pyapc.com