Accountable Care + Patient Experience = Accountable Experience


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See page six in the attached Pennsylvania MGMA Matters publication. Capitation with gain-sharing—
Improving outcomes
and increasing value—Revisiting
integrated delivery tactics
among primary care physicians,
specialists, and hospitals—
Bending the health care
cost curve for managed populations—
Whatever your definition
(in whole or in part) may
be, Accountable Care Organizations
(ACOs) pose a strategic
opportunity for hospitals and
large physician practices alike.
If ACOs can overcome concerns
from a Stark and anti-trust
perspective and are successfully
implemented, patients and
ACO market leaders will see
stronger physician alignment,
improved quality, cost reduction,
and an improved patient

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Accountable Care + Patient Experience = Accountable Experience

  1. 1. Page Pennsylvania MGMA
  2. 2. KeepY Patients Connected. our We have the patient communications solutions you need. Whether you need help keeping your patients connected to your practice or you want to free up your staff from time-consuming phone duty, notifymd has the solution. Our HIPAA-compliant Automated and Live Voice solutions can improve operational efficiencies, enhance patient communication and increase practice revenue. Call 866-735-8591 for more info.Size: 7.75x4.75 Client: Notifymd Job No: NMD-33170 Job Title: Maryland Pennsylvania
  3. 3. BusinEss OPErAtiOns By Tina Minnick Director of Business Development, TeamHealth Medical Call Center, (THMCC) Accountable Care + Patient Experience = Accountable Experience C apitation with gain-shar- ing—Improving outcomes and increasing value—Revisit- perspective and are success- fully implemented, patients and ACO market leaders will see the country. While the organi- zational structure of an ACO is loosely defined, it does require Doing so “will require focused efforts to improve care for the 10% of patients who account ing integrated delivery tactics stronger physician alignment, that primary care physicians be for 64% of all U.S. health care among primary care physi- improved quality, cost reduc- a component. The ACO pilot costs.” (Orszag PR, Emanuel Ej. cians, specialists, and hospi- tion, and an improved patient program looks to work with “Health care reform and cost tals—Bending the health care experience. Medicare populations begin- control.” New England Journal cost curve for managed popula- ning in January 2012, and Medicine 2010; 363:601-3). The tions—Whatever your defini- What is and who will drive health care observers agree that real bottom line is that the U.S. tion (in whole or in part) may the ACO movement? commercial payers will follow cannot continue the current be, Accountable Care Organiza- The Medicare Shared Savings the Medicare lead. approach with health care deliv- tions (ACOs) pose a strategic Program in the 2010 Patient ery. Analysts predict health care opportunity for hospitals and Protection and Affordable Care The goal of the ACO movement will be one fifth of our nation’s large physician practices alike. Act broadly defined the ACO is that provider organizations gross domestic product (GDP) If ACOs can overcome concerns concept to include the many be accountable for the value of from a Stark and anti-trust health care organizations across a population’s health care costs. See Accountable Care on page 7Page Pennsylvania MGMA
  4. 4. Accountable Care from page 6 BusinEss OPErAtiOns patterns. Domination of the before, during, and after the market will occur by those who ACO implementation. act and succeed first. Where to begin and what to do Critical Success Factors for may feel like difficult next steps. ACOs: Dominating Market Listed below are ten questions Share and the Patient that can help you gain insight Experience into what your current experi- Market share is the percentage ence feels like and where to of total sales volume in a market capitalize on market share. captured by a brand, product, or firm—in this case, by your (1) What are patients specifi- practice or hospital. The patient cally saying about commu- experience will drive brand nication to and from their loyalty, repeat patient visits, and doctors and nurses? new business to you. (2) How are you responding to patients’ comments, whether Thinking about market share they are good, bad, or in health care can sometimes indifferent? be difficult because many of (3) What reporting is available us may think “once a patient to help you gain an always a patient” or that we are understanding of your the only game in town with patient experience? regard to a particular service (4) Would your patients line or insurance type needed recommend you to friends by the patient. In the past, these and family? thoughts may have held up, but (5) How are you capturing with transparency and patients’ potential patient inquiries in options such as telemedicine or the community? going for care outside of your (6) How are you serving service area, your hospital’s or your community to grow by 2019, and ACOs are part of having been treated by the group’s niche, appeal, and repu- awareness? the prescription to impact cost hospital’s primary care physi- tation need to be top of mind. (7) How are you managing and quality. Coordinated care cians.” (John M. Harris, Daniel unnecessary processes in that provides value and reduces M. Grauman, Rashi Hemnani. ACOs clearly have to develop a crowded and busy emer- cost will become the standard. “Solving the ACO Conun- business plans for service area, gency department? ACOs will be looked upon as drum.” hfm Magazine, Novem- target market, reimbursement, (8) How consistent is your major drivers of reducing the ber, 2010; page 69). information technology (IT), patient follow-up for both health care cost curve. quality, providers and orga- patient experience and Large physician practices are nizational structure. Each of quality care? Both hospitals and large physi- also likely to want to lead ACO these areas stand on its own as (9) What tools are available to cian groups are prime leaders for efforts. Physicians often self-re- a major strategic decision, and promote work/life balance the ACO movement. Growing fer, and the thought of obtain- execution of these plans will for your physicians? market share will be key for ing additional “gain-sharing” determine an ACO’s success. (10) What risk management hospitals, and a strategy focused funds by reducing hospitals’ Independent of these compo- strategies are in place to on retaining and gaining new census could be a motivating nents, the fact is that ACOs are document after-hours patients will be needed to off- factor. Whether a large primary designed to increase value and patient interaction and set lower utilization. Hospitals care group forms their own decrease costs, and it is impera- provide peace of mind for should “focus on retaining ACO or remains as an affiliated tive that market share and the your employed physicians? cases from the population that hospital partner, hospitals could patient experience be critical previously had been ending up see volume shift as primary care success factors in your plans to in different hospitals, despite physicians choose alignment grow and/or maintain revenue See Accountable Care on page 8January-March 011 Page
  5. 5. OrgAnizAtiOnAl gOVErnEnCE Achieving shared Vision Building support for strategic planning within your practice By Kent E. Frese Managing Director, Leadership Management Institute W hile most acknowledge the importance of strategic planning, many people see stra- need to learn to be more effective at working together as a team. This transition can be stressful the use of the 4 C’s of Group Effectiveness: (1) commitment, (2) conflict, (3) creativity and (4) some patience and persistence to get traction from everyone. The development of commitment tegic planning as akin to going and, unfortunately, often falls consensus. Importantly, Hall’s means that the team cares about to the dentist office. It is just not on the practice manager to shep- research showed that all four the values, mission and vision of always approached with enthu- herd the change with reluctant steps are important, as is the or- your practice. Improvement in siasm—you may even be one of physicians and intimidated staff. der of the four steps. this area requires a manager to those people. Unfortunately, a Without a coherent strategy ensure that everyone has a voice large body of evidence supports and a process to follow through, The first “C” in this approach in the process—that includes the importance of strategic plan- change becomes a painful, high involves using collaborative ap- both physicians and administra- ning, or more appropriately stra- stress process that sometimes proach to create commitment tive staff. tegic management, for the suc- feels like one step forward and and feelings of ownership among cess of any business. For medical two steps backwards. So what is key staff members and eventually Unfortunately, collaboration practices, the pace of change a manager to do? all staff members. It is criti- and commitment can have a side makes it imperative that you can cal that any successful process effect that causes managers to quickly adapt to changes in the Good strategic planning and develops employee feelings of surrender and this next “C” is short term and keep your team management includes several key understanding and buy-in to conflict. When people engage focused on the long term vision elements that you can incorpo- your organizational values and and care, divergent opinions of a desired future. As healthcare rate into your process to improve mission. For teams that are not will inevitably emerge and our delivery continues to change and physician and staff buy-in. Ac- used to getting involved, espe- natural instincts sometimes functionalize at all levels, clini- cording to social psychologist cially with core issues like values, cal and non-clinical staff will Jay Hall, a good process involves mission and strategy, it may take See Vision on page 10Page Pennsylvania MGMA
  6. 6. QuAlity MAnAgEMEnt the Benefits of a Quality Program in your Practice By Gregory J. Kuntz, FACHE Owner and Principal, BTA Consulting U sually, the message you hear from Medicare is how they are under unrelenting pres- incentive program have been in place since 2008. In 2009 and 2010, they provided an incen- ways to report your participa- tion. Some Vendors offer prod- ucts that don’t require a large modified in 2007, 2008, and once again in 2010. Successful participation qualified a prac- sure from all corners to reduce tive payment equal to two per expenditure on software and tice for an incentive payment cost. All too often, practice cent of an eligible provider’s systems to get started. Incentive in addition to their Medicare leaders hear that CMS has just total part B allowable charges programs are here to stay, and allowable charges. cut payment somewhere, a CPT for reporting quality activities. will start to penalize providers code was just bundled, or there’s For example, if a provider billed that don’t participate. Some In 2011, the program was re- an old program that was never $100,000 in part B charges in a start next year. named Physician Quality Re- quite resolved(remember SGR?). given year, the program would porting System (PQRS), and Over time, this is going to re- provide an incentive payment of PQRS: now includes 190 individual duce payments significantly. $2000 for PQRI, and another The 2006 Tax Relief and quality measures, and 14 mea- $2000 for eRx. Health Care Act required the sures groups. A practice can Every provider talks about qual- establishment of a physician qualify by reporting individual ity, and every practice boasts Many providers think they quality reporting system, and measures or measures groups that it has a quality program, need an EHR in use to qualify. included an incentive payment via claims, by using a quali- but the benefits of these pro- While an EHR can make your program for providers who fied registry, or via their EHR. grams are often difficult to participation a lot easier, it’s not reported data on quality mea- Each reporting method has its articulate. Automated systems a necessity. Both programs have sures for professional services advantages, disadvantages, and such as an EMR or electronic multiple methods to qualify for provided to Medicare beneficia- associated costs. prescribing will drive out payment, as well as a number of ries. This program was further variation and standardize your processes. You can calculate a Reporting Method Advantage Disadvantage financial benefit from increased Claims Simple Method---G codes are added 50% reporting level. Difficult efficiency, but there are also to claims submissions to retrieve reports from CMS to ways to get paid for quality. confirm timely submission. Many practices are already do- ing many of the things that are Registry Can report for as few as 30 patients Cost--typically priced per provider. necessary to qualify, and often, for measures groups. Registry will Many specialties are unable to fit it’s a matter of taking credit for validate data for completeness and in measures groups due to volumes what you’re already doing. provide proof of submission of diagnoses or procedures in numerator group. CMS has had two programs that reward practices for qual- EHR Direct data interchange High reporting threshold—80%. ity activities. The Physician Requires an operational EHR. Quality Reporting Initiative (PQRI) and E-Prescribing (eRx) See Benefits on page 12January-March 011 Page 11
  7. 7. Upcoming EVENTS T he Pennsylvania Medical Group Management Association [PA MGMA] provides a comprehensive educational program in conjunction with the Body of Knowledge and the eight learning domains as published by the American College of Medical Practice Executives, ACMPE. Program Listing March 25, 2011 July 2011 Regional Practice Management Webinar Forum 8:00 a.m. – 10:30 a.m. August 19, 2011 Hospice of the Sacred Heart Regional Practice Management Moosic, PA Forum Feature Topic: Accountable Care 8:00 a.m. – 10:30 a.m. Organizations Lewisburg, PA April 2011 September 16, 2011 Webinar Regional Practice Management Workshop May 5 6, 2011 8:00 a.m. – 11:30 a.m. State Conference Cranberry, PA City Avenue Hilton Hotel Philadelphia, PA October 2011 “Jazz it up! How to Reinvent Yourself Webinar and Your Practice” November 2011 June 2011 Regional Practice Management June 24, 2011 Forum Regional Practice Management King of Prussia Forum 8:00 a.m. – 10:30 a.m. Erie, PA Program Description The Regional Practice Management Forum includes one-half hour of networking and two hours of presentation. The Webinar is one and a quarter hours. Participants must have access to the Internet. Registration must be received by noon no later than two days prior to the telecast. Location The Regional Practice Management Forum rotates around the state based on an odd/even year schedule as follows: Month Odd Year Even Year January Harrisburg Lancaster March Scranton Bethlehem June Erie Pittsburgh August Lewisburg State College November King of Prussia King of Prussia The State Conference is held in May in Philadelphia. Continuing Education Units Each Forum, conference and webinar is approved for continuing education units as awarded by the ACMPE, American College of Medical Practice Executives. Registration and Other Information Registration for all of our programs is required. Pennsylvania MGMA members can attend the Regional Practice Management Forum and participate in our Webinars [free of charge]. Nonmembers are welcome; there is a nominal fee of $30. The State Conference requires a registration fee; Pennsylvania MGMA members receive a discounted rate. Please visit our online calendar for program content and changes. nJanuary-March 011 Page 13
  8. 8. aSk ThE Expert FinAnCiAl MAnAgEMEnt irs Delays new nondiscrimination rules for group Health Plans Kelly Davis, Manager LarsonAllen LLP CPA’s, Consultants Advisors Anita Baker, Principal with LarsonAllen LLP CPA’s, Consultants Advisors QUEStIOn: What is the implementation date for this new requirement? AnSWER: A provision in the health care reform legislation imposes new nondiscrimination standards on employer-provided group medical insurance plans. The provision prohibits “highly compensated” company executives or shareholders from receiving better health care benefits than “rank and file” employees – with very harsh penalties for violations (nondeductible excise tax of $100 per employee per day). Now the IRS has postponed implementation of this requirement, taking pressure off for the short term. The provision did not clearly define what represents discriminatory benefits in a group health insurance arrangement, so the IRS will reconvene to better clarify and provide administrative guidance in applying the rule. Once that guidance is issued, group health plan sponsors will be given additional time to adjust their coverage benefits and comply. Originally, the provision was to apply to new plans created after September 2010. “This is much needed relief,” notes Kelly Davis, benefits manager with LarsonAllen. “Based on the IRS Notice, we expect it will be many months before they issue regulations applying this nondiscrimination requirement. And once those are issued, it will likely be at least another year before they go into effect, with compliance on a prospective basis rather than retroactively applied to prior plan years.” The IRS has reopened the taxpayer comment period while it irons out the uncertainties in this Congressional mandate. You can send your comments to the IRS on this particular provision through March 11, 2011. Kelly and Anita can be reached at 480-615-2300.January-March 011 Page 14
  9. 9. Peer Peer 2 How do we effectively motivate/reward/incentivize our staff? E ach individual is motivated in different ways and each situation requires motivation to achieve a different result. Perhaps one individual needs to be motivated just to get through each day being a productive employee but yet another needs motivation to continue trying to be a star performer and reaching new heights with every new project. This requires us as managers to learn what motivates each individual. In these difficult economic times, cash incentives are not always possible and not always the answer. Some people are motivated by recognition. This can be something as simple as being singled out during a staff meeting or given a special parking spot for the week or month. Others like the idea of working toward a goal and a specified prize for reaching that goal. One example is using coupons from vendors. I have accumulated these “prizes” and then used them during quarterly staff meetings. Employees can earn points during the quarter for different milestones achieved. Think outside the box. Perhaps a certain amount of points for perfect attendance, for positive patient and staff comments on behavior, finishing a project on time or early, developing a new process that improves efficiency, etc. This can involve the staff during the entire quarter and keep them engaged in the competition. The staff member with the most points gets first choice of the prizes available and so on down the line. If you don’t have prizes available you could use other motivators such as a day to come in late or leave early, a day to take a longer lunch or park in a prime parking spot. Sometimes an entire department or team of staff members can be motivated to complete a project and be given a group reward. The important thing to remember is that everyone is motivated differently. It doesn’t always take a large amount of money to motivate individuals or teams to achieve goals. Think outside the box and customize your incentive to motivate each individual. traci L. Evans, CMPE, Director of Surgical Specialties, Mount Nittany Physician Group, State College, PA T he staff of this practice is offered significant ongoing education in the field of ophthalmology. We have a learning organization where inquiries and answers are encouraged through all departments and all levels of the corporation. Continuing certificate retention educa- tion credits may be obtained with no cost to the employee. Representatives from pharmaceutical companies are afforded the opportunity to educate staff members at luncheons. Every staff meeting includes an education component. “Perks” may be retained by Opticianry staff members. Exceptional performance may be rewarded with movie tickets or a gift certificate for not more than $25.00. Each employee is given a small monetary incentive should they volunteer to work on a Saturday. It is rare to give bonuses to staff members however; rewards may be given for the performance of a single outstanding project. Bonuses have also been given for perfection on audits or inspections. Fi- nally, a simple thank you goes a long way. Public acknowledgement of a job well done is the single most important staff motivator. April Butts, Administrator, Premier Eye Care Group, Inc., Harrisburg, PA I find that motivating, rewarding, and incentivizing our employees is one of the most challenging parts of my job as well as one of the most satisfying. I recognize that everybody has their monthly bills that need to be paid and compensation is probably the leading driver for most employees; however, it is not the only factor that drives employees. Work satisfaction plays an integral part as well. From the top of the organization to the bottom, each employee needs to take ownership and feel that their efforts are contributing to the success of the organization. Each employee should be encouraged to think of creative and innovative ways to make the organization run more efficiently. If their new idea is implemented in the organization then they should be acknowledged in some capacity such as an announcement sent to fellow co-workers announcing the new idea. Not only does the organization benefit from the idea but the employee feels proud of their accomplishment and the co-workers become motivated to come up with the next great idea. Since employees need to feel that they can express themselves, all supervisors/managers should make a conscious effort to listen and keep an open line of communication with their staff on a regular basis. If the supervisor/manager promises to get back to an employee within a certain time period then they must keep their promise. There’s nothing worse for an employee than when their supervisor’s/manager’s promise goes unfulfilled. Employees are the most valuable asset of any organization and need to be treated with respect and reverence. Adam Cooper, MBA, Business Manager, Allergic Disease Associates, PC Philadelphia, PAJanuary-March 011 Page 1
  10. 10. We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company. Donald J. Palmisano, MD, JD, FACS Board of Governors, The Doctors Company Past President, American Medical Association The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical malpractice insurer. And, local physician advisory boards across the country. Why do we go this far? Because sometimes the best way to look out for the doctor is to start with the patient. To learn more about our medical professional liability program, call our Harrisburg office at (866) 990-3001 or visit 011 Page 18