Future Of Physcian Payments 081612


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  • Future Of Physcian Payments 081612

    1. 1. presentThe Future of Physician Payments Presented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC Presented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC 1 © 2012 Zetter HealthCare
    2. 2. Disclaimer 2• No copyright claimed on government material or information. This material is designed to offer basic information. The information presented is based on the experience, training and interpretation of the author. Although the information has been carefully researched and reviewed for accuracy and completeness, neither the author, DecisionHealth or Part B News accept any responsibility or liability with regard to errors, omissions, misuse or misinterpretation. 2 © 2012 Zetter HealthCare
    3. 3. TakeawaysState of HealthcareSCOTUSCapital Hill & Emerging OpportunitiesAccountable Care ModelsPrivate Payer InitiativesMedicare InitiativesPayment Reforms 3 © 2012 Zetter HealthCare
    4. 4. State of Healthcare Healthcare Reform/Transformation • 27.4% 2012 Medicare rate cut averted for 12 months • 2012 “doc fix” cost $21.1B • MedPAC recommendations to realign fee-schedule to support primary care and ACOs, bundled payments, capitated models & shared savings programs • MedPAC SGR recommendation slides – http://tiny.cc/u58qv • SCOTUS on ACA Legislation/Regulation 4 © 2012 Zetter HealthCare
    5. 5. State of Healthcare National & Global Efforts • Create efficiencies, increase access & stabilize rocketing costs • As compared globally, we ranked #1 on costs, but 20-40th on outcomes Beginning the Shift to Paying for Reporting & Quality • 27+ legislatures have proposed bills on accountable care • 221 known ACOs active in 45 states • Physician-led ACOs nearly double; from 38 to 70 5 © 2012 Zetter HealthCare
    6. 6. SCOTUS Observations Upheld the individual Mandate through Congress’ taxing authority • Result = $1 Trillion tax bill Rules that HHS can’t put sanctions on states’ existing Medicaid funding if the states decline to go along with the Medicaid expansion Most States now will quickly implement Health Insurance Exchanges & Medicaid expansion strategies Still some legal challenges – Medical loss ratios & rate reviews 6 © 2012 Zetter HealthCare
    7. 7. SCOTUS Observations Amplified movement away from FFS towards Shared Savings Increased momentum and security for care coordination strategies and more pressure for aligning incentives and creating efficient care models Could see stabilization of insurance premiums now • Not the 10%-17% annual increases of the past Full repeal will be nearly impossible by next President of Congress 7 © 2012 Zetter HealthCare
    8. 8. Capital Hill Update Meaningful Use Stage 2 • Final Rule for MU Stage 2 – Out anytime this fall • ONC discussions at AMIA Annual Symposium 11/3-11/7 Chicago White House • Heavily engaged in HITECH progress w/ frequent panels & town halls lately • REC, HIE, Beacon, Standards, Interoperability, etc. FDA, ONC & FCC • FDA Safety and Innovation Act, S 3187 • Prescription Drug User Fee Amendments Act of 2012 • Requires the HHS w/i 18 months to publish report “that contains a proposed strategy & recommendations on an appropriate, risk-based regulatory framework pertaining to health IT, incl. mobile medical applications, that promotes innovation, protects patient safety and avoids regulatory duplication 8 © 2012 Zetter HealthCare
    9. 9. Emerging Opportunities EHR Meaningful Use Stages 2 & 3 Regional Extension Centers Health Information Exchanges ACOs Accountable Care Medical Home Models Patient-Centered Medical Home Communities of Health EHR-enabled Clinical Research …..Navigating Payment & Delivery Reform 9 © 2012 Zetter HealthCare
    10. 10. State of ARRA & HITECH Act EHR Meaningful Use • Over $27B available w/ no cap (protected in Medicare Trust Fund) • As of May – over 248,000 care providers registered for MU • Over 102,000 care providers achieving incentive payments • Over $5.76B in incentives paid to EPs & hospitals already • Over $152M just to nurses & PAs under Medicaid • Meaningful Use Stage 2 Overview Chart – http://bit.ly/z0MHUC 10 © 2012 Zetter HealthCare
    11. 11. State of ARRA & HITECH Act EHR Certification • 6 ONC-ATCB certifying entities  CCHIT remains industry gold standard Regional Extension Centers  Operations underway at various levels of execution  Find your local REC – http://bit/ly/zUb3O9 Health Information Exchanges  Operations underway at various levels of operation 11 © 2012 Zetter HealthCare
    12. 12. The Evolution…essential building blocks for a sustainable healthcare system 12 © 2012 Zetter HealthCare
    13. 13. Accountable For What? Electronification / Health IT & EHR Utilization Interoperability Coordinating Care (with Care Team) Best Practices Quality Improvement / Outcomes Improvement Patient Education Patient Satisfaction Cost Containment Cost Reduction (to increase Shared Savings) 13 © 2012 Zetter HealthCare
    14. 14. Accountable Care Models 14 © 2012 Zetter HealthCare
    15. 15. Accountable Care Models 29 4 11870 In the past 8 months, the numbers of ACOs sponsored by physician groups has almost doubled. 15 © 2012 Zetter HealthCare
    16. 16. ACO Organization Types Single Provider ACO: Usually an integrated delivery system that receives payment for a population and takes on the responsibility of providing accountable care Multiple-Provider ACO: Two or more entities have partnered to provide accountable care for a population Insurer ACO: A regional or national insurer who organizes providers so that the insurer bears the burden of assuring accountable care Insurer-Provider ACO: The insurer and the provider are equal partners in providing accountable care 16 © 2012 Zetter HealthCare
    17. 17. Accountable Care Models 17 1343 148 The dominant model for ACOs is largely single provider groups, however, there is an increasing interest to share the risk. 17 © 2012 Zetter HealthCare
    18. 18. Private Payer Initiatives Every major carrier has an ACO-type plan  Aetna, Blue Cross Blue Shield, CIGNA, and Anthem/Wellpoint Various approaches utilized across the board  Shared Savings, Shared-Risk, Partial Capitation Real world example – CIGNA  22 programs in 13 states; 270,000 customer/patients  Primary care focus, open to multi-specialty, IDNs, physician- hospital organizations  Must meet quality improvement and cost reduction criteria to receive benefits 18 © 2012 Zetter HealthCare
    19. 19. Medicare ACO Initiatives Medicare Shared Savings Program (MSSP)  Initial 27 Medicare ACOs announced in April  Next round of Medicare ACOs slated for July Pioneer ACO Model  32 chosen to improve patient care and save $1.1B over five years  Rapid movement from Shared Saving to population-based payment model  Offers heightened risk/reward with more flexible payment methods Advance Payment ACO Models  Initial 5 organizations named in April; more schedule to being in July  Upfront payments awarded to design care coordination infrastructure *All programs found at http://innovations.cms.gov 19 © 2012 Zetter HealthCare
    20. 20. Medicare ACO Initiatives Major goal: Reduce the inappropriate utilization of high-cost emergency care by Medicaid recipients Many state Medicaid programs are forming ACO Models  Colorado’s Accountable Care Collaborative  New Jersey Demonstration Project Varying structures influenced by  Individual states’ experience with managed care  Existing delivery arrangements  Serving low-income and chronically ill populations 20 © 2012 Zetter HealthCare
    21. 21. Integrating the Patient Combining care processes with patient expectations Improves patient adherence, satisfaction & enrollment Care processes: Evidence-based team plan for:  Surgical procedure, care transition, preventive care, cost containment, low readmission  Utilizing EHR, PHR, and case management software  Example: EHR clinical extracts & HIE for specific reporting requirements (home health, skilling nursing) CMS data  Beacon Community Model – information systems supporting care processes matched with performance goals exist 21 © 2012 Zetter HealthCare
    22. 22. Managing the Patient Patient Engagement, Empowerment & Management Strategies  Produce analytics on patient/ consumer population Sample Functionality  Phone & “text” reminders  eMail calendar invites  Customized (automatic) patient education materials that incorporate video and “smart” self-help tools Robust Patient “CRM” –type Strategies & Functionality  Analytics comparing and contrasting outcomes & quality reports  eMail marketing tools & “smart” patient education materials 22 © 2012 Zetter HealthCare
    23. 23. Payment Reform Trends The transition from fee-for-service to risk-based reimbursement is inevitable The most important clinical components of managing risk-based payments are patient care coordination & population care management – with robust use of data aggregation, analytics & shared information Innovation will fuel health IT adoption and usability Payment reform will fuel health IT usability as well • Pay for quality, not for “clicks” 23 © 2012 Zetter HealthCare
    24. 24. Payment Reform Trends Consumers will drive change as tools and incentives become readily available Government will likely follow rather than lead the transition to risk-based payments as we witnessed Macro variables like economic growth and the ability of the federal government to borrow capital will greatly impact the transition to risk-based payment, but to varying degrees. 24 © 2012 Zetter HealthCare
    25. 25. Practice or Community Strategy Ensure 3-5 year Operating or Growth Plans If you are approached by a local Accountable Care Plan or ACO…  Financial incentives to join ACO?  Strategic incentives to join ACO?  Access to bi-directional data/ interoperability?  Legacy vs. Innovation  Standards-based interoperability  What data requirements are they requesting?  Binding?  Non-binding? 25 © 2012 Zetter HealthCare
    26. 26. Accountable Care Positioning Assess EHR, interoperability & overall technology infrastructure Assess beneficiary patient volume; patients can opt in/out voluntarily Engage peers, associations, payers, employers & health systems in your community Identify CMS, private payer or combined care coordination/ACO opportunities ACOs, Accountable Care & “At-Risk” communities are forming today around the country 26 © 2012 Zetter HealthCare
    27. 27. Accountable Best Practices Pinpoint patients for clinical teams at the point of care Engage & educate patients to hold them accountable for outcomes Identify reporting requirements which will include a key focus on patient satisfaction, screenings and assessments Utilize Health IT to increase the velocity of coordination in your community by placing a focus on the importance of EHRs and meaningful use Develop care management resources to monitor delivery and ensure that patients receive appropriate follow-up care 27 © 2012 Zetter HealthCare
    28. 28. Additional ResourcesImportant Government & HHS Sites CMS Innovation Center (http://www.innovations.cms.gov) HHS Breach Notification Rule (http://tiny.cc/xytq5) HHA Privacy Rule (www.hhs.gov/healthprivacy)Agency ACO Sites Medicare ACO Final Rule (http://tiny.cc/pem0cw) CMS Educational events Page (http://tiny.cc/aszkn) CMS ACO/Shared Savings Page (http://www.cms.gov/sharedsavingsprogram) 28 © 2012 Zetter HealthCare
    29. 29. For Follow-up & Further Questions Contact: David J. Zetter,PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC 717.691.7100 Email: djzetter@zetter.com Subscribe to our newsletter at Follow us on www.twitter.com/djzetter and www.linkedin.com/in/djzetter 29 © 2012 Zetter HealthCare