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MACRA is not the Macarena But It Is A Dance You Can Learn

The Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, is on the minds of physicians and practice managers from coast to coast. As with any new ruling from CMS, the challenge is to fully understand the changes to the law and what it means for your practice. Change is never easy, but this change has to be met head-on, or the clinic’s bottom line may suffer.

To help address your questions about MACRA, GE Healthcare is hosting a webinar called “MIPS, MACRA and YOU in 2018” on Monday, November 27th from 9:00 a.m. to 10:00 a.m. Pacific Time. The webinar will feature Mark Segal and Donna Maddox from GE Healthcare, and David Swartout from Mountain View Medical in Forest Grove and Hillsboro, Oregon.

While MACRA presents a host of new challenges for clinics, Donna Daniel of IBW Watson Health argues that managing and analyzing patient data is the core function that clinics must learn to master.

Provider performance will be measured against national peer performance to establish goals, incentives, and payment structure. Organizations that perform well against the quality benchmarks while controlling costs will be financially rewarded. Those who miss the mark may see their Medicare reimbursements shrink. This puts a great deal of pressure on providers to immerse themselves in performance metrics.

We all know that practicing medicine has plenty of its own pressures. Know that you can lean on HealthCo and GE Healthcare to help you manage MACRA/MIPS.

Understanding Merit-based Incentive Payment System (MIPS)

MIPS replaced the Physician Quality Reporting System, Value-Based Modifier, and Meaningful Use of electronic health records programs. It also added a fourth component, Improvement Activities, which is intended to give physicians credit for their efforts to reduce disparities in care, engage patients in shared decision-making, and other activities designed to improve care.

Instead of three separate programs, MIPS is designed to be one cohesive program with a single score for each physician or group. The score will be derived from four components: quality, costs, improvement activities, and advancing care information.

Sandy Marks, Assistant Director of Federal Affairs at the American Medical Association, notes that MIPS presents a variety of special challenges for small and rural practices.

When Congress enacted MACRA, it recognized the unique challenges facing physicians in small and rural practices. For example, the law required CMS to set a low-volume threshold so that physicians who do not treat enough Medicare patients to have a chance at getting a positive return from participating in MIPS would be exempt from it. MACRA also called for creating virtual groups so that physicians in small and rural practices can combine their resources to jointly report on MIPS measures.

Get A Firm Grip On 2017 MIPS Reporting

Under MIPS, each clinician will be measured against four categories: quality, cost, improvement activities and advancing care information. Quality is the most important category right now, as it accounts for 60% of the clinician’s overall score. Each clinician under the MIPS program receives a final score (from 1 to 100) and that number determines the amount of payment the clinician is eligible to receive in 2019.

If you’d like to learn more about these four reporting categories, CMS has excellent “explainer” videos on the topic available.

Our dedicated team of Centricity Practice Solution specialists is also available to walk you through any specific MACRA- or MIPS-related questions.

GE Healthcare Recognized As Leader in Revenue Cycle Management

SANTA CLARA—Based on its recent analysis of the revenue cycle management (RCM) industry, Frost & Sullivan recognizes GE Healthcare with the 2017 North America Enabling Technology Leadership Award for its highly customized, scalable, and agile RCM IT solutions for hospitals, ambulatory practices, specialty practices, health plans, billing companies, managed service organizations, and other stakeholders.

Each year, Frost & Sullivan presents this award to a company that has developed a pioneering technology that not only enhances current products but also enables the development of new products and applications. The award recognizes the high market acceptance potential of the recipient’s technology.

Despite the widespread adoption of basic RCM IT solutions, most US healthcare providers still grapple with low operating margins resulting from poor accounts receivable (A/R) performance and high average denial volumes. As a result, hospitals across the country lose approximately $262 billion per year on denied claims from insurers. Frost & Sullivan observed that many large healthcare providers, including accountable care organizations, integrated delivery networks, and group practices, continue to manage revenue cycles in silos, without taking advantage of an RCM IT solution that can drive RCM performance while managing all payment models. This often results in underpayments and lost rebates and incentives from payers.

“Healthcare providers have long struggled with the difficulty of implementing enterprise-wide RCM solutions,” said Koustav Chatterjee, Industry Analyst, Frost & Sullivan. “In our analysis, we found GE Healthcare’s value proposition to be unique, disruptive and pioneering from the context of the US RCM vendor market. The company’s solutions integrate with virtually any EHR [electronic health record] and can help facilitate clinical and financial analytics across the enterprise while delivering informed workflows that drive the outcomes that are critical to organizations’ success.”

“GE Healthcare is proud to have been recognized by Frost & Sullivan with the Best Practices Award for Enabling Technology in Revenue Cycle Management,” said Shiv Gopalkrishnan, Vice President, GE Healthcare. “This award is a testament to our commitment to helping our customers deliver the revenue cycle outcomes necessary to enable them to pursue their mission of caring for their community.”

Ge Healthcare’s RCM IT solution begins with their flagship solution, Centricity™ Business, which enables health systems to manage both ambulatory and hospital RCM all on one RCM platform and can be combined with a range of other value-added financial solutions. GE Healthcare takes payer connectivity to the next level by offering Centricity EDI (Electronic Data Interchange) Services to optimize billing process, DenialsIQ™ to reduce the costly impact of denied claims, and Centricity Payer Connect to ensure that customers can monitor, benchmark, and respond to gaps in care in real time and prevent revenue leakage.

GE Healthcare’s financial management solution portfolio spcifically improves the following:

  • Payment experience for patients: Patient-portal connectivity (incumbent or external portal) provides effective scheduling and built-in payment modules for informed financial decision-making.
  • Value-based payment model adoption and care management for providers and payer-providers: For healthcare organizations engaged in risk-based contracts and value-based reimbursement ranging from shared savings to global capitation, GE Healthcare provides highly scalable solutions that streamline management of administrative costs, utilization, and care coordination of patient populations.
  • Cost management for all: The company’s point-of-service toolkits can estimate patient liability and propensity to pay, thereby preventing loss of revenue. Additionally, with the help of EDI and DenialsIQ, patient eligibility assessment is digitized, claim errors are auto-highlighted, and denials are managed with predictive analytics.

“GE Healthcare enables its customers to achieve tangible financial outcomes that are better than the industry standards,” said Chatterjee. “For example, GE Healthcare’s top 20 ambulatory customers’ average number of A/R days is at least 10% lower than average. This is achieved through its efficiency in A/R management, using a persistent approach to optimizing patient access processes, streamlining billing workflows, pre-adjudicating claims, and automating financial reporting around claim denials’ root-cause analysis and regulatory adherence.”

GE Healthcare has been successful in driving a consolidated, value-based care approach for its customers. The company has demonstrated its proven expertise in streamlining costs and optimizing collections through an impressive portfolio of IT solutions combined with optimization services that ensure greater financial performance. For these reasons, GE Healthcare has earned Frost & Sullivan’s 2017 North America Enabling Technology Leadership Award.

Accurate ICD-10 Coding Is Critical To The Clinic’s Bottom Line

GE Healthcare’s Centricity Practice Solution, like all business-essential software, helps remove complexity from tasks that would otherwise be unmanageable. For one, the clinic’s EHR software must assist physicians and medical coders in the clinic with the correct choice of ICD-10 codes. With more than 68,000 options in the International Classification of Diseases database today—up from just 13,000 in the ICD-9 standard—the likelihood of human error is too high to proceed without automated assistance.

To provide just one example, “degenerative myopia with retinal detachment” has five ICD-10 codes assigned to it, not one. This granular level of detail helps describe the precise diagnosis. The good news here is we have Clearinghouse tools available in Centricity to help you manage the complexity of ICD-10 coding and maximize revenue.

Improving clinic workflows is another critical aspect in getting ICD-10 right the first time. Data is only as good as the inputs received, which squarely places the responsibility on the clinic’s physicians to make the accurate call at the point of care. You never want the clinic’s coder(s) to guess which code is correct after the fact and input the wrong code or series of codes. That will quickly make for an unnecessary billing logjam. The chain of communications from physician to coder to payer needs to be flawless, or payments will be denied or lost in the system.

“The idea is to minimize billing time, reimbursement time, get a clean claim and get money get faster and improve cash flow,” Denver Wade Harless, who works for the Sacred Heart Health System, told Healthcare Finance News. Harless believes “a lot of clinical legwork needs to be done to get more specific information from physicians.” Our take is, workflow improvements are always highly beneficial, but workflow realignments, in combination with added functionality in the EHR, produce the biggest wins for the clinic.

Four Keys To ICD-10 Coding Success

1) An awareness of the issue and a commitment to solve it
2) Physician training to help identify the right codes at the point of care
3) Customization and optimization of Centricity
4) Select clinic workflow improvements (determined on a case by case basis)

There’s no question that the challenges in value-based care, including keeping up on the latest developments in ICD-10, puts an extra onus on practice administrators and physicians. The complete solution includes hiring talented coders, internal training, process improvement, and software upgrades.

Our implementation team at HealthCo is available to discuss your ICD-10 questions on a call that I am happy to set up fro you. Send me a note at rachaelr@healthcosystems.com.

HealthCo Stacks Its Lineup With Another GE Centricity Pro

TUALATIN—HealthCo Information Systems, a value-added reseller of GE Healthcare software for medical practices, has hired veteran software executive William Giacone to lead the sales organization. Giacone joins HealthCo directly from GE Healthcare, where he served as a top performing Regional Sales Executive on the East Coast until last August.

Before joining GE Healthcare, Giacone was a founder of Virtual OfficeWare (VOW), the next largest GE Centricity VAR, after HealthCo and Quatris. While at VOW, Giacone did many of his own product demos and worked directly with VOW’s early customers before taking on sales leadership and other duties as the organization grew.

Giacone is now the leader of a five-person sales team at HealthCo, and he is excited to bring his consultative approach and industry experience to HealthCo’s customers in ambulatory practices.

“For the past few years, the need for revenue cycle management and financial risk management tools has been great,” says Giacone. “I see that trend continuing as clinics struggle to capture revenue, keep and train staff, and meet their financial performance goals.”

Giacone is also intent on helping clinics that run Centricity begin, continue, or finish their migration to the cloud. “Physicians and practice administrators want to protect their patient data at all costs,” says Giacone. “GE Healthcare and HealthCo both understand their concerns and how to help clinics take the next steps into a more flexible and secure data environment.”

Giacone is a graduate of Hofstra University in New York and a lifelong Mets fan.

Better Data Leads To Improved Care And Higher Profits

Meeting the various reporting and measurement standards imposed by CMS is no cakewalk. On one hand, clinicians must be adept at change management. On the other, they must be technically proficient and knowledge rich.

There can be no doubt that successfully practicing medicine today requires clinicians to overcome several significant challenges. It’s our job to reduce at least one challenge—and we do, by clearing the path to payment under value-based care.

Shiv Gopalkrishnan, GE Healthcare’s General Manager of Enterprise Financial Management Solutions, addresses one problem head-on when he asks, “How can we deliver solutions faster through the cloud?”

In busy clinics, resources are limited, which puts an extra onus on technology to do more of the heavy lifting. As Centricity migrates to the cloud in 2018 and beyond, physicians and practice managers will begin to benefit from the “no touch, low touch solutions” that help drive automation, which leads to optimized workflows and a notable reduction in workloads around the clinic.

Gopalkrishnan says, “Whether it is clinical outcomes, financial outcomes, or operational outcomes, we know with value-based care, these are all going to be tied together. You’re going to get paid because you demonstrate clear clinical outcomes and quality of clinical outcomes.” He adds, “It’s very important that we deliver a solution suite that helps clinics achieve these net financials.”

In order to deliver the results our partners in clinics count on, GE Healthcare and HealthCo bring a true understanding into provider workflows and reporting requirements. Thanks to our years of experience working in clinics and with clinics, we also understand the pressures involved (in making big changes) and how to relieve them.

Let’s recap. The “Triple Aim” of value-based care can be summarized like so:

    1) Reduce the cost of healthcare
    2) Enhance the patient experience
    3) Improve population health

At HealthCo, we are on board with all of the above. We also come to work each day ready to deliver on these core promises:

    4) Enhance care quality
    5) Improve provider efficiency
    6) Strengthen financial performance

We know the move from fee-for-service to value-based care is a big change, and the entire transition cannot normally be made all at once. It takes time, a solid plan, and reconfiguration of systems to properly record the numerous measures of quality that help determine the overall health of your patient population.

Remember, you need to demonstrate improvement to get paid today.

According to RevCycle Intelligence:

Value-based reimbursements are calculated by using numerous measures of quality in determining the overall health of populations. Unlike the traditional model, value-based care is driven by data because providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on hospital readmissions, adverse events, population health, patient engagement, and more.

We are happy to help you refine your tracking procedures and update your workflows to meet the need of value-based care. Measuring the full set of outcomes that matter most to patients is indispensable to better meeting patients’ needs. It is also one of the most powerful vehicles for lowering health care costs. Let’s work on it together. Better care at a lower cost is a promise for the future that is within reach today.

It’s Conference Season and We’re Headed To Bend, Boise, and New Orleans

Bend, Oregon is a favorite destination for golfers, mountain sports enthusiasts, and people in search of the sun. This week, The Riverhouse in Bend will also host hundreds of practice administrators from around the state at the annual Oregon MGMA Conference.

Some of the key sessions we’re looking forward to:

  • Benchmarking Your Key Performance Indicators
  • MACRA – State of Affairs and Updates

HealthCo will also have a booth on the exhibitor floor at the Riverhouse. Please stop by Booth #501 and say hello. We are also giving away three fully loaded gift baskets!

Directly on the heels of Oregon MGMA in Bend, the HealthCo team heads to Boise for Idaho’s annual MGMA Conference. The Idahoans are always great hosts and this year is no exception. The event kicks off with a golf tournament at Warm Spring Golf Course. Whether you’re an expert golfer or have never played, come and enjoy a morning of fun, prizes, contests, and the excellent company of your peers.

When we get down to business in Boise, there will be incredible programming available. In fact, all three of these of the following presentations are in the same time slot (forcing one to make a tough choice):

  • Good Clinics to Great Clinics
  • Mentoring: The Key to Professional Development
  • Engaging Physicians

After returning from these key annual pilgrimages, we will begin to prepare for CHUG Fall 2017, which is in New Orleans this October.

I sense beignets in our future.

The keynote speaker at CHUG is Dr. Kavita Patel, a co-founder of Tuple Health, a physician-led company focused on practical clinical solutions to bring care back to health. Dr. Patel was previously a Director of Policy for The White House under President Obama and a senior adviser to the late Senator Edward Kennedy.

We’re always interested in seeing our customers at these key industry events, and hearing from industry leaders about important topics in healthcare IT and practice management. If you’d like to schedule a time to chat during these upcoming events, let’s do so now.