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 experience.

2. Page Pennsylvania MGMA

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6. 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 7
Page Pennsylvania MGMA

7. 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 8
January-March 011 Page

9. 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 10
Page Pennsylvania MGMA

11. 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 12
January-March 011 Page 11

13. 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. n
January-March 011 Page 13

14. 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

16. 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, PA
January-March 011 Page 1

18. 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 www.thedoctors.com.
January-March 011 Page 18