Driving Efficiency in Community Health
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FQHC's are extremely complex and difficult to manage. Learn how to drive efficiency while navigating through the world of community health.
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Driving Efficiency in Community Health
- 1. Driving Efficiency in Community Health Mike McDonnell Group Sales Executive Manager
- 3. “FQHCs are an extremely complex corner of an already complex system. Keeping up with the reporting requirements is a constant struggle.” -Bobbie Wunsch Founder, Pacific Health Consulting Group
- 4. April 16th MACRA, H.R. 2, made law • Medicare Access and CHIP Reauthorization Act • Replaced SGR formula • EHR Incentive Programs to be streamlined into one new payment system • Incentivizes the shift to alternative, value-based payment models News from Washington:
- 5. It’s not going to get any easier SOURCE: The Medicare Access and CHIP Reauthorization Act of 2015; Advisory Board analysis. 2. APM participants who are close to but fall short of APM bonus requirements will not qualify for bonus but can report MIPS measures and receive incentives or can decline to participate in MIPS. Merit-Based Incentive Payment System1 2020: -5% to +15% 2019: -4% to +12% 2022 and on: -9% to +27% 2021: -7% to +21% 2018: Last year of separate MU, PQRS, and VBM penalties 2019 - 2024: 5% participation bonus 2019 - 2020: 25% Medicare revenue requirement 2021 and on: Ramped up Medicare or all-payer revenue requirements 1. Positive adjustments may be scaled by a factor of up to 3 times the negative adjustment to ensure budget neutrality. Actual positive adjustments may be lower than numbers shown here. In addition, top performers may earn additional adjustments of up to 10 percent. Advanced Alternative Payment Models22 1
- 7. The Cloud-based Service 7 Performance&visibility HIGH HIGH Connection to Outcomes Software ASP SaaS Cloud- Based Service The Cloud
- 9. First, we view software as a technology enabler, not as the product itself 9 SOFTWARE KNOWLEDGE SERVICESSOFTWARE • EMR • PMIS • BI • ACO • PAC
- 10. Second, we deliver constantly updated knowledge into the practice workflow 10 KNOWLEDGE SERVICES • MU • D2D • ICD • CPT • DRG • IPA • TLA SOFTWARE KNOWLEDGE US Patent # 7,720,701
- 11. Finally, we handle all the back-office work that technology doesn’t automate 11 SOFTWARE KNOWLEDGE SERVICESSERVICES • EOB • ANSI • ERA • CSI • HL7 • CCD • PCI • SOC 1 (SAS70) • FAX
- 12. Estimates of the proportion of primary care visits that might be attended by PAs or NPs range between 50%-75% Hospital-based physician Office-based physician Mid-level provider Support staff Patient Bring the principle of comparative advantage to the health care supply chain 12
- 13. Estimates of the proportion of primary care visits that might be attended by PAs or NPs range between 50%-75% Hospital-based physician Office-based physician Mid-level provider Support staff Patient Bring the principle of comparative advantage to the health care supply chain 13
- 14. Estimates of the proportion of primary care visits that might be attended by PAs or NPs range between 50%-75% Hospital-based physician Office-based physician Mid-level provider Support staff Patient Bring the principle of comparative advantage to the health care supply chain 14
- 16. We were once just like you.
- 17. 17 Fewer C-Sections 50% Fewer days in NICU 40%
- 18. 18 64,648 Providers on our network 200 million Automated patient messages delivered in 2014 $3.84 billion Collections posted per quarter 60 million Patient records 1.2 billion Data transactions processed annually
- 19. 19 51 million patients 110,000 interfaces 50B web hits / year 1 billion electronic transactions / year
- 20. athenahealth’s award-winning services can help you thrive through change 20“2014 Best in KLAS Awards: Software & Services,” January, 2015. © 2015 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com #1 Practice Management System (1-10, 11-75 physicians) #2 Practice Management System (over 75 physicians) #2 EHR (over 75 physicians) #2 Patient Portal #2 Overall Physician Practice Vendor 2014 Best in KLAS • 67,500+ providers on athenaNet® • Clients ranging from 1 to 5,000+ providers • 50 states and 112 medical specialties • $14 billion in client collections per year • 300k physicians on Epocrates • Entry into the Inpatient Space – Jan, 2015
- 22. 50 45 40 35 30 25 20 15 10 5 0 2009 2010 2011 2012 2013 2014 2015 athenahealth Growing FQHC Footprint 22 In implementation Customers live
- 23. athenahealth was first to undergo NCQA PCMH Corporate Review 23 athenahealth covers about 60% of the points required for NCQA’s highest level of PCMH recognition 85 35.25 45.5 0 20 40 60 80 100 Minimum amount of points for NCQA Level 3 Practice Responsibility 4.25 athena-Enabled Auto Credit* NCQA Level 1 NCQA Level 2 *pre-validated NCQA points *practice support points athenahealth PCMH Accelerator Program
- 24. FQHC billing is complex 24 Identification of and creation of “wrap around claims” Flexible reporting system to support UDS Claim splitting “rules” reduce work for billing staff Poverty-based sliding scales support indigent care
- 25. 25 First of its Kind Dental Integration Consolidated UDS Reporting
- 26. We are uniquely positioned to give FQHCs: CASH, CONTROL and FOCUS ON THE MISSION 26 $ No up front capital investment DAR: 38 days LPCR reduced by 3.73% 12% increase in collections % 100% of payment is success-based DAR Improvement: 46% Same day encounter close: 78% Provider documentation time: 6.7 UDS reporting PCMH accelerator service NO FAXES
- 27. Seaport Community Health Center athena Learning Center Community Offering Showcase Medical Practice Employee Health Benefit Belfast Health Center Initiative
- 29. Thank You
Notes de l'éditeur
- We’re starting today with the bottom line of it all: It’s really hard to be an FQHC. Though we’re living in the age of “digitization,” FQHCs have more reporting requirements than any other organization.
- The FQHC program remains an essential tool for meeting the health care needs of the underserved nationwide. However, the federal program’s sometimes convoluted requirements, coupled with similarly elaborate — and often duplicative — state demands, can test even the most sophisticated organizations. Bobbie Wunsch, founder and partner of San Anselmo, California-based Pacific Health Consulting group, a firm that provides management consulting to public sector health care entities. Source: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20ClinicsTaleChasingFQHCStatus.pdf
- On April 16th, the Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2 was signed into law, and is the basis for all of these recent changes. While this law permanently repealed the sustainable growth rate (SGR) formula, the new legislation also includes a small addition that has huge repercussions on the Medicare framework for paying physicians. Sources: http://www.familydocs.org/payment-reform/macra https://www.acponline.org/advocacy/where_we_stand/assets/macra_handout_need_to_know_2015.pdf Image source: http://www.healthcarefinancenews.com/news/icd-10-debate-hits-washington-most-prepared-worry-persists
- To dive a little deeper, per MACRA, providers will have two Medicare value-based reimbursement options: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). Put very simply: this bill represents the continued shift toward value-based reimbursement. The bill proposes that CMS offer a significant incentive for practices to make the move to providing care through, what they’re calling “Alternative Payment Models” or APMs, that are proven to bring about greater levels of care coordination and patient-center health management, such as PCMH. The bill proposes that starting in 2019, providers receive an automatic 5% participation bonus simply for proving that they are participating in an APM. AAFP - Additionally, the American Association of Family Physicians recommends that providers working in any size practice select option two, an APM such as a PCMH. Additionally, it is estimated that 75% of FQHCs have achieved NCQA-PCMH Level III Recognition in 2013. Source: http://www.nmfonline.org/file/pclp-project-database/Abraham-Jerry-Paper.pdf
- How to run a tight ship on a shoestring budget? With the cloud. Not necessarily with athena but here is what you have to look for, we’ll just use our model as an example today.
- Like banking – which is 67% cloud, health care is slowly moving up the evolutionary curve when it comes to technology. The key aspect when making any technology decision is What is the economic and performance relationship between my supplier and my organization. Am I paying for a tool or Am I paying for a result. When I win does my supplier win, when I lose does my supplier lose? How rapidly can my platform evolve with changing business conditions and how much is it going to cost me in terms of human capital and financial capital. What’s the utility – is the tool set good? Now let’s talk about where current technologies live on the evolutionary path.
- Remind people of our business model: We are a cloud-based business service and get paid based on results Software + Knowledge + Work = results
- Made immediately available Complete PMS, EMR & Patient Communications Functions Web-native, On-demand Guaranteed availability Intuitive, easy-to-use No capital expense Performance monitoring
- Bullets: Creates new rules for everyone on the Network Monitors, fixes broken claims Identifies and helps manage P4P data requirements so get every dollar you qualify for Formulary checking Drug /drug interaction Clinical reminders
- Bullets: Reminder & results calls Eligibility checking Claim submission / follow-up Denial & results handling Build and maintain free lab & Rx interfaces Meaningful Use Guarantee Performance coaching Handle document mgmt Add number of closed loop orders Post payments
- Comparative advantage Doctors shouldn't be doing paperwork - you do what you're best at and tell others what to do that they're best at
- Comparative advantage Doctors shouldn't be doing paperwork - you do what you're best at and tell others what to do that they're best at
- Comparative advantage Doctors shouldn't be doing paperwork - you do what you're best at and tell others what to do that they're best at
- We are constantly learning and making changes to better equip FQHCs to win. We know that 93% of FQHCs have adopted an EHR but we also know just how much time using that EHR can take up, adding headaches and frustrations and taking you away from face time with the patient. Back In the 1990s, Todd Park and Jonathan bush tried to re-imagine the birth experience and expenses in this country as the “Starbucks” of birthing centers. Took credentialed and skilled midwives to provide a safe, comfortable customer experience for mothers. Didn’t just treat pregnancy as an illness to be eradicated quickly. Tackle the low-hanging fruit and the glaring inefficiencies in the birthing process. Received a large portion of referrals from community health centers
- Customers loved our service. Births at our center resulted in C-sections 14% less often than the industry average. Our babies had 40% fewer days in NICU than the industry average. All of this for less than the cost of giving birth at a hospital
- We couldn't survive because we didn't have the infrastructure we needed to get paid. We changed our business plan to build the information backbone to help yours and others succeed One study estimated that doctors spend 168.4 million hours on administrative tasks per year while the average time spent with a patient during the exam is eight minutes. http://www.pnhp.org/news/2014/october/administrative-work-consumes-one-sixth-of-us-physicians’-time-and-erodes-their-mor The average U.S. doctor spends 16.6 percent of his or her working hours on non-patient-related paperwork, time that might otherwise be spent caring for patients. And the more time doctors spend on such bureaucratic tasks, the unhappier they are about having chosen medicine as a career.
- 51M patients 110,000 interfaces EDIs per day? 50B web hit/year 1B electronic transactions/year
- How we help FQHCs specifically
- We have many FQHC clients just like you
- PCMH accelerator program Level 1 with NCQA requires 35 points and with athenahealth’s 35.5 baseline auto credits, you easily achieve Level 1 just by applying. What this means is, if you remember back to MACRA, this is an automatic earning of that 5% included within MACRA now. We are one of three vendors offering auto credits in this way but we are the only ones offering so many that you achieve PCMH Level One status right from the start. Only two other vendors who have any auto –creds Animation: Automatic
- athenaNet reporting supports (Unified Data Set) UDS requirements across all Medicare programs athena has flexible reporting infrastructure and data warehouse availability to support data elements required for UDS reporting (we don’t have built in UDS, but we track the data) athena has fields on language, race, ethnicity, veteran status, etc athena has discrete data on OB/GYN episodes and HIV We don’t do staffing and cost reporting Poverty-based sliding scales support indigent care There are certain tiers of federal poverty guidelines based on income and size of family Once you enter income and size of family athenaNet auto-calculates their sliding fee (e.g. a 20% discount) Ability to provide enhanced support for identification of and creation of “wrap around claims” Other systems do this very poorly If patient has insurance with a Medicare or Medicaid Managed Care Program (replacement program), we send the claim to the managed care program, but the managed care program may only pay a portion of what would have been paid by Medicare or Medicaid directly. Athena automatically generates a second claim to send to Medicare or Medicaid to get our clients paid the difference between what the Managed Care company paid and what Medicare/Medicaid would have paid, with a unique revenue code that designates the wrap-around claim. In some cases you can’t submit the claim for some time after the first submission to the Managed Care Program, so athena has rules to HOLD the claim for a sufficient amount of time. Claim splitting “rules” reduce work for billing staff Claim formatting and coding rules reduces requirement to have many CBO staff that have deep understanding of FQHC claim splitting and formatting requirements With athenahealth, you enter charges one way and the same way for all claims, with a single charge entry screen You don’t need to remember the crosswalks – athenahealth rules engine automates the crosswalks for our clients We will split what goes to Part A vs Part B and then determine which provider numbers are needed for Part B vs Part A The splitting logic is based on procedure code and some other more complex circumstances Medicare has one standard set of rules for claim splitting across the country, but each Medicaid program may have different rules for their program (derivations of the Medicare program) (e.g. if the state code 101 is required, the client doesn’t need to remember, athenahealth does it for you)
- We do all of your reporting UDS and Dentrix
- Results to prove how good we are DAR improvement for FQHCs = 46%
- We are constantly learning through our on-campus FQHC Whole rooms dedicated to athena teaching that are learning rooms – observations all day long athenanet just built for FQHCs tiger team to continue to improve