In an April, 2018 letter from the American Medical Association (AMA) to Centers for Medicare and Medicaid Services (CMS) top administrator Seema Verma, a “reduced reporting period for future MIPS program years in order to reduce administrative burden” was requested, further illustrating the stress felt by practices bracing for a sea change.

Capitol Hill staffers cited physician workload and administrative burden as the primary catalysts for physician meeting requests with their congressman in an October 11, 2018 meeting with PharmD Live®’s executive team. They further described the uptick in administrative burden due to increased QPP reporting requirements as the root cause.  

Dr. Paul Williams, PharmD Live®’s Chief Medical Officer, stated, “Many QPP measures focus on between-visit care, which can add significantly to the physician’s workload. Many practices have chosen to partner with third-party vendors, such as PharmD Live®, which have the potential to reduce physician burden and boost quality metrics while increasing direct and indirect practice revenue.”

But how does a partnership with PharmD Live® alleviate the administrative burden and reduce physician workload?

PharmD Live®’s chronic care management services are designed to ease the transition to value-based care. As you know, Medicare reimburses for chronic care management and complex chronic care management delivered via telehealth between office visits. PharmD Live®’s board-certified pharmacists deliver between-visit care and are medication experts capable of making high-level clinical decisions. Pharmacists are available around-the-clock to deliver care, answer questions and tend to patient needs.

Because the PharmD Live® technology solution is integrated with the physician’s electronic health record (EHR), patient information is updated in real time. PharmD Live® provides billing reports and metrics data to streamline Medicare billing and communications.

To learn how a partnership with PharmD Live® can ease your transition to value-based care, schedule a demo.

The post Reducing Burden In A Value-Based Care Model: What Physicians Need To Know appeared first on Pharmdlive.

Value-Based Care is not as complicated as it sounds.  “The Affordable Care Act (ACA) in 2010 was the first legislation to make mention of the change to Value-Based Care.”² However, the changes took nearly a decade to implement. .  FFS theoretically caused physicians to emphasize the number of procedures and patients, which led to suspicions that FFS was driving up medicine’s overall cost. .  “Value-Based Care is a ‘new’ healthcare payment model that shifts medical provider’s reimbursement from Fee-for-Service to Fee-for-Value, with value defined as care quality, cost, efficiency, and effectiveness. Physician reimbursement will be tied directly to care quality, patient outcomes and overall cost-efficiency, rather than to the act of performing tests or procedures — i.e., physicians will only receive full reimbursement from insurers for effective care.”

The Merit-based Incentive Program System (MIPS) is one of two payment tracks under the Quality Payment Program (QPP). The other compensation track is Value-Based Care (VBC). There is some expectation that VBC may drive down patient billings.  It may be more accurate to say that billings might remain flat for some time .

VBC should have the effect of reallocating a practice’s time, focusing on optimizing care instead of numbers. FFS was adequate, but VBC will drive clinical quality.    As you will see in this analysis, compensation will not differ significantly  under VBC.  The new model proposes that physicians spend more time with the elderly and the chronically ill, especially those age 65 and older.  This change will lower the morbidity of those groups and reduce their likelihood of ER or hospital visits.  Physicians (expert caregivers) can concentrate on improving outcomes for these  high-risk patients.  In turn, they will see improved Quality Payment Program (QPP) measures in their practices.  

When high-risk patients are under an expert and watchful eye, metrics such as “hospital readmissions” can improve for patients on four or more drugs. Overprescribing is out of control and everyone involved needs to check and check again.  With this change of focus in mind, let’s talk briefly about designing a VBC compensation plan. 

Constructing a compensation plan to motivate and reward physicians and other staff can be straightforward.  “There are many factors to consider when selecting quality metrics, but best practices are measures that drive desired physician performance improvement to those that influence reimbursement. Maintain a coordinated strategy for quality metrics…to ensure payer requirements overlap and focus on a low number of measures.”³ Creating only a few metrics is the best way to keep staff focused and motivated.  Practices want them to succeed and be optimistic about the new measures.  “Value-based performance incentives are most often tied to quality measures, chosen by a collaboratively derived physician committee.”⁴  It is essential to include the ability for staff to achieve full or half credit on quality measures.   

We encountered several sample compensation plans online.  The most common element in those plans is that 80% of compensation is positioned to be guaranteed.  Incentives on various metrics can allow staff to earn back the remaining 20%.  Administrators are working with physicians so that they are reasonably able to earn what they earned under FFS.  There does not seem to be a punitive nature to the new compensation.  One consideration is that practices are measured on the whole, not on the contributions of individual physicians.   But are there ways to improve the viability of the entire practice?

One way that we have alluded to here relates to elderly patients with more than one chronic illness.  Among your practice, these patients tend to be 65 and older, standing out because of their polypharmacy and frequency of hospitalizations.  What if there was a way to protect their health?  What would that do to your quality measures?  Chronic Care Management (CCM), is a Medicare program that can improve 80 different MIPS measures while improving the health of the age 65 and older population.  The priority of CCM is to provide special attention and medication management to this at-risk population.  Because this group typically takes multiple medications, increased medical oversight is indicated and recommended by Medicare.  Medicare has announced billing codes for CCM patient care intended to occur between their regular office visits.  CCM patients can receive remote care through telehealth, or other technology, from doctors, advanced practice registered nurses and other practitioners.  CCM partner companies can handle the regular care and monitoring of these patients.  A number of firms offer CCM outsourcing.  One company, PharmD Live®, specifically employs clinical pharmacists as direct care providers. Pharmacists are highly trained in medication management to ward off Adverse Drug Events (ADEs). The PharmD Live® pharmacy team uses proprietary Artificial Intelligence software to find impending ADEs and disease care gaps.  Since medication is key to chronic care, their staff focuses on improving medication management and adherence.

PharmD Live®’s pharmacy staff assists the patient where they are: at home, in a facility, or in transition.  Keep in mind that many medication errors happen when patients move.  PharmD Live®’s CCM solution reinforces the physicians’ treatment plan and instructions to their patients.  Our CCM goals are to improve patients’ health and bolster ties to their physicians.  PharmD Live® engages with the patient to create health goals to be included in a Care Plan for the patient that are billable to Medicare.  In summary, the increased attention of CCM is life-improving and enables the patient to spend more time at home with loved ones.  Taken further, CCM, under Value-Based Care, will improve practice quality scores and increase compensation opportunities.

Medicare studies have shown that CCM creates better outcomes. VBC is already rewarding better outcomes.  CCM means an additional profitable revenue stream for practitioners.   PharmD Live®’s technology is HIPAA-compliant and enables a bi-directional patient data flow in real-time.  PharmD Live®’s implementation team is experienced and will set up CCM care with minimum disruption.  If you have barriers to starting CCM, like limited time or technology, PharmD Live® can help your practice succeed.   We provide optimal healthcare with efficiency, sensitivity, and the right telehealth solutions.  CCM is a way to increase MIPS Scores, VBC participation, and population health.  With so many changes in healthcare, keep your practice ahead of future trends and technology.  Find out about CCM with PharmD Live®.    

1. https://www.medicaleconomics.com/view/bringing-value-based-compensation-your-medical-practice
2. https://vittana.org/17-fee-for-service-pros-and-cons
3. https://hbr.org/2005/07/the-balanced-scorecard-measures-that-drive-performance
4. https://cokergroup.com/understanding-value-based-compensation-models/

The post Value-Based Care & Compensation appeared first on Pharmdlive.

Chronic Care Management Reimbursements are Generous 

CCM will see the most remarkable change in 2022, with reimbursement increases as high as 60% (see chart below). CMS increased reimbursement rates generating substantial revenue for physician practices.*  Let’s put that into context: 

2022 CCM REIMBURSEMENT RATES 

[wptb id=3829]

An easy way to gauge potential revenues for your practice is the 40-40-20 rule: 40% of your CCM patients will require 20 minutes of time, 40% will require 40 minutes of time, and 20% will require an hour or more, per month.

Remote Patient Monitoring CMS Reimbursement Adjusted

CMS adjusted pricing downward for their reimbursement model for RPM CPT codes. Despite these lower rates (see chart below), RPM is still a beneficial program to include in your practice both from the perspective of improved health for your chronic care patients and your bottom line. 

2022 RPM REIMBURSEMENT RATES 

[wptb id=3830]

Despite handsome CMS reimbursement rates for chronic disease management, only 5% of the $40 billion CMS incentive dollars have been disbursed to physician practices around the country. That’s because many practices  believe there is excessive investment of their time and technology required to get a chronic disease management program implemented. This is where PharmD Live® can help. We provide turn-key CCM and RPM solutions with personalized chronic care coordination and medication management through board-certified pharmacists who function as an extension of your team. We charge no upfront costs or monthly subscription fees. We are paid based on your CMS monthly reimbursement.

Contact us today to determine how much additional annual income your practice can earn.

The post New 2022 Rates Position CMS’ Chronic Care Programs Are Ripe for Increased Revenue, Improved Outcomes appeared first on Pharmdlive.

A national survey, The Physician Task Load and the Risk of Burnout Among US Physicians (The Joint Commission Journal on Quality and Patient Safety 2021; 47:76–85), describes the look and feel of an albatross around the necks of struggling providers. The metaphor is supported by the direct relationship between physician task load and burnout. Overburdened with tasks, providers struggle to reconcile workload and patient care, often sacrificing necessary social relationships and support. To guide improvement efforts, the study highlights two key areas for meaningful improvements: staffing and technology.

Until now, most solutions suggest an either/or scenario. Bring in more staff, on contract if necessary (which the study shows can degrade team spirit), or add technology. This is less than helpful. While technology is not going away, incorporating it well and in a hurry may be more trouble than it’s worth in a moment of crisis.

MIPS performance year 2022 (with payment year in 2024) offers fewer performance guard rails and exceptions–we’ve entered real-time quality improvement and performance measurement. It’s time to shake off the giant bird and figure out how to restore the feelings of camaraderie in the office to improve morale. Make a move to increase patient satisfaction and overall quality scores.

Capture the best of Q3-4 2022 MIPS, CCM, and RPM 

Countless technology firms have pitched ways to code the work that captures maximum Part B reimbursement, but they often cost money up front resulting in a gamble because these alternative coding and billing schemas are unproven and risky. Meanwhile, the staff is exhausted. Some have left for greener pastures and others find their time monopolized with non billable activities for chronic care patients. To increase revenue, you need to land on the far right side of the curve and improve quality, reimbursement, staff and patient satisfaction. Something has to give. 

Physician practices that accept Medicare are already enrolled in the Merit-Based Incentive Payment System (MIPS). Whether or not they have submitted data in the past, practices must prepare for the realities of performance-based payment now, not 2 years down the road. With the first quarter of Performance Year 2022 in the books, being inattentive for the balance of 2022 will have steep financial consequences in 2024 when payments are disbursed.

Practices need an effective, easy solution NOW

To grow revenue AND alleviate the issues of burnout, ideally you can work with a service that provides the staff resources to follow chronically ill patients and Medicare patients with two or more chronic conditions. They should provide technology to code and keep medical records for prompt reporting to CMS without introducing the stress of a steep technology learning curve. 

PharmD Live® offers patient-centered, chronic care management services that can alleviate the workload burden and assist with relevant coding and billing, improving practice morale and revenue in one simple step. 

With an algorithm to identify at-risk patients, clinical pharmacists working on behalf of your practice use PharmD Live® technology to capture relevant data. 

Medicare programs for Chronic Care Management (CCM) and Remote Physiologic (Patient) Monitoring (RPM) are structured to provide billable time for the patients who will benefit from closer supervision between regular office visits. Patients achieve improved outcomes, and the practice is compensated for time spent on these activities. The benefits of having a PharmD monitoring medications and health indicators include elevating the remote care provided to identify and prevent adverse drug events and flag potential health issues.

“Pharmacists’ innovations touch our daily lives and, most importantly, pharmacists complete the care cycle for patients. PharmD Live®’s pharmacist leaders are rooted in rigorous education and the highest standards of professionalism,” says PharmD Live® CEO Cynthia Nwaubani, PharmD, BCGP, CMTM. Founded and managed by clinical pharmacists, PharmD Live® offers disease and medication management solutions to identify and address disease care gaps and medication-related problems.

Choose the method and technology to stay ahead of the curve

The value of the PharmD Live® approach to solving post-acute care was recognized by trend scouting and analysis firm StartUs Insights. In examining 762 global HealthTech startups and scaleups in 2021, they noted, “Staying ahead of the technology curve means strengthening your competitive advantage.” PharmD Live® ranked in the top five.

The StartUs Insights recognition looked at post-acute care. PharmD Live® is better known for its chronic care management services. Dr. Nwaubani explained the benefits of PharmD Live®, “Medication misuse, underuse, and overuse is detrimental to patients and accounts for $300 billion in healthcare costs, which are both unsustainable and preventable.” 

PharmD Live® model is attractive for medical practices

MIPS tracking improves patient health and other targets. A potential financial gain is possible  when paired with the CMS’ chronic care management and remote patient (physiologic) monitoring programs. 

CMS reviews and adjusts various performance categories annually, at a minimum. PharmD Live®’s practices are continuously updated to ensure your data collection and reporting reflect the rules. 

PharmD Live® provides chronic care management services to capture data for CCM and RPM reimbursement reports the primary care physician can submit for the 2022 performance year:

• Performance threshold: Establishes a performance threshold of 75 points, up 15 points from last year
• Performance category weights 2022 performance year/2024 payment year: 
  • 30% quality
  • 30% cost
    • Cost performance category: five episode cost measures were added to the cost category
  • 15% improvement activities
  • 25% promoting interoperability–reporting requirements have changed 

Enroll in CCM and RPM programs with PharmD Live® and pay nothing for implementation, no subscription fee, and benefit from additional quality measures identified by PharmD Live®. Revenue is generated for both parties through the CMS reimbursement process the doctor’s office submits monthly to Medicare. 

Links

www.startus-insights.com

www.startus-insights.com/innovators-guide/discover-5-top-post-acute-care-solutions-impacting-healthcare

www.pharmdlive.com

References

Webinar slides: Integrating Organizational Actions Toward Patient Safety and Clinical Wellbeing

Michael R Privitera MD MS Medical Director, University of Rochester Medical Center;  Kate MacNamee MS Director of Design Research at Ximedica Senior Human Factors Engineer; July 15, 2021 https://www.ama-assn.org/system/files/organizational-actions-toward-patient-safety-webinar-slides.pdf

The post Part B reimbursement: earn revenue while saving time appeared first on Pharmdlive.