Office Managers Meeting October 16, 2013
KATHY OBSTARCZYK DIRECTOR OF PHYSICIAN SERVICES
ICD-10 UPDATELINDA HORTONVice PresidentClinical Innovations & OutcomesCatholic Health
ALLISON SPARAProject Team CoordinatorKAREN BURGERCDI ManagerCatholic Health
ICD-10 Overview • ICD International Classification of Diseases is used on virtually 100% of patients and visits within CH – all ministries • ICD CODES are used to describe and catalog the patients’ conditions (Diagnosis) and the Acute Inpatient Procedures • ICD directly influences 90% plus of all of CH Revenue Streams $$$,$$$,$$$.$$ • The WORDS and Clinical VALUES ( a tumor size measurement) present in the clinical record are used to assign the CODES • ICD-10 is federally mandated change from ICD-9, due Oct 2014 • ICD-10 directly impacts Software Applications that contain/process ICD-9 codes – all will need to be upgraded • ICD-10 is a major Financial risk and significant Clinical impact
What are the Benefits of ICD 10? • Improve operational processes across the health care industry by classifying detail within the codes to accurately process payments and reimbursements. • Increase flexibility for future update. • Enhance coding accuracy and specificity to classify anatomic site, etiology, and severity. • Provide more detailed data to better analyze disease patterns and track/respond to public health outbreaks. • Provide payers, program integrity contractors, and oversight agencies with opportunities for more effective detection and investigation of potential fraud or abuse and proof of intentional fraud.
What Does Specificity Look Like? 50% of all code sets in ICD -10 relate to musculoskeletal system 36% of all ICD -10 codes distinguish ‘right’ vs ‘left’
CHS Resources:Catholic Health Intranet • CHS Intranet ICD-10 Education & Training Page • https://my.chsbuffalo.org/edu/icd-10
CHS Resources:El Sevier Online Training • El Sevier/MC Strategies Performance Manager – ICD-10 eLearning Page • www.webinservice.com/CatholicCoreLearning The default username and password is as follows: • Username: Learner’s First Initial (caps) + Learners Last Initial (caps) + Four digit year of Birth + Last four digits of SSN • Password: hello
CMS Resources:Implementation Guide & Timeline • CMS ICD-10 Implementation Guide for Small and Medium Practices • http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumPracticeHandbook.pdf • CMS ICD-10 Small Providers Timeline • http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallProvidersTimeline.pdf • CMS ICD-10 Myths and Facts • http://cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10MythsandFacts.pdf
AMA Resources • AMA ICD-10 Resource Page: • http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page • See AMA Educational Resources Fact Sheets #4 & #5 for Implementation
Basic ICD-10 Curriculum • Orientation to ICD-10 for Physicians and Non-Physician Practitioners / Managers / Non-Coders • 1 lesson, 1 hr • El Sevier eLearning Page • Nuance Awareness Presentations • Clinical or Non-Clinical Focused (45min) • Navigate to CHS Intranet, ICD-10 Education Page for Links
ICD-10 Non Clinical Nuance Presentation The Non-Clinical Video is tailored for billing, finance, and administrative associates. • Non-clinical Video - full video and audio presentation • Non-clinical PowerPoint The Clinical Video is tailored for any associates involved in documentation, and the administration of direct patient care – physicians, nurses, therapists, etc. • Clinical Video - full video and audio presentation • Clinical PowerPoint
Who? • Awareness Presentation and Orientation to ICD-10 should be completed by: • Physicians/Clinicians • Office Management • Office Staff • Administration
Tips for your Next Steps Begin your Education Create a written inventory of everything you do with ICD-9 codes in your practice (who, what, where, when, why, how?) Find your top list of ICD-9 Codes currently used in your practice – then use resources to understand how ICD-10 will impact them Watch for Communications from us and from I3 HEALTHeLINK Partnership
What is a Health Insurance Exchange? • It is a store or shop specializing in health insurance merchandise.
Two Types of Exchange: • Private Exchange: health insurance exchange managed by a private company (broker/insurance) • Public Exchange: health insurance exchange managed by a public entity (State, Federal Government) for individuals and small businesses
New York State Exchange • Individual Market Health Insurance Exchange: sells individual and family insurance. Selection from multiple plans ranging from high to low deductible. Individual pays premium directly to health plan. • Group Exchange: an exchange that sells group health plans to an employer who pays a percentage of premium. Employer pays the health plan on behalf of the employees.
Benefits • Doctor visits/outpatient services • Emergency services • Hospital care • Maternity/newborn • Mental Health/Substance abuse • Pharmacy • Rehabilitation/habilitations services/devices • Laboratory • Wellness preventive services • Chronic disease management • Pediatric - oral/vision
Out of Pocket Maximum • Individuals - $5,950 • Family - $11,900
Four Levels of Insurance from the New York State Insurance Exchange
Penalty • $95.00 for individuals or 1% of income whichever is greater • 2015 - $325.00 or 2% of income whichever is greater • 2016 - $695.00 or 2.5% of income whichever is greater
Small Groups < 50 (30 hours of employment) • 60 day notice in advance renewal • Options: • Discontinue coverage • Public Exchange – individuals • SHOP - your group • Continue with health plan (4 metals) • Broker • Private Exchange
Summary • Health care is a concept • The real product is health insurance • Two types: individual/group • Public Exchange has advantage of having a tax credit • Individuals with annual income 133 - 400 percent FPL will have contributed capped at 9.5% of income when purchasing the Silver level plan. • Businesses with fewer than 25 employees paying average salaries of less than $50k will qualify for tax credits.
Approved Monthly Premium Rates – Buffalo, NY Single Coverage Rates Rates: Employees with Spouse: Multiply by 2.00; Employees with Child(ren): Multiply by 1.70; Employees with Family: Multiply by 2.85; Source: http://www.governor.ny.gov/assets/documents/Approved2014HealthInsuranceRates.pdf
Survey Background • CG – CAHPS: Clinician and Group – Consumer Assessment of Health Providers and Services • Industry standard tool for clinical group offices • National Committee for Quality Assurance (NCQA) and • The Agency for Healthcare Research and Quality (AHRQ) • Catholic Medical Partners has adopted this tool and methodology so that we can compare data across populations and to national benchmarks. • New Vendor: Our survey vendor is National Research Corporation, Inc. , in Lincoln, Nebraska. That is where the surveys will be mailed from and returned to.
2014 Patient Experience of Care Survey • Physicians in the following specialties will have their patients surveyed and will receive reports: • Family Practice • Internal Medicine • Cardiovascular Disease • Endocrinology • Pulmonary Disease • Nephrology • Obstetrics and Gynecology
2014 Patient Experience of Care Survey Details • In January 2014, Catholic Medical Partners will send a patient experience survey to patients under our contracts who have had a visit in the past year. EXCEPT the Medicare FFS patients under the ACO contract. Medicare will be surveying ACO members (Medicare FFS) in January 2014 with the same survey. • No patient will receive two surveys. e.g., if a patient had a visit with two or more Catholic Medical Partners physicians they will only receive a survey for one of the physicians. • The survey is of the patient’s experience with their physician and their physician’s office.
2014 Patient Experience of Care Survey Details • The practice name the will appear on letters and envelopes and physician name will appear in the letter. • We will not be using practice logos this year. • Surveys will be mailed with a postage paid return envelope and an 800 number to call if they have questions. • A follow up survey will be mailed to non responders 3-4 weeks later, also with a postage paid return envelope.
2014 Patient Experience of Care Survey • As we get closer to the mailing, you will receive e-mails notifying you of mail dates, links to materials posted on our website and other materials such as an office FAQ. • All physicians whose patients are surveyed will get a report of their results during the 1st Quarter of 2014. • All reporting will be online.
2014 Patient Experience of Care Survey PLEASE In December, we will ask that you: • Inform your staff that this survey is taking place • Share survey materials with staff The more returns, the more reliable and actionable the information is for you.
Questions? • Contact Nancy Hourigan 862-2166 or via e-mail at firstname.lastname@example.org
Program Overview • 3-year contract with Medicare for Medicare Shared Savings Program • 302 participating practices • Take care of a defined population of patients • MCR FFS beneficiaries only • ~25,500 • Bend the cost trend to come under the MCR-set budget • at least 2.4% • Score well on 33 quality measures for a chance to share in the savings • These measures replace reporting for MCR’s PQRS
Administrative Program Requirements • Display ACO poster*, visible to all patients, in each participating location • Notify once each MCR FFS patient of your participation in the program • Document this notification-in case of future audit • Give patient opportunity to decline to share claims data • Not good for us if they decline • If they DO decline, have them sign a form* and fax back to Vera Dovirak at 886-1721 or mail to CMP *Poster and declination forms can be obtained from me after the meeting
ACO Attribution Model-taking care of a defined population ~4,500 or 15% of all ACO patients are attributed through Step 2
2012 GPRO Overview • Sample of ~4000 patients • many selected from those attributed based on SCP • Used data from cycle reports and manual upload • 33 Measures encompassing 4 categories: • Patient/Caregiver Experience (CAHPS)- administered by MCR • Patients’ Rating of Doctor • Access to Specialists • Care Coordination/ Patient Safety • Preventive Health • Tobacco screening and counseling • Mammography/ BP screening and follow-up • At-Risk Population • Diabetes composite Scored below 30th Percentile Scored below 30th Percentile Scored below 30th Percentile
Outpatient Care Quality Measures (1 of 2):it’sall about access to primary care
Outpatient Care Quality Measures (2 of 2):it’s all about the experience provided by your office
How to Optimize Our ACO Performance • PCPs: run reports to capture patients not seen in 12 months • SCP: encourage patients to see their PCP at least annually • Keep in mind the ACO quality measures for which we are responsible • Notify all MCR FFS patients of your practice’s ACO participation • We can request claims data on all notified patients=knowing where to look for data during next GPRO=less work for practices
ACO Model:A Feedback Loop • HCC scores are used in determining our annual ACO budget • Metrics are used to determine quality of care provided to the ACO population • Example: 250.00 (unspecified diabetes) • Receive base HCC score=least $$ allowed • If patient is more complicated, then the budget expenditures • $$ not allotted in the budget are spent on providing quality care • <$$ left eligible for shared savings
Strategies • Continued emphasis on Primary Care and selected specialties to provide infrastructure and care model consistent with population management.