PulseThe

ofWinter 2018

continued on page 2

Many of these achievements and support provided by TPA are part of member benefits.

TPA recognized 140 specialty practices with the Service Excellence Award in Care Coordination and 24 practices with the Service Excellence Award in Quality Improvement. This new program highlights the importance of collaboration between specialty practices and Patient Centered Medical Home primary care practices to improve care coordination and quality. TPA created marketing templates for practices to promote their SEA achievement.

130 primary care practices received Patient Centered Medical Home designation from Blue Cross Blue Shield of Michigan, representing 92 percent of all TPA primary care practices and 95 percent of TPA primary care physicians in the Physician Group Incentive Program (PGIP). This means that 97 percent of all TPA PGIP patients are attributed to a PGIP practice.

A variety of patient education materials were developed to help stimulate conversations regarding important screenings, decreasing unnecessary

Continuing to support physician successThe Physician Alliance is heading into

a new year on the heels of a busy

and successful year. The healthcare

industry continues to change, often at

a moment’s notice, and the physician

organization works to fluidly prepare

for and move with those changes.

Let’s take a moment to recognize

some key accomplishments of the

organization and member practices.

2

Dear members,

Happy New Year! I hope you had a happy and healthy holiday season. Last year was one of the most dynamic years our organization experienced since our formation in 2011. You can read in our cover story of several milestones our organization achieved. I’m proud of the hard work of our staff, practice resource team, regional medical directors, board of managers and committees in meeting the ever-changing demands of the healthcare industry.

There are many of your accomplishments we also celebrate – 352 of our primary care physicians achieved patient centered medical home designation, representing 92 percent of all TPA primary care practices. This is quite an achievement since our 428 total PGIP practice units span six counties and over 1,500 square miles. TPA presented 140 specialists with our new Service Excellence Awards for Care Coordination and Quality Improvement, and 896 of our specialists receive value based reimbursement uplifts of 5-10% on their BCBM business. Our organization improved our Medicare Advantage PPO quality score rating to 4.5 (out of 5).

This new year brings broad market trends, including growing government regulation that will pressure profitability, raise the bar for quality and accelerate the transition to value. The continued shift of costs and decision-making to consumers will push healthcare into a more demand-driven market. These trends, and other changes in the healthcare industry, will be focus areas for TPA as we work to ensure our members be leaders in the marketplace.

I’m proud of our accomplishments in 2017, especially of the teamwork that goes into these successes, including from your staff and you. We couldn’t achieve these improvements in patient care without you. I look forward to the possibilities of 2018.

In good health,

Michael R. MaddenPresident & CEO

President’s MESSAGE

diagnostic tests and antibiotics, and more. TPA also created non-prescription pads to help decrease antibiotic use for viral infections in adults and pediatrics, and decrease imaging for low back pain. These materials are available for download or ordering from TPA’s website (click on the Learning Center).

A comprehensive gap in care closure pilot launched in early fall to assist practices in improving quality metrics. TPA staff and practice resource team worked with primary care physicians and practice staff to identify and correct false gaps, and contact patients to complete screenings and diagnostic tests. These efforts led to more than 2,150 gaps closed (46 practices) Sept. 1-Dec. 31, 2017. TPA is developing action plans to assist practices in focusing on gaps closure throughout the year.

TPA hosted many education programs for practice staff and physicians, focusing on coding and billing, critical compliance issues, patient self-care engagement and more.

The rebranded Affiliate Partners program (formerly Physician Discount program) continued to provide practices with access to high quality, competitively priced programs and services from 19 experts in a multitude of industries.

556,243 patients are included in TPA’s disease registry, Wellcentive, with 371 primary care physicians receiving monthly clinical data feeds from 34 interfaces feeding into Wellcentive. <

Team work prepares for new year continued from page 1

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A patient sits in your exam room, presenting symptoms of congestion, ear pain and low fever. Her medical history includes cancer, low blood pressure and smoking. What diagnosis codes are entered into her electronic medical record? What codes will you get reimbursed for?

Correctly coding patient conditions can be the difference in a physician being considered a low-cost provider versus high cost, affecting overall payment. Low cost, high quality providers are eligible for up to four percent increase in reimbursement from the Centers for Medicare and Medicaid Services starting in 2019.

Accurate coding helps ensure that costs are properly aligned with the patient disease burden. This helps control overall healthcare spending costs and assists in physicians receiving appropriate payment reimbursement.

Using the MEAT method when coding a patient encounter can help ensure documentation is correct and fulfills CMS’ requirements for appropriate diagnostic coding. The codes provide support for the medical need for services, letting the payer understand why a service was performed. Here’s a breakdown of how MEAT can help with documentation:

M E A TMonitoringThe information included in the medical record, including signs, symptoms, disease progression/regression.

EvaluationTest results, responses to treatment and medication effectiveness in treating the disease should be part of an evaluation in a medical record.

AssessingProcesses considered part of assessing the patient include discussion of symptoms and disease, ordering of appropriate tests, reviewing records and counseling of patient.

TreatingTherapies, medications and other modalities are part of treating that should be included in the medical record.

A matter of coding correctlyBe cautious in codingMedicare Advantage plans look for common chronic conditions to be documented in the Medicare patient’s chart, such as congestive heart failure, breast cancer, angina, and diabetes (without complications).

Practices should code all documented medical conditions presented at the time of a patient encounter, including those that affect treatment and care management. However, practices should be cautious to not assume the past medical history of a patient has a direct effect on the current condition that the patient is receiving treatment. Past medical conditions can’t be coded during the current visit unless that condition has a direct link to the current encounter. For example, stating ‘history of’ indicates the patient no longer has that particular condition.

Coding is becoming more critical to ensuring quality care is given to the patient, and physicians receive appropriate reimbursement for their services. Knowing proper codes, implementing best practices and creating action plans to close gaps in care are important steps in improving quality of care and payment. <

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Quality reports that show missing screenings and diagnostic tests have far reaching effects on the healthcare system. Reports may indicate patients are missing important screenings to detect a potentially life-threatening illness and physicians are deemed low quality providers and lose revenue.

There are various reasons that gaps in care are reported. Noncompliant patients, coding errors, reporting errors, gaps in time of reporting, missing EMR data and others. Creating processes to address and prevent gaps can lead to improvement in quality scores, revenue and overall patient health.

Last fall, The Physician Alliance took steps to assist practices in closing critical gaps in care for screenings. This project included working with primary care physicians and practice staff to review gaps, identify and correct false gaps, and establish plans to contact patients to complete screenings and diagnostic tests. The team work enabled 46 practices to close more than 2,150 gaps between Sept. 1–Dec. 31, 2017. The project focus included adult patients. Pediatric patients will be included in the first quarter of 2018.

The new year marks a good time to establish action plans to focus on remaining gaps and prevent gaps going forward. The tips provided in the box can help start the plan.

Gaps in care

update

Tips to close gaps nowContact patients who didn’t get screenings or tests by Dec. 31, 2017 to ensure these are completed.

Send notices in the patient portal, mail letters or postcards, make calls to patients to schedule in 2018.

Talk to patients during appointments about necessary screenings and make sure to provide scripts. Create a plan with your staff to help patients schedule screenings and follow up before leaving your office.

Check your gaps in care reports quarterly to see your gaps and progress. Doing a little at a time can be much easier and more efficient with staff time and projects.

Check out the patient education materials created by The Physician Alliance that focus on key quality metrics and screenings, such as managing diabetes, breast cancer screening and more. Download these at www.thephysicianalliance.org/LearningCenter/PatientEducationMaterials. <

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401(k)/Wealth Management Hollander & Lone Contact: Dan Hollander dhollander@hollanderlone.com (248) 485-8111

Accelerate Patient Payments Exchange EDI Contact: Joseph Fox info@exchangeedi.com (248) 509-0894

Accounts Receivable Management and Collections Transworld Systems, Inc. Contact: Michael Glass Michael.glass@transworldsystems.com

Commercial Real Estate Services Lino Realty Contact: Michael Pulcini michael.p@linorealty.com (586) 212-0755

Construction and/or Design Services Ferlito Construction Contact: Mike Ferlito mike@ferlitogroup.com or Tony Ferlito, tony@ferlitogroup.com (313) 237-2000 Ext 224

Cyber liability insurance Huntington Insurance Contact: Rick Loss rick.loss@huntington.com (419) 720-7911

Digital TV Marketing Reel Health Network Contact: Michelle Santino Nichols, msnichols@reelhealthnetwork.com 313-804-4337

Document Scanning Sharecare Health Data Services Contact: Melissa Wetli melissa.wetli@sharecare.com (248) 977-3926

Document Storage Leonard Bros. Data Management Contact: Blaine Belford bbelford@leonardbros.com (248) 591-6904

Employee benefit/Insurance consulting services LoVasco Consulting Group Contact: Michael LoVasco mlovasco@lovascogroup.com (313) 394-1702

Legal Services Rickard & Associates, P.C. Contact: Lori-Ann Rickard info@larlegal.com (586) 498-0600

Medical Answering Service Ambs Call Center Contact: Aaron Boatin or Ryan Ambs sales@ambscallcenter.com (586) 693-3800

Medical Malpractice Insurance Coverys Contact: Tina Dowler tdowler@coverys.com (517) 886-8345

Medical Supplies J & B Medical Supply Contact: Mark Novak mnovak@jandbmedical.com (248) 730-2789

Medical Waste Services Bio-MED Medical Waste Contact: Chris Dreckmann chrisd@biomedmedicalwaste.com (800) 736-2466

Office Supplies & Solutions Office Depot Contact: Christina Leza Christina.Leza@officedepot.com (855) 337-6811 x12734

Technology Support MBM Technology Solutions Contact: Sales@MBMSolutions.com (248) 597-1095

Vaccine Purchasing Program Merck Contact: Melissa Ottinger melissa.ottinger@merck.com (586) 214-5112

Kick off the new year with savings!The Affiliate Partners program is a great benefit for The Physician Alliance members that provides access to premium services and products at discounted pricing. The following list highlights companies that offer preferred pricing to TPA members. Additional information can be found at www.thephysicianalliance.org (Affiliate Partners tab) or by directly contacting the companies.

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CMO CORNER

By Karen Swanson, M.D.

The grim statistics for the current opioid crisis are too familiar. Prescribed substances are killing 91 Americans daily, more than heroin and cocaine combined, according to the Centers for Disease Control and Prevention. The deluge of journal articles, newspaper headlines, and cable network “breaking news stories” on the epidemic is overwhelming, depressing, and alarming for most physicians. The opioid problem was declared a national emergency in October 2017, although funding stalled to treat the emergency.

Many experts believe the crisis began in the mid 1990s when a national effort to better control pain was implemented and pain became the 5th vital sign. Physicians felt pressure to eliminate pain without guidelines or best practice approach. Patient satisfaction surveys began including questions related to pain control and health care workers dramatically increased their prescribing of controlled substances. In the decade following the arrival of the 5th vital sign, opioid prescriptions quadrupled. The rates of overdoses and deaths related to opioids spiraled in tandem with the prescription rates.

The health insurers also limited access to less additive alternative pain treatments such as nerve blocks, cannabinoids, duloxetine (Cymbalta), anti-epileptics, and methadone/naloxone combinations (Suboxone and Vivitrol). The insurers have been reluctant to cover alternative forms of pain management which include massage, acupuncture, TENS units, yoga, cognitive behavior therapy, and virtual reality game therapy (SnowWorld). Payers have also linked performance incentives to patient satisfaction surveys which include question about how well the pain was controlled after a procedure or hospitalization. Socioeconomic factors such as unemployment, lack of upward mobility. and financial insecurity contributed to the system.

How can physicians assist in putting the genie back in the bottle? The United States writes 81% of worldwide oxycodone prescriptions and far more opioids than any other country in the world. The current expectation of opioid medication for primary treatment for acute and chronic pain

has created the crisis. Doctors need to rethink how they treat pain and initiate honest discussions with patients about the level of expected pain so that patients can understand some pain is normal. Educating patients that opioids are not necessarily the best way to manage pain will assist in countering our cultural reliance on opioids. Physicians also need to recognize patients with depression, anxiety or social challenges are at high risk for abusing opioids.

Limiting prescriptions to the amount a patient will actually use after an injury or surgery is critical. Writing 60 tablets after a procedure so that a patient won’t call back for a refill is harmful for both the patient and the family members that have access to the narcotic (53% of people abusing opioids obtain them from friends or relatives). Patients who continue to use opioids for more than a month after surgery have more psychological distress, more symptoms and more disability than patients who do not use opioids (J Bone Joint Surg Am. 2014).

Physicians should consider adding improved opioid dispensing to their group’s quality metrics. Setting practice policies about how opioids are used and educating staff about opioid misuse are essential steps in countering the epidemic. Utilizing prescription drug monitoring programs to identify patients at risk of abusing opioids should be a practice goal. State databases such as MI Automates Prescription System (MAPS) enables prescribers to check patients’ other opioid prescriptions and coordinate with other healthcare providers. Physicians should be familiar with the CDC’s practice guidelines calling for reduced use of opioids in the chronic pain population. The American Pain Society also announced new guidelines for pain management and has advised providers NOT to rely on a single class of medication.

The healthcare industry, government agencies, law enforcement, schools and community organizations need to re-boot and develop a long-term strategy to counter the opioid crisis and rehabilitate the people who are now addicted. <

OPIOID CRISISA prescription for the

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The healthcare landscape is experiencing extreme changes

in all areas of the care continuum. Ethica was formed by

The Physician Alliance to support the growing needs of

physicians and practices to meet the demands of these

changes. Founded on the extensive experience, ideals

and successes of The Physician Alliance, Ethica provides

solutions to assist and improve practice performance.

Ethica was first formed to offer consultation services related to the Centers for Medicare and Medicaid (CMS) new Merit-based Incentive Program (MIPS). MIPS consulting services include analysis of reports, assisting with MIPS measures selection, recommend improvement to a practice’s MIPS performance, maintain required documentation, and support annual CMS attestation.

An increase in practice demand for varying assistance has led to expanded services to provide a robust selection of support. These include:

• A readiness evaluation helps assess a practice’s overall preparedness for participation in CMS’ Merit-based Incentive Program (MIPS).

• A security risk analysis evaluates practice processes and controls to minimize threats to infrastructure. A practice must have an annual security risk analysis performed by an independent company to participate in MIPS.

• Practice process improvement services include a multitude of options focusing on processes and strategies affecting a practice’s business performance. Services range from front desk operations improvement, evaluation and selection of EMR technology, lean services, patient turnaround time, physician workflow and more.

For more information on Ethica services or to schedule a meeting, email info@ethicaholdings.com.<

*Ethica is a wholly-owned subsidiary of The Physician Alliance.

Ethica expands services to help practices

Last fall the Michigan House passed bills to combat the opioid epidemic in the state. Effective June 2018, providers will be required to check the Michigan Automated Prescription System (MAPS) to track prescriptions. The updated system is expected to respond to searches in seconds as opposed to the longer timeframe experienced in the past. Use of the system is expected to minimize “pill mills” and doctor shopping, two problems related to the opioid epidemic.

On the national scene, Healthcare IT News reported in August that a new bill had been filed on Capitol Hill recommending that e-prescribing controlled substances (EPCS) be required as a means to provide more robust oversight to the dispensing of opioids and other addictive drugs. The bill awaits approval.

If you would like more information on how to e-prescribe controlled substances in your practice, please contact Fran Burley, MSN, RN, CPHQ, clinical program manager at The Physician Alliance, at Francine.Burley@thephysicianalliance.org.<

Opioid epidemic focus of LEGISLATIONUse of the system is expected to minimize “pill mills” and doctor shopping, two problems related to the opioid epidemic.

20952 12 Mile, Ste. 130St. Clair Shores, MI 48081

PRE SORTEDNON PROFIT MAIL

US POSTAGE

PAIDST. JOHN HEALTH

Dennis Ramus, MD Chairperson

Daniel Megler, MD Vice Chairperson

Trpko Dimovski, MD Treasurer

William Oppat, MD Secretary

Eugene Agnone, MD

Mazin Alsaqa, MD

Bruce Benderoff, DO

Paul Benson, MD

Dennis Bojrab, MD

James Fox, MD

Michael Little, MD

Sidney Simonian, DO

Kevin Thompson, MD

Michael R. Madden President & CEO

Robert Asmussen Senior Business Advisor

Heather Hall Executive Director, Corporate Communications

Jennie Lekich Director, Clinical Applications

Katrina Mackrain Executive Director, Project Management & Business Analytics

Michele Nichols Vice President, Administrative Services & Business Development

Carolyn Rada, RN, MSN Vice President, Operations

Sharon Ross, RN, MSN, NP Executive Vice President, Population Health

Oleg Savka Director, Systems and Informatics

Karen Swanson, MD Chief Medical Officer

TPA Leadership Team TPA Board of Directors

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