Rx for practice management

SpRing 2015

Are you ready for the next step?The ins and outs of Stage 2 meaningful use

Dissension in the ranksHow to knock out physician conflicts

Compensating providers for the value of their work

Tips on how to engage your patients

he federal government’s initiative to encourage the deployment of meaningful use (MU) among health care providers

has moved on to Stage 2. The bar has been raised for what’s demanded of physician practices. There are more core measures, new menu measures and higher reporting thresholds. In Stage 2, MU focuses on care coordination and patient engagement.

Meeting the deadline

Eligible providers who didn’t start the MU pro-gram and meet the March 20, 2015, attestation deadline will be penalized in 2015 the equivalent of 1% of their Medicare Part B reimbursement. The penalty increases to 2% in 2016, and providers won’t be eligible for Electronic Health Record (EHR) incentive payments.

If a practice hasn’t yet initiated its MU program, it should do so immediately because it must start by meeting Stage 1 standards. There are certain steps you’ll need to do, such as registering with the CMS. (At cms.gov, type “ehr” in the search box to reach the “EHR Incentive Programs” link that leads to the EHR page. Clicking on “Registration & Attestation” at left leads to a registration link.) Then, select an EHR system that’s suited to your practice, certified to 2014 MU standards and com-pliant with the upcoming ICD-10 transition.

Next, designate a team that includes doctors to lead the effort. If you’re already behind schedule, consider hiring a consultant. From there, choose the Clinical Quality Measures (CQMs) for which your practice intends to demonstrate MU. Pick measures that are most relevant and beneficial to the practice. Last, deploy a patient portal, which is mandatory under both Stage 1 and Stage 2.

Moving on to Stage 2

If your practice is currently satisfying Stage 1 and is ready to move on to Stage 2, it can look for-ward to some new standards. Your practice must achieve 17 core objectives and its choice of three out of six menu objectives, for a total of 20 objec-tives. Here are a few of the core objectives:

x Use computerized provider order entry for medication, laboratory and radiology orders.

x Generate and transmit permissible prescriptions electronically.

x Record demographic information.

x Provide patients the ability to view, download and transmit their health information online.

x Create clinical summaries for patients for each office visit.

x Keep lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach.

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Are you ready for the next step?The ins and outs of Stage 2 meaningful use

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The six menu objectives include submitting electronic syndromic surveillance data to public health agencies and recording electronic notes in patient records.

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x Collect clinically relevant information to iden-tify patients who should receive reminders for preventive/follow-up care.

x Implement secure electronic messaging to communicate with patients on relevant health information.

The six menu objectives include submitting electronic syndromic surveillance data to public health agencies and recording electronic notes in patient records. Other objectives include mak-ing imaging results accessible through Certified Electronic Health Record Technology, record-ing patient family health history, identifying and reporting cancer cases to a state cancer registry, and identifying and reporting specific cases to a specialized registry.

Still another objective is to commit to nine CQMs out of a total of 64 options. Those nine must lie in at least three of the following domains:

x Patient and family engagement,

x Patient safety and care coordination,

x Population and public health, and

x Efficient use of health care resources.

The last objective aims to improve clinical process and effectiveness.

Testing the system

The performance of MU activities revolves around the practice’s EHR system, which must be tested and cer-tified under the Office of the National Coordinator for Health Information Technology Certification Program. The original certification criteria expired last year and were replaced by a 2014 edition. All EHRs must be upgraded to that edition.

The transition to Stage 2 should be rel-atively seamless. The EHR vendor must insert Stage 2 thresholds into the EHR workflow to make sure the right person is

doing the right work. Vendors also need to ensure delivery of critical information to physicians at the point of care. And all of this should be accompa-nied by support, training and coaching until the practice is comfortable with the new system.

Creating a portal

Stage 1 required that practices make an online portal available to their patients, without neces-sarily doing anything to ensure that they use it. Under Stage 2, the portal must be engaging and user-friendly, and must support patient-centered outcomes. The portal must be integrated into clin-ical encounters so that it can convey information, communicate with patients, and support self-care and decision-making. Finally, the practice must actively promote and facilitate portal use.

Meeting the requirements

Whether you’re just starting Stage 1 or ready to move on to Stage 2, make sure you work with your health care advisor on meeting these requirements. He or she can walk you through the process. x

Upgrading your EHR system

When upgrading your Electronic Health Record (EHR) system, be sure that it has the following features:

x Is certified to all of the 2014 certification criteria.

x Takes into account the ICD-10 compliance date of Oct. 1, 2015.

x System software is updated to include new mean-ingful use standards and related workflow changes.

x Meaningful use objectives and measures are incorporated into the workflow so they can be easily recorded.

x Training and support are provided on how to satisfy the objectives and measures, with the results documented.

x Further support and guidance are available when the practice needs to attest to what it has achieved.

t’s sad to say, but not all doctors in physi-cian practices get along. Whether they’re haggling over administrative matters or a

partner’s job responsibilities, the strife it creates can turn a normally congenial practice into a war zone. But there are ways to coexist peaceably.

Elect a strong leader

Many partnerships consist of one partner who leads the practice. The other physicians may have appointed this leader because the articles of incor-poration require them to pick someone. Or they did so because that physician seems like the only one who has the interest or skills to run a business.

Subsequently, the leader becomes the administrator responsible for daily practice issues. The problem? He or she is left holding the bag while other partners focus on issues that affect only them — not the practice as a whole. Elect a strong leader and pay a monthly compensation for handling administrative matters.

Unfortunately, physicians often downplay the importance of leadership instead of emphasizing it. Define partners’ job responsibilities so they share authoritative duties equally. Then, make sure partners are compensated for the hard work, extra hours and positive outcomes they contribute.

Expect challenges

If a practice stagnates, it will die. One key to staying alive is establishing a practice vision — its purpose, expectations, concerns and goals. Whether starting a new venture, adding new partners or implementing strategic changes, your partners must mutually maintain this vision.

Of course there will be challenges, such as adding new services or procedures. Moreover, the prac-tice will likely encounter certain issues if it opens up a new office or hires additional staff physicians. Such operational changes can alter your practice’s vision and create significant problems.

Because weathering these changes isn’t easy, don’t expect partners to always agree. Instead, allow each the opportunity to express his or her viewpoint. After all, rational, professional debate is healthy as long as it doesn’t deteriorate into heated arguments.

Avoid preferential treatment

Physician partners’ age differences can also cause problems. Doctors from different generations (and cultures) often disagree about how to practice, what constitutes work hours and whether senior physicians deserve preferential treatment.

For example, older partners may feel they have the right to make special requests of younger partners, such as to take on an

older doctor’s night and emergency calls. Their reasoning is often because they themselves had to comply with such demands early in their careers.

But younger partners may disagree with these requests and feel they unjustly create more

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Dissension in the ranksHow to knock out physician conflicts

When reimbursements don’t keep pace with operating-cost increases, partners’ stress levels may rise.

t’s hard to miss news reports discussing the shift in the basis for provider reimburse-ments from “volume” to “value.” Public

(Medicare and Medicaid) and private payers are promoting value-based payment methodologies for physicians and hospitals — including “meaningful use,” “pay-for-performance,” “Accountable Care Organizations,” and “patient-centered medical homes.” So, what does value mean in your practice?

Balance price and product

Value is typically defined as the balance between price and product features. In health care, this appears as a combination of reducing costs and increasing quality. The current value initiatives achieve their goals through compensation plans that include target quality metrics that physicians and practices must meet.

Examples of those metrics include breast and cervical cancer screening, beta-blocker treatment after a heart attack, adult body mass index assess-ment and controlling high blood pressure. In 2013, around 3% of physician compensation was based on quality.

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Compensating providers for the value of their work

work for them. And they’re usually right. In a true partnership, partners’ accountability lies in direct proportion to their ownership percentage — both financially and operationally. Therefore, partnerships typically shouldn’t provide unequal perks based on seniority.

Create a compensation model

When reimbursements don’t keep pace with operating-cost increases, partners’ stress levels may rise. A need to decrease partner bonuses can add even more fuel to the fire. And if you’re trying to unify your partners, or add new ones, the financial turmoil only intensifies.

For instance, ill will can occur when one part-ner isn’t as involved in financial decisions as the others. Similarly, many practices struggle with

partners who fail to produce results commensurate with their salaries.

To mitigate these issues, implement a clear, amenable compensation model for physician part-ners. At minimum, each partner must generate enough revenue, less expenses, to cover his or her salary. Also, annually set partners’ goals and review their performances and compensation.

Keep the peace

It can be traumatic when partners in a medical practice lock horns. If your practice is experi-encing this scenario, you need a committee to help you work out the issues. Ask your CPA and health care advisor to step in. He or she can help you work out any issues, without pointing fingers, and return your practice to a peaceful state. x

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There are several initial steps that your practice should take to adapt to these value requirements from payers:

x Note the quality measures that they’re empha-sizing and make sure the practice is gathering relevant data,

x Consult with your clinicians to set standards for their performance of these activities, and

x Compile regular reports on each clinician’s handling of his or her quality responsibilities, and discuss the causes of poor performance.

It’s critical that everyone agree on the strategies for improvement. When appropriate, coach clini-cians on changing their practice behaviors.

In addition, many of the quality metrics used by payers are related to patient satisfaction. You can address them by implementing simple patient feedback and aggressively managing any problems raised by patients. If you haven’t already done so, familiarize yourself with the Medicare Physician Quality Reporting System.

Determine compensation

A critical challenge will be redesigning the meth-odology by which physicians and other clinicians are compensated. Start by deciding what you want to accomplish through the practice’s compensation plan. For example, what changes do you want to implement? And what goals or objectives do you want to achieve?

The first step is to set up a system to gather pro-ductivity and compensation data related to those goals, by physician. Likely data sources are internal financial reports, patient care records and payer analyses. To persuade doctors to accept the results and adjust their behavior accordingly, the data must be current, accurate and reliable.

Once you interpret the data that comes in, compare it to benchmark figures from the practice’s history, practices in the area and the industry in general. Then, identify any problem areas in the practice’s operations — either existing or impending.

The second step is to develop a compensation struc-ture that uses the data to meet practice goals, adheres to legal and regulatory mandates, and aligns provider incentives with payer requirements. If there’s time, propose two or three alternative structures that serve the same purpose.

Keep in mind that the compensation scheme must meet two secondary practice needs: physician retention and recruitment. While reorienting doc-tors toward more value-based practice behaviors, you need to avoid alienating physicians so much that they leave the practice. The compensation plan must also be tolerable for new physicians joining the practice.

Keep score

Prepare a report on how the proposed plan would impact the practice as it’s presently functioning. Present scorecards to each clinician showing how well he or she is performing on the quality param-eters. Then, translate this into potential changes in the compensation that the clinician would receive.

Through the practice’s governance procedures, decide whether to proceed with the plan, as described, or perhaps make adjustments. Make sure your implementation strategy enhances the likelihood of acceptance.

Stay on the right track

As your plan takes effect, monitor its effectiveness. For example, are key quality metrics improving? Are physicians satisfied with their earnings? And, are payers satisfied with the practice’s overall per-formance? Work with your advisors to ensure you’re on the right track. x

atient engagement has always been con-sidered a desirable feature of physician practices and health care organizations.

Today, it’s become vital to business success in the delivery of care. In fact, the elements of a robust patient engagement strategy are among the required objectives of a Stage 2 meaningful use program.

The benefits

A practice that implements a patient engagement strategy will improve the care experience of its patients, who will likely pay more attention and fol-low directives. Engaged patients maintain a stronger attachment to their medical practices, and experience greater value, trust and quality in their care.

Focusing on patient engagement improves effi-ciency, reduces out-migration and can reduce the costs of care. Patients who are actively involved in their health care can achieve better outcomes and even have lower per capita costs than patients who are less engaged.

The concept

Patient engagement occurs at the interface between the practice and its patients. It involves both parties collaborating on record keeping, care plans, health tracking, appointments, preventive care, decision making, patient-focused education and medication management.

Also incorporated in patient engagement is the ability and willingness of patients to manage their own health care, as well as a practice culture that prioritizes and supports patient engagement. A true partnership between patients and providers to manage health outcomes is the ultimate objective.

The strategy

To create your strategy, define an idealized future state of patient engagement for the practice and compare this to where the practice is today. Then, identify any gaps that must be closed. This strat-egy should be tailored to individual specialties and departments, and to particular staff members and care teams.

Next, build a practice culture that embraces patient engagement. Implement engagement- friendly technologies, with patient portals being the best example. The portal solution should connect to the practice’s Electronic Health Record, billing and practice management systems. It serves as an integrated, multifeatured patient communications platform that offers live operator support; automated phone, text and e-mail reminders for bills and appointments; and medication schedule alerts.

Promote the portal to existing patients and during orientation for new patients. Explain its benefits clearly, and provide incentives for using it.

A great team

Naturally, it’s critical that you use regular patient input (such as short surveys and focus groups) to help shape engagement efforts. Over time, you should find that you and your patients make a great team. x

Practice notes

Tips on how to engage your patients

7This publication is distributed with the understanding that the author, publisher and distributor are not rendering legal, accounting or other professional advice or opinions on specific facts or matters, and, accordingly, assume no liability whatsoever in connection with its use. ©2015 RXsp15

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Promote the portal to existing patients and during orientation for new patients.