From the Consultant’s Corner 2/21/14

Dusting off Your Physician Compensation Plan: 5 Steps to Creating a Value-based Strategy

For most practices, I suspect physician compensation is not something you are frantically trying to change. However, the sense of urgency may grow as healthcare reform continues to evolve.

As we all know, reform is shifting the focus of compensation from physician productivity (volume) to care quality (value), and payers are beginning to include patient satisfaction and quality as part of various payment reimbursement methodologies. As a result, practices may want to consider aligning their compensation plans with the shift toward value in order to remain viable.

Before we discuss how to align, let us take a closer look at how value-based payment is changing physician compensation. In the past, physicians were paid a percentage of charges or cash collected. More recently, the industry standard shifted to wRVUs (work relative value units) to incent performance. This model uses a point system for services rendered, with the accumulated points converted to a monetary value at the end of each quarter or year.

The wRVU method is almost counterintuitive to healthcare reform as the new emphasis on value disrupts the traditional mindset of “the more services provided, the more providers get paid.” The new thinking rewards quality and efficiency, not performing more surgeries or sending patients for expensive MRIs. In fact, payers see the focus on volume as inconsistent with protocols for quality care.

As you can see, it is a good time to review your compensation plan and ensure it is aligned with healthcare reform. Below are five steps to guide the alignment effort.

1. Find a physician champion. Strong physician leadership can support a smoother alignment process as this individual can address and overcome any physician reservations. Simply put, administrators cannot do this work on their own. A good choice for physician champion might be the head of the practice or a department chair.

2. Form a multidisciplinary compensation committee. If your practice includes several different specialties, you may want to create a committee to review compensation, which includes respected leaders in the practice and representatives of each specialty. This group can communicate to the rest of the practice frequently and transparently.

3. Conduct research and educate the committee. Look for and share information about current payers offering incentives or bonuses based on quality. Good sources of information might be the Healthcare Financial Management Association (HFMA) and the Medical Group Management Association (MGMA) or anecdotal information from other practices in the market.

4. Determine incentive goals and measures. Goals must be fair, measurable, obtainable and lucrative enough to get physicians’ attention. Ideally, you should balance base salary, productivity, quality, satisfaction and other measures. In my opinion, it is best to employ one compensation methodology across the group while the actual measures and goals within the group can vary by specialty. If the practice is already measuring quality for meaningful use (MU), use one or two of those agreed upon measures per specialty. If you are currently measuring patient satisfaction, use a score that reflects how patients feel about the physicians. Regardless of the measures, review incentive amounts to ensure they are meaningful to the physician and specialty.

5. Before launching a new plan, verify your practice can fund it. Make sure you do the math to check that the highest payout scenario is affordable. You also may want to phase the plan in to ensure the goals are captured in the EMR and the plan is doable. Most importantly, design the plan to be adaptable, so it can evolve when you review it annually.

We all know physician compensation plans are a challenge regardless of external influences, such as healthcare reform and value-based reimbursement. While there is no need to rush in and dramatically change your approach, it is definitely time to assess the current landscape and begin planning for the future. Remember, this cannot be done overnight or in a vacuum, especially with all the other priorities such as MU and ICD-10. In my view, the practices that are proactive in aligning their compensation plans will be the most successful going forward.

Johanna Epstein is vice president of management consulting services at Culbert Healthcare Solutions,

News 2/20/14

CMS announces it will offer end-to-end ICD-10 testing in summer 2014 to a small group of providers. The testing will include providers sending test claims using ICD-10 codes and CMS returning remittance advice to outline any claims adjudication.

Meanwhile, more confirmation that most providers are not ready for ICD-10: Aloft Group finds that 50 percent of providers are a quarter of the way or less complete with the ICD-10 implementation process with physician buy-in the top conversion obstacle.

University of Michigan Medical School researchers report that most people find physician-rating sites at least “somewhat important” when choosing a doctor and that usage of such sites is “substantially higher” than just a few years ago. I happen to be in that majority, having recently searched various sites before selecting a new primary care provider. I also admit that the only times I have ever left a online review on any site for any product or service has been when the experiences were negative (I bet I am in the majority for this behavior as well.)

The US Patent and Trade Office awards Greenway three patents related to the automation of medical research designed to improve population by coordinating the collection, analysis, and reporting of relevant patient data contained in EHRs.

More work must be done to mitigate inappropriate access of patient data by employees, according to a HIMSS Security Security survey conducting with funding from MGMA and Experian Data Breach Resolution. Despite federal initiatives,19 percent of health systems and physician practices surveyed report having a security breach within the last 12 months and 12 percent have had at least one known case of medical identity theft reported by a patient.

Nordic Consulting moves into expanded space in Madison, WI. The four-year-old company reported $81 million in revenue in 2013 and has 400 employees, 350 of them Epic consultants and two-thirds of those being former Epic employees. Most of them live in areas other than Madison. It also took in $38 million of investment funds.

Aprima makes available its EHR/PM platform to run on the three pound, touchscreen Toshiba KIRAbook Ultrabook computer.

CureMD announces the death of its president, CEO, and co-founder Kamal Hashmat, MD following a “tragic accident.” Co-founder and CIO Bilal Hashmat will take over as president and CEO. Condolences to his family and co-workers.

The Northwest Area Health Education Center REC (NC) helps 399 providers from 102 practices meet the first stage requirements for MU, which surpasses the agency’s goal of 393 providers.

If you have any suggestions for ambulatory HIT technology or sessions during HIMSS next week, please let me know. In between fun parties and trinket hunting, I do plan to check out as much as possible so please send me your recommendations.

Email Inga.

DOCtalk by Dr. Gregg 2/19/14

HIMSS 2014 – “DON’T FORGET THIS JUNK” LIST

Every February, I pull out my handy dandy HIMSS checklist. You probably have a similar list of your own, but there might be a few things here that are worth adding to yours, in case you’ve overlooked them.

My Official HIMSS 2014 – “DON’T FORGET THIS JUNK” LIST

• Tennis shoes – Remember your solemn oath: “I promise my feet that I will never again run the HIMSS triple marathon on somewhat carpeted concrete in hard sole shoes.” (And, God, please bless the women that do it in heels.)
• Dr. McGinty’s Amazing Hangover Cure and Spot Remover
• Deodorant (Remember that guy last year… ew… don’t wanna be him.)
•  Ibuprofen (and plenty of it)
• Extra cell phone battery and multiple chargers/cords (More power!)
• Hand sanitizer (You know why.)
•  Dr. McGillicutty’s Amazing Energy Booster and Blemish Cream
• Business cards (Remember, lots of folks still use them despite all our digital wizardry.)
• Lint remover brush (Nobody needs to know you have a dog.)
• Breath mints (Remember that gal last year… ew …don’t wanna be her.)
• Hair trimmer/scissors (Think “nose and ear hairs.”)
• Dr. McDougal’s Amazing Anti-Flatulence and Static-Reducing Powder
• Sunscreen (It may not be toasty, but it is Florida and you’re leaving snow-laden and gray-skied, frigid and frosty, it’s still-winter-here-in-the-“New Arctic”-Ohio.)
• Preparation H (You never know and plane rides can seem like forever.)
• Stamps (It may be old-fashioned, but it’s really fun to get a postcard. Make someone else smile and send a few… especially the funny ones, like with an alligator biting off a girl’s bikini.)
• Your tickets (Duh.)
• Dr. McGuinness’ Amazing Anti-Belch and Shoe Shine Liquor
• Triple Antibiotic Cream (Remember that guy with that rash last year?)
• NSA-approved list of safe text and email terms (No need to stir up any trouble.)
• Personal and heavily-encrypted MiFi wireless hotspot (No need making it easier than you have to for the hackers.)
• Noise-reducing ear buds (The kind that block noise and unwanted sales pitches.)
• Dr. McDonagall’s Amazing Bullhockey Detector and Battery Booster
• Humility (God knows there’s not much of that to be found at HIMSS.)

From the trenches…

"I’m not a list person.” – Joan Jett

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 2/18/14

The Colorado Health Institute analyzes the state’s looming shortage of primary care providers, which mirrors deficits across the country. The CHI offers several recommendations to address the estimated shortfall of 258 providers, including the use of emerging technology to increase patient self-care of common ailments and to advance options for self-diagnostic testing. The CHI also encourages streamlined policies to increase the use of telemedicine.

ONC reports that RECs have “far exceeded” their goal to support the adoption and use of HIT by 100,000 small practices, CHCs, and rural and public hospitals, while continuing to support providers to reach MU. I found the ONC’s announcement a little confusing since only 85,000 PCPs had met the MU milestone by the end of November, which is clearly short of the 100,000 goal.

The Worcester Business Journal looks at EHR adoption in the state of Massachusetts, which is requiring all providers to sign onto the Mass HIway HIE by 2017. Small practices and certain specialized providers are most resistant to automation, largely due to cost concerns and skepticism over potential benefits. Girish Navani, CEO for the Worcester-based eClinicalWorks, notes that it will be “only a matter of time before providers everywhere will convert” to meet regulatory requirements and to recognize the benefits of sharing patient records electronically.

I was looking at the latest MU Workgroup Stage 3 recommendations and noted a few new items that could potentially impact EPs, should these requirements be included in the final rule. Recommendation requirements include:

• The EHR would assist with follow-up on orders, including the return of results from specialty consults to the ordering provider.
• The EHR would provide EPs with access to medication fill information from pharmacy benefit manager
• Patients would have an easy way to request an amendment to their record online to offer corrections, updates, or additions.
• Patient-generated health information could be added electronically through a questionnaire, survey, or intake form, or, through secure messaging.

The National Testing Program for ICD-10 readiness of HIPAA transactions extends certification to Greenway’s SuccessEHS solution.

Benchmark Systems will offer its customers electronic statements and online pay solutions from PatientPay. Benchmark also announces several new customers including Comprehensive Pediatrics of Brooklyn (NY) for EHR and PM, Advent Medical Group (MO) for EHR, and, Dawn’s Medical Billing (VA) and American Self (VA) for PM.

SimplifyMD version 14.0 achieves 2014 Edition Complete EHR Ambulatory ONC HIT Certification from ICSA Labs.

Researchers from the University of Pennsylvania find that dermatologists that evaluated hospitalized patients using teledermatology provided nearly identical assessments as doctors examining the conditions in person.

Email Inga.

News 2/13/14

ICD-10 implementation costs for physician practices could be almost three times higher than estimated five years ago according to an AMA report that considered such factors as training materials, consulting fees, software upgrades, testing, payment disruptions, and physician productivity losses. The study predicts that small practice costs will range from $56,639 to more than $226,000; medium practices will pay between $213,364 and $824,735; and, large practices could spend between $2 and $8 million. Vendor/software upgrade costs represent a major cost variable that most, though not all,  practices will face. Meanwhile, the AMA “strongly urges CMS to reconsider the ICD-10 mandate,” which the organization believes is financially disastrous for physicians, impedes progress to a performance-based environment, and is unlikely to improve the care physicians provide their patients.

Sobering: a survey of 1,000  (seemingly self-selected) physicians finds that 70 percent don’t think the HITECH program was worth its cost. Other key findings:

• 65 percent say their EHR implementation has led to financial losses.
• 45 percent believe care has become worse since implementing EHR.
• 73 percent of the largest practices would not purchase their current EHR system again.
• 67 percent dislike the functionality of their EHR systems.
• Nearly half believe the cost of these systems is too high.
• More than two-thirds say that coordination of care with hospitals has not improved.
• Nearly 38 percent doubt their system will be viable in five years.
• 26 percent doubt their vendor will be in business in five years.

RelayHealth Financial achieves full EHNAC HNAC accreditation for the 14th consecutive year.

Privia Medical Group (VA) will implement athenahealth’s PM, EHR, patient communication, and care coordination services for its 154 providers and affiliated ACO.

Also from athenahealth: the company  announces that it has integrated drug monographs from its Epocrates acquisition into athenaClinicals.

Four Ellis Medicine (NY) primary care locations deploy PCMH transformation management and analytics tools from Arcadia Healthcare Solutions to earn Level 3 NCQA PCMH recognition.

HIMSS Analytics recognizes 51 clinics of Northeast Georgia Physicians Group with its Stage 7 Ambulatory Award.

CMS and ONC introduce Randomizer, a tool that allows providers to exchange data with a test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement.

Kareo launches a new MU resource center that includes links to articles, websites, and white papers, as well as FAQs that cover basics about MU and attestation.

Email Inga.