December 2014 Newsletter
Volume 3 Number 12
December 1, 2014
Key Changes to Medicare Physician Fee Schedule for 2015
1) The Medicare Physician Fee Schedule will include a Chronic Care Management fee, which will incentivize providers that coordinate care of Medicare recipients with multiple chronic conditions.
2) Medicare will pay for beneficiaries to receive their annual wellness visit via telemedicine, as well as psychoanalysis and psychotherapy visits.
3) Changes to the Value Based Payment Modifier Program:Medicare will adjust payments to physicians based upon quality and cost of care.Physicians that provide high quality care while reducing costs will receive an increase in payments, while physicians that under perform will receive a reduction in payment.
4) Changes to Hospital Outpatient and Ambulatory Surgery Centers:There is a new comprehensive Ambulatory Payment Classification that will provide one payment for all related hospital items and services, instead of separate payments for each service.
5) The quality measure data that is available on Physician Compare will be increased and will be available for public reporting.
6) While the total number of ACO quality measures will remain at 33, there will be an increase in the number of measures calculated by claims and a decrease in the number of measures reported through ACOs.Focus of the new measures will be on avoidable re-admissions for patients with multiple chronic conditions, heart failure and diabetes; all cause re-admissions from skilled nursing centers; documentation of current medications; depression remission and stewardship of patient resources.
7) A quality improvement measure was added which provides points to each of the 4 quality measure domains based upon improvement.MSSP ACOS can receive up to 4 bonus points for improvements in quality performance.
8) A Standardized Readmission Ratio to assess the rate at which End Stage Renal Disease dialysis patients are readmitted within 30 days will begin in 2017.
HUSKY Health Primary Care Increased Payments Policy
Under the Affordable Care Act (ACA), Medicaid increased payments to equal the 2013 and 2014 Medicare fee for specific primary care codes when billed by an eligible primary care provider, who submitted a valid attestation to the Department of Social Services.The ACA requirement was set to expire on December 31, 2014. The Connecticut General Assembly appropriated funding within the Medicaid budget and established a policy for the primary care increased payments to fall within the appropriation.Therefore, the HUSKY Health Primary Care Increased Payments Policy will be effective January 1, 2015 through June 30, 2015.Continuation beyond June 30, 2015 will be decided by the Connecticut General Assembly.
Codes that are eligible under this policy include specific services routinely used by primary care providers.The codes for office based visits will remain the same as the 2014 ACA fee.A different amount will be set for services rendered in a facility setting.
Providers who have already attested and remain eligible under the ACA Increased Payments for Primary Care Services will continue to be eligible.
Providers that are attesting for the first time, must self attest to practicing in one or more of the following specialties recognized by ABMS, ABPS or AOA:
- Pediatric Medicine
- Internal Medicine
- Sub-specialists within one or more of the specialties listed above
To qualify, the primary care provider must attest that he or she actually practices in primary care and that: He or she is Board Certified in a specialty or sub-specialty listed above; or
At least 60% of billed Medicaid codes are comprised of the qualifying Evaluation and Management service and vaccine administration codes.
Bundled Payment for Care Improvement Initiative (BPCI)
Weekly update calls continue to review the status of the project.
In preparation for the April 1stroll out, the Transitional Leadership Committee has been meeting on a monthly basis. This month’s meeting was held on Thursday, November 20th. The BPCI timeline was reviewed to reflect the updated April 1stimplementation date. Dr. Robert Fitton gave a high level presentation on Palliative Care. Discussion centered around palliative care in our network and current gaps in care. He also discussed holding a more extensive educational program the first quarter of 2015 for the network. ProHealth Partners and the Preferred Skilled Nursing Center providers gave an overview o services that are provided in their settings. A case study regarding a transition between the hospital and one of the Skilled Nursing Centers was presented. It was identified how critical it is that all parties communicate and know clearly what is expected from each other.
The next Transitional Leadership Committee meeting will be held on Thursday, December 18that 1:30 in the Hawley conference room.
We anticipate that the work that is done in these meetings will positively overflow to the transitions of all patients between each of the settings and across the clinically integrated network.
Please join me in welcoming Susanne Salgado and Mina Gasdia to the SVHP team!Susanne is our new Operations and Communications Assistant.As the Operations and Communications Assistant, Susanne will be responsible for the overall day to day operational support of the SVHP team.She will also assist with maintaining the website.Susanne comes to SVHP with extensive experience as an Executive Assistant not only in the finance and banking industry but also in corporate healthcare.Susanne can be reached at (203) 275-0201 or via email at email@example.com.
Mina Gasdia, BA, RN,is our new Care Coordination and Integration Associate and will play a key role in the clinically integrated network by helping the provider network members continuously improve the care experience of the patient and improve health outcomes using evidenced based practices. Prior to joining SVHP, Mina was a Care Coordinator and was responsible for overseeing the transition of patients in the bundled payment care initiative.
Dr. Thomas Raskauskas, President/CEO, (203)275-0205
Dr. Michael Hunt, Chief Medical Officer/Chief Medical Informatics Officer, (203)275-0203
Anthony Brockman, Director of Information Technology, (203)275-0206
Colleen Swedberg, MSN, RN, CNL, Director for Care Coordination and Integration, (203)275-0209
Karen O’Driscoll, Director of Professional Relations, (203)275-0205
Sophia Jackson, RN, Care Coordination Associate, (203)275-0212
Mina Gasdia, BA, RN, Care Coordination and Integration Associate, (203)275-0207
Kyle Lanning, JD, Information and Integration Manager, (203)275-0204
Erika Foster, Integration Associate, (203)275-0208
Susanne Salgado, Operations and Communications Associate, (203)275-0201