July 2014 Newsletter
Volume 3 Number 7
July 1, 2014
Bundled Payments: Last month we introduced Bundled Payments. The BPCI initiative consists of 2 phases for Models 2, 3 and 4. The first phase is the “preparation” period in which CMS shares data with participants and participants prepare for possible implementation and assumption of financial risk. Once approved by CMS, the participants can enter into a BPCI Model Agreement with CMS and begin Phase 2.
We are currently in Phase 1-the “preparation” phase. This month we will receive data from CMS on all 48 episodes of care. From this information, we will select the triggering episodes of care. On January 1, 2015, we will then become accountable for the quality and cost of the episodes that are chosen and enter into Phase 2, also known as the “risk-bearing” phase. The Board voted to partner with NaviHealth as our financial convener and therefore, NaviHealth will assume the risk.
SmartHealth: Effective July 1, 2014, SVHP will be the “Population Health Management Partner” to provide a local population health management program for SmartHealth members. The Care Coordination and Clinical Integration Department will provide our network physician providers with reports that include attribution, high risk patients, utilization and prevention data. This information will allow each practice to successfully manage your SmartHealth population.
Expanding the Post Acute Care Setting
As St. Vincent’s Health Partners expands our Clinically Integrated Network, some of the providers that we are adding as members are in the Post Acute Care setting (PAC). Providers in this setting are Skilled Nursing Centers (SNFs), Home Health Agencies (HHAs), In-Patient Rehabilitation Facilities (IRFs) and Long Term Acute Care Hospitals (LTACs).
What is driving the interest in the PAC setting? The Affordable Care Act (ACA) is driving the interest. Three components in particular are: 1) the Acute Readmission Penalty, 2) Value Based Purchasing and 3) ACOs.
The Acute Readmission Penalty: In 2013, Medicare began financially penalizing hospitals with higher-then-expected readmission rates on 30 day re-admissions. The maximum payment reduction started at 1% and will increase to 3% by 2015. At the current time, the PAC setting is not penalized. With over 43% of Medicare beneficiaries being discharged from the hospital to the PAC setting, there is a need to work with our PAC providers to decrease recidivism.
Value Based Purchasing: This program rewards hospitals with incentive payments based upon Quality Indicators and Patient Satisfaction. Medicare Spending per Beneficiary Measure is part of VBP. This measure includes all Part A and Part B claims between 3 days prior to admission to 30 days after the hospital discharge.
ACO’s: ACOs are focused on high quality, outcome oriented providers and deal with at risk contracting.
While PAC accounts for less then 10 cents on every dollar, the ability to impact spending in length of stay management, readmissions and total cost of care is significant. And because PAC providers have no incentive to consider the total cost of care per episode or to coordinate care across the settings, it is critical that SVHP works to develop our PAC network.
SVHP has put together a selection team and a selection process to develop our PAC network. The selection process includes a discovery meeting, provider interview, data sharing, review by SVHP team, selection of providers, presentation to the Board of Directors and finally membership contracting.
The 3 Skilled Nursing Facilities that were presented to the Board of Directors in May and approved are Jewish Senior Services, Lord Chamberlain and St. Joseph’s Manor. The 4 Home Health Agencies that were presented to the Board of Directors this month and approved are Bayada, Jewish Senior Services, Stratford VNA and VNS of Connecticut. These providers will not have voting privileges and will be under the Hospital component of the PHO. Dr. Scifo will be their representative on the Board.
These providers, along with representatives from our hospital partner, will make up the Transitions of Care Committee. The committee will map out processes to coordinate care across the continuum and will become part of the SVHP Playbook. In essence, we will be working with our PAC partners to assure patients are referred to the most efficient and effective care setting.
We welcome our Post Acute Care providers and are excited as we reach another milestone in our organization!
Provider Engagement and Transitions of Care Educational Series
Health reform is happening at a rapid pace. To aid the membership in keeping up with the latest regulations and information on health reform, St. Vincent’s Health Partners, in partnership with Fairfield County Medical Association, offers educational programs with CMEs available.
Thank you to the members that attended our education program entitled “Data Privacy and Cyber Liability: What Healthcare Professionals Need to Know” by Robert Price, CPCU. Some of the topics that Bob discussed were data breach, litigation trends and costs, compliance and notice regulations and what can be done. If you would like a copy of the presentation, please contact Karen O’Driscoll, Director of Professional Relations at (203) 275-0205 or by email at firstname.lastname@example.org.
Our next program will be held in September. Enjoy your summer!
Care Coordination and Clinical Integration
Over the past 9 months, the Care Coordination & Integration department has been providing practices with monthly reports about their attributed patients that focus on risk, utilization, and gaps in preventative care. SVHP is now ready to roll out our first Provider Scorecard, as shown below, based on data from one payer. The Acute and Chronic Care Management bucket contains 10 measures and the Preventive Care bucket contains 2 measures. These measures represent a subset of all of the measures that will be reflected in the shared savings calculations. As the data becomes available, the scorecard will reflect additional measures as well as additional benchmarks.
ICD-10 Readiness: Adapting your documentation strategy to ensure success
By Kyle Lanning, JD
Like it or not, the transition to ICD-10 is scheduled to begin in a little less than a year and a half. According to a study by the Aloft Group released last quarter, nearly half of US healthcare providers have completed only 25 percent or less of their ICD-10 implementation process. Another study, this one conducted by the MGMA, found that less than 10 percent of practices have made significant progress to prepare for the transition.
Yet, not all the news and information surrounding the impending ICD-10 implementation is negative. Many providers are well on their way to ensuring they and their staff receive the appropriate education to take advantage of all the positives the new codes will bring. Some experts suggest that that thanks to the specificity and detail required by the new ICD-10 codes, providers will likely see a reduction in claim denials for medical necessity as a result of insufficient information.
For groups like St. Vincent’s Health Partners, the new codes will serve an even greater purpose. As an organization that is radically innovating new models of population health management, and assisting providers in caring for their patients, the new code set will provide a rich and complete picture of each patient interaction, leading to more information and even better coordination of efforts.
Success with ICD-10 starts with proper documentation. No amount of voluminous coding books will help fill in the gaps left by inadequate documentation. Here are some additional details that will be required in the new ICD-10 code set:
- Axis of classification,
- Site of occurrence,
- Laterality, and
- Trimester specificity for pregnant women.
ICD-10 will also feature expanded drug and alcohol codes, complication codes, and combination codes – all of which will require additional detail and documentation to successfully navigate.
Last but not least, it’s important to note that having an EHR does not absolve providers of the responsibility to upgrade their documentation strategies. While many EHR systems now give providers the ability to enter the level of details that will be required under ICD-10, many vendors still have a way to go. In fact, a WEDI study published in 2013 indicated that 20% of vendors would not be ready to even beta test their ICD-10 compliant products until 2014. For a list of questions to ask your vendor, see the article from EHR Intelligence in the additional resource section below.
The transition to ICD-10 continues to be a tough journey for many but the most recent delay has given providers the much needed time to prepare. One way to ensure a successful transition to the new codes is to first ensure proper documentation strategies are being implemented. ICD-10 will require greater specificity and provider documentation needs to reflect this change or the consequences (to both the patient and the provider) could be severe. Providers who equip themselves with new documentation habits and strategies will fare much better in the coming transition to ICD-10. Those who do not, will struggle to catch up and will make it much more difficult on themselves and their support staff.
For more information on ICD-10 and updating your documentation strategy, see the following resources:
AAPC: ICD-10 Documentation Example
CMS: How will ICD-10 Affect Clinical Documentation
EHR Intelligence: Top ten ICD-10 readiness questions to ask your vendors
Healthcare IT News: ICD-10 starts at clinical documentation
PhysiciansPractice.com: Improve Clinical Documentation for ICD-10
 Becker’s Hospital Review. (2014, March 06). 5 Notable Surveys on ICD-10 Readiness. Retrieved fromBecker’s Hospital Review: http://www.beckershospitalreview.com/icd-10/5-notable-surveys-on-icd-10-readiness.html
 Bresnick, J. (2013, July 10). Top ten ICD-10 readiness questions to ask your vendors. Retrieved from EHR Intelligence: http://ehrintelligence.com/2013/07/10/top-ten-icd-10-readiness-questions-to-ask-your-vendors/
Provider Discount Program
Please welcome McKesson Medical Surgical to our Group Purchasing Discount Program!
MCKESSON MEDICAL SURGICAL
With over 150,000 products ranging from gloves and gauze to vaccines and laboratory equipment, McKesson Medical Surgical is the largest distributor of medical products and services in the private physician market. The cornerstone of McKesson’s success has come from the belief that your health is our health.
The Customers We Serve
• Physician offices and clinics
• Surgery centers
• Medical laboratories
The Problems We Solve
We develop solutions specific for our customers that:
• Reduce Costs
• Improve Efficiencies
• Increase Revenue
The Difference We Make
• Cost Containment Programs
• Next Day Delivery
• Biomedical Repair Services
• Weekly educational webinars
• Business reviews & business conversations specific to your practice.
If you are not already a McKesson account, please feel free to reach out to Sean Mullin to schedule a business conversation.
Dr. Thomas Raskauskas, President/CEO, (203) 275-0202 email@example.com
Dr. Michael Hunt, Chief Medical Officer/Chief Medical Informatics Officer, (203) 275-0203 firstname.lastname@example.org
Anthony Brockman, Director of Information Technology, (203) 275-0206 email@example.com
Colleen Swedberg, MSN, RN, CNL, Director for Care Coordination and Integration, (203) 275-0209 firstname.lastname@example.org
Karen O’Driscoll, Director of Professional Relations, (203) 275-0205 email@example.com
Alvino Williams, Jr., IT Analyst/Clinical Integration, (203) 275-0207 firstname.lastname@example.org
Kyle Lanning, JD, Integration Associate, (203) 275-0204 email@example.com
Erika Foster, Integration Associate, (203) 275-0208 firstname.lastname@example.org
Gretchen Cavaliere, Administrative Assistant, (203) 275-0201 Gretchen.email@example.com