Category: SHP News

SHP can help with your ACO!

SHP is excited to announce that we now provide both consultation and management services for primary care providers who are interested in forming an  ACO (Accountable Care Organization). Based on the continuing market transition under healthcare reform, SHP strongly believes that primary care physicians have a unique opportunity to move from generating their revenue solely from patient care to a combination of patient care and shared savings and that this transition will continue to encourage long-term viability and success.

 

Our ACO services include education and engagement, feasibility analysis, development of ACO quality criteria, partner selection (capitalization and administration), and market selection as well as ongoing ACO management. SHP will be hosting events over the coming weeks to discuss the new ACO opportunities for primary care physicians across Georgia, South Carolina, and Alabama.

 

Georgia Hospital Health Services, Inc. announces alliance with Strategic Healthcare Partners, LLC.

GEORGIA HOSPITAL HEALTH SERVICES, Inc. (GHHS), a wholly owned subsidiary of the Georgia Hospital Association, is proud to announce a strategic alliance with STRATEGIC HEALTHCARE PARTNERS (SHP). SHP provides various financial related services to over 30 community based hospitals and 600 physicians. GHHS and SHP will work together to create programs or offerings that offer a benefit to large numbers of GHA member hospitals. Offerings may include ACO development/operation, IPA management, managed care contracting, supply chain review/oversight, revenue cycle assessments/outsourcing, provider enrollment, data analytics, strategic planning, and IT services. Based out of Savannah, they have offices in Albany and Atlanta as well as other remote locations. We look forward to our future with SHP and bringing further value to the healthcare of Georgia.

Proposed Medicare Fee Schedule 2013

Proposed Medicare Fee Schedule for 2013

CMS has published their proposed Medicare Physician Fee Schedule (MPFS) for 2013 and the final schedule will be posted in November 2012. The proposed fee schedule is 765 pages; therefore, please see below for a synopsis of the proposed changes to the 2013 MPFS:

1. Projected 27% Cut to Physician Reimbursement: When combining the continued use of the SGR (sustainable growth rate) formula to calculate the physician schedule and the legislative fixes that have been implemented to prevent previous cuts to the schedule, the MPFS is scheduled for a 27% cut for 2013. In previous years, Congress has intervened to prevent these reductions; however, at this time, no proposed legislation has been introduced.

2. Transition Care: For the first time, CMS is proposing to pay for the care required to help a patient transition back to their community following the discharge from a hospital or nursing facility. CMS is proposing to make a separate payment to a physician’s community physician or practitioner to coordinate their care in the 30-day period following their hospital/nursing facility discharge.

3. E-Prescribing Incentive Program (eRx): CMS has proposed two new hardship exemptions for physicians to avoid the 2013 and 2014 eRx payment penalties:
a. Eligible physicians who achieve EHR meaningful use during the six or 12 month payment adjustment reporting period.
b. Eligible professionals who have registered to participate in the EHR incentive program and adopted certified EHR technology prior to applying the respective payment adjustment.
4. Increasing the number of Medicare-covered preventive services that can be provided through telehealth. CMS proposes to add the following list of services for 2013:

a. G0396: Alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention, 15 to 30 minutes
b. G0397: Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention greater than 30 minutes
c. G0442: Annual alcohol misuse screening, 15 minutes
d. G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
e. G0444: Annual Depression Screening for adults, 15 minutes
f. G0445: High-intensity behavioral counseling to prevent sexually transmitted infections, face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semiannually, 30 minutes
g. G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
h. G0447: Face-to-face behavioral counseling for obesity, 15 minutes
5. Implementing a face-to-face requirement between physician and patient as a condition for payment of certain high-cost Medicare DME items (Please see http://www.mwe.com/overview-of-2013-mpfs-proposed-rule-and-dme-written-order-and-face-to-face-encounter-requirements-07-25-2012/ for additional details on this requirement.

6. Application of a multiple procedure payment reduction to the technical component of the second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor to the same patient on the same day. Under the proposed rule, Under this proposed policy, CMS would make full payment for the highest paid cardiovascular or ophthalmology diagnostic service and reduce the technical component payment for subsequent cardiovascular or ophthalmologic diagnostic services furnished by the same physician or group practice to the same patient on the same day by 25%.

7. When permitted by State law, Medicare will now pay for interventional pain management performed by CRNAs in order to foster access to these services

8. Introduces next phase to enhance the Physician Compare Website (http://www.medicare.gov/find-a-doctor/provider-search.aspx). CMS plans to foster transparency and public reporting of certain information to allow Medicare beneficiaries access to more information when choosing a physician, including the following:

a. CMS proposed to publish performance rates on quality measures that group practices submit through the GPRO web-interface under the 2013 PQRS and Medicare Shared Savings Program.
b. In 2014 or later, CMS proposes to publicly report composite quality measures.
c. CMS proposes to add patient experience survey-based measures as well as publicly report patient experience data for all group practices participating in the 2013 PQRS through the group reporting option and the Medicare Shared Savings Program.

EHR Meaningful Use Incentives

In 2011, CMS introduced financial incentives for eligible professionals (EPs) who became meaningful users of electronic health records (EHRs). EPs who meet the Stage 1 meaningful use requirements in either 2011 or 2012 remain eligible to earn the maximum financial incentives for their EHR transitions.

In their first year of the incentive program, EPs must attest that they have met meaningful use measures for a consecutive 90-day period; therefore, if you are planning to begin the EHR incentive program in 2012, you must begin your 90-day reporting period on October 3, 2012.

Under the initial EHR Incentive rule, EPs who met Stage 1 criteria in both 2011 and 2012 would then move into the Stage 2 meaningful use measures for calendar year 2013. However, when CMS released their proposed rule for the Stage 2 criteria, they recommended that the roll-out for Stage 2 of the Meaningful Use measures should be moved to 2014 in order to give EHR vendors the opportunity to develop and certify the new modules that will be able to meet any new requirements for Stage 2. Therefore, EPs can continue to use EHRs certified under the Stage 1 criteria until the end of 2013.

CMS’s proposed rule for Stage 2 Meaningful Use also addresses the payment penalty that is slated to be introduced in 2015 for Medicare physicians who have not become successful EHR meaningful users. CMS proposes that:

1. Any successful meaningful user in 2013 would avoid payment adjustment in 2015.
2. Any Medicare provider that first meets meaningful use in 2014 would avoid the penalty if they are able to demonstrate meaningful use at least 3 months prior to the end of the calendar or fiscal year (respectively) and meet the registration and attestation requirement by October 1, 2014 (EPs).
3. The following exceptions be instituted concerning the payment penalty:
a. Lack of availability of Internet access or barriers to obtaining IT infrastructure
b. A time-limited exception for newly practicing physicians who would otherwise be unable to avoid payment adjustments
c. Unforeseen circumstances such as natural disasters; these exceptions would be handled on a case-by-case basis.

EPs who are not exempted from the EHR requirements and have not met meaningful use as outlined above will be subject to a 1% payment penalty on their Medicare claims for 2015. This penalty will increase in subsequent years for physicians who do not become meaningful EHR users.

Finally, the proposed rule identifies the objectives for Stage 2 meaningful use. Almost all of Stage 1 criteria are carried over; however, the measures may have been tightened and EPs will have to demonstrate that they are meeting the objectives for a greater percentage of their patient population. There are two major changes that our physicians should be aware of:

1. Stage 2 Meaningful Use requires that physicians give patients “electronic/online access” to their health information. If this measure makes it to the final rule, physicians will have to operate or contract for an online portal that will allow their patients to access their health information at any time.
2. Stage 2 Meaningful Use will require that physicians provide a summary of care record for patients that are sent to other providers.