News You Can Use

New Podcast: Value Based Care Trends, Impact, and Strategies for Providers in the Primary Care Market.

New Podcast: Value Based Care Trends, Impact, and Strategies for Providers in the Primary Care Market.

 

SHP Principle’s Mike Scribner and John Crew, alongside VP of Managed Care Kelly Mooney, discuss the various value based care trends in the market today as they pertain to the Primary Care provider. We’ll also touch on the impact of these trends, the detailed nuances, and potential strategies around each for the PCP setting.

Launching 02/13!!

Principal and Co-Founder of SHP, John W. Crew is a graduate of Valdosta State University and has over 25 years of experience in healthcare. He is experienced in ACO formation and management, IPA/PHO formation and management, managed care, and development of ancillary revenue streams.

John resides in Athens, GA (Home of the back to back college football national champions) with his beautiful wife Vickie. They have 2 sons that are now out conquering the world.

You can reach him @ jcrew@shpllc.com or (912) 691-5711.

Mike Scribner is the Principal of Strategic Healthcare Partners (SHP), based in Savannah, GA. He has an extensive background in managed care contracting, revenue cycle, CFO support, budget
development, decision support, and growth strategy development. He holds a Master’s in Accounting from the University of Mississippi and is a member of HFMA and NAHU.

Mike began his career at Ernst & Young in Memphis, Tennessee. He later served as the Director of Finance at LeBonheur Children’s Medical Center, then Director of Managed Care for its parent organization, Methodist Health System. Mike moved to Savannah, Georgia in 1996 to become CFO for CareOne Home Health at Memorial Health University Medical Center. During his tenure with Memorial Health System, Mike served in capacities of Vice President of Finance/Administrator-Corporate Finance, then Vice President of Managed Care/Homecare for the Health System.

Mike left Memorial in 2004 and launched a managed care consulting firm called Health Resources Group. In December of 2008, HRG and Preferred Healthcare Consultant (PHC) combined to form Strategic Healthcare Partners (SHP), which now has offices in Villa Rica in the
Atlanta area and Savannah.

Mike lives in Savannah with his wife, Stephanie, two children and three grandchildren. He has served as an active youth ministry volunteer for the past 25 years, while also cheering on his beloved Rebels!

You can reach him @ mscribner@shpllc.com or (912) 691-5711.

Beyond the Stethoscope: Vital Conversations with SHP

Beyond The Stethoscope Season 2 Coming Soon!

Beyond The Stethoscope Season 2 Coming Soon!

We’rrrreee back…SHP’s podcast, Beyond the Stethoscope: Vital Conversations with SHP launches season 2 in mid-February.

We are changing format slightly with a weekly episode, alternating between guest interviews and news headlines with relative discussions between hosts Aaron Higgins and Jason Crosby. Topics will include Diabetes Management Clinic services, ASC trends, Primary Care trends, IT in the provider setting, Objectives and Key Results, and others. Join us as we get up and going in the coming weeks!

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon.

Beyond the Stethoscope: Vital Conversations with SHP

 

Listen Today! “What is a Clinically Integrated Network (CIN)? And Why Should A Provider Consider Joining?” #2

Listen Today! “What is a Clinically Integrated Network (CIN)? And Why Should A Provider Consider Joining?” #2

Listen Today! “What is a Clinically Integrated Network (CIN)? And why should a provider consider joining .”

Jason will help clear up the vague three letter acronym, CIN. We’ll talk through what a Clinically Integrated Network is exactly, why you should look into joining one, and how they can fit into your provider strategy.

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon.

Beyond the Stethoscope: Vital Conversations with SHP

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 10 – Keys to a Successful CIN | With Jason Crosby

In this episode, Jason shares with us the results of a study that shows PCPs may be unfairly punished with poor MIPS scores. Aaron shares a warning about two different crypto viruses targeting healthcare organizations. And we briefly discuss our upcoming season 2.

 

Then, Aaron sits down with our very own Jason Crosby to talk about CINs, how they work, how to start or join one, the keys to a successful CIN, the potential for legal pitfalls, and how CINs may fit the greater goal of providing value-based care. 

 

Aaron’s News
https://www.hhs.gov/sites/default/files/lockbit-3-analyst-note.pdf

https://www.hhs.gov/sites/default/files/blackcat-analyst-note.pdf

Jason’s News

Value-based payment system shortchanges PCPs, says study (fiercehealthcare.com)

 

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Aaron C Higgins

Executive Producers: Mike Scribner & John Crew

TRANSCRIPT

 

Last Episode of  Season 1, 12/17: “What is a Clinically Integrated Network (CIN)? And Why Should A Provider Consider Joining?”

Last Episode of Season 1, 12/17: “What is a Clinically Integrated Network (CIN)? And Why Should A Provider Consider Joining?”

Last Episode of Season 1 Launches 12/21: “What is a Clinically Integrated Network (CIN)? And why should a provider consider joining .”

Jason will help clear up the vague three letter acronym, CIN. We’ll talk through what a Clinically Integrated Network is exactly, why you should look into joining one, and how they can fit into your provider strategy.

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon.

Beyond the Stethoscope: Vital Conversations with SHP

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 9 – Coding Changes for 2023 (Including E&M, New G-Codes, and Screening Reimbursements) | With Steve Adams

On today’s episode, Jason shares an article about how Mark Cuban is expanding his low-cost pharmacy project. And Aron shares about how charging for digital messages may be on shaky ground.

Jason sits down with our guest Steve Adams. A Certified Professional Coder Instructor with InGauge Healthcare Solutions with more than 20 years-experience with training others how to code in all arenas of care. Steve dissects the coding changes for 2023 in the Final Rule, including E&M, new G-codes, and screening reimbursements.

Aaron’s news: https://www.beckerspayer.com/policy-updates/mychart-message-fees-live-on-unstable-ground.html

Jason’s news: https://www.beckershospitalreview.com/pharmacy/mark-cuban-cost-plus-partners-with-2nd-pbm-hints-at-insulin-market-entry.html

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

 

Transcript

Jason Crosby
All right, today our guest is Steve Adams, senior consultant with inHealth professional services.
OK, he is a certified professional coder with over 20 years experience of various settings including many, many guest speaking engagement. Steve, thanks for joining us today and welcome to the podcast.
Steve Adams
This it’s my pleasure. This is my first one, so I’m excited.
Jason Crosby
Alright, well, good deal. We’ll tell you what, what the timing of the the podcast we got about a month left just for the listeners month left in the 2022. So obviously the last couple of months.
Lots of changes, final ruling AMA and their coding changes. Let’s let’s dive right in. Can you give us a quick overview of the E&M changes you’re expecting or what you’re seeing for 2023 for the audience?
Steve Adams
Yeah, it’s really it’s really pretty easy. The biggest change that you’re gonna notice in your CPT books this year is there were about 393 changes in the CPT book, but nearly half of those were just revisions and deletions in the evaluation and management section. And you know, when I look at this, I’ve seen a new one, looks like they have about one new code, 49 have been revised and 25 were deleted. And we’re also busy that a lot of times people are missing out.
On all these revisions, and then Medicare just published their Federal Register about three weeks ago, when they came out with a lot of new G codes, they changing the time requirements for depression screens and for alcohol use screening. So there’s a lot of things going on regardless of what specialty you’re in. It would be, it’s worth taking a look at some of these changes that we’re going to go over today.
Jason Crosby
Fantastic. Let’s jump right on then. There which which are some of the key ones that you’re seeing as far as on the deletion side in any revisions that you had mentioned?
Steve Adams
Yeah. I think the biggest thing to kind of realize is that in 2021 CMS and AMA changed the way that we documented our evaluation and management services in the outpatient setting and they did that just to kind of see how it was going to work and it worked so well that now they’ve incorporated those changes into facility based coding. So now what you’re going to see is the opportunity to build total daytime on almost every visit still except the emergency room visits. But we are seeing all that time change we’re seeing now that you just have to have a medically appropriate history and a medically approx.
For an exam for all code. So if you’re used to doing auditing, you no longer will have to download a doctor for an initial hospital visit. If they don’t have 10 review of systems or an 8 organ system exam, I think probably the biggest thing that’s gonna be a change for a lot of people is CMS has done away with the observation codes. So we’ve seen the observation codes, deleted the initial ones, the subsequent the annual nursing facility code has been deleted.
They’ve changed all the domiciliary and rest home as well as home visit code, so they’ve deleted all those and again revised just about everything else. So even if you’re in the emergency room, you know they’ve revised those codes. They’ve revised the consultation codes, nursing home, home health. They’ve made some nice changes to the transitional care management codes that if you’re doing that, I’ll make it a little bit easier to explain to your physicians what’s happening. But those are some of the things that I want to kind of look at today is how they’ve incorporated those.
Observation codes. Now that you might be familiar with 992189921999220 and they’ve just incorporated those into the old initial hospital codes like 99221 used to read initial.
You know, initial hospital visit and now it just says initial hospital or observation service, so you no longer have the discharge code for observation and there’s a couple other little things that are important in there, especially if you do hospital coding.
Jason Crosby
Yeah, it it definitely looks like different settings have some variables that have been tossed in the some of the codes might have gone away, descriptions altered, that sort of thing. So what should folks be looking for that are there on the front lines every day in the coding world?
Steve Adams
I think the biggest thing that you can do is if you do in hospital coding, remember that.
The history and exam is all going to be medically necessary when it’s stressed to your providers about that. You also kind of want to be cognizant of the fact that CMS has dropped the conversion factor this year and some of the codes that we used to do really well on like your initial hospital code used to pay about $200.00. Now it’s down to about 170. The only code that’s really increased are some of your subsequent hospital visit codes and that’s because they’ve really stuck it to us on.
The time components. So if you do hospital coding a lot of times, doctors would do 99233 based on what we call unit 4 floor time. So if you spent greater than 50% of your time on the floor and that time was 35 minutes, you were able to build like a 99233. Now in the hospital nursing home everywhere else they’ve transitioned to total daytime. So it’s gonna be really important for you to update your physicians that the New Times are substantially more.
Then they used to be. So for example a 99233 that used to be 35 minutes greater than 50% was unit. Floor time is now up to 50 minutes unit floor time, so that changes the dynamics a lot on your Level 3 visits and one of the reasons that they went up on those codes, 232 used to be 25. Now it’s 35 minutes. So what you used to be able to Bill is A33 is now A32 and they’ve also taken out of the CPT book and this is important. The disclaimers that used to be under those codes. So it used to be AT233, which everybody wanted to bill, used to have to be 35 minutes greater than 50% unit floor time, or the patient had to have a such a significant problem. They weren’t responding at all to treatment, major complications. So I think that we’re going to see some reductions in the number of 9923 threes. And I mean, I think that when I’m teaching physicians this week and next week on all these changes, that’s the thing. I’m really driving home because at the end of the day, you actually have to document less.
Then you did in the past. The only thing that’s really shifted is the amount of time, and it’s no more greater than 50%. It’s total daytime and in your CPT book they have a section on that and they kind of go over with you. The nine things that count as total daytime. So I would definitely take a look at that, just open up the front of that CPT book and you’ll see all of these changes in the front where you’re and requirements are.
Jason Crosby
So some of the feedback I’ve been reading up on these changes, would you agree that the the process itself is more simple and flexible? What do you think there’s gonna be some natural give and take us folks learn what these changes are?
Steve Adams
I think the changes are the documentation. Requirements are so much easier. I I think that the thing about it is and honestly I’m.
I I work with several hospitalist groups and I think the one thing that’s gonna kill a lot of doctors is this time this additional time required for the 99233. I mean, if you think about a typical hospitalist working a 12 hour shift and they used to be able to build 9923 threes, you know three or four every couple hours and now they’re not able to do that. So I think once you start delving into it is really funny. Before we started talking, you know, I even brought up the fact that I’ve went back to school to get a third degree.
So that just because this stuff is getting a little bit more easy, I have a Plan B myself to back out of this system because this when I started in 92, this stuff was so difficult and it was so just redundant and there was no medicine being practiced. Now that they’re shifting to billing based on the complexity of the patient, that makes everything so much easier for your providers. And the thing that is really impressive is that the AMA has worked with CMS on this. And I mean, I’m really impressed with that. And I think it’s just.
And I think the future is gonna be a lot easier for doctors to support various levels of service.
Jason Crosby
Good feedback for sure. So with all that said, because every year there’s a lot to absorb with such changes.
For audience that’s listening that that is in there every day. What can they do to prepare for those changes here in the next few weeks?
Steve Adams
I think one of the things again that you do is you know you reach out to whoever you’re coding person is whether or not it’s a. If you work with the State Medical society. I know I do consulting for the Georgia Academy of Family Practice, Georgia, OBGYN Society, the American College of Physicians, and those are areas where if you’re part of those groups, you can they have webinars every year. I’m doing the OBGYN when this Friday and the Georgia Academy of Family Practice next week.
If you’re in plastic surgery, you can contact the Georgia Academy of Plastic Surgery, ophthalmology into whatever they should have some resources for you. Normally they have a consultant who works closely with them. Who does these kinds of E&M seminars that will get you ready and that way it’ll save you some money because the biggest thing that I see and I hate.
These companies who send you these emails that say, you know, did you know there were 373 coding changes and for $750, you know, we can explain it to you. And I always tell my private clients, you know, don’t do that unless it’s somewhere like in Las Vegas where you can fly out there or Miami this time of the year. But don’t get confused by the emails that you’re going to get. Contact your specialty societies, your national society. And again, they’re going to have some resources that will give you this information because.
I mean, if you look at Medicare, especially with prolong services, when we know that we had the 99417, when we went 15 minutes over for an outpatient facility code and then Medicare came up with their own code G2O12 and now we have these new prolong service codes for hospital. You know AMA came out with 99418, but now we also have Geo 3160317, go 318. There’s just so many little nuances.
In the coding world that you really, if you don’t want to pay a lot of money, reach out to your societies first. And I think that’s gonna be your best bet.
Jason Crosby
Yeah. So if if you’re a kind of keep going down that path.
If if you’re sort of new into the field or looking to to sort of take on this new skill set and maybe this is kind of OK Steve, go back to when you first got into the field.
How describe how best for that person to maybe expand on that if they’re just starting out aside from reaching out to the consultants, any other types of resources, education tracks or maybe highlight for us how you got into it as well?
Steve Adams
The hard thing about any kind of coding change is that they’re honestly just, there’s not a lot of people out there who specialize it anymore. I’d be just honest with you. It’s really hard. A lot of the hospital systems that I used to consult with have just decided, well, hey, listen, we’re going to go out and hire a guy full time to work in our facility. So what I would tell people to do because my neighbor, I helped her become certified and she’s worked for a great family practice here in Augusta.
For, you know, at least a decade and what I would tell her is just go to Google.
Umm, I mean, I have a wife and kids and dogs and cats and I love to make money, but I I’ve been in this business since 1992 because I wanna save people money and I would literally just go to Google and or YouTube and I would just type in 2023.
E&M coding changes or 2023 CPT. Coding changes and there are people who put out free information to kind of draw traffic to their website. So I would if your society doesn’t have anything and you want to learn more about coding, that’s a good place to start. Another fantastic place to start is your local aapc coding chapter. Now, if you’ve got an ink pen, I’ll tell you how to do this. I get calls at least once a week. Somebody who wants to enter this field.
Steve Adams
And when I tell him to do is coders on the on the whole are pretty introverted. We only like our own people and we get together usually every month that these local coding chapters and these local coding chapters, you get an opportunity to network with fellow nerds. And even if you’re not certified, you can do that. And the way that you do that is simple. You just, I’m going to give you a phone number. You’re going to call them or you can go on their website, you find a local coding chapter. You can join that local coding chapter and then they have guest speakers who come once a month, either virtually or in person.
And they talk about this and it’s so stupid to say this, but I mean, I’m a pretty big deal in this business and I have a a local chapter right here in Augusta, and they never ask me to speak anymore. I don’t know if it’s because they’re afraid I’m going to take their clients. I don’t know what it is, but I try to tune in every once in a while to a local chapter meeting and you’ll find good resources there. So here’s what you do. You call one 800-626-2633 and it’s easy to remember. That’s one 800-626-CODE.
Since a lot of us are on social media and etcetera, you can go also to the Internet and just go to Aapc American Academy of Professional coders.com. Apc.com has a lot of great resources and you can just call them and you can go to their website and just look for local coding chapters, call them up and just say, hey, listen, I live in the perimeter area of Atlanta. Do you have a coding chapter? They’ll tell you who the contact person is. You look them up, they’re going to have people come in and talk about.
Uh, talk about this. These coding changes and again, that’s a membership opportunity for you. And so that’s what I would say, yes. And I would say if you want to get into this field, I every time I talk to somebody, I’m like, yeah, you can come to one of my coding classes, but I can’t get you a job. You’re only going to get a job, usually through these local coding chapters. So I hope that wasn’t too long of an explanation, but use YouTube, Google, go to apc.com, join their organization. They send out newsletters, they have webinars that you can attend as well. And that’s how I would recommend it.
Jason Crosby
Fantastic. Fantastic. Very, very helpful. And it I I would add to that, it probably doesn’t matter what type of setting you’re in where you’re located there. There’s always an evolution to this part of the field that’s always going to have some sort of demand to it.
Steve Adams
And Jason, I don’t wanna interrupt you here, but I I’m going to because a lot of times people think well, I don’t want to be a certified professional coder. You know, I’ve been coding for 20 years. I don’t wanna be a CPC, the aapc of which I receive no money from. Trust me. God, I pay them probably $2500 a year just to teach their stuff and give their test. But they have credentialing for specialists. So, I mean, if you’re a GI coder, you don’t want to be a CPC, become a GI coder. You can take their certification test. Interventional radiology.
Again, you can do so many different things right now a big field is HCC and risk value based coding. You can take their online home study courses for that. There’s just so many opportunities. They’re on Facebook, they’re on Twitter. They have a campaign right now that just talks about how people have a three times better chance of passing their national exams. If you take their their online courses. So just don’t be constrained. And just think I want to be a CPC and know a little bit about everything, focus in on your specialty. That’s another opportunity for you to learn.
Jason Crosby
Great insight as we wrap up here to tell our listeners how can they get in touch with you if they need to request your services.
Steve Adams
It is so simple to reach out to me, the first thing I tell people is just my e-mail. So I have a I work for a firm called in health and that’s in Atlanta. I live in Augusta. A lot of people just send me emails because I’ve known in this industry as the King of coders. So really easy way that people reach out to me is just going to the king of coders@gmail.com and sending me an e-mail. I tried to make things simple. So the king of coders@gmail.com you can also go to my website. I’ve just updated it. A lot of that information that we’re talking about today I have.
The ICD 10 manual up there, I just have a lot of resources for 2023 and it’s easy to remember that too because I made coding consultant so my website isthecodingconsultant.com and you can go out there and take a look at some of my stuff and you can e-mail me from there. You can call me. There’s no secretary since 1992. It’s just been me, a rental car and a laptop and my number is simple, it’s 706-483-4728 and just in case my firm hears me, my company e-mail is steve.adams@inhealthps.com and that’s why I never give out that web because it’s a I don’t understand. When I worked at Mag Mutual, my e-mail was so cool. They used the first initial of your name and your last name at Mag Mutual. So I was saddams@magmutual.com. Now, if you’re, you know, I was involved in the first Gulf War, so it was really cool for me because older people remembered Saddam Hussein. So don’t send emails to saddams@magnitude.com I no longer work there. They sold us. So the kingofcoders@gmail.com is probably the best way to reach out to me or go to my website.
Jason Crosby
That’s awesome, Steve. That’s good. Alright, well, well, great information, Steve. We can certainly go on for hours, probably just diving into the details each time they’re it changes and we’ll have to certainly have you on again soon and really appreciate your time and joining us today.
Steve Adams
To my pleasure, half an hour out of my life is no problem. This is my first podcast. I can’t wait to tell everybody that I was officially on a podcast now, and I’ll be making millions of dollars and endorsement deals, and I’ll be pimping AMA stuff and ICD 10 products. I’ll have my own shirt line. It’ll be great. So thanks for giving me the opportunity to retire early. Guys. I really appreciate it.

Listen Today! “What You Need to Know About the Billing & Coding Changes to All Lines of Services in the E&M Section for 2023”

Listen Today! “What You Need to Know About the Billing & Coding Changes to All Lines of Services in the E&M Section for 2023”

The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains 393 editorial updates including 225 new codes, 75 deletions, and 93 revisions. Steve Adams is well known on the speaking circuit and very engaging is reviewing such changes, how they reduce medical coding burden for evaluation and management (E/M) visits, and impact to your organization.

Guest: Steve Adams, CPC, CEMC, CPMA, CRC, PCS, COC, FCS

Steve Adams is a Certified Professional Coder for both office (CPC, PCS) and hospitals (CPC-H, FCS) with more than 20 years experience in military, multi-specialty, hospital, and the private sector practice of medicine. He has both training and knowledge as a technician, educator, lecturer, and medical group practice manager. His experience includes the evaluation of managed care agreements, fee schedule development, and the implementation of policies to optimize compliance and medical insurance reimbursement.

Steve currently holds the position of Senior Management Consultant with InGauge Healthcare Solutions where he has been employed as a consultant for 20 years.

Mr. Adams is also a licensed Certified Professional Coding instructor for the American Academy of Professional Coders (AAPC) and provides:

  • Retainer consulting for more than 400 physicians nationwide, making up more than 20 specialties in North American, Bermuda and the Southern Caribbean;
  • Facility based, rural health, and multi-specialty medical practice billing reviews and restructuring;
  • The Professional Medical Coding Curriculum (PMCC) course for the AAPC.

As a lecturer and educator, he conducts key note addresses and specialty specific presentations on Human Resources, Medicare/Medicaid billing, coding, and compliance.

 

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon.

Beyond the Stethoscope: Vital Conversations with SHP

New Episode 12/14! “What You Need to Know About the Billing & Coding Changes to All Lines of Services in the E&M Section for 2023”

New Episode 12/14! “What You Need to Know About the Billing & Coding Changes to All Lines of Services in the E&M Section for 2023”

The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains 393 editorial updates including 225 new codes, 75 deletions, and 93 revisions. Steve Adams is well known on the speaking circuit and very engaging is reviewing such changes, how they reduce medical coding burden for evaluation and management (E/M) visits, and impact to your organization.

Guest: Steve Adams, CPC, CEMC, CPMA, CRC, PCS, COC, FCS

Steve Adams is a Certified Professional Coder for both office (CPC, PCS) and hospitals (CPC-H, FCS) with more than 20 years experience in military, multi-specialty, hospital, and the private sector practice of medicine. He has both training and knowledge as a technician, educator, lecturer, and medical group practice manager. His experience includes the evaluation of managed care agreements, fee schedule development, and the implementation of policies to optimize compliance and medical insurance reimbursement.

Steve currently holds the position of Senior Management Consultant with InGauge Healthcare Solutions where he has been employed as a consultant for 20 years.

Mr. Adams is also a licensed Certified Professional Coding instructor for the American Academy of Professional Coders (AAPC) and provides:

  • Retainer consulting for more than 400 physicians nationwide, making up more than 20 specialties in North American, Bermuda and the Southern Caribbean;
  • Facility based, rural health, and multi-specialty medical practice billing reviews and restructuring;
  • The Professional Medical Coding Curriculum (PMCC) course for the AAPC.

As a lecturer and educator, he conducts key note addresses and specialty specific presentations on Human Resources, Medicare/Medicaid billing, coding, and compliance.

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon.

Beyond the Stethoscope: Vital Conversations with SHP

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 8 – The Quality Payment Program 2023 & Beyond | With Aaron Higgins

In this episode, Jason shares with us a few of the “Top 10 Digital Health Stories of 2022” and Aaron discusses a recent survey that shows 6 out of 10 patients have had a poor experience with healthcare in the last year. Then we tease a bit about our upcoming changes in season 2.

Then Jason interviews Aaron about the Quality Payment Program (QPP). The program has continued to evolve in the last several years, and this year is no exception. Aaron goes into some of the history of how QPP came about, where the program is heading, and what practices need to be doing now to prepare for it.

Jason’s news: The Top 10 Digital Health Stories Of 2022 – The Medical Futurist
Aaron’s news: PX Pulse – The Beryl Institute – Improving the Patient Experience

Aaron can be found on:
LinkedIn

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

Visit our website
Like us on Facebook
Tweet @ us on Twitter
Follow on Linkedin
Send an email contact@shpllc.com

 

Transcript

Jason Crosby

Hi. I’m joined today by familiar voice, my podcast partner in crime Aaron Higgins of SHP.

Today’s topic. We’re gonna cover the basics, the ends and outs and all things related to the quality payment program final ruling that recently came out. Aaron, how are you? And thank you for joining.

Aaron Higgins

I’m doing pretty good, Jason. How about you?

Jason Crosby

Fantastic. Thank you. Thank you. So Aaron has been with us SHP for quite a few years now between our analytics department and as our IT strategist, but a lot of his background and current function is knowing anything and everything related to MIPS and now QPP.

But Aaron, as we get started, tell us a little bit how you got started in healthcare and specifically how you became involved with quality in the first place.

Aaron Higgins

Sure. So my background starts relatively benign. I was the IT guy brought on to a cardiology group in in the waning years of the Bush administration in the early days of meaningful use, PQRS at that same time, the practice, like many practices, was moving from paper church to digital church. And so I was brought in to help them move to their new EHR and it just kind of got coupled with the whole EHR.

Deployment of well, we have to do PQRS. We have to do this meaningful use thing. Using your EHR. You’re the expert on the EHR. So why don’t you run it? And so it had the snowball effect from there where a larger and larger chunk of time went from, hey, my mouse isn’t working to hey, how come my erx scores low and it just the the growth of it was sort of this natural onset and.

Coming to Savannah several years ago, I did primarily that sort of thing, PQRS and then at the time QPP or MIPS was new. So I helped the practice get on board with that and and do their scoring and then coming to SHP, it grew from just being a solo practice focus to helping a lot of our clients do their.

Their QPP work. So in that time I’ve worked with IPA’s and large practices, small practices, helping them solve their quality payment program questions.

Jason Crosby

Kind of a natural evolution from the IT background, EMR support and the QPP, which is pretty common. It seems like these days, if not clinical kind of coming from that EMR side gives you some unique insight I can imagine.

Aaron Higgins

Yeah, absolutely. Yeah. The the biggest part of that being successful with QPP really comes down to workflows, making sure you’re documenting the care and the right way according to your EMR’s needs. So that was really the biggest barrier that we had with adoption within easy sort of quality payment fill in the blank, whether it was meaningful use or PQRS, it came down to workflows.

Jason Crosby

Fantastic. Well, well on that front, let’s, let’s back up a little bit, explain a bit around the origins of the quality payment program.

Aaron Higgins

Sure. Uh, I’ve already mentioned PQRS and meaningful use, so those were the forbearers. But we actually have to go back even further to the late 90s. A lot of the private payers we’re trying to figure out ways that they could reduce costs and improve patient outcomes. And at the same time too the federal government was doing the same thing. And so the two kind of came together the private payers, a lot of the private organizations such as the American Medical Association and the federal government sat down in the mid aughts.

And said we need something, we don’t know what we need, but we need something that improves patient care. That’s measurable, that everyone can do. And in again the late Bush years, so circa 2008.

We started seeing a lot of rumblings from CMS about this new meaningful use program to get people to use EHRs and use them in a meaningful, useful way. EHRs were thing they just they weren’t widespread. And so that program took on a life of its own. And then under the Obama administration, it grew even further than by the time the Obama terms were nearly done. We ended up with MACRA, which was the Medicare and Chip Reauthorization Act of 2015.

From that MACRA program we got the quality payment programs which is the umbrella term that we use to cover MIPS. So the merit based incentive payment system MIPS, we got a lot of the ACOs and the advanced payment models that we have today APMs all of that came out of macro. So it’s been 20 years or so of just gestation and constant evolution of the programs.

Jason Crosby

Yes, sounds like it, whether it’s the alphabet soup that’s evolved over the umbrella of reimbursement underneath it, measures, et cetera, definitely a big evolution. So let’s let’s touch on that a little bit. Over the last seven years in particular, since it was passed in 2015, lots of changes even within that small window. Why would you say that it is and how has that program changed so much?

Aaron Higgins

One of the big complaints about meaningful use was how rigid it was. It it changed a little bit every year, but it was extremely rigid. There wasn’t a good feedback in mechanism for it. So at its heart macro was written by Congress to require a lot of feedback and CMS has taken that feedback every year, so they they release a proposed rule. And that being said, laws have always required a feedback period. It’s just with MACRA that was baked right in they were very strict on CMS soliciting feedback and very clear on the release schedule for and so every summer we get a proposed rule for QPP and then come Porter three or quarter four sometime we’ll see the final. Now this year it was great. Final rule dropped in late October is on Halloween. So it was a little bit of a treat and I say that because in prior years they’ve waited as long as the first week of December. So there’s not a whole lot of time to read through the final rule.

But, but going back to that feedback that that’s been an important element and a big driver of how the programs evolved when the program was first introduced, it was very all a cart kind of.

Take your own adventure sort of thing, and now it’s kind of going back to that rigidity that we had with meaningful use, but with a lot more care and a lot more feedback put into it with the introduction of MVP, which is the way that MIPS is going to evolve for non-APM practices in the future.

Jason Crosby

Let’s keep going on that path. So lots of changes obviously as you just mentioned.

And my folks are listening now to 2023 final rule, which just came out as you just mentioned.

Hit on specifically some of the measures and points that you feel are most influential for folks coming in with 23 bowl.

Aaron Higgins

Yeah, some of the changes that we’re seeing with 23 aren’t as huge as we’ve had in prior years. Some of the years the programs drastically changed. And again, going back to that feedback element, the final rules always have this question or an answer, I guess, feedback and answer response sort of mechanism in there. And it’s, it’s fascinating to read through that if you’re a normal like me because you get an idea of what CMS is thinking when they’re writing these rules.

And in many cases we’ve seen it where someone’s left comments and it’s made a change in the final outcome and we saw that this year too there were several measures that were proposed for removal and the quality and ended up staying and getting changed instead. So the feedback matters. But this year some of our bigger changes were actually a little bit of a surprise for some of us because they weren’t in the proposed rule. And CMS has allowed to do that. Things come up between the time that the proposed rule is released and the time that the final rule is released.

So they make changes, so one of the big changes is in regards to the certified EHR technology or see hurt. It’s right now 2015 C hurt is required to participate in any form of QPP.

But they have updated the CEHRT certification to the Cures update, so you need to make sure your EHR vendor is updating your EHR to the 2015.

Certified EHR Technology cures update it it’s a bit of a mouthful. Reach out to your EHR vendor, talk to them. It’s really important that you do that. Depending on how you’re reporting your quality measures, it could be as soon as January 1st. So this is really timely. That would be January 1st, 2023 or at the very latest October 1st, 2023. You need to talk to your EHR vendor. It has to do with the way that you’re reporting your quality measures really important.

Some of the other changes that we’re seeing is the automatic exemptions for small practices, so small practices. According to CMS QPP rules or practices with 15 or fewer eligible clinicians. If you are an eligible practice, you may be able to take some automatic exemptions on promoting interoperability. CMS has seen small practices struggle with that, so they’re taking the burden off while they either retool it.

Or they allow small practices to figure out what they need to do to actually do well on it.

And another exemption, but you have to apply for it is the cost category. The cost category is really hard for small practices to know what their score is going to be until after they get their scores. So there’s no chance for them to change it and that’s going to be available for small practices.

But there’s been a significant number of individual quality measures that were changed over 75 of them. Were we actually just did a webinar on this a couple weeks ago. I invited our listeners to go check that out. We go into greater detail about what those measures are, the new and changed improvement activities. There’s a whole laundry list of individual small changes that were made in the program this year.

Jason Crosby

Great info there. And to reiterate Aaron’s point, I think you’ll find the webinar very informative. Lots of info. There were about good 45 minutes worth of stuff where you guys to go out and check out.

Alright, given that know. we’ve obviously got various folks listening practices, hospitals, etcetera. What would you tell a practice who has not participated in MIPS before, or maybe who just hasn’t scored as well? Where should they start and seeking out? Should I go down this path or how to improve? What would you suggest first?

Aaron Higgins

Yeah, it is very daunting like any federal program, it’s confusing. There’s a lot of rules. The rules change every year. Where to begin and…great question…I would say start by seeing if you’re providers are eligible or not. If you know for certain that they are eligible or you’re maybe you’re practice as a whole is eligible.

Uh, so that’s important, because if you’re not eligible and you haven’t started this year?

For 2023, use 2023 instead as a preparation year to participate in 2024. Now, if you are eligible and you’re panicking right now, well, don’t panic. There’s a lot of great resources out there for small practices. Again, that’s 15 or fewer clinicians. There’s a lot of free resources available to you where CMS has vendors that will come alongside and hold your hand through the process. Of course, there’s CHP. We’re more than happy to sit down with you, spend 20-30 minutes on a call with you to talk you through what all you need to do because you’re going to need an identifying measures, measures that are relevant to your organization and your type of practice. Gonna need a fine improvement activities. You’ll need to check with your EHR vendor to see what measures and activities they’re supporting and promoting interoperability. Getting patients enrolled in patient portal, that’s where thing. There are a lot of moving parts and if you are eligible for MIPS in 2023 and you haven’t begun preparation.

Well, I hate to say it’s it’s too late. It’s never really, truly, too late. But you need to start working on it now instead of waiting until after the first of the year. But we are more than happy to help you out as HHP our website ashpllc.com webinars is where you’ll find recordings of all of our webinars regarding QPP. So that may be another place you want to begin.

A few years ago, Jason, we did some webinars about the origins, the individual origins and really deep diving into each of the categories. That would also be a great resource for someone who wants to learn the whole history and and how we got to where we are.

Jason Crosby

Yeah. Now that they’re, they’re reimbursement penalty.

Is climbing the ranks there and as hurtful as it is, another incentive to kind of get on the train there.

Aaron Higgins

Yeah, and and that that raises a good point, Jason, if you don’t participate and you are eligible, that’s a 9% reduction on your Medicare Part B payments. And for a practice that has a large Medicare population that could be huge.

Jason Crosby

Yeah. Yeah, early on that when it was less that was kind of the rationale for folks not participating right OHG it’s only you know one percent, 2% and now it’s nine. It’s kind of moves the dial a little bit. So we we’ve talked about how you got in the QPP, we’ve talked about the origins of it, we’ve talked about the changes for next year. And then just now a lot of what to do action called action type items, anything else you wanna highlight for the group?

Aaron Higgins

Yeah, I hinted at it earlier. We have the MIPS evolution, the MVP program so MVP is the way that traditional MIPS is going to evolve. If you’ve ever participated in an ACO or know someone who has think as an MVP, as a micro ACO. So that’s the way that the program will evolve in the future. We’ll make the administrative burden a little bit lighter and this final rule went into some more information about the types of MVPS that you’ll be able to choose from starting next year. It’ll be a voluntary process.

And then three years from now, in 2026, it’s going to be mandatory that you participate in MVP. So if you’re just getting started or you been in the program for a really long time, understanding what the MVP’s are and how they’re going to work for you is really important. Again, going back to, if you have questions about that, you can call us or you can call the QPP help desk there available at qpp.cms.gov and more than happy to help their great resource.

Jason Crosby

And I I’ll reiterate again that the webinar that Aaron’s referencing, if you go to shpllc.com\webinars, you’ll see it there dated November 15th.

Jason Crosby

Very informative PowerPoint presentation there for your reference. Uh, please take a look at it.

Aaron’s information’s on the website. Otherwise how can they find you here?

Aaron Higgins

You can find me on LinkedIn Aaron C Higgins or you can click the link in the show notes. We’ll have everything linked below, or you can shoot me an e-mail. That’s ahiggins@shpllc.com.

Jason Crosby

Fantastic. Great information. I appreciate your time, Aaron. And then slight appreciate everybody listening. I’m sure we’ll talk QPP at some point next year as well. Obviously what that thanks again for joining us and have a great rest of your day.

Aaron Higgins

And you too, Jason.