Top CV Concerns Survey: Results and Quick Tips Part 2

Thursday, January 11, 2018 | MedAxiom Consulting

Priorities. Issues. Problems. Challenges. Opportunities. In health care today, we all have long lists of things that need our attention. What’s rising to the top of those lists right now? We surveyed cardiovascular health care leaders about their greatest concerns; in Part 2 of this blog post, we share more of the list we culled from the survey responses. And, for each issue, the MedAxiom Consulting team offers a “quick tip” to help you tackle it. If you would like more information on each issue and answer, contact the specific consultant listed below. If you missed last week’s post, check out Part 1 of the list here.

Transition from Volume to Value

Several recent articles take the position that “volume to value” is a cliché or has lost its meaning. For instance, it has been suggested that perhaps we should be increasing volume (preventive, cardiac rehab, coronary flow reserve, etc.). At the same time, we definitely want to provide greater value; the question is, what does that really mean? We can all agree that our current health care delivery system needs to improve. There isn’t enough money in the federal budget to support Medicare. If we don’t learn to operate more efficiently and effectively—deliver greater value—then Medicare will simply continue to ratchet down reimbursement. Working to reduce clinical variation and identifying opportunities to improve workflow will be at the top of the list for improving health care delivery. – Pat White, [email protected].

Outreach Analysis

Historically, no subspecialty has worked as hard as cardiology to build outreach channels. As markets and demographics change, however, it is imperative to regularly analyze your outreach to make sure that you are deploying the right resources to the right locations rather than blindly doing outreach as you have in the past. – Larry Sobal, [email protected].

MIPS Reporting in 2018 (The Top 10 Things You Need to Know!)

• There are greater exemptions available for lower volume providers.
• The 2018 MIPS performance year final score changes: Quality, 50%, Advancing Care Information, 25%, Improvement Activities, 15% and Cost, 10%.
• Virtual groups offered if you meet the low-volume threshold.
• More Practice Improvements Activities available (112 total).
• There is a 10% bonus available for using 2015 CEHRT exclusively. 
• Clinicians can earn up to 5 bonus points for treating high-complexity patients.
• Bonus points (5) for smaller practices that submit data on at least 1 performance category in an applicable performance period.
• Up to 10 percentage points available at the performance level for improvements in quality.  
• The MIPS minimal performance threshold was raised to 15 points (instead of 3). 
• There is a minimum 12-month performance period for Cost & Quality. Advancing Care Information and Improvement Activities continue to have a minimum 90-day performance period in 2018. 

Now that cost is a factor in 2018, where do we start? Pull your last QRUR and review your scores for cost and quality. Reach out to hospitals in your area to make sure a transition of care is happening when patients are being discharged. This is a great time to start Chronic Care Management and/or Transition of Care Management in your clinics if you haven't already done so. – Cherie Aduli, [email protected].

Workforce Planning

Our health care world is changing rapidly and with it, so are our workforce needs. Cardiovascular medicine, perhaps more than any other specialty, is deeply subspecialized with diverse needs and talents around specific clinical content areas. Further, as our system is charged with delivering care to entire populations of patients – not just the acutely ill – we will need to design our workforce in such a way to deliver lower-cost care to an expanding patient panel. This will mandate the efficient use of physicians, advanced practice providers and the entire care team. – Joel Sauer, [email protected].

Revenue Cycle Reimbursement and Capture

Revenue cycle processes flow from the first patient contact through payment or adjustment. Each process affects one another and can have significant rippling effects. Errors in the process are more costly to recover than revenue. You should be looking at key performance indicators for your process; these can include front end denials, missed authorizations, charge lag times, and tracking of adjustments. – Nicole Knight, [email protected].

Value-Based Reimbursement

While value, aka risk-based reimbursement, may appear to be a new phenomenon, the reality is that the concept reaches back to the launch of DRGs. The more recent growth of ACOs, bundled payments, and other models are continuations and expansions on the trials and experiments of CMS (and commercial payers). All signs point to further expansion and proliferation of value-based reimbursement, sometimes voluntary and sometimes not. Successful organizations are preparing today by looking at their data, understanding the drivers of cost and quality, and engaging their physicians in new and more productive ways. – Larry Sobal, [email protected].

Declining Procedural Volumes

If your program is experiencing declining PCI procedural volumes, you are in good company. Programs are combating this trend by growing structural heart with EP services leading the way. Another area of opportunity is acute care program consolidation—imagine acute care consolidation and ambulatory site growth! – Anne Beekman, [email protected].

Bundled Payment Models

New reimbursement models are challenging the traditional delivery of cardiovascular care. As our institutions become responsible beyond the care we deliver for the entire cost spectrum during a defined time period (bundled payment model), our processes will need to change. This redesign will not come easily nor will it happen organically. Deliberate, data-driven changes will need to be engineered into long-standing legacy systems. To accomplish this, organizations must have effective governance and leadership structures – where physicians hold real and meaningful leadership roles – that have the ability to effect positive change. – Joel Sauer, [email protected].

Service Line Governance

Governance is what distinguishes successful service lines. Having a clear vision of the purpose of the service line, a defined scope, and thoughtfully designed infrastructure to execute service line strategy are all necessary foundational elements. – Larry Sobal, [email protected].

Cath Lab Efficiency

Running a level loaded cath lab schedule has never been more difficult. If your program has 20 cases one day and five the next, or long breaks in the middle of the day, you are likely using an outdated cath lab scheduling model. Achieving an efficient cath lab schedule requires a well-coordinated plan between the office and the hospital. – Anne Beekman, [email protected].

 

llustration: Lee Sauer

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MedAxiom Consulting is the nation’s leading cardiovascular-specific consulting group, working with a range of private practices, hospitals and health systems across the country to improve the delivery of CV health care. To learn more about our team, please visit our website.