Dec 20, 2018 | Uncategorized
MERRY CHRISTMAS & HAPPY NEW YEARn——————n
nThe team at Welter Healthcare Partners has been celebrating this joyous season and would like to send our greatest wishes to you this holiday season. We hope you enjoy the joy and cheer that Christmas brings and that you will create memories that will last a lifetime. We are thankful for the joy that each of our clients has brought us over the last year and we are excited for what 2019 has in store.nnAll of us at Welter Healthcare Partners would like to wish you and your families a very Merry Christmas and Happy New Year!nn
Dec 13, 2018 | Uncategorized
To successfully transition to value-based care, health systems must engage their physicians in the process.nnFiguring out the best way to engage physicians, however, is often one of the toughest challenges for organizations as they move from traditional fee for-service (FFS) models to models based on the efficient delivery of high-quality care.nnPhysicians drive the bulk of utilization decisions that influence health outcomes, which is one reason their buy-in is critical for transforming care delivery. Success in this new model requires physicians to adapt to a new way of practicing medicine, as well as to adjust to a new compensation model that rewards clinicians for providing high-quality care and containing costs, rather than on the volume of care provided.nnThe transition may be particularly tough for primary care physicians (PCPs) who are now called to serve as care quarterbacks. In this new world, PCPs will be tasked not only with serving the patients in front of them, but also starting to manage entire patient panels outside of the four walls of their clinics. Unfortunately, physicians are not always prepared to take on these additional tasks and must first overcome a number of systemic hurdles.nnUnderstanding current hurdlesnHealth systems attempting to engage physicians in the transition to value should be cognizant of factors that add to the challenge. For example, until recently most physicians have not been educated on the principles of newer care models based on the delivery of cost-effective outcomes, nor on population health management. Only now are medical schools beginning to incorporate these subjects into their curricula—but the impact remains to be seen. They also must address the ongoing challenge of how to influence physician behavior during the gradual shift away from FFS. Because physicians are still mostly paid on a fee-for-service basis, rather than for coordinating care and quality improvement, they have remained focused on providing more services that drive higher reimbursements.nnPhysicians must also adapt to new care coordination requirements. Traditionally no one provider has been responsible for tracking a patient’s care across all provider types and care settings. What makes it even more challenging is that technologies were not built to support this effort—they were built to sustain the FFS model. Physicians haven’t had to worry about financial penalties for duplicating care, nor for missing opportunities to improve patients’ health. Furthermore, physicians have lacked technologies to help advance care coordination efforts because legacy IT systems were designed primarily to support FFS billing functions and lack interoperability. Value-based care models, however, require PCPs and their care teams to manage care more effectively.nn
In addition, the pressure of these many hurdles is magnified for PCPs because of the historical undervaluation of their services in comparison to their specialist counterparts – despite the complexity and variety of conditions seen in primary care. Meanwhile, physicians are overburdened with regulatory and administrative requirements that squeeze them financially and reduce the amount of time spent on patient care. Attempts by payers and purchasers to enforce value-based behaviors using diverse metrics and proprietary programs add to the overload – particularly if physician compensation is not properly aligned. With all these pressures, it’s little wonder that physicians are experiencing widespread career dissatisfaction and burnout.nnTaking a programmatic approach to drive changenGiven all these challenges, how can a health system successfully engage physicians in value-based initiatives? Ideally organizations should adopt a holistic, prescriptive methodology that is supported by people, processes and technology and strives to achieve the Triple Aim plus One – that is, improved clinical outcomes, lower costs and higher patient satisfaction, plus better physician engagement.nnTo successfully engage physicians and drive change, consider this programmatic approach:n
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- Analyze opportunities and measure the organization’s baseline capabilities to identify targets for initial improvement efforts.
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- Establish physician-led governance, a strong clinical leadership team, and a network of high-performing physicians who share a common vision for better care at a lower cost. It’s key to creating a culture of accountability and implement mechanisms for financial outcome accountability.
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- Align incentives by revamping physician contracts at the group and individual physician levels to emphasize value over volume, to encourage physicians to meet quality and cost goals, and to support higher risk models over time.
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- Enhance care improvement by structuring the care model to deliver accountable primary care. Assess current care management programs and add new offerings as needed.
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- Enable behavior change among physicians and care team members through effective training, education and workflows. In addition, implement technology and tools that provide actionable clinical and financial information at the patient and population level.
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- Build on successes by leveraging data, programs and knowledge resources to find and act upon new opportunities for financial and clinical improvement. Monitor internal and external factors so the organization can adapt to changes in the patient population, the market and government regulations.
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nFor systems to succeed in value-based contracts, physicians must be engaged partners in the process. Health systems and payers must view physicians as strategic assets that deserve the necessary training, operational support and technology investments to succeed in a value-based world.nnA comprehensive physician engagement strategy is critical. Organizations must consider information technology needs, create the right governance structure and provide clinicians with educational and mentoring options. The strategy must also align physician payment and provider workflows with the organization’s financial and clinical goals that drive cost-effective, high-quality outcomes.nnThe transition to value-based care can be challenging – and more so if physicians are not engaged in the process. However, organizations can position themselves for value-based success by embracing a comprehensive and prescriptive strategy that addresses the needs of physicians and positions them for success.nnOriginal article published on beckershospitalreview.com.
Dec 6, 2018 | Uncategorized
In the 2019 proposed rule on the Medicare Physician Fee Schedule (PFS), the Centers for Medicare and Medicaid Services (CMS) proposed revisions to the E/M documentation guidelines intended to reduce administrative burden on physicians. In addition, the federal CMS proposed coding and payment changes to new and established office visit services. The AMA led the development of a joint comment letter from 170 physician and other health professional organizations calling for the agency to finalize several proposed changes to E/M documentation guidelines for CY2019.nn“The AMA is pleased to report that the federal CMS is implementing the documentation policies, which will significantly reduce administrative burden and allow all physicians to spend more time with their patients,” the AMA stated. The agency has also acknowledged the work of the AMA’s CPT/RUC Workgroup on E/M and has postponed any coding and payment-related changes for E/M office visit services until CY2021. This delay in implementation will allow the CPT Editorial Panel to consider the workgroup’s proposal in February 2019 prior to prompt consideration by the AMA/Specialty Society RVS Update Committee (RUC).nnOn page 584 of the rule, the federal CMS states:nn“We recognize that many commenters, including the AMA, the RUC, and specialties that participate as members in those committees, have stated intentions of the AMA and the CPT Editorial Panel to revisit coding for E/M office/outpatient services in the immediate future. We note that the 2-year delay in implementation will provide the opportunity for us to respond to the work done by the AMA and the CPT Editorial Panel, as well as other stakeholders. We will consider any changes that are made to CPT coding for E/M services, and recommendations regarding appropriate valuation of new or revised codes.”nnRemoving restrictions on E/M codingnnThe federal CMS finalized several changes to E/M documentation guideline which were strongly supported by the AMA and other members of the federation.n
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- The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.
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- Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated.
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- Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.
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nThese changes will take effect Jan. 1, 2019.nnThe original proposal condensing office visit payment amounts and documentation requirementsnnIn the 2019 proposed rule, the federal CMS proposed to implement a single payment rate for level 2 through level 5 office visits and to reduce documentation requirements for this collapsed payment to that of a level 2 CPT visit code. The agency proposed to continue to use existing CPT structure for office visit codes 99201-99215, though proposed to change guidelines and only enforce certain aspects of the CPT structure by allowing physicians to choose the method of documentation, among the following options:n
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1995 or 1997 Evaluation and Management Guidelines for history, physical exam and medical decision making (current framework for documentation).n
- Medical decision-making only.
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- Physician time spent face-to-face with patients.
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nThe federal CMS had also proposed an add-on code to each office visit performed for primary care purposes and an add-on code for specialties with inherently complex E/M visits. The agency relayed that commenters overwhelmingly opposed this proposed payment collapse. The federal CMS will not finalize the proposal for CY 2019.nnOther coding/payment proposals related to E/MnnThe following policies were also opposed by the AMA and will not be implemented by the federal CMS:n
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- Payment reductions by 50 percent for office visits that occur on the same date as procedures (or a physician in the same group practice). The AMA brought attention to the fact that duplicative resources have already been removed from the underlying procedure through the current valuation process.
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- In addition, the federal CMS proposed to no longer allow for podiatry to report CPT codes 99201-99215 and instead would use two proposed G-codes for podiatry office visits as well as a new prolonged service code that would have been implemented to add-on to any office visit lasting more than 30 minutes beyond the office visit (i.e., hour-long visits in total).
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- Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty. This change would also have resulted in the exclusion of the indirect practice costs for office visits when deriving every other specialty’s indirect practice expense amount for all other services that they perform, which would have resulted in large changes in payment for many specialties (i.e., a greater than 10 percent payment reduction for chemotherapy services).
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nProposals for CY 2021 and the CPT/RUC Workgroup on E/MnnFor CY 2021, the agency conveyed its intention to propose two basic payment rates for office visit services, one for straightforward visits and another for complex visits. In addition, the federal CMS noted their intention to propose add-on codes for primary care and inherently complex specialty E/M visits.nnCMS noted they will also consider input from the AMA and the CPT/RUC Workgroup on E/M as well as input from across the medical community. In response to the Medicare Proposed Rule, the chairs of the AMA CPT Editorial Panel and the AMA/Specialty Society Relative Value Update Committee (RUC) formed the CPT/RUC Workgroup on E/M to:n
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- Capitalize on the CMS proposal and solicit suggestions feedback on the best coding structure to foster burden reduction, while ensuring appropriate valuation.
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- Consider a code change application to be submitted to the CPT Editorial Panel for consideration at their Feb. 7-9, 2019 meeting.
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nThe workgroup is comprised of 12 experts in both coding and valuation (six members each from each of the CPT and RUC processes). In addition to the 12 workgroup members, roughly 300 additional stakeholders from national medical specialty societies, the federal CMS and other health-care-related organizations have participated.nnThe workgroup has expressed their appreciation of the agency’s efforts to address long-standing issues with E/M services and has worked tirelessly over the past several months to establish a long-term, stable CPT coding solution. Listening to the federal CMS and other stakeholder concerns, the workgroup has worked to build consensus around modernizing the office and outpatient E/M CPT codes to simplify the documentation requirements and better focus code selection around medical decision-making and physician time. The workgroup proposal will be formally reviewed by the national medical specialty societies via the CPT Advisory Committee process. The CPT Editorial Panel will review the proposal, and related comments, at the Feb. 7-9, 2019 meeting.nnClick here for more information on the Medicare PFS portion of rule.nnOriginal article posted on cms.org.
Nov 29, 2018 | Uncategorized
CMS has proposed to reward physicians who consult electronically/by phone with other physicians in 2019. The agency also proposed starting to pay physicians to review photos that patients text/e-mail to them. Telehealth is now playing a new role for appropriating medical services and giving providers the helping hand to create connected care platforms!nnUnderstand Medicare telehealth requirements—including coverage, coding, and documentation rules—and ensure your telehealth program and claims comply.nnBank on TCI’s all-new, end-to-end Telemedicine & Telehealth Handbook for Medical Practices 2018 to equip you to plan and implement your telehealth services, weigh the cost of care and technology, and master payment aspects, compliance, and other legal requirements.nnOur experts take the guesswork out of best practices and government regulations, laying out in-depth information on Medicare and Medicaid reimbursement. Capitalize on insightful answers to readers’ questions. Get the inside scoop on coding, billing, compliance, and everything between to launch your telehealth services without a hitch.nnGrow your patient population—and improve outcomes—with a vital telemedicine program:n
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- Capitalize on new telemedicine options from CMS
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- Telehealth Medicare payment policy, with Part B fee-for-services guidance on originating sites, distant site practitioners, telehealth services, and billing and payment services
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- Master the new 2018 telemedicine codes
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- Nail down telemedicine terminology with comprehensive list of terms and definitions
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- Wield social marketing for telehealth
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- Measure telehealth patient outcomes
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- Get modifier updates and other expert documentation tips
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- Use this telemedicine primer to prep for coding opportunities
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- Capitalize on new telemedicine options from CMS
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- Ace coding for your E/M telemedicine services
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- Apply these telehealth indicators to recoup for your distance treatment services
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- Discover telemedicine interventions for chronic disease management
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- Navigate the ins and outs of telemedicine and telehealth
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- Nail down where telehealth services can take place
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- Tackle HIPAA and compliance issues for telemedicine and telehealth
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- Get to know the basics on telehealth reimbursement
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- Ace accurate coding for telemedicine and telehealth
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- Power up your claim submittals for services furnished via telehealth
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- Conquer inpatient telehealth consultations
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- Lock down appropriate licensure
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- Are you eligible for a geographic waiver?
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- Soar to success with telemedicine and telehealth at your facility
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- Gain tips for managing the rapidly changing telehealth technology
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- Make the grade with these consumer-centered telehealth design principles
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- And so much more!
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nBONUS features include a glossary of telemedicine and telehealth terminology, TOOLKIT for proposing new telehealth services to CMS, and easy look-up to find telehealth services and codes either alphabetically or by code number.nnORDER NOW!nnInformation originally provided by TCI Handbooks.
Nov 20, 2018 | Uncategorized
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As many of us reflect on the things in life we are thankful for, all of us at Welter Healthcare Partners would like to say Happy Thanksgiving to our clients, business partners, families and friends! We are extremely grateful for each of you and appreciate your continuous support!nnIn observance of the holiday, we will be closed on Thursday, November 22nd to give our employees time to enjoy the day with their loved ones. We hope you have a wonderful Thanksgiving!nn
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