Medicare Value Partners

Transcription

1 Medicare Value Partners Medicare Shared Savings ACO Program Frequently Asked Questions (FAQ) Q: What exactly is a Medicare Shared Savings Program ACO? A: Medicare Shared Savings Program accountable care organizations, such as Medicare Value Partners, are groups of physicians, hospitals and other health care providers that work together to coordinate and provide high quality care to their Medicare patients. The goal is to ensure that patients get the right care at the right time without unnecessary duplication of services and at high level of quality. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share the savings it achieves for the Medicare program. An ACO provides the opportunity to reward physicians for providing the high quality and patient-centered care they were trained to provide. Q: What is Medicare Value Partners? A: The Centers for Medicare & Medicaid Services (CMS) approved Presence Health application to participate in the Medicare Shared Savings Program as an Accountable Care Organization. The contract began effective as of January 1, Medicare Value Partners operates as a patientcentered accountable care organization that provides high quality, coordinated and cost-effective care to Medicare fee-for-service beneficiaries by: (i) facilitating coordination and cooperation among providers; (ii) promoting accountability for the care of Beneficiaries, evidence-based medicine and Beneficiary engagement; and (iii) encouraging investment in infrastructure and redesigned care processes. The initial target populations were Medicare populations served by Saint Joseph Hospital - Chicago, Resurrection Medical Center, the portion of Presence Medical Group operating under the Resurrection Services TIN, independent primary care physicians in the market, and the Presence affiliated long-term care providers providing such services in the Chicago area. During the three year term of the contract, Medicare Value Partners will have the ability to add additional participating providers who serve different Beneficiary populations, thereby expanding overall size of the ACO. Medicare Value Partners will add more than 150 physicians in Q: How will physicians benefit from participating in Medicare Value Partners? A: Medicare Value Partners provides physicians with the opportunity to earn incentives for meeting quality and safety benchmarks that will deliver better care at a lower cost. As a Medicare Shared Savings Program ACO, Medicare Value Partners will meet benchmarks for care quality and efficiency, and it will share in the savings it generates for the Medicare program. The program provides the following benefits to the physicians: 1

2 Opportunities to improve reimbursement, compared with the traditional fee-for-service reimbursement model for providing cost-effective, evidence-based health care. Movement from transaction-based, fee-for-service reimbursement methodologies to outcomes-based incentive reimbursements tied to the health of the covered Medicare population. Early adoption of this program will enable the providers to be much better positioned for other similar arrangements and influence how those models function. Focusing more on population health management, quality improvements, access, and patient satisfaction should prove to be rewarding to the Medicare patient population and allow providers to be better positioned to retain and grow their patient base. Rewards providers for providing quality care. Physicians will have a voice in the development and implementation of changes in how clinical care is provided. We will work proactively with your practice to provide more efficient outcomes and improve the patient care experience. Q: How will physicians receive their Medicare payments if they participate in Medicare Value Partners? A: Medicare will continue to pay providers directly in accordance with the Medicare physician Fee-For- Service schedule. There is no change in the claims submission process for traditional Medicare Fee- For-Service claims; continue to send claims using your existing processes for paper or electronic claims submission. While physicians, hospitals and other health care providers who participate in Medicare Value Partners, will still be paid by Medicare on a fee-for-service basis, participating providers also have an opportunity to earn shared savings payment distributions by keeping costs down and meeting a specific set of quality benchmarks. If Medicare Value Partners meets quality measures established by CMS and provides more efficient care as a result of improved care coordination, the resulting savings will be shared between CMS and MVP participants. Q: What can Physicians do to ensure the success of Medicare Value Partners ACO? A: This is a new era of healthcare. Quality, cost and patient satisfaction count. To be successful, we ll need to do things differently. This is how you can lead the change. Partner with Care Coordinators. Approximately 50% of health care spending is on behalf of 5% of patients. We ll identify these high risk patients and assign them to care coordinators. Let us know if you have patients who are difficult to manage. Care Coordinators will take care of them between the visits. Use CI Registry. That s where all ACO measures and Medicare claims data are. You should use it on a regular basis. Promote health and wellness. Encourage a healthy lifestyle rather than treating illnesses. Make room for same day appointments. Especially for high risk patients. This will decrease ED visits and potentially unnecessary hospitalizations. 2

3 Let us help you engage your patients. We ll remind your patients to come for regular screenings and come back to see you if they haven t been to your office in a while. Assume All Your Medicare Beneficiaries are ACO Members. Get involved. You are invited to participate in one of the Medicare Value Partners committees - Medical Management Committee, Operations and Finance Committee, or Medicare Beneficiary Engagement Committee. Q: How will this benefit my Medicare patients? A: Medicare patients will reap the health benefits provided by high-quality, well-coordinated care. The data you will have for your Medicare patients will help you to determine which patients are at the highest risk for medical crises so new interventions or procedures can be put in place to help improve the care your patients receive. Q: How will I know if a Medicare beneficiary is a Medicare Value Partners member? A: A list of your patients that have been attributed to MVP will be loaded into the registry software. Generally, CMS will attribute all traditional Medicare Fee-For-Service patients into the Medicare Value Partners ACO as these patients have office visits under your TIN. Therefore, you should assume all traditional Medicare beneficiaries will be attributed to the ACO over time. CMS will provide updated lists on a quarterly basis. Q: How will patients be notified that they have been attributed to Medicare Value Partners? MVP will receive a list from Medicare of all beneficiaries attributed to our ACO. As required by Medicare, MVP will notify them that their primary care doctor is participating in MVP and provide the chance to decline to have their claims information shared by Medicare with MVP. The content of this communication is prescribed by Medicare. This mailing will include a letter and a form. During their first visit, your practice will also need to notify your patients about your participation in the Medicare Value Partners ACO and provide notification letter and the opt-out form. Medicare requires that the practice maintains documentation of in-office notification. MVP is looking to load the list of your patients that have been attributed to MVP into the registry software. Q: Who can my patients contact for more information? A: The patient communication material directs Medicare beneficiaries to contact MEDICARE to opt out of data sharing. In addition, MVP has established a dedicated phone line for patient questions This number will be included in the Medicare beneficiary communication. It is inevitable that some Medicare patients would like to talk to their own doctor. Your staff should use the Medicare template script provided in the MVP ACO Toolkit to answer patients questions. Q: Can my Medicare patients opt out of the ACO? A: No. Your patients are attributed to MVP by Medicare. They can opt out of data sharing, but they cannot opt out of the ACO. The ACO will be accountable for the care of these patients even if they opt out of data sharing. 3

4 Q: Will my Medicare patients be told they have to use certain providers or use specific facilities if I join? A: No, your Medicare patients are free to choose their own providers, services and facilities for their care. ACOs are not intended to interfere with patient choice. Q: Can I be in more than one Medicare Shared Savings ACO? A: The answer to this question depends on whether you provide primary care services to Medicare beneficiaries. CMS Medicare Shared Savings Program requirements stipulate that physicians who bill Medicare for primary care services as defined by CMS must be exclusive to one ACO. Currently, CMS defines primary care services by the following HCPCS codes: (a) through 99215; (b) through 99340, and through 99350, G0402 (the code for the Welcome to Medicare visit), G0438 and G0439 (codes for the annual wellness visits); and (c) Revenue center codes 0521, 0522, 0524, 0525 submitted by federally qualified health centers (for services furnished prior to January 1, 2011), or by rural health centers. Although some ACOs require exclusivity, from all physicians, Medicare Value Partners will not require exclusivity from physicians who do not bill Medicare for primary care services. Q: Will this be a lot of extra work for my office and my staff? A.: We will offer a team to help your office determine workflow issues related to participation and help you and your staff get up and running quickly, often in as little as two weeks. Obviously this will not come without some effort from you and your office team but we will be there to offer assistance to help make it a smooth transition. Q: How will you keep track of clinical data for my patients? A: Presence Health has an ongoing partnership with ICLOPS, a company that specializes in providing the technology and service infrastructure for accountable care and clinical integration initiatives. ICLOPS is a CMS-Qualified PQRS Registry. Q: How will you store and transfer data to CMS for this? A: We are developing a partnership with a health information technology company called Harris Health. Harris Health has provided solutions for large-scale health information exchange enterprises such as the Department of Veterans Affairs and the Department of Defense, and they have experience managing secure confidential health care data and supporting the IT components of accountable care. Q: My office uses paper charts and has no electronic medical records ( EMR ). Can I still participate? A: Absolutely, we are happy to work with you using paper prompts. We can easily train your staff and develop a workflow that can have you up and running very quickly without any use of electronic medical records. 4

5 Q: Do I have to use or have a specific electronic medical records system to participate? A: We can work with any electronic medical records system that meets the Centers for Medicare and Medicaid Services standards. There is no one specific electronic medical records (EMR) system that you must use. Q: Could an individual practitioner/small group practice form a Medicare Shared Savings ACO by themselves? A: No. The CMS Medicare Shared Savings Program is designed to provide an incentive for individual physicians and groups of physicians to come together as an ACO. At a minimum, an ACO must include primary care ACO professionals sufficient for at least 5,000 assigned Medicare beneficiaries. Solo and small group practitioners whose practices wish to participate will need to align themselves with larger groups of physicians, such as Medicare Value Partners, in order to participate in the new world of health reform that emphasizes coordination and value to patients over volume of care. Q: Can I refer outside of Medicare Value Partners network? A: Medicare Beneficiaries have the option to receive services from providers outside of the ACO at any time, and ACOs are forbidden from restricting which providers a beneficiary may seek care from. The foundation of the ACO model is to enhance care coordination across the continuum, therefore referring within the Medicare Value Partners network is the preferred model. The MVP network incorporates integration and care coordination processes to optimize the patient experiences as patients move through the continuum to facilitate continuity of care and ensure appropriate access to programs such as disease and case management. The Medicare Fee-For-Service benefits remain the same and there are no prior authorization requirements to receive services Q: What is the governance structure of Medicare Value Partners? A: The MVP Chief Executive Officer is Dr. Richard Ferrans, MD. MVP Board consists of 15 members. One community stakeholder representative One Medicare beneficiary representative 13 ACO participant representatives MVP Chairperson - John Baird, CEO Presence Resurrection Medical Group MVP Vice Chairperson James Clancy, Family Medicine Physician on staff at Presence Saint Joseph Hospital in Chicago Need more information or have questions that are not addressed in this FAQ? If you have any questions, please feel free to contact our Provider Relations Department at or MedicareValuePartners@presencehealth.org. They will be happy to meet with you. 5