Regimen Profiler. User Guide & Frequently Asked Questions. Copyright 2011 McKesson Specialty Health. All rights reserved.

Transcription

1 Regimen Profiler User Guide & Frequently Asked Questions Copyright 2011 McKesson Specialty Health. All rights reserved.

2 Regimen Profiler User Guide Table of Contents Introduction to Regimen Profiler... 3 Launching Regimen Profiler from 5 First Time Setup... 7 Navigating Regimen Profiler Tools Resources Regimen Administration Payer Administration Patient Profiler Administration Feedback /Help with Regimen Profiler Frequently Asked Questions For questions about McKesson Clinical Tools, us at msh.providers@mckesson.com, or visit 2 Copyright 2011 McKesson Specialty Health. All rights reserved.

3 Introduction to Regimen Profiler Regimen Profiler is a web-based tool that helps community oncology and multi-specialty practices and patients understand financial and clinical information for commonly used treatment regimens. Practice-specific drug pricing is automatically loaded and updated, ensuring current cost calculations Customizable payer fee schedules provide unparalleled visibility into reimbursement across multiple payers in your region Patient-friendly templates allow financial advisors to help patients understand their co-insurance and copayment responsibility Regimen Profiler part of McKesson Specialty Health s portfolio of practice management resources helps practices run more efficiently so staff can focus on delivering high-quality patient care. Key Benefits A Valuable Resource for Everyone in Your Practice With many commonly used, evidence-based and referenced drug regimens, Regimen Profiler is tailored to fit the needs of everyone in your practice. For Physicians and Nurses Comprehensive reports detailing each regimen s administration The ability to customize supportive care drugs commonly used Comparisons of the treatment cost for multiple regimens For Practice Administrators and Billing Staff Create or load custom payer fee schedules View financial information on different regimens View automatically updated practice specific drug pricing For Financial Advisors Generate patient-friendly reports to help patients understand their financial responsibility for different treatments they may receive Define regimens at a detailed level so patients fully understand the treatment they will be receiving 3 Copyright 2011 McKesson Specialty Health. All rights reserved.

4 Highlights Regimen Profiler helps practices assess costs and reimbursement for administering specific oncology, rheumatology, and urology regimens. Easy to use and customizable, Regimen Profiler reports provide a comprehensive overview of the financial details of both the drug and non-drug costs associated with administering a regimen. A capability unparalleled in the marketplace, utilization is pulled from Lynx Mobile data to help practices analyze the cost & reimbursement implications of actual regimen utilization patterns. Comprehensive Regimen Resource Regimen Profiler contains over 400 evidence-based regimens frequently used in oncology, rheumatology, and urology care. In addition, it allows for full regimen customization. Complete Cost and Reimbursement Analysis the Regimen Financial Detail report offers an overview of the cost and reimbursement associated with administering a selected regimen, including drug and non-drug costs. Tools for Revenue Assessment and Forecasting the Treatment Cost & Reimbursement Analysis report allows practices to view their total cost and reimbursement across aggregated Lynx Mobile regimen utilization, as well as forecast the impact of utilizing different yet clinically comparable regimens. Patient-Focused Reports to Aid Financial Conversations the Patient Profiler report helps practices demonstrate expected financial responsibility for patients over the life of therapy. 4 Copyright 2011 McKesson Specialty Health. All rights reserved.

5 Launching Regimen Profiler from Getting Started: Log in to the website with your existing User ID and Password. If you have trouble logging in, please call After logging in: From the Top Navigation, choose Practice Management From the Drop Down Menu, choose Regimen Profiler Terms & Conditions: The first time you log into Regimen Profiler, the Terms and Conditions of Use will appear. You must click I Accept to the Terms to use Regimen Profiler. Be sure to scroll to the bottom of the page to accept the Terms and Conditions. 5 Copyright 2011 McKesson Specialty Health. All rights reserved.

6 Educational Webcast on Using Regimen Profiler: The Regimen Profiler homepage includes a link to an informative webcast that will provide an overview of the various resources within this tool. Please ensure the WebEx player is installed to view this webcast. 6 Copyright 2011 McKesson Specialty Health. All rights reserved.

7 First Time Setup To use Regimen Profiler, you will first need to enter some practice specific information. Follow these 5 steps to get started: Step 1: Configure Locality Assign a locality to each of your sites. Localities are needed to calculate Medicare Reimbursement for procedures because different regions have varying reimbursement schedules. Once you have entered localities for all of your sites, click on Save Locality Preferences. 7 Copyright 2011 McKesson Specialty Health. All rights reserved.

8 Step 2: Configure BSA and Treatment Rate Body Surface Area (BSA): The BSA values will be used to calculate doses for the Regimen and Patient Profiler reports. BSA values set up on this page are averages for the practice. Treatment Rate: Include all applicable overhead practice costs here, including staff, supply and infrastructure values. This amount will be added to drug costs during reporting. If you are not sure what your Treatment Rate is, a default rate has been provided. Once you have selected your BSA amounts and Treatment rate, click on Save BSA and Treatment Rate Preferences. 8 Copyright 2011 McKesson Specialty Health. All rights reserved.

9 Step 2: Configure BSA and Treatment Rate Cont d Example of the Overhead Chair Time Cost Calculator Worksheet: If you need assistance in determining your practice s treatment cost per hour, please refer to the Overhead Chair Time Cost Calculator Worksheet. A link to this spreadsheet is available on the Configure BSA and Treatment Rates webpage. 9 Copyright 2011 McKesson Specialty Health. All rights reserved.

10 Step 3: Configure Supportive Care Select your practice s most commonly used anti-emetic (5HT3-RA) and CSF agent from the drop down lists. Once you have selected your commonly used agents, click on Save Supportive Care Preferences. Step 4: Configure Metastatic Treatment Duration Set a default treatment duration for all metastatic regimens that will be used when calculating total regimen cost and reimbursement in our reports. For example, enter a value of 12 to compare approximately three months of therapy, or enter a value of 4 to compare one month of therapy. 10 Copyright 2011 McKesson Specialty Health. All rights reserved.

11 Step 5: Configure Formulary Drugs This page contains a list of commonly used drugs. The Default Cost Per Billing Unit field is pre-loaded with the price your practice would pay for the least expensive single or multiple dose vial currently available for each drug. The Default Cost does not take into account any drug rebates or discounts, which may be factored in by overriding the Default Cost Per Billing Unit with custom pricing. To do this, enter a custom Invoice Price per Container and Total Units Per Container in the fields below. Once you have entered a custom price for a product, it will be used in all Regimen Profiler reports. To delete a custom price and revert back to your Default Cost, clear the Invoice Price Per Container and Total Units per Container fields, and click on Save Formulary Preferences. Because custom pricing is not automatically updated, it is recommended that you regularly refer to your practice's McKesson Specialty Health pricing to understand current regimen costs. 11 Copyright 2011 McKesson Specialty Health. All rights reserved.

12 Navigating Regimen Profiler Tools Home The Home page includes a brief description of each area in Regimen Profiler, with links to each section. Also note: the homepage includes a link to a report that includes all regimens available in Regimen Profiler. Please find this link towards the bottom of the homepage, at the end of the Updates section. Resources The Resources page contains a list of up to date documents that you can download at any time, including the latest Quick Start Guide, Frequently Asked Questions, Drug Cost and Reimbursement report, CMS ASP, GPCI, LAB and RVU publications. Click on the associated link to download the document. 12 Copyright 2011 McKesson Specialty Health. All rights reserved.

13 Regimen Administration The Regimen Administration page contains over 400 literature based regimens that you can view in detail. Analyze all aspects of the regimens by using one of the four reports available to you: Regimen Financial Detail focuses on financial information for the regimen selected. Regimen Summary provides treatment details for the regimen selected. Regimen Comparison report provides comparisons for up to three regimens based on diagnosis, site and fee schedule. Treatment Cost and Reimbursement Analysis report pulls actual patient treatment information from Lynx Mobile to allow practices to compare cost and reimbursement for a set of regimens. Users can filter the report by diagnosis, specific site, treatment setting and date range to see how changes in utilization patterns can impact payer and practice costs over time. 13 Copyright 2011 McKesson Specialty Health. All rights reserved.

14 Navigating Regimen Administration: Regimen Financial Detail report shows the financial detail around an individual treatment regimen. It can be customized to view a selected regimen with a particular payer custom fee schedule and a specific practice location. Select the following filters from the drop down lists: Diagnosis, Treatment Setting, Regimen, Fee Schedule and Site. Click the Show Regimen Details button to produce the report with the regimen s financial details. To analyze with CMS or cost values from historical periods, select More Detail 14 Copyright 2011 McKesson Specialty Health. All rights reserved.

15 Regimen Summary shows treatment characteristics of a regimen including how drugs are administered the individual drug, E&M, drug administration and lab codes by payer. Select the following filters from the drop down lists: Diagnosis, Treatment Setting, and Regimen Click the Show Regimen Summary button to produce a report with the treatment and dosing information details Regimen Comparison allows the user to compare the cost and reimbursement for up to three treatment regimens. Report filters allow you to compare regimens across payers using different fee schedules. Select the following filters from the drop down lists: Treatment Setting, Fee Schedule, Site, and Diagnosis To compare regimens at a fixed treatment length, select a metastatic treatment setting. Choose the three Regimens that you would like to compare Click on the Show Comparison button to produce the comparison report 15 Copyright 2011 McKesson Specialty Health. All rights reserved.

16 Treatment Cost and Reimbursement Report pulls actual patient treatment information from Lynx Mobile to allow practices to compare cost and reimbursement for a set of regimens. Users can filter the report by diagnosis, treatment setting and date range to see how changes in utilization patterns can impact payer and practice costs over time. Select the following filters from the drop down lists: Diagnosis, Specific Site, Treatment Setting, and Usage Time Frame Click the Next and Show Report buttons to produce a report with the details of the cost and reimbursement per patient for each regimen and the average cost and reimbursement per patient 16 Copyright 2011 McKesson Specialty Health. All rights reserved.

17 Navigating Payer Administration The Payer Administration page allows you to enter, view, copy and edit customized fee schedules specific to individual Payers. Create a new Payer Fee Schedule View Payer Schedule Copy or Edit Payer Schedule Change Payer Fee Schedule Status 17 Copyright 2011 McKesson Specialty Health. All rights reserved.

18 Create a New Payer Fee Schedule Page 1: Page 2: Step 1: Name your Payer Fee schedule Step 2: Choose the procedure setup your new fee schedule will be based on: Conversion Factor will calculate the total RVU multiplied by the conversion factor you enter for all procedures. Custom Fee Schedule will let you set up custom amounts for all procedures. Step 3: Choose the drug setup your new payer fee schedule will have. % of ASP will calculate the drug reimbursement based upon a % of ASP Custom Fee Schedule will let you set up custom reimbursement amounts for all drugs Step 4: To customize individual Fee Schedule Items, choose whether you would like to fill out a web form or an Excel template by clicking on the appropriate button All drugs and procedures shown are based on the setup options you selected in Page 1. Schedules based on Conversion Factors and ASP will reflect the numbers you entered on the previous screen. You may enter custom amounts for procedures or drugs into the Fee Schedule using the web form. Alternatively, you can choose to use the download/upload Excel template and copy from your Practice Management System. Verify the amounts, edit if necessary and then click on the Save This Payer Fee Schedule button. 18 Copyright 2011 McKesson Specialty Health. All rights reserved.

19 If you choose to upload an Excel template, this page will appear: Confirmation Screen 19 Copyright 2011 McKesson Specialty Health. All rights reserved.

20 Patient Profiler The Patient Profiler page assists in financial planning by displaying the patient s treatment related responsibility based on co-pay and/or co-insurance in the Patient Co-Insurance Report. Use this section to generate co-insurance reports that can be used to help patients understand the costs of treatment and their financial responsibility for treatment regimens. Navigating Patient Profiler Select the following filters from the drop down lists: Diagnosis, Regimen, Fee Schedule, Site Enter the patient specific values for: Patient Co-Insurance, Number of Patient Visits, and Patient Co- Pay. To analyze with CMS or cost values from historical periods, select More Detail Click on the Show Patient Insurance Details button to produce the report. 20 Copyright 2011 McKesson Specialty Health. All rights reserved.

21 Administration The Administration page allows you to edit Locality, Formulary, BSA, Metastatic Treatment Duration, and Supportive Care Preferences at any time. 21 Copyright 2011 McKesson Specialty Health. All rights reserved.

22 Feedback The Feedback page allows you to submit comments and suggest enhancements for Regimen Profiler. Help with Regimen Profiler Help Text Pop-Ups are provided throughout Regimen Profiler. For assistance, place your mouse over the icon: Live Assistance is available to assist you from 5:30 am PT to 5:30 pm PT by calling If you need further assistance, remote and in-person training sessions can be scheduled with your clinical specialist. 22 Copyright 2011 McKesson Specialty Health. All rights reserved.

23 Frequently Asked Questions 1) Regimen Administration Section 1.1 What if I want to compare a regimen that is not on the list? McKesson Specialty Health frequently updates the list of literature-based regimens to include in Regimen Profiler. Check back periodically to see if the specific regimen you are looking for has been added. Send feedback for regimens you would like added to msh.providers@mckesson.comand include the name of the regimen and a reference for it from literature. 1.2 How/Where do I find the literature that accompanies each regimen? You can find literature-based regimen references listed at the top of each Regimen report. By clicking on the reference link you will be directed to one of the referenced articles for your review. 1.3 What if I want to change the BSA default? To change the BSA default, select Administration on the side navigation bar, then select BSA/Treatment Rate. Modify the BSA values that need to be changed and then click on the Save BSA and Treatment Rate Preferences button. 1.4 How do I change the BSA for a specific patient and then go back to our practice setting? To change the BSA for a specific patient, first choose the report you wish to run, then click on More Detail on the bottom of the page. Modify the BSA value and run the regimen report to get the correct dosing for your patient s BSA. The new BSA will remain until you exit the reporting section of Regimen Profiler. 2) Payer Administration Section 2.1 How do I upload my individual Payer fee schedules? The following steps will help you upload a payer fee schedule from outside of Regimen Profiler. Ensure that you have already downloaded and saved a fee schedule, in Excel format, from your Practice Management Software (PMS) system. I. Create a new Payer Fee Schedule a. Name your fee schedule b. Set your Procedure Setup option to Custom Fee Schedule c. Set your Drug Setup option to Custom Fee Schedule d. Proceed to the next step and answer the following question, How would you like to add amounts to your individual Fee Schedule items? Click on By filling out an Excel Template button. e. Now you are in the Customize Items XLS page. Click on the link which will give you an option of opening the Excel file or saving it, select Save and name your file. Next, open your newly saved Excel file and you will see a list of all drugs and procedures utilized in the Literature-based Regimens each with a zero amount. f. Take the download from your PMS system and copy and paste the corresponding HCPC code amounts into the Excel template. Once you have finished entering all of your HCPC codes, save and close your spreadsheet. Alternatively, format your existing fee schedule in a three column format to match the template, and paste all of the pricing amounts into the Regimen Profiler Excel sheet in any order. g. Next click the Browse button and select the Excel template that you just saved and then click on the Upload File button. h. You will then be taken to the Customize Items-Web. Double check your amounts, make any changes you feel are necessary, and click on the Save This Payer Fee Schedule button when you are all done. i. You are finished and your new custom fee schedule has been saved and is ready for use. 23 Copyright 2011 McKesson Specialty Health. All rights reserved.

24 3) Patient Profiler Section 3.1 What is the patient s true responsibility? The patient s true responsibility would be the total co-insurance amount, if they have one, plus their total co-pay visit amount. 3.2 I don t have a financial counselor, how can I use this report in my practice? This report will help patients understand the costs of treatment and what their financial responsibility would be for that treatment regimen. This report can also allow you to have a discussion with your patient about different treatment options based on their costs or co-pay amounts. 3.3 Why does the Patient view include reimbursement? The reimbursement amount is shown on the Patient Co-Insurance report to help the patient understand how the total patient responsibility amount was calculated. The patient will already have a reimbursement amount on the Explanation of Benefits (EOB) that the patient receives from their insurance company. 4) Administration Section BSA and Treatment Rate Section 4.1 How do I calculate Treatment Cost Per Hour? Treatment cost per hour is based on all costs of operating the "infusion center." It does not include drugs, or medical supplies that are reimbursable, but does include unreimbursed med supplies, equipment depreciation (Ctx Chairs, pumps, BSC Hood(s) etc), infusion space, staff including salaries and benefits (typically 25% of salaries), utilities, maintenance, housekeeping, insurance, etc. Some of these costs (i.e. space, utilities, maintenance, housekeeping, insurance etc.) can be based on sq ft allocation. All these costs (annualized) divided by the # of hours per year that the Infusion Center operates (i.e. 10 hrs per day x 252 work days per year = 2520 hrs/year), yield total cost per operating hour. Therefore if total costs per year for the Infusion Center were to be $400,000 and operating hours were to be 2520 then infusion center cost per hour would be $ This divided by the # of "Infusion Chairs" (i.e. 5) would then yield a cost per treatment hour of ~$ We suggest using available hours, not the hours used, because empty chairs still have cost. Additionally, you can also refer to the Overhead Chair Time Cost Calculator Worksheet in determining your practice s treatment cost per hour. A link to this spreadsheet is available on the Configure BSA and Treatment Rates webpage. 5) Administration Section Formulary Drugs 5.1 How can I most accurately represent my practice drug costs in Regimen Profiler? Regimen Profiler helps oncology practices understand detailed financial and clinical information for many oncology treatment regimens. A critical component of accurately calculating financial information is setting up the drug costs section of the tool in a way that best fits your practice. There are currently three options by which drug costs can be set: 1) Default, 2) Manual Override, and 3) Importing Practice Invoice Pricing. Rationale and set-up steps for using these options are outlined below. 5.2 When would I use the Default Drug Costs? Rationale: This drug cost option is the default for all practices. The default cost per billing unit reflected is representative of the least expensive NDC available through McKesson Specialty Health to your practice. This option is useful for getting a quick general understanding of hypothetical costs. It does not necessarily represent what your practice is purchasing. Practices can also enter their actual costs, if desired. The NDC for the price shown is also displayed so you can discuss purchasing this product with your sales representative. 24 Copyright 2011 McKesson Specialty Health. All rights reserved.

25 Set-Up: From the Administration Menu, choose Formulary (Drugs) to display the default drug costs under the Default Cost Per Billing Unit section Notice the Filter By drop-down box shows Anti-Neoplastics only. Be sure to review the other drug groups, such as Antiemetics and CSF. Regimen Profiler automatically loads and updates this drug pricing nightly. The default NDC used appears under the drug Description on the left side of the page. 5.3 When should I override the default drugs costs manually? Rationale: This option allows you to override any of the default costs which already appear. This is valuable when a practice wants to change the cost of an item to more accurately reflect their purchase price. For example, the override could be used to accommodate rebates, or to reflect purchases of smaller quantity packs, which may cost more per billing unit, but may make more sense for the practice s patient load. Set-Up: Enter your Invoice Price Per Container and Total Units Per Container in the Custom Pricing Data Entry area. The NDC will change to N/A to represent that this price was entered by the practice directly. Press Save Formulary Preferences to save the update. 5.4 When should I import practice invoice pricing? Rationale: This option allows practices to import pricing based on their purchase history. The cost reflected will enable financial information to be calculated most accurately with what the practice is actually seeing. In addition, importing Invoice Pricing will allow the practice to identify where there might be lower cost alternatives to their current inventory. Set-Up: Press the Import Practice Invoice Pricing button. This button will search for purchases the practice has made in the past 3 months. Based on the number of billing units purchased of each NDC, Regimen Profiler will return the price of the most commonly purchased item at the practice. The NDC purchased by the practice appears under the drug Description on the left side of the page. Press Save Formulary Preferences to save the update. If the Default Cost per Billing Unit is less than the Final Net Per Billing Unit, the practice may have the opportunity to reduce drug costs by evaluating the reasonability of purchasing an alternate product. Simply remove the values in the Invoice Price per Container and Total Units Per Container fields to see the NDC of the alternate product. 5.5 How is the Default Cost Per Billing Unit Calculated? Regimen Profiler automatically loads and updates practice-specific drug pricing nightly. The Default Cost Per Billing Unit reflects the least expensive NDC available through McKesson Specialty Health for each drug, as grouped by the HCPC code. The default NDC used appears under the drug Description on the left side of the page. Example: If Abatacept, NDC , costs $ per 250 mg SDV, with a Medicare Billing Unit of 10 mg, the Default Cost Per Billing Unit is $ If no other NDC is cheaper for the practice on a per billing unit basis, this NDC will be used as the default. 5.6 Why don t I see the Default Cost Per Billing Unit on my invoice? Some practices may choose not to purchase the cheapest available NDC. In some cases, that cheapest available product may reflect a larger vial size, or may be packaged in bulk, which may not be practical for use in the practice. In these cases, the practice should use Import Practice Invoice Pricing. For details, see that section of this document. 25 Copyright 2011 McKesson Specialty Health. All rights reserved.

26 5.7 Why aren t my rebates included in the Default Cost Per Billing Unit? McKesson Specialty Health is unable to anticipate which rebates practices will earn. If you would like to include your expected rebates in pricing, use Custom Pricing Data Entry to enter the price including rebates. 5.8 Why aren t my purchase prices updated? Once Custom Pricing Data Entry information is saved, it is not updated automatically. If you would like to have the most current pricing, you will need to Import Practice Drug Pricing again. 26 Copyright 2011 McKesson Specialty Health. All rights reserved.