Revenue Cycle Management + Value-Based Medicine

Transcription

1 Revenue Cycle Management + Value-Based Medicine Presented by: Justin T. Barnes, VP of Industry & Government Affairs Bryan Koch, VP of Revenue Cycle Solutions

2 Safe harbor Safe harbor statement under the Private Securities Litigation Reform Act of 1995: In addition to historical information, this presentation includes certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of Such statements include both implied and express statements regarding the company s financial condition, growth strategy, business development efforts, service offerings, and service delivery models. Such forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties and other factors that may cause the actual results, performance or achievements of the company to differ materially from the historical results or from any results expressed or implied by such forwardlooking statements. Risks that could affect the company s future performance include, but are not limited to, our ability to adapt to evolving technology and industry standards; our ability to implement our growth strategy; our ability to retain management and other qualified personnel; failure to prevent disruptions in service or damage to our third-party providers data centers; failure to avoid liability for the use of content we provide; regulation of the healthcare information technology industry; our ability to ensure our solutions meet industry and government standards; failure to maintain adequate security measures for our customers confidential information and personal identifiable information and their patients protected health information; our ability to obtain new provider clients; failure of the HITECH Act and other incentive programs to be fully implemented or funded by the government; our ability to implement our strategic relationships as currently intended; failure to establish, protect or enforce our intellectual property; restrictions in our credit facility and future indebtedness. The company operates in a continually changing business environment and new factors emerge from time to time. Greenway cannot predict such factors or assess the impact, if any, of such factors on our financial position or results of operations. The company undertakes no obligation or duty to update or modify these forward-looking statements. 2 Greenway Medical Technologies, Inc. All rights reserved.

3 Revenue Cycle Management + Value-Based Medicine Presented by: Justin T. Barnes, VP of Industry & Government Affairs Bryan Koch, VP of Revenue Cycle Solutions

4 State of healthcare Healthcare Reform/ Transformation 27% Medicare rate cut averted for doc fix cost $25B+ MedPAC recommendations to realign fee-schedule to support primary care and ACOs, bundled payments, capitated models & shared savings programs Bipartisan support now in Congress for permanent SGR fix Sequestration Went into effect on March 1 st Automatic budgetary measure to cut $1.2 trillion over 10 years if Congress and the Administration do not agree on a plan 2% Medicare cuts across the board; EP Meaningful Use funds reduced by $240 - $360

5 State of healthcare HHS/CMS Merging Privacy, Claims, Coding Initiatives New HIPAA regulations effective March 26 Expands breach reporting and covered entities Final compliance Sept. of 2013 or 2014 per data use agreements ICD-10 CM (diagnosis) and PCS (procedure) codes Final effective deadline Oct. 1, 2014 (extended from Oct. 1, 2013) ICD-10 coding for claims filed through HIPAA 5010 transfer standards Will not affect outpatient CPT coding, no changes Initiatives instigated by the HITECH Act

6 State of ARRA & HITECH Act EHR Meaningful Use Over $27B available with no cap. Protected in Medicare Trust Fund Stage 1 criteria well within expectations ~ 14 EH/15 EP Core Measures & 5 Menu Stage 2 criteria well within expectations ~ 16 EH/17 EP Core Measures & 3 Menu Incentives are front-loaded so begin as soon as you can As of January, over 388,000+ care providers registered for Meaningful Use Over $12.7 billion in incentives paid to eligible providers & hospitals already! Over $351 Million just to Nurses & PAs under Medicaid Meaningful Use Stage 2 Overview Chart ~ Regional Extension Centers Operations underway at various levels of execution Find your local REC ~

7 Value-based medicine Overriding approach to delivery and payment reform Population management rewarding outcomes and cycle of care over episodic care and volume ACO, PCMH are well-known value models introducing shared savings, shared risk and bundled payments Affordable Care Act seeks expanded Medicare VBM models Establish national data aggregation and cost transparencies Merge with private payer models to encompass: Group and ambulatory practices Hospitals and Critical Access Hospitals (CAHs) Home health agencies and skilled nursing facilities

8 Why accountable care? Initial Results from Cigna Collaborative Accountable Care program 52 programs in 22 states (500,000 patients) Lower medical cost trend ER visit cost savings Quality Physician referrals ER visits >50% lower per-patient annual medical cost trend than traditional care methods 7% lower ER visit costs than traditional care methods 5% improvement in EBM measures 11% higher utilization of highperforming specialists 12% reduction in avoidable ER visits

9 New payment models Accountable Care, ACO & Narrow Network Models Medicare: 285 CMS-led models coordinate care to Medicare patients Medicaid: States adopting strategic approaches to manage Medicaid population (ex: air conditioning units purchased for members) Commercial: Payers institute plans for members to meet quality improvement goals Patient-Centered Medical Home (PCMH) Innovative program to transform primary care delivery NCQA seen as a top certification body for provider organizations Search for EHR vendors that offer auto credits CDW PROPRIETARY AND CONFIDENTIAL. COPYING PROHIBITED.

10 PrimeRCM Revenue Cycle Services Bryan Koch Vice President RCM Services

21 Point of Care Denials NCCI Violations (bundled procedures) Medical Necessity Violations Procedure Age/Sex Conflict (wrong CPT choice) Global Services (charge not warranted) Qualifying Procedure Required 21 Greenway Medical Technologies, Inc. All rights reserved.

22 Point of Care Denials NCCI Violations (bundled procedures) Medical Necessity Violations Procedure Age/Sex Conflict (wrong CPT choice) Global Services (charge not warranted) Qualifying Procedure Required 22 Greenway Medical Technologies, Inc. All rights reserved.

23 Charge Entry Denials 25 Modifier (E&M and procedure on same day) 59 Modifier (Warrants distinct procedure) Dx Linking (Warrants supportive reasoning) Place of service Outdated CPT/ICD-9 23 Greenway Medical Technologies, Inc. All rights reserved.

24 Charge Entry Denials 25 Modifier (E&M and procedure on same day) 59 Modifier (Warrants distinct procedure) Dx Linking (Warrants supportive reasoning) Place of service Outdated CPT/ICD-9 24 Greenway Medical Technologies, Inc. All rights reserved.

25 Financial Performance Total accounts receivable Days in accounts receivable Percentage of A/R Over 90 Days Clean claims Denials Administrative work at site Net collection percentage Increased Healthcare Quality Decreased Costs of Revenue Cycle Management 25 Greenway Medical Technologies, Inc. All rights reserved.

28 Why is quality the future? EHR Adoption 30%+ have comp. EHRs Training & usability are key Meaningful Use 260,000+ care providers est. to achieve MU incentive If you don t qualify, use MU criteria as a playbook Accountable Care/ Value-based Medicine Quality Reporting Outcomes-based Payments

29 Optum Health says this.

30 Meaningful Use Stage 2 Stage 1 established core and menu objectives 15 core & 5 menu objectives Stage 2 increases thresholds of participation 17 core & 3 menu objectives New core objective Use secure messaging to communicate w/ patients on relevant health information 5% of unique patients Change to core Provide patients the ability to view online, download and transmit their health information w/in 4 business days of the information being available 30 Greenway Medical Technologies, Inc. All rights reserved.

31 Meaningful Use Stage 2 Clinical Quality Measures As of 2014, all providers in MU will report CQM s Must report 3 cores (Hypertension, Preventative Care, Weight) Must chose 3 of 6 key health care policy domains Patient & Family Engagement Patient Safety Care Coordination Population & Public Health Efficient use of Healthcare Resources Clinical Processes/Effectiveness 31 Greenway Medical Technologies, Inc. All rights reserved.

33 ICD-10 All about data granularity Granularity/specificity of diagnosis assignment will: Enhance/improve patient outcomes Safety Education Care coordination Drug usage & effectiveness Resource utilization 33 Greenway Medical Technologies, Inc. All rights reserved.

37 ICD-10 From a revenue cycle perspective: More granularity/specificity will lead to: Revised reimbursements (probably decreased) Revised medical necessity (more limitation) Revised NCCI edits (bundling) Revised global periods (more specific to illness severity) 37 Greenway Medical Technologies, Inc. All rights reserved.

40 Collaborative Care Market Presence

41 Accountable For What? EHR Utilization Double Weighted Measure Interoperability Care Coordination Best Practices Quality and Outcomes Improvement Patient Education Patient Satisfaction

42 What will providers need? 1. Clinically driven systems Care coordination Revenue cycle Data analytics Population Health ICD-10 preparedness 4. Contract management & adherence Greenway Medical Technologies, Inc. All rights reserved.

43 St. Luke s Cornwall Medical Group Multi-specialty group in New York s Hudson Valley Eight locations, 13 physicians and two nurse practitioners PrimeRCM results: Increased cash collections by 17% Shorter A/R cycles Faster, cleaner claim generation Real-time eligibility checking Improved patient satisfaction Read the entire story. Greenway provides a clean, contemporary billing system and processes that have been the secret to our success with RCM. Stephen Heath, director of Network and Practice Management 43 Greenway Medical Technologies, Inc. All rights reserved.

44 Questions? To learn more about Greenway and PrimeRCM: Join us on our next RCM webinar: Revenue Cycle Management + Your Peers Tuesday, April 17, 1:30 pm Eastern