In this month’s letter I will start with some good news. It is not often that we REMOVE pop-ups and forms from the EMR. With the WHO declaring Liberia Ebola free on May 9th, Guinea and Sierra Leone are countries still reporting cases, we are hopefully almost at the end of the Ebola Virus Exposure pop-up. I believe in celebrating small victories!
Clinical Visit Summaries (CVS)
In continuing the trend of good news, the weekly audits of Clinical Visit Summaries remains error-free.
The audits looked at 5% of the total of arrived patients for Internal Medicine (the department affected by the previous CVS errors). A chart review of patient demographics, medications, problems, allergies and vital signs is yet to find a CVS printed incorrectly.
Please continue to emphasize that staff be reminded and encouraged to check patient name and identifiers on printed CVS to ensure accuracy before handing it to the patient.
Hopefully providers and patients saw the improved and shortened CVS that went into effect recently.
Payment Reform and Penalties
Many of you are aware that congress and the President recently passed into law the “SGR Fix” eliminating the dreaded 21% Sword of Damocles that hung over providers heads for many years. This is needed so cheers for Congress! (Did I say that?)
One thing that lurks under the surface is the consistent push of CMS to change care into a value based world. A good summary of these changes can be found here (see attached).
From 2015 until 2019, Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value Based Payment Modifier (VBM) will all exist and have penalties based on system and provider attainment of CMS stipulated goals. When the PQRS, VBPM and MU penalties are combined along with sequestration cuts, the actions (or inactions) of providers in 2015 could result in a cumulative 11% cut to their 2017 Medicare payments.
However, starting in 2019, MU, PQRS and VBM will be phased out (actually merged into a new beast) and physicians will be paid either according to a merit-based incentive payment system (MIPS) or through an alternative payment model (APM). Physicians may switch between models from one year to another.
MIPS – closer to fee-for-service, but allows the CMS to incrementally adjust fees based on scores in clinical quality, MU, efficiency and practice improvement. Under the model, physicians will be compared either to their peers in the same specialty or to themselves to determine how they have maximized resources from year to year. In 2019, the range of positive or negative payment adjustments in the MIPS program is minus 3.5 percent to plus 4.5 percent, and gradually increase until it settles at plus or minus 9 percent in 2022.
APM – this system offers the highest possible reimbursement; a guaranteed 5 percent annual payment increase from CMS over the first 6 years of the program, within the construct of an accountable care organization (ACO) of the practice’s choice. What’s more, if a practice is a certified patient-centered medical home (i.e. Kenworthy Family Medicine Practice), they are guaranteed the highest possible clinical improvement score, which represents 15 percent of the total value score. However, the risks are also greater with the APM model, because physicians who do not meet the metrics stipulated by their ACO will not be rewarded with their shared savings on top of their CMS updates.
We are just beginning the evaluation process of how these various payment systems would affect us. The ACP is also developing a software tool that will help physicians determine the best payment method for them.
Meaningful Use (MU) Tools
Beginning next month we shall be implementing a tool to help departments monitor and improve upon MU and PQRS measures called SA Ignite. We shall use it during our anticipated MU measurement period of July 1 to September 30, 2015. The hope is that by providing easy to view dashboards to providers and administrators, we will be able to track and improve whatever glitches may arise – “If you can(’t) measure, you can(’t) manage”
So What’s New?
- Cortext – Secure texting solution is rolling out to the clinical departments over the summer and fall. Family Medicine and Surgery already started.
- CareManager, a tool that we currently use in Family Medicine and Internal Medicine quality management, will start printing out Clinical Scorecards to patients in primary care (see attached).
- Over the next few months, the Referral Management System (RMS) undergoes system changes and improvement for efficiency and effectiveness.
- Part of the changes in referral management will be the initiation of an eFax system to accept outside referrals and to send external referrals within the EMR system. We are presently testing this with Centro San Vicente clinic.
- Over the next few months, Chairs, Administrators, and designated providers will be contacted as point persons in each department to assist with MU and PQRS reporting in their clinical departments.
- The Clinical Information System (CIS) and MPIP team continue to work with billing and coding to ICD-10 in the billing interface.
If you ever think Healthcare IT is driving you crazy then read this.
For an insight into what may be the future of the connected patient read here.
And if you need a quick Ted Talk Tour-de-force, Daniel Kraft is quite thought provoking.
Please feel free to contact me with any questions or concerns.
Ogechika K Alozie, M.D., M.P.H., CPHIMS
Chief Medical Informatics Officer (CMIO)