Quality and Cost Adjustments May Hit Your Bottom Line in 2017

by: Tammie Lunceford, CPC with Warren Averett LLC

Although the most talked about topic in healthcare in the last few months has been MACRA, another topic is starting to gain much attention—the Value Based Modifier (VBM). The VBM went into effect in 2014 to affect payment in 2016 for practices with 10 or more providers. Eligible professionals are classified as physicians, mid-level providers and certain therapists. Prior to 2014, a group’s only adjustments related to a lack of PQRS participation. It is important to understand the Value Based Modifier is calculated at the tax identification level. Even if a group reports quality as individuals, they will be identified as a group by the number of eligible providers associated with their tax identification number through Medicare enrollment with PECOS.

The Center for Medicare and Medicaid Services (CMS) reports the results of the quality and cost through Quality and Resource Use Reports (QRURs). These reports are released in April as a mid-year QRUR and September for the final year QRUR. The annual QRUR report shows PQRS reported quality information along with CMS calculated outcomes and cost measures to calculate two composite scores: a quality composite and a cost composite. CMS classifies each score into high, average or low based on whether the score is at least one standard deviation above/below the national mean score. This process identifies statistically significant outliers. The outliers are then assigned to the respective quality and cost tier. The CMS quality and cost tiering analysis determines whether the score will earn the medical practice a bonus, penalty or no adjustment to their reimbursement based on performance in these categories.

Most of us understand the quality portion of the VBM, but there are many questions related to cost analysis. The cost portion of the VBM is based on six cost measures to calculate your TIN’s Cost Composite score.

1. Per Capita Costs for All Attributed Beneficiaries

2. Per Capita Costs for Beneficiaries with Diabetes

3. Per Capita Costs for Beneficiaries with COPD

4. Per Capita Costs for Beneficiaries with Coronary Artery Disease

5. Per Capita Costs for Beneficiaries with Heart Failure

6. Medicare Spending per Beneficiary (even providers not in your TIN)


In 2017, all practices will be impacted by the VBM, even solo physicians. We have been afforded flexibility in 2017 for the implementation of MACRA, but since the new Merit Based Incentive Program has a portion that represents quality reporting, it is important for quality reporting to be improved each year. To access your QRUR reports, you must have an account with Enterprise Identity Management to select an administrator. We encourage administrators to obtain the 2015 QRUR reports immediately to assess performance. All practices have until November 30, 2016 to dispute results of the 2015 QRUR report.

While some practices have reported no adjustments after reviewing their QRUR reports, others have reported negative adjustments. Specialty practices with a payer mix of more than 40 percent Medicare can lose large amounts of reimbursement with a 2 percent negative adjustment.

         Quality/Cost                 Low Cost                     Average Cost                 High Cost

High Quality	+ 4%	+2%	No payment change
Average Quality	+2%	No payment change	-2%
Low Quality	No payment change	-2%	-4%

        

The better performing groups have aligned themselves with a progressive EHR and a practice management system that allows them to track performance by provider. Many of these systems are registered to allow direct reporting of quality to CMS via the EHR web reporting mechanism. Many better performing groups have joined Qualified Clinical Data Registries to increase the number of domains and gain support from other practices in their specialty. Claims-based reporting has proved to be problematic and is not considered the best option for reporting quality data. It is best for large groups to register and report as a group as opposed to individual reporting in most cases. Monitoring individual performance can be difficult, and a single provider’s lack of performance could affect the entire group. Group registration will open early in 2017 and last through June 30. Consider this option if your practice has between 2-99 providers.

We have discussed the 2015 QRUR reports and how they will affect 2017 reimbursement, however, 2016 is almost over. The 2016 performance year affects the 2018 reimbursement for all providers. Be sure to assess your performance and make changes now to improve your scores. Contact your academy or governing board for your specialty to assure you are using the resources available to you. Create a team or committee to focus on VBM workflow; improvement in reporting involves physicians, clinical operations, coders, and a close relationship with your EHR vendor.

Key Areas to Address Now:

• Set up an account with EIDM

• Obtain your QRUR reports

• Contact your academy or vendor for resources

• Evaluate your reporting options

• Evaluate how you collect data in your EHR; are your providers providing actionable data?

• Hire a consultant to assist you in improving quality performance and cost reduction

Healthcare continues to change, and it is highly important to remain engaged and to monitor your success.

Ran•som•ware

By: Curtis Woods
President at Integrated Solutions, LLC

noun: ransomware;

1. a type of malicious malware/software designed to block access to a computer system until a sum of money is paid.

How much will ransomware cost me?

The demanded costs to unlock your files can vary greatly. The prices can range from $25 up to $1000 or more. It is also important to note that paying the ransom does not guarantee that you will ever get your files back.

How does ransomware infect my system?

Ransomware usually infects a system in one of two ways:

1. Your system may become infected by visiting malicious or unsecured websites.

2. Ransomware infections also come through email attachments or links from untrusted emails or emails that have been hacked.

Traditional advice to prevent ransomware

1. Have and maintain a firewall. - Your first line of defense is a strong and well maintained firewall.

2. Use Anti-virus software. - While no Anti-virus protection is good enough to catch everything….the combination of firewall and AV protection is your best combination for protection.

3. Make sure your pop-up blocker is enabled and working. - Many ransomware infections come in the form of a pop-ups that end users click on, thereby unknowingly downloading a virus.

4. Only go to trusted websites. - Make sure everyone in the office is aware of this policy and state clearly what types of websites are not to be visited under company policy.

5. Only open links and attachments from trusted senders. - If there is any question about the authenticity of the sender, call them to verify that the email is legitimate.

6. Make sure your backups have “multiple restore points.” - One of the most important tips is to make sure your backups can be restored from multiple restore points. Some of the most common backup solutions can only restore to the last known backup. For example, if you leave work today at 5:00pm and at 7:00pm your system is infected with Ransomware and your backups run at 10:00pm….you now have a backup of your data, but unfortunately the backup is of corrupted data.

Advanced options for preventing ransomware

• Deep Packet Inspection Devices – These are typically hardware devices that “review” all of the inbound and outbound network traffic and block anything detected as malicious.

• End point security software – This is software specifically directed at malware (Ransomware is malware, not a virus). Security software companies are starting to release applications that are specifically directed at Ransomware.

• Security awareness training – Products like Knowbe4 offer security awareness training and testing for your employees. They offer self-phishing campaigns to help companies properly train employees to not gullibly click on unsafe email attachments and links.

What should I do if I become infected?

• Shut down your computer immediately. This may prevent the Ransomware from spreading.

• You MUST report it to DHS if ePHI has been compromised.

• Call your trusted IT professionals at Integrated Solutions.

The Value of a Year End Meeting

By: Chase Campbell, CPA
Pearce, Bevill, Leesburg, Moore, P.C.

It’s my favorite season: football championships, holiday parties, and year-end meetings. After several years in public accounting, I am still surprised at how many business owners do not schedule a formal year-end planning session with their trusted advisors, including their CPA. Many people presume the best time to meet with their CPA is when their mailbox fills up with those dreaded tax documents starting in January of each New Year. This is unfortunate because you could be missing out on valuable tax saving opportunities through proper planning prior to December 31st.

The following are a few examples of tax related issues that should be addressed prior to December 31st:

• Fixed asset purchases: Assets must be placed in service prior to 12/31 in order to qualify for Sec. 179 and 50% bonus depreciation deductions. Should we purchase new or used assets? Will the purchase be in cash or with debt?

• Compensation: Is compensation fair and reasonable based on projected results and practice’s methodology? Have the business owners paid in the appropriate amount of tax? Ensure bonus checks will be issued prior to 12/31.

• Retirement plan funding: What is our projected current year minimum and maximum funding? How much funding remains? Will cash flow allow funding prior to the tax return due date?

In addition to mapping out your tax strategy, a year-end meeting with your CPA is a wonderful time to assess other business needs. Contrary to popular belief we understand business related issues other than just taxes! In my experience, clients generally want to discuss the following three non-tax related matters:

• Revenue Cycle Management: These discussions would include a review of the practice’s financial key performance indicators, as well as talking through issues affecting the revenue cycle, such as current and upcoming regulatory changes, technology and software needs, payer mix, collection issues, etc.

• Identifying New Revenue Streams: With healthcare practices, we need to analyze the profitability of procedures. Should they be outsourced, kept in house, or vice versa to improve the bottom line? Are there additional services or treatments that could be offered? This is also a time to discuss your practice’s marketing efforts and referral sources regarding these revenue streams.

• Human Resources Matters: Physician employment, compensation arrangements, clinical and administrative staffing levels, benefits, succession planning, and retirement plan structure.

In closing, I hope you can see that a year-end meeting can encompass more than just tax savings. This is the last opportunity each year to analyze where we’ve been, where we are going, and how we are going to get there.

Splash Down in Haiti and Saving Lives

Physicians Giving Back with Richard McGlaughlin, M.D.
Splash Down in Haiti and Saving Lives

By: Lori M. Quiller, APR Director, Communications and Social Media Medical Association of the State of Alabama

It was his love of flying and his intrinsic need to help others that originally led Richard McGlaughlin, M.D., to Haiti in 2010. In January 2010, the small Caribbean country of Haiti had been rocked by a devastating earthquake, and the task of getting supplies to the recovering nation was proving more than just difficult.

Transportation of what life-saving supplies to Haiti by cargo ship was nearly impossible because the ships were unable to get to Port-au-Prince. Dr. McGlaughlin, who owned a small, single-engine aircraft read about the situation on a member’s-forum for the Cirrus Owners & Pilots Association. Bahamas Habitat was asking for volunteers to fly missions to Haiti to transport supplies, so Dr. McGlaughlin loaded up his aircraft with medical supplies for a trip “that has changed my life.”

That was almost seven years ago, and Dr. McGlaughlin has continued making trips to Haiti every year since…including one trip that nearly took his life and that of his daughter.

Dr. McGlaughlin, a gastroenterologist in Birmingham, wasn’t sure what to expect when he first arrived at the makeshift medical camps in Haiti. The one thing he knew for certain was that he was there for a reason.

“It started out as an airplane adventure just bringing in the supplies that were needed. But, the needs of the Haitians were so great, I just couldn’t turn my back,” Dr. McGlaughlin said. “I felt I could make a difference here. I wanted to make a difference.”

For Dr. McGlaughlin, the key wasn’t just to volunteer once in a while. His theory is a little different. He believes that to make a difference, a constant presence is necessary.

“If you apply continual force on a single point more than once, not just over a weekend or two, it can open eyes. Even that wasn’t enough to help the Haitians. We would give them medicine and treat their wounds, but medicine runs out and sometimes wounds don’t heal, so visiting just once in a while wasn’t working the way we wanted it to. We knew the Haitians needed more,” Dr. McGlaughlin said.

When a cholera outbreak began to ravage the residents, Dr. McGlaughlin, whose background is in cholera research and treatment, found himself more useful than ever. He began working with St. Luke’s Hospital to not only treat the Haitians infected with cholera, but also help train other aid workers in the treatment protocols.

Soon Dr. McGlaughlin met a very charismatic Catholic priest named Father Rick Frechette, CP, D.O. Father Rick has worked in Haiti through St. Luke’s Hospital for more than 30 years, and when the two met, Dr. McGlaughlin was amazed by just what Father Rick had managed to do so much with so little.

“Father Rick is the type of person who makes you want to be a better person,” Dr. McGlaughlin said. “He finds these resources, these people that need work, and the people at the camp need certain things, and Father Rick just finds ways to put them together. He’s built a community through connections, given work and jobs to those who need it…it’s amazing to be part of that,” Dr. McGlaughlin said.

When Dr. McGlaughlin first started working with St. Luke’s, he likened the atmosphere to a smaller version of the United Nations with volunteers from many nations pooling their resources together. Everyone lived in tents, ate together, and unfortunately worked in less-than-the-best medical circumstances.

Eventually, the need for more permanent facilities became apparent, but without funding, because this is a charity operation, the permanent facilities would most likely take a while. So, Father Rick did what he did best and used the resources he had at hand – cargo containers.

After the earthquake in 2010, supplies had been shipped in to Haiti by cargo ships and housed in large, metal cargo containers. When the containers were emptied, they had served their purpose, for the moment. When Dr. McGlaughlin told Father Rick more permanent facilities were necessary for the more complicated and urgent cases needing some semblance of a sterile environment until a proper facility could be built, Father Rick produced a solution.

“We built a container hospital,” Dr. McGlaughlin laughed! “And, it worked for what we needed at the time. You use what you have, and that’s what we had.”

Dr. McGlaughlin continues to fly to Haiti, lending his medical skills and his flying expertise to the people of Haiti he has come to know and love. One flight stands out more than any other. In January 2012, he and his daughter, Elaine, were about to leave the Miami airport when he suggested she purchase a camera. This would be her first trip to Haiti with him, and he knew she would want to document the occasion. When she returned with a small, disposable camera, Dr. McGlaughlin laughed and suggested she try again with a better camera.

“It was a beautiful day for a flight,” he laughed. “You couldn’t have asked for more perfect conditions for flying…until I noticed the oil pressure was dropping. I didn’t want to alarm Elaine. She wasn’t paying much attention to me. She was studying the book for her new camera, but she finally looked at me when she noticed my voice changed.”

Dr. McGlaughlin said they didn’t have much time once the oil pressure sharply dropped, seizing the engine, and freezing the propeller. His plane was equipped with a parachute, which is now standard on all Cirrus models. With the parachute engaged, the pair had enough time to get out of the aircraft before it was too late. As they sat in the life raft, they watched the medicine and equipment floating to the surface, but they were safe. Then the disposable – waterproof – camera floated up. It wasn’t what they expected, but they made good use of it.

“It happened, and it could have been so much worse. So much worse,” Dr. McGlaughlin said shaking his head. “But, it wasn’t. Elaine and I flew back to Haiti together and finished the trip. I’ve even lectured on behalf of the use of the plane’s parachute. Some pilots won’t use it. It’s there…use it. I’m here today because I did.”

Father Rick, Dr. McGlaughlin and the battalion of volunteers attached to St. Luke’s Hospital in Haiti continue to work in Haiti by building schools and rendering medical aid to residents day in and day out. Dr. McGlaughlin’s next scheduled visit will be in January 2017, and he plans to take as many donated items as his plane will hold.

However, St. Luke’s Hospital is in great need of donations. The physicians and other volunteers donate of their time and skills, but monetary donations can move mountains. If you would like to donate and be a part of the St. Luke’s Hospital movement in Haiti, visit St. Luke’s Foundation for Haiti at www.stlukehaiti.org

                                          

 

 

 

 

When You Run, You Are Going to Sweat

Susan Pretnar

President at KeySys Health LLC

Why aren’t more things this simple? When it comes to today’s healthcare environment, the people responsible for managing provider practices and clinics seem to be running pretty hard and sweating more than ever, but not the satisfying sweat of accomplishment. They are sweating how they are going to be responsive to patients and keep them healthy, how to care for their employees and make them productive, how to keep the lights on and stay in compliance with rules and regulations that affect the business. That is, they are sweating running a business.

The title phrase hit me as I was listening to a commentator express the obvious about a topic under discussion. The running analogy is most poignant when applied to managing information technology in the healthcare world:

When you buy technology, you are going to have to invest in it

It doesn’t matter what business you are in: it can’t be said any more plainly. Based on current average IT expenditures and the number of breaches experienced by healthcare businesses, that fact still seems to be ignored or simply not believed. Invest in ‘what’ you might ask: invest in, maximize and support current technologies (including upgrading the basic EMR you bought a few years ago); invest in greater communication capability; invest in education and training; invest in a strategy for adding future technologies.

In truth, investment is only necessary if you are not really going to act on the threat to abandon your patients and your business in 2017. In spite of statistics about impending provider shortages, where IT infrastructure is concerned, healthcare entities are still expected to manage their practices like every other business, or cease to operate. Pressure to add technological capability is escalating, on the one hand because of incentives, penalties or regulations, but even more so because patients are becoming ‘consumers of healthcare’; expecting to interface with their healthcare providers like they do other services.

Accepting the idea that patients want to compare prices for treatment, want to communication with you like they do their bank, want to be assured you can protect the privacy of their information, and want to question why you are recommending a certain treatment plan when Google suggests otherwise, is still being resisted in healthcare. In truth, the people and technology needed to succeed in this present and future operating reality will cost any healthcare business more time and money than they are accustomed to investing.

The not so simple solution is ‘when you buy technology, consciously plan to invest your time and financial support to maximize its use’. Celebrate every successful implementation and learn from inevitable mistakes.

New Report Reveals Serious Security Risks within Healthcare Industry

By: TekLinks staff 

A new report reveals the healthcare industry is lacking in basic security awareness among its staff, which can jeopardize entire medical infrastructures.

The healthcare cybersecurity report was released by SecurityScorecard, a security rating and continuous risk monitoring platform.

The 2016 Healthcare Industry Cybersecurity Report found that network security, IP reputation, and patching cadence are healthcare's biggest struggles.

The study also exposes a risk of attacks through social engineering. "Security breaches in this industry pose devastating consequences because they can render an entire system or network inoperable, creating a life or death situation that needs immediate attention," reports StreetInsider.com.

"The low social engineering scores (15th out of 18) among a multitude of healthcare organizations show that security awareness and employee training are likely not sufficient," says Alex Heid, Chief Research Officer at SecurityScorecard. "Security is only as strong as the weakest link, and employees are often the lowest-hanging fruit when it comes to phishing, spear phishing, and other Social Engineering attacks. For a hacker, it only takes one piece of information such as learning the email structure of an organization to exploit an employee into divulging sensitive information or providing an access point into that organization's network."

Among the report's key findings are:

• Over 75% of the entire healthcare industry has been infected with malware over the last year

• 96% of all ransomware targeted medical treatment centers

• Healthcare manufacturing nearly reaches a 90% malware infection rate

• 63% of the 27 Biggest US Hospitals have a C or lower in Patching Cadence, which measures an organization's ability to implement security software patches in a timely fashion

• Healthcare has the 5th highest count of ransomware among all industries

• Over 50% of the Healthcare industry has a network security score of a C or lower

Healthcare providers who are serious about securing their practices can download TekLinks' free Ultimate Guide to Data Security or contact TekLinks at info@teklinks.com . Our IT experts support clinical systems that collectively serve more than 1 million patients each year.


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