Staying ahead of the curve

Staying Ahead of the Curve with Quirk

Quirk Healthcare Solutions White Paper NOV. 2014

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What the Future Holds The future of healthcare is being shaped by a major paradigm shift in everything from reimbursement to the role of the patient. In fact, the very delivery of medicine is changing. At the core of this shift are the evolving roles of providers and patients as well as the realization that unless the existing systems of volume-based reimbursement are replaced with value-based reimbursement, the per capita cost of healthcare will continue to grow. As a result, providers are becoming stakeholders in increased accountability of cost-efficiency even as the focus of care delivery is expanding to include prevention and wellness. A variety of patient engagement technologies, social media, and the increasing availability of patient education and health awareness resources on the Internet have catalyzed the evolution of the patient as a savvy utilizer of healthcare. At the same time, patient-centric models of healthcare delivery encourage patients to play a more active role in their care.

About Quirk Healthcare Solutions Our team has worked with clients in industries ranging from onephysician clinics to nationwide organizations. Our staff includes physicians, nurses, MHAs, and MBAs to provide a multi-faceted view to all challenges. We’ve distilled what works, and we can provide an invaluable perspective. Everyone on our team brings real-world experience to the table.

We are doers, not theorists. This wealth of knowledge offers us a unique perspective into the strategies that work and those that don’t; we want to share the most effective ones with you.

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Transparency In a growing shift toward transparency, quality scores reported by Eligible Professionals under the Value-Based Modifier and/or the Physician Quality Reporting System will be published to the general public on the Medicare Physician Compare website. Sub-par or missing scores could have a negative financial impact on a practice and will certainly color patient perception. The Centers for Medicare and Medicaid (CMS) has also published financial data for providers who serve its beneficiaries.

In addition to the availability of quality metrics data, providers are also starting to publish cost data to facilitate treatment cost estimates. The availability of quality, cost, and other data prior to treatment can help lower costs, improve health outcomes, and optimize clinical performance. Many payers are already sharing this data with patients to encourage them to make healthcare choices that provide the best quality at the best price.

Quirk Healthcare Solutions data analytics subject matter experts will team with you to improve quality and cost transparency. Leverage our expertise in providing innovative approaches in utilizing transparency tools more effectively.

The availability of quality, cost, and other data prior to treatment can help lower costs, improve health outcomes, and optimize clinical performance.

We can guide you and your organization in joining the effort to build a better and more transparent healthcare system that emphasizes value over volume.

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Value-Based Reimbursement PCMHs, ACOs, and Patient Engagement Medicare recently announced that it will reimburse providers for care coordination if patients are willing to pay their coinsurance.

The types of payments associated with the ACO model should allow ACOs to increase primary care compensation through quality and cost incentives.

However, Accountable Care is really about improving and maintaining the health of a population of patients and not just controlling costs. Several organizations are developing programs that recognize and/or accredit medical homes according to specified sets of standards.

The alignment of quality and revenue cycle models that demand massive transformation within care settings has stakeholders battling their way through complex challenges and threats to sustainability. Although over 10 percent of U.S. primary care practices have earned NCQA PCMH recognition, the model is unsustainable without proper financial alignment with payment reforms.

Currently, many of the core principles of the PCMH are reimbursed poorly, if at all, by Medicare and commercial payors. This readily discourages organizations from transitioning to the PCMH model. To address this gap,

Quirk Healthcare Solutions is actively engaged in helping organizations drive Healthcare IT and facilitate their transformation from a traditional fee-for-service, visitdriven reimbursement model to that of evaluating and improving outcomes. We recognize the importance of a “total needs� approach to using HIT for effective change as a powerful foundation that enables process change to ultimately foster stronger teams, interoperability, and information exchange within the context of an overall medical neighborhood and within complex payor matrices.

Leading by Example – Savannah, GA Quirk Wellness Center is an incubator and showcase site for changes in value-based reimbursement. Incorporating the structure and principles of high-functioning Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs), Quirk Wellness Center delivers services designed to ensure ongoing total wellness of patients, including treating acute illnesses and long-term support in managing chronic conditions. In addition, our model adopts a holistic preventive care approach that addresses the biopsychosocial needs of the whole person, including physical condition, nutrition, lifestyle choices, and emotional and mental well-being. All services are delivered by provider-led care teams and include fitness and nutrition coaches.

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Regulatory Reform Meaningful Use The bar for achieving Meaningful Use keeps moving, making it increasingly challenging for Eligible Professionals (EPs) to keep current with the changes and requirements for achieving Meaningful Use. Payment reductions under the Medicare program have already kicked in, forcing many EPs to consider whether participating in this program is even viable for them.

Quirk Healthcare Solutions prides itself on being a leader in guiding clients through the often-confusing requirements to achieve Meaningful Use. Our subject matter experts combine regulatory and clinical knowledge with a deep understanding of EHRs to assist our clients in demonstrating and attesting for Meaningful Use. Whether your organization participates in the Medicare, Medicaid, or Medicare Advantage program, we have the right solution.

PQRS and Its Evil Cousin – Value Based Modifier A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation.

The Value Modifier is part of the growing trend of quality-based reimbursement. Even commercial payors are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible.

Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not keeping pace with these changes may be surprised by an additional hit to revenue in 2016.

To remain financially solvent under value-based reimbursement models, providers must look for revenue from all possible sources. Partner with Quirk and let our regulatory reform subject matter experts guide you along the way. Our suite of services is designed for everything from helping you achieve Meaningful Use to planning your PQRS process.

We’ll even help you choose from over 200 quality measures with codes and patient data that are relevant to your specialty or practice. You will gain a better understanding of the incentives and adjustments schedule and be able to validate your quality of care.

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Practice Operation Efficiency and Revenue Optimization Operational and Clinical Efficiency The growing reductions in reimbursements have created a critical need for providers to increase the number of high quality visits that are also costeffective. Our consultants will team with you to identify potential areas for workflow optimization. An analysis of the current workflow will evaluate the practice’s opportunities for greater efficiency, and best use of software and utilities, as well as the most effective staff utilization. In addition, we will look for opportunities for additional automation to streamline your workflow.

Quirk Healthcare Solutions has an accomplished team of developers that can assist with everything from fixing a minor glitch in template functionality to creating fully customized templates and sophisticated reports. Our development team has expertise in a range of specialties and has been called upon to solve complex operational and clinical needs for EHR vendors as well as for our client base.

Revenue Cycle Optimization Our professional team engages in an initial on-site Discovery and Analysis Assessment, and presents its findings to your stakeholders. We analyze your financial performance indicators to determine how your practice compares to best practice standards and assist in establishing benchmarks for your practice to measure your results. Our team has assisted our clients in bringing the focus back to identifying ways to reduce the costs, and increase the revenue in the most efficient ways possible, including identifying additional opportunities for workflow automation.

SWAT Team Often, practices find themselves in a position where they need implementation and deployment assistance immediately. Quirk Healthcare Solutions’ certified team is here to assist you and your business with as little as 24 hours notice, remote or onsite. Our range of services includes training, strategy deployment, staff augmentation, and upgrade assistance.

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Engage With Us and Stay Connected Topics discussed here are only the most high profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, computer systems and financial expectations. Tremendous pressure is coming to bear within a limited timeframe. We are seeing an industry in the midst of tectonic change, with 2014/2015 as the fault lines. It is unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive. Keep up to date with our following free information sessions:

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The Future of Healthcare Is Now. Partner with Quirk Healthcare Solutions to thrive in spite of these challenges.

For more information on how Quirk Healthcare Solutions can help your practice contact us at 855.WE.QUIRK or info@quirkhealthcare.com

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