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1© 2015 Community Oncology Alliance
CAN Call
Thursday 12/10/15 2:00 pm– 2:45 pm
Kim Woofter
Michiana Hematology Oncology
Maryann Roefaro
Hematology Oncology Associates of
Central New York
CAN Co-Chairs:
▪The audio portion of the call will be recorded. Playback instructions will be sent later.
▪Callers will be muted once the call begins. Toggle between mute and unmute with *6.
▪Please do not place our call on “hold” while unmuted.
Reminders:
Randy Broun, MD, Oncology Hematology Care
Paulo da Costa, Vantage Oncology
Nancy Egerton, NY Oncology Hematology
Ellen Feinstein, University of Chicago Medicine
Carrie Frederick, Oncology Hematology Assoc. of Northern PA
Mitch Harris, Oncology Center Of Iowa
Welcome to:
Thomas Harwood, North Shore Hematology Oncology Assoc.
Erin Horner, Gettysburg Cancer Center
Pamela Iverson, Hematology-Oncology Associates of the
Quad-Cities, PC
Amy Lawhead, Tulsa Cancer Institute
Kristi Maya, Breastlink Medical Group, Inc.
Elizabeth O'Donnell, Virginia Cancer Institute
Welcome to - continued:
Yinka Ogundipe, Cancer & Blood Care, PC
Sharon Ondreyco, Saguaro Oncology
Jane Osterson, Medical Oncology and Hematology Associates
Tammi Ramos, Hematology Oncology Associates of Brooklyn
Lori Schneider, Green Bay Oncology
LeslieSorenson, Legacy Health
Welcome to - continued:
Renee Stitt, Compassionate Oncology Care
Martha Stricker, Regional West Physicians Clinic
Diego Taylor, Rio Braco Cancer & Blood, P.A.
Matthew Williams, Comprehensive Cancer Centers of Nevada
Welcome to - continued:
8© 2015 Community Oncology Alliance
CAN Call
Update from Ted
▪ 340B
▪ OCM & HR 1934
▪ Dual eligibles
▪ Other
Update from Ted
9© 2015 Community Oncology Alliance
47 responses - 22 States Represented
Medicaid secondary to Medicare – Poll results
Treating? Yes -
Always
No - Never Only when
can afford it
Other
Managed Medicaid 43% 15% 19% 23%
Traditional Medicaid 53% 9% 19% 19%
Medicaid Secondary 70% 6% 13% 11%
Yes -
Always
No - Never When M’care
< M’caid
Other
Receiving 20% when
Medicaid is 2nd to Medicare25% 17% 45% 13%
Medicare QRUR
Sarah Cevallos
Jeremy Behling
Agenda
• Medicare Quality and Resource Use Reports - What is it and Why it is important?
• Practice implications – How does it effect our practice?
• Next steps - Where do I start?
Medicare Quality and Resource Use Reports (QRUR)
• Comparative report for physicians and medical practice groups that assess quality and cost of care
• Influences differential payments under the Medicare Physician Fee Schedule (PFS)
• Available for every group practice and solo practitioner in September 2015
Quality Composite Score
Quality Outcome Measure Description
Acute Prevention Quality Indicators Potentially preventable hospital admissions for dehydration, urinary tract infections and bacterial pneumonia.
Chronic Prevention Quality Indicators Potentially preventable hospital admissions for heart failure, chronic obstructive pulmonary disease and diabetes. The rate of potentially preventable hospital admissions for diabetes is a composite measure of uncontrolled diabetes, short term diabetes complications, long term diabetes complications and lower extremity amputation for diabetes.
All cause readmissions The rate of provider visits within 30 days of discharge from an acute care hospital per 1,000 discharges among eligible beneficiaries assigned. CMS will exclude this measure from the quality domain for a group or solo practitioner who has fewer than 200 cases during the relevant performance period.
PQRS Based on measures reported
Cost Composite ScoreCost Outcome Measure Description
Total per capita costs Total per capita costs include payments under both Part A and Part B, but do not include Medicare payments under Part D. The cost score compares how a TIN performs relative to the mean performance on a measure-by-measure basis within each cost domain.
Total per capita costs for beneficiaries with the following four chronic conditions:
Chronic Obstructive Pulmonary Disease (COPD) Heart Failure Coronary Artery Disease Diabetes
Medicare spending per beneficiary measure (MSPB)
An MSPB episode spans from three days prior to an index admission at a subsection (d) hospital through 30 days post discharge, with some exclusions. CMS will risk adjust and standardize all VBPM cost measures.
Value-Modifier Timeline
2014₁ QRUR RESULTS
2016 VM applied to physicians in groups ≥ 10 EPs
2015 QRUR RESULTS
2017 VM applied to physicians or solo practitioners and physicians in groups ≥2 EPs
2016 QRUR RESULTS
2018 VM applied to physician and non-physicians EPs and physician & non-physician EP solo practitioners
Physician reimbursement
adjustment applied based
on QRUR scores from -2% - +2%₂
₁ 2015 & 2016 VM will not be applied if participating in a MSSP, ACO, or CPC.₂2014 QRUR results for 2016 payments for groups with 100 or more EPsVM exclusive of PQRS penalties
Setting Up Data
• Match Index to Master File (Exhibit 2A)
– Use Vlookup function in Excel
• Pull and Code data to attribute to useable information from other exhibits
– Sum Counts of Hospitalizations, Discharges, Total Costs etc.
• Stratify data based on Physicians and other KPIs
– Hospitalizations
– Total Costs
Example of cost discovery through QRUR report
# of Chronic Diseases 1 2 3 4 5 Total/Avg
Total Patients 2628 1331 692 297 65 5013
Pt Count with Hospitalization 469 490 371 196 55 1581
% of Patients With Hospitalization 18% 37% 54% 66% 85% 32%
Hospital Visits/Pt 1.53 1.76 1.87 2.15 2.62 1.80
Last Avg LOS 5.20 4.66 5.52 6.68 8.98 5.42
Other Items
• Hospitalizations
– Attribute total hospitalizations by MD and % of costs associated from Exhibits 2B and 4
• Rate
– Divide total hospitalization count by Total Patients to find rate
– Compare by physicians
• Chronic Diseases
– Attribute Chronic Diseases by Cost, Hospitalization and LOS
Actions Taken
• Prioritization
– Volume matters
– Look for key outliers and investigate
• Initiatives to improve coordination with patients
– Identify Comorbidities
– Focus on Hospitalization data (with one day or less)
• Also Sum of Admit though ED by Patient
• Check for direct admit options
Take Action
• Download the reports: (https://portal.cms.gov)
• Instructions on how to set up appropriate accounts and access reports: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.html
• Ensure that you have the latest report (2014 may have had revisions)
• Set dedicated time to review the extensive reports; December 16th deadline to submit errors
• Look for outliers and areas of improvement
• Educate and work with your providers to explain this will effect their future reimbursement
Resources
• https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
• http://can.communityoncology.org/
• http://www.mgma.com/government-affairs/issues-overview/medicare-payment-policies/medicare-sustainable-growth-rate-sgr
▪ Services
▪ E&M
▪ Infusion
▪ Radiation
▪ Imaging
▪ Includes NEW Advanced Care Planning codes
▪ 99497
▪ 99498
▪ May need customizing for your practice – easily done.
Model: 2016 Final Medicare Fee Schedule
Model: 2016 Final Medicare Fee Schedule
Services Codes + Codes -
Infusion 6 29
E & M 15 42
Radiation 53 11
Imaging 33 66
2016 2015
Conversion Factor $35.8729 $35.9335
CAN Meeting Agenda:
• OCM and other initiatives
• Value Based Initiatives
• Preparing for reform
CAN Meeting – April 13th, 2016(Community Oncology Meeting – April 14-15)
QUESTIONS?
Next CAN Call – Thursday 1/28/16 – 2:00 pm ET
28© 2015 Community Oncology Alliance
COPA Call
Thursday 12/10/15 2:45 pm– 3:30 pm
Josh Cox
Dayton Physician’s Network
Tommy Harwood
North Shore Hematology and Oncology
Associates
COPA Co-Chairs:
▪The audio portion of the call will be recorded. Playback instructions will be sent later.
▪Callers will be muted once the call begins. Toggle between mute and unmute with *6.
▪Please do not place our call on “hold” while unmuted.
Reminders:
Sanjay Agarwal, Carolina Blood and Cancer Care
Tiffany Angley, Central Park Hematology & Oncology
Seth Benkel, Goldberg and Mathew Medical Associates
Trisha Cook, Oncology Hematology Associates
Lisa Day, Ventura County Hematology Oncology Specialists
Cheryl Downs, Regional Hematology Oncology Associates
Welcome to:
Mary Duong, Compassionate Oncology Medical Group
Carrie Frederick, Oncology Hematology Associates of
Northern PA, P.C.
Harish Gowda, Mid Florida Hematology and Oncology Centers
Katherine Grigsby, Oncology Consultants, P.A.
Mitch Harris, Oncology Center of Iowa
JoyceHartshorn, Oncology Specialists of Charlotte
Welcome to - continued:
Mary Hicks, The Center for Cancer and Blood Disorders DBA
The Center Pharmacy
Tina Hile, Oncology Hematology Associates of Southwest
Indiana
Erin Horner, Gettysburg Cancer Center
Kimberlee Kegley, Connecticut Oncology Group PC
Lisa Lasita, Oncology Hematology Care, Inc
Amy Lawhead, Tulsa Cancer Institute
Welcome to - continued:
Terri Loew, Georgia Cancer Specialists
Jeff Lombardo, CCS Oncology
Maureen Lowry, Consultants in Medical Oncology and
Hematology
Jessica Maloney, Cancer Specialists of NF
Bansari Mandalia, Gettysburg Cancer Center
Kristi Maya, Breastlink Medical Group, Inc.
Welcome to - continued:
Stacy McDaniel, Northwest Georgia Oncology Centers, P.C.
Neil Nebughr, Utah Cancer Specialists
Sharon Ondreyco, Saguaro Oncology
Jane Osterson, Medical Oncology and Hematology Associates
Christine Puebla, Levine Cancer Institute
Tammi Ramos, Hematology Oncology Associates of Brooklyn
Welcome to - continued:
Joan Rawle, Utah Cancer Specialists
David Ritter, Oncology Hematology Care, Inc
Lori Schneider, Green Bay Oncology
Mary Ellen Simms, Vista Cancer Center
Carol Redline, Bay Hematology/Oncology
Barbara Sutherland, Comprehensive Cancer and Hematology
Welcome to - continued:
Robert Vandenberg, Nazha Cancer Center
Tiffany Vandiver, Northwest Georgia Oncology Center
Lori Vinci, Connecticut Multispecialty Group
Welcome to - continued:
▪ Congratulations – Clearview Cancer Institute!
▪ ACHC Oncology Standards
▪ COPA web site
▪ 2016 Community Oncology Conference
COPA Update
38© 2015 Community Oncology Alliance
39© 2015 Community Oncology Alliance
GREAT
JOB!!!!
▪ COPA Co-Chairs are working with ACHC on next steps:
• Oncology Accreditation
• Finalizing standards
• Objective measures
• Train the Trainer
• Other
▪ ACHC team will speak at the Community Oncology
Conference April 15, 2016
ACHC Accreditation
40© 2015 Community Oncology Alliance
http://www.coapharmacy.com/ LIVE!!!
▪ Register under MEMBERS ONLY to access tools and other
resources
▪ Patient stories are needed.
Email [email protected]
OR share on [email protected]
COPA Web Site
41© 2015 Community Oncology Alliance
• Heads up – Personal invitation headed your way.
• Register soon – rooms go fast.
Community Oncology Conference
April 14-15, 2016
QUESTIONS?
Next COPA Call – Thursday 1/28/16 – Noon ET