PulseThe

ofWinter 2020

Success often comes from the ability to be open to new ideas, and be flexible in processes, thinking, determination and hard work. The Physician Alliance is fortunate to have physicians, practice staff, associates, practice resource team, partners and others willing to work together for success. These achievements help improve quality metrics, cost of care, revenue and patient health.

While the momentum from the past propels us into a future full of new projects, challenges, outcomes and more, it’s always interesting and insightful to reflect on the path that brought us to this point. Before we move too far forward into the new year, let’s look back at some accomplishments:

Quality management• 125 primary care practices, representing 354 physicians,

were designated patient centered medical home by Blue Cross Blue Shield of Michigan. Of the 99% of TPA practices nominated for PCMH 96% received the designation. PCMH practices receive an additional value-based reimbursement – this year, 46% of our practices are receiving a 25% VBR (139% increase from 2018) and 49% are receiving 30-50% VBR (66% increase from 2018).

• 879 specialty physicians received BCBSM’s value-based reimbursement (69% received 10% VBR; 31% received 5% VBR).

• 97% PCMH accuracy factor with BCBSM onsite practice visits.

• 41% of Provider Delivered Care Management (PDCM) practices received additional PDCM value-based reimbursement.

• Increased e-prescribing of controlled substances from 47.40% to 51.2%.

• The American Medical Association will be highlighting TPA’s work on engaging practices and patients in the Diabetes Prevention Program following positive outcomes from TPA’s Organized System of Care transition plan that focuses on preventing diabetes.

• Over 40,200 gaps in care were reviewed with 6,159 (15%) closed through Nov. 30, 2019.

A L O O K B A C K O N A B U S Y Y E A R

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Dear members,

Happy New Year and welcome to a new decade! I’m proud to share many of the achievements that our physician organization reached last year in this issue (see cover story). Our days sometime go so quickly as we juggle multiple projects that we forget to pause to acknowledge the work and dedication needed to reach these goals. This is always a great time of year to cheer on our successes, recognize lessons learned and prepare for the future.

I’m also pleased to share that TPA joined Ascension Michigan and other healthcare companies in BCBSM’s Blueprint for Affordability, a new reimbursement model that involves risk sharing in a narrow network. Stay tuned for more news and updates related to this initiative. This new year will be busy with an emphasis on disease management and decreasing cost of care through the Blueprint program, Organized System of Care transition model and patient care and coding improvement, to name a few.

In our efforts to provide support to our member practices, we already have a strong line up of education opportunities scheduled. These programs will provide assistance with panel management, coding, patient education and more to close gaps in care, increase reimbursement and improve quality of care. Visit thephysicianalliance.org and click on Upcoming Events for information and registration.

As always, we are grateful for your continued commitment to working with us to improve the health of our patient population. We look forward to a successful year for everyone.

In good health,

Michael R. MaddenPresident & CEO

President’s MESSAGE

Education and communication• Through the Learning Institute, TPA hosted 24

seminars and webinars on important health topics, including diagnostic coding, compliance, care management, improving quality metrics, social media/reputation management, practice and personal wealth management and more. Attendance reached almost 1,000 participants. Online registration and onsite electronic check-in were implemented for ease of guest registration, communication and tracking.

• Created 10 new posters and handouts to add to a comprehensive line up of patient education materials focused on key quality metrics (diabetes care, breast cancer screening, blood pressure management, urgent care access and more).

• Developed three animated videos to increase physician education on diagnostic coding and organized system of care principles.

• Re-branded TPA’s Affiliate Partners program with new name and logo. Four new businesses joined the program (see page 7 for a full list of partners).

Clinical informatics and information technology • Blue Care Network and Health Alliance Plan eligibility

and claims interfaces went live in Wellcentive, TPA’s disease registry. There are now 39 interfaces feeding into Wellcentive to support practices in managing 1.5 million patients (via Wellcentive).

• 89.6% of TPA provider groups within the Wellcentive platform have been trained to use Wellcentive for Admission, Discharge, Transfer (ADT) messages (2019 goal was 84%).

• Created online information technology ticket system to better support practices in need.

• Developed algorithm for predicting a patient’s risk for hospital admission in the next 6-12 months. <

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Identifying and closing gaps in care

is an important step in improving

quality measures, revenue and patient

quality of care. Focusing on closing

gaps early can help avoid large, last-

minute, time-consuming outreach

efforts at the end of the year.

Creating and administering an outreach plan to target specific patients based on conditions can help make the plan manageable and successful. Gaps in care reports can be generated through a practice’s electronic medical record system and TPA’s disease registry, Wellcentive.

Tips to create a successful

GAPS CLOSURE PLANThe importance of closing gaps: A better managed patient population can lead to:

• Diagnosing potentially life-threatening illnesses in patients

• Helping improve the health of your patient population

• Being eligible for more incentive dollars from payers

Tips for creating a successful outreach plan: • Run report using metrics on your tracking tool (provided by your practice

resource team (PRT) member)

• Send reminder letters to patients listing screenings and tests that are due

• Follow up with patients via phone calls, emails and/or text messages (based on patient preference)

• Post and share patient education materials created by TPA that focus on a variety of quality metrics and screenings. These are available complimentary to TPA practices. Visit thephysicianalliance.org to view and order materials.

• Utilize the patient portal for additional reminders

• Place a copy of worked reports and lists in your patient centered medical home binder, along with the tracking tool to go over at a PRT visit. <

Creating and administering an outreach plan

to target specific patients based on

conditions can help make the plan

manageable and successful.

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CHRONIC DISEASE MANAGEMENT PILOTS help practices support patient care

Last April, TPA engaged in a new Blue Cross Blue Shield

of Michigan (BCBSM) pilot focused on improving care

coordination and management of high-risk chronic

disease patients. The pilot includes the use of telehealth

visits in a care management model.

The telehealth pilot utilizes a centralized registered nurse management model to engage two patient populations – high risk diabetes patients and congestive heart failure (CHF) patients, totaling over 1,500 patients. The main premise of the pilot is for the centralized RN to coordinate telehealth transition of care visits for patients in the pilot practice population, including medicine reconciliation) and provide chronic disease management services for patients in the pilot practice population, such as HEDIS gaps in care outreach, diabetic retinal exam completion, self-management goal setting, and chronic disease education.

The pilot measurement period is April 2019–April 2020. Progress has focused on providing support to the identified pilot offices/patients, providing centralized panel management for high-risk and high cost patients, providing outreach and closing gaps in care for identified patients.

With the pilot more than halfway completed, outcomes are measuring as:

• Patient education (mailings, care manager engagement) – goal reached

• Increase completed retinal eye exams (for diabetic population) – on track to meet goal

• Improve A1C control less than 8 – goal reached

• Increase medication reconciliation – goal reached

• Reduce emergency room visits – on track to meet goal

• Reduce 30-day re-admission – below target goal

“Some of our goals have been more easily achieved than others,” said Carolyn Rada, executive vice president of population health management at TPA. “Those that are more challenging, such as reducing emergency room visits and reduction in 30-day readmissions, bring opportunities to find more creative solutions to meet the goals and improve the health of our patients.”

Many of the plans related to these goals resulted in creation of multi-faceted approaches to closing gaps and improving patient care, including:

• TPA RN panel managers received access to Care Convene, a virtual health platform, providing telehealth functionality, admissions, discharge and transfer (ADT) information and real-time pinging. Wellcentive, TPA’s disease registry, will continue to be used for practices to access ADT information.

• TPA staff utilize a custom developed dashboard to track metrics for the practices and submit data to BCBSM on pilot outcomes.

• To reduce emergency department utilization, TPA’s team assessed the pilot offices’ after hour processes, including calling the primary care office first and developing urgent care partnerships. Materials were created for practices to use, focusing on a “Call Us First” theme that provided staff buttons, office posters and tear off sheets with urgent care information to be shared with patients. <

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Quality, coding improvement lead education line up in new yearA variety of complimentary education opportunities are available to practices to learn about

important topics, including diagnostic coding, decreasing risk, improving patient care and more.

For more details and to register for programs, visit www.thephysicianalliance.org and click Upcoming Events. Check your inbox as events are promoted through The Physician Alliance’s e-newsletters and special eblasts. <

CODING PROGRAMSLunch with the Coder: Coding Tools to Increase Revenue webinarWednesday, March 11 | 12–1pm

Lunch with the Coder: Hierarchical Condition Categories Coding webinarWednesday, June 10 | 12–1pm

Hierarchical Condition Categories Coding seminarTuesday, August 18 | 8–9am | Southfield

Lunch with the Coder: ICD-10 Coding webinarWednesday, September 9 | 12–1pm

Lunch with the Coder: CPT Coding webinarWednesday, December 9 | 12–1pm

QUALITY / CARE MANAGEMENT PROGRAMSQuality webinarsDifferent quality metrics will be covered during each webinar. Q&A time included. Webinars are 12–1pm.

January 14 | May 12 | July 14 | November 10

Complex Care Management Training (in person)This course provides a framework for the complex care management role, elements of integration into the ambulatory care setting and enhancing care management skills. Meets requirement for BCBSM provider delivered care management and Priority Health care management incentives.

Tuesday, April 21 | 8am–4:30pm | Madison Heights

Tuesday, October 13 | 8am–4:30pm | Madison Heights Community Resource FairsThese annual events bring local organizations together to share valuable community resources to address patients’ social determinants of health.

Tuesday, October 13 | 8–10am | Warren

Thursday, October 22 | 8–10am | Novi

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New physician fee schedule released for new year

CODING CO

RN

ER

In 2018, CMS addressed the redundancy of documentation criteria:

“For established patient visits, when relevant information is already contained in the medical record, practitioners would only be required to focus their documentation on what has already changed since the last visit or on pertinent items that have not changed, rather than re-documenting a defined list of required elements such as review of systems and family/social history.

Additionally, we are clarifying that for E/M office/outpatient visits, for new and established patient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.”

Physicians still review prior data, update as necessary, and indicate in the medical record they have done so; and they must still conduct clinically relevant and medically necessary elements of history and physical exam.

More changes will come in the 2020 Final Rules for Physician Fee Schedule. Effective Jan. 2021, the following will be implemented:

• New and established codes selected on a newly defined Medical Decision Making (MDM) or Time-Based coding system

• Removal of History and Exam as key components in coding

• Time coding redefined from face-to-face time to total time spent on the day of the encounter• Preparing to see the patient (e review of tests)• Obtaining and/or reviewing separately obtained history• Performing a medically appropriate examination

and/or evaluation• Counseling and educating the patient/family/caregiver• Documenting clinical information in the electronic or other

health record• Independently interpreting results (not separately reported)

and communicating results to the patient/family/caregiver• Care coordination (not separately reported)

• Redefining prolonged office or other outpatient E&M services including total time with or without direct patient contact beyond the usual service on the date of the primary service

• Revision of Medical Decision Making (MDM) definitions to include new key words as part of the definitions of all three parts of MDM

• The elimination of code 99201

• New time requirements for coding for time based E&M office visits

• Increased RVU across all remaining E&M levels

That’s right! Physicians have one year to start thinking in a completely new way about documenting and coding, and how coders will be auditing for outpatient office visits. Throughout 2020, The Physician Alliance will be offering education programs related to coding and documentation updates. Visit www.thephysicianalliance.org and click on Upcoming Events for more information.

The Centers for Medicare and Medicaid Services (CMS) announced the

Patients Over Paperwork initiative in late 2017. This program focuses on

reducing administrative burdens placed on clinicians while improving care

coordination and health outcomes. Keeping an ever-watchful eye on these

changes, and what they mean for documentation, coding, and auditing, is

essential in remaining relevant in the healthcare industry.

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The Physician Alliance launched the Affiliate Partners program (formerly called Physician Discount program) more than a decade ago to offer special services and pricing to members. The program offers a variety of services through preferred partner companies. As one of Michigan’s largest physician organizations, TPA’s size allows for valuable purchasing power in negotiating discounts and special offerings for its member base.

A vast array of services caters to physician practices to help efficiently and effectively manage business and clinical needs. Everything from compliance and legal services, cyber security, office supplies, medical malpractice insurance, payment collection services, financial services, and more.

Begin the new year by reducing overhead with cost effective solutions to help save time and money. Check out each Affiliate Partner’s webpage on thephysicianalliance.org for a complete overview of companies and services offered.

Current Affiliate Partners include:

InsuranceCoverys offers preferred pricing on flexible coverage options for medical professional liability insurance.

Huntington Insurance offers cyber liability to physicians to help reduce exposure from their access to patients’ private information.

Document ScanningSharecare Health Data Services provides medical record copying request services.

Financial Planning Services/401(k)Hollander & Lone, LLC provides in depth financial planning advice and services to physician practices and individuals.

VantagePointe Financial Group provides comprehensive financial planning services with no minimum asset requirement.

Legal ServicesRickard & Associates, P.C. provides legal services and assistance with a myriad of business operations services, from general legal counsel to employee issues to compliance and more.

Medical Answering ServiceAmbs Call Center is a medical answering service that provides a full range of quality services to practices.

Mortgage & Banking ServicesHuntington Bank has exclusive mortgage benefits for TPA through a premier mortgage program to physicians and residents looking to buy or refinance a home. Special rates on deposits are also available.

Revenue ManagementCRT Medical provides full end-to-end revenue cycle management (RCM) services focused on both insurance and patient responsibility.

Transworld Systems, Inc. provides TPA members with new automated solutions to help practices improve cash flow and reduce slow pay concerns.

Office Supplies & SolutionsOffice Depot offers a comprehensive office supply and solutions program with competitive pricing and customer service.<

Affiliate Partners Program offers special pricing

EFFECTIVE JAN. 2021Est. Patient E&M Code

Time (minutes)

New Patient E&M Code

Time (minutes)

99211 No time 99201 Deleted

99212 10–19 99202 15–29

99213 20–29 99203 30–44

99214 30–39 99204 45–59

99215 40–54 99205 60–74

EFFECTIVE JAN. 2021Code Current 2021 RVU % Increase

99201 .48 Deleted ––

99202 .93 0.93 0%

99203 1.42 1.6 13%

99204 2.43 2.6 7%

99205 3.17 3.5 10%

99211 0.18 0.18 0%

99212 0.48 0.7 46%

99213 0.97 1.3 34%

99214 1.5 1.92 28%

99215 2.11 2.8 33%

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20952 12 Mile, Ste. 130St. Clair Shores, MI 48081

PRE SORTEDNON PROFIT MAIL

US POSTAGE

PAIDST. JOHN HEALTH

Dennis Ramus, MD Chairperson

Daniel Megler, MD Vice Chairperson

Trpko Dimovski, MD Treasurer

William Oppat, MD Secretary

Eugene Agnone, MD

Mazin Alsaqa, MD

Bruce Benderoff, DO

Paul Benson, MD

Dennis Bojrab, MD

Michael Little, MD

Sidney Simonian, DO

Robert Takla, MD

Kevin Thompson, MD

Robert Zaid, DO

Michael R. Madden President & CEO

Robert Asmussen Senior Business Advisor

Heather Hall Vice President, Corporate Communications

Jennie Lekich Director, Clinical Informatics

Michele Nichols Executive Vice President, Administrative Services

Carolyn Rada, RN, MSN Executive Vice President, Population Health Management

Kathleen Rheaume, MD Senior Physician Advisor

Oleg Savka Director, Information Technology

Ashley Shreve Director, Practice Transformations

Karen Swanson, MD Chief Medical Officer

TPA Leadership Team TPA Board of Directors

www.thephysicianalliance.org

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