Spring Town Hall Event

Scripps Epic Wave 3 Outreach & Scripps ACO Updates

May 3, 2018

Opening Remarks & Introductions

Michael Couris, MDVice President - Scripps Mercy Physician Partners

& Mercy Physicians Medical Group (MPMG)

To develop a medical community that benefits

our independent physicians, affiliate partners,

and Scripps Health, as well as provides the

necessary technology, business services,

education & events that strengthen it.

Why are we here?

Agenda

- Keynote Presentation “Scripps Epic Wave 3 Outreach & Scripps ACO Updates”

- Closing Remarks & Door Prizes! (Michael Couris, MD)

Estimated program length, 75-minutes

Keynote Presentation

Joseph Stein, MDExecutive Medical Director

Inpatient Epic

Scripps Epic Wave 3 Outreach & Scripps ACO Updates

Shane Thielman, FACHEAssistant Vice President

Medical Management, Scripps Health

Barbara PriceCorporate Senior Vice President Chief Executive, Scripps ACO

Cindy GipsonSenior Director of Operations

Scripps ACO

Your Connection to Epic

Options for the Independent Physician

Joseph B Stein MD FACC FACP FHRS

2 Interpretations

2 Interpretations

Big Man

Connection to Epic

Be Connected

Epic - Connection to Independent Office EMR

With Your EMR

EPIC IS Your EMR

Vs

“Epic Connect”

Apprehensive about changes coming?

An Independent Pencil

Might break under stress

An band of Pencils is much harder to break

Herd Protection - not new

HOW DO WE HANDLE CHALLENGES?

Cautious Merger

TRUST

ACO - Experiment ACO - Current Vehicle for Scripps to Partner

MDCR ~43k MSSP Qualcom ~14k PACO

 

1 DWT 21522424v2 0050033-000233

ACOs: Fraud & Abuse Waivers and Analysis

Robert G. Homchick and Sarah Fallows Davis Wright Tremaine, LLP

I. Introduction

The Patient Protection and Affordable Care Act of 2010 (ACA) fosters the development of new patient care models designed to improve the coordination, quality and efficiency of health care services to Medicare and Medicaid patients. Section 3022 of the ACA mandates the creation of the Medicare “Shared Savings Program,” which allows qualified groups of providers to earn a share of the savings generated as a result of reducing the overall cost of providing care to an assigned population of Medicare fee-for-service beneficiaries. To participate in the Shared Savings Program, providers band together to form Accountable Care Organizations (ACOs). To facilitate the establishment of ACOs, Section 3022(f) of the ACA grants the Secretary of Health and Human Services the authority to waive certain provisions of the fraud and abuse laws under the Social Security Act or other provisions of the Medicare law (herein “ACO waivers”).

The Centers for Medicare & Medicaid Services (CMS) published the final ACO

regulations on November 2, 2011 (ACO Final Rule). At the same time, CMS and HHS Office of Inspector General (OIG) published an Interim Final Rule with Comment (IFC) establishing waivers of the Stark law, the anti-kickback statute, and certain provisions of the civil money penalty law (CMP), including the so called Gainsharing CMP and the prohibition on inducements to beneficiaries.1 The IFC establishes five separate waivers that, when considered in the aggregate, permit ACOs significantly more latitude than the waivers as initially proposed by CMS and OIG.2 As the IFC states: “These five waivers provide flexibility for ACOs and their constituent parts to pursue a wide array of activities, including start up and operating activities, that further the purposes of the Shared Savings Program.”3 The design of the ACO waivers is premised on the expectation of both CMS and OIG that the risks of fraud and abuse, such as overutilization, inappropriate utilization and underutilization, will be mitigated in the first instance by the design of the Shared Savings Program.4

                                                            1 The IFC was published in the Federal Register at 76 Fed. Reg. 67992 (November 2, 2011). Because the IFC addresses a range of regulations affecting several statutes, CMS and OIG elected not to publish formal regulation text. The IFC can be located in the Federal Register and on the CMS and OIG websites. 2 On April 7, 2011 CMS and OIG jointly published a notice with comment period describing proposed ACO waivers and other waiver design considerations (ACO Proposed Waiver Notice). 76 Fed. Reg. 19655 (April 7, 2011). 3 76 Fed. Reg. at 67993. 4 76 Fed. Reg. at 68003.

3/16/2016

1

HCCA 20TH ANNUAL COMPLIANCE INSTITUTEAPRIL 17-20, 2016 LAS VEGAS, NV

SESSION 710

TAKING ADVANTAGE OF THE ACO WAIVERS:DOING IT THE RIGHT WAY AND AVOIDING SUBSTANTIAL RISK

STEPHEN H. SIEGEL, ESQ.CERTIFIED HEALTHCARE COMPLIANCE/FLORIDA BOARD CERTIFIED HEALTH LAW

BROAD AND CASSEL, MIAMI, FL

SHSIEGEL@BROADANDCASSEL.COM

1

ACO WAIVERS

PRESENTATION GOALS:

- HOW TO USE ACO WAIVERS TO ACHIEVE THE “TRIPLE AIM”

- APPRECIATING THE LIMITS OF THE ACO WAIVERS

- MAKING SURE USE OF ACO WAIVERS SATISFIES REQUIREMENTS AND AVOID TRADITIONAL FRAUD AND ABUSE AND SELF-REFERRAL RESTRICTIONS

2

ACO - Experiment ACO - Current Vehicle for Scripps to Partner

ACO - Experiment ACO - Current Vehicle for Scripps to Partner

MDCR ~43k MSSP Qualcom ~14k PACO

“Only MDCR rates”

If this is the best Scripps can negotiate on behalf of 900+ MDs with a year of work. Would an individual or small group do better??

ACO - Experiment ACO - Current Vehicle for Scripps to Partner

MDCR ~43k MSSP Qualcom ~14k PACO

“Only MDCR rates”

Independent gets same advantage as SMF/Coastal

Would you turn away a new MDCR patient? Can you live on MDCR rates?

Shouldn’t We Be Connected?

Can we provide: 1) Better Care 2) Be More Efficient/Cost Effective 3) Improve Patient and Provider Experience

Epic viaCitrix

(Remote Access to Inpt EMR& Hosp Inpt/Outpt Orders)

Independent

Physician Office

Any MD Trained

on Epic Inpt

Independent

Physician Office

SNF/ASC/UC

Epic Connect(Full Inpt/Amb EMR)

Epic(Full Inpt/Amb EMR)

Green

La Jolla

Encinitas

Mercy SD

Mercy CV

SM-Foundation

S-Coastal

Epic Link

(Remote Access to Inpt EMRReferrals & Hosp Outpt Orders)

Independent

Physician Office

Independent

Physician Office

Epic ViewOnly

HIE

Epic - Connection to other EMRs

A Simple Handshake?

More Complicated Than It Seems

Epic Connect - Office EMR Work in 1 system - avoid a 10-20% inefficiency

What do you want?

Epic View Only Epic Link Epic via Citrix Epic Connect

Results ✔ ✔ ✔ ✔

Orders x Ambulatory & Referrals

Inpt/Outpt as at Hosp. All

PeriOp x x ✔ ✔

Document x Scan; 2018 - PDF Hospital All

Training eLearn eLearn 1/2 day 2-3 days

When Now Now Wave 2-3Rollout starts

2018

Cost x x x Subsidized Subscription

Accessing Epic from MD Office

Connection Must Be Clear SimpleEasy to Teach

PEDIGREES

HIT$Vendor$Mergers$&$Acquisi4ons$JMP Securities HCIT Consolidation Chart

HIT$Vendor$Mergers$&$Acquisi4ons$JMP Securities HCIT Consolidation Chart

HIT$Vendor$Mergers$&$Acquisi4ons$JMP Securities HCIT Consolidation Chart

Allscripts Cerner

Epic

KLAS & HIMSS DATA

EMR - KEY ISSUES

One Database, One Portal, One Billing, Seamless Inpatient and Outpatient, and departments as needed

Easy Direct Exchange of Patient Data and Order Sets with UCSD-Rady-Kaiser (except Sharp)

Offer connection to community and affiliates

No one leaving, absorbing systems previously on other EMR; Market and Patient Dominance (51%)

EPIC AT NOVANTDEPLOYED TO ALL COMMUNITY PROVIDERS

Consolidated Billing

Replaced 91 separate systems/billers

Portal - Center of Care Neighborhood

MD-Patient Communication

Centralized Scheduling all appointments, lab, imaging

eVisits

Video Visits

Epic Connect

Mercy Physician PartnersTown Hall

Scripps Community Connect Update

05.03.18

Purpose of Scripps Accountable Care Organization (ACO)

Deliver a high performing, clinically integrated network that supports physicians in providing the value and experience we want for our family and friends.

Build the product with the access and experience we want for our family and friends

Scripps ACO is committed to partnering with our integrated, independent physician members to realize that vision.

The subsidized Scripps Community Connect (SCC) offering is one way in which Scripps and the Scripps ACO are supporting independent physicians’ delivery of high value care.

2

Purpose of Scripps Accountable Care Organization (ACO)

3

Scripps ACOClinically Integrated Network with demonstrably high value performance

Improve patient experience

Improve the health of populations

Reduce the per capita cost

Improve clinician experience

Scripps ACO is committed to supporting aligned, independent physicians to be successful in value-based care

Scripps Community ConnectFully integrated EHR for Scripps ACO providers

Contracts / Volume

Alana Disease Management

SNF Preferred Network

Data and Analytics

Update on ACO Activities

4

▪ MSSP Quality Reporting successfully submitted by Scripps ACO on behalf of all participating providers

▪ Initial round of Scripps Community Connect pre-assessments completed

▪ Key performance improvement opportunities identified, including post-acute care (e.g., SNF, Home Health), 1-2 day length of stay, and Part B medication utilization.

▪ As opportunities to improve cost and quality of care are identified, we will look to collaborate with participating providers on how best to close gaps in performance

Summary of SCC Pre-Assessments

5

▪ Total practices identified for initial round of pre-assessments: 45

▪ Central/South: 17 practices (62 providers)

▪ North: 28 practices (223 providers)

▪ Total practices with completed pre-assessments: 27

▪ Central/South: 14 practices (59 providers)

▪ North: 13 practices (70 providers)

Evaluation of Epic Revenue Cycle for Affiliated Physicians

1. Scripps ACO pipeline practices evaluating UCSD Community Connect offering which includes Epic’s professional billing solution.

2. Desire for a integrated revenue cycle, practice management and clinical EHR solution.

3. Enhanced MyScripps features similar to enterprise functionality --paperless billing, self-pay, and ability to expand Welcome kiosk features.

4. Reduction in operational and management complexity for Community Connect practices by managing patient registration, billing, and accounts receivable in one system.

6

Scripps Health will not provide billing services for Community Connect practices• Provide professional billing module implementation expertise; practices will be solely

responsible for the management of their AR• All practice / billing data will not be visible to Scripps Health or other Community

Connect practices

Pilot Practices: Go-Live Update

7

▪ Go-Live for pilot practices: Monday, May 7

▪ Coastal Pulmonary Associates (Dr. Scott Eisman)

▪ Surgical Associates of La Jolla (Dr. Mark Sherman)

▪ Implementation milestones

▪ Training completed for all providers and staff

▪ Appointment scheduling conversion complete

▪ Clinical and technical dress rehearsals completed

Closing Remarks & Door PrizesMichael Couris, MD

Vice President - Scripps Mercy Physician Partners & Mercy Physicians Medical Group (MPMG)

$50 Gift Card Fleming's Steakhouse

2 - $50 Gift Cards Nordstrom

$50 Gift Card P.F. Chang's

2 - $50 Gift Cards Shogun Restaurant

$50 Gift Card P.F. Chang's

Kindle Fire HD

Kindle Fire HD

Thank you for attending!