welcome your new board of directors - amazon s3 memorial health system lima immediate past president...
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PresidentMona Miliner MHA, NHA, FACHE, FACMPE, CHFPDpt. of Psychiatry and Behavioral Neuroscience - UCHealthCincinnatiPresident-ElectDavid Rausch CMPE, FACHEBlacklickVice PresidentSheelah Westerbeck CMPEWest Medical, Inc.CantonSecretaryLaurie Nicholls RNMidwest RetinaDublinTreasurer
Amy SchmidtLima Memorial Health SystemLima
Immediate Past PresidentKathleen Kostelnick FACMPE, CMMPioneer Physicians Network Inc.UniontownMember At LargeJenna BlattPioneer Physicians Network Inc.UniontownMember At LargeDiana Everage MHA, BSN, RN, FACMPEAkron Digestive Disease Consultants and Gastro GroupAkronACMPE Forum RepresentativeMichael O'Connell MHA, FACHE, FACMPESolonLegislative LiaisonTammy Langdon MBA, FACHETrihealthCincinnati
Membership Mattersa publication for members of Ohio Medical Group Management Association
November 2016
Special Recognition to our outgoing Past PresidentKatherine Pandolfo MBA, MSN, RN, CMPE5+ year member of Ohio MGMA President of Ohio MGMA 2015Served on Ohio MGMA Board since 2011Member of National MGMACertified Member in the American College ofMedical Practice ExecutivesVolunteer on numerous Ohio MGMA committees
Special Recognition to our outgoing TreasurerMary Alice Streeter CPA, CMPE, CGMA40+ year member of Ohio MGMA President of Ohio MGMA 1981Served on Ohio MGMA Board for over 10 yearsMember of National MGMACertified Member in the American College ofMedical Practice ExecutivesMember of North East Ohio MGMAFormer Board member of North East Ohio MGMAFounder Mary Alice Streeter Scholarship Program
WELCOME YOUR NEWBoard of Directors
Term runs October 1 - September 30 annually
About MedManagement MattersMedManagement Matters is a publication by the Ohio Medical GroupManagement Association. Articles or portions of articles may not becopied without written consent of Ohio MGMA. Articles published inMedManagement Matters contain the expressed opinions and experi-ences of the authors and do not necessarily represent the position ofOhio MGMA. The content of this newsletter is for information purpos-es only and is not intended to replace financial or legal advice.
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Upcoming Events and EducationMore information and registration can always be found at:http://www.ohiomgma.com/site_page.cfm?pk_association_webpage_menu=735&pk_association_webpage=1349
December 14 / 1:00 pm - 2:15 pm easternFree Member Webinar"Getting Ready for 2017: The Reimbursement Landscape for MedicalPractices"presented by Elizabeth Woodcock, MBA, FACMPE, CPC
January 10 / 1:00 pm - 2:00 pm easternFree Member WebinarTitle and Speaker forthcoming
February 14 / 1:00 pm - 2:00 pm easternFree Member WebinarTitle and Speaker forthcoming
*Access our available On-Demand Member Webinars! Sign-in at www.ohiomgma.com with your username/password andproceed to the Members ONLY page for free viewing of previouslyrecorded webinars and handouts
March 16 / 10:00 am - 3:00 pmMGMA Lean Six Sigma White Belt Certification ProgramThe Eye Center, Columbus Registration is limited to 40 participants
March 17 / 8:45 am - 4:00 pmOSMA Education Symposium in partnership with Ohio MGMAHilton Columbus at Easton, Columbus
Membership RemindersREVIEW AND UPDATE YOUR MEMBERSHIP ACCOUNT Checking and updating your Ohio MGMA MembershipAccount periodically, ensures we have your proper contact infor-mation. We need your current contact information so that youreceive the most out of your Ohio MGMA membership. Checkand update your account today.Instructions:• Go to www.ohiomgma.com• SIGN-IN using your Ohio MGMA username & password• After you sign in go to MY ACCOUNT and check/update yourmembership profile at any time• If you have forgotten your Ohio MGMA username/password, goto the sign-in page and select “forgot password”
MEMBERSHIP DUES RENEWAL STARTS IN DECEMBEROhio MGMA will begin our 2017 Membership Renewal period inDecember. Membership dues will need to be paid by January 31,2017 to remain on our membership roster and maintain access tomember benefits. Keep an eye on your email inbox for your duesrenewal invoice coming in December!
A special THANK YOU to Ohio MGMA’s 2016Corporate SponsorsOhio MGMA would like to gratefully acknowledge our annual corporate sponsors for their support of our association
and our members this year.
Protecting the assets of healthcare providers with four levels of unmatched protection -since 1899. Contact, Eric Arthurs (800) 463-3776 / [email protected] / www.medpro.com
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Featured ArticleHow to Handle Staff Wars at Your Practice
Written by Linda Girgis, MDPhysicians Practice
www.physicianspractice.com
Like in every other profession, people working in healthcare possess unique personalities and there are times when staffersat your practice will just clash. Despite our best efforts to remain impartial and on the sidelines, continual tension betweenstaff members starts to gnaw away at office morale. While this may be entertaining if we are watching the Kardashians, itcan begin to affect patient care if we allow it to snowball out of control. The most important item to realize as a doctor and/or owner in a practice is that you are the last to know the war that hasbeen simmering below the surface for some time. The staff all want to make a good impression on you and tend to keep thedrama to themselves. If they come to you to complain about another employee, chances are this battle has been brewing forsome time and you are only hearing an over-dramatized rendition of events.
As the leader of the healthcare team, how can staff wars be handled?- First, try to take a hands-off approach. These are adults and not children and as professionals, they should be able tomake their own peace and compromise. I rarely step into these wars unless it is starting to affect how the practice is func-tioning. When staff members come to me and ask for my help, I try to make the involved parties sit down together for a dis-cussion, between them only. The more thorough direction I give them in directly solving the tension, the longer lasting it willbe I have found. If you jump in right away and make new initiatives to help people get along, they will start seeking your helpfor every dispute that arises. Do you really want to play kindergarten cop?- It is imperative to listen to both sides of the story. Even if your "best" employee is giving you the details, you still need tolisten to the other person. I have been surprised, even shocked, by acts that were done by those I considered outstandingworkers. Remember you are dealing with humans and no one is perfect. Don't automatically discount an unbelievable tidbitsomeone tells you just because of the person involved.- Investigate the allegations. Often, truth is very easy to discern by looking at all available facts and speaking to all involvedparties.- Be prepared to take action. If you must, issue warnings and make new office guidelines. You are the leader and the staffwill be attuned to your authority. If they feel you will not take any action, they will not change. In my practice, depending onwhat kind of behavior is being covered, we often cut hours. If two staff members refuse to compromise and poison theatmosphere in the workplace, you cannot just sit back idly. The rest of the staff will become poisoned. Previously, I have hademployees who made me hate going to work, at my own practice where I pay them their salary. Why make anyone's life somiserable?- Don't give in to unreasonable demands just to make peace. Once, an employee insisted I change another employee's workschedule because she refused to work with her. It got to the point that she said she would refuse to work any hours whenthe other staff member was there. I ended up firing her because the employees cannot dictate how you run your practice.She was a very good employee but the workplace was much happier after she left and the others started working harder.Besides, who wants to be a baby-sitter for a diva employee?- Have regular social functions for your staff. This allows them to get to know each other on a more personal level. This maybe just lunch once a month in the office. Every summer, we take our staff plus one guest to Six Flags. We give them ticketsand then we all meet up for lunch. They always come back best of friends for weeks following this event.Whatever you decide to do, the least involvement you offer the better. But, when it lands at your feet and you are forced totake action, be fair to all parties and be firm. Don't we already face enough toxicity in the healthcare environment every day?
Ohio MGMA ACMPE Advancement Committee in support of our members
Six Ohio board certified members in medical practice management have joined together to form Ohio MGMA’s ACMPE Advancement Committee.
Your Ohio MGMA ACMPE Advancement Committee is here to help you achieve your professional goals.
Feel free to contact us for additional information or help during any one of the steps on your way Certification and Fellowship!
Committee Chair:Michael O’Connell, MHA, FACMPE, FACHE
Solon, [email protected]
Committee Members:Frank Combs, MBA, FACMPE
Columbus, [email protected]
Susan Kruger, FACMPEPainesville, OH
Mona Miliner, MHA, NHA, FACHE,FACMPE
Cincinnati, [email protected]
Cyndi Paluch, FACMPEKettering, Ohio
Kathy Kostelnick FACMPE, CMMUniontown, Ohio
Congratulations to Ohio’s newest ACMPE Certified MembersRussell Benfield, Columbus Jessica Minesinger, DaytonAimee Burbacher, Groveport Michael Moddeman, DaytonNicholas Cook, Columbus Stacy Porter, ClevelandMatthew Dressler, Cincinnati Jeffrey Slade, ToledoLaurie Garman, Canfield Derek Theodore, DaytonMarsha Justus, Delaware Randall Wayne, AkronJacqueline Lucas, Columbus
Congratulations to Ohio’s newest ACMPE FellowsSteve Davies MS, MBA, FACMPE / Cindy Dormo FACMPE / Diana Everage MHA, BSN, RN, FACMPE
This year, these individuals have attained the highest distinction in the field of medical practice management: Fellow in the American College ofMedical Practice Executives (FACMPE). Achieving Fellowship through ACMPE demonstrates an individual's willingness to embrace greater chal-lenges and drive practice performance to new levels through the completion of a professional paper or three case studies.
ACMPECORNER
The MGMA ACMPE Certification Commission hasannounced 2 important updates for ACMPE.
Transition the current essay portion of the exam to an objectively scored,scenario-based exam. The revamped exam will present scenarios just as thecurrent essay exam does. However, instead of drafting open-ended essay
responses to the scenario, examinees will answer a series of objective questions aboutthe scenario. ACMPE will convert the current exam with the help of Castle Worldwide and will debut the new exam in Sept.2017. You will not need to retake the exam to hold your advancement.
Change eligibility requirements for the certification program. In order to continually elevate the program and increase itsvalue in the marketplace, nominees will be required to have a bachelor's degree or the equivalent of 120 hours of collegecredit in addition to two years of healthcare management experience. This requirement will take effect Jan. 1, 2019, but willnot apply to those who are already board certified within ACMPE.
Exam dates for 2017 are as follows: Exam Dates Location Registration
March 11 – 25, 2017 Nationwide computerized testing Jan. 30 – Feb. 10, 2017
June 10 – 24, 2017 Nationwide computerized testing April 24 – May 5, 2017
September 9 – 23, 2017 Nationwide computerized testing July 24 – August 4, 2017
December 2 – 16, 2017 Nationwide computerized testing October 23 – November 3, 2017
Board Certification Study Group 2016 is on-demand There were 8 weekly webinar modules covering the 6 domains in the Body of Knowledge, which are open to members andnon-members. See the webinar series in the MGMA store for more details.
Fellowship Study Group is on-demandThe Fellowship study group webinar series is designed to help individuals considering Fellowship to learn more about theprocess and requirements to earn their FACMPE. All webinars are now available on-demand. See the webinar series in theMGMA store for more details.
Books, books, and more books! Ohio MGMA has a library of books available for your use. These books are especially important as medical profes-sionals prepare for the ACMPE board certification exams. These books are available free of charge to OhioMGMA members to borrow.If you are interested in borrowing a book, email [email protected] and provide the following information:
1. Name of book(s) to borrow2. Mailing address to send the book 3. Your email address and telephone number4. A listing of available books can be found online at www.ohiomgma.com / Resources / Library
On receipt of the request, the book will be mailed to you at our cost. You have up to 6 weeks to read the book. When youhave completed reading the book, please return it to us (at your cost).
If you have any questions, please feel free to contact met at [email protected]. Happy reading!
ACMPECORNER
Featured ArticleMACRA final rule: Four tenets to establish a proactive quality
payment program strategyWritten by Justin Barnes,
Partner and Chief Growth Officer, iHealth Innovations | October 31, 2016 With final rule on the Medicare Access and CHIP Reauthorization Act now inhand, physician practices across the nation are preparing for the most dramatichealthcare payment reform this generation has seen.
MACRA and its associated Quality Payment Programs replace formerSustainable Growth Rate provisions for physician Medicare reimbursement andsignal the industry's tipping point in the move to value-based care. Fee forService Models in place today will quickly transform to reflect the seriousnessof a cost-conscious era of quality-based reimbursement.
Research conducted in early 2016 suggests that only 43 percent of practiceshave compensation tied to quality or value of care heading into MACRA. Thestudy also cites regulatory and paperwork burden as the biggest deterrent topractice satisfaction among physicians. The Centers for Medicare and MedicaidServices new policy framework, more than eight years in the making, works toaddress those concerns, combining several previously unintegrated healthcarereporting initiatives into a unified QPP that most healthcare providers willqualify for.
With pick-your-pace options, flexible measure selection, reporting period flexi-bility and small-practice provisions cemented by the final rule, providers have aunique opportunity to engage new value-based strategies slowly withoutpenalty. The march toward MACRA is officially underway. This article lays outfour key focus areas to help providers successfully navigate the new pay-for-performance model in 2017's inaugural reporting year: financial, clinical, tech-nical and staff training.
Understanding the MACRA landscape: two paths to participationUnder MACRA, eligible clinicians can begin collecting performance data oncare given and technology utilized anytime between Jan. 1, 2017 and Oct. 2,2017. Data captured by providers during the 2017 reporting period is due byMar. 31, 2018. Eligible clinicians have two reporting track options to participatein QPPs under MACRA which are the Merit-based Incentive Payment Systemand the Advanced Alternative Payment Model. Of those eligible clinicians, 90percent are expected to participate in MIPS and 10 percent in APMs
MIPS: This QPP option combines outcome and quality-based payments withreduced fee-for-service reimbursement. MIPS integrates three payment pro-grams—the Physician Quality Reporting System, Meaningful Use, and Value-based Payment Modifier—with an assessment of clinical practice improvementinitiatives to establish an annual Composite Performance Score that reflects aphysician's standing relative to reporting peers, on a scale of 1-100. That scoredetermines Medicare incentive or penalty payments for physicians at a 4 per-cent adjustment rate starting in 2019, and up to a 9 percent adjustment rateby 2022.
While cost will be tracked by CMS in 2017, cost category determinants will notbe factored into payment adjustments until 2018. Under MIPS, providers canchoose quality reporting objectives and measures that best align with medicalpractice specialty and workflow specifics. Only physicians practicing underMedicare for the first time in 2017 and those who anticipate billing less than
$30,000 for fewer than 100 Medicare Part B patients are exempt (unless ofcourse you are in a CMS Advanced APM).
Clinicians have four "pick-your-pace" avenues for payment program participa-tion in MIPS:
Option 1: NonparticipationProviders who do not submit 2017 QPP data will suffer a 4 percent negativepayment adjustment.
Option 2: Submit partial dataProviders who submit QPP data on at least one quality measure or improve-ment activity, or the required measures in advancing care information canavoid a negative payment adjustment.
Option 3: Partial reporting periodProviders who submit more than one quality measure, more than oneimprovement activity, or more than the required measures in advancing careinformation for a period of 90 days can earn a neutral or small positive pay-ment adjustment.
Option 4: Full reportingProviders who submit for a full 90-day period or a full year of 2017 data in allcategories may earn a moderate (or full) positive payment adjustment.
Clinicians can report MIPS data independently or with a group entity. For theinitial transition year under MIPS, reporting thresholds have been lowered andan additional $500 million has been provisioned annually for "exceptional per-formance" bonuses to clinicians who achieve a final score of 70 or higher.
Advanced APMs: The second category of QPP under MACRA is AdvancedAPMs. Less than 10 percent of MACRA-eligible providers are expected to quali-fy for an Advanced APM in the first reporting year under this regulation.Physicians who qualify to report under an Advanced APM get a 5 percentbonus each of the first six years of MACRA, and base payment updates higherthan those under MIPS from 2026 onward, when the reporting party earns sig-nificant revenue (25 percent) or sees sufficient patient volumes (20 percent)through qualifying Medicare or payer models.
Payment adjustments based on 2017 performance data will go into effect onJan. 1, 2019. The MACRA final rule provisions $20 million each year for fiveyears to fund training and education for small practices of 15 or fewer clini-cians and practices in rural areas.
Four keys to navigate the transition.Implementing a comprehensive strategy is critical to provider success underMACRA. Assessing infrastructure before layering in payment program initiativesensures future plans are built on a solid foundation. Practices should focus onfour areas in evaluations and strategic planning: financial, clinical, technicaland staff training.
Financial successThe best place to start when evaluating infrastructure is the existing revenuecycle. Stabilize and optimize revenue streams to ensure the practice isn't leav-ing money on the table. Renewed emphasis on accurate coding, documenta-tion support, self-audits and denial management can help plug revenue leaks,potentially shoring up funds that may serve the practice elsewhere. It's impor-tant to understand key performance indicators, trending and the cost of oper-ation heading into QPP participation.
Providers should know how to scrutinize their payer reimbursements. Analyzecontracts and variance rates to ensure revenue due to the practice is collected.It's also important to understand any value- and risk-based contracts a practicemay qualify for. Reach out to the commercial payers engaged with the practiceto determine what is available in the area. Many plan-specific and state-basedincentive programs that exist are not advertised.
Clinical successWith performance on quality targets accounting for 60 percent of MIPS scoresin the first year of QPP, quality measures will be an essential aspect of success.Understanding where the practice has performed strongly in previous yearsand aligning those services to MIPS measures, will influence quality measurefocus going forward and can help practices be competitive. Take advantage ofmeasures that appear across multiple categories to reduce reporting burdens.Population health and care coordination are at the heart of QPP models. Focuson expanding communication with beneficiaries and patient care teams as wellas specialists. Much of the care coordination measures center around collect-ing and sharing patient information with care teams, referred providers andthe patient themselves. Optimize outcomes by partnering with facilities acrossthe continuum of care. Be consistent in using existing functionality for elec-tronic data exchange and messaging or identify new, cost-effective opportuni-ties for patient engagement, communication, education and empowerment.
Technical successTechnology infrastructure is paramount to reporting under MACRA. Establish afirm understanding of the measures and the existing EHR functionality that isavailable to track for the adopted payment model. Practices will need to inte-grate data from financial and clinical sources to monitor and report onrequired measures and factors. In many instances, we have found thatproviders have not been able to optimize the most recent functionalityenhancements in the EHR and health IT systems they already have.In some cases, EHR template and workflow customization as well as dashboardcreation can help practices quickly and routinely target measures and KPIs per-tinent to practice objectives. Test the process for submitting reporting metricsahead of time, streamline workflows and leverage technology wherever possi-ble to create efficiencies for patient engagement and throughput.
Staff successSecuring inside expertise on new payment models, health information man-agement and technology implementation is a major challenge for practicestoday. Practices need to align with partners who can help shoulder the burdenof expertise and implementation, educating practice stakeholders along theway while still allowing them to focus on patients as priority number one. Lookfor partners who will keep practice staff informed, proactively evaluate pay-ment models, offer coaching on how to go engage payers and help manage-ment flesh out strategic initiatives.
Involve and educate appropriate staff members at different points in the plan-ning process and make sure the team has a collective general understanding ofpractice objectives so everyone is working toward the same goals. Take advan-tage of resources such as Medicare's Physician Compare and Quality Resource
Use Reports to benchmark and compare physician performance and reportingpractices.Moving past provider hesitationCompeting priorities, limited resources and general unfamiliarity with MACRAand the final rule have contributed to market hesitation to embrace reform,even with MACRA's commencement close at hand. That said, there will notlikely be a more ideal time for physicians to prepare for the QPP transition.Flexible, scaled participation options mean physicians can stave off first-yearlosses and potentially earn incentive and bonus payments via partial reportingas clinicians learn to navigate the new system. In rewriting policy, close atten-tion was paid to identifying quality measures that were applicable across mul-tiple models to incentivize providers for improving outcomes while simplifyingthe reporting process. Diminished reporting data thresholds have been imple-mented during the first reporting year. CMS also built in small and rural prac-tice training resources to counter market concern.
Care providers who proactively engage with new payment and care deliverymodels, and cultivate the right partnerships and expertise, will unequivocallyhave more opportunity in the future. These three steps quickly engage stake-holders and establish proactive momentum for the MACRA journey:
• Take advantage of every resource available to learn about QPP specifics and support practice efforts
• Engage partners with the needed expertise or designate internal resources to lead the charge
• Establish a strong game plan that begins by January 2017
The average practice can easily qualify for incentives under the new QPP, butmany lack the internal resources necessary to succeed under MACRA.Proactive leadership and expert partnerships are essential to juggle the newinitiatives and cultivate a value-based business strategy. Look for partners thatwill go "at-risk" with you. Tie them to your success, that way everyone is guar-anteed to win.
Embracing a business approach for value-based careThere is real opportunity for practices to be a catalyst for change within com-munities. Patient growth, panel participation, partnership opportunities andcare model invitations are among the benefits that proactive practices standto reap, all of which could have big implications for coordinated care and pop-ulation health initiatives. Practices that lead the charge, participate in broaderpatient and community engagement and grow the care ecosystem will havethe long-term advantage.
About the Author:Justin Barnes is a nationally recognized business and policy advisor who servesas Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman ofthe Accountable Care Community of Practice. As Chief Growth Officer withiHealth, Justin assists providers with optimizing revenue sources and transi-tioning to value-based payment and care delivery models. Justin has formallyaddressed Congress and the last two Presidential Administrations on morethan twenty occasions on the topics of MACRA, value-based medicine,accountable care, interoperability, consumerism and more. He is also host ofthe weekly syndicated radio show "This Just In." (404) 538-0707 | @HITAdvisor
This Just In Radio | HIMSS Radio