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Population Health Initiative: Examining the Revenue Lines Print E-mail
Written by Mario Espino   
Wednesday, 23 August 2017 17:53

In part I of this series, we took a high-altitude look at a population health initiative. Today we will examine two core revenue lines essential for a successful initiative. These revenue lines are generated from Medicare-allowables but are transferable to other payer models as they all mostly follow traditional Medicare.

Transitional Care Management (TCM), not to be confused with Transformational Care, is the first one to embrace. Properly implemented TCM provides the practitioner the best chance to get started, not only gathering data, but getting those patients recently discharged from an inpatient acute care setting back in front of their primary care physicians (PCPs). This is crucial as we find that many PCPs are not aware of the inpatient stay and the event that caused the admission, let alone the changes and/or additions made to the patient's care plan and medications.

TCM is a fundamental opportunity to coordinate medical treatment plans for better management of the patient’s condition(s). This is done in either a less than 7 day (CPT Code 99496) or a less than 14 day (CPT Code 99495) window, from the date of discharge, for the patient to be seen by the primary care physician after discharge, as a face-to-face encounter. Revenue ranges from $130 to $200 per patient.

Chronic Care Management (CCM) is the second leg of the core data-gathering process that enables a comprehensive population health initiative. This allows for the collection, aggregation, and management of data from across the continuum and converts the same into one care plan that is actionable and can be supervised by the PCP. This is critical because we know that coordination of care provides better outcomes and saves money. But before CCM, there was no incentive to manage and collect patient information from other continuum providers while collaborating with patient and PCP to look for gaps or improvements in care.

The chronic care management market is big and growing. 36 million Medicare patients suffered from two or more chronic conditions in 2016. That number is expected to jump to 80 million by 2030. 

CCM started later than TCM, and it is a non-face-to-face, per month, per patient amount of monies to manage the care for those that meet the CMS chronic care management definition. There were key improvements for 2017: Increased payment and additional codes. The single CCM code in 2016 paid approximately $42. Now there are 3 codes and payment can range from approximately $43 to over $141, depending on how complex a patient’s needs are. There are requirements by CMS that will have to be in place to bill; but the benefits outweigh the requirements.

There are more revenue lines but these should be at the core of a successful population health initiative.
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Resources for TCM and CCM

CMS: TCM Services Fact Sheet

Healthcare IT News: Chronic Care Management: $50 Billion Market

WSJ: Moving Away from Fee-for-Service

CMS: Chronic Care Management Services Changes

CMS: MLN Chronic Care Management

About the author:
Mario Espino is the Chief Population Health Officer for Accountable Care Options of Florida, in Boynton Beach. Mr. Espino is the founder of MGM Medical Group as well as a Blogger/Writer for www.PopulationHealthAnalytics.org.
 
Veteran S. FL Health Attorney Launches Compliance Business Print E-mail
Written by FHI News   
Thursday, 17 August 2017 12:49

Jeffrey L. Cohen, board-certified founder of the Delray Beach based Florida Healthcare Law Firm, has started a new venture. Launched earlier this year, RiskShield Tools is a platform created by attorneys and leading industry professionals to make compliance easier for healthcare professionals and businesses. The firm can assist laboratories, addiction treatment facilities, physician practices, home health providers, pharmacies and hospice.

And just like any other competent healthcare pro, RiskShield Tools is set up to diagnose, prescribe and treat. The diagnostic tool, delivered via the website, is the first guided self-assessment survey of its kind and is designed to help healthcare providers determine whether their business complies with important healthcare laws. Once the survey is completed, the RiskShield Tools team provides an in-depth, onsite assessment and generates a comprehensive report with prioritized action items. "You don’t just get a plan that sits on a shelf," states Mr. Cohen. "Instead, you’ll receive specific guidance regarding action to take and be reminded to schedule regular visits with our compliance team, who are trained to help you stay on track." The treatment plan includes crucial support if a provider is audited or investigated, including:

·         Audit Notice Response

·         Audit Risk Analysis

·         On Site Representation

·         Policies & Procedures Development

·         Corrective Action Plan Implementation

RiskShield Tools also offers an ever expanding Compliance Training Library and five star support.

"Healthcare regulatory compliance is often performed by consultants who are not lawyers," states Mr. Cohen. "This can create tension between the professionals, since they may see the same issue differently. The best possible legal and regulatory compliance product for a healthcare client is one that blends expert consulting services with expert healthcare legal compliance. That's why I started RiskShield Tools."

A free guided self assessment is available online that allows healthcare professionals to anonymously answer a few questions and determine where they stand. Click http://riskshieldtools.com/surveys/ to get started.   
 
A Population Health Initiative: What Should It Look Like At Its Core? Print E-mail
Written by Mario Espino   
Sunday, 13 August 2017 09:59

A Population Health Initiative is a fluid, dynamic process that is not yet, in its entirety, in place in many institutions. Yes, there are risks but the potential rewards won by capturing the marketplace early are clear. Time is of the essence and the collection of the right technology, people and processes is crucial. Implementing the initiative requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations and reducing the per capita costs (aka The Triple Aim). Analytics captured through a 360° view utilizing interoperability are the key to enabling and achieving The Triple Aim as defined by the Centers for Medicare and Medicaid Services (CMS).

Valued Based Care, at the core of population health, necessitates the collection of structured and unstructured data. Unstructured data is often overlooked as it presents challenges. That said, there are opportunities within the environment today that will allow for it to be collected and re-entered into a structured format. This would meet the goal that healthcare professionals seek: capturing the entire data throughout the continuum of care without limitations of interoperability. Care plans have to be comprehensive and rich in data and outcomes cannot be limited by lack of data.

Technology must be considered early and thoughtfully through process-rich algorithms as it is the only way to capture and stratify for desired results. It can make or break the initiative. In the first risk ventures, we saw that Medicare Advantage companies, without technology as it relates to population health management software, had the ability to control medical costs/ratios. They accomplished this by centralizing infrastructure. A couple of notable pioneers were Leon Medical Centers and Pasteur Medical. In today's era, possessing both infrastructure and population health software is essential. This gives the provider an opportunity to successfully promote the population health initiative to payers and risk-based participants. Attracting large payers requires replicating the infrastructure components agreed to, having the right strategic technology partner in place and expanding geographic footprint.

Coordination of care, medications, referrals and authorizations for the entire continuum of care, with one care plan, will serve as the best practice model. This strategy, if implemented properly, will survive rigorous comparative analysis. The Population Health Initiative should be wrapped into a Clinically Integrated Network (CIN) or Integrated Delivery Network (IDN). The ongoing costs associated with the initiative can be offset by the added revenue lines, particularly Transitional Care Management (TCM) and Chronic Care Management (CCM).

The initiative should look inward and outward for opportunities. Specifically, outward, there should be an upside for physicians by joining the CIN/IDN. For example, physicians could become Medical Home (PCMH) accredited, now no longer limited by lack of data to participate in risk opportunities. Their CIN/IDN participation provides them a mechanism for the reporting of metrics and other payments for performance strategies. Also, the CIN/IDN can protect them from any penalties e.g. not meeting reporting requirements demanded by the government (MACRA). CIN/IDN should include management assistance in modifying workflows or creating workflows that will enrich these practices, patient satisfaction and the overall goal of “Best Care Practice” models. This type of outreach will also encourage other practices to join the team as the CIN/IDN entity makes it easier for individual practitioners to manage MACRA and risk within their managed care contracts, meet outbound opportunities for patient satisfaction as well as reporting. From the institutional side (Healthcare Systems), the legacy process that has been in place should be modified and run in parallel, embracing the Primary Care Practitioner (PCP) as the Gate Keeper going forward.

Population health will dominate all future revenue lines. Do not underestimate the community of services and resources which will be needed to succeed.

About the author:
Mario Espino is the Chief Population Health Officer for Accountable Care Options of Florida, in Boynton Beach. Mr. Espino is the founder of MGM Medical Group as well as a Blogger/Writer for www.PopulationHealthAnalytics.org.

Last Updated on Wednesday, 16 August 2017 18:19
 
A 'perfect storm' superbug: How an invasive fungus got health officials' attention Print E-mail
Written by Helen Branswell | STAT   
Tuesday, 01 August 2017 17:18

Try as they might, the infection control specialists at Royal Brompton Hospital could not eradicate the invasive fungus that was attacking already gravely ill patients in the intensive care unit.

Enhanced cleaning didn't stop the dangerous bug from spreading from one patient to the next in the 296-bed hospital. Neither did segregating infected patients, to keep them from spreading the fungus.

Eventually, officials who run the Royal Brompton, located a couple of miles from Buckingham Palace in London's tony Chelsea neighborhood, resorted to a last-ditch move no hospital ever wants to have to take. They temporarily shut their ICU. That appears to have put a stop to the more than year-long outbreak, which ended last year and involved at least 50 patients.

Last Updated on Tuesday, 01 August 2017 17:28
 
'Living Drug' That Fights Cancer By Harnessing Immune System Clears Key Hurdle Print E-mail
Written by FHI's Week in Review   
Monday, 17 July 2017 00:00

Rob Stein reports for Health News Florida on 7/12/17:
 
A new kind of cancer treatment that uses genetically engineered cells from a patient's immune system to attack their cancer easily cleared a crucial hurdle Wednesday...The treatment takes cells from a patient's body, modifies the genes, and then re-infuses those modified cells back into the person who has cancer. If the agency approves, it would mark the first time the FDA has approved anything considered to be a gene therapy product...The treatment is part of one of the most important developments in cancer research in decades - finding ways to harness the body's own immune system to fight cancer.

Last Updated on Wednesday, 19 July 2017 11:58
 
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