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Leading the Transformation of Healthcare

Reducing Inappropriate ED Visits

In an effort to improve access and reduce unnecessary ED utilization, Signature Partners would like you to utilize a new telemedicine initiative for your patients who may need to access care after hours. Earlier this year, Inova partnered with American Well to launch a 24 hour, 7 days a week telemedicine service, white labeled as “Inova OnDemand.” Patients with acute, minor conditions are able to access a board-certified physician for a real-time video visit. These physicians are contracted and credentialed through American Well, one of the largest and most successful national telemedicine provider groups. The charge to the patient is $49. When setting up the appointment, patients are asked who their primary care provider (PCP) is, and are directed to follow-up with their PCP after completing the video visit. We encourage you to market Inova OnDemand to your patients as a means to access care for minor symptoms after hours as opposed to going to the ED or urgent care which costs much more. Decreasing ED utilization is one of the key areas where we can reduce total cost of care.

 

Payor Plans Update

Innovation Health Medicare Advantage Plan: Innovation Health will be offering a Medicare Advantage HMO and PPO plan effective January 1, 2018. The HMO plan will be a $0 premium plan. Both plans will be utilizing the Signature Partners network of providers. Innovation Health is organizing several meetings in the area to disseminate information to interested members and providers.

Meetings locations:

  1. Fairfax, Hilton Garden Inn, 3950 Fair Ridge Dr. on November 7th at 2pm; November 14th at 10am
  2. Vienna, Courtyard by Marriott Dunn, 2722 Gallows Road, on November 8th at 2pm; November 13th at 10am
  3. Arlington, Arlington Mill Senior Center, 909 S Dinwiddie Street – Rm 418 on November 15th at 11:30am and 2:30 pm
  4. Alexandria, Hampton Inn, 5821 Richmond Hwy, on November 2nd at 10am; November 8that 2pm; November 16th at 10am

For more information, call 1-855-609-1902 or visit www.IHMedicare.com

John Hopkins US Family Health Plan: Signature Partners is the only network in Northern Virginia for the Johns Hopkins US Family Health Plan, a TRICARE Prime plan for family members of active duty personnel.  This plan became effective in Northern Virginia on May 1, 2017 and is steadily growing, with the current enrollment at 1,400 members. Learn more by visiting www.hopkinsmedicine.org/usfhp or by calling 1-800-801-9322.

John Hopkins US Family Health Plan Update

Signature Partners is the only preferred network in Northern Virginia for the Johns Hopkins US Family Health Plan, a TRICARE Prime plan for family members of active duty personnel. This plan became effective in Northern Virginia on May 1, 2017 and already has 493 members enrolled.  Two member briefings have already been held to discuss the details of the plan with eligible military families.  Two future briefings are scheduled as follows:

Wednesday, July 26th – Inova Fair Oaks Hospital – 7 pm/refreshments start at 6:30 pm

Tuesday, August 29th – Inova Alexandria Hospital – 7 pm/refreshments start at 6:30 pm

These briefings provide great opportunity for Signature Partners PCPs, participating with this plan, to recruit new patients to their practice.

Learn more about the plan by visiting www.hopkinsmedicine.org/usfhp or by calling 1-800-801-9322.

Signature Partners Providers to see increase in Innovation Health members attribution

Starting July 17th, Signature Partners Primary Care Provider (PCP) may see an increase in new Innovation Health patients establishing care with their offices. Innovation Health has engaged with EMMI Solutions to call their members who have not selected a PCP, to discuss the importance of choosing a Signature Partners PCP. During this call, the members will be provided with three options of Signature Partners PCP closest to their address; EMMI Solutions will then connect the member directly to the PCP of their choice to schedule an initial visit.  In addition, brochures explaining this initiative will be mailed to Innovation Health members to encourage them to select a Signature PCP.

Signature Partners new membership in CAPG

Signature Partners and all its providers are now members of CAPG. CAPG offers educational opportunities, healthcare issue updates in addition to many other benefits as listed below. For more information about CAPG log onto www.capg.org/risk essentials to access the benefits they offer. .

CAPG is the leading association in the country representing physician organizations practicing capitated, coordinated care. Our membership currently comprises more than 250 multispecialty medical groups and independent practice associations (IPAs) across 40 states, the District of Columbia, and Puerto Rico.

CAPG members provide comprehensive healthcare through coordinated and accountable physician group practices. We strongly believe that patient-centered, coordinated, and accountable care offers the highest quality, most efficient delivery mechanism, and greatest value for patients. CAPG members have successfully operated under this budget-responsible model for more than two decades.

 


 

How CAPG Supports its Members

Advocacy
CAPG’s government affairs teams in Washington, DC, and Sacramento keep abreast of federal and state policy and legislation issues and ensure that physician organizations have a voice.

News and Information
We keep members informed on today’s healthcare issues via email updates, committee and regional meetings, CAPG Health magazine, special reports, and surveys.

Programs
We offer a variety of educational and enhancement programs designed to help physician organizations succeed in all aspects of capitated, coordinated care.

  • Committees and Regional Meetings: Topics range from healthcare financing, management, contracting and pharmacy to the organized delivery model, clinical integration, credentialing, and peer review.
  • CAPG Educational Series 2016:
  • National Standards of Excellence™:
  • Practice Transformation:
  • CAPG Consulting:

Conferences

  • The CAPG Annual Conference features industry leaders speaking on the latest issues concerning physician groups providing coordinated, capitated care.
  • The CAPG Colloquium, held in Washington, DC, convenes industry-wide stakeholders to focus more specifically on federal policy and alternative payment models in Traditional Medicare, Medicare Advantage, and other programs.

Access to industry leaders. Our membership and alliances allow our physician organizations the ability to discuss practice management issues with thought leaders from all sectors.

Networking. The ability to share and discuss information and relevant topics with influential professionals and peers provides invaluable support for physician organizations striving to improve healthcare delivery.

Medicare Quality Payment Program MACRA Overview

MACRA 2017 Update:

Practices NOT participating with Signature Partners’ Medicare Shared Savings Program must designate how they intend to report MIPS data to CMS by June 30, 2017

Medicare Quality Payment Program & Medicare Access & CHIP Reauthorization Act of 2015 Overview

  • The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently repealed the Medicare Sustainable Growth Rate (SGR). The SGR tied the Medicare Physician Fee Schedule (PFS) to Gross Domestic Product (GDP); cuts to the PFS were predicted to be as high as 21%.
  • All physicians (MD, DO, doctor of dental medicine or surgery, podiatry, optometry and chiropractors), nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists (future MACRA rule-making may include speech language pathologists, physical or occupational therapists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dieticians) that bill Fee for Service (FFS) Medicare are subject to MACRA*.

*Three Exclusions may apply: (1) this is the provider’s FIRST year billing Part B Medicare, (2) the provider billed LESS than $30,000 in Part B charges in the year, or (3) the provider billed services for FEWER than 100 FFS Medicare patients in the year.

  • Providers must decide before June 30th on how they intend to participate in the Quality Payment Program (QPP). MACRA designates two separate Medicare payment paths in the QPP (qpp.cms.gov):
    1. The Merit Based Incentive Payment System (MIPS) and
    2. Alternative Payment Models (APMs)

The QPP stays budget neutral by paying the high performing clinicians’ positive adjustments and bonuses with the low performing clinicians’ negative adjustments.

  • 2017 is the first performance year in the QPP. Providers will submit data in 1Q2018 from 2017, CMS will report back 2017 performance results in 3Q2018, and the corresponding financial adjustment will begin on 1/1/2019.

Which Path is Right for You?

Are you on an EHR? If so, your vendor can facilitate individual and group MIPS reporting.

Are you a part of an APM? Or more precisely, is the tax identification number (TIN) that you bill your Medicare Part B claims through a participant in an APM? If so, consult with your APM to better understand your reporting obligations.


MIPS

  • Nominal financial risk
  • Positive or negative adjustments applied to payments up to +/- 4% in 2019 to 9% in 2025 and beyond (high-achievers also earn additional bonuses).
  • 25% update to the PFS annually (2026)
  • Providers report individually or as a group (defined by TIN)
    • Quality (formally PQRS)
    • Resource Use (formally VBPM)
    • Improvement Activities (new)
    • Advancing Care Information (formally Meaningful Use/EHR Incentive Program).
  • Providers earn points in each category listed above; the categories are weighted and used to calculate a MIPS Composite Performance Score (CPS).
    • The CPS is applied to a Performance Threshold that is calculated annually using the scores of all eligible clinicians.
    • Providers in the bottom quartile will automatically receive the maximum negative adjustment that applies in the period, while those earning scores above the performance threshold will receive positive adjustments and potential bonuses.

APMs

  • Advanced APMs incur financial risk and are obligated to repay CMS according to their program design when they spend beyond the expected cost of care benchmark
    • Advanced APMs must meet a threshold of patients or payments associated to the program e.g., amount of billing from attributed beneficiaries
    • Other APMs (not deemed Advanced) will fall into the MIPS payment path
  • Advanced APMs receive 5% lump sum bonuses
  • 75% update to the PFS annually (2026)
  • Providers report according to the requirements of APM participation (check with your APM)
    • Track One MSSP ACOs report through the GPRO web interface, but, certain data must be reported through each participants’ EHR
  • When an APM falls into the MIPS payment path, each participating TIN in the APM will receive a MIPS Composite Performance Score (CPS).
  • The APM’s TINs’ scores are weighted by the number of providers in each TIN and averaged to derive one score for all of the providers in the APM that is then applied to the Performance Threshold.

The Quality Payment Program applies to all Medicare Part B services and future Physician Fee Schedule (PFS) Updates impacting services rendered in physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities, hospices, outpatient dialysis facilities, clinical laboratories, beneficiaries’ homes including observation stays, office visits, surgical procedures, anesthesia services, and other diagnostic and therapeutic services.

  • PFS annual updates under MACRA depend on the payment track that the provider/tax id falls into for the payment year: after 2026 (MIPS = +0.25% and advanced APMs = +0.75%), 2017-2019 PFS updates projected to be +0.5%, and 2020-2025 no projected change.
  • PFS payment rate formula continues to apply:

[wRVU x wGPCI + peRVU x peGPCI + mpRVU x mpGPCI] x CF = payment

CF (2017 = $35.89)

wRVU = Work Relative Value Unit which the time and intensity associated with the service

peRVU = Practice Relative Value Unit reflects the cost of maintaining a practice/overhead

mpRVU = Malpractice Relative Value Unit reflects the cost of malpractice insurance

GPCI = Geographic Practice Cost Indices, each RVU component is modified by geography

Advanced APMs

In order for the advanced APM participant to receive bonuses through 2026, and 0.75% PFS updates thereafter, Eligible Clinicians within the Advanced APM must COLLECTIVELY meet payment OR patient count thresholds.

When an advanced APM does not meet either the payment or patient count threshold, they will fall back into the MIPS payment structure. This determination will be made in the year following the performance year (and prior to the payment year) e.g., 2018, for performance year 2017/payment year 2019.

MIPS and the Performance Threshold

  • The Performance Threshold calculation is the key to the program’s budget neutrality. Each entity, be it an individual physician, group practice (defined by TIN), or APM (non-qualifying or non-risk bearing), will receive a MIPS Composite Score (CPS) calculated by the point values obtained in the 4 performance categories (Quality, Cost, Improvement Activities, and Advancing Care Information). CMS calculates the Performance Threshold annually, applies each entity’s CPS, and assigns the financial adjustment for the payment year.

SNFist Services Now Available!

Signature Partners has contracted with two physician groups, Mount Vernon Internal Medicine and Virginia Internal Medicine, to provide SNFist services throughout the skilled nursing and rehabilitation centers (SNFs) in Northern Virginia. These physician groups will enable Signature Partners to establish collaborative partnerships with SNFs to drive quality outcomes, improve patient experience and ensure smooth transitions from hospital to home.

The SNFs that we are currently contracted with are:

  • Inova Loudoun Nursing and Rehabilitation
  • Woodbine Rehabilitation and Health Center (Mount Vernon Internal Medicine/Virginia Internal Medicine)
  • ILiff Nursing and Rehabilitation (Virginia Internal Medicine)
  • Manor Care Alexandria and Arlington (Mount Vernon Internal Medicine)
  • Fairfax Nursing and Rehabilitation (Virginia Internal Medicine)
  • Mount Vernon Nursing and Rehabilitation

If you have any questions about this initiative, please email Elissa Clark at elissa.clark@inova.org.

Aetna Medicare Advantage Collaborative

Signature Partners has entered into an ACO Collaborative with Aetna Medicare Advantage in which Signature Providers will have the opportunity to receive additional payments for the care they provide to their attributed MA beneficiaries. These additional payments include payments for care coordination and closing gaps in care, completing the Patient Assessment Forms (PAFs), and PMPM payments for achieving quality targets.  This value-based program will result in improved quality and efficiency for the MA beneficiaries attributed to our providers.

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