html5-img
1 / 11

The Business Case for Hiring Staff to Support QI/Research in Our Practice

The Business Case for Hiring Staff to Support QI/Research in Our Practice. 2014 PPRNet Annual Meeting August 23, 2014 Oscar F. Lovelace Jr., MD. Agenda. Quality Improvement Research Return on Investment Medicare 2015 CCM CCM Reimbursement. QI/Research.

justin
Download Presentation

The Business Case for Hiring Staff to Support QI/Research in Our Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Business Case for Hiring Staff to Support QI/Research in Our Practice 2014 PPRNet Annual Meeting August 23, 2014 Oscar F. Lovelace Jr., MD

  2. Agenda • Quality Improvement • Research • Return on Investment • Medicare 2015 CCM • CCM Reimbursement

  3. QI/Research Pay for Performance is here to stay • PQRS (Physician Quality Reporting System) • NCQA (National Committee for Quality Assurance) • PCMH (Patient Centered Medical Home) • ACO (Accountable Care Organizations) • MU (Meaningful Use) If we care about quality, we need process & metrics. How much time is available at the end of the day?

  4. Research Need for more community based research • Data drives process improvement – PPRNet • Increase in practice / university affiliation • AHRQ more focused on primary care research Future offers practice level research opportunities • ACOs will require outcomes research • Self funded health plans for independent practices

  5. QI/Research The QI/Research professional • An office champion • A part-time employee • A full time employee in a group practice • A department within a larger organization

  6. QI – Return on Investment • PQRS $ 5,000 • PCMH $ 18,000 • NCQA /BCBS $ 26,000 • CCI $ 38,000 • Meaningful Use $ 95,000 Since 2011

  7. Medicare 2015Chronic Care Management • Services are designed to pay separately for non-face-to-face coordination of care • New G-Code for Traditional Medicare Patients • Payment will be $41.97 per patient per month - Patient responsibility is 20% of this fee = $8.28 • Will reimburse one physician within 30-day period

  8. Chronic Care Management Patients must: • Have 2 or more chronic health conditions, expected to: • last at least 12 months or until death • place the patient at risk of death, acute exacerbation or functional decline • Be informed of the program • Sign a consent form

  9. Chronic Care Management Providers must: • Ensure patients have had (within the past year) either an: • AWV (Annual Wellness Visit) or • IPPE (Initial Preventive Physical Examination) • Document a minimum of 20-minutes of clinical labor time for non-face-to-face interaction • Offer patients access to care 24/7 • Use an EMR that meets HHS certification for MU

  10. CCM Reimbursement 100 patients x 12 months x $42 = $ 50,400 300 patients x 12 months x $42 = $151,200 1000 patients x 12 months x $42=$504,000

  11. Conclusion • Payment transition from encounter to quality based • Benefits of investing in QI / Research staff • Additional funding may offset personnel expenses • Thinking ahead keeps us from being left behind!

More Related