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Capitation with gain-shar-ing—Improving outcomes

and increasing value—Revisit-ing integrated delivery tactics among primary care physi-cians, specialists, and hospi-tals—Bending the health care cost curve for managed popula-tions—Whatever your defini-tion (in whole or in part) may be, Accountable Care Organiza-tions (ACOs) pose a strategic opportunity for hospitals and large physician practices alike. If ACOs can overcome concerns from a Stark and anti-trust

Accountable Care + Patient Experience = Accountable Experience

By Tina MinnickDirector of Business Development, TeamHealth Medical Call Center, (THMCC)

perspective and are success-fully implemented, patients and ACO market leaders will see stronger physician alignment, improved quality, cost reduc-tion, and an improved patient experience.

What is and who will drive the ACO movement?The Medicare Shared Savings Program in the 2010 Patient Protection and Affordable Care Act broadly defined the ACO concept to include the many health care organizations across

the country. While the organi-zational structure of an ACO is loosely defined, it does require that primary care physicians be a component. The ACO pilot program looks to work with Medicare populations begin-ning in January 2012, and health care observers agree that commercial payers will follow the Medicare lead.

The goal of the ACO movement is that provider organizations be accountable for the value of a population’s health care costs. See Accountable Care on page 7

Doing so “will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.” (Orszag PR, Emanuel Ej. “Health care reform and cost control.” New England Journal Medicine 2010; 363:601-3). The real bottom line is that the U.S. cannot continue the current approach with health care deliv-ery. Analysts predict health care will be one fifth of our nation’s gross domestic product (GDP)

BusinEss OPErAtiOns

January-March �011 Page �

by 2019, and ACOs are part of the prescription to impact cost and quality. Coordinated care that provides value and reduces cost will become the standard. ACOs will be looked upon as major drivers of reducing the health care cost curve.

Both hospitals and large physi-cian groups are prime leaders for the ACO movement. Growing market share will be key for hospitals, and a strategy focused on retaining and gaining new patients will be needed to off-set lower utilization. Hospitals should “focus on retaining cases from the population that previously had been ending up in different hospitals, despite

having been treated by the hospital’s primary care physi-cians.” (John M. Harris, Daniel M. Grauman, Rashi Hemnani. “Solving the ACO Conun-drum.” hfm Magazine, Novem-ber, 2010; page 69).

Large physician practices are also likely to want to lead ACO efforts. Physicians often self-re-fer, and the thought of obtain-ing additional “gain-sharing” funds by reducing hospitals’ census could be a motivating factor. Whether a large primary care group forms their own ACO or remains as an affiliated hospital partner, hospitals could see volume shift as primary care physicians choose alignment

patterns. Domination of the market will occur by those who act and succeed first.

Critical Success Factors for ACOs: Dominating Market Share and the Patient ExperienceMarket share is the percentage of total sales volume in a market captured by a brand, product, or firm—in this case, by your practice or hospital. The patient experience will drive brand loyalty, repeat patient visits, and new business to you.

Thinking about market share in health care can sometimes be difficult because many of us may think “once a patient always a patient” or that we are the only game in town with regard to a particular service line or insurance type needed by the patient. In the past, these thoughts may have held up, but with transparency and patients’ options such as telemedicine or going for care outside of your service area, your hospital’s or group’s niche, appeal, and repu-tation need to be top of mind.

ACOs clearly have to develop business plans for service area, target market, reimbursement, information technology (IT), quality, providers and orga-nizational structure. Each of these areas stand on its own as a major strategic decision, and execution of these plans will determine an ACO’s success. Independent of these compo-nents, the fact is that ACOs are designed to increase value and decrease costs, and it is impera-tive that market share and the patient experience be critical success factors in your plans to grow and/or maintain revenue

before, during, and after the ACO implementation.

Where to begin and what to do may feel like difficult next steps. Listed below are ten questions that can help you gain insight into what your current experi-ence feels like and where to capitalize on market share.

(1) What are patients specifi-cally saying about commu-nication to and from their doctors and nurses?

(2) How are you responding to patients’ comments, whether they are good, bad, or indifferent?

(3) What reporting is available to help you gain an understanding of your patient experience?

(4) Would your patients recommend you to friends and family?

(5) How are you capturing potential patient inquiries in the community?

(6) How are you serving your community to grow awareness?

(7) How are you managing unnecessary processes in a crowded and busy emer-gency department?

(8) How consistent is your patient follow-up for both patient experience and quality care?

(9) What tools are available to promote work/life balance for your physicians?

(10) What risk management strategies are in place to document after-hours patient interaction and provide peace of mind for your employed physicians?

Accountable Care from page 6 BusinEss OPErAtiOns

See Accountable Care on page 8

Page � Pennsylvania MGMA

While most acknowledge the importance of strategic

planning, many people see stra-tegic planning as akin to going to the dentist office. It is just not always approached with enthu-siasm—you may even be one of those people. Unfortunately, a large body of evidence supports the importance of strategic plan-ning, or more appropriately stra-tegic management, for the suc-cess of any business. For medical practices, the pace of change makes it imperative that you can quickly adapt to changes in the short term and keep your team focused on the long term vision of a desired future. As healthcare delivery continues to change and functionalize at all levels, clini-cal and non-clinical staff will

Achieving shared Vision

By Kent E. FreseManaging Director, Leadership Management Institute

See Vision on page 10

need to learn to be more effective at working together as a team. This transition can be stressful and, unfortunately, often falls on the practice manager to shep-herd the change with reluctant physicians and intimidated staff. Without a coherent strategy and a process to follow through, change becomes a painful, high stress process that sometimes feels like one step forward and two steps backwards. So what is a manager to do?

Good strategic planning and management includes several key elements that you can incorpo-rate into your process to improve physician and staff buy-in. Ac-cording to social psychologist Jay Hall, a good process involves

the use of the 4 C’s of Group Effectiveness: (1) commitment, (2) conflict, (3) creativity and (4) consensus. Importantly, Hall’s research showed that all four steps are important, as is the or-der of the four steps.

The first “C” in this approach involves using collaborative ap-proach to create commitment and feelings of ownership among key staff members and eventually all staff members. It is criti-cal that any successful process develops employee feelings of understanding and buy-in to your organizational values and mission. For teams that are not used to getting involved, espe-cially with core issues like values, mission and strategy, it may take

some patience and persistence to get traction from everyone. The development of commitment means that the team cares about the values, mission and vision of your practice. Improvement in this area requires a manager to ensure that everyone has a voice in the process—that includes both physicians and administra-tive staff.

Unfortunately, collaboration and commitment can have a side effect that causes managers to surrender and this next “C” is conflict. When people engage and care, divergent opinions will inevitably emerge and our natural instincts sometimes

OrgAnizAtiOnAl gOVErnEnCE

Building support for strategic planning within your practice

January-March �011 Page 11

By Gregory J. Kuntz, FACHEOwner and Principal, BTA Consulting

Usually, the message you hear from Medicare is how

they are under unrelenting pres-sure from all corners to reduce cost. All too often, practice leaders hear that CMS has just cut payment somewhere, a CPT code was just bundled, or there’s an old program that was never quite resolved(remember SGR?). Over time, this is going to re-duce payments significantly.

Every provider talks about qual-ity, and every practice boasts that it has a quality program, but the benefits of these pro-grams are often difficult to articulate. Automated systems such as an EMR or electronic prescribing will drive out variation and standardize your processes. You can calculate a financial benefit from increased efficiency, but there are also ways to get paid for quality. Many practices are already do-ing many of the things that are necessary to qualify, and often, it’s a matter of taking credit for what you’re already doing.

CMS has had two programs that reward practices for qual-ity activities. The Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx)

See Benefits on page 12

incentive program have been in place since 2008. In 2009 and 2010, they provided an incen-tive payment equal to two per cent of an eligible provider’s total part B allowable charges for reporting quality activities. For example, if a provider billed $100,000 in part B charges in a given year, the program would provide an incentive payment of $2000 for PQRI, and another $2000 for eRx.

Many providers think they need an EHR in use to qualify. While an EHR can make your participation a lot easier, it’s not a necessity. Both programs have multiple methods to qualify for payment, as well as a number of

ways to report your participa-tion. Some Vendors offer prod-ucts that don’t require a large expenditure on software and systems to get started. Incentive programs are here to stay, and will start to penalize providers that don’t participate. Some start next year.

PQRS: The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system, and included an incentive payment program for providers who reported data on quality mea-sures for professional services provided to Medicare beneficia-ries. This program was further

modified in 2007, 2008, and once again in 2010. Successful participation qualified a prac-tice for an incentive payment in addition to their Medicare allowable charges.

In 2011, the program was re-named Physician Quality Re-porting System (PQRS), and now includes 190 individual quality measures, and 14 mea-sures groups. A practice can qualify by reporting individual measures or measures groups via claims, by using a quali-fied registry, or via their EHR. Each reporting method has its advantages, disadvantages, and associated costs.

the Benefits of a Quality Program in your Practice

QuAlity MAnAgEMEnt

Reporting Method Advantage Disadvantage

Claims Simple Method---G codes are added to claims submissions

50% reporting level. Difficult to retrieve reports from CMS to confirm timely submission.

Registry Can report for as few as 30 patients for measures groups. Registry will validate data for completeness and provide proof of submission

Cost--typically priced per provider. Many specialties are unable to fit in measures groups due to volumes of diagnoses or procedures in numerator group.

EHR Direct data interchange High reporting threshold—80%. Requires an operational EHR.

January-March �011 Page 13

UpcomingEVENTS

The Pennsylvania Medical Group Management Association [PA MGMA] provides a comprehensive educational program in

conjunction with the Body of Knowledge and the eight learning domains as published by the American College of Medical Practice Executives, ACMPE.

Program Description

The Regional Practice Management Forum includes one-half hour of networking and two hours of presentation.

The Webinar is one and a quarter hours. Participants must have access to the Internet. Registration must be received by noon no later than two days prior to the telecast.

LocationThe Regional Practice Management Forum rotates around the state based on an odd/even year schedule as follows:

Month Odd Year Even Year January Harrisburg Lancaster March Scranton Bethlehem June Erie Pittsburgh August Lewisburg State College November King of Prussia King of Prussia

The State Conference is held in May in Philadelphia.

Continuing Education UnitsEach Forum, conference and webinar is approved for continuing education units as awarded by the ACMPE, American College of Medical Practice Executives. Registration and Other InformationRegistration for all of our programs is required. Pennsylvania MGMA members can attend the Regional Practice Management Forum and participate in our Webinars [free of charge]. Nonmembers are welcome; there is a nominal fee of $30. The State Conference requires a registration fee; Pennsylvania MGMA members receive a discounted rate. Please visit our online calendar for program content and changes. n

March 25, 2011Regional Practice Management Forum8:00 a.m. – 10:30 a.m.Hospice of the Sacred HeartMoosic, PAFeature Topic: Accountable Care Organizations April 2011Webinar May 5 & 6, 2011State ConferenceCity Avenue Hilton HotelPhiladelphia, PA“Jazz it up! How to Reinvent Yourself and Your Practice” June 2011June 24, 2011Regional Practice Management Forum8:00 a.m. – 10:30 a.m.Erie, PA

July 2011Webinar August 19, 2011Regional Practice Management Forum8:00 a.m. – 10:30 a.m.Lewisburg, PA September 16, 2011Regional Practice Management Workshop8:00 a.m. – 11:30 a.m.Cranberry, PA October 2011Webinar November 2011Regional Practice Management ForumKing of Prussia

Program Listing

January-March �011 Page 14

ExpertaSk ThE FinAnCiAl MAnAgEMEnt

QUEStIOn: What is the implementation date for this new requirement?

AnSWER: A provision in the health care reform legislation imposes new nondiscrimination standards on employer-provided group medical insurance plans. The provision prohibits “highly compensated” company executives or shareholders from receiving better health care benefits than “rank and file” employees – with very harsh penalties for violations (nondeductible excise tax of $100 per employee per day).

Now the IRS has postponed implementation of this requirement, taking pressure off for the short term. The provision did not clearly define what represents discriminatory benefits in a group health insurance arrangement, so the IRS will reconvene to better clarify and provide administrative guidance in applying the rule. Once that guidance is issued, group health plan sponsors will be given additional time to adjust their coverage benefits and comply. Originally, the provision was to apply to new plans created after September 2010.

“This is much needed relief,” notes Kelly Davis, benefits manager with LarsonAllen. “Based on the IRS Notice, we expect it will be many months before they issue regulations applying this nondiscrimination requirement. And once those are issued, it will likely be at least another year before they go into effect, with compliance on a prospective basis rather than retroactively applied to prior plan years.”

The IRS has reopened the taxpayer comment period while it irons out the uncertainties in this Congressional mandate. You can send your comments to the IRS on this particular provision through March 11, 2011.

Kelly and Anita can be reached at 480-615-2300.

irs Delays new nondiscrimination rules for group Health PlansKelly Davis, Manager LarsonAllen LLP CPA’s, Consultants & Advisors

Anita Baker, Principal with LarsonAllen LLP CPA’s, Consultants & Advisors

January-March �011 Page 1�

Each individual is motivated in different ways and each situation requires motivation to achieve a different result. Perhaps one individual needs to be motivated just to

get through each day being a productive employee but yet another needs motivation to continue trying to be a star performer and reaching new heights with every new project. This requires us as managers to learn what motivates each individual. In these difficult economic times, cash incentives are not always possible and not always the answer. Some people are motivated by recognition. This can be something as simple as being singled out during a staff meeting or given a special parking spot for the week or month. Others like the idea of working toward a goal and a specified prize for reaching that goal. One example is using coupons from vendors. I have accumulated these “prizes” and then used them during quarterly staff meetings. Employees can earn points during the quarter for different milestones achieved. Think outside the box. Perhaps a certain amount of points for perfect attendance, for positive patient and staff comments on behavior, finishing a project on time or early, developing a new process that improves efficiency, etc. This can involve the staff during the entire quarter and keep them engaged in the competition. The staff member with the most points gets first choice of the prizes available and so on down the line. If you don’t have prizes available you could use other motivators such as a day to come in late or leave early, a day to take a longer lunch or park in a prime parking spot. Sometimes an entire department or team of staff members can be motivated to complete a project and be given a group reward.

The important thing to remember is that everyone is motivated differently. It doesn’t always take a large amount of money to motivate individuals or teams to achieve goals. Think outside the box and customize your incentive to motivate each individual.

traci L. Evans, CMPE, Director of Surgical Specialties, Mount Nittany Physician Group, State College, PA

The staff of this practice is offered significant ongoing education in the field of ophthalmology. We have a learning organization where inquiries and answers are encouraged through all departments and all levels of the corporation. Continuing certificate retention educa-

tion credits may be obtained with no cost to the employee. Representatives from pharmaceutical companies are afforded the opportunity to educate staff members at luncheons. Every staff meeting includes an education component. “Perks” may be retained by Opticianry staff members. Exceptional performance may be rewarded with movie tickets or a gift certificate for not more than $25.00. Each employee is given a small monetary incentive should they volunteer to work on a Saturday. It is rare to give bonuses to staff members however; rewards may be given for the performance of a single outstanding project. Bonuses have also been given for perfection on audits or inspections. Fi-nally, a simple thank you goes a long way. Public acknowledgement of a job well done is the single most important staff motivator.

April Butts, Administrator, Premier Eye Care Group, Inc., Harrisburg, PA

I find that motivating, rewarding, and incentivizing our employees is one of the most challenging parts of my job as well as one of the most satisfying. I recognize that everybody has their monthly bills that need to be paid and compensation is probably the leading driver

for most employees; however, it is not the only factor that drives employees. Work satisfaction plays an integral part as well. From the top of the organization to the bottom, each employee needs to take ownership and feel that their efforts are contributing to the success of the organization. Each employee should be encouraged to think of creative and innovative ways to make the organization run more efficiently. If their new idea is implemented in the organization then they should be acknowledged in some capacity such as an announcement sent to fellow co-workers announcing the new idea. Not only does the organization benefit from the idea but the employee feels proud of their accomplishment and the co-workers become motivated to come up with the next great idea. Since employees need to feel that they can express themselves, all supervisors/managers should make a conscious effort to listen and keep an open line of communication with their staff on a regular basis. If the supervisor/manager promises to get back to an employee within a certain time period then they must keep their promise. There’s nothing worse for an employee than when their supervisor’s/manager’s promise goes unfulfilled. Employees are the most valuable asset of any organization and need to be treated with respect and reverence.

Adam Cooper, MBA, Business Manager, Allergic Disease Associates, PC Philadelphia, PA

Peer Peer2

How do we effectively motivate/reward/incentivize our staff?

January-March �011 Page 18

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