Provider Reimbursement Rate Tables KEY - A CR Rate Change ...
Provider Reimbursement Strategies for 2014
-
Upload
fraser-trebilcock-lawyers -
Category
Health & Medicine
-
view
444 -
download
2
description
Transcript of Provider Reimbursement Strategies for 2014
![Page 1: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/1.jpg)
PROVIDER REIMBURSEMENT STRATEGIES FOR 2014 Michael P. James, J.D., M.B.A., CSSGB
Phone: (517) 377-0823 (313) 965-9038
Email: [email protected]
www.linkedin.com/in/MichaelJamesLaw
Fraser Trebilcock Davis & Dunlap, P.C.One Woodward Avenue, Suite 1550Detroit, Michigan 48226www.fraserlawfirm.comPhone: (313) 237-7300Fax: (313) 961-1651
Fraser Trebilcock Davis & Dunlap, P.C.124 W. Allegan Street, Suite 1000Lansing, Michigan 48933www.fraserlawfirm.comPhone: (517) 482-5800Fax: (517) 482-0887
© 2013 Fraser Trebilcock Davis & Dunlap, P.C.
![Page 2: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/2.jpg)
Shifting Landscapes Under Health Care Reform
![Page 3: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/3.jpg)
Physician Landscape
Accenture predictive modeling. Accessed 12/3/13.http://www.accenture.com/us-en/outlook/Pages/outlook-online-2011-adapting-new-model-physician-employment.aspx
![Page 4: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/4.jpg)
Reimbursement Landscape
National Health Expen-ditures
Gov-ern-mentPrivate
National Health Expen-ditures
Gov-ern-mentPrivate
64.5% 35.5% 55% 45%
2000 2011
Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/tables.pdfAccessed 12/3/13. (see Historical; NHE Web tables, Table 5).
![Page 5: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/5.jpg)
Evolving Reimbursement Models under HCR Fee-for-Service Bundled Payments/Episode of Care Payments Partial or Full Capitation Care Management Fees Shared Savings
One-Sided Two-Sided
Reimbursement Landscape
![Page 6: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/6.jpg)
Riding the Wave of Change
How do you address these shifting landscapes to continue to drive profits?
![Page 7: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/7.jpg)
Medicare Shared Savings Program (MSSP)
MSSP designed to improve beneficiary outcomes and increase value of care by promoting: Accountability for patient population; Coordination of care for services; Investment in infrastructure; and Redesign of care processes.
![Page 8: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/8.jpg)
ACOs are the vehicles through which providers/suppliers participate in the MSSP. A legal entity designed to manage and coordinate care
for Medicare fee-for-service beneficiaries under the MSSP.
What Are ACOs?
![Page 9: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/9.jpg)
Fundamental Principles of ACOs
Improve Care for Beneficia
ries
Enhance Health in its Population
Reduce Growth of Beneficia
ry Expendit
ures
What Are ACOs?
![Page 10: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/10.jpg)
Types of ACOs
Integrated Delivery System Model ACO
CMS
Health System ACO
Hospital Physicians
Skilled Nursing Facility
Etc.
![Page 11: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/11.jpg)
PHO Model ACO
PHO ACOHospital
Independent
Practice Assn.
CMS
Types of ACOs
![Page 12: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/12.jpg)
Independent Practice Association Model ACO
IPA ACO
CMS
Physician
Physician
Physician
Physician
Types of ACOs
![Page 13: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/13.jpg)
Group Practice Model ACO
Group Practi
ce ACO
CMS
Specialists
Hospital
Types of ACOs
![Page 14: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/14.jpg)
5% of Members = 45% of costs15% of Members = 35% of costs
80% of Members = 20% of costs
ACO Membership
![Page 15: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/15.jpg)
Predictive Modeling for Last 2 Years of Life: Medical homes Home Calls Care Plans Navigators ER / Hospital Hospice
Multiple Chronic Diseases: Medical Home Care Plans Team Care Navigator ER / Hospital
Utilization Management
![Page 16: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/16.jpg)
Chronic Disease: Medical Home Care Plans Team Care ER / Hospital
All Others: Medical Contact & Education Care Plans ER / Hospital
Utilization Management
![Page 17: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/17.jpg)
Insurance License. Claims Processing. Alignment of Fee Structures. Incentive to Move from Volume to Value. Quality Monitoring Systems.
Payment Evolution
![Page 18: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/18.jpg)
Culture of Restructuring
More Patients in
System
Reduce
Capacity of
System
Risk Sharing
![Page 19: Provider Reimbursement Strategies for 2014](https://reader033.fdocuments.in/reader033/viewer/2022061205/5480c3075806b5c9108b45b2/html5/thumbnails/19.jpg)
Fraser Trebilcock Davis & Dunlap, P.C.124 W. Allegan Street, Suite 1000Lansing, Michigan 48933www.fraserlawfirm.comPhone: (517) 482-5800Fax: (517) 482-0887
Fraser Trebilcock Davis & Dunlap, P.C.One Woodward Avenue, Suite 1550Detroit, Michigan 48226www.fraserlawfirm.comPhone: (313) 237-7300Fax: (313) 961-1651
Michael P. James, JD, MBA, CSSGB
Phone: (517) 377-0823 (313) 237-7300
Email: [email protected]
www.linkedin.com/in/MichaelJamesLaw
© 2013 Fraser Trebilcock Davis & Dunlap, P.C.
Fraser Trebilcock Health Care Reform
www.mihealthcarelaws.com