Humana finally settled up for nearly all of 2013 – the initial period of the new pay for performance contract.
The good news is all practices in that Humana contract have earned a bonus payment. Each practice that
helped us meet quality metrics and achieved cost savings by having less than a 85% medical loss ratio on
their Humana attributed patients received their pro rata share of those bonuses.
Humana finally settled up for nearly all of 2013 – the initial period of the new pay for performance contract.
HPI is pleased to announce an agreement reached with MTBC (Medical Transcription Billing Corporation) for provision
of EHR and billing services. MTBC is a Deloitte Technology Fast 500 (2009, 2010, 2011, 2012) and has been recognized
by Inc. 500 as one of the fastest growing companies. They are a Microsoft certified partner and have need awarded the
Surescripts White Coat of Quality
Through the agreement with HPI, MTBC has agreed to offer their proprietary Meaningful Use Stage 2 ONC-ACTB certified
EHR at a special rate to HPI members of $500 one time only start up fee and then a $165 per provider per month
rate for as long as you stay on the EHR. There is no yearly fee, no license to buy. If at any time the practice decides to stop using the service, they charge no fee for standard data files in C-CDA format to switch to a new system. They also offer their HISP DataMotion at no charge for use.
The other added benefits include:
ONC-ATCB certified web based HER
Meaningful Use Coaching
Customizable specialty specific templates
mHealth applications (iRx, iPHR, iCheckin)
Patient health records via the online patient portal
Specialty specific EHR for Podiatry, OB/GYN, Internal Medicine and other specialties
24/7 technical support
Assisted payer enrollment and ERA/EFT Setups
Clinical and Business analytis
Proprietary continuously updated rules-based scrubbing engine
Real-time claims adjudication
Unlimited 24 hour claims submission (including secondary and tertiary payers)
Electronic patient statements
Automated appointment reminder calls
From the research performed by HPI, this can be a system that can meet the needs of providers and our network for
many years to come. Since it is web based, it can run on any computer or tablet device with access to the internet. Updates to the programs are done on a regular basis. For additional information, please contact Jane Berke @ 423-392-
By Amy Schatz Dec. 9, 2013 7:35 p.m. ET
WASHINGTON—An annual push by doctors to delay cuts to Medicare patient fees is afoot, but this time the prognosis is better for a permanent solution to the long-festering problem.
The Senate Finance Committee is scheduled to vote Thursday on “doc fix” legislation that would permanently change how Medicare providers are paid by the government for their services. Similar legislation was unanimously passed by the House Energy and Commerce Committee in July.
Lawmakers and analysts say fatigue over dealing with the “doc fix” nearly every year for the past decade is driving the current bipartisan effort to resolve the issue.
An unexpected cut in the estimated cost of addressing the problem also has played a major role: On Friday, the Congressional Budget Office lowered its projection for the expense of repealing the current system to $116 billion over a decade, down from previous estimates that topped $300 billion at one point.
“From a budgetary standpoint, it’s easier now to fix it than it used to be,” said Mark McClellan, a senior fellow at the Brookings Institution think tank who ran the Centers for Medicare and Medicaid Services during the George W. Bush administration. “To spend all of this time and effort every year to just tread water in place is by no means the best use of everyone’s time and effort.”
The problem dates to a congressional measure in 1997 aimed at restraining the growth of Medicare payments. That law cut reimbursement rates through a formula that tied payment increases to growth in the economy. But health-care costs rose faster than the economy, and Congress has consistently acted to override the cuts that the 1997 measure prescribed.
This year brings a familiar deadline: If Congress does nothing by Dec. 31, Medicare reimbursement rates would drop about 24% in January. That is because the annual payment reductions the 1997 law envisioned never took place due to stopgap measures Congress passed.
The Health Law Rollout
Doctors say such a drastic cut would make it harder to care for these patients, potentially leaving some seniors in the lurch.
Because lawmakers are soon set to recess for Christmas, most observers expect them to pass another short-term fix this month. But they say the new CBO projection offers promise for a permanent fix in 2014.
Doctors are tired of the annual uncertainty about Medicare payments, said Ardis Dee Hoven, a Lexington, Ky., doctor who is president of the American Medical Association. “We think the momentum is there for them to do it,” Dr. Hoven said.
The current system has left seniors and physicians “hamstrung by short-term patches instead of the certainty of a permanent solution,” House Ways and Means Chairman Dave Camp (R., Mich.) said last week.
Most proposals for a fix aim to prod doctors to save money for Medicare, which traditionally has allowed physicians to earn more by performing more procedures regardless of patient outcomes.
The Senate proposal, written with the help of House Ways and Means members, would freeze current Medicare rates over the next decade, but give extra payments to doctors who meet certain performance measures.
The AMA and other doctor groups say they agree with the idea of giving incentives to physicians who provide better care, but don’t think base rates should be frozen. The House Energy and Commerce bill would provide small annual increases, along with performance incentives.
The 2010 Affordable Care Act, also known as Obamacare, already includes some measures that tie Medicare reimbursement to performance, such as punishing hospitals that have excessive patient readmissions.
But these cost-saving measures aren’t expected to pay the entire price of a “doc fix.” No consensus plan for that has yet emerged.
Two years ago, the Medicare Payment Advisory Committee, a congressional group, released a list of potential cuts to fund the “doc fix,” including reducing the amount the government pays drug makers for prescription drugs for people who are eligible for both Medicare and Medicaid, the federal health program for lower-income people. The drug industry has opposed the idea.
On the policy side, “we have a pretty good idea of what people on both sides can accept,” said Rep. Michael Burgess (R., Texas), an obstetrician who helped write the House Energy and Commerce bill. But paying for it “becomes more problematic.”
This Article Originally appeared in the Wall Street Journal Dated Tuesday December 10th, 2013, and can be seen online HERE (Subscription Required).
To any provider office that needs them, the 2014 Drug Formularies for Our Humana contracts are posted in the Office Manager Portal under Office Manager Materials. The portal is linked below for your convenience. If you cannot remember your password or have never set up an account give Joshua Lyons a call at (423) 392-1920.
Linked below are copies of presentations similar to the ones presented at HPI’s April 16th, 2014 Symposium by Teresa Breen from The Advisory Board Company.
The ability of healthcare providers to communicate quickly and accurately across the gaps between different companies and platforms in the Tri-Cities took a major step forward last month as Mountain States Health Alliance joined the OnePartner Health Information Exchange (HIE). The exchange acts as a universal translator and information storage center and clearinghouse for the disparate electronic medical records systems utilized by various physicians’ groups, lab facilities, and now hospitals in the region.
Mountain States has a common electronic medical record system across all 14 of its hospitals in Northeast Tennessee and Southwest Virginia. Now that system can be linked to the systems of other providers with whom Mountain States shares patients.
“Mountain States Health Alliance is committed to enhancing quality patient care and improving the health of the community through innovative partnerships with our affiliated physicians and organizations like OnePartner”, said Alan Levine, president and CEO of Mountain States Health Alliance in a release. “We are pleased to join OnePartner to support our region’s medical community and enable our physicians to quickly and securely share clinical information about patients they have in common with other healthcare providers outside our system.”
The addition of Mountain States to the OnePartner HIE has been two years in the making, said Dr. Scott Fowler, president of OnePartner. “We’ve been working with both hospital systems for quite a while to get data to flow in the same way into a translated format where everybody could share the same data. So as that process has moved forward, the desire to manage some of the changes in reimbursement systems and the contracts that are out there in the marketplace have moved us closer and closer to a common understanding that this is something that is critical that we do. It’s a step that we have to take together.”
Fowler credited Levine for taking the lead on shifting the talks between OnePartner and Mountain States to a higher gear. “Well, we were engaged in talking to MSHA before Alan got here so we had moved the project, in people’s minds, pretty close to the decision point by the time he got here. But I think that when Alan came into town and sort of looked around the community, he said, “How do we do the right things not only for the hospital but for the community we serve?” It was pretty obvious that this was a win/win for everybody. I think that’s really what happened. We finally got on the same page about how we need to work together.”
“The addition of Mountain States greatly increased the value of the HIE”, said Fowler. “When MSHA signed up not only did we get the data of our patients that we’re already caring for into this system, but also all of those doctors that are in those groups now sharing their data too. So it’s not just the hospitals, it’s the hospital plus 300 or 400 doctors out in the community. That greatly sort of expands the importance of that record inside the system.”
“Those records create not only a more complete picture of any particular patient’s care, but also can be used to create broader pictures of how patients are being treated and how they are responding.”
“We use those records to go back and find all sorts of potential safety issues, gaps in care, medication contraindications, all kind of things that we wouldn’t be able to find out about how a patient is being cared for,” said Fowler. “Most patients, even patients that are primarily Holston Medical Group patients, almost all of them see somebody else or go to a system that is involved with the hospital somehow. This is critical to us doing a better job for patient care. It’s also critical that this data reside in this doctor patient relationship or provider patient relationship, it’s protected in there, but we need all of it.”
“I think there’s a level of collaborative intelligence that’s developing around this OnePartner project”, Fowler added. “Maybe the OnePartner project can be instrumental in having a system of collaborative intelligence that can break down the barriers that historically kept the systems from working together as well as they probably needed to and certainly will need too in the future.”
“And yes”, Fowler did say, “systems,” not just “system.” In addition to Mountain States joining the HIE that already has 85 practices and more than 1,000 providers in place, Fowler is optimistic Wellmont will join as well.
“I spoke with Bart Hove yesterday about this very topic,” said Fowler in early October. “We had delivered the full contract to (former Wellmont CEO) Denny (DeNarvaez) and of course we’d been talking to them a long time too. It’s been a year of discussion. I think right now the sand is shifting under Wellmont with the new CEO and we are very optimistic that that will eventually be something that we will have. It’s the right thing to do. It’s about breaking down barriers and building trust to get everybody to participate in this but it’s the best thing for the patients. I’m sure when Bart gets his feet underneath him and Wesley (Combs OnePartner’s chief information officer) is working tightly with Wellmont’s IT division so that connection can take place very easily if they decide to do that. We are hopeful.”
OnePartner is also hopeful that the data gleaned from the HIE can be used to show the Centers for Medicare and Medicaid Services that the accountable care organizations in the region are performing at a high level, thus making sure CMS continues to pay providers under the gradually implementing fee for quality model.
“It can be used to show whether we do a better job or a worse job,” Fowler said. “In other words, what we’re being asked to do by the government and everybody else, quite frankly, is prove that we’re providing quality. If they’re going to pay us a dollar they want to know if they got a dollar’s worth of quality out of this. In the old days they didn’t have a way to measure any of that. That’s part of this new system of value that’s moving everybody forward. We actually won’t be able to get paid if we can’t prove we actually are doing a better job or at least an average job.”
“The ACO model is based on national benchmarks. Qualuable, the ACO of Holston Medical Group, the company that started OnePartner did very well in its last accounting,” said Fowler. “Across the entire United States we were one of the highest quality ACOs that was out there. Of the ones that made money we were in the top probably half of the ones that made money, only 25 percent made money or something like that. When I say made money, what I meant was, saved money for the system. We had a better quality at a lower cost, which is what we’re after. That data is critical for proving that you’re doing a better job. If you’re not in a system that has this type of thing you can’t prove you’re doing a better job. If you can’t prove you’re doing a better job you’re not going to get paid with the new models.”