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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.

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

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  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!

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