You don’t need to be told that the speed of change in healthcare continues to accelerate. From healthcare reform to Medicare reimbursements to technology deployments, you must be ready to move with a quick and effective response to any and all challenges that come your way. The reward? Clinical and financial viability, now and well into the future. Here’s a peek at some market and regulatory forces that you will likely confront in 2013:
The Way is Paved for PPACA
The Patient Protection and Affordable Care Act (PPACA) was passed, the U.S. Supreme Court ruled to uphold the law and the potential Republican reversal to healthcare reform legislation came up short in a bid for the White House. If they haven’t already, physicians should gear up big for changes. PPACA will increase access to care for the millions of Americans who have previously been unable to obtain medical insurance; the expansion of Medicaid alone is estimated to result in up to 15 million new enrollees during 2014i. It’s important for practices to routinely verify information for its Medicaid patients, and with the impending, significant growth in this population, it will be increasingly vital to confirm that patient information is accurate. Whether coverage is obtained through private companies or government programs such as Medicaid, small practices better be ready.
An Adjustment in Income?
As it stands now, physicians may face an adjustment of 27 percent or more in Medicare reimbursements in 2013ii. Congress did implement a temporary patch last year to keep 2012 rates stable, but has yet to apply a permanent fix and replace the current sustainable growth rate (SGR) reimbursement system with a more stable and predictable payment mechanism.
Increasing Quality Reporting Demands
With the release of the new Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) announced that providers who do not successfully participate in the Physician Quality Reporting System (PQRS) during the 2013 program year will be subject to a one and a half percent payment adjustment in 2015, and a two percent adjustment in subsequent yearsiii. On the flip side, eligible professionals (EPs) who satisfactorily report quality measure data will qualify for a half percent bonus in 2013. To help you avoid reimbursement adjustments, CMS has proposed two additional reporting options. The first is to satisfactorily report at least one PQRS measure or measures group via a claims, registry or EHR-based reporting mechanism. The second option allows you to utilize administrative claims-based reporting for related measures. Be aware, however, that if you elect one of these reporting options, you will not qualify for an incentive payment.
ePrescribing Actions
CMS continues to aggressively push ePrescribing. The goal of CMS’ ePrescribing Program is ultimately to increase patient safety through the reduction of medication errors and adverse drug events. Besides the improvement in efficiency that physicians gain through this program, there is also a financial benefit for being an early adopter. In 2013, the last year of the Medicare ePrescribing incentive system, you can receive a half percent financial bonus for conducting a portion of prescription orders electronically. Considering that you will be subject to a one and a half percent payment adjustment for noncompliance, those easy to use ePrescribing platforms are beginning to look pretty attractive.
EHR Deployment Progress
Better known as “Meaningful Use,” the EHR Incentive Program continues in 2013, with many physicians preparing for their 90-day reporting period that will enable them to prove they are meaningful users of the technology under Stage 1 requirements. While the reporting period for Stage 2 compliance has been pushed back until October 2014, you should take advantage of the additional time and prepare for rising Stage 2 qualification thresholds, including demonstrating that at least 50 percent of your prescriptions are completed through ePrescribing, up from the 40 percent required in Stage 1.
Requirement to Accept Electronic Payments
Expect 2013 to be a watershed year for participation in emerging Medicare payment initiatives that are driving the formation of accountable care organizations (ACOs), shared savings programs, bundled payment pilot projects and value-based payment modifiers. And if Meaningful Use is not enough of an incentive for you to ramp up your EHR deployment efforts, these new initiatives surely demand that you look closely at enabling solutions to access and utilize the data you need to improve care and reduce costs. Additionally, January 1, 2014, is the deadline by which all payments under Medicare must be conducted via electronic funds transfer (EFT). And, while providers will not be required to accept electronic payments from commercial health plans, all payers will be required to have the ability to facilitate these transactions.
To help small practices navigate healthcare reform, Emdeon Office Suite provides many tools to increase accuracy and efficiency while reducing interruptions in the revenue cycle. Online pre-registration, real-time eligibility and benefits verification, and claims and payment management, including the facilitation of electronic funds transfer, are some of the key services this technology offers. Emdeon also provides a convenient and cost-effective way for providers and pharmacies to exchange ePrescribing transactions through its Emdeon Clinical Exchange EHR Lite, an ONC-Certified EHRiv.
ihttp://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidEligibilityFinalRule_Regulatory-Impact-Analysis.pdf
iiMedicare Physician Fee Schedule; http://www.beckersasc.com/media/CMSFinalRule2013MPFS.pdf; Page 15
iiiMedicare Physician Fee Schedule; http://www.beckersasc.com/media/CMSFinalRule2013MPFS.pdf; Page 1195
ivThis Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Emdeon Inc, 01/19/12, Emdeon Clinician 7.6, 0119201230701, NQF0064/PQRI128, NQF0041/PQRI110, NQF0024, NQF0028, NQF0038, NQF0059/PQRI1, NQF0064/PQRI2, NQF0061/PQRI3.
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Preparing Your Practice for the Future: A Look Ahead to 2013
