Provider Reimbursement Strategies for 2014
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Understanding reimbursement models for 2014, including Accountable Care Organizations (ACO's), Private Payer Models, and Health Care Reform Initiatives.
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Provider Reimbursement Strategies for 2014
- 1. PROVIDER REIMBURSEMENT STRATEGIES FOR 2014 Michael P. James, J.D., M.B.A., CSSGB Phone: (517) 377-0823 (313) 965-9038 Email: mjames@fraserlawfirm.com www.linkedin.com/in/MichaelJamesLaw Fraser Trebilcock Davis & Dunlap, P.C. One Woodward Avenue, Suite 1550 Detroit, Michigan 48226 www.fraserlawfirm.com Phone: (313) 237-7300 Fax: (313) 961-1651 Fraser Trebilcock Davis & Dunlap, P.C. 124 W. Allegan Street, Suite 1000 Lansing, Michigan 48933 www.fraserlawfirm.com Phone: (517) 482-5800 Fax: (517) 482-0887 © 2013 Fraser Trebilcock Davis & Dunlap, P.C.
- 2. Shifting Landscapes Under Health Care Reform
- 3. Physician Landscape Accenture predictive modeling. Accessed 12/3/13. http://www.accenture.com/usen/outlook/Pages/outlook-online-2011adapting-new-model-physicianemployment.aspx
- 4. Reimbursement Landscape 2011 2000 National Health Expenditures National Health Expenditures Government Government 64.5% 35.5% 55% Private 45% Private 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.pdf Accessed 12/3/13. (see Historical; NHE Web tables, Table 5).
- 5. Reimbursement Landscape 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
- 6. Riding the Wave of Change How do you address these shifting landscapes to continue to drive profits?
- 7. 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.
- 8. What Are ACOs? 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.
- 9. What Are ACOs? Fundamental Principles of ACOs Reduce Growth of Beneficiary Expenditur es Improve Care for Beneficiari es Enhance Health in its Population
- 10. Types of ACOs Integrated Delivery System Model ACO CMS Health System ACO Hospital Physicians Skilled Nursing Facility Etc.
- 11. Types of ACOs PHO Model ACO CMS PHO ACO Hospital Independent Practice Assn.
- 12. Types of ACOs Independent Practice Association Model ACO CMS IPA ACO Physician Physician Physician Physician
- 13. Types of ACOs Group Practice Model ACO CMS Group Practice ACO Hospital Specialists
- 14. ACO Membership 5% of Members = 45% of costs 15% of Members = 35% of costs 80% of Members = 20% of costs
- 15. Utilization Management 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
- 16. Utilization Management Chronic Disease: Medical Home Care Plans Team Care ER / Hospital All Others: Medical Contact & Education Care Plans ER / Hospital
- 17. Payment Evolution Insurance License. Claims Processing. Alignment of Fee Structures. Incentive to Move from Volume to Value. Quality Monitoring Systems.
- 18. Risk Sharing Culture of Restructuring More Patients in System Reduce Capacity of System
- 19. Michael P. James, JD, MBA, CSSGB Fraser Trebilcock Health Care Reform www.mihealthcarelaws.com Fraser Trebilcock Davis & Dunlap, P.C. One Woodward Avenue, Suite 1550 Detroit, Michigan 48226 www.fraserlawfirm.com Phone: (313) 237-7300 Fax: (313) 961-1651 Phone: (517) 377-0823 (313) 237-7300 Email: mjames@fraserlawfirm.com www.linkedin.com/in/MichaelJamesLaw Fraser Trebilcock Davis & Dunlap, P.C. 124 W. Allegan Street, Suite 1000 Lansing, Michigan 48933 www.fraserlawfirm.com Phone: (517) 482-5800 Fax: (517) 482-0887 © 2013 Fraser Trebilcock Davis & Dunlap, P.C.