Spring Town Hall Event Scripps Epic Wave 3 Outreach & Scripps ACO Updates May 3, 2018
Opening Remarks & Introductions Michael Couris, MD Vice President - Scripps Mercy Physician Partners & Mercy Physicians Medical Group (MPMG)
Why are we here? To develop a medical community that benefits our independent physicians, affiliate partners, and Scripps Health, as well as provides the necessary technology, business services, education & events that strengthen it.
Agenda - Keynote Presentation Scripps Epic Wave 3 Outreach & Scripps ACO Updates - Closing Remarks & Door Prizes! (Michael Couris, MD) Estimated program length, 75-minutes
Keynote Presentation Scripps Epic Wave 3 Outreach & Scripps ACO Updates Joseph Stein, MD Executive Medical Director Inpatient Epic Barbara Price Corporate Senior Vice President Chief Executive, Scripps ACO Shane Thielman, FACHE Assistant Vice President Medical Management, Scripps Health Cindy Gipson Senior Director of Operations Scripps ACO
Your Connection to Epic Options for the Independent Physician Joseph B Stein MD FACC FACP FHRS
2 Interpretations
2 Interpretations
Big Man
Epic - Connection to Independent Office EMR Connection to Epic Be Connected With Your EMR Vs Epic Connect EPIC IS Your EMR
Apprehensive about changes coming?
An Independent Pencil An band of Pencils is much harder to break Might break under stress Herd Protection - not new
HOW DO WE HANDLE CHALLENGES?
Cautious Merger
TRUST
ACO - Experiment ACO - Current Vehicle for Scripps to Partner MDCR ~43k MSSP Qualcom ~14k PACO 1 ACOs: Fraud & Abuse Waivers and Analysis HCCA 20 TH ANNUAL COMPLIANCE INSTITUTE APRIL 17-20, 2016 LAS VEGAS, NV SESSION 710 TAKING ADVANTAGE OF THE ACO WAIVERS: DOING IT THE RIGHT WAY AND AVOIDING SUBSTANTIAL RISK STEPHEN H. SIEGEL, ESQ. CERTIFIED HEALTHCARE COMPLIANCE/FLORIDA BOARD CERTIFIED HEALTH LAW BROAD AND CASSEL, MIAMI, FL SHSIEGEL@BROADANDCASSEL.COM Robert G. Homchick and Sarah Fallows Davis Wright Tremaine, LLP I. Introduction The Patient Protection and Affordable Care Act of 2010 (ACA) fosters the development of new patient care models designed to improve the coordination, quality and efficiency of health care services to Medicare and Medicaid patients. Section 3022 of the ACA mandates the creation of the Medicare Shared Savings Program, which allows qualified groups of providers to earn a share of the savings generated as a result of reducing the overall cost of providing care to an assigned population of Medicare fee-for-service beneficiaries. To participate in the Shared Savings Program, providers band together to form Accountable Care Organizations (ACOs). To facilitate the establishment of ACOs, Section 3022(f) of the ACA grants the Secretary of Health and Human Services the authority to waive certain provisions of the fraud and abuse laws under the Social Security Act or other provisions of the Medicare law (herein ACO waivers ). The Centers for Medicare & Medicaid Services (CMS) published the final ACO regulations on November 2, 2011 (ACO Final Rule). At the same time, CMS and HHS Office of Inspector General (OIG) published an Interim Final Rule with Comment (IFC) establishing waivers of the Stark law, the anti-kickback statute, and certain provisions of the civil money penalty law (CMP), including the so called Gainsharing CMP and the prohibition on inducements to beneficiaries. 1 The IFC establishes five separate waivers that, when considered in the aggregate, permit ACOs significantly more latitude than the waivers as initially proposed by CMS and OIG. 2 As the IFC states: These five waivers provide flexibility for ACOs and their constituent parts to pursue a wide array of activities, including start up and operating activities, that further the purposes of the Shared Savings Program. 3 The design of the ACO waivers is premised on the expectation of both CMS and OIG that the risks of fraud and abuse, such as overutilization, inappropriate utilization and underutilization, will be mitigated in the first instance by the design of the Shared Savings Program. 4
ACO - Experiment ACO - Current Vehicle for Scripps to Partner
ACO - Experiment ACO - Current Vehicle for Scripps to Partner MDCR ~43k MSSP Qualcom ~14k PACO Only MDCR rates If this is the best Scripps can negotiate on behalf of 900+ MDs with a year of work. Would an individual or small group do better??
ACO - Experiment ACO - Current Vehicle for Scripps to Partner MDCR ~43k MSSP Qualcom ~14k PACO Only MDCR rates Independent gets same advantage as SMF/Coastal Would you turn away a new MDCR patient? Can you live on MDCR rates?
Shouldn t We Be Connected? Can we provide: 1) Better Care 2) Be More Efficient/Cost Effective 3) Improve Patient and Provider Experience
Epic Link Green La Jolla Encinitas Mercy SD Mercy CV Epic (Full Inpt/Amb EMR) Epic Connect (Full Inpt/Amb EMR) SM-Foundation S-Coastal SNF/ASC/UC Independent Epic via Citrix Physician Office (Remote Access to Inpt EMR & Hosp Inpt/Outpt Orders) Independent Physician Office Any MD Trained on Epic Inpt HIE Epic View Only Independent Physician Office (Remote Access to Inpt EMR Referrals & Hosp Outpt Orders) Independent Physician Office
Epic - Connection to other EMRs A Simple Handshake?
More Complicated Than It Seems
Epic Connect - Office EMR Work in 1 system - avoid a 10-20% inefficiency
What do you want?
Accessing Epic from MD Office Epic View Only Epic Link Epic via Citrix Epic Connect Results Orders x Ambulatory & Referrals Inpt/Outpt as at Hosp. All PeriOp x x Document x Scan; 2018 - PDF Hospital All Training elearn elearn 1/2 day 2-3 days When Now Now Wave 2-3 Cost x x x Rollout starts 2018 Subsidized Subscription
Connection Must Be Clear Simple Easy to Teach
PEDIGREES Allscripts JMP Securities HCIT Consolidation Chart HIT$Vendor$Mergers$&$Acquisi4ons$ JMP Securities HCIT Consolidation Chart Cerner HIT$Vendor$Mergers$&$Acquisi4ons$ JMP Securities HCIT Consolidation Chart HIT$Vendor$Mergers$&$Acquisi4ons$ Epic
KLAS & HIMSS DATA
EMR - KEY ISSUES One Database, One Portal, One Billing, Seamless Inpatient and Outpatient, and departments as needed Easy Direct Exchange of Patient Data and Order Sets with UCSD-Rady-Kaiser (except Sharp) Offer connection to community and affiliates No one leaving, absorbing systems previously on other EMR; Market and Patient Dominance (51%)
EPIC AT NOVANT DEPLOYED TO ALL COMMUNITY PROVIDERS Consolidated Billing Replaced 91 separate systems/billers Portal - Center of Care Neighborhood MD-Patient Communication Centralized Scheduling all appointments, lab, imaging evisits Video Visits
Epic Connect
05.03.18 Mercy Physician Partners Town Hall Scripps Community Connect Update
Purpose of Scripps Accountable Care Organization (ACO) Deliver a high performing, clinically integrated network that supports physicians in providing the value and experience we want for our family and friends. Build the product with the access and experience we want for our family and friends Scripps ACO is committed to partnering with our integrated, independent physician members to realize that vision. The subsidized Scripps Community Connect (SCC) offering is one way in which Scripps and the Scripps ACO are supporting independent physicians delivery of high value care. 2
Purpose of Scripps Accountable Care Organization (ACO) Scripps ACO Clinically Integrated Network with demonstrably high value performance Improve patient experience Reduce the per capita cost Improve the health of populations Improve clinician experience Scripps ACO is committed to supporting aligned, independent physicians to be successful in value-based care Contracts / Volume SNF Preferred Network Alana Disease Management Data and Analytics Scripps Community Connect Fully integrated EHR for Scripps ACO providers 3
Update on ACO Activities MSSP Quality Reporting successfully submitted by Scripps ACO on behalf of all participating providers Initial round of Scripps Community Connect pre-assessments completed Key performance improvement opportunities identified, including postacute care (e.g., SNF, Home Health), 1-2 day length of stay, and Part B medication utilization. As opportunities to improve cost and quality of care are identified, we will look to collaborate with participating providers on how best to close gaps in performance 4
Summary of SCC Pre-Assessments Total practices identified for initial round of pre-assessments: 45 Central/South: 17 practices (62 providers) North: 28 practices (223 providers) Total practices with completed pre-assessments: 27 Central/South: 14 practices (59 providers) North: 13 practices (70 providers) 5
Evaluation of Epic Revenue Cycle for Affiliated Physicians 1. Scripps ACO pipeline practices evaluating UCSD Community Connect offering which includes Epic s professional billing solution. 2. Desire for a integrated revenue cycle, practice management and clinical EHR solution. 3. Enhanced MyScripps features similar to enterprise functionality -- paperless billing, self-pay, and ability to expand Welcome kiosk features. 4. Reduction in operational and management complexity for Community Connect practices by managing patient registration, billing, and accounts receivable in one system. Scripps Health will not provide billing services for Community Connect practices Provide professional billing module implementation expertise; practices will be solely responsible for the management of their AR All practice / billing data will not be visible to Scripps Health or other Community Connect practices 6
Pilot Practices: Go-Live Update Go-Live for pilot practices: Monday, May 7 Coastal Pulmonary Associates (Dr. Scott Eisman) Surgical Associates of La Jolla (Dr. Mark Sherman) Implementation milestones Training completed for all providers and staff Appointment scheduling conversion complete Clinical and technical dress rehearsals completed 7
Closing Remarks & Door Prizes Michael Couris, MD Vice President - Scripps Mercy Physician Partners & Mercy Physicians Medical Group (MPMG)
$50 Gift Card Fleming's Steakhouse
2 - $50 Gift Cards Nordstrom
$50 Gift Card P.F. Chang's
2 - $50 Gift Cards Shogun Restaurant
$50 Gift Card P.F. Chang's
Kindle Fire HD
Kindle Fire HD
Thank you for attending!