Posts by Alex

Pivotal Health offers clinical labs tools to succeed in evolving value-based market

Posted by on Feb 20, 2018 in Latest News | Comments Off on Pivotal Health offers clinical labs tools to succeed in evolving value-based market

  As regional and independent laboratories across the country try to keep up with constant changes in value-based care while providing better outcomes to patients, many are finding it difficult to not lose clients to commercial giants like Quest Diagnostics or LabCorp. That’s why labs must be considering how they can provide added value to clients beyond just offering quick turnaround times and good customer service, says Pivotal Health Co-Founder Michael Stevens, whose company partners with laboratories and other health care providers to repurpose clinical data into a “PivotScore” that can provide guidance to improving a patient’s health. “With all the changes in the health care reimbursement landscape as it relates to Accountable Care Organizations and value-based payment systems, everyone has to be innovating in order to stay ahead of the game,” says Stevens, who co-founded Pivotal with his partner, Dr. Siva Mohan, in May of 2016. “When I look at the laboratory space, clinical labs will always be relevant, but in order to keep reimbursements where you want them and not continue to see a decline in clinical lab reimbursement, you have to be able to participate in that value-based market.” Stevens says that while a patient’s score is validated by a digital algorithm that relies on clinical lab values and electronic health record data, the key to its effectiveness is how simple it is for both patients and providers to understand and use as a catalyst for creating better outcomes. Primarily, a PivotScore focuses on patients at risk for or suffering from diabetes, stroke or heart disease and aims to help them better understand their lab results and how those can be improved. But in addition to helping patients better manage chronic diseases, Stevens also says Pivotal can help labs gain an edge financially at a time when reimbursements are declining. “You need to be doing something different, bringing value to your clients outside of just running labs,” Stevens says. “If you as a laboratory can bring something like this to your client base as a way to keep them sticky and bring extra value to that client, your customer, they’re going to want to keep doing business with you.” Stevens, whose 20-year career in health care prior to founding Pivotal includes stints in revenue cycle management, cancer care and EHR tech, says his company is still exploring the possibilities of joint venture partnerships with labs throughout the country. “It’s a market we’re involved in and want to be further involved.” To learn more about Pivotal or to contact Stevens directly, feel free to reach out to him at...

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Navigating the CMS “Targeted Probe and Educate” audit initiative

Posted by on Feb 7, 2018 in Latest News | Comments Off on Navigating the CMS “Targeted Probe and Educate” audit initiative

Navigating the CMS “Targeted Probe and Educate” audit initiative

With CMS now directing its Medicare Administrative Contractors to focus audits and claim reviews on providers with consistently high error rates, it’s important to understand specifically what shortcomings could put your claims process under the microscope. CMS has said the goal of this new initiative, dubbed “Targeted Probe and Educate” (TPE), is to prevent fraud, avoid unnecessary payments and to be less of a burden on providers whose billing operations are running smoothly. Select MACs are being asked to choose claims for services that carry a significant financial burden for Medicare, in addition to those that produce consistently high error rates. Some commons claim errors:   The good news is that unlike the old review system, which included all providers for a designated service during the initial round, providers who are already submitting claims with low error rates will be exempted from the review process. What error rate triggers the TPE cycle? CMS has not outlined a specific error rate that would automatically trigger the TPE process. Instead, the agency is reserving the right to vary its determination depending on the MAC and specific service under review. What does the review process entail? MACs will focus on providers and suppliers who have the highest claim denial rates or who have billing practices that vary significantly from their peers. TPE involves the review of 20-40 claims per provider, per item or service. This is considered a round, and the provider has a total of up to three rounds of review.  After each round, providers/suppliers are offered individualized education based on the results of their reviews.  Providers/suppliers are also offered individualized education during a round to more efficiently fix simple problems.   What happens if a provider doesn’t improve? Unfortunately, while this new process will reward compliant providers with less oversight, those who are found to be consistently falling short of CMS’s standard will need to show substantial improvement between reviews to avoid penalties. Those who are determined to still have a poor error rate after three rounds of review could face actions such as referral to a recovery auditor, extrapolation or 100 percent pre-pay review. Providers must display an ability to reduce their claims error rate between rounds of review in order to be removed from the cycle. What does this mean for the average group? The bottom line is that it’s more important to ensure your billing staff is informed of this change and is working with you to minimize claim errors, given that even small mistakes could put you under the crosshairs of the new...

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How MIPS will affect pathologists in 2018

Posted by on Jan 23, 2018 in Latest News | Comments Off on How MIPS will affect pathologists in 2018

How MIPS will affect pathologists in 2018

Now that most groups are wrapping up their 2017 Merit-based Incentive Payment System reporting, they now can turn their attention to … learning the requirements for 2018 MIPS reporting. Fortunately, there are very few significant changes from the inaugural MIPS year, especially if you’re a non-patient facing specialist like most pathologists. Below is a rundown of the major changes you should take note of as you begin your quality reporting for the new year. 1) Significant increase of the low-volume exemption thresholds • CMS is raising the low-volume MIPS exemption thresholds to $90,000 in annual Medicare payments or services to 200 or fewer Medicare beneficiaries, a significant increase from the $30,000 or 100 patient thresholds for 2017. Falling below either one of these thresholds as an individual clinician will exempt you from participation, which means those who were barely over the 2017 mark will most likely be exempt from the program next year. Keep in mind, however, that the same thresholds are applied at the group level if your group elects to report collectively. 2) Penalties rising, category weights stay the same • Penalties and bonuses for the 2018 MIPS reporting year will rise to +/-5 percent for the corresponding 2020 payment year. • Quality: Still comprises 85 percent for non-patient facing (NPF) groups and 50 percent for patient-facing physicians. • Improvement Activities: Still the remaining 15 percent for NPF groups. • Advancing Care Information: 25 percent for regular participants. • Cost: 10 percent for regular participants. (No reporting requirement regardless). 3) No requirements for the “Cost” category for non-patient facing clinicians • While participants had originally been told to anticipate the introduction of a “Cost” category based on the old value modifier in 2018, CMS is now proposing to again give no weight to the fourth MIPS category next year for non-patient facing clinicians. That being said, patient-facing groups will see Cost comprise 10 percent of their total MIPS score for 2018. CMS is tracking Cost progress in 2018 based on Medicare Spending per Beneficiary and total per capita cost measures, meaning groups do not have to do any additional reporting to be scored in this category. 4) Quality reporting data completeness rising to 60 percent • Clinicians will now be required to submit quality data on at least 60 percent of their eligible patients if they’re seeking to achieve a strong quality score, as opposed to the traditional 50 percent requirement under PQRS and the initial MIPS performance period. Individuals reporting via claims are still only required to report on Medicare patients, while groups utilizing registries must report on data from all payers. 5) Slight threshold increase for penalty avoidance • Clinicians who were happy with the extremely low bar set by CMS this year to avoid a Medicare penalty in the 2019 payment year should find relief in learning they won’t be asked to do much more next year to avoid a 2020 penalty. While the 2017 performance threshold of 3 (the total MIPS score required to receive a neutral adjustment) was able to be achieved by essentially submitting any quality data or completing at least one improvement activity, the 2018 threshold will be raised to just 15 points. • AVOIDING A PENALTY IN 2018: 15 points o Complete your improvement activity attestation: 15 points o SMALL PRACTICE OF 15 OR FEWER: Submit incomplete data for at least four quality measures throughout the year, receiving three points for each measure. This practice would also receive five bonus points for its size: 17 points o KEEP IN MIND: While the bar for penalty avoidance is still low,...

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Vachette supports Dr. James E. Richard for 2019 CAP presidential bid

Posted by on Dec 11, 2017 in Latest News | Comments Off on Vachette supports Dr. James E. Richard for 2019 CAP presidential bid

Vachette supports Dr. James E. Richard for 2019 CAP presidential bid

Vachette Pathology would like to announce our company is supporting James E. Richard, DO, FCAP, for his 2019 bid to be elected president of the College of American Pathologists. Dr. Richard is a Michigan-based pathologist who has spent more than 30 years in the field. He also currently serves as CAP Speaker of the House of Delegates, a position he has held since 2014. He also sits on the Michigan Society of Pathologists Board of Directors, and previously served as the organization’s president from 2007 to 2010. Dr. Richard’s career achievements include: 1996 – 2014. Partner and Laboratory Director of CAP-Lab, LLC Grew a private AP laboratory from 457 Sq Ft of rented space with one employee to a 10,000 Sq Ft laboratory with 49 employees. Negotiated sale of this laboratory to largest hospital in the area that included permanent positions for every employee. 2005 – 2010. Laboratory Director and Hospital Board member in Charge of Board Quality Committee Improved the quality level of a 400-bed hospital in five years by devising and executing a hospital wide quality plan that included all departments of the organization. 2006. Laboratory Director and Department Chairman Directed a Pathology Department to receive the highest JD Powers Service Award in Healthcare. 2010 to Present. Partner and Department Chairman Provided pathology services to local surgery centers and small critical access hospitals without increasing costs to those institutions via a CAP accredited Mobile Laboratory. 2014 – Present. Laboratory Director, Department Chairman Operated hospital and outreach laboratory below budget for the past three years while increasing volume and revenue each year. 2014 – Present. CAP Speaker of the House of Delegates Leads the CAP House of Delegates (432 members). Increased filled member seats from 57% to 85% and increased overall satisfaction of meeting attendees from a score of 85% to 94%. You can learn more about Dr. Richard by visiting his website, www.jimrichard2019.com/. You may also use the “contact me” button to reach out to him directly with...

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What Could a Single-Payer Plan Mean for Pathologists?

Posted by on Nov 27, 2017 in Latest News, White Papers | Comments Off on What Could a Single-Payer Plan Mean for Pathologists?

What Could a Single-Payer Plan Mean for Pathologists?

Let’s face it, the United States is broke. As a country 12 percent of our tax dollars are paid just to keep up on the interest of our total debt. This would be like paying 12 percent of your paycheck every month just to pay the interest on your credit card bill. Not pretty, huh? Well, imagine you have this debt, plus you just got a big health care bill. That’s our country today.   So how do pathologists fit into this changing landscape? I believe we are heading to a single-payer system sooner rather than later. This means we will both ration and lower the quality of health care. We cannot keep going forward on the current path, which means the next election will be driven by this idea. In fact, it wouldn’t surprise me if our Tweeter-in-Chief actually proposes a single-payer system himself. I’ve been lucky enough to see inside our current Medicare bureaucracy to learn how it works. We have to remember that Medicare is the largest insurance plan in the nation, given that they cover around 100 million people. It’s easy to see how Bernie Sanders’ Medicare for all plan could eventually gain legs. However, the biggest obstacles to a single-payer plan are the private insurance plans. These giant companies have to make 5 percent a year to keep their shareholders happy. Do we really think the big insurance lobbies would stand by and let this happen? Nope. The only way it would work is if we can get them to also buy into the idea. How do we do this? Perhaps we give them each a market share of the new national Medicare-for-all plan. This way, each company would get a fifth of the marketplace to manage. If we have 380 million Americans, then each company would get about 76 million covered lives. There would still be a market for Medicare Advantage plans, in addition to a smaller boutique market for those who wish to buy a supplemental plan. In this instance, the commercial insurance industry wouldn’t disappear, it simply would change. If this plan was made enticing enough to insurance conglomerates, then it would pass. Obviously, promoting a health care change of this magnitude would be very difficult considering politicians cannot get re-elected after being forced to limit a social program. And rest assured, this change would eventually limit health care to a degree previously unseen in this country. If you think this is untrue, look at the countries in Europe who are running out of cash: Portugal, Italy, Greece and Spain. These countries all have massive amounts of social unrest because they eliminated or decreased their social programs when they ran out of money. But, have our collective views on single-payer plans changed over time? In 2008, more than half of physicians opposed a single-payer system, according to polling data at the time. Compare that against a recent survey by Merritt Hawkins that shows 56 percent of physicians now either strongly support or are somewhat supportive of a single-payer system. In less than ten years, we have come full circle on this idea. Where will this evolution put us in 10 more years?   It’s also important to ask ourselves what this change could mean for the average person like you and me. For starters, it would mean more taxes. If we examine most countries with nationalized health care, you’ll find the average citizen pays more taxes than the average American citizen. Everyone would have to pay this new tax, however, approximately 44 percent of the working people of this country currently...

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