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Tuesday, September 22, 2015

QRUR reports now available, as is the opportunity to appeal penalties

The 2014 Quality and Resource Use Reports (QRURs) are now available to all group practices and solo practitioners, including non-physician practitioners and those who participated in the Medicare Shared Savings Program, Pioneer Accountable Care Organization Model, or Comprehensive Primary Care Initiative in 2014. Groups and solo practitioners are identified in the QRURs by their taxpayer identification number (TIN).

The 2014 QRURs show how most groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 value-based payment modifier (VBPM). However, those measures are not included for solo practitioners and groups that reported for the Physician Quality Reporting System (PQRS) in 2014 using the qualified clinical data registry or electronic health record (EHR) reporting option because the Centers for Medicare and Medicaid Services’ (CMS) was unable to determine the accuracy of those data. Likewise, practices participating in the Medicare Shared Savings Program, a Pioneer accountable care organization, or the Comprehensive Primary Care Initiative will only receive claims information in their QRURs.

For groups with 10 or more eligible professionals (EPs) that are subject to the 2016 VBPM and bill under the group’s TIN, the QRUR also shows whether the VBPM will affect their payments under the Medicare Physician Fee Schedule (MPFS). For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the MPFS in 2016. The VBPM will not affect groups of nine or fewer EPs and solo practitioners until 2017, based on 2015 quality and cost measures.

Authorized representatives of group practices and solo practitioners can access the 2014 QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit “How to Obtain a QRUR”  on the CMS web site.

On a related note, CMS on Sept. 11 began notifying individual EPs and group practices that did not satisfactorily report 2014 PQRS quality measures that they will see a 2 percent cut in all of their 2016 MPFS payments. Practices that are not subject to this adjustment will not receive notification.

The 2016 PQRS payment adjustment letter sent to individual EPs includes a TIN/National Provider Identifier (NPI) combination; the adjustment applies only to the individual EP associated with the TIN/NPI noted within the letter and not the clinic or facility. The 2016 PQRS payment adjustment letters sent to PQRS group practices includes a TIN only and applies to all EPs who have reassigned their billing rights to the TIN. Please check your letter in the upper left hand corner to determine if it contains your TIN or TIN/NPI. Note that the PQRS payment adjustment is separate from any additional adjustment that may be applied under the VBPM and to individual EPs who are physicians under the Medicare EHR Incentive Program.

If your QRUR indicates you will receive a payment reduction under VBPM in 2016 or if you’ve received a payment adjustment letter because of your 2014 PQRS performance, you have options. First, you can submit an informal review request. You must submit all informal review requests by Nov. 9 through a web-based tool, the Quality Reporting Communication Support Page. You can find information on how to file an informal review in CMS’ reference guide. CMS will email a final decision within 90 days to those requesting an informal review. All CMS informal review decisions are final, and there is no further review or appeal.

Additional Resources
•    Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).
•    For details regarding the 2016 PQRS payment adjustment, please see the Payment Adjustment Information page of the PQRS website and click on the payment adjustment toolkit.
•    For information regarding other Medicare physician quality programs that apply payment adjustments, please see the Value-Based Payment Modifier website and/or the EHR Incentive Program website.
•    For additional questions, please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@hcqis.org. They are available from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.

Also, look for an article on QRURs in the November/December issue of Family Practice Management.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, September 8, 2015

ICD-10 and workers' compensation

Among the few health care entities not federally required to move to ICD-10 codes starting after Oct. 1 are state workers’ compensation (WC) programs.

That being said, at least 20 states have enacted legislation requiring that their WC programs comply with ICD-10 beginning Oct. 1 anyway. Other states have similar legislation pending or will require ICD-10 codes for specific claim types.

The Workgroup for Electronic Data Interchange (WEDI) has released a chart outlining whether and how each state WC program accepts ICD-10 diagnosis codes. WEDI will regularly update the chart as it receives news from the states. If your state is among those not adopting ICD-10 for WC, you may need to accommodate and maintain dual processing systems, so you can bill both WC for ICD-9 and everyone else for ICD-10.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, September 1, 2015

Place of service codes for outpatient practices to change in 2016

Beginning Jan. 1, the Centers for Medicare & Medicaid Services (CMS) is changing how physicians affiliated with hospitals record where they provide health care services to patients.

To differentiate between provider-based hospital departments located either on or separate from the hospital’s main campus, CMS is creating a new place of service (POS) code. POS code 19 is for “Off Campus-Outpatient Hospital.” CMS describes this as “a portion of an off-campus hospital provider-based department (that) provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.”

CMS is revising the current POS code 22 from “Outpatient Hospital” to “On Campus-Outpatient Hospital.” The description for this POS is “a portion of a hospital’s main campus (that) provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.”

The payment policies that currently apply to POS 22 will continue to apply to both this POS and POS 19, unless CMS states otherwise. For instance, Medicare will pay for covered services at either POS at the facility rate under the Medicare physician fee schedule. Likewise, CMS will allow POS 19 to be billed for G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) and G0473 (Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes) in the same way as those services are billed with POS code 22.

CMS plans to use the coding change to better understand the trend of hospitals acquiring physician offices and treating those locations as off-campus provider-based outpatient departments. For more information, you can read a Medicare Learning Network Matters article on the CMS web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, August 28, 2015

Claims acceptance rate dips slightly in final ICD-10 test

The Centers for Medicare & Medicaid Services (CMS) finished its series of end-to-end testing ahead of the Oct. 1 transition to ICD-10 coding with an acceptance rate nearing 90 percent.

During July 20-24, around 1,200 physicians, other health care providers, and billing companies volunteered to send test claims. Unlike ICD-10 acknowledgement testing, which simply determines if the tester’s claim is accepted or rejected, end-to-end testing processes the claims through all Medicare system edits and provides an Electronic Remittance Advice.

CMS called the test “successful” and said it accepted 87 percent of the 29,286 test claims submitted. That is down slightly from the 88 percent accepted in April but above the 81 percent accepted in January.

The agency noted that some of the rejected claims were submitted incorrectly on purpose to make sure the Medicare system caught the errors, although it didn’t indicate how many. In any event, the percent of test claims rejected in the July period for having an invalid ICD-10 diagnosis or procedure code remained steady compared with the April results at around 2 percent, while the percentage of invalid ICD-9 diagnosis or procedure codes jumped from less than 1 percent in April to almost 3 percent in July.

Other claims were denied for technical problems, such as using an incorrect National Provider Identifier (NPI), health insurance claim number, submitted ID, or HCPCS code; using a date of service outside the valid range for testing; or using an invalid place of service. CMS said that most of these rejected claims represented provider submission errors in the testing environment that wouldn’t be duplicated with actual claims.

While this was the final end-to-end test, CMS encouraged physicians to continue acknowledgement testing by themselves ahead of the Oct. 1 deadline.

Tuesday, August 25, 2015

Wrestling with the ACA's 60-day rule for overpayments

The Affordable Care Act (ACA) requires physicians to report and return Medicare and Medicaid overpayments within 60 days of when the overpayment is “identified.” An improperly retained overpayment becomes an “obligation” under the False Claims Act (FCA), possibly resulting in fines of up to $11,000 per claim and treble damages. Unfortunately, the ACA does not define “identified.”

The Centers for Medicare & Medicaid Services (CMS) attempted to define the term by issuing a proposed rule in February 2012. However, CMS announced this past February that it would delay finalizing the rule for at least a year because of the complexity of the issue and the volume of comments it had received, much of them opposed to CMS’s proposed definition.

On Aug. 3, the U.S. District Court for the Southern District of New York weighed in on the matter. Its decision in U.S. ex rel. Kane v. Continuum Health Partners, Inc. et al. is the first to interpret the ACA’s 60-day rule. In its decision, the court concluded that awareness that overpayments likely existed triggered the 60-day clock. This means that a 60-day time frame begins when a physician has established the mere possibility of overpayments.

Thankfully, the court also concluded that its ruling should not be read to create FCA liability in the case of a physician who is diligently working to investigate a potential overpayment and has not returned the overpayment within 60 days, as long as the physician can establish that he or she did not intend to withhold repayment once he or she established the amount to be repaid. The court stated that “it is only when an obligation is knowingly concealed or knowingly and improperly avoided or decreased that a provider has violated the FCA. Therefore, prosecutorial discretion would counsel against the institution of enforcement actions aimed at well-intentioned healthcare providers working with reasonable haste to address erroneous overpayments.”

Consequently, if you discover the possibility that an overpayment exists, you should work diligently to uncover the scope of the problem and make the necessary repayments without unnecessary delay, preferably within 60 days of when you are aware of the possibility of an overpayment. Likewise, you should promptly investigate reports of potential overpayments and ensure the investigation is well-documented.

More information on the court’s decision and its implications for physicians is available online.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, August 18, 2015

Avoid errors when coding pulmonary diagnostic procedures

The latest issue of the Medicare Quarterly Provider Compliance Newsletter includes a useful reminder that billing for evaluation and management (E/M) services and pulmonary diagnostic procedures provided to the same patient on the same date often requires the use of a modifier. Failure to use the appropriate modifier may result in getting paid only for the procedure and not the E/M service. Alternatively, it may result in Medicare identifying it as an overpayment and requesting repayment.

The newsletter notes that at least one Medicare recovery auditor conducted an automated review and identified overpayments associated with limited E/M services (identified by Current Procedural Terminology (CPT) codes 99211-99212) billed without modifier 25 on the same date of service as a pulmonary diagnostic procedure (CPT code range 94010-94799). According to the National Correct Coding Initiative Policy Manual for Medicare Services (especially Chapter 11, Section J.2), when a physician performs a pulmonary function study and obtains a limited history and exam, separately coding for an E/M service is inappropriate. However, if the physician performs a significant, separately identifiable E/M service unrelated to the technical performance of the pulmonary function test, the physician may report an E/M service with modifier 25 appended to the E/M code. (You can find the National Correct Coding Initiative Policy Manual in the “Downloads” section of the National Correct Coding Initiative Edits web page.)

As a reminder, you use modifier 25 to indicate that on the day you performed a procedure or service identified by a CPT code, the patient’s condition required a significant, separately identifiable E/M service above and beyond the procedure that you performed. You must document the separate E/M service consistent with CPT E/M services guidelines. Note that the E/M service may be prompted by the symptom or condition for which you provided the procedure and/or other service. As such, you do not need different diagnoses for reporting the E/M services on the same date.

Pulmonary diagnostic procedures, such as spirometry, are commonly done in family medicine in conjunction with another E/M service. When this happens, first ensure that your documentation of the E/M service supports that it can stand alone from the pulmonary function procedure (i.e., the E/M service was above and beyond the limited history and exam typically associated with the procedure). Then, append modifier 25 to the E/M service on your claim. Doing so will go a long way toward ensuring that you are appropriately paid for both services and that Medicare will not demand an overpayment from you somewhere down the road.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, August 14, 2015

The whys and hows of ICD-10 testing now

As I write this, the ICD-10 implementation date is just 47 days away. Hopefully you have tested your systems and processes by now. But if you have not, we’ll discuss how to get started.

It's important to start ICD-10 testing as soon as possible. First, testing is vital to ensure you can actually create and submit claims using ICD-10 come Oct. 1. Second, the earlier you test, the more time you have to resolve any issues you encounter. Finally, testing is one of the best ways to make sure you avoid cash flow issues after the compliance date.

To get started, map out your workflows and identify where you use ICD-10 codes. This includes any system that stores, processes, sends, receives, or reports diagnosis code information. Examples include:

•    Generating a claim
•    Performing eligibility and benefits verification
•    Preparing to submit quality data
•    Updating a patient’s history and problems
•    Coding a patient encounter

Then prioritize your testing by focusing first on the most important workflows using the diagnoses you see most often. Doing so will likely lead you to focus on your highest-risk scenarios (e.g., claims processing).

Testing is not limited to inside your practice. You also need to test with trading partners, such as vendors, clearinghouses, billing services, and health plans. Test with trading partners to:

•    Verify that you can submit, receive, and process data with ICD-10 codes
•    Understand how ICD-10 updates affect the transactions you submit
•    Identify and address specific issues before Oct. 1

Because time is short, test inside your practice and with partners at the same time if you are just getting started. You can check for testing opportunities at the website of the Cooperative Exchange, an association of clearinghouses.

When testing claims processing with trading partners, be aware that there are two types of testing. In acknowledgement testing, you submit claims with ICD-10 codes. While claims are not adjudicated, you receive an acknowledgement that your claim was accepted or rejected. During end-to-end testing, you submit claims containing valid ICD-10 codes and health plans process the claims through system edits to return an electronic remittance advice.

To get the most out of testing for your practice, you should:
•    Review testing requirements to understand the scope and format of the testing available
•    Focus on your highest-risk scenarios, such as claims processing and the diagnoses you see most often
•    Prioritize testing with health plans, concentrating on those that account for the majority of your claims
•    Test as often as you can

Also, remember that you can test even if you have not yet installed an ICD-10-ready system. One good way to start is to look at the ICD-10 codes for the top 10 conditions you see. Consider volume of conditions and those that account for most of your revenue. Look at recent medical records for patients with these conditions, and try coding them in ICD-10 for practice. Do the records include the documentation needed to select the correct ICD-10 code? You can use any cases of insufficient documentation to create a checklist for physicians and other health care professionals in the practice to consult.

To learn more about getting ready, visit the Centers for Medicare & Medicaid Services website for free resources including the Road to 10 tool designed especially for small and rural practices, but useful for all health care professionals. You can also check out the AAFP ICD-10 resources online.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, August 7, 2015

Studies show differing opinions on enforcing patient care quality

A pair of recent studies demonstrate that the medical community is far from unified on the subject of rewarding or penalizing physicians based on the quality of patient care.

The American Association of Physician Leadership and the Navigant Center for Healthcare Research and Policy Analysis jointly polled almost 2,400 physician leaders and medical executives and reported that 69 percent of them agreed or strongly agreed that physicians should be held accountable for both the cost and quality of care they provide to patients.

Sixty-three percent of those surveyed disagreed or strongly disagreed that the ongoing shift from fee-for-service reimbursement to payments based on value will hurt the quality of patient care.

In a released statement, Paul Keckley, Navigant’s managing director, said the leaders' support for greater accountability would likely cause “tension at home,” given that many physicians object to being held accountable when they have little or no control over the costs of tests, procedures, and medical devices.

“If leaders think their rank-and-file members need to be held accountable for costs,” Keckley said, “we had better quickly come to some consistent methodology for determining how a clinician is to know what costs are, and then a methodology for incenting them for lower cost and protecting them from frivolous lawsuits (if they deny care to control costs).”

Partially echoing Keckley’s comments, a new study by The Commonwealth Fund and the Kaiser Family Foundation found that half of the 1,624 primary care physicians who participated said the increased use of quality measures to evaluate provider performance was hurting the quality of care. Interestingly, that percentage was the same whether the physician was currently receiving quality-based incentive payments or not.

Only 22 percent of physicians said they felt the use of quality performance measures was improving care (the number was slightly higher, 28 percent, among physicians currently paid based on quality).

In total, 55 percent of the physicians reported receiving some sort of financial incentive based on quality or efficiency.

Fifty-two percent of physicians also said financial penalties for unnecessary hospital admission or readmissions were hurting care quality. Only one in six said programs with those types of penalties were helping.

Tuesday, August 4, 2015

PQRS interim claims feedback for 2015 now available

Physicians who have used claims-based reporting to file at least one quality measure this year under the Physician Quality Reporting System (PQRS) can now view their quarterly data with the 2015 PQRS Interim Feedback Dashboard. The dashboard allows participants to monitor, on a quarterly basis, the status of their claims-based measures to see if they are meeting PQRS reporting requirements. Authorized users view the dashboard by accessing the Enterprise Identity Management System. For assistance, refer to the Centers for Medicare & Medicaid Services (CMS) 2015 Interim Feedback Dashboard User Guide.

As a reminder, failure to satisfactorily report under PQRS in 2015 will result in a 2 percent Medicare pay cut in 2017. Given that Medicare’s value-based payment modifier (VBPM) is tied to PQRS, failure to satisfactorily report under PQRS in 2015 will also result in an automatic payment decrease under VBPM in 2017. On the other hand meeting the PQRS reporting requirements this year can help avoid both penalties and potentially contribute to a payment incentive under VBPM in 2017.

Note, if you or your group is reporting 2015 PQRS data through a mechanism other than claims, such as an electronic health record or a registry like the PQRS Wizard, you will not be able to view your interim feedback reports through the dashboard. CMS has indicated that data submitted with alternative 2015 reporting methods will be available for review in the fall of 2016 through final PQRS feedback reports.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, July 31, 2015

CMS, AMA offer additional guidance on ICD-10 coding flexibility

As you may have heard, earlier this month the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) announced a series of changes aimed at easing physicians’ transition this fall from ICD-9 to ICD-10 coding.

In particular, the changes provided flexibility for practices still grappling with the large number of new diagnosis codes and the increased level of specificity required. CMS said that for the first year ICD-10 is implemented, physician claims will not be denied solely because the diagnosis code is not specific enough as long as it is from the appropriate “family” of ICD-10 codes.

Like everything else attached to the Oct. 1 switch to ICD-10, this announcement generated its own share of confusion. To help clarify the situation, CMS this week released a series of frequently asked questions and answers about the changes.

Some of the more important points:

• This is not a delay in the implementation of ICD-10. Medicare claims with a date of service on or after Oct. 1 will be rejected if they do not include a valid ICD-10 code. “Valid” is defined as having the full number of characters required for that code to be billed, which could require up to seven characters.

• CMS has defined “family of codes” as the ICD-10 three-character category, such as H25 (age-related cataract). Most categories include additional characters that provide additional information, such as the type of condition and what part of the body is affected (for example, H25.22 for age-related cataract, morgagnian type, left eye). Physicians still must provide a "valid" code, which means they will likely have to report more than just the initial three category characters.

• CMS noted that claims may still be denied for being insufficiently specific because automated claims processing edits that are tied to Local Coverage Determinations or National Coverage Determinations are not changing based on the new guidance. Also, Medicare fee-for-service prior authorization requests and prepayment reviews will still require ICD-10 codes with the correct level of specificity.

• The loosening of the specificity requirement does not extend to Medicaid claims, only to those billed under the Medicare fee-for-service Part B physician fee schedule. It also doesn’t extend to private payers unless those payers determine to offer similar flexibility.

Wednesday, July 29, 2015

Does physician compensation differ in an accountable care organization?

A new study published in the Annals of Family Medicine suggests that family physicians in accountable care organizations (ACOs) may not be paid that much differently than their counterparts in non-ACO practices. The study also raises questions about the ability of ACOs to affect cost and quality if physician payment incentives are not aligned with those of the ACO.

The study in question used data from a national survey of physician practices to compare primary care physicians’ compensation among three types of practices:

•    practices not participating in a Medicare ACO and with no substantial risk for primary care costs
•    practices not participating in an ACO but with substantial risk for primary care costs
•    practices participating in an ACO regardless of their risk for primary care costs.

Researchers measured physicians’ compensation based on salary, productivity, clinical quality or patient experience, and other factors. They then used regression models to estimate physician compensation as a function of ACO participation and risk for primary care costs while controlling for other practice characteristics. Among the findings:

•    Physicians in ACOs and non-ACO practices with no substantial risk for costs were compensated similarly; on average, they received nearly one-half of their compensation from salary, slightly less from productivity, and about 5 percent from quality and other factors.

•    Physicians not in ACOs but with substantial risk for primary care costs received two-thirds of their compensation from salary, nearly one-third from productivity, and slightly more than 1 percent from quality and other factors.

•    Participation in ACOs was associated with significantly higher physician compensation for quality; however, ACO participation was not significantly associated with compensation from salary, whereas financial risk was associated with much greater compensation from salary.

The authors concluded that although practices in ACOs provide higher compensation for quality, compared with practices at large, they provide a similar mix of compensation based on productivity and salary. The authors also concluded that incentives for ACOs may not be strong enough to encourage practices to change physician compensation policies for better patient experience, improved population health, and lower per capita costs.

As the study authors themselves ask, if physicians in ACOs and physicians outside ACOs are paid similarly, will they practice differently? The corollary question would seem to be, if they don’t, will ACOs still be able to deliver the lower cost and better quality that they otherwise promise? Only time and additional research will likely tell.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, July 28, 2015

Primary care pay rises faster than that of specialists

Compensation for primary care physicians outpaced that of specialists last year, although the median for primary care physicians remains far less.

The Medical Group Management Association (MGMA) released its annual Provider Compensation and Production Survey Report this week, comparing information gathered from almost 70,000 physicians and other providers.

Primary care physicians received a median compensation of $241,273 in 2014, a 3.6 percent gain from the previous year, according to the report. By comparison, the median compensation for specialists rose 2.4 percent to $411,852. MGMA defines compensation as salary, bonuses, incentive payments, research stipends, honoraria, and profit sharing. It does not include retirement or health care benefits, automobile allowances, or expense reimbursements.

The median compensation for a family physician who performed obstetrics was $227,883; without obstetrics, the median was $221,418.

Halee Fischer-Wright, MD, the president and CEO of MGMA, said in a release that the study confirmed that compensation models have begun shifting from being purely based on productivity to ones that incorporate value.

“We hope to see physicians’ salaries remain healthy throughout this transition,” Fischer-Wright said.

Wednesday, July 22, 2015

Update on access to Quality and Resource Use Reports

The Centers for Medicare & Medicaid Services (CMS) on July 13 retired its Individuals Authorized Access to CMS Computer Services (IACS) system. Physicians used the IACS system to access their Quality and Resource Use Reports (QRURs) data. To still use QRURs, you will need to sign up for an account under the new Enterprise Identity Management (EIDM) system and access it at the CMS portal.

CMS has provided new details on physicians' options going forward:

•    If you did not have an IACS account and do not already have an EIDM account, then follow these instructions on the CMS website to sign up for an EIDM account with the correct role.
•    If you had an IACS account that you previously used to access QRURs and don’t have an EIDM account, then follow these instructions  to sign up for an EIDM account. You will be able to perform the same tasks using your EIDM account that you were able to perform with your IACS account.
•    If you already have an EIDM account, then follow these instructions to sign up for the correct role in EIDM.

For additional assistance regarding IACS or EIDM, you can contact the QualityNet Help Desk Monday through Friday from 8:00 a.m. to 8:00 p.m. (EST) at 1-866-288-8912 (TTY 1-877-715-6222), by fax at 888-329-7377, or via email at qnetsupport@hcqis.org.  

Additional information on accessing QRURs is available on the CMS website.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, July 16, 2015

Survey shows rise in solo practice physician searches

The number of solo practices looking for new physicians or advanced practitioners rose last year, one of the largest physician recruiters says.

Physician search firm Merritt Hawkins in its annual review says 4 percent of the 3,120 search assignments conducted by itself and affiliated firms between April 1, 2014, and March 31, 2015, were for solo practices. This represents a sizable increase from the year before when solo practice assignments made up less than 1 percent of the company’s workload.

Physician-owned medical groups also made strides, making up 20 percent of search assignments, compared with 13 percent the year before, while those from hospitals fell from 64 percent to 51 percent. But the trend is still clearly with employed practice. Merritt Hawkins said 95 percent of its assignments during the review period were for employed positions, compared with less than half in 2004. Assignments from community health centers and academic positions also increased.

Family physicians continued to be the most frequent search assignment for the ninth year in a row, followed closely by internal medicine, psychiatrists, hospitalists, and nurse practitioners. The firm noted that advanced practitioners, a category combining nurse practitioners and physician assistants, would have been fourth on the list, up from fifth last year. Four years ago, neither made Merritt Hawkins’ top 20 assignments, either together or separately.

“Concierge” and other practice models where patients pay their physician directly for care without going through third-party payers, while gathering increasing attention from physicians, remained a tiny piece of the assignment mosaic. The company said it fielded only 25 assignments for concierge practices during the review period, down from 32 in the previous year.

After hitting a five-year high last year, the average base salary for family physician assignments during the study period fell slightly, declining from $199,000 to $198,000.

While policymakers have increasingly discussed the switch of reimbursement from fee-for-service to models based on quality and value, Merritt Hawkins said only 23 percent of its assignments included bonuses tied to quality metrics, down from 24 percent during the previous year. Fifty-seven percent of assignments still relied on relative value units (RVUs) for measuring physician productivity.

Wednesday, July 15, 2015

CMS opens up 2014 Open Payments data to the public

On June 30, CMS published Open Payments data for 2014 that detail transfers of value, such as direct payments, honoraria, or research grants, by drug and medical device makers to physicians and other health care providers. The data include information about 11.4 million financial transactions, attributed to more than 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion. The Open Payments program is a product of the Affordable Care Act.  

With this data release, both the 2014 and 2013 financial records are now available to the public. CMS will continue to update the Open Payments website annually to incorporate data collected from the previous year and to include updates to data disputes and other data corrections made since the initial publication. For more information about the program, including how physicians can register so they can review payments tied to them and report potential errors, please visit the Open Payments page on the CMS website.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

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The views expressed here do not necessarily reflect the opinion of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. See Terms of Use.