Getting Paid in 2016:Business TrendsPresented by John LynnDecember 2, 2015

webinar

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Agenda

2

Agenda

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• Welcome & Introductions• The Business of Medicine

2016• Kareo’s Role• Your Questions

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Speaker

John Lynn Editor & Founder

HealthcareScene.com, a network of 10 EHR and HIT blogs

Co-founder of InfluentialNetworks.com & Physia.com

Blogs have published over 8,000 health care IT posts with more than 16 million views

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Agenda

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Agenda

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• Welcome & Introductions• The Business of Medicine

2016• Kareo’s Role• Your Questions

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US Healthcare Spending and Life Expectancy

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What’s Your Perspective on Healthcare Costs?

• Provider Perspective- Increasing Costs = Increasing Revenue- Decreasing Costs = Decreasing Revenue

• No Decrease in Expectations- Lower Quality- Fewer Patients

Doctors Expected to Do More with Less!

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Changing Reimbursement Models

• Accountable Care Organizations (ACOs)• Value-Based Reimbursement

- Government- Other Payers

• Increase in High-Deductible Plans• Government Penalties

Do You Treat These Changes As a Problem or An

Opportunity?

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Accountable Care Organizations (ACOs)

• More than 420 Medicare ACOs- 7.8 million Americans

• In 2014- ¾ of ACO’s Failed to Create Shared Savings- $1 Billion in Shared Savings- Total Medicare Spend ~$600B- 15% of Medicare Beneficiaries- ~1% Improvement

Longer Term ACOs Seem to Be Performing Better

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Value Based Reimbursement

• CMS:- 30% of Payments Tie to ACO or Bundled Payments by End of 2016- 50% By End of 2018

• Health Care Transformation Task Force- Aetna, Blue Cross, Health Care Services Corporation, Ascension Health,

and Trinity Health- 75% Of Business Under Value-Based Payments by 2020

This Shift is Inevitable!

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ACO and Value-Based Reimbursement Trends

• Be Careful Who You Choose as Partners- Other Provider Organizations- Vendors

• Do Partner with a Vendor- Understand the Regulation- Act as Intermediary- Shared Cost Savings- Infrastructure- Focus

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What Tech is Needed?

1. EHR – Is Any of This Possible without an EHR?2. Data Exchange3. Analytics4. Patient Engagement

- Mobile- Portals- Social

5. Care Management

Reality Check:Change is Upon Us

andChange is Hard!!!

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Lesson Learned

You Can Finally Focus on the Patient In Your Practice

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Increase in High-Deductible Plans

• 2009 – 22.5% on High-Deductible Plans- 6.6% with a Health Savings Account- 15.9% without a Health Savings Account

• 2014 – 36.9% on High-Deductible Plans- 13.3% with a Health Savings Account- 23.6% without a Health Savings Account

• 2013 – 39% of Employers• 2015 – 48% of Employers• Most Insurance Exchange Plans are High-Deductible Plans

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Trends and Impact

• Patients are More Selective and Involved- If- When- Where

• More People Opting for Retail Medicine- Telemedicine?

• Large Increase in Patient Pay Portion of A/R- Patient Collections is Much Harder- Potential Cash Flow Problems?

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What Tech Is Needed?

1. Process for Effective Eligibility Checks- Identify Early the Actual Costs to the Patient- Don’t Surprise the Patient

2. Online Patient Payment Portal3. Automated Messaging and Collection Process

- Text- Email- Secure Email- Automated Calls

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Lesson Learned

Small Practices Need to Improve Their Patient Collection Capabilities

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Government Penalties

• Meaningful Use- 2016 – 2% Penalty (Based on 2014 Data)- 1% Annual Increase Up to 5%

• Physician Quality Reporting System (PQRS)- 2016 – 2% Penalty (Based on 2014 Data)

• Value-Based Modifier (VBM)- Linked to PQRS- 2016 – Performance Based – Groups of 10+ Eligible Providers- 2017 – All Eligible Providers

Up to 9% Penalty in 2017 Based on 2015 Participation

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Avoiding Penalties

• CMS Guide – 9 Pages- Cliff Notes Version: Participate in the Programs

• Are More Penalties Coming?• “The Purpose of Any Government Organization is to Ensure Its

Future Existence”• Should You Try and Avoid the Penalties?

- Sunk Costs

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Lesson Learned

Penalties Aren’t Going Away…

Maximize Around Them

Do You Treat These Changes As a Problem or An

Opportunity?

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Agenda

25

Agenda

25

• Welcome & Introductions• The Business of Medicine

2016• Kareo’s Role• Your Questions

@GoKareo 2626

Awards

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processing• Online billpay

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Discover Kareo’s Role

Kareo EHR

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ready• 2014 Edition Certified

for MU

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Kareo Medical Billing: Web, Mobile & Messaging!

• Web and Mobile Software

• Calendar & Patient Check-in

• IBM & MAC Enabled• Secure Messaging• Revenue Cycle

Performance for Visibility

• Kareo Success Team

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Discover Kareo’s Role

DoctorBase Practice Marketing & Patient Engagement• Appointment reminders• Recalls• Email & text

communications• Patient surveys• Website & SEO• Online reviews• Provider directory• And more

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Agenda

31

Agenda

31

• Welcome & Introductions• The Business of Medicine

2016• Kareo’s Role• Your Questions

@GoKareo 3232

How to Participate Today…

Type your questions

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