2016 Billing and Coding Collaborative- Webinar Two Michigan Primary Care Transformation Project August 30, 2016

AGENDA Welcome/Introductions Our Focus Today: PCP Follow-Up After Admission End Date Analysis Presentation by Alice Stanulis (MDC) Discussion and Q and A CMS Proposed Physician Fee Schedule (2017) Highlights (Diane Marriott)

The 2016 MiPCT Billing and Coding Collaborative All are invited (whether interested in practice learning credits or not) Remaining 2016 One Hour Webinar Sessions: September 27 (noon); November 15 (noon) Practice Learning Credits Option Four credits maximum possible PO or practice may participate

PCP Follow-Up After Hospital Admission End Date (7 days; 14 days)

PCP Follow-Up Within 7 or 14 Days of Discharge Why it is important To patient care To billing transitional care management codes 99495 for followup within 14 days 99496 for followup within 7 days To State Innovation Model (2017 metrics)

PCP Follow-Up Within 7 or 14 Days of Discharge What the analyses shown attempts to do Shed light on current state Provide discussion opportunity for analysis refinements Identify and spread best practices that partners have been found to be helpful Analytic approach Analyze unique patients with PCP visit wtihin 7 or 14 days of end date of hospital admission (discharge) at PO level across payers and overall

PCP Follow-Up Within 7 or 14 Days of Discharge Analytic approach (cont.) Dates of service: October 2014-Sept 2015 September 2015 Provider and Member attribution Payer specific cuts and overall At PO level (practice level cuts are possible if of interest) Shown unblinded

7 and 14 Day Findings

PCP Follow-Up Within 7 or 14 Days of Discharge Questions on approach? Interpreting results Note volumes as well as %s (larger numbers more helpful) Assess risk level (or modal age as a proxy) MDC is exploring values over 100 to better understand Does this align with your experience of your PO’s performance? “Gold standard” level? Refining analysis

2017 Proposed Physician Fee Schedule (PFS) Release and Comment Preparation

MiPCT Physician Fee Schedule Annual Comment Cycle CMS issues the draft schedule for the upcoming year (annually in July) 60 day public comment period commences MiPCT assesses codes related to care management and population health and proposes draft response letter to SC SC members review, comment and provide signature approval for comment letter CMS issues revised and final schedule with comment theme responses (annually in Oct/Nov)

PFS 2017 – Two Overall Key Themes New focus on care management and behavioral health issues Enhanced payment levels that for care of patients with multiple chronic conditions

2017 PFS Areas Relevant to MiPCT 1) Improve payment for care management services provided in the care of beneficiaries with behavioral health conditions (including services for substance use disorder treatment) through new coding, including three codes used to describe services furnished as part of the psychiatric CoCM and one to address behavioral health integration more broadly Temporary codes to be used for 2017 until permanent codes are available (2018) Why Should CPCI Be Of Interest for MiPCT and MAPCP States? Potential for consideration of CPCI expansion into MAPCP areas CPCI payment rate is more currently more generous than MAPCP rates CPCI payment is a blended approach (part PMPM, part shared savings, part fee-based codes) Could be interpreted as a constructive sign of increased consideration by CMS of post-demonstration continuity and sustainability

2017 PFS Areas Relevant to MiPCT 2) Improving payment for Chronic Care Management (99490) code Introduction of new add-on G code to improve payment for visits that qualify as initiating visits for CCM services (GPPP7) Changes to reduce the infrastructure requirements (24/7, etc. Discussion of improved 99490 payment rates Why Should CPCI Be Of Interest for MiPCT and MAPCP States? Potential for consideration of CPCI expansion into MAPCP areas CPCI payment rate is more currently more generous than MAPCP rates CPCI payment is a blended approach (part PMPM, part shared savings, part fee-based codes) Could be interpreted as a constructive sign of increased consideration by CMS of post-demonstration continuity and sustainability

MiPCT Multi-Payer Summary Billing Documents

Polling Questions 1) Was this webinar helpful? (Very helpful, somewhat helpful, not helpful)

Polling Questions 2) What is your #1 problem in seeing patients at the PCP office after an admission within 7 days? Within 14 days? (Please enter your response as free text)

Polling Questions 3) What best practice have you found helpful in getting patients in to the PCP within 7 days of discharge? Within 14 days? (Please enter your response as free text)

THANK YOU!