1. 2016 Billing and Coding Collaborative- Webinar Two Michigan Primary Care Transformation Project August 30, 2016

2. 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)

3. 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

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

5. 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)

6. 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

7. 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

8. 7 and 14 Day Findings

9. 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

10. 2017 Proposed Physician Fee Schedule (PFS) Release and Comment Preparation

11. 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)

12. 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

13. 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

14. 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 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

15. MiPCT Multi-Payer Summary Billing Documents

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

17. 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)

18. 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)

19. THANK YOU!