Archives for January 2018

UPG + UVA Benefits List

Click to Enlarge Image

MACRA/MIPS: What UPG Providers Need to Know

UPG is committed to ensuring that our providers understand the programs under MACRA, and we plan to share developing information as relevant to our UPG clinicians. We understand that many of you are likely to hear specifics about these programs from your specialty societies as well. Those specifics may or may not be applicable to you as an UPG member.  Rest assured: We are focusing on these programs and understand their import to our valued providers. Please don’t hesitate to reach out with any questions or concerns, or if you seek further clarification:

Here are 4 facts regarding MACRA/MIPS, relevant to UPG providers:

  1. Under MACRA, there are two reimbursement structures: MIPS (Merit Based Incentive Payment System) and APMs (Alternative Payment Models). Because we are in a fee for service environment, we qualify for the MIPS structure —  not APMs.
  2. All UPG clinicians benefit from the fact that UPG is a large organization with over 1,000 providers. We report our performance measures as a practice group, and our MIPS composite performance score is calculated as such. Providers most at risk for penalization under MIPS regulations are solo specialty providers, solo practitioners and small groups. UPG providers do not face such risk.
  3. While penalization isn’t an immediate concern, as we look to the future and the MIPS requirements become more stringent we will need to focus efforts on performance measures:
      • Quality
      • Resource Use
      • Clinical Practice Improvement
      • Meaningful Use of Certified EHR Technology
  4. Physicians can contribute individually to group performance by:
      • Thorough documentation of patient care
      • Diligent management of screening, managing and monitoring patient conditions
      • Providing input as necessary with regard to EHR system technology

UPG Declaration of Commitment

Dear Colleagues,

On behalf of UPG Executive Leadership, Happy New Year! We look forward to a collaborative and productive 2018, with renewed focus on clear communication and defined objectives.

In this spirit of dedication and clarity, we share the following UPG Declaration of Commitment:

  • During this dynamic time in our healthcare environment, UPG is committed to supporting the shared Mission, Vision and Values of the UVA Health System to enhance patient care by:
    • Providing clinical, administrative and financial services tailored to meet the needs of our patients and clinicians with emphasis on personalized customer service; and
    • Using its agility to advance regional patient care and the future of UVA Health System through clinical management + support with a growth mindset.
    • In all that we do, we strive to act as efficient stewards of resources and effective advocates for the best interests of our members.
  • UPG is provider-centered, so our providers can be patient-centered.

In addition, UPG President Bobby Chhabra, M.D. and I have prepared an overview of UPG’s role and services for providers, which we have begun presenting at departmental faculty meetings. Our intention is to promote discussion and understanding, and to answer questions. We will provide upcoming scheduling information as it becomes available.

As always, we are grateful for your contributions as a valuable member of the UPG community. Our success is dependent upon your hard work and excellence. Thank you for all that you do.


Brad Haws

Key Messages: December 2017 + January 2018 Clinical Chairs Committee Meetings

December 2017

UPG CFO Susan Rumsey presented information to promote understanding of the current method of Indigent Care Allocation and alternate methodologies. While payments are made based on cost, the VA Administrative Code and Virginia State Plan are silent on the distribution of funds. In FY06, a task force of Clinical Chairs recommended an allocation methodology based on patient care volumes without a cost component, which was approved by the Clinical Chairs. When UPG Clinical Operations were included in the cost reporting, total funding increased but internal allocation wasn’t modified. As a result, funding to the 21 SOM Clinical Departments increased disproportionately.

According to the current method of Indigent Care Allocation, funds are allocated to each unit proportionate to indigent care RVUs. This assumes cost per RVU is constant across all units. Alternate methodology would have funds allocated to units based on their individual ratio of cost to charges applied to indigent volumes. Medicaid funds are currently allocated to each unit proportionate to Medicaid claims payments (as a proxy for Medicaid volumes) – which assumes that costs are constant across units. Alternate methodology would have funds allocated to each unit based on individual cost to charge ratios applied to Medicaid charges.

After discussion and questions, the chairs proposed delaying the decision until greater clarity about the group practice model is developed. The motion was made and seconded, and passed unanimously.

The remainder of the meeting was spent in Closed Executive Session focused on discussing UPG services, fees and costs.

January 2018

Motion for the appointment of UPG Board of Directors Public Director Sanford Williams was made and approved.

**For those who may be interested in the UPG Board of Directors composition and public member appointment process, please click to enlarge the slides below.

Click to Enlarge Image

Click to Enlarge Image

UPG Director of Finance Beth Allen presented information regarding Calculation of Facility Fee Payment, including history of the Provider Based Clinic MOU, the need for the change in calculation, the existing method of calculation and proposed method and implementation options. Ms. Allen said that she intended to ask Department Chairs to make two (2) decisions: 1. Implementation for FY18, and 2. Calculation method for FY19 and beyond. After discussion and questions, Department Chairs decided to vote by email after reviewing cash numbers through November 2017.

UPG COO Corey Feist provided an update on Anthem negotiations. The current contract with Anthem doesn’t expire until December 2019, but negotiations began in spring 2017. Input was obtained from the Contracting & Performance Based Payment Committee on factors important to UPG providers in this contract. UPG is currently waiting for Anthem to reply to the recent UPG counter offer. Once the reply is received, it will be analyzed and a recommendation will be made to Clinical Chairs.

Key Messages: December 13, 2017 Board of Directors Meeting

UPG Board of Directors Chair Kate Acuff introduced new Board members Babur Lateef, M.D. (UVA Board of Visitors Representative) and Timothy McLaughlin, C.P.A, C.F.A. (public member).

UPG President Bobby Chhabra, M.D.  made opening remarks, stating his intention to use his role as UPG President to help improve communications and provide information about UPG. He expressed his gratitude to Department Chairs and members of the UPG Board for their support.

UVA EVP for Health Affairs Dr. Richard Shannon made leadership remarks emphasizing the rapid pace at which changes in healthcare, and specifically in reimbursement, are occurring. Dr. Shannon stated that it is vital both to be nimble and cost-conscious in order to navigate unanticipated changes.

UVA Medical Center CEO Pam Sutton-Wallace presented an update on Ambulatory Optimization. With 1.1M ambulatory visits recorded in 2016, outpatient settings prove a major point of entry for the UVA Health System. Changes in ambulatory environment and patient expectations have occurred, and adequate processes and systems to manage the complexity of care are required. The A3 Problem Solving Approach is being employed to make improvements in ambulatory patient care from the time of scheduling through post-visit follow-up. The timeline for this project initiative is aggressive over the next three quarters.

UPG Chief of Clinical Operations Wes Campbell provided information about the opening of UVA Primary Care – Riverside, which is a relocation of UVA Forest Lakes Family Medicine. The rationale for the move included location visibility and responsiveness to marketplace changes around urgent care and retail medicine. The practice is designed to facilitate team care and materially increase patient access to care, and provide a prototype for future clinics. UVA Primary Care – Riverside features after hours walk-in care until 9pm Monday through Friday, and from 8am to 5pm on Saturdays.

UVA Primary Care – Riverside

UPG Board Treasurer Bill Shenkir announced that the Audit Committee had accepted the results of the external audit of consolidated financial statements for FY17, and introduced BDO representatives Karen Fitzsimmons and Tracy Lewis to review the audit findings. There was one corrected misstatement related to the Medicaid Supplemental settlement receivable which had a net effect of increasing revenue by $322,000.

UVA Chief Human Resources Officer Kelley Stuck and UPG CEO Brad Haws provided an update on Ufirst. The intention of the update was to expand upon the information presented at the September UPG Board of Directors Meeting, with the understanding that no final recommendation was being offered at this time. Ms. Stuck presented the business case for, and objectives of, Ufirst – including the emphasis on integration of knowledge and service delivery, streamlining of processes and succession planning. UPG will continue to have customized local support for clinical faculty, providers and team members, and will retain its decision making role. The Memorandum of Understanding (MOU) between UVA and UPG is currently in draft form, and addresses multiple legal and service level considerations. Next steps in the process are: Coming to an agreement on open items, finalizing the MOU and presenting to the Board of Directors, supporting the smooth transition of services and HR professionals to aligned roles, engagement in Workday technology configuration and engaging clinical faculty to support the transformation.

Dr. Gina Engel presented on Opioids in the Primary Care Setting, with particular focus on how to limit use of opioids in order to minimize addiction risk which can lead to heroin use and addiction. Data supports use of thorough documentation, nonpharmacologic therapy and nonopioid options, and improved communications with patients, pharmacists and office teams. Improved pain screening tools are recommended for use, as well as the prescription drug monitoring program that has recently become available for use in Epic.

UPG CFO Susan Rumsey provided an update on FY18 Financial Operations and Investments. Consolidated Financial Results for the first four (4) months of FY18 demonstrate that Clinical Departments are $2.9M unfavorable to budget, driven by $1.0M reversal of FY17 support, $1.0M unfavorable patient revenue, and compensation $2.5M over budget. Regional Primary Care practices were $1.1M unfavorable to budget on $1.5M unfavorable patient revenue, offset by $0.4M favorable expenses. Funding status for the CRP/CSRP was 86%/73% as of June 2017, compared to 81%/68% as of December 2016. FY18 Year to Date Workload Trends November results are over stated by approximately 23,000 WRVUs. Adjusting for these values, November results are 1.8% over budget and 4.1% over prior year. Patient Collections Trends FY18 Year to Date November results are 0.8% below budget and 0.8% ahead of the prior year.

UPG CFO Susan Rumsey presented an Epic Phase 2 update. System optimization began October 1, 2017, and system upgrade will begin in February 2018 with completion expected in Fall 2018. Ms. Rumsey reviewed identified issues, including unscheduled referrals and orders to schedule, and reporting. Resolutions are in progress to resolve these issues. Metrics as of December 2017 demonstrate that UVA is performing above average compared to peers, and in the top quartile in Legacy Days, Cumulative Epic-Only Payments and Undistributed Days. Impact to Physician Billing AR days was at its peak as of December 2017 and is expected to decrease in upcoming months. Likewise, the impact to Physician Billing cash has followed the expected trajectory with the low point in October 2017 and is demonstrating increase which can be expected to continue.

During her recommendation of Consent Agenda items, Dr. Acuff made particular note of the resolution honoring Ella Strubel in recognition of her impactful contributions during her tenure on the UPG Board of Directors.