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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

Lean Successes: Zion Crossroads

When the Zion Crossroads Multi-Specialty Clinic opened in August 2013, it represented a new business model of outreach care for the UVA Health System. Housing 22 primary and secondary specialties, a pharmacy and imaging under one roof, the practice was intended to be a “one-stop-shop” of multi-disciplinary UVA health care for the community.

A little over three years later, after what Zion Crossroads Director of Clinical Operations Renee Viette refers to as “a few stumbles along the way”, the practice is thriving and growing, and leads by example when it comes to the high-quality, value-added lean success model. “We think of it as an intersection between the Be Safe initiative in patient care, and administrative process improvement,” says Viette.

According to Supervisor of Practice Teshema Anderson, one of the earliest hurdles they needed to surmount at the new practice was streamlining the scheduling process. “The challenge was to meet the needs of all the physicians and all the patients across the multi-disciplinary practice, but the way the scheduling was originally set up was inefficient and complicated,” says Anderson. The resulting lean project was to redesign the scheduling templates and work closely with physicians to accommodate their calendars and configure the best method for patient access. The results have been successful: Scheduling and referral errors have been reduced to near zero, and the communication between physicians and staff has improved measurably. “Being able to quell the frustrations of our physicians and staff has been really rewarding,” reflects Anderson. “They have all the tools they need to succeed.”

Michelle Young, Assistant Nurse Manager for the clinic, readily admits that at first she questioned whether or not nursing had a place in the lean model. Until, she says, the matter of patient medical records reached a critical juncture. The volume of information on a patient’s history was often extensive and at least partially irrelevant to their current situation. However, determining which information was important and what was obsolete lay outside the area of expertise of the administrative staff who were generally tasked with managing patient records. The result? Often inclusion of extraneous information which takes time and resources to go through. “One day,” Young recalls, “I just looked at it and said, “This is a nursing issue. We have the background to determine what medical history is relevant for a patient’s present care.”

Once nurses took charge of patient medical records, under Young’s leadership, the amount of time taken by physicians to scan records looking for vital information was greatly reduced. “What this translates to is exponentially more face-to-face time between doctor and patient,” says Young. “This allows us to provide the best, most personalized care possible – and that’s our ultimate goal.”

Michelle Young, Renee Viette, Jeffrey Moore, Teshema Anderson



Viette is quick to point out that while the clinic’s lean successes are certainly worth celebrating, the thing she is perhaps most pleased with is their team member engagement. “When I learned that we had measured in the 92nd percentile of employee engagement, I was just floored. I’m so proud of our team,” she says. “The spirit of collaboration can be felt throughout the clinic, from nurses to administration to physicians and housekeeping staff.”

When asked what the future holds for the Zion Crossroads Clinic, Viette answers: “Growth. We have grown so fast, which is wonderful. We’ve maxed out our current operating space and are ready to expand.” She has proposed expanding hours, and the team is ready to make use of the 8000 square feet of reserved space at their facility. “We are clearly meeting a need here,” she remarks. “Both serving regional patients closer to home, and attracting new patients to the UVA Health System.”


ZCR Halloween 2016

Zion Crossroads Halloween Celebration

Activity Index for March 2016: Clinical Volumes, Collections, Payer Mix Trends

Patient volumes through the first 8 months

Clinical volumes through February were 3.6% above the prior year and 1.1% over the target with newly hired clinicians. Through February, 30 of the 68 planned clinical hires were on board. All service areas showed growth in patient volumes over the prior year, with double-digit growth in the departments of dermatology, pediatrics and anesthesiology. [Read more…]

Health System Quality Data Now Public

In an effort at greater transparency, the UVA Health System is now posting a range of quality and safety data online for the public to view. Executive Vice President of Health Affairs Richard Shannon, MD, has noted that being open about our progress with quality and performance is important to achieving our goals for safety and excellence, while giving our patients the information they need to make informed choices about their care. [Read more…]