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

From the CEO’s Desk: Lean Management Update

Brad Haws

We are proud that UPG has led the Health System in using Lean management practices in administrative operations in order to serve as efficient stewards of Health System resources. The following is an update on some important results of those efforts.

  • UPG has had Lean projects in every unit in the past 24 months.
  •  To date, UPG Lean projects have created $2.5M of value for the Health System. 
  • Generated margin in administrative unit in FY2016 and rebated $380K of fees back to clinical units.
  • Last year, UPG was the only organization in the Health System not to add a single FTE. UPG’s FY18 budget continues this trend.
  • Lean Successes include:
    • Zion Crossroads
      • Redesigned scheduling process, reducing rate of errors from 30% to near zero.
      • Reduced referral errors from 30% to near zero so that patient connects with the right physician for their condition the first time.
      • Improved communication between physicians and staff.
    • Life of a Surgical Charge
      • Developed automated OR log in Epic, used by 11 Clinical Departments
        • Estimated increase of $800K/year in collections by adding Accustream to identify missed charges.
        • Time savings of ~960 hours/year.
    • In FY17, Billing and Collections teams have seen a 20% increase in productivity while absorbing a 14% decrease in time processing.
      • Charges and collections are up 8.2%.
      • Timely adjustments are down 60% from $1,217,217 to $481,204.
      • 35 process improvements identified; 33 of which have been implemented.
    • Electronic Enrollment with Medicare, Medicaid and VA.
      • Reduces held charges and increases timely payment
    • Monthly Financial Close Cycle
      • Shortened close cycle from 16th to 10th business day
      • More timely financial statements to the Health System
      • Eliminated waste
      • Team freed up to work on other projects
    • Physician Hiring Platform
      • Creation of a streamlined hiring platform for providers, aligning credentialing and date of hire with ability to bill for services.

From the CEO’s Desk: Delay in Pension Plan Changes

Brad Haws

Brad Haws

UPG Executive Leadership is consistently trying to strike a balance between representing our individual employees, and managing our legal and fiscal responsibilities to the group and to the UVA Health System.

Recent discussion about the upcoming changes to the clinicians’ pension plan highlighted the delicacy of that balance, and as a result the UPG Board of Directors has resolved to temporarily delay the plan changes that were to become effective at the end of this calendar year.

The letter below from Jim Rutrough, Chairman of the UPG Board of Directors, and myself, outlines the landscape surrounding this complex matter. This letter was sent out to UPG Clinicians earlier this week.


Dear UPG Clinician,

In anticipation of a January 1, 2017 transition date for revised Clinicians Supplemental Retirement Plan (CSRP) pension benefits, multiple meetings were held to provide faculty members with the opportunity to discuss the upcoming changes. During these meetings, some faculty members indicated that they did not feel that their demographic was adequately represented during the CSRP review process.

We write this letter, and have taken the actions it describes, in response to those identified concerns.

The CSRP, which is the pension plan for full-time clinicians hired since August 1, 1985, has undergone an intensive review over the past two years. The primary reason for review was that the plan has reached a critical point where it is likely to fail federal testing requirements in the near future. Should this occur, all plan participants will immediately be taxed a lump sum amount on the current value of their CSRP benefit. We feel a keen responsibility to prevent this from happening. The secondary reason for review was financial. Over the last few years we have seen increasing spikes in the cost of maintaining the current plan. These spikes were caused by external market forces and changing actuarial tables leading to double digit increases each year in pension expense to the clinical departments. For these reasons we find it necessary, as so many medical centers across the U.S. have already done, to change to a defined contribution plan from a defined benefit plan.

In order to mitigate these risks, the UPG Board of Directors convened a CSRP Review Committee and hired an actuarial firm, AON Hewitt, to evaluate the viability of the CSRP and research alternative options. The Review Committee was comprised of a cross-section of representatives from faculty, the UPG Board, the Dean’s Office, UPG Legal Affairs and School of Medicine Administration. Their objective was to make recommendations that balance offering a competitive plan and the legal and financial constraints: an extraordinarily difficult process due to the many competing variables.

During the course of the Review Committee’s work, the Board received regular progress updates and carefully weighed multiple factors that would affect their decisions. The Board sought to protect the best interests of our clinicians while balancing their fiduciary responsibility.

After substantial actuarial analysis of data, multiple projections and consideration of legal consequences as advised by counsel, the Review Committee brought its recommendation to the UPG Board of Directors for their deliberation at the December 9, 2015 Board Meeting. The Board approved the recommended resolution, and resolved that the changes to the CSRP would become effective January 1, 2017.

Although substantial analysis had been completed by the Committee in arriving at their recommendation, it is important to address the issues raised most recently by members of our faculty before moving forward. With that in mind, UPG convened a Special Board Meeting on November 11, 2016, and passed a resolution to delay any changes to the CSRP to permit time for re-evaluation of potential scenarios.

In the spirit of collaboration with the dedicated, excellent physicians who enable UVA to achieve and maintain our shared goal of providing the highest standard of patient care, this pause in the decision-making process is important. We encourage you to continue to engage in the discussion as we work together through a mutually beneficial outcome.

Please don’t hesitate to reach out with further questions or concerns. Your feedback is most certainly valued, and we will keep you informed of our progress. Please check the website regularly for updates:

As always, thank you for being a part of the UPG community.



Brad Haws

Chief Executive Officer, UPG


Jim Rutrough

Chairman of the Board of Directors, UPG


From the CEO’s Desk: Getting Personal With Your Health

BeWell-ConnectMarch marks the beginning of a major investment by the UVA Health System.  It’s not a capital project or new clinic but something much closer to home: the health and well-being of the people who work here every day. [Read more…]