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 a 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 sole 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

Now Open: UVA Primary Care Riverside

  • Relocation of UVA Forest Lakes Family Medicine
  • Opened November 20, 2017
  • Created in response to changes in the marketplace around urgent care, retail medicine and one-stop shopping


  • After hours walk-in care until 9PM M-F
  • Walk-in care 8AM – 5PM Saturday
  • X-ray, CBC
  • Team Care Medicine

PFA Project Leadership Announcement

Dear Colleagues,

As of December 11, 2017, UPG Chief of Ambulatory Operations Katie Fellows will serve as the Interim Patient Friendly Access (PFA) Administrator. In this role, Katie will report jointly to UPG Chief of Audit and Billing Quality Melanie Lewis, and UVA Medical Center Chief Operating Officer Bill Fulkerson.

Katie has been an integral part of our PFA Executive Group.  She was instrumental to the successful Epic Phase 2 Implementation in our Clinical Practice Group (CPG) practices, and she will surely be a valuable asset to this project.

In order to support Katie’s transition to Interim PFA Administrator, UPG Manager of Business Development David Stebbins will serve as Interim Director of RPC North Operations, and UPG Clinical Operations Specialist Brigitte Mehl will serve as Interim Clinical Operations Manager.

We greatly appreciate the spirit of collaboration that is being demonstrated during this dynamic time in our environment. Thank you for doing your part to ensure progress and continued success so our patients’ needs are met.


Bill Fulkerson                            Brad Haws

COO UVA Medical Center      CEO UVA Physicians Group




Epic Update: Week 13 Professional Billing Metrics

Metric UVA Average  
AR Days (% change from Baseline) 19% 20%
Cumulative Charges (% of Baseline) 99% 100%
Cumulative Payments (Week variance) -0.67 -1.06


Summary + What to Expect

  • We are trending with other Health Systems that have undergone Epic implementation.
  • Metrics are being closely monitored so that resources and efforts can be focused on addressing issues as they arise.
  • Slowdown in revenue cycle is expected to turn around by fiscal year-end.

Key Messages: Administrative Affairs Meeting August 17, 2017

Basic Science and Clinical Departments, Centers


Health System Financials (Doug Lischke)

  • Mr. Lischke provided an overview of unaudited Health System financials for FY2017.
  • Overall the balance sheet remains very healthy, assets total $4.5B and Investments returned 12.4% for the fiscal year.
  • The $39.2M operating margin well exceeded budget, driven by Medical Center volume and higher acuity / CMI.
  • FY2017 was a successful year similar to FY2016, with a good margin near 2%. Operating cash flow of $186.2M is strong; approximately $10M lower than last year.
  • Mr. Lischke reported that the long range (7-year) financial plan from UPG, SOM and MC came together smoothly and reflects continued solid performance expected: an anomaly in the industry. There is, however, considerable uncertainty in the industry. 


Consolidated SOM/UPG Financials (Allison Holt)


Mouse Per Diem Costs (Dr. Steven S. Wasserman)

  • Dr. Wasserman reported that per diem mouse costs are decreasing from $1.05 to $0.99.


Renting External Space (Dr. Steven S. Wasserman, Jessica Hurley Smith)

  • Dr. Wasserman stated that there is an effort underway to shorten the timeline for renting external space, due to the arduous process required.
  • Administrators are encouraged to put in future initial leasing requests to Ms. Smith, who will then put them in contact with UVA Real Estate to begin the detailed form and state process, which requires that contracts meet state agency requirements.
  • Dr. Wasserman stated that due to the length of time it takes to execute a lease, allowing six (6) months is wise; also, the market for property close to grounds is scarce. 


Budget System Project Update (Anelia Farhi)

  • Ms. Farhi stated that there are extenuating factors affecting the Budget System Project, including a tentative plan for the University to restructure its accounting structure during the year after Ufirst and Workday implementation.


Re-introduction of Susan Rumsey (Anne Kromkowski)

  • As of July 31, 2017, Susan Rumsey returned to her previous role as UPG Chief Financial Officer.
  • Ms. Kromkowski expressed gratitude on behalf of the group to Beth Allen, who did an excellent and effective job of fulfilling her duties as interim CFO in Ms. Rumsey’s absence.


UPG Accounting Update (Beth Allen)

  • Ms. Allen stated that with the transition to Epic, opportunities exist to streamline processes and UPG is reviewing options when possible.
  • There has been a change to the allocation of the registration fee as established in the current MOU with the Medical Center. The fee will now be allocated as a fixed amount instead of a percentage. The fee will be split by 12 and distributed 1/12 each month beginning in July, based upon Net Patient Service Revenue.
  • Discussions are underway with the Medical Center regarding simplifying the facility fee process going forward. Updates will be provided once further discussions have occurred.
  • At the end of FY2017, UPG worked with the auditors to extend the amortization period for the CRP pension plan. Expenses will be amortized for 12 years, which is the remaining expected lifetime for participants (rather than the remaining expected time of service, which was 2.5 years).
  • Chargebacks will continue at the budgeted amount of $12.9M for FY2018.


Departmental Business Development Update (Dave Stebbins)

  • Mr. Stebbins introduced the UPG Business Development team, and outlined the services they provide.
  • The Business Development team consists of subject matter experts who are available to ensure consideration and standardization of financial, legal, HR and IT matters for external projects outside of UVA grounds.
  • Services available include project management, strategic planning, due diligence/vetting, coordination of legal, financial, credentialing and facilities services and Telemedicine.
  • Mr. Stebbins stated that the Business Development team intends to set up meetings with each department to determine how they can be of assistance. Additionally, department administrators are encouraged to contact the Business Development team as project needs arise.