Key Messages: February 2018 Clinical Chairs Committee Meeting

UPG COO Corey Feist presented an update on contract negotiations with Anthem. Department Chairs approved proposed contract terms as outlined. Next steps include reevaluation of current Super Specialty Codes, as well as reconstituting/charging the Performance Based Contracting Team.

UPG CFO Susan Rumsey reviewed Provider-Based Clinic Cost Allocation. The current methodology distributes funds to each unit proportional to indigent care RVUs. The alternate methodology would have funds allocated to units based on their individual ratio of cost to charges applied to indigent volumes. A motion was made and approved to adopt the alternate methodology for the last six (6) months of FY18, and beginning in full for FY19.

UPG President Bobby Chhabra, M.D. distributed a handout of questions from the UPG Cost Survey. The survey was administered by the UVA Center for Survey Research to 23 Association of American Medical Colleges (AAMC) peer institutions. The survey was designed and administered as part of ongoing efforts to discover best practices and promote understanding of UPG’s comparative cost structure. Results are expected in Spring 2018.

The remainder of the meeting was spent in Closed Executive Session focused on discussing the Group Practice Model.

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: November 2017 Clinical Chairs Committee Meeting

Piedmont Liability Trust Annual Report

Piedmont Liability Trust (PLT) CEO Rebecca West, General Counsel Bill Archambault and COO Bruce Gehle shared the PLT Annual Report which included an Executive Overview, Claims Report, Risk Management, Education and Legal Services Report, and Financial Report. There were more changes in governance this year than in the past few years. PLT representatives asked Department Chairs for help in getting new clinicians to attend orientation sessions for educational credit. Department Chairs were apprised of key long term and short term issues.


CMS Quality Payment Program/MACRA

UPG Chief of Audit & Billing Quality Melanie Lewis provided an update on the CMS Quality Payment Program. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) streamlined three (3) legacy programs with the Quality Payment Program: Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals; Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM). There are two ways to take part in the Quality Payment Program: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPM). UPG will participate in MIPS as a group. Ms. Lewis outlined MIPS participants and exemptions, as well as scoring for quality, scoring for improvement activities and scoring for costs. In 2018, several changes will take place including: Cost Performance category is increased to 10% of the total MIPS final score, Quality Performance category is reduced to 50%, MIPS performance threshold increased from 3 to 15 points, a bonus for using only 2015 Certified Electronic Health Record Technology, 5 bonus points on the MIPS final score for treatment of complex patients and the number of dually eligible patients treated, and the Patient Centered Medical Home Activity requirement is revised to include at least 50% of the practice sites within the Taxpayer Identification Number.


Epic Phase 2 Implementation Status Update

UPG Chief Financial Officer Susan Rumsey provided an Epic Phase 2 Implementation Status update. Issues have been identified around referrals and reporting; resolution efforts are underway. Of the 510,000 referral contacts made between July and October, 350,000 are linked to a scheduled appointment. Of the remaining 160,000 referrals, 100,000 don’t need an appointment and the remaining 60,000 referrals are being worked. Focused sessions with Department Administrators and the Epic Reporting Team are taking place to identify areas of need including locating existing reports, modifying existing reports and developing additional reports in Epic or Webi. Current metrics demonstrate strong performance overall, with several areas measuring above average and four in the top quartile across organizations at the same week of implementation. According to average performance projections, we are positioned to come out of the current trough in both AR Days and Cash later in FY18.


The remainder of the meeting was spent in Closed Executive Session focused on discussing top faculty priorities.



Key Messages: October 2017 Clinical Chairs Committee Meeting

Opening Remarks

Dr. Bobby Chhabra made opening remarks in his first meeting as President of UPG, having been elected on September 12, 2017. Dr. Chhabra stated that he was honored to have been elected and that he looked forward to using this time of transition as an opportunity to evaluate UPG’s role in UVA Health System and determine how its evolution should take shape in order to best fulfill its mission. Dr. Chhabra expressed interest in using his leadership role to help improve UPG dialogue with stakeholders, encourage transparency and a review of UPG cost structure, and ensure that UPG is the best possible advocate for clinicians. Dr. Chhabra had already met with several Health System leaders to discuss alignment in purpose and vision. Three aspects in which Dr. Chhabra would like to see UPG play a significant role as a supporting ally of the Health System are: outreach practices, improvement of ambulatory operations and developing a group practice model.

As part of his mission to improve dialogue across the Health System and seek opportunities to strengthen UPG’s position as an advocate for physicians while staying committed to its core mission, Dr. Chhabra asked Department Chairs to reach out to faculty in order to identify top issues, and bring these to the next Clinical Chairs Committee Meeting.

Dr. Chris Ghaemmaghami, Chief Medical Officer and Senior Associate Dean for Clinical Affairs, said that he and Dr. Chhabra had discussed the transition and that he was fully committed to working collaboratively with UPG in his role as liaison for clinical activities among the UVA School of Medicine, UVA School of Nursing and UPG.

Indigent Care and Medicaid Supplemental Funding 

Brad Haws presented an update on Allocation of Indigent Care and Medicaid Supplemental Funding. The two programs, Indigent Care and Medicaid Supplemental, are intended to cover 95% of costs of providing clinical care and are based on those costs. Regulations are silent on how funds are allocated internally, and internal allocation has no impact on total funding. The existing internal allocation method is based on Indigent/Medicaid patient volumes with no cost component. This method was proposed by a sub-committee of the Clinical Chairs and adopted by the Clinical Chairs in FY06.  Historically, the program covered costs for only the 21 SOM Clinical Departments but effective FY13 UPG Clinical Operations was added. The addition of these practices increased the total amount of funding; the Clinical Departments benefitted from the increase in total funding due to the internal allocation method. The question has since been raised as to whether the internal allocation should mirror the way funding is received. Such a change would align the funding with the costs, and shift funding toward UPG Clinical Operations from the 21 SOM Clinical Departments. Mr. Haws said that it was not his intention to come to a resolution during this meeting, but to begin the discussion regarding potential models: either keeping the current volume-based model, or changing to a cost-based model. Discussion on the topic included the nature of RVU valuation for different specialties as well as the suggestion of a blended formula rather than a binary decision.

Aetna Medicare UVA Health System Prime Plan 

UVA Medical Center Contract Management Administrator Milton Dunlap introduced the Aetna Medicare UVA Health System Prime Plan. UVA and Aetna have jointly established a co-branded Medicare Advantage Plan which is being offered in the market effective January 1, 2018. Open enrollment runs from October 15 through December 7. This is a UVA-only plan with a closed network of UVA providers and UVA facilities including UVA HealthSouth, the UVA Imaging Center and Culpeper Medical Center. For the first year, the plan is being offered to patients in the City of Charlottesville as well as the counties of Albemarle, Fluvanna, Greene, Louisa, Madison and Nelson. Approximately 1200 individuals are expected to enroll in the first year. Potential plan benefits for UVAHS include: Capturing new patients who aren’t currently in UVAHS and retaining them for all services, an opportunity to learn how to better manage patient populations, the possibility of influencing payment rules and gaining access to patient data we would not otherwise have had, and the potential for future gain sharing. Providers were asked to direct patients with questions to call Aetna at the phone number provided.  A handout with plan comparison data was distributed.

Ufirst/UPG HR Future State

Mr. Haws provided an update on UPG’s involvement in the Ufirst initiative. With regard to division of services, specifics were not yet available because data is still being mined and gathered to determine which services will remain at UPG after the transition and which will be shared with UVA HR. It is likely that the more “high touch” services will remain at UPG, and that the split will be roughly 50/50. Mr. Haws thanked the group for their support and data, and said that leadership would follow up with more information when it becomes available.

Epic Phase 2

Mr. Haws presented an update on Epic Phase 2. The system implementation phase of the project is complete; the next phase is to optimize the system within our workflows and business processes. During the system transition, performance is being monitored against other Epic implementations of the Professional Billing (PB) functionality. Comparisons indicate that UVAHS is performing above average in most metrics, and in the top quartile for a few metrics. Based on experience with previous clients, Epic has provided expectations for Days in AR and cash collections. We are just entering the most difficult period, when Days are highest and Collections are lowest. Recovery is expected after the turn of the calendar year.

Key Messages: Clinical Chairs Committee Meeting September 12, 2017

The Committee approved Timothy G. McLaughin as a new public member of the UPG Board of Directors.

Bobby Chhabra, M.D. was elected President of University of Virginia Physicians Group. Dr. Chhabra’s three (3) year term became effective September 12, 2017. Dr. Chhabra succeeds Paul Levine, M.D., who served as UPG President since 2012 and whose term concluded on August 31, 2017.