AAOS Now, July 2017
Patient-Reported Outcome Measures for Research, Reimbursement, and Point of Care
Patient-reported outcome measures (PROMs) have become more common over the past 30 years. Providers have been exposed to PROMs through the reporting of performance measures for the Physician Quality Reporting System and payment reform efforts such as the Merit-based Incentive Payment System track in the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA).
Is Your Practice Not Getting Paid?
It's easy to blame a practice's skyrocketing accounts receivable (A/R) on coding and the insurance companies. But our experience with orthopaedic practices, and the results of AAOS/KarenZupko & Associates (KZA) pre-workshop surveys on coding and reimbursement, indicate that the problem is a lot more complex. To ensure that "clean" claims go out and proper payments are received, physicians and staff must accurately code and document services.
Transforming Clinical Practice Initiatives and MIPS
Under the Medicare Access and CHIP Reauthorization Act, The Quality Payment Program (QPP) replaces the sustainable growth rate formula in determining physician reimbursement by Medicare. The QPP replaces three previous programs—the physician quality reporting system, the value-based modifier, and meaningful use. In their stead is one budget-neutral program, the Merit-based Incentive Payment System (MIPS).
Meeting the Unmet Need: Independent Medical Examinations
The Centers for Disease Control and Prevention reports 80.1 million visits per year to physician offices, hospital outpatient centers, and the emergency department for injuries. The nearly 3 million nonfatal workplace injuries and illnesses reported by private industry employers in 2014 occurred at a rate of 3.2 cases per 100 equivalent full-time workers. Many of these workplace injuries result in a lawsuit or workers' compensation claim.
Maximize Benefits, Minimize Risk Through Clinically Integrated Networks
Although clinically integrated networks (CINs) have been around for decades, their popularity appears to be on the rise, coinciding with the increase in alternative payment models (APMs) and value-based care initiatives. That's because CINs offer both patients and physicians—including specialists such as orthopaedic surgeons—many tangible benefits. Patients receiving care via a CIN typically have a single point of entry during which their medical history and current symptoms are recorded.
Total Joint Coding and Documentation in Quality Programs
Both the Comprehensive Care for Joint Replacement (CJR) and Bundled Payment for Care Improvement (BPCI) programs mandate increased alignment between hospitals and physicians. Historically, coding of the patient experience during the hospitalization has affected hospital reimbursement, but not physician reimbursement. With these new initiatives, physicians now have a stake in the game.
Staying out of Trouble Prescribing Controlled Substances
Physician and public awareness of issues related to opioid use has skyrocketed over the past several years. Prescription drug abusers outnumber those who use all other "street" drugs except marijuana, and twice as many deaths are caused by prescription opioids than heroin. Every state except Missouri now has a Prescription Drug Monitoring Program (PDMP) that tabulates and distributes data about federally controlled substances that are prescribed and dispensed.
Orthopaedic Practice in the United States
Every 2 years, the AAOS research, quality, & scientific affairs department gathers demographic and practice data on orthopaedic surgeons through the Orthopaedic Practice in the United States (OPUS) Survey, also known as the Census Survey. The most recent data comes from the 2016 Census Survey, which had a response rate of 26 percent.