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Imaging Performance Partnership Health Care Hot Topic Cheat Sheets FOR IMAGING LEADERS Translating Health Care Trends for Imaging

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Page 1: Health Care Hot Topic Cheat Sheets - Advisory...Introducing the Health Care Hot Topic Cheat Sheets 10 ways to use cheat sheets: 1. Prepare for internal meetings about your organization’s

Imaging Performance Partnership

Health Care Hot Topic Cheat Sheets

FOR IMAGING LEADERS

Translating Health Care Trends for Imaging

Page 2: Health Care Hot Topic Cheat Sheets - Advisory...Introducing the Health Care Hot Topic Cheat Sheets 10 ways to use cheat sheets: 1. Prepare for internal meetings about your organization’s

Introducing the Health Care Hot Topic Cheat Sheets

10 ways to use cheat sheets:

1. Prepare for internal meetings about your organization’s shift toward risk-based payment

2. Incorporate cheat sheets into technologist onboarding to get frontline staff well-versed in major market trends

3. Engage in conversations with health system executives about recent market trends

4. Train imaging’s physician liaisons to effectively discuss how imaging can support primary care population health management goals

5. Identify ways imaging can help your organization achieve pay-for-performance targets

6. Educate health system executives on Medicare’s imaging clinical decision support mandate

7. Stay informed on the latest policy updates, what they mean for your organization, and how they translate to imaging

8. Evaluate how new legislation will impact the imaging book of business

9. Recognize the impact of the mandatory bundled payment policy on your market

10. Understand what ACO providers are looking for in imaging partners

The cheat sheets are a series of quick two-pagers on key health care trends.

What does population health really mean? How do bundled payments impact imaging? You hear your colleagues talking about patient consumerism, but what does consumerism mean for imaging?

The health care market is ever evolving. And many issues, such as clinical decision support or patient consumerism, affect imaging first, making it imperative for imaging leaders to quickly adapt their strategies to the changing environment. Because imaging crosses all service lines, even when it isn’t directly targeted, it is still impacted by almost every change in health care. With all the imaging leader’s competing responsibilities, staying up-to-date on every issue is a daunting task.

So to help you get smart—and stay smart—on health care’s biggest changes, the Imaging Performance Partnership created an online library of “Hot Topic Cheat Sheets.” These two-page guides take five minutes to read and provide a quick primer on health care topics. Importantly, each cheat sheet outlines how a different trend impacts imaging and provides actionable next steps for imaging leaders.

Visit advisory.com/ipp/cheatsheets for our library of Health Care Hot Topic Cheat Sheets to learn how to talk about these issues with confidence.

What are they?

• Directors of imaging

• Radiologists

• Radiology group leaders

• Radiologist physician champions

• New imaging managers

• COOs

• VPs ancillary services

• Imaging IT vendors

• Imaging equipment vendors

Who are they for?

Page 3: Health Care Hot Topic Cheat Sheets - Advisory...Introducing the Health Care Hot Topic Cheat Sheets 10 ways to use cheat sheets: 1. Prepare for internal meetings about your organization’s

May 2016 1)  MSSP participants are eligible to participate in two other ACO programs: ACO Investment

Model and Advanced Payment ACO Model 2)  Fee-for-service.

Source: Accountable Care Organizations (ACOs), CMS.gov; Imaging Performance Partnership research and analysis.

How Do ACOs Work? All ACOs assume accountability for the total costs of patient care and therefore require a unique level of coordination between providers and payers. These unprecedented interactions requires closer communication to care for patients and to complete the billing and reimbursement cycles. Under the Medicare Shared Savings Program (MSSP), by far the most popular Medicare ACO arrangement, ACOs that keep per-beneficiary Medicare expenditures below benchmarks based on ACO-specific historical patient demand for services are eligible to receive a portion of the savings.

Based on Pioneer ACO Model and MSSP experiences, Medicare developed the Next Generation ACO Model that provides more attractive opportunities for advanced-risk programs. The model provides greater risk and reward and flexible payment options including capitation. Additionally, participants can financially incentivize beneficiaries to seek care at affiliated providers outside of ACO.

Summary of Medicare ACO Models

Pioneer ACO Shared Savings Program1 Next Generation ACO

Summary Medicare pilot group of advanced risk-taking

organizations

Group of providers contractually united with

Medicare to control costs for FFS2 beneficiaries

Advanced model focused on coordinating care for an entire

population

Potential Participants

Advanced risk hospitals and providers Hospitals, providers, suppliers Advanced risk hospitals and

providers

Approx. # of ACOs detapicitna 02-51 004> )23 ylremrof( 91

Beneficiary Requirements

≥15,000 Medicare FFS beneficiaries

≥5,000 Medicare FFS beneficiaries

≥10,000 Medicare FFS beneficiaries

Financial Risk High Moderate; option for greater risk

High; flexible (ranging from FFS to capitation)

1 2 3 4

Typical Accountable Care Payment Cycle

Assignment: Patients assigned to ACO based on terms of contract

Billing: Providers bill normally, payers pay standard fee-for-service payment

Comparison: Total cost of care for assigned patients compared to target

Shared Savings: Payer levies payment or penalty based on how expenditures compare to target

Main ACO Constituents

Patients

Providers Payers

Imaging Performance Partnership

©2016 The Advisory Board Company advisory.com

May 2016 May 2016 1)1) MSSMSSPP participants are eligible to participate in two other participants are eligible to participate in two other ACO programs:ACO programs: ACO Investment ACO Investment

Model andModel and Advanced PaymentAdvanced Payment ACO Model ACO Model Source:Source: Accountable Care Organizations (ACOs), CMS.gov; Accountable Care Organizations (ACOs), CMS.gov;

How DoHow Do ACOs ACOs WWork? ork? AllAll ACOs assume accountability for the total costs of patient care and therefore require ACOs assume accountability for the total costs of patient care and therefore require a unique level of coordination between providers and payers.a unique level of coordination between providers and payers. These unprecedented These unprecedented interactions requires closer communication to care for patients and to complete the billing interactions requires closer communication to care for patients and to complete the billing and reimbursement cycles. Under the Medicare Shared Savings Program (MSSP), by far and reimbursement cycles. Under the Medicare Shared Savings Program (MSSP), by far the most popular Medicarethe most popular Medicare ACO arrangement,ACO arrangement, ACOs that keep per-beneficiary Medicare ACOs that keep per-beneficiary Medicare expenditures below benchmarks based onexpenditures below benchmarks based on ACO-specific historical patient demand for ACO-specific historical patient demand for services are eligible to receive a portion of the savings. services are eligible to receive a portion of the savings.

Based on PioneerBased on Pioneer ACO Model and MSSACO Model and MSSPP experiences, Medicare developed the Next Generation experiences, Medicare developed the Next Generation ACO Model that ACO Model that provides more attractive opportunities for advanced-risk programs.provides more attractive opportunities for advanced-risk programs. The model provides greater risk and reward and The model provides greater risk and reward and flexible payment options including capitation.flexible payment options including capitation. AdditionallAdditionallyy, participants can financially incentivize beneficiaries to seek car, participants can financially incentivize beneficiaries to seek carat aat afffiliated providers outside offiliated providers outside offffiliated providers outside offf ACO. ACO.

Summary of MedicareSummary of Medicare ACO ModelsACO Models

PioneerPioneer ACOACO Shared Savings ProgramShared Savings Program11 Next GenerationNext Generation ACO ACO

Summary Summary Medicare pilot group of Medicare pilot group of advanced risk-taking advanced risk-taking

organizations organizations

Group of providers Group of providers contractually united with contractually united with

Medicare to control costs for Medicare to control costs for FFSFFS22 beneficiaries beneficiaries

Advanced model focused on Advanced model focused on coordinating care for an entire coordinating care for an entire

population population

Potential Potential Participants Participants

Advanced risk hospitals and Advanced risk hospitals and providers providers Hospitals, providers, suppliers Hospitals, providers, suppliers Advanced risk hospitals and Advanced risk hospitals and

providers providers

Approx. # of Approx. # of ACOs ACOs ddeettaappiicciittnnaa0022--5511000044>>))2233yyllrreemmrrooffoofoo((9911

Beneficiary Beneficiary Requirements Requirements

≥≥15,000 Medicare FFS 15,000 Medicare FFS beneficiaries beneficiaries

≥≥5,000 Medicare FFS 5,000 Medicare FFS beneficiaries beneficiaries

≥≥10,000 Medicare FFS 10,000 Medicare FFS beneficiaries beneficiaries

Financial Risk Financial Risk High High Moderate; option for greater Moderate; option for greater risk risk

High; flexible (ranging from High; flexible (ranging from FFS to capitation) FFS to capitation)

1 1 1 2 2 2 3 3 3 4 4 4

TTypicalypicalTTypicalTT Accountable Care Payment Cycle Accountable Care Payment Cycle

Assignment: Assignment: Assignment: Assignment: Patients Patients assigned toassigned to ACO based ACO based on terms of contracton terms of contract

Billing: Billing: Billing: Billing: Providers bill Providers bill normallnormallyy, payers pay , payers pay standard fee-for-service standard fee-for-service payment payment

Comparison: Comparison: Comparison: Comparison: TTotal cost of otal cost of TTotal cost of TTcare for assigned patients care for assigned patients compared to target compared to target

Shared Savings: Shared Savings: Shared Savings: Shared Savings: Payer Payer levies payment or penalty levies payment or penalty based on how expenditures based on how expenditures compare to target compare to target

MainMain ACO Constituents ACO Constituents

Patients Patients

ProvidersProviders Payers Payers

Imaging Performance Partnership Imaging Performance Partnership

©2016 The Advisory Board Company advisory.com

May 2016

Imaging Performance Partnership

Accountable Care Organizations

Health Care Hot Topic Cheat Sheets for Imaging Leaders

Why Are ACOs a Key Issue for Imaging? • Possesses growing popularity: ACOs, both private and public,

are ubiquitous, with at least one ACO in 89% of hospital referral regions and one-in-ten Medicare beneficiaries attributed to an ACO. The model popularity only continues to grow, with more than 120 new ACOs forming in 2014 alone.

• Threatens referral patterns: Providers involved in ACOs seek referral partners to help deliver on ACO goals. Imaging providers delivering high-value care will win referrals, regardless of established patterns, meaning becoming the preferred imaging provider will be increasingly difficult.

• Creates cost-conscious referring providers: Accountability for patient costs commonly results in ACO providers acting as gate- keepers for patient care. Imaging is particularly susceptible due to clear price discrepancy of imaging exams by sites of care without well-defined quality differences.

• Prioritizes utilization management: To control total cost of care, ACO providers must focus on providing only necessary, cost-effective, high-quality care across the continuum. Imaging provides a clear opportunity for utilization management (UM), as many organizations already participate in national imaging UM initiatives such as Choosing Wisely and Image Gently.

Number of Public and Private ACOs As of January 2015

2011 2012 2013 2014 2015

64 174

447

621 744

How Can Imaging Leaders Prepare for ACOs? • Engage in conversation: Learn if your organization, partner hospitals, or referring providers participate in ACOs. While

typically centered around primary care, ACOs impact specialty services. Imaging leaders must proactively engage with ACOs to demonstrate value and prevent exclusion.

• Position imaging as care partner: Providers involved in ACOs seek specialists that can act as care partners. For imaging, this means ACO referring providers will choose imaging providers that do more than simply read exams. Imaging providers available for consultations, monitoring unnecessary utilization, and delivering seamless patient access—all of which help referring providers achieve their ACO goals—will win referrals.

• Leverage imaging screening programs: Screening services detect diseases early, resulting in improved patient outcomes and reduced total cost of care. Screening is a key area where the goals of imaging and ACOs seamlessly align. Collaborate with ACOs for imaging screening services, such as breast cancer and lung cancer screening, to both grow imaging screening program volumes and manage the health of the ACO population.

Source: Accountable Care Organizations (ACOs), CMS.gov; Imaging Performance Partnership research and analysis.

Educational Briefing for Imaging Leaders

What is an Accountable Care Organization (ACO)? Groups of providers may form Accountable Care Organizations (ACOs) that assume responsibility for the cost and quality of care delivered to a population of beneficiaries. Comprised of one or more providers (physician groups, hospitals) and a payer (Medicare, private insurers), ACOs receive shared savings bonuses—along with traditional fee-for-service payments—for lowering costs and increasing quality of care for their assigned patients. Four types of ACO arrangements exist. Pioneer ACOs, Medicare Shared Savings Program (MSSP) ACOs, and Advanced Payment ACOs are three types of Medicare arrangements with standardized cost and quality incentives. Private ACOs are varying arrangements between providers and commercial insurers.

Provides high-level summary of topic

Explains what the topic means for imaging

Off ers strategic guidance for how imaging can adapt to meet new market demands

Describes how the topic is manifesting in the market, so you can confi dently approach conversations

Translating Health Care Trends for Imaging Sample Excerpt

Page 4: Health Care Hot Topic Cheat Sheets - Advisory...Introducing the Health Care Hot Topic Cheat Sheets 10 ways to use cheat sheets: 1. Prepare for internal meetings about your organization’s

2445 M Street NW, Washington DC 20037P 202.266.5600 | F 202.266.5700

advisory.com

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Health Care Hot Topic Cheat SheetsAvailable Online

More available in this series:

Care Delivery Transformation

• Accountable Care Organizations

• Patient Centered Medical Homes

• Population Health Management

Payment Innovation

• Bundled Payments

• Physician Pay-for-Performance

• Hospital Pay-for-Performance

Quality

• Radiation Dose Management

• Peer Review

• Pediatric Imaging

Market Trends

• Patient Consumerism

• Imaging Enterprise IT

• Imaging Screening Programs

• Digital Breast Tomosynthesis

• Health Care Mergers and Acquisitions

• Hospital-Radiology Alignment Models

• Health Insurance Exchanges

Policy Updates

• Clinical Decision Support

• Site-Neutral Payment

• X-ray Reimbursement Reductions

• Two-Midnight Rule

• Meaningful Use

Interested in learning more?

Each cheat sheet will link to additional resources from the Imaging Performance Partnership, such as benchmarks, webconferences, tools, blog posts, and best practice studies on related topics.

Visit us at: advisory.com/ipp/cheatsheets

Questions? Contact Sruti Nataraja at: [email protected] or 202.266.5890

READING TIME

5 min.