Returning guest, Vanessa Rose Bisceglie, discusses the new law changes within MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and how physicians can stay in compliance and earn the highest bonus in their medicare payment. She also discusses the telehealth care management services that they offer that assists patients between office visits.
Vanessa is highly specialized in Cybersecurity, Care Management, Ambulatory Healthcare IT and MACRA/ Quality Payment Program which has two pathways: MIPS and APM where she guides her team of consultants and care managers to assist providers in their transition to value-based care and performs Security Risk Analysis for over 100+ clients in the last 10 years. These are all the main focus areas of CareVitality. She founded CareVitality to help providers transform their practices by optimizing their existing technology and provides additional care teams to improve patient outcomes and generate additional revenue to their practice while staying focused what truly matters to providers which is providing patient care. CareVitality continues to offer cybersecurity support many of their clients nationally as well.
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us here on this Health Supplier Segment with returning guest, Vanessa Rose Bisceglie. She’s joining us here once again from CareVitality and she’s going to talk about some of the new changes with the MACRA or Medicare Access and Chip Reauthorization Act of 2015 and how doctors can stay in compliance thereby earning the highest bonus in their Medicare payments. She’ll also going to talk about services that are offered at CareVitality, specifically telehealthcare management. Welcome back to the program Vanessa, how have you been?
Vanessa Rose Bisceglie: I’ve been terrific, thanks for having me back Neal. I appreciate it.
Neal: Great. Well for our listeners who may not be familiar with you when you were here before, it give us a brief background about yourself and tell us who Vanessa Rose Bisceglie is.
Vanessa: Oh great. Hi, my name is Vanessa Biscegli. I’m the President and CEO of CareVitality, a subsidiary of our parent company EMR and practice management consultancy, we’ve been in business for 10 years. My background and leading the organization is I have a clinical IT, legal, business and compliance background. So prior to starting this organization 10 years ago, I’ve worked in medical clinics, been admitted to medical school, went to law school … physicians and I worked for a series of health IT vendors mainly focused in the ambulatory space where I helped implement and solve the practice management revenue cycle management systems and their electronic health records. Then starting in 2009 right before the Stimulus Act came out where it was basically mandating all providers to have to go on electronic health record, I started a consultancy to help all providers in sort of specific systems. We can work on over 150 different systems, I myself have today that has given us the knowledge to help people hit those goals that they had to with the prior law which is called Meaningful Use so they didn’t get decremented in their pay and that they adopted electronic health records. And then in 2015, we created a subsidiary CareVitality which helps in the new transition to the new law which is called MACRA about all providers are now aware of, it actually was announced in 2015 at the same time that a lot of the telehealth codes such as chronic care management were released because what it does is it takes the prior requirements for what was Meaningful Use which was usability on the electronic health record systems and it adds, helping improve the patient outcome. So now because all the providers have their data pretty much on an electronic health record, the government knows that you can report on how well the patients are doing with specific conditions. So they added the care management codes to that to help pay for that time that providers are spending but it’s really not specific for providers, it’s specific for care teams working with patients in between office visits and when their transitional care management codes for when they’re leaving the ER so that the patients can stay hopefully healthier or maintain their health in their homes instead of returning to the ER, getting rehospitalized, being readmitted. So what they found out is by paying for these codes which are between 40 and 50 dollars for the chronic care management codes, it saves a heck of a lot of money in the long term, thousands and thousands of dollars by helping, keeping people out of hospital. So people don’t want to be in hospitals, they don’t have to be, right, and to helping maintain and monitor their health in their home which is everyone would prefer and helping them learn how to manage their chronic condition better.
Neal: That’s quite an added bit of responsibility on the shoulders of the healthcare provider. Now in keeping in compliance with all of that data, all of that input, all of that cross-referencing in return for that, they’re reimbursed at a higher or lower rate based on their compliance and that’s where CareVitality comes in, in helping them achieve that compliance. Am I right?
Vanessa: Yeah. So let’s explain, so now we’re going to talk about new changes in the law, so we’re walking into 2019 today and every year, the government or CMS increases what they have to do in regards to be compliant. So when the prior years, when they introduced the new law, it was introduced in 2015 but it went into effect in 2017. So payments providers on a lot of it was primarily based on how successful their patients were performing based on the care that was given and another 25% was usability on the electronic health record was at 4% this last year which I’m finishing a testing client for that’s due tomorrow but Medicare’s deadline which is a 5% impact on their pay so they can either get incremented or decremented by 5% of their pay based on adhering to what the requirements are for the law this coming year now 2019 at 7% of their pay. So they’re their traditional Medicare payments can be impacted by plus or minus 7% if they are a qualifying provider and the next year will be 9% so in it’s going on the program through 2026 so is we got quite a while that it’s going to be here and who knows that they’ll put out next but what we can talk about as some new changes which is helpful so you can understand how we can be of help or understand what providers need to understand to move forward in 2019 is that in the quality outcomes, what they’ve been doing is there’s four sections. So the first section is quality and where the providers have to submit at least six quality outcome measures that they feel are a good performance measures for them to be met on. But some performance measures have been around for a while now and some of the providers are all doing terrific on it so they call them ‘topped out.’ So providers need to look at when they’re deciding which measures to choose for 2019 which are topped out because they won’t be able to get their full ten points on those because everyone’s doing well, the government lowers the ability to score maybe seven out of ten points and no one can get higher. The other thing to know about the measures in 2019 is there has been some new measures added, some taken away so you should all check to make sure that the measures you chose in the previous years are there. There’s a lot of measures now stemming for opiates, so you know how we’re trying to decrease the opiate addiction rates in this country, so a lot of my pain management clients for instance are starting to look at the new opiate measures to seek those might be much better measures for them to meet than primary care measures that are really not specific to them so there’s more specialty specific measures. I think if you’re a pain management, looking at the new opiate measures are good to take in account because you might be able to shine in those areas. And then the other thing which we do is when someone comes to us we help them strategically understand which are the best measures, which ones are based on their type of practice. We might help them, if your specialty specifics, a lot of these vendors today only pull primary care for you to submit so we can help match you with a registry that might actually be able to submit your specialty specific measures if your EHR vendor cannot. So that’s kind of three areas to think about depending on if your primary care is specialty, that all specialty can do all three points or a good primary care by the first point I discussed.
Neal: Well if I’m understanding correctly it’s basically even if you’re specialized, even more focused your strategies thereby I guess reducing, for lack of a better term, the liability when it comes to getting your reimbursements based on all the other things that you’ve got to deal with where you come in and say “Hey this is a whole area that you shouldn’t even have to deal with.” Taking that liability away from that plus/minus seven percent.
Vanessa: Well they still have to deal with it but I think what happens is a lot of providers may not always be submitting their best measures and I think the specialists don’t always realize that there are registries available that they can use beyond their vendor that will just focus on their specialty specific measures. So that’s even better because sometimes the vendors like “Oh we don’t do that measure, this measure, that measure.” And their score is not really good because it’s a primary care driven measures they’re submitting on their behalf, their EHR vendors. So when I come in I say “Okay, these are the best ones. Let’s talk as a team and figure out which ones you’re doing here and let’s narrow that down and then let me match you with the registry where you can submit the ones that you’re doing on a regular basis.” So that’s a very big, that’s the majority, a big bulk of their scores coming through these quality metrics and also these quality metrics and there’s four on how they’re doing incomplete is also which we’ve only gone through one section we’ll go through the other three sections quickly after this, but those sections of the full MACRA, the full score that they will be getting will be publicized on a provider compare report, that physician compare report that you and me and all patients can see how the doctor is performing. So this shows like they used to have for hospitals, they still do, where they can have star ratings. It’s going to be the ratings of the providers so that when people are choosing which provider they want to go to and it’s a cardiologist, they’re going to be able to go and check “Well let me compare this cardiologist’s success rates compared to another provider’s success rates and keeping their patients healthy.” The other area, so now this involves reputation, this type of new law, so it not only affects their finances but their reputation. Then promoting ‘interoperability’ which is the section that used to be very similar to ‘meaningful use’ that carried over a lot of the things that we helped providers on in the past. Now in 2019 has been focused and some of it has been changed because people have been doing those same measures for a long time that they’ve decided “Let’s narrow these measures down and focus them truly on interoperability.” So some of the measures that the providers have been doing in the past have been taken away because everyone’s been doing them pretty much successfully and they’re making them focus on interoperability so this means three pronged – interoperability with patients so communicating with patients through the portal and there’s three areas of the portal as folks know so it’s like secure messaging. Having them be able to view, download and transmit portions of their charts such as their note summary for the day or their labs and then enrolling patients in the portal. So now all three of those are mandatory, before just engaging them to join the portal was the mandatory one, now all three are. Then they’ve also expanded the registries, the registries which were prior and nice to have, now all are requirements. And then the other aspect is communicating from provider to provider, so those rates are, as well communicating so now what’s happening is there’s this thing called ‘care quality and care everywhere’ where people who are on Epic Systems or on care everywhere, care quality is another bulk of the industry which have all come together to communicate electronically between EHRs. So now it’s enabling more of that connectivity and communicating with providers outside of the office electronically through an information exchange. So what we do here is we work with practices on these areas to help them improve those areas.
Neal: You offer a full range, a wide spectrum of telehealthcare management services. Where can we go online and get much more information about CareVitality and the services that you offer?
Vanessa: Yes, so the services that we offer with regards to telehealth is with regards to the improvement activities which also improves the quality metrics which we were discussing earlier. So that’s where we come on board for clinics that need additional support that can bill for these codes and they still keep a profit but they augment their team and they supplement their team with us where we provide the nursing support to manage and monitor the outcomes when the patients actually leave the office so we do that through chronic care management, we do that through transitional care management and we also help improve and increase their wellness visits which has also become a big thing. So we do about 80 to 90% of the visit telephonically, they can be done non face to face where actually the rest of the wellness visits gets finished off in the office and the provider can bill for that extra income. So that all helps improve their score that they have to submit at the end of the year which directly affects their positive 7%, hopefully bonus we can get those clients up too by working with us from a consultancy effort on the new law and helping them understand what has to be done in 2019 as well as taking it to the next level where CMS wanted to be was providing additional support outside the office. So if anyone has interest in having us help in those areas or help them understand those deeper or the new portions of the law or providing additional care support to bill those codes, they can find us at carevitality.com or they can contact us at 800 376 021 12 and my name is Vanessa Rose Bisceglie and a short email to me would be firstname.lastname@example.org. We’re here to help now and in the future. We’ve been here for 10 years and we’re very successful and we’re backed by organizations such as the AMA, the AOA, several state medical societies, EHR vendors partner with us. We have over 30 partners that promote us for helping in these areas.
Neal: Thank you for coming back and joining us on the program Vanessa, always a pleasure and always great to hear about the good things that you’re doing there at CareVitality. Thanks for joining us today.
Vanessa: Thank you very much.
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