Wednesday, April 19, 2017

Credentialing Made Easier for Medicaid Providers in Texas

This article was originally posted on Texas Dentists for Medicaid Reform

New Legislation

In Texas, private health plans or managed care organizations (MCOs) manage the Medicaid program for the State. The State began transitioning to this approach, called the managed care model, in recent years as an alternative to the former costly and inefficient fee-for-service (FFS) model. The managed care private-market approach drives innovation through flexibility and competition, reduces health care costs, and holds Medicaid health plans accountable for providing access to quality care. It has saved the State and Texas taxpayers $4 billion over a six-year period and is expected to save another $3 billion or more by 2018.

Through this process, MCOs gather and assess background information on health care providers in an effort to confirm the provider is in good standing, ensure patient safety, and prevent fraud, waste and abuse. As it stands, each MCO gathers this background information from providers separately and with varying deadlines, requiring providers to submit and re-submit their information to all 20 Medicaid health plans individually and at different times.

Recently, Texas Medicaid health plans brainstormed on how to simplify this process for physicians and providers and make Medicaid a more welcoming program for quality providers to participate in and provide care to Texas patients. The health plans proposed a statewide CVO concept, which was endorsed during the 84th Texas Legislature in SB 200. The bill establishes a way for Texas to streamline the Medicaid provider credentialing process.

How Does The New Process Work?  

First, there will be a single source for all credentialing information. That means that if a physician or provider in an area of the state wishes to participate in the network of several health plans in that area then the provider information need only be collected once and is then shared with all of the plans.

Second, the Texas Medicaid health plans elected to adopt a single re-credentialing date. That means that when a physician must be re-credentialed, generally a process that occurs every three years, the doctor will be re-credentialed once for all of the participating plans.

The project implementation will begin immediately with  statewide operations expected to begin October 2017.

Monday, April 10, 2017

(Podcast) How Will MIPS and MACRA Affect Patient Satisfaction?

Join our host, Brad Weeks, Director of Performance Improvement and Research at HealthStream, as we share insights from some of the most respected leaders and experts in the healthcare industry.

In Episode 1, Brad interviews Dr. Miles Snowden, the Chief Medical Officer at TeamHealth. Dr. Snowden shares his personal insight on the Medicare Access and CHIP Reauthorization Act (MACRA), and what it means for physicians, hospitals, and consumers.

Below is a short excerpt from the recording with HealthStream’s Brad Weeks, our host:


What do you see as the impact [of MIPS and MACRA] on the patient experience…?

Dr. Snowden:

I am not at all certain that patient satisfaction with care will be improved. And, I think there is a reasonable argument to be made that satisfaction may diminish a bit under MIPS and MACRA. The quality metrics are very narrow, and they result in a very narrow focus. Patients like a very holistic engagement with their physician, a sense of taking care of the whole person or the whole family or the whole home. And these quality measures are not developed with a holistic approach nor could they be frankly at this point in time because how do you report them, in scale, at scale? So the narrowness of the quality measures are inconsistent with the holistic relationship that patients seek for full satisfaction.

So I don't think patient satisfaction will be improved, and it may be diminished, as a result of MIPS. On the other hand, most physicians will tell you some of the least satisfied patients have the best clinical outcomes and vice versa. And that probably holds true here as well. So while patient satisfaction probably won't be significantly improved under the program, clinical outcomes particularly longer term clinical outcomes, I suspect, will be improved.
For the next two or three years, there aren't going to be many patients that are thankful for the promulgation of the final rule for MACRA. Over the next decade or so, I think people will be able to point back and say, "Outcomes, particularly amongst chronic illnesses, did get impacted favorably."


We’ve talked a lot about potentially dire consequences to MIPS reporting and MACRA. What’s the upside?

Dr. Snowden:

It's easy to take a glass half empty approach to MIPS and MACRA, as a physician myself who is in the latter half rather than the first half of my career. I don't feel that way, and I don't see that amongst the physicians who make up our 19,000 clinicians. I see for the most part physicians who are energized and enthusiastic about their practice. I see physicians who generally are comfortable with the use of EMRs now, who are comfortable with being measured against peers, who are comfortable with being required to improve quality outcomes overtime, who are comfortable with supervising advanced practice clinicians, etc.

The physicians who are vocal about being unhappy with the practice of medicine either recently or certainly will be under the new MIPS burdens are generally those who frankly will be gone, with this change. They are in that half of the physician population in the US, 440,000 or so physicians in little groups, or older physicians who probably will look for opportunities to depart. Now that's not a good thing because of course these are highly experienced physicians, they will be terribly hard to replace. But when you think about the remaining physician workforce, these are younger physicians who never knew what it was like to practice medicine in the 80s and 90s. They don't have the context of the older physician who is bemoaning the loss or the way practice of medicine used to be. If you don't have the context of what the practice of medicine used to be, you don't miss it.

I think we have a generation of physicians who are actually very comfortable with more regulated, more peer comparison based practice of medicine. I like that. I think that having more of a team-based approach to healthcare, more of a collaboration based approach, more of a willingness to accept measurement against peer, is bound to improve the quality of medicine over time. And as we migrate to a generation of physicians who are comfortable with technology and EMRs and don't know how to use a pen on a paper chart, we'll see that general group satisfaction rise. And with that, outcomes and patient satisfaction should rise similarly.

Listen to the full podcast here.