N Ph i i P id on-Physician Providers - s3.gi.org

20 Pages·2014·1.59 MB·English

Colleen M. Schmitt, MD, MHS, FASGE
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NNon-PPhhysiiciian PProviidders
Colleen M. Schmitt, MD, MHS, FACG, FASGE
Galen Medical Group
Chattanooga, TN
[email protected]
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 1
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 To define the stepps to developp ancillaryy
infusion and histopathology services
 To recognize the regulatory challenges to
ancillary service provision
 To understand how NPP can add value to
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 To describe how integrating NPP into
practice can impact delivery of care
 Infusion  Laboratory*
 Pathology  Imaging *
 Anesthesia  Research *
 Weight loss clinic  Drug dispensing*
””WWee hhaavvee ddeeeepp ddeepptthh.””
--Lawrence Peter Berra
* Especially if Multi-specialty group
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 2
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 Practice integration
 Coordinated clinical pathways
 Improved communication between specialists
 Control of data, quality, costs bundle
 Decreased costs and increased convenience for
patient in a familiar and comfortable setting
 PPaattiieenntt aaddhheerreennccee
 Opportunity for patient interaction and
education
 Standard of care at point of service
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 3
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
Equipment Quantity Cost
IInffusiion chhaiir 2 $$3,000
Infusion pump 2 $3,400
BP monitor 1 $1,500
Updateoffice space $2,500
Entertainment $1,500
Misc.supplies $1,500
--IV catheters,, tubingg,, extension sets
--IV poles
--locked refrigerator
--stocked crash cart
--medications
Total start up costs $13,400
 Staff  Check state licensure
 Salary, benefits limitations for medication
 RN, NP, PA infusion
 Rent
 Other support staff
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 4
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
BUY AND BILL ASSIGNMENT
 EEssttaabblliisshh aaccccoouunntt wwiitthh  CCoovveerreedd uunnddeerr RRxx ddrruugg ppllaann
wholesaler for specialty Rx  Requires preauthorization
 Purchase Rx from vendor  Specialty pharmacy ships
 Bill patient’s insurance plan specific doses for patient
 Specialty pharmacy verifies
insurance information and
bills copayment
Examine individual prescription drug policies and procedures
Research various vendors to verify most competitive prices
Guarantee availability
CPT Descriptor Examples Payment
96360 Hydration 1sthour NS $58.51
96361 Hydrationadditional hour NS $15.31
96413 1sthour infusion Anti-TNF $143.22
96415 Each addition hour infusion Anti-TNF $30.62
96374 IV push, single drug Prednisone $57.50
DDiipphheennhhyyddrraammiinnee
H2 Blocker
96375 Additional sequential IV push of new drug Above $22.46
96401 Chemo admin, SQ or IM Methotrexate $75.87
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 5
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 Singgle denial = thousands of dollars
 Manage with infrastructure
 Preauthorization
 Pay staff by service rather than hourly
 Ensure no practice “tax” on drug
Only one initial code in the drug administration
family; all other codes must use a subsequent code
All supplies are included and cannot be billed
separately
 local anesthesia; IV start; access to indwelling IV, SQ
catheter/port, flushes; standard tubing, syringes
BBiillll ffoorr ddrruugg wwaassttaaggee aass ppeerr ccoonnttrraacctt ((-JJWW mmooddiiffiieerr))
Bill E/M service if patient has separate, identifiable
problem that requires this (-25 modifier is suggested)
Includes nursing visit
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 6
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 Start-upp costs 55770 s.f. lab $110,,000
 Histology technician $23.35/hr
 Lab manager, Director $36,000/yr
 Rent $41,700/yr
 Supplies $25,560/yr
52% reduction in 2013 Medicare Fee Schedule for
Level IV path CPT 88305 Technical Component (TC)
Increase in Professional Component (PC) by 2%
Overall 33% decrease in Global
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 7
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 Local ggroupp versus outside
 Hiring issues
 Part of team
 Desirable lifestyle
 Per unit payment
 Assume ~ 60 specimens per day or more
CPT Descriptor PC TC Global
88305 Level IVPath $36.74 $33.34 $70.09
88312 H. Pylori $26.54 $71.11 $97.65
88313 Iron $11.91 $55.80 $67.71
8888334422 IImmmmuunnoohhiissttoocchheemmiissttrryy $$4422.1199 $$7733.1155 $$111155.3344
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 8
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 Propposed TC 8833055 cut of 77%
 Proposed limit to practice expense payments
used to calculate the technical component
(TC) of pathology services to the lesser of the
amount paid at either the hospital outpatient
aammoouunntt oorr aammbbuullaattoorryy ssuurrggeerryy cceenntteerr
payment rate
 PC cut 1-2%
 Volume-based billing
 In-Office ancillary services exception (Stark)
 H.R. 2914, the Promoting Integrity in Medicare Act of
2013
 Offset by Appropriate Use Criteria
 Anti-markup payment limitation
 Oversight requirements
 LLiicceennssee aanndd cceerrttiiffiiccaattiioonn;; aaccccrreeddiittaattiioonn
 Liability
 Further payment cuts
 Decision support tools
ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 9
Copyright 2014 American College of Gastroenterology
Colleen M. Schmitt, MD, MHS, FASGE
 Our biopsy “behavior” did not change before and
affter we estabblliishhedd llabb or bby siite off serviice
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ACG Board of Governors/ASGE Best Practices Course - Las Vegas, NV 10
Copyright 2014 American College of Gastroenterology