Practice Top 5

The AAN understands you face many complex practice issues. To help you on your way to mastering such matters, we've boiled each topic down to the Top 5 things you need to understand. Each list includes links to more in-depth background material and resources to further your knowledge.

Top 5: Key Facts about Interoperabilty

  1. Interoperability is the ability of your electronic health record (EHR) to exchange data with other data systems such as other EHRs or registries, and view the data within your EHR.  Interoperability is needed for providers to view all the care delivered to a patient across sites and settings. Interoperability decreases duplicate testing, and provides a longitudinal view of the patient’s care, saving money and time for both providers and patients and potentially increasing safety and quality of care. Manually scanning documents into your EHR that are faxed from another site is not true interoperability!
  2. The Federal Government is revising the purpose of the Meaningful Use program to focus on Promoting Interoperability. More details available from CMS.
  3. There are technical barriers to interoperability. Considerable work or configuration may be required at both the transmitting EHR and the receiving EHR. In addition, because the United States does not use a national patient identifier, matching patient records across data systems depends on matching demographic fields (i.e., name, date of birth) that may not always be accurate.
  4. Some EHRs charge fees for exchanging data and require additional licenses or modifications to your EHR contract. Please check with your EHR vendor for additional information. The AAN continues to advocate for legislation that supports the free exchange of data between vendors. 
  5. While a connection can be built from your site to another specific site, it can also be done between your site and national/state/regional health information exchanges (HIEs) or data frameworks (such as Carequality and CommonWell), enabling access to much more information.  A number of third party vendors also offer products and services to enhance EHRs interoperability features.

Top 5: Tips to Improve Patient Access

  1. Refer to your EHR vendor's manual or support services to automate processes such as flagging open slots and cancellations.
  2. Consider an advanced access/open-scheduling model to allow for a certain amount of same-day or next-day appointments. Test the model with a single provider as a trial.
  3. Tailor any increase in dedicated visit slots to match a specific demand. For example, increase the number of reserved new-patient appointment slots.
  4. Implement strategies to accommodate for or reduce no-shows. Consider strategic overbooking for patients with past "no-show" visits, use technology to remind patients of appointments, or reduce lead time by scheduling appointments no more than six months in advance.
  5. Ensure scheduling policies make efforts to maintain provider-patient continuity of care in group practices.

Top 5: Things to Know About Advancing Care Information (ACI) Category of MIPS

  1. Ensure you meet all ACI base score measures, which are mandatory, to avoid receiving an overall ACI score of zero.
  2. Choose your measure set carefully to ensure you earn the highest score possible.
  3. Earn 10 ACI bonus points by using CEHRT to implement at least one qualifying Improvement Activity (see slide 23).
  4. Enroll in the AAN Axon Registry® to earn five ACI bonus points, as well as fulfill other Improvement Activities measures.
  5. Report on all ACI performance score measures to take advantage of partial credit. You do not need to score maximally on all performance measures to achieve the maximum overall ACI score.

Top 5: Ways to Be Successful in the Cost Category of MIPS

  1. Learn more about the measures used in this category.
  2. Review your Field Test Report (or mock report, if not available) in your EIDM Portal.
  3. Verify that you are coding specifically to improve Hierarchical Condition Category/Risk Adjustment Factor.
  4. Ensure that your specialty is accurate by looking at Physician Compare.
  5. Check whether your patients have Primary Care Physicians.

Top 5: Reasons You Should Complete the Neurology Compensation and Productivity Survey

  1. Determine if you are being paid fairly relative to your peers based on your sub-specialty, region, and practice type.
  2. Use the data in contracting with payers and demonstrating your value.
  3. Understand where you excel and where you can improve practice inefficiencies.
  4. Benchmark your progress compared to peers in the transition to value-based payments.
  5. Receive the report and access to the customizable results dashboard in July for free ($600 value)!

Top 5: Critical Monthly EHR Reports for Neurology Administrators

  1. Review your total charges monthly and be able to explain both positive and negative fluctuations.
  2. On a monthly basis, monitor your adjusted collection ratio (collections + adjustments + write-offs) as a percent of charges, which should hover in the 95% range for efficient practices.
  3. Track how many days in A/R that you carry; efficient practices should keep this number to around 30 days. Also, monitor what percent of your A/R is 90 days or older.
  4. Scrutinize your monthly total patient volume in your clinic and ancillary services provided by your practice.
  5. Track your third available date for a next new-patient visit slot on a monthly basis. If it is more than three weeks from today, you may be losing referrals and your no-show rate will rise accordingly.

Top 5: Considerations for Incorporating Telemedicine into Your Practice

  1. Is there a needed service that you can provide remotely?
    1. Cover remote hospitals for telestroke, tele-EEG, tele-ICU, emergency, or routine neurology consultations
    2. Expand your services to outpatient clinics to provide remote neurologic consultations
    3. Provide more continuous care for your existing patients who may be immobile or remote.
  2. Are you meeting all necessary requirements to provide those services?
    1. Know what the state-specific rules and regulations are regarding the practice of medicine in your chosen remote locations
    2. Ensure you are licensed to practice medicine in those states
    3. Ensure that your malpractice insurance covers telemedicine practice in that state
  3. How will interruptions in care be handled?
    1. Interruptions in service or technical issues
    2. Staff vacations
    3. Service line agreements
  4. Do you have the appropriate technology in place to provide these services?
    1. Secure, uninterrupted connectivity
    2. HIPAA compliant
  5. Can you get reimbursed for these services?
    1. As part of an accountable care organization or alternative payment model
    2. Medicare, Medicaid, and private insurance
    3. On a concierge or cash basis

Top 5: Strategies to Develop and Maintain Relationships with Payers

  1. Create and maintain a template that allows you to collect and organize key contact information for the payers with whom you contract.
  2. Develop a template letter to serve as an introduction to the payer before a specific issue arises.
  3. Set a goal to meet annually and in person with a medical director or other decision-maker from each payer on your list. Conference calls are an acceptable way to communicate and nurture an established relationship, but never underestimate the power of an in-person meeting as an opportunity for personal connection to build credibility and develop mutual trust.
  4. Effectively communicate by being prepared with all of the information ahead of time, speaking in a professional manner, avoiding inflammatory rhetoric, and listening. Review payer-specific policies and get to know the "buzzwords" used by the payer and their meanings to the payer (e.g., some payers automatically deny a claim when certain terminology is used).
  5.  Work with your state neurological or medical society to understand and address regional payer policies.

Top 5: Ways to Improve and Maintain Your Referral Network

  1. Proactively establish an identity for your practice by setting up a strong referral management program with a dedicated program liaison, if possible. Plan to personally visit key practices that serve as a referral source for you.
  2. Ensure your practice is running well and that patients receive an exceptional experience at your office and under your care. Develop analytics to track progress. Undersell and over perform.
  3. Know what information patients are seeing when they are searching online for qualified neurologists in your area. Google yourself and your practice. Develop a webpage for the practice and proactively control what patients see. Use social media responsibly and professionally to represent the practice.
  4. Become aware of how payers are rating you in their designation programs (e.g., stars). These programs use quality and cost designations to financially incentivize primary care physicians' referrals to offer lower co-pays to patients who choose to see designated physicians.
  5. Commit to providing a note back to the referring physician within 48 hours of seeing the patient.

Top 5: Ways for Solo or Small Practices to Remain Financially Sustainable Without Losing Their Identity

  1. Look for opportunities in your community or state to join forces with other practices in non-financially dependent entities.
  2. Align with other practices through an independent physician association (IPA). These often include primary care, though specialty-specific IPAs are developing (article starts on page 8).
  3. Join a management services organization (MSO) for greater support and more alignment. An MSO can help you with managed care contracting, quality reporting, and administrative support (article starts on page 20).
  4. Expand your referral base by joining additional health system physician networks.
  5. If independence is of primary importance and the current revenue system is untenable, then evaluate the concierge practice model.

Top 5: Tips to Ensure Your First Value-based Contract Is a Success

  1. Choose a payer with whom you have an established, positive relationship. Involve leaders-including both providers and administration-in the contract negotiations.
  2. Review evidence-based quality measures developed by the AAN to see if you can incorporate them into the contract.
  3. Consider what type of feedback reports you will need from the payer and articulate your preferred timeline for receiving the data.
  4. Invest in technology and other resources that help you to know your data and costs.
  5. Consider your market and outliers. Identify any areas for improvement and start there!

Top 5: Reasons You Should Sign at Least One Value-based Contract

  1. Get ahead of the curve and gain experience! In an attempt to pay for higher-quality, lower-cost care, Medicare and commercial payers are rapidly embracing a move to value-based reimbursement over current fee-for-services systems.
  2. The AAN has laid the groundwork. The Academy develops and disseminates evidence-based quality measures for neurologic diseases that can be used as a basis to negotiate value-based contracts.
  3. Showcase strong neurologist leadership and involvement. Your efforts to start the conversation do not go unnoticed. Think of the payer as a partner at the table collaborating on ways to get better care to patients at a lower cost.
  4. Open lines of communication with your payers. You can use the development and negotiation of a value-based contract to build trust and discover the types of payer data available to you.
  5. Learn about opportunities to improve the care you provide to your patients. It's important to start somewhere. Choose a topic with which you are comfortable and interested.

Top 5: Ways to Get into the Value Mindset

  1. In contract to traditional ways of thinking under fee-for-services payment systems, recognize that using services creates expense-rather than revenue-in risk arrangements.
  2. Accept that different incentives and new reporting structures are needed in order to set providers up for success in improving patient outcomes and reducing health care costs.
  3. Make care delivery a team sport! Everyone has an important role to play. Use advanced practice providers (e.g., NPs, PAs) to the top of their license. Learn how neurologists can function as a Medical Home Neighbor.
  4. Seek out evidence-based resources from the AAN (e.g., guidelines, quality measures, shared decision-making tools) and provide evidence-based services to all patients, regardless of payer agreements.
  5. Learn about new payment and care delivery models.

Top 5: Mistakes to Avoid when Joining an Accountable Care Organization (ACO)

  1. Signing a contract without reading it or getting your own legal review. Understand Physician Employment Agreements Under ACO.
  2. Failing to understand both the financial obligations and reimbursements. Access AMA ACO Resources.
  3. Underestimating the demand for clinical information exchange. Familiarize yourself with best practices for using technology to support success in an ACO.
  4. Relying on non-neurologists to serve on the leadership and quality committees. Participate to ensure the specialist perspective is considered.
  5. Joining without considering an exit strategy. Read more questions to consider when talking to an ACO.