Medicaid Unwinding: AAP Resources for Preserving Medicaid and CHIP Coverage

A policy that kept individuals continuously enrolled in Medicaid during the COVID-19 public health emergency (PHE) will end on March 31, 2023.

Over the next 14 months, states must check whether every person currently enrolled in Medicaid is still eligible, then either renew or terminate that person’s coverage; starting April 1, 2023, states may begin disenrolling individuals who are no longer eligible for Medicaid. Those families who are no longer eligible for Medicaid may lose their coverage and/or be moved to other forms of coverage, like CHIP or the marketplace. This process of redetermining the eligibility of all 90 million Americans enrolled in Medicaid is being called the “unwinding.”

The AAP has a suite of resources to help members, patients, and families understand and navigate the Medicaid Unwinding.

See the resources here.

10 Tips to Enhance Small Healthcare Practice Profit

via Ballast Consulting Group


Managing a healthcare practice can be an incredibly difficult challenge in the current environment.

Practices face headwinds regarding labor shortage pressures, increase costs, and ‘the new normal’ for patient volumes and fluctuations. To make matters worse, large payers are often unwilling to increase claim reimbursements to account for these challenges, meaning practices must make more with less.

The need for improved operational finance within small-to-medium-sized healthcare practices is more essential than ever; finance leaders must provide financial visibility to make the necessary improvements to keep the practice growing and profitable. Here are 10 simple changes your finance team can implement to improve your practice’s bottom line, without sacrificing staff morale or quality care:

  1. Review claim amount and revenue collected per visit monthly to ensure maximum value earned per encounter. Your finance team should consistently review the total amounts billed each month, and what is subsequently collected from insurance to identify deviations from historical and expected data.
    • Is the average E&M code per encounter going up or down, and why? Are you seeing a different mix of patient visit types and what is driving it? Is the profit per patient visit increasing or decreasing?
    • Monitoring charges and collections per visit ensures that payer’s contracted rates are being paid and give an accurate breakdown of patients per payer, which can be helpful for future payer negotiations.
    • Monitoring the time lapse between claim creation and full payment (time in accounts receivables) is helpful for a variety of reasons, including alerting the practice of payer issues or disputes, and cash flow planning. Understanding your accounts receivables can be helpful in securing lines of credit from a bank to ease cash availability.

Learn how Ballast measures and monitors billing data for healthcare clients.

  1. Review and report profit per patient visit. Determine the driving cost factors for a healthcare facility when the volume of patient visits change. On average, how much does your practice spend treating a patient, and how much does that vary depending on the nature of the visit? How does seasonality, and/or staffing pressures change your practice’s gross profits? Answers to these questions can help you do the following:

One Ballast client saved ~$250,000 a year in supply costs by negotiating pricing with its primary distributor of supplies.

    • Understand the impact of labor on your profit per visit and staff appropriately. How much does it cost the practice if providers see one less patient per hour? Practices need to understand the embedded costs of the provider compensation, as well as all the clinical staff costs and how much might be saved or is wasted if throughput (patients per staff-hour) fluctuates. Your finance team should routinely provide metrics to your leadership team on throughput, ideally on a provider-basis. This can be incredibly valuable information for your operations team when establishing schedules which:
      • Maximize revenue per provider hour
      • Reduce required provider hours to essential patient-care functions (ie. Hire scribes if excess provider time spent charting)
      • Provide sufficient capacity for quality care
      • Provide sufficient capacity for sustainable staff morale
      • Determine appropriate compensation/bonus plans for staff using objective data

Learn more here about how Ballast provides healthcare practices insights on labor efficiency by centralizing their ecosystem of data sources.

  1. Actively monitor and track inventory of supplies purchased and used. Efficient management of inventory on-hand can help a practice:
    • Understand how much inventory is used on patients rather than purchased (necessary to review true profit per patient visit)
    • Reduce practice investment in excess inventory to improve cash flow
    • Reduce costs of excess inventory related to unnecessary storage, spoilage or slippage
    • Creating an inventory management process is not as difficult or tedious of a task as one might expect.

Learn how Ballast helps healthcare practices implement and manage an efficient inventory management system.

  1. State revenues and expenses on a ‘modified accrual-basis’. Measuring and monitoring many of the previous items will be far more difficult to accomplish if your profit & loss doesn’t show you what occurs in the months that your revenues are earned, and expenses are incurred. Producing accrual-basis revenue for payer-based medical practices is challenging, here is how we approach:
    • Accounting for medical claims on an accrual basis
    • Accounting for supplies/inventory usage on an accrual basis
    • Accounting for labor/staff expenses on an accrual basis
  2. Build a financial forecast to measure the impact of key decisions. A financial forecast that is rooted in the historical data of the practice is imperative for understanding future trends.  Forecasting the next several months of revenues, expenses, and other impacts to cash flow, while predicting the next 2-3 years trends will ensure the practice’s Executive team a clear vision of the financial direction of the practice. The financial forecast should be a tool that leadership regularly reviews (monthly at a minimum), and use to scenario-plan new service offerings, hirings, new facility buildouts, etc.
  3. Create an annual plan and measure performance against the plan. Use the financial forecast as a tool to proactively manage the operations of your business. Simplifying the key goals to 3-4 of the most important will allow easier retrospective analysis and allow your team to better focus on just the essentials. Things to consider:
  4. Make your goals SMARTan example of a SMART goal for a healthcare practice might be:
    • “Increase patient visit volume in 2023 by 8% above 2022, of which 5% comes from new patients.”
    • “Improve profit margins by a minimum of 5% by reducing supply costs per visit”
  5. Determine the requirements to achieve those goals, and what roadblocks or risk factors stand in the way. What investments in sales & marketing does the practice need to make to grow visit volumes by 8%? Does the practice have sufficient staff capacity to handle that kind of increase? Break the achievement of those goals into smaller steps, set deadlines to achieve, and assign responsibility to a key individual for achievement (i.e.: “create a marketing budget to allocate spend by channel for 2023 by January – Head of Marketing’s responsibility”).
  6. Measure the upside and downside to achievement/failure of these goals. Use the financial forecast model to determine if the rewards outweigh the risks for attempting to accomplish the goals. What will happen to profit and cash flow if your practice achieves its goals? What will happen if you make the necessary investments, and the practice does not achieve the desired outcome? Forecasting these in advance can help the leadership team of a practice prioritize the objectives that provide the best risk-adjusted benefit to the practice.
  7. Use your accounting data ecosystem to track progress toward those goals. Just as a practitioner has regular ‘check-ups’ with his/her patients to monitor the patient’s health towards their desired outcomes, the executives of a healthcare practice should review the financial health of the practice in comparison to the goals set out by the organization during its planning session. What goals did you focus on achieving this year, and what do your financials tell you about how you are tracking toward those goals? What improvements need to be made to reach them? What unforeseen circumstances caused you to fall short or exceed your expectations?

Learn more here about how Ballast creates and manages a plan for continuous improvement for its clients.

Regulated Medical Waste (RMW) Updates

The Virginia Department of Environmental Quality (DEQ) recently updated the regulations concerning its regulated medical waste (RMW), effective March 15. There were several key changes for MSV membership:

  1. The definition of “sharps” has been expanded and now explicitly includes culture slides and culture dishes, which shall be disposed of in sharps containers.
  2. Records of RMW treatment or shipment to offsite facility shall be maintained for 3 years by the generator.
  3. Generators of less than 250 gallons of RMW per calendar month must arrange for removal of such waste at least once per calendar month. No RMW may be stored for more than 45 calendar days.  Generators of more than 250 gallons must arrange for removal once a week.
  4. The definition of “storage” was updated to include all generators of RMW; whereas, previously it only applied to generators of 200+ gallons of RMW. There is a whole new section regarding storage, requiring RMW to be stored in a manner that maintains integrity of packaging, minimize potential for spills, is clean and orderly, and meets packaging and labeling requirements in the regulation.
  5. New rules pertaining to reusable RMW containers to ensure properly disinfected.
  6. New rules on how to handle spills of RMW—anyone handling RMW shall have a spill containment and cleanup kit onsite within the vicinity of where RMW is stored/managed. Such a kit must include material designed to absorb any liquids, one gallon of EPA-registered hospital grade disinfectant in a spray container, enough red plastic bags to enclose at least 150% of the RMW managed at the site, and relevant PPE.

If there are questions as to the new regulations, we encourage our members to work seek legal counsel, and if necessary, reach out to DEQ.

Inflation Reduction Act Tamps Down on Prescription Drug Price Increases Above Inflation

New Medicare Prescription Drug Inflation Rebate Program protects people with Medicare and taxpayers when drug companies increase prices faster than the rate of inflation

HHS announces savings for some people with Medicare on 27 Part B prescription drugs

via CMS Newsroom – The Biden-Harris Administration has made lowering prescription drug costs in America a key priority — and President Biden is delivering results. Today, the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced 27 prescription drugs for which Part B beneficiary coinsurances may be lower from April 1 – June 30, 2023. Thanks to President Biden’s new law to lower prescription drug costs, some people with Medicare who take these drugs may save between $2 and $390 per average dose starting April 1, depending on their individual coverage. Through the Inflation Reduction Act, President Biden and his Administration are lowering prescription drug costs for American seniors and families.

“The Biden-Harris Administration believes people with Medicare shouldn’t be on the hook when drug companies inexplicably jack up the prices of their drugs,” said HHS Secretary Xavier Becerra. “President Biden made lowering prescription drug costs for Americans a top priority and we’re using every lever we have to deliver results. With the inflation rebate program, we are fighting to ensure seniors can afford the treatments they need, taxpayers aren’t subsidizing drug company excess prices, and the Medicare program is strong for millions of beneficiaries now and in the future.”

The Medicare Prescription Drug Inflation Rebate Program is one of the many important tools Medicare has to address rising drug costs. By reducing coinsurance for some people with Part B coverage and discouraging drug companies from increasing prices faster than inflation, this policy may lower out-of-pocket costs for some people with Medicare and reduce Medicare program spending for costly drugs. ​

“The Medicare Prescription Drug Inflation Rebate Program is a critical way to address long-term price increases by drug companies while improving access and affordability for the millions of people with Medicare coverage,” said CMS Administrator Chiquita Brooks-LaSure. “Continued implementation of the new drug law strengthens Medicare, faithfully guards taxpayer dollars, and improves the long-term sustainability of the program for generations to come.”

CMS has released information about these 27 Part B drugs and biological products in the quarterly ASP public file, available here.  A fact sheet is available here.

Lower Part B coinsurance will go into effect on April 1, 2023. This coinsurance adjustment applies to certain drugs and biologicals covered under Medicare Part B. The Part B drugs impacted by this coinsurance adjustment may change quarterly.

See the initial guidance detailing the requirements and procedures for the Medicare Prescription Drug Inflation Rebate Program here.

In addition, HHS released a report on how much Medicare Part D enrollees would have saved on vaccine cost-sharing if the Inflation Reduction Act has been in effect in 2021.


Resources

  1. Medicare Part B Drug ASP Webpage
  2. List of Part B Rebatable Drugs with a coinsurance adjustment for April 1-June 30, 2023
  3. Fact Sheet/FAQs
  4. ASPE Vaccine Cost-Sharing Brief

VDH Clinician Letter: Meningococcal Disease Outbreak Update, Invasive Group A Strep Infections

Via vdh.gov


Dear Colleague:

I am writing to provide you with important updates on several emerging conditions of public health significance.

Meningococcal Disease Outbreak in Eastern Virginia

The Virginia Department of Health continues to respond to a community outbreak of meningococcal disease in the eastern region of Virginia.  Twelve cases of invasive meningococcal disease (IMD) serogroup Y have been reported since June 2022 in eastern Virginia,  a doubling of cases since VDH notified eastern region providers in September 2022.  Most case-patients have presented with symptoms of IMD meningococcemia, including fever, chills, nausea, and vomiting.  All isolates available for sequencing (9 out of 12) were genetically related and susceptible to ciprofloxacin and penicillin.  VDH has not identified a common risk factor; we suspect the cases are connected by asymptomatic community transmission.  Case-patients are all residents of Hampton Roads and most are Black or African American adults between 30-60 years of age.  Eleven case-patients are unvaccinated for serogroup Y, and one is partially vaccinated.  Three case-patients have died from complications associated with the disease, indicating this outbreak strain may have a higher case fatality rate (25% CFR) than is commonly observed in serogroup Y cases.  This strain is believed to be circulating more widely, both in Virginia and other states.

VDH responds to reports of suspect meningococcal disease by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis and recommending one dose of the meningococcal conjugate vaccine (MenACWY) to all outbreak-associated close contacts who are identified as high-risk for meningococcal disease.

Healthcare Providers should maintain a high index of suspicion for IMD.  Immediately notify your local health department (LHD) of clinical findings or laboratory results of gram-negative diplococci or Neisseria meningitidis from a normally sterile site. Your LHD can coordinate sending specimens/isolates from newly identified cases to the Division of Consolidated Laboratory Services (DCLS) for serotyping.  Ensure that all individuals who are high-risk for meningococcal disease are up-to-date on the MenACWY vaccine.  Continue to encourage routine administration of the MenACWY vaccine in younger children and adolescents, as required for students enrolled in the 7th and 12th grades.

Increase in Invasive Group A Strep Infections

The Centers for Disease Control and Prevention (CDC) have noted an increase in invasive group A Streptococcus (iGAS) infections in children in the United States.  Although the number of iGAS cases reported in children in Virginia is not above average for this time of year, we are observing increased activity in general.  Group A Streptococcus bacteria can cause a range of illnesses; severe iGAS infections include necrotizing fasciitis and streptococcal toxic shock syndrome and require immediate treatment, including appropriate antibiotic therapy.

VDH responds to reports of suspect iGAS infections by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis, and urgently investigating clusters of GAS infections, especially in high-risk settings such as among residents of long-term care facilities and school aged children.

Please consider the following actions:

  • Consider iGAS as a possible cause of severe illness, including in children and adults with concomitant viral respiratory infections. Be mindful of potential alternative agents for treating confirmed GAS pharyngitis in children due to the shortage of amoxicillin suspension.
  • Offer prompt vaccination against influenza and varicella to eligible persons. Educate patients, especially those at increased risk, on signs and symptoms of iGAS requiring urgent medical attention, especially necrotizing fasciitis, cellulitis and toxic shock syndrome.
  • Notify your local health department (LHD) as soon as possible about severe iGAS cases affecting minors or clusters of any iGAS infections. All cases of Streptococcal disease, Group A, invasive or toxic shock should be reported within 3 days to VDH.  Laboratories in Virginia are required to submit GAS isolates to DCLS when cultured from a normally sterile site.

Thank you for your attention and partnership.

Sincerely,

Laurie Forlano, DO, MPH
Acting State Epidemiologist and Director
Office of Epidemiology

Colorectal Cancer Screening: 4 Steps for Success in Your Practice

By Arthur J. Vayer, Jr., MD, FACS
Woodbridge, Va

Are you talking to your patients about colorectal cancer screening? Colorectal Cancer Awareness Month is an important time for conversations with your patients about the disease, including screening and prevention — because your patients are more likely to have seen, heard, or read information about it right now. It’s also the perfect time to assess how your own practice is doing with patient screenings, because you know screening is the secret weapon in the fight against cancer.

Setting up your practice for colorectal cancer screening success is as easy as following 4 steps recommended in a guide by the National Colorectal Cancer Roundtable (NCCRT), which was co-funded by the American Cancer Society and the Centers for Disease Control and Prevention. We’ve summarized the guide for you below.

#1 Make the Recommendation for a Colorectal Cancer Screening

Are you consistently recommending screenings? According to the guide, the primary reason patients don’t get screened is their doctor didn’t make the recommendation. You can see how this makes communication with your patients critical. Create the messages you and your staff will use to discuss colorectal cancer screening with your patients, which take into consideration their risk status, individual preferences, and insurance coverage. Determine how you will overcome objections relative to their receptivity to screening. Consider how you will present screening options. The guide offers several helpful tools for your practice about screening options and patient readiness, although be advised it does not reflect the new 2018 American Cancer Society guideline for colorectal cancer.

#2 Develop a Colorectal Cancer Screening Policy

Create an action plan for colorectal cancer screening, engaging your staff in its development as well as its execution. Inputs for the plan should include national screening guidelines (which you can find on the colorectal cancer screening guidelines for healthcare professionals page of the American Cancer Society website), the realities of your practice, patient history and risk level, patient preferences and insurance coverage, and local medical resources. Patient education and communication tools are essential to this action plan. Both the NCCRT site and the American Cancer Society page have links to tools for your practice as well as patient education materials you can download.

#3 Be Persistent with Reminders

You procrastinate, get busy, get distracted, and push things to the back burner. And so do your patients. Delays go up especially if the task is something someone doesn’t really want to do — and getting screened for colorectal cancer certainly fits that bill. Develop a system for taking action that includes how and when your office will follow up with patients, like with secure phone calls, letters, and electronic communications they have access to. Beyond tracking whether a screening was done, create a follow-up for all positives as well.

#4 Measure Practice Progress

If you’re not measuring it, you’re not effectively monitoring it; so says common business wisdom. Measure your practice’s progress so you can adjust your plans and policies to increase screening rates among your patients. Ask staff for their feedback to discover opportunities for improvement.

Despite colorectal cancer being the fourth most common cancer and the fourth leading cause of cancer-related deaths in the U.S., only about 70 percent of adults ages 50 to 75 are up to date with their screenings. Physicians are mission-critical to impacting improvement in screening rates, which hopefully will impact treatment success rates as well. Diagnosing your practice for colorectal cancer screening success is imperative if you want to be part of the solution.


Dr. Vayer specializes in surgery with a focus on Colon & Rectal Surgery and has over 20 years of general surgery experience.

The information contained in this blog is for educational purposes only and does not constitute health care advice.

New Resources from the AMA: Webinars, Events, Reports, and More

The following are resources from the American Medical Association’s (AMA) Professional Satisfaction and Practice Sustainability unit.

Podcasts

No One Left Behind: Expanded Peer Support and Second Victim Syndrome

Dr. Alicia Pilarski, Associate Professor of Emergency Medicine, Associate Chief Medical Officer, and Medical Director of the Supporting Our Staff (SOS) Peer Support Program for Froedtert Hospital & Medical College of Wisconsin, shares her experience building an expanded peer support program for the entire health care team. Listen on Apple Podcasts or Spotify.

Reframing Compassion Fatigue: Compassion as a Tool for Combating Burnout

Dr. Rola Hallam, British-Syrian consultant anesthetist, humanitarian and founder of CanDo, a social enterprise that enables local, frontline health care workers to provide health care to their own war-affected communities, shares the story of her “valley of darkness” and how compassion can be a tool to combat burnout. Listen on Apple Podcasts or Spotify

Private Practice Simple Solutions Learning Sessions

Support Staff Recruitment

This eight-week session focuses on recruiting and retaining support staff for your private practice. Session one available on demand, Session 2 launches March 28. Register now.

Team-Based Care

Using the AMA STEPS Forward® Team-Based Care Toolkit as a guide, this eight week session covers topics such as pre-visit planning, expanded rooming and discharge, team documentation, prescription management, and EHR in-basket management. Launches April 4, 2023. Register Now.

Webinars

Supporting Private Practices: AMA & Medline University | Tuesday, March 7 | 10:15 a.m. CT

Learn how to use the AMA STEPS Forward® Private Practice Playbook to your advantage in this open access webinar designed to help physicians streamline employee training in their private practices. Register Now

Exploring Physician-led Innovation through Entrepreneurship and Intrapreneurship | Thursday, March 16 | 11 a.m. CT

Hear a live panel of physician entrepreneurs and intrapreneurs discuss their journey towards building the future of health. Presented by the Future of Health Immersion Program and AMA STEPS Forward® Innovation Academy. Register Now

Actionable Insights: Key Steps to Engaging Patients in Psychosocial Interventions | Thursday, March 23 | 10 a.m. CT

Experts will discuss the spectrum of brief psychosocial interventions along with how best to use them to help address behavioral health needs for both adult and pediatric patient populations. Presented by the BHI Collaborative and AMA STEPS Forward® Innovation Academy. Register now

Publications

High cost of broken relationships

This BMJ Quality & Safety editorial co-authored by Dr. Christine A. Sinsky, AMA Vice President of Professional Satisfaction, offers recommendations on how to decrease the high costs of physician turnover by prioritizing relationships and reducing burnout.

Funding Research on Health Workforce Well-being to Optimize the Work Environment

This JAMA Viewpoint article co-authored by Dr. Christine A. Sinsky, AMA Vice President of Professional Satisfaction, outlines the importance of federal funding to support research on system interventions that promote clinician well-being.

Reports

2022 Telehealth Impact Report (pdf)

This newly updated report offers a thorough overview of AMA’s efforts to aggressively expand digital medicine advocacy, research, and resources to better understand the specific needs around telehealth and digitally enabled care.

Events

The American Conference on Physician Health: Call for Abstracts

Last chance to submit an abstract for ACPH 2023! Especially interested in showcasing research focused on the connection between health information technology and physician well-being. Deadline is March 15.

The American Conference on Physician Health: Sponsors & Exhibitors

Show your dedication to prioritizing physician health by becoming an ACPH 2023 Exhibitor and/or Sponsor! Learn more at the ACPH 2023 Sponsors & Exhibitors website.

Virginia State Loan Repayment Program Accepting Applications through March 31

In an effort to attract health care professionals to underserved areas to improve and increase access to quality health care practitioners, the Virginia Department of Health is now accepting applications for the Virginia State Loan Repayment Program.

Applicants are sought for Primary Care Practitioners, Mental Health Practitioners, and Dental Health Practitioners in a HPSA in Virginia to serve at least two years. Additional funds are available for those who live and work in the Tobacco Region.

The application deadline is March 31st, 2022.

More details and application submission available here. Questions can be directed to [email protected] or call 804-864-7431.

Medicaid Unwinding Summit: Reserve Your Space

Wednesday, March 8, 2023
9:30 am – 12:00 pm
Greater Richmond Convention Center

Recent federal guidance has ended the protections put into place in March of 2020, preventing Medicaid members from losing coverage in the program due to changes.

With those requirements coming to an end, the Department of Medical Assistance Services (DMAS) and the Department of Social Services (DSS) are preparing to resume normal Medicaid operations in March of 2023. Over the course of 12 months, redeterminations for ongoing Medicaid eligibility will be initiated for all 2.2 million Virginians enrolled in Medicaid.

To learn more, attend the Medicaid Unwinding Summit at the Greater Richmond Convention Center on March 8th. Click here to RSVP.

Freedom Virginia: Honoring our Black Healthcare Heroes

To honor the tremendous contributions of the Black healthcare heroes in the Commonwealth, join Freedom Virginia’s celebration on February 25 at 4 PM at the Hope Center in Roanoke, Virginia.

The event will honor Burrell Memorial Hospital, Henrietta Lacks, Dr. Finn Victor, Miriam Smith, RN, Dr. Walter Claytor, and many more. Speakers include Shmura Glenn and a representative from the Harrison Museum.

Sign up here.