Current Updates on the Affordable Care Act

As a member of the HCRC, I suggested to our committee chair Michael Sharland, Ph.D., L.P., ABPP, that a summary of the 6/10/16 conference “Ethics and Risk Management in the Age of the Affordable Care Act: Everything You Didn’t Want to Know and Were Afraid to Ask” might be helpful to MPA members who couldn’t attend (take a deep breath, run on sentence).  I thought much of the information provided by that conference is germane to the mission of the HCRC, namely keeping MPA members informed regarding likely changes to psychological practice because of the Accountable Care Act (ACA). 

The 6/10/16 conference was sponsored by MPA and The Trust (formerly known as APAIT).  Daniel O. Taube, J.D., Ph.D., was the presenter.  Every time I start to think of something the HCRC should discuss with MPA members, it feels like there is a moving target or we are herding cats.  Starting to work on this article, I came across a webinar offered 6/30/16 by the website OpenU that also seemed germane to this article. 

United HealthCare offers a link to OpenU for UHC/Medica/UBH-contracted psychologists.  The 6/30/16 OpenU webinar was titled, “MIPS and APMs and MACRA…Oh My.”   Ravi Ganesan, president of Core Solutions, presented the webinar.  Core Solutions is an EHR software company that markets its products to behavioral health providers. 

Both Dr. Taube and Mr. Ganesan talked about Medicare’s requirement for medical and behavioral health providers to prove effective treatment and document such.  We have been hearing about the requirement for outcomes data for years.  We have all heard the acronym PQRS.  The OpenU webinar was very thorough but left me with more questions than answers. 

Both the 6/10/16 Trust risk management conference and the 6/30/16 OpenU webinar described additional Medicare acronyms MIPS (Merit-Based Incentive Payment System) and APM (Alternative Payment Model).  MACRA is the acronym for Medicare Access and CHIP Reauthorization Act, CHIP the acronym for Child Health Insurance Plan.  These acronyms were discussed in the 6/10/16 and/or 6/30/16 presentations (cannot remember, it is all overwhelming).  I still had to look these acronyms up on Medicare sites because I don’t type/take lightening-speed notes anymore! 

Many of us MPA members might think, “Why worry what Medicare’s doing if you are not a Medicare provider?”  Both the 6/10/16 and 6/30/16 presentations made the point that what Medicare requires ultimately becomes required by state health insurance and commercial insurance plans.  Both presentations made it clear Medicare will be requiring all Medicare providers to use EHR in the ‘near’ future, in order to be eligible for incentive payments. Incentive/penalty payments will range from 4-9% over time as the program progresses. One aspect of evaluation for incentives is use of EHR.

Both the 6/10/16 and 6/30/16 presentations indicated that only Medicare providers who bill Medicare more than $10K per year or see more than 100 Medicare patients a year will be required to participate in the next generation of Medicare data gathering.  PQRS will be grandfathered in a couple of years, morphing into a different data-gathering system, with different acronyms (MIPS? APM? MACRA?)  It sounds like those of us who participated in Medicare’s PQRS system successfully/un-successfully are the guinea pig psychologists.  I am usually a very compliant person, so I followed APA’s advice to participate in the PQRS program.  But now I wonder if it was even worth my time reporting PQRS data, since I am told by someone at Medicare I didn’t report successfully! (Enough of my editorializing/moaning and groaning!!)

Dr. Taube also discussed Individual Provider Associations (IPAs) at the 6/10/16 risk management conference.  APA suggests we can survive in independent psychological practices if we private practice folks band together in an IPA.  Ordinarily, providers who are in competition cannot band together because of anti-trust concerns. IPAs offer the opportunity for psychologists to maintain their independence yet receive some benefits from participating in a larger virtual group. Those advantages would include better positioning to contract with payers, and better ability to engage in payment models that are value-based. There has been concern that the Federal Trade Commission (FTC) might find IPAs in contempt of price-fixing laws, however.  Dr. Taube indicated 6/10/16 that the FTC has determined an IPA will not be seen as violating anti-trust laws if two conditions are met, namely, that all partners in the IPA agree to meet certain standards of care often utilizing specific practice guidelines and that they are using the same EHR system so billing and reporting of quality data can be done. Members of an IPA can see patients who are not part of the IPA system, and can maintain their own private offices. It is a complicated virtual relationship, but one that holds promise to keep psychologists enjoying private practice. Sounds logical…More questions than answers again, but it all starts to sink in over time…I think. For more information, consider attending the MPA President’s Conference, which will address these practice model issues.

Dr. Taube also discussed Direct Secure Messaging (DSM) at the 6/10/16 Trust Risk Management conference.  He indicated that DSM is the very near future communicating between healthcare providers whether or not they have EHR’s.  Not too long after the 6/10/16 conference, MPA’s EHR committee chairperson Trisha Stark, PhD, LP posted information about DSM vendors the Minnesota Behavioral Health Network (MNBHN) has researched/vetted.  See www.mnbhn.net for further information. 

Also in the last few weeks, Dr. Stark list-served regarding two informational meetings offered by Fast-Tracker MN.  I have noticed that few MPA members have listed their single/small psychological practices with Fast-Tracker.  Many large mental health clinics are listed.  I notice that several psychiatrist’s offices are listed with Fast-Tracker. The vision of Fast-Tracker is ultimately to allow other providers and patients to actively schedule on your calendar for openings you post as available, with the hope of improving access for patients and efficiency for providers.

I listed my office probably two years ago.  It’s FREE…kind of like a bare-bones free website for our solo/small group practices.  See www.Fast-TrackerMn.org.  Fast-Tracker is a program of the Minnesota Mental Health Community Foundation (MMHCF), in association with the Minnesota Psychiatric Society.  Two informational meetings were held by Fast-Tracker, 6/16/16 and 6/30/16. 

I went to the 6/30/16 meeting.  There were six people there.  I was the only MPA member there…and the only psychologist there.  Two of the six of us were office managers for two mental health clinics.  The other three were employees of Fast-Tracker.  With what I learned at the 6/10/16 Trust risk management conference, from the 6/30/16 OpenU webinar, and from MNBHN’s website, I was able to ask the Fast-Tracker folks fairly germane questions, I think. 

I asked whether Fast-Tracker could become a platform for psychologists aiming to develop an IPA.  I asked whether Fast-Tracker could be a platform for an IPA of psychologists using DSM.   The Fast-Tracker folks indicated on 6/30/16 that they are working on signing up some of the medical clinics we are all probably familiar with.  The Fast-Tracker folks said that their IT folks continue to tweak the Fast-Tracker system as new information/new technology/new ACA rules and regs come about.  Just today (7/7/16) I registered for DSM service with MaxMD, one of three DSM providers vetted by MNBHN.  Again, see www.mnbhn.net. Discussions are in process with Fast-Tracker to have providers’ direct email addresses on the site so that we can find each other as this DSM process rolls out.

Some of us remember signing up three or so years ago for an older form of encrypted e-mail.  State of MN representatives were present at MPA’s Annual Conference several years ago along with representatives from a state-approved e-mail provider.  Those of us who obtained the older e-mail service probably remember we were a few lone psychologists in the e-address book with mostly out-state medical clinics.  

DSM is the current encrypted e-mail platform approved by the government.  MaxMD costs $199 per year for 1 psychologist, with increases relatively appropriate for 2, 3, 4, 5 psychologists, etc.    There was no credentialing fee.  Three years ago the e-mail provider charged me $300 for the background/credentialing fee, then $129 per year. 

Registering the encrypted e-mail service three years ago was a very tedious affair.  MaxMD was rather easy…And I’m not particularly tech-savvy, so that’s saying something.  MaxMD representatives were very helpful talking me through errors I made registering their DSM product.  My DSM address is [email protected].  You can register with any DSM provider sanctioned by the State and you can list yourself however you want, as long as noone else has the same user name, etc. So, if you own a domain name for your website, you can use that domain name as part of your new DSM address, to make recognition easier. So that’s all I know…and I’m sticking to it! 

Lisa S. Squire, Ph.D., L.P., has an independent practice in Bloomington, MN.  She sees children, teens, and adults for psychotherapy and psychological assessments.  Dr. Squire is also a member of MPA’s Health Care Reform Committee (HCRC).  She can be reached at 952-854-2440.  Website, www.lisasquire.com.

Trisha A. Stark, Ph.D., L.P., MPA is chair of the Minnesota Psychological Association’s legislative committee and task force on Electronic Health Records. She has a small independent practice but works primarily in the area of advocacy. She can be reached at 952-457-3431 or [email protected]shastarkphdlp.com

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