Sunday, April 14 | 1:00 pm to 5:00 pm
Tacoma Convention & Trade Center
I. Understanding Costs from the Payer’s Perspective
Beginning on the premise that some perceive payers as being from Mars and providers as being from Venus, this course will begin by exploring the stakeholders’ conflicting interests, the health care customer food chain, the four ultimate payers, payer market structure in the Pacific Northwest, and evolving payer segments and product lines. The next section will assess what payers want and need from providers (general priorities, the value equation, networks and sub-networks, accountability, and new strategies and tactics) and what providers want and need from payers (general priorities, hospital issues, primary care/cognitive physician issues, specialty care/procedural physician issues, and new strategies and tactics). We will then review several case studies in payer/provider conflicts, examining respective issues, answers, and lessons learned. During the next section we will examine systemic threats to payers and providers such as the unsustainability of entitlement programs, cost-shifts, fragmented financing and delivery systems, fee-for-service reimbursement, misaligned incentives, waste, workforce supply issues, horizontal integration, and market consolidation. The course will conclude with a discussion of opportunities presented by the Affordable Care Act, future health reform, accountable care strategies, alternatives to fee-for-service reimbursement, learning from successful foreign and domestic health systems, state-of-the-art insurance products, vertical integration, highly-efficient networks, and informed consumers.
Phillip J. Haas serves on the Board of Trustees for Group Health Cooperative and as Clinical Assistant Professor in the Department of Health Services at the University of Washington. He was previously Network Market Head for Aetna Life Insurance Company, Administrator-Payer Relations for Valley Medical Center, Executive Director of Virginia Mason Health Plan, and President/CEO of First Choice Health.Back to Top
II. Understanding and Implementing ICD-10
The Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets with ICD-10 code sets, effective October 1, 2013. This requirement will radically change the way that ICD coding is currently performed. The ICD code set will grow from its current 17,000 codes to more than 141,000, with a new format that will dramatically impact your medical practice. This transition will require very significant dedication of effort and time to achieve this transition. It is critically important to begin preparing now.
This session will provide an introduction to ICD-10 code sets as well as review the operational and financial impacts that physician organizations should consider in preparation for the transition to ICD-10-CM. Learning Objectives:
- List the general changes and differences between ICD-9 & ICD-10.
- Describe how to prepare an Educational Readiness program to assist practice staff in determining the most effective way to gain proficiency levels with the new coding system.
- Describe the elements of a financial assessment to determine budget requirements for coding systems transition, including contingency planning and other budget considerations.
Michelle M. Lott, CPC, CPMA, is the Health Insurance Coding Specialist and Associate Director of the Practice Resource Center for the Washington State Medical Association (WSMA). She is an Approved ICD-10-CM/PCS Trainer through the American Health Information Management Association.Back to Top
III. Seeing the Forest and the Trees: How to Use Pivot Tables to Analyze your Practice’s Performance
As the saying goes, knowledge is power – and understanding how to get at that knowledge quickly and accurately gives you the edge in a tough industry. This workshop will introduce you to pivot tables in Microsoft Excel™ and give you practical tips, using sample medical practice performance data, on how to get to the answers you need. Learn how to easily identify your biggest payers, your highest producing providers, the conditions your practice most commonly treats, and much more with this very useful and straightforward tool.
Specific topics to be covered include: basic pivot table functions, data summary and drill-down techniques, formula writing (within pivots as well as referencing them), pivot chart creation, and presentation formats.
Workshop attendees should already have a working knowledge of Excel – this is not a beginning course. Attendees will be supplied with a data set in advance and are expected to bring a laptop loaded with a copy of Excel 2007/2010™.
James Hudson has worked in practice management for 20 years, and has extensive experience in practice analytics and financial reporting. While with University of Washington Physicians, a position he recently left to be the administrator of a private medical practice, he was the primary analyst for over 1,800 providers in every medical specialty. James holds Masters Degrees in public health and health administration, as well as the esteemed status of Fellow in the American College of Medical Practice Executives. He is currently the practice administrator a Women’s & Family Health Specialists in Renton, WA.Back to Top
The American College of Medical Practice Executives (ACMPE) is the standard-setting and certification body of MGMA. Earning board certification and Fellowship through ACMPE is one of the best professional decisions you can make as a group practice administrator. The Certified Medical Practice Executive (CMPE) credential validates and verifies your expertise and experience in medical practice management and reflects the knowledge and skills necessary for success. This workshop provides an in-depth understanding of the ACMPE board certification requirements, process, study methods, and preparation for the examination. This overview will cover sample questions from the objective and essay exams along with study techniques and tips for the certification exam. Fellow status (FACMPE) is the highest level of distinction you can earn in the medical practice management profession. The professional papers portion of this presentation will include instruction and handouts on how to complete your professional paper or case studies for your Fellowship. You will leave the course with a topic in mind.
Workshop Leaders: Jeff Baird MBA, CMPE; Elaine J. Beeble FACMPE; Marilyn Happold-Latham MBA, FACMPE; Kerry McMullin FACMPEBack to Top