Looking Long Term

MGMA of St. Louis prepares for mandate changes, adapts to mergers, focuses on succession planning

Nationally and locally, Medicare and Medicaid reimbursement changes will top the list of priorities for practice managers to address in 2012, followed closely by a host of federal mandates and other hot-button issues.

“In addition, we’ll make sure to continue educating the groups that have merged with larger hospital associations,” said Lisa Malloy, 2012 president of the Medical Group Management Association of Greater St. Louis. “We’re focused on keeping those groups who are now part of larger entities educated about mandates and also adaptation to market changes.

Among the educational venues, webinars will address, among many topics, the new HIPAA Version 5010 electronic transaction standards. Last month, a fresh MGMA study highlighted the need for the Department of Health and Human Services (HHS) to immediately issue an expanded contingency plan. (See sidebar, “Key Findings,” for a recap of survey results.)

“Version 5010 compliance is a very hot topic,” said Malloy. “We’re making sure to give our members needed information to be compliant with 5010 and ICD-10 code mandates.”

Malloy said the MGMA of Greater St. Louis, which held its annual planning meeting in late fall, doesn’t view the trend of mergers that have reduced the local practice management workforce as “a threat in any way.”

“We want to make sure we evolve to suit the needs for future issues that practices may face,” she said.

For example, the MGMA of Greater St. Louis recently began focusing attention on succession planning.

“We’ve reached out to various local colleges to get students going through healthcare programs more involved in our local chapter,” said Malloy. “Over the past few years, we’ve been able to significantly grow our student population. That’s something very few organizations have been able to accomplish. We’ve reduced our membership fees for students. They’re coming to our luncheons and other events, not just those portions focused on students.”

Despite healthcare reform greatly changing the landscape of the medical industry, a large number of students in the community are entering practice management, Malloy noted.

“Taking classes doesn’t give you the full picture of practice manager responsibilities,” said Malloy, MBA, administrator of Suburban Surgical Associates in West St. Louis County, an 11-surgeon group established in 1985. “We have a wonderful mentoring program. I’ve brought in students to shadow me to learn what a day in the life of a practice manager is really like. For example, one gentleman who shadowed me said at the end of the day, ‘I need to focus on my accounting classes a little more!’”

Monthly MGMA meetings will cover Medicare, lean healthcare, hospital/physician integration, ICD-10 integration, fraud prevention, IT changes and human resources changes. (See Events Box for details.)

For more information on MGMA of Greater St. Louis, call (314) 416-2230 or visit www.mgma-sl.org.

Related Story: Strength in Numbers (655)

The Medical Group Management Association (MGMA) and the American College of Medical Practice Executives (ACMPE) merged in the last quarter of 2011 to form a new, stronger national association. The marriage should result in decreased annual dues and therefore, increased membership, say state MGMA leaders.

MGMA is the nation’s largest professional membership association for medical practice management leaders, while ACMPE is the most respected certification and standard-setting organization for medical practice leaders. The aligned organization with nearly 30,000 members became official Jan. 1.

“As healthcare evolves, so must we,” said MGMA Board Chair Shena Scott. “Many of our members and their physicians are moving into new employment models where they’ll need different skill sets. As the largest professional membership association and the premier certifying body of medical practice executives, we need to leverage our strengths to provide our members with the tools they’ll need to succeed in many different environments. We can do that more efficiently and effectively as one association that focuses its resources on adding value to the services we provide to our members and creates a more accessible avenue to certification and fellowship – tools that we believe will become increasingly critical to success as the evolution of healthcare progresses.”

Strategic planning to form the new association began two years ago to create efficiencies through unifying processes that were formally redundant, such as budgeting, financial audits and strategic planning. Even though both organizations are financially solvent, one organizational structure creates efficiencies that best position the new association for success, said ACMPE Board Chair Alan Winkler, adding that during extensive visioning and strategic planning sessions, “it became apparent there was a spirit of unified energy.”

For example, to help local and state MGMA chapters better prepare, MGMA conducted research that clearly indicates many state Medicaid plans will be unable to accept Version 5010 claims, and the software upgrades and health plan testing haven’t yet occurred for a significant number of practices. The new contingency measures should go beyond what HHS announced on Dec. 14 and should permit health plans to continue accepting HIPAA Version 4010 transactions and adjudicate Version 5010 claims that lack all the required data. This contingency plan should last for a minimum of six months, said MGMA-ACMPE President and CEO Susan Turney, MD.

As it stands, HHS announced that in December, practices and plans that have tested and been approved for Version 5010 will be given 30 days to transition to the new claims format. Also, physician practices and others that haven’t yet tested with their Medicare Administrative Contractor (MAC) will be notified they must submit their “transition plan and timeline” to their MAC in 30 days.

“We’ve been tracking the Version 5010 coordination between physician practices and their key trading partners throughout 2011 and it’s clear that a significant number of these stakeholders aren’t ready to meet the Jan. 1 compliance date,” Turney said in mid-December. “Our main concern is that the failure to implement Version 5010 by the compliance date will impact payment to practices for the services they provide. We oppose requiring the submission of a transition plan and timeline as a needless bureaucratic exercise that adds to the workload of the providers who have to produce them and the government employees who have to review them. HHS should immediately allow physician practices to continue submitting Version 4010 transactions.”

Turney said the MGMA is “very concerned that at least seven state Medicaid plans, including California, have announced they’ll be unable to meet the mandated Jan. 1 deadline.”

“With the large number of practices reporting that they’ll revert to paper claims, we’re concerned about the potential delay in adjudicating the large volume of paper claims,” she said. “Further, the serious challenges in meeting the Version 5010 mandate and the need for a comprehensive contingency plan from HHS call in to question the ability of the industry to transition to ICD-10 by the Oct. 13, 2013, compliance deadline.”

Related Story: Key Findings (260)

Highlights from the MGMA study on the new HIPAA Version 5010 electronic transaction standards:

·      Internal Testing. One in three study respondents reported that their organizations’ practice management system software has been upgraded to the HIPAA Version 5010 standards and that internal testing had been completed. Nearly one in four indicated that either their software has not yet been upgraded or that testing is not even scheduled.

·      Medicare Contractor. Just 32 percent of respondents said that testing has been completed with their Medicare contractors. Additionally, 22 percent reported they haven’t scheduled testing with their Medicare contractors.

·      Medicaid Plan. Nearly 18 percent of respondents said they’ve completed testing with their Medicaid plans. More than 30 percent indicated that testing isn’t scheduled or their Medicaid plans aren’t yet accepting test claims.

·      Major Commercial Health Plans. An overwhelming 79 percent of study respondents indicated that testing with all major commercial health plans remains incomplete. Almost one quarter (23.5 percent) reported that testing is still not scheduled with any major commercial health plans, a finding that is nearly identical to Medicare contractor testing.

·      Current Implementation Status. Just two weeks before the Jan. 1 deadline, only 13.9 percent of respondents rate their 5010 implementation status as fully completed. More than 56 percent rate it as between zero and 75 percent finished.

·      Contingency Plans. Study respondents were asked about their contingency plans following the Jan. 1 compliance date. Almost one quarter (23 percent) reported that they plan to revert to paper claims in an attempt to avoid cash flow issues.

SOURCE: MGMA.

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