Practice Transformation

Practice Transformation programs assist primary care providers with optimizing practice workflows and systems by focusing on quality of care, cost reduction, patient engagement in care plan development, electronic communications, patient and provider satisfaction, and preparation for value-based payment.

Through value-based payment, practices are reimbursed based on the value, rather than quantity, of care they provide. Value is measured by patient outcomes and satisfaction, and cost of care. By 2020, 80% of primary care services will be reimbursed under a value-based arrangement.

With funding from the Centers for Medicare and Medicaid Services and the New York State Department of Health, NYC REACH provides free technical assistance to health care sites participating in Practice Transformation programs.

Quality Payment Program

The release of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) led to the implementation of a new, unified payment framework called the Quality Payment Program (QPP). QPP is administered by the Centers for Medicare and Medicaid Services (CMS).

QPP offers two participation tracks for eligible clinicians: The Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS)

MIPS allows eligible clinicians to earn a performance-based payment adjustment to their Medicare payments. It is a combination of three previous quality-based reporting incentive programs – Physician Quality Reporting System (PQRS), the Value-Based Modifier (VM), and Medicare EHR Incentive Program.

Eligible clinicians have the flexibility to choose measures and activities through four categories that are relevant to the type of care they provide:

 

qpp-quality qpp-advancing-care qpp-improvement-activities qpp-cost
Replaces PQRS Replaces the Medicare EHR Incentive Program (Medicare Meaningful Use) New Category Replaces the Value-Based Modifier

Clinicians have the option to determine their performance length for submitting data for the Quality, Advanced Care, and Improvement Activities categories during the 2017 performance year.

A clinician’s level of participation for 2017 will determine their payment adjustment in payment year 2019. The Cost category will be calculated in 2017, but will not be included in calculating a clinician’s payment adjustment.


Three Options for MIPS Participation in 2017 Performance Year:

submit-somethingSubmit Something: Clinicians submit the minimum amount of data for the Quality, Advanced Care, and Improvement Activities categories to avoid any negative payment adjustment

 

 

submit-partial

Submit a Partial Year: Clinicians submit data for the Quality, Advanced Care, and Improvement Activities categories for 90 days may earn a neutral or small positive payment adjustment

 

submit-full

Submit a Full Year: Clinicians submit a data for the Quality, Advanced Care, and Improvement Activities categories for a full year may earn a moderate payment adjustment

 

Clinicians will receive a negative 4% payment adjustment if they do not participate in MIPS in the 2017 performance year.


MIPS Eligibility

Types of clinicians who are eligible to participate in MIPS are:

  • Physicians (MD, DO, DPM, OD, DCM)
  • Dentists (DDS, DMD)
  • Physician assistants (PA)
  • Nurse practitioners (NP)
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

These eligible clinician types have billed more than $30,000 in Medicare Part B allowable charges and provided care for more than 100 Medicare Part B unique patients in a year. Clinicians can visit https://qpp.cms.gov/participation-lookup to verify MIPS 2017 participation status.


RESOURCES

Fact sheets and training videos are available to help eligible clinicians better understand MIPS program participation and data submission for participation year 2017.

MIPS Participation Overview

MIPS Scoring

MIPS Data Submission
For eligible clinicians to submit 2017 Quality Payment Program (QPP) performance data, click here to access the CMS data submission system.

For additional information, view the following 2017 data submission training videos:

Visit the resource library for additional resources available to all NYC REACH member practices.

Not a member? Contact us today to learn more about NYC REACH membership.

ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)

An Alternative Payment Model (APM) is a payment approach, developed in partnership with the clinician community, that provides added incentives to clinicians who deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition or population.

Advanced APMs are a subset of APMs that let participants earn more incentives by taking on some risk tied to patients’ outcomes. In order to qualify for an incentive payment, a participating clinician must receive a certain percentage of payments for covered professional services or see a certain percentage of patients through the Advanced APM during the respective performance year.

Eligible clinicians that are able to sufficiently participate in Advanced APMs can potentially receive an incentive from 2019 through 2024 and are exempt from any reporting requirements and payment adjustments tied to MIPS.


Advanced APMs Eligibility

Eligibility for Advanced APMs is based on the available models applicable to your region and scope of practice. In 2017, the following models are Advanced APMs:

  • Comprehensive ESRD Care (CEC) – Two-Sided Risk
  • Comprehensive Primary Care Plus (CPC+)
  • Next Generation ACO Model
  • Shared Savings Program – Track 2
  • Shared Savings Program – Track 3
  • Oncology Care Model (OCM) – Two-Sided Risk
  • Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT)

Types of clinicians who are eligible to participate in Advanced APMs are:

  • Physicians (MD, DO, DPM, OD, DCM)
  • Dentists (DDS, DMD)
  • Physician assistants (PA)
  • Nurse practitioners (NP)
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

These eligible clinician types have billed more than $30,000 in Medicare Part B allowable charges and provided care for more than 100 Medicare Part B unique patients in a year.

Please visit https://qpp.cms.gov/learn/apms for more information on Advanced APMs

Note: Community Health Centers (CHCs) providers that do not bill Medicare Part B are not required to participate in MIPS. However, they can voluntarily submit data if they are interested in receiving performance feedback from CMS. CHCs that do bill Medicare Part B and meet the eligibility criteria are required to report for MIPS.


Resources

NYC REACH has developed resources that provide additional information on QPP for all NYC REACH member practices. Please visit the resource library to access these resources.

Not a member? Contact us today to learn more about NYC REACH membership.

Advanced Primary Care

Advanced Primary Care (APC) is a New York State care delivery model built on principles established by the EHR Incentive Program (i.e. Meaningful Use) and Patient-Centered Medical Home. It includes multi-payer financial support. APC enhances a practice’s ability to identify patients by health risk, develop care plans in cooperation with patients, and engage electronically with patients through a patient portal.

For practices participating in APC, NYC REACH will provides free technical assistance and conduct on-site and remote visits to support practices with workflow re-design, staff training, and electronic health record optimization.

Practices interested in participating in APC must complete a brief self-assessment to confirm eligibility.
Complete the self-assessment here.

Patient-Centered Medical Home

Patient-Centered Medical Home (PCMH) is a patient-centric model for primary care practices that emphasizes care coordination and communication. PCMH is a fundamental component of the New York State Health Innovation Plan and Medicaid’s Delivery System Reform Incentive Payment (DSRIP) Program.

PCMH achieves the “Quadruple Aim,” a health care framework with four simultaneous goals: 1) improve the quality of care provided, 2) improve patient experience of care, 3) increase provider satisfaction, and 4) reduce the per capita cost of health care.

PCMH-recognized practices receive enhanced reimbursement from New York State Medicaid.
NYC REACH has assisted over 800 practices to achieve PCMH recognition.

The video above highlights the framework of the Patient-Centered Medical Home.

Effective May 1, 2018 – June 30, 2018, the reimbursement amounts will be:

Medicaid NCQA PCMH Level 2 2014 Standards NCQA PCMH Level 3 2014 Standards* NCQA PCMH 2017/NYS PCMH Standards*
MCO Per Member Per Month $0.00 $2.00 $2.00
FFS – Article 28 Clinic/FQHC
Per Visit
$0.00 $29.00 $29.00
FFS – Office-Based Provider
Per Visit
$0.00 $25.25 $25.25

*New York State Medicaid plans to add Advanced Primary Care providers, who are Gates 2 and 3 certified, into the PCMH incentive program (pending federal approval). Providers will be paid at the 2014 PCMH Level 3 rates.

Effective July 1, 2017, the revised reimbursement amounts will be:

Medicaid NCQA Level 2 2014 Standards NCQA Level 3 2014 Standards
MCO Per Member Per Month $3.00 $7.50
FFS – Article 28 Clinic/FQHC Per Visit $23.25 $23.25
FFS – Office-based Provider Per Visit $20.25 $29.00

Please note: Incentive payments will no longer be available for NCQA’s 2011 standards after July 1, 2017.

Effective May 1, 2018 – June 30, 2018, the reimbursement amounts will be:

Note: New York State Medicaid plans to add Advanced Primary Care providers, who are Gates 2 and 3 certified, into the PCMH incentive program (pending federal approval). Providers will be paid at the 2014 PCMH Level 3 rates. Click here for more information.

Effective July 1, 2017, the revised reimbursement amounts will be:

TRANSFORMING CLINICAL PRACTICE INITIATIVE

The Transforming Clinical Practice Initiative (TCPI) is funded by the Centers for Medicare and Medicaid Services (CMS). TCPI supports changes to clinical and business practices to prepare providers for participation in new payment models. Participating clinicians, organized into Practice Transformation Networks (PTNs), engage in peer-based learning networks to support the practice transformation process.

Practice Transformation Networks

NYC REACH supports participation in two Practice Transformation Networks: the New York State Practice Transformation Network and the Greater New York City Practice Transformation Network (a group led by the New York University School of Medicine).

TCPI Benefits for Clinicians

Regional Health Information Organization Connectivity

A Regional Health Information Organization (RHIO) is a public Health Information Exchange (HIE). An HIE allows providers and patients to securely access and share medical information electronically. This enables all providers in the RHIO to coordinate patient care more effectively.

RHIOs collect patient data from electronic health records (EHRs) that are used in small practices, hospitals, behavioral health organizations, community based organizations, and major health systems. RHIOs can also notify providers when patients are hospitalized. Practices that contribute to a RHIO can share patient data with other providers who use the same RHIO, access patient data from other practices and facilities using the RHIO, and use the Statewide Health Information Network of New York (SHIN-NY).

The RHIOs serving the New York City area are:

  • Receive notifications when your patients visit the Emergency Department.
  • See discharge summaries without going through hospital medical records.
  • Obtain consult notes from specialists.

MENTAL HEALTH SERVICE CORPS

Join the Mental Health Service Corps!

Join an unprecedented ground-breaking initiative to close the gaps in behavioral health services and implement these services into primary care.

The Mental Health Service Corps (MHSC) is a key initiative of ThriveNYC, a city program committed to promoting and protecting the wellbeing of all New Yorkers. MHSC aims to fill the long neglected gaps in mental health and substance use services throughout NYC by placing behavioral health clinicians within high-need communities.

For more information about ThriveNYC, visit https://thrivenyc.cityofnewyork.us/

Apply to be part of Mental Health Service Corps! There are a limited number of Corps members.

PRIMARY CARE

MHSC will reduce the stigma and ease the access of behavioral health services for New Yorkers by implementing the Collaborative Care Model to integrate behavioral health services into primary care settings.

Primary care practices in high-need communities throughout the city will receive full-time, fully-funded clinically trained masters- and doctoral-level mental health counselors, social workers and clinicians who are committed to working in high-need communities that have experienced barriers to mental health care.

Apply to bring the Collaborative Care Model and MHSC to your practice.

Complete an application here: http://bit.ly/2j93FNM

Behavioral health clinicians will promote and support the integration of behavioral health services using the Collaborative Care Model. In addition to a supervising social worker, the behavioral health clinicians will also be supported by a MHSC supervising psychiatrist. Supervising psychiatrists provide clinical assistance and support to primary care practices and behavioral health clinicians. Services provided by the behavioral health clinicians will include screening, assessment and treatment for depression, anxiety and substance use.

To be eligible to receive a behavioral health clinician, a primary care practice must:

  • Designate a representative within the practice or site to be the lead contact for MHSC
  • Dedicate staff who can provide onsite support, task supervision and crisis support to MHSC behavioral health clinicians
  • Be located in a high-need area and/or serve a high-need population
  • Demonstrate a need for additional mental health clinicians
  • Have appropriate clinical and work spaces for behavioral health clinicians and patients
  • Be willing to participate in on-site trainings offered by MHSC program to facilitate integration services

 

If your primary care site is selected, it will be expected to:

  • Identify clinical leaders at the site who are dedicated to the Collaborative Care Model
  • Provide access to the site’s electronic health record to MHSC behavioral health clinicians
  • Have a panel size of at least 1,500 unique patients per site
  • Establish processes for the behavioral health clinician to generate a caseload
  • Become a member of NYC REACH (New York City Regional Electronic Adoption Center for Health), which assists NYC-based practices with quality improvement and practice transformation initiatives (membership is free)
  • Obtain and process the proper clearances for the behavioral health clinician to work at the site
  • Orient, train and support the behavioral health clinician in site workflow processes and procedures

 

Apply to join the Corps: http://bit.ly/2j93FNM

Printable Worksheet: use this worksheet to prepare for the Primary Care Application

Frequently Asked Questions

BEHAVIORAL HEALTH

Substance use programs, mental health clinics, and other behavioral health practices in high-need communities throughout the city will receive full-time, fully-funded clinicians. The Mental Health Service Corps (MHSC) will reduce the stigma and ease the access of behavioral health services for New Yorkers.

Apply to change how health care is delivered by participating in MHSC and host a behavioral health clinician.

Complete an application here: http://bit.ly/2j8igZk

The behavioral health clinician is comprised of clinically trained and early career masters- and doctoral-level mental health counselors, social workers and clinicians committed to working in high need communities that have experienced barriers to access to mental health care. The behavioral health clinician will be selected based on their experience and their interest and ability to work with diverse cultures (i.e., ability to speak languages and understand the culture specific to the patient population, oriented to ensure highest standard of social service).

Behavioral health clinicians will expand and enhance the behavioral health site’s existing capacity to meet the needs of the community served while promoting the use of evidence-based innovations. Behavioral health practices will include New York State Office of Mental Health licensed Article 28 and 31 mental health clinics providing services to children and/or adults; New York State Office of Alcohol and Substance Abuse Services licensed Article 32 substance use clinics; and other behavioral health practices such as Personalized Recovery Oriented Services programs, Partial Hospital programs, and field-based Assertive Community Treatment teams.

To be eligible to receive a behavioral health clinician, a behavioral health practice must:

  • Designate a representative within the practice or site to be the lead contact for MHSC
  • Dedicate staff who can provide onsite support, task supervision and crisis support to MHSC behavioral health clinicians
  • Be located in a high-need area and/or serve a high-need population
  • Demonstrate a need for additional mental health clinicians
  • Have appropriate clinical and work spaces for behavioral health clinicians and patients
  • Be willing to participate in on-site trainings offered by MHSC program to facilitate integration services

 

If your behavioral health practice site is selected, it will be expected to:

  • Participate in trainings or meetings to align with MHSC evidence-based practices in behavioral health treatment
  • Participate in interviews or surveys as part of program operations and evaluation
  • Establish processes for the behavioral health clinician to generate a caseload
  • Provide clinical coverage for clinician’s time away from the site to attend MHSC-sponsored meetings and trainings
  • Obtain and process the proper clearances for the behavioral health clinician to work at the site
  • Orient, train and support the behavioral health clinician in site workflow processes and procedures

 

For any questions, please contact Iyashia Abednego at iabednego@health.nyc.gov.

Apply to join the Corps: http://bit.ly/2j8igZk

Printable Worksheet: use this worksheet to prepare for the Behavioral Health Site Application

Frequently Asked Questions