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: The Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Eligible clinicians can enter their 10-digit National Provider Identifier (NPI) number in the QPP Participation Status tool to view their QPP participation status. Click here to access the tool.

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:

 

Quality Improvement Activities Cost Promoting Interoperability

Eligible clinicians must submit data in the Promoting Interoperability and Improvement Activities categories for 90 days or more; and submit data in the Cost and Quality categories for 12 months. Eligible clinicians who do not participate in MIPS in the 2018 performance year will receive a negative 4% Medicare Part B payment adjustment in 2020.


MIPS Eligibility

Clinicians who are eligible to participate in MIPS include:

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

These clinicians must have billed more than $90,000 in Medicare Part B allowable charges and provided care for more than 200 Medicare Part B unique patients in a year.

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.


PARTICIPATION TIMELINE

Each performance year runs from January 1st to December 31st. Eligible clinicians submit performance data in March of the following year.

A clinician’s level of participation in any performance year determines their Medicare Part B payment adjustment two years later.

Example timeline:

January 2018 – December 2018
Clinician participates in MIPS Activities

January 2019 – March 2019
Clinician submits performance data

March 2019 – July 2019
CMS analyzes performance data, determines payment adjustment, notifies clinician

2020
Clinician receives payment adjustment

Deadlines for data submission are subject to change. NYC REACH notifies members of all deadline updates.


RESOURCES

Fact sheets are available to help eligible clinicians better understand program participation for performance year 2018.

MIPS 2018 Performance Categories:

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 who participate in Advanced APMs can receive incentive payments from 2019 through 2024 and are exempt from any reporting requirements and payment adjustments tied to MIPS.

Eligible clinicians who participate in an Advanced APM in performance year 2018 will earn a five percent incentive payment in 2020 if they 1) receive 25 percent of their Medicare Part B payments through an Advanced APM or 2) see 20 percent of their Medicare patients through an Advanced APM.


Advanced APMs Eligibility

Eligibility for Advanced APMs is based on the available models applicable to a clinician’s region and scope of practice. In performance year 2018, the following models are Advanced APMs:

Clinicians who are eligible to participate in Advanced APMs include:

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

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


Participation Timeline

Each performance year runs from January 1st to December 31st. Eligible clinicians submit performance data in March of the following year.

Example timeline:

January 2018 – December 2018
Clinician participates in Advanced APM

March 2019 – July 2019

CMS determines eligibility for incentive payment, notifies clinician

2020
Eligible clinician receives/does not receive incentive payment

Deadlines for data submission are subject to change. NYC REACH notifies members of all deadline updates.


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 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.

As of April 2018, practices participating in APC will transition into the New York State Patient-Centered Medical Home (NYS PCMH) program.

Practices interested in participating in this program 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.

Practices interested in achieving PCMH recognition must participate in NYS PCMH. Complete a brief self-assessment to confirm eligibility.

Complete the self-assessment here.

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

Effective July 1, 2018, the revised reimbursement amounts will be:

Medicaid NCQA PCMH Level 2 2014 Standards NCQA PCMH Level 3 2014 Standards NCQA PCMH 2017 / NYS PCMH Standards
MMC Per Member Per Month $0.00 $6.00 $6.00
FFS – Article 28 Clinic/FQHC Per Visit $0.00 $25.25 $25.25
FFS – Office-based Provider Per Visit $0.00 $29.00 $29.00

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: https://bit.ly/2I5ybVc

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: https://bit.ly/2I5ybVc

Printable Worksheet: use this worksheet to prepare for the 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: https://bit.ly/2I5ybVc

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: https://bit.ly/2I5ybVc

Printable Worksheet: use this worksheet to prepare for the application

Frequently Asked Questions