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 2019 performance year will receive a negative 7% Medicare Part B payment adjustment in 2021. Eligible clinicians who do participate can receive up to a 7% positive adjustment.


MIPS Eligibility

Clinicians who are eligible to participate in MIPS include:

  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Registered dietitians or nutrition professionals
  • 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 2019 – December 2019
Clinician participates in MIPS Activities

January 2020 – March 2020
Clinician submits performance data

March 2020 – July 2020
CMS analyzes performance data, determines payment adjustment, notifies clinician

2021
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 2019.

MIPS 2019 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 2019 will earn a five percent incentive payment in 2021 if they 1) receive 50 percent of their Medicare Part B payments through an Advanced APM or 2) see 35 percent of their Medicare patients through an Advanced APM entity.


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:

  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Registered dietitians or nutrition professionals
  • 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.

New York State Patient-Centered Medical Home

WHAT IS NEW YORK STATE PATIENT-CENTERED MEDICAL HOME?

The patient-centered medical home (PCMH) model supports primary care practices with providing patient-centric care, improving quality outcomes, and performing well under value-based care arrangements. New York State Department of Health (NYS DOH) has partnered with the National Committee on Quality Assurance (NCQA) to create New York State Patient-Centered Medical Home (NYS PCMH), a PCMH program designed specifically for New York State providers.

NYS PCMH promotes the Quadruple Aim: a healthcare framework focused on improving patient experience, care team well-being, population health, and reducing the cost of care.

WHY SHOULD I PARTICIPATE?
  • Effective population health management is required for successful performance under value-based care. Practices that join NYS PCMH strengthen their population health capabilities by:
    • Coordinating with specialists
    • Connecting patients with community resources
    • Using population information to deliver evidence-based and culturally appropriate care
    • Providing whole-patient care including physical health, behavioral health, and social determinants of health
  • NYS PCMH simplifies practice workflows by aligning its program measures with other federal and state programs and insurance plans. This reduces time spent on administrative tasks associated with other programs.
  • Practices that implement NYS PCMH activities improve their performance under value-based care arrangements.
  • Practices that join NYS PCMH improve performance in programs such as Meaningful Use, the Quality Payment Program’s Merit-Based Incentive Payment System, and qualified entity incentive programs.
PROGRAM INCENTIVES
  • Practices that successfully participate in the program achieve NYS PCMH Recognition. NYS PCMH-recognized practices receive a per-member per-month (PMPM) care management payment for all services provided to Medicaid patients.
  • Practices that join NYS PCMH receive fully-funded technical support. All fees associated with the program are covered by NYS DOH. This support is offered for a limited time only, so providers are encouraged to sign up as soon as possible.
  • Practices that join NYS PCMH receive funding to cover the cost of connecting to a qualified entity (also known as a­ regional health information organization).

Effective July 1, 2018, the reimbursement amounts are:

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
WHAT DO I HAVE TO DO?
DETERMINE ELIGIBILITY

All primary care practices are eligible to participate, including:

  • Internal medicine
  • Pediatrics
  • Family Medicine
  • Geriatrics

NYS PCMH Recognition is awarded at the practice level.

Practices that are already PCMH-recognized should participate in NYS PCMH to sustain PCMH activities.  Practices that are PCMH 2014-recognized can advance to NYS PCMH at any time.

NYC REACH provides free technical assistance with all phases of program participation. Space is limited. Click the CONTACT US button below to learn more.

JOIN A QUALIFIED ENTITY

Practices must connect to a qualified entity (QE), which is also known as a regional health information organization (RHIO). The costs of joining a QE are covered by NYS DOH.

NYC REACH provides free assistance with connecting to a QE.

ACHIEVE NYS PCMH GOALS

Achieving NYS PCMH Recognition involves a set of concepts and activities that practices must implement. Practices upload documentation and track their progress in the program’s online portal throughout the recognition process.

The activities are geared toward improving practices’ ability to:

  • Routinize evidence-based guidelines for comprehensive care management
  • Improve care coordination with other providers and close referral loops
  • Address gaps in behavioral health screening and treatment
  • Optimize the use of health information technology to improve workflows and patient care

NYC REACH provides free technical assistance with all phases of program participation. Space is limited. Contact us to learn more.

Qualified Entity Connectivity

A Qualified Entity (QE), also known as 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 QE to coordinate patient care more effectively.

QEs 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. QEs can also notify providers when patients are hospitalized. Practices that contribute to a QE can share patient data with other providers who use the same QE, access patient data from other practices and facilities using the QE, and use the Statewide Health Information Network of New York (SHIN-NY).

The QEs 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.

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).

MENTAL HEALTH SERVICE CORPS

Thank you for your interest in the Mental Health Service Corps (MHSC).

Leadership and operations for MHSC will transition from the New York City Department of Health and Mental Hygiene (DOHMH) and the City University of New York (CUNY) to NYC Health + Hospitals as of January 1, 2020. The current MHSC program will continue to operate through December 31, 2019. Due to the transition of the program, no new sites will be considered for the program and sites with vacancies will not be filled. The redesigned program will only serve sites affiliated with NYC Health + Hospitals.

We thank all of our partners for your advocacy and support for this program over the last three and a half years. For questions, please email MHSCsupport@health.nyc.gov.