X

Practice Transformation

Quality Payment Program

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

QPP offers two 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.

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

What is Advanced Primary Care?

New York State Department of Health is launching Advanced Primary Care (APC) because healthcare billing and reimbursement will change dramatically in New York State over the next few years. By 2020, 80% of primary care will be paid for under a value-based arrangement. Insurance companies, including Medicaid and Medicare, will base payments to providers on the quality of care a provider delivers to their patients. For a provider to meet these new and higher standards of care as well as to manage and report their quality accurately to payers, providers will need to change practice workflows, operations, and use of health information technology.

APC builds on principles established by Meaningful Use and Patient-Centered Medical Home to also include multi-payer financial support. Practices committed to APC will enhance their abilities for identifying patients by health risks; developing care plans cooperatively with patients; and electronically engaging with patients via the patient portal.

Practices participating in Advanced Primary Care can receive up to two years of free technical assistance support from NYC REACH. Technical assistance for APC support is available until January 2019.

Eligibility
APC services are provided at the site-level. Practices with sites that provide primary care services such as pediatrics, internal medicine, and family medicine are eligible to participate in Advanced Primary Care.

A practice is eligible to participate in APC if they are not concurrently receiving federally-funded transformation technical assistance (e.g. TCPI, DSRIP-supported PCMH). NYC REACH can determine if a practice meets these eligibility requirements.

Free Technical Assistance
Technical assistance from NYC REACH includes:

  • Training and guidance on implementing workflow changes
  • Education on new and existing state and federal payment reform programs, such as the Quality Payment Program (QPP) and Patient-Centered Medical Home (PCMH)
  • Customized practice assistance, tools, and coaching
  • Remote and on-site support from practice transformation experts
  • Peer networking opportunities through trainings and collaborative events

For practices interested in participating in APC and receiving free technical assistance from NYC REACH must complete a self-assessment.

Please click here to access the APC self-assessment tool.

Financial Incentives
Practices will receive outcomes-based incentive payments from multiple payers as they achieve APC benchmarks.

APC programmatic benchmarks consist of making a commitment to the program, demonstrating readiness for care coordination, and demonstrated APC capabilities through outcomes.

Alignment
Participation in APC will support a practice’s progression through additional incentive-based federal and state programs:

Medicaid EHR Incentive Program – Achieving Meaningful Use establishes a foundation that will lead to successes in MIPS, PCMH, and APC.

Patient-Centered Medical Home (PCMH) – Practices that receive Level 3 PCMH recognition are able to enter APC at a higher threshold, which can result in higher incentive payments.

Merit-Based Incentive Payment System (MIPS) – APC prepares practices for the MIPS portion of the Medicare Access and CHIP Reauthorization Act (MACRA).

Regional Health Information Organization (RHIO) – Connection to a RHIO is a requirement for advancing in APC. Funding for RHIO connectivity is currently available from the New York State Department of Health.

For questions about APC, please contact apc@health.nyc.gov or join NYC REACH’s free Office Hours on the last Tuesday of every month starting at 2:30 p.m.

Click here to access the Office Hours: http://bit.ly/PTOfficeHours and use the password “Nycreach1”

Patient-Centered Medical Home

What is PCMH?
A Patient-Centered Medical Home (PCMH) is a model for primary care practices that emphasizes care coordination and communication. This patient-centric approach ensures that each patient is assigned a physician within a practice whom the patient can see consistently. Utilizing this model, practices have the capability to give their patients increased access to their physicians.

PCMH achieves the “Triple Aim” and is a fundamental part of the New York State Health Innovation Plan and Medicaid’s Delivery System Reform Incentive Payment (DSRIP) Program. Triple Aim is a framework that strives to simultaneously pursue three dimensions: improve the patient experience of care, improve the health of populations, and reduce the per capita cost of health care. PCMH offers a framework that helps practices become ready for 21st century health care by ensuring that processes are in place for care coordination, care management, and quality improvement.

A practice that achieves PCMH recognition receives enhanced reimbursement from New York State Medicaid. In addition, PCMH-recognized practices will also see an improvement with care coordination, patient engagement, and health outcomes.

NYC REACH has assisted over 700 practices to achieve PCMH recognition.

The video above highlights the framework of the Patient-Centered Medical Home.
How can a practice become a PCMH?
Transform your practice using the Standards and Guidelines set by the National Committee for Quality Assurance (NCQA) and achieve recognition.

The NCQA PCMH program’s six standards align with the core components of primary care:

PCMH Standards Overview

Source: Emmi Solutions, LLC

Why should a practice become a Medical Home?
By becoming a Medical Home, a practice will:

  • Improve care coordination, patient engagement, and health outcomes
  • Establish efficient workflows for clinic operations.
  • Receive enhanced reimbursement from NYS Medicaid:
Effective July 1, 2017, the revised reimbursement amounts will be as follows:
Updated PCMH Graphic (Website)
Please note: Incentive payments will no longer be available for NCQA’s 2011 standards after July 1, 2017.

How Can NYC REACH Help?

NYC REACH offers a range of PCMH services established by the National Committee for Quality Assurance (NCQA) to assist with PCMH transformation. NCQA PCMH recognition is the most widely adopted model for transforming primary care practices into medical homes. NYC REACH has worked with hundreds of practices and offers services such as coaching, gap analysis, and documentation review. For questions regarding any services, please contact PCMH@health.nyc.gov.
PCMH Services Provided by NYC REACH

Group Training

Held monthly, the full-day in-person group training focuses on a review of the NCQA Standards and Guidelines and advises practices with their preparation, documentation, and submission process. The group training is a first step for practices interested in PCMH transformation. Click here for more information and to RSVP for an upcoming group training.

 

NYC REACH also offers customized training for large organizations, ACOs, and IPAs, to meet goals set by member practices. This organizational-based training can include “train-the-trainer” sessions wherein NYC REACH staff will coach others to then deliver PCMH training. For more information and to set up a training session for your practice, e-mail PCMH@health.nyc.gov.

Documentation Review

NYC REACH will audit and review all prepared application materials and documentation prior to submission to the NCQA and provide a detailed summary report of the audit.

Gap Analysis

NYC REACH will conduct an assessment of a practice’s workflow and utilization of health information technology. This assessment will help provide an understanding of a practice’s progress in regards to PCMH recognition. This includes an interview with key staff and an on-site visit, as well as a written report with recommended next steps.

Coaching and Transformation

NYC REACH offers coaching and assistance to aid practices with project management support and technical assistance to enhance workflows, EHR setup, and practice team capabilities to meet PCMH Standards and initiate the PCMH recognition process.

Free Office Hours

NYC REACH hosts free monthly online office hours for NYC REACH members. Participants have the opportunity to ask questions on topics such as PCMH standards, guidelines, and documentation processes.

Delivery System Reform Incentive Payment/Performing Provider Systems Services

NYC REACH assists DSRIP PPSs with readying associated primary care practices to achieve NCQA PCMH Level 3 recognition. Partnering with PPS leads, NYC REACH aligns PCMH implementation objectives with selected DSRIP projects, collaborates with PPS stakeholders on practice transformation strategy, and develops customized work plans to best meet the specific cultural and geographic needs of PPS practices.

How Can I Learn More About PCMH?

PCMH Resources
The following links provide great foundational information that will help practices learn more about PCMH and practice transformation:

PCMH Group Training Testimonials

Transforming Clinical Practice Initiative

What is the Transforming Clinical Practice Initiative?

The Transforming Clinical Practice Initiative (TCPI) helps clinicians thrive in the advancing healthcare environment by supporting changes to clinical and business practices for participation in new payment models. Organized into Practice Transformation Networks (PTNs), clinicians engage in peer-based learning networks to assist the practice transformation process.

NYC REACH members can join the New York State Practice Transformation Network (NYS PTN) and receive technical assistance services from NYC REACH at no cost to the practice. TCPI is funded by the Centers for Medicare and Medicaid Services (CMS).

Eligibility
Enrollment in the NYS PTN is open to primary and specialty care providers:

  • MDs, DOs, PAs, NPs, Clinical Nurse Specialists, Clinical Psychologists, LCSWs
  • Providers using a 2014 certified EHR
  • Providers not currently participating in a Medicare Shared Savings Program, Pioneer ACO Program, Multi-Payer Advanced Primary Care Program, or Comprehensive Primary Care Initiative
Free Technical Assistance
Practices interested in participating in the NYS PTN receive:

  • On-site and remote-based practice transformation services
  • Peer networking opportunities through trainings and collaborative events
  • Access to resource guides from national experts

TCPI Benefits for Clinicians

Doctor Image

Practice Transformation Networks

NYC REACH supports two Practice Transformation Networks: the New York State Practice Transformation Networks and the Greater New York City Practice Transformation Network (a group led by NYU School of Medicine).
TCPi Logo 1
NYS PTN Logo
NYUsom_2CP_PMS_NYULMC

Learn More about TCPI

Resources:
Healthcare Communities: The official TCPI website that disseminates key information and notifications.

Incentives for RHIO Connectivity: Joining a Regional Health Information Organization can help a practice succeed in TCPI and new payment models. Incentive money is currently available to eligible practices for RHIO connection.

Regional Health Information Organization Connectivity

Connect Today to Succeed in Practice Transformation

What is a Regional Health Information Organization?

A Regional Health Information Organization (RHIO) is a public Health Information Exchange (HIE). An HIE allows providers and patients to access and securely share medical information electronically.

RHIOs receive patient data from the EHRs that are used in small practices, hospitals, behavioral health organizations, community based organizations and major health systems. Practices that contribute to a RHIO can share patient data with other providers who also use the RHIO; access information about their patients who see other providers; 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.
Program Alignment
RHIO connectivity can help practices be successful in current practice transformation programs:

Advanced Primary Care

Patient-Centered Medical Home

Transforming Clinical Practice Initiative

How do Practices Pay for RHIO Connectivity?

The New York State Department of Health offers an incentive through the Data Exchange Incentive Program (DEIP) to defray the cost of connecting to a RHIO. Funding support is available until September 2018 and awarded on a first-come first-serve basis.

For more information, please contact Sydney Sasanow at ssasanow@health.nyc.gov.

Data Exchange Incentive Program: Eligibility Requirements

  • MD, DO, Dentist, NP, CNMW, PA, or Behavioral Health provider

  • Organization uses Certified EHR Technology (CEHRT) that is able to submit data to the RHIO as CCD or C-CDA

  • Organization has at least one provider that accepts Medicaid in one of the following forms: Fee for Service, Managed Care, or HARP

  • Received payment for any year or stage of either the Medicaid or Medicare Meaningful Use Program

For more information about the RHIO incentive program, please contact Sydney Sasanow at ssasanow@health.nyc.gov.

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 Sabina Saleh at ssaleh@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