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Quality Improvement Services

Vendor Selection Assistance

NYC REACH can guide a practice in choosing a Certified EHR that best fits their needs.

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NYC REACH offers educational materials to connect a practice to resources that will help in the decision of which EHR will best serve the practice.
For help starting your EHR system search, contact NYC REACH today!

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Choosing a Certified EHR depends on:

Cost
Clinical Specialty Support
Customer Support Services
Public Health Reporting Capabilities (e.g. immunization registry, syndromic surveillance, cancer registries)
Implementation timelines (how quickly the system can be installed, tested and turned on in your practice)
Available integration with lab and diagnostic companies
Ability to exchange information with other EHR systems and Health Information Exchanges (HIEs)
Reporting capabilities for participating programs such as Meaningful Use, Accountable Care Organizations, and Patient Centered Medical Home

Meaningful Use

What is Meaningful Use?
Meaningful Use, also known as Centers for Medicare and Medicaid Services’ (CMS) EHR Incentive Program, gives financial incentives to providers who demonstrate “Meaningful Use” of EHR technology. Providers can receive payments and avoid penalties if they use an EHR to capture patient data, coordinate care of the patient and engage with patients.
Why should I participate?
  • Providers who see more than 30% Medicaid patients can earn up to $63,750 in incentive payments.
  • All providers who bill Medicare Part B should participate in Meaningful Use to avoid payment adjustments.
  • Aside from financial reasons, successful achievement of Meaningful Use establishes a necessary foundation for other quality improvement and incentive programs supporting value-based care, care coordination, and quality improvement such as Patient-Centered Medical Home (PCMH), Physician Quality Reporting System (PQRS), and Delivery System Reform Incentive Program (DSRIP).

Keep in mind that adopting and documenting enough data in an EHR to qualify for Meaningful Use can take months, so do not put off making this important decision to transform your practice.

What do I have to do?

1. Determine EHR Incentive Program Eligibility

Eligible* provider types:

  • Physicians (MD, DO)
  • Dentists (DDS, DMD)
  • Nurse Practitioners (NP)
  • Certified Nurse-Midwives (CNMW)
  • Physician Assistants (PA) who practice in a Federally Qualified Health Center (FQHC)

*These provider types are eligible for Meaningful Use if they are not hospital-based practitioners. Hospital-based practitioners are defined as providers who see more that 90% of patients as hospital inpatients or ED visits are considered hospital-based.

Providers can qualify for either the Medicaid or the Medicare EHR Incentive Program:

  • Medicaid EHR Incentive Program – requires providers to meet a 30% Medicaid patient volume (20% for pediatricians) threshold. Participation will earn incentives for the provider and protect the provider from Medicare penalties, if the provider sees any Medicare patients.
  • Medicare EHR Incentive Program – for providers who cannot meet the 30% Medicaid patient volume so as to avoid the Medicare Part B penalty. The Medicare EHR Incentive Program no longer provides incentive payments, but will prevent penalties.

To find out more information about eligibility, visit the CMS website.
For more information about payment adjustments, read Payment Adjustments below.

2. Adopt Certified EHR Technology

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have set standards and other criteria that EHRs must use in order to qualify for the Medicare and Medicaid EHR Incentive Programs. In order to be eligible for an incentive payment, providers must use an EHR that is specifically certified for the EHR Incentive Programs. Certified EHR technology offers providers with the necessary technological capabilities and security to help meet Meaningful Use criteria.
NYC REACH can guide a practice in choosing a Certified EHR that best fits their needs. Contact NYC REACH today to start your EHR system search.

To determine if an EHR system is currently certified, view the ONC Certified Health IT Product List (CHPL).

3. Meet Meaningful Use Requirements

Providers must meet specific required measures and document data in the EHR to attest to Meaningful Use

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4. Attest

All participating providers must successfully demonstrate Meaningful Use by submitting EHR data to an attestation system in order to receive incentive payments and/or avoid payment adjustments.

INCENTIVE PAYMENTS

Incentive payments are only available through the Medicaid EHR Incentive Program.

Participants in the Medicaid EHR Incentive Program can earn up to $63,750. Incentive payments are time-sensitive and require measures to be met within a particular timeframe each year and for attestations to be completed by March 31st of the following year.

To receive the entire amount of incentive payments, providers must start the Medicaid EHR Incentive Program in 2016.

Providers can qualify for the first payment by Adopting, Implementing, Upgrading OR by demonstrating Meaningful Use of Certified EHR Technology in their first participation year. Providers are required to demonstrate Meaningful Use in each subsequent year to continue to qualify for payment and avoid payment adjustments.

PAYMENT ADJUSTMENTS

All providers that bill for Part B services on the Medicare Physician Fee Schedule will experience payment reductions in 2015 if they do not demonstrate Meaningful Use in 2013.

The payment reduction for Medicare Fee-for-Service physicians starts at 1% and increases up to 5% for every year that you are not demonstrating Meaningful Use. Hospital-based physicians are not subject to possible payment reductions.

Medicaid providers who are only eligible to participate in the Medicaid EHR Incentive Program are not subject to these payment adjustments.

Payment adjustments are calculated on a two-year schedule. As an example, a physician who accepts both Medicare and Medicaid reimbursements but was not able to demonstrate Meaningful Use in 2013 will have a Medicare fee-schedule reduction in their Medicare claims.

The payment reduction for Medicare Fee-for-Service physicians starts at 1% and increases up to 5% for every year that you are not demonstrating Meaningful Use. Hospital-based physicians are not subject to possible payment reductions.

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). QPP has two participating tracks: The Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

Merit-based Incentive Payment System (MIPS)

MIPS is a combination of three previous quality-based reporting incentive programs – Physician Quality Reporting System (PQRS), the Value-Based Modifer (VM), and Medicare EHR Incentive Program.

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

 

QPP Categories

 

Please note: The cost category will be calculated in 2017, but will not be used to determine a clinician’s payment adjustment. Cost will be used in determining a clinician’s payment adjustment starting in 2018.
Clinicians participating in MIPS in 2017 will be given the option to pick their pace – a clinician’s level of participation for 2017 will determine their payment adjustment.

Participation in MIPS for the 2017 reporting year is categorized into one of three options:

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Submit Something: Clinicians submit the minimum amount of data to avoid any negative payment adjustments

 

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Submit a Partial Year: Clinicians submit data for 90 days may earn a neutral or small positive payment adjustment

 

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Submit a Full Year: Clinicians submit a data for a full year may earn a moderate payment adjustment

 

Please note: Clinicians that do not participate in MIPS for the 2017 reporting year will receive a negative 4% payment adjustment.

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 to provide high-quality and cost-efficient care. Some 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.

Options for Advanced APMs for New York-based providers are currently under review.

Eligibility

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

  • Physicians (MD, DO, DPM, OD)
  • Dentists (DDS, DMD)
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist

These eligible clinician types must also bill more than $30,000 in Medicare Part B and provide care for more than 100 Medicare Part B unique patients in a year.
Eligibility for Advanced APMs: Eligibility is based on the available models applicable to your region and scope of practice. Please visit https://qpp.cms.gov/learn/apms for more information.

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.

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

Additional Services

As the healthcare industry shifts to value-based care, NYC REACH wants to continue to help providers succeed in delivering the best care to their patients.
NYC REACH supports providers through participation in programs around accountable care, patient-centered care and targeted improvements on public health priorities.

NYC REACH has services to help practices improve care coordination, patient engagement, and utilize health information systems, such as electronic health records (EHRs), to follow-up and monitor the health of their patient populations.

Group training and personalized support are offered for:

Revenue Cycle Optimization
Documentation and coding can be complex, and with requirements changing under the Affordable Care Act and adoption of ICD-10, this complexity is sure to increase.
NYC REACH will help prepare providers for the future by offering new services including billing consulting services and new revenue cycle management classes.
Members of NYC REACH can purchase personalized support and review revenue cycle optimization best practices, such as:

  • Clearinghouse support (e.g. rejection analysis, ERA / EFT enrollment assistance)
  • Front Desk related workflow (e.g. eligibility verification, referrals, appointment scheduling, visit status reconciliation, co-payment collection)
  • Creating, scrubbing, submitting claims and posting payments
  • Documentation & Coding (e.g. Specialty Specific CPT, ICD-9 and HCPCS Codes)
  • Identification of problem areas through financial reporting tools (e.g. A/R analysis)
  • Updates relating to Transitional Care Management (TCM) and Chronic Care Management (CCM) requirements

If you have any questions about these services, don’t hesitate to contact us:

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Clinical-Community Program Linkages

The goal of Clinical-Community Program Linkages (CCPL) is to develop sustainable and scalable pathways from the clinical environment to evidence-based intervention programs.

CCPL aims to:

  • Collaborate with providers and colleagues to increase evidence-based intervention program referrals
  • Support clinicians and worksites to offer evidence-based intervention programs
  • Increase patient participation with evidence-based intervention programs

In an effort to create an efficient connection with these programs, collaborating providers can leverage a physician portal provided by the Quality & Technical Assistance Center of New York (QTAC-NY).

Evidence-Based Interventions

CCPL assists with generating clinical referrals and setting up workshops for the following evidence-based intervention programs:

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Patients Referred

127

NYC Practices Who Referred Patients to an EBI Program

97

Lifestyle Coaches Trained

61

Workshops Hosted by Collaborating Organizations

The Quality & Technical Assistance Center of New York (QTAC-NY)

The Quality & Technical Assistance Center of New York (QTAC-NY) Compass Portal is an easy and free online registration and referral tool. Through QTAC-Compass, providers/physicians in clinical settings can refer and enroll their patients into a variety of evidence-based interventions.
Benefits of Referring through Compass by QTAC-NY

  • Ability to directly register patients/participants for programs in real time
  • Patients/participants can choose classes from a variety of providers at a variety of locations
  • If a patient/participant attends a workshop, the provider/physician will receive automated feedback regarding the patient’s/participant’s attendance, physical activity, and weight loss

National Diabetes Prevention Program

The National Diabetes Prevention Program (NDPP) is a Centers for Disease Control and Prevention (CDC) recognized evidence-based lifestyle change prevention program for adults with prediabetes (i.e., adults who have not been diagnosed with diabetes, excluding gestational diabetes).

The program consists of 16 weekly sessions of core classes at 1 hour per week and is followed by monthly maintenance sessions for the combined duration of one year. The classes are facilitated by a certified lifestyle coach who follows a CDC approved curriculum including concepts related to physical activity, coping mechanisms, healthy eating, and stress management.

The overall objective of the NDPP is for participants to lose at least 7% of their body weight and adopt healthier habits into their lifestyles.

Diabetes Self-Management Program

The Diabetes Self-Management Program (DSMP), developed by Stanford University’s Patient Education Research Center, is designed to assist patients in managing type 2 diabetes.

The DSMP teaches self-managed lifestyle change and coping strategies to enable participants to manage their diabetes, medications, and increase physical activity levels.

Patients with type 2 diabetes attend the workshop in small groups for 2½ hours per week, for six weeks. Workshops are facilitated by two trained leaders, one or both of whom is a peer leader with diabetes.

Chronic Disease Self-Management Program

The Chronic Disease Self-Management Program (CDSMP), developed by Stanford University’s Patient Education Research Center, is designed to assist patients in managing their chronic or ongoing health condition.

The CDSMP teaches self-managed lifestyle change and coping strategies to enable participants to manage their health condition(s), medications, and increase their physical activity levels.

Patients with different chronic health conditions attend the workshop in small groups for 2½ hours per week, for six weeks. Workshops are facilitated by two trained leaders.

Referring to evidence-based intervention programs is free, easy, and aligned with many of NYC REACH’s Quality Improvement initiatives.
For more information, please contact EBI_Referrals@health.nyc.gov

Quality Improvement Projects

NYC REACH’s quality improvement projects introduce innovative system changes that promote disease prevention and control through the following actions:
  • Improve blood pressure control among hypertensive patients
  • Deliver smoking cessation interventions
  • Reduce the number of patients with uncontrolled diabetes
  • Reduce the prevalence of diabetes by increasing participation in the National Diabetes Prevention Program
  • Increase cancer screenings to detect and treat early and reduce mortality
  • Adopt and use of health information technologies
  • Transform practices to achieve federal and state-driven initiatives for advanced primary care models
September 2014 – September 2018

Join the BEAT

Join the BEAT’s goal is to integrate community-based programs and resources with medical practice-based quality improvement to promote hypertension control and diabetes prevention. The program has an emphasis on neighborhoods within areas of the District Public Health Offices and Southeast Queens. BEAT stands for:

  • Be Active
  • Eat Healthy
  • Act on Your Cardiovascular Risks
  • Take Your Prescribed Medication

June 2015 – May 2018

HealthyHearts NYC

HealthyHearts NYC aims to improve cardiovascular disease prevention and treatment in primary care by focusing on the ABCs of cardiovascular care:

  • Aspirin as Appropriate
  • Blood Pressure Control
  • Cholesterol Management
  • Smoking Cessation

Healthy Hearts is a partnership with NYU Langone Medical Center (NYULMC) and the Community Health Care Association of New York State (CHCANYS).

September 2013 – June 2018

NYC Care Calls

NYC Care Calls helps patients control their diabetes through consistent telephonic interventions intended to promote long-term behavioral change. Topics discussed during these telephonic self-management support calls include:

  • Medication Adherence
  • Healthy Eating
  • Physical Activity
  • Community Resources

This project is a partnership with the Albert Einstein College of Medicine.

Began September 2015

Public Health Detailing Action Kits

NYC REACH, in collaboration with the Bureau of Chronic Disease Prevention & Tobacco Control, is involved with the development and dissemination of Public Health Detailing Action Kits. These kits, made up of clinical tools and resources for both patients and providers, promote evidence-based best practices and chronic disease management. Some topics discussed by the detailing action kits include:

  • Smoking Cessation
  • Diabetes
  • Hypertension
  • Colon Cancer

Click here for more information on these and other detailing action kits.