Dec. 31st is coming soon, MIPS-eligible clinicians can easily avoid 4% negative payment adjustment!

If you are a Merit-based Incentive Payment System (MIPS)-eligible family physician or other clinician (check here to check eligibility: 31, 2017 is the final day to act to avoid a negative payment adjustment in the 2019 payment year! 

*Contact the Quality Payment Program at or 1-866-288-8292 to act now*

We urge any undecided clinicians to take the “test” option--capture a minimum amount of MIPS data (for example, one quality measure or one improvement activity for any point in 2017)–-to avoid a negative payment adjustment. 

If you are a board-certified Family Physician and you don’t have an EHR to capture quality measure data, or you are currently stuck in PRIME Registry onboarding due to issues with your EHR, our PRIME Registry technology vendor, FIGmd, has provided a 2017 MIPS manual web tool for you to use. Email for more info.

In addition, CMS offers no-cost help so clinicians can be successful in the program and make the best decisions about how to participate. Please contact the Quality Payment Program at or 1-866-288-8292 to act now.

The Centers for Medicare & Medicaid Services designed the program to be flexible and minimize burden to the extent allowed under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).


Finding the Bright Spots in Value-Based Care

Interesting article in Sept-Oct 2017 Family Practice Management journal, authors Drs. Farzad Mostashari, Jen Brull, Jonathan Lilly, and Julio Navarro argue that while the "transformation shift, from rewarding volume to rewarding value" can feel overwhelming, "it may ultimately give family physicians new opportunities to prosper ... [and] finally be able to offer patients the kind of care that drew them to medicine in the first place – personal, proactive care that provides true value for patients without wasting resources."


Learn More About Forming a Virtual Group to Participate in MIPS in 2018

News from the CMS Quality Payment Program
November 9, 2017

Apply Now Until December 31 to Form a Virtual Group for MIPS in 2018

Solo practitioners and groups can choose to participate in the Merit-based Incentive Payment System (MIPS) as a virtual group for the 2018 performance period. To form a virtual group for 2018, solo practitioners and groups must follow an election process, and submit their election to CMS by December 31, 2017

What is a Virtual Group?

As outlined in the Quality Payment Year 2 Final Rule, a virtual group is a combination of two or more Taxpayer Identification Numbers (TINs) made up of one or more solo practitioners or one or more groups consisting of 10 or clinicians (including at least 1 MIPS eligible clinician), or both, that elect to form a virtual group for a performance period for a year.

To be eligible to join a virtual group, you must be a:

  • Solo practitioner who exceeds the low-volume threshold; and who is not a newly Medicare-enrolled eligible clinician, a Qualifying APM Participant (QP), or a Partial QP choosing not to participate in MIPS.
  • Group that exceeds the low-volume threshold at the group level (i.e., the NPIs within the TIN collectively exceed the low-volume threshold) and has 10 or fewer clinicians (including at least 1 MIPS eligible clinician).

How Do I Form a Virtual Group?

To form a virtual group, there is a two-stage virtual group election process:

  • Stage 1 (optional): If you’re a solo practitioner or a group with 10 or fewer eligible clinicians, you can choose to contact your Quality Payment Program Technical Assistance representative. Your representative can help you figure out if you're eligible to join or form a virtual group before you:

1. Make any formal written agreements.

2. Send in your formal election registration.

3. Budget your resources for your virtual group.

For groups that don’t participate in stage 1 of the election process and don’t ask for an eligibility determination, CMS will see if they’re eligible to be in a virtual group during stage 2 of the election process.

  • Stage 2 (required): As part of the stage 2 election process, a virtual group must have a formal written agreement between each solo practitioner and group that composes the virtual group prior to submitting an election to CMS. Each virtual group has to name an official representative who is responsible for submitting the virtual group's election via e-mail to by December 31, 2017.

If all the criteria for forming a virtual group are met, CMS will contact the virtual group’s representative and provide the virtual group with a performance identifier.

Learn More about Virtual Groups

For more information about participating in MIPS as part of a virtual group, the election process, and formal agreements, please see the Virtual Groups Toolkit. The toolkit contains:

  • Virtual Group Participation Overview Fact Sheet
  • Virtual Groups Election Process Fact Sheet
  • Virtual Groups Agreement Checklist
  • Virtual Groups Sample Agreement Template

Need Help with the Election Process?

Contact the QPP Service Center at or 1-866-288-8292 (TTY: 1-877-715-6222).  Or, contact your local support organization.  

Upcoming CAPG Webinars-How to Select Measures and Position Your Organization for APMs

CAPG Educational Series 2017 Improvement Activities – How to Select Measures and Position Your Organization for APMs; and Advanced Alternative Payment Models—The Good, Bad and Ugly

CAPG is pleased to present a new complimentary webinar series for physicians and physician groups participating in the Quality Payment Program, part of the Medicare Access and CHIP Reauthorization Act (MACRA). Through a co-branding agreement with the Centers for Medicare & Medicaid Services (CMS), the sessions combine CMS expertise on the regulation content with CAPG members’ knowledge of how clinicians are responding on the ground to the important changes it brings.

Each session will include Q&A time with the presenters. We believe the webinars will be a valuable resource to help you successfully participate in MACRA in 2017 and beyond. Upcoming sessions in the series will focus on: 

Title: Improvement Activities – How to Select Measures and Position Your Organization for APMs

Date: September 15, 2017

Time: 12:00pm -1:30pm PT / 3:00pm - 4:30pm ET


Subject matter experts from CMS will provide an overview of the Improvement Activities performance category under the Quality Payment Program.

CAPG will have its members cover key implementation steps for physicians and physician organizations starting on this important transition. Our members will tell the audience about the rationale behind their strategy and any implications this will have on their organization.


CMS Speakers:

  • Angela Foster, Health Insurance Specialist, Division of Electronic and Clinician Quality, CMS
  • Dr. Paul Rosen, Medical Officer, CMS

CAPG Speakers:

  • Trista Johnson, AVP Ambulatory Quality and Clinical Services Physician Services, Providence Health & Services
  • Dr. Fiona Wilson, Senior Vice President and Chief of Clinical Transformation, Brown and Toland Physicians

Title: Advanced Alternative Payment Models—The Good, Bad and Ugly

Date: October 2, 2017

Time: 12:00pm -1:30pm PT / 3:00pm - 4:30pm ET


Subject matter experts from CMS will review the MACRA requirement for qualifying to become an advanced alternative payment model (APM) and clarify the final rule statements.  Also, CMS may review some key aspects of the proposed rule.

CAPG members will share best practices and lessons learned in embarking on APMs in the last few decades. What has worked well and where are the opportunities? Our members will share with the audience about the rationale behind their strategies and any implications for their organizations.


CMS Speakers:

  • Rob Furno, MD, MPH, MBA, Chief Medical Officer, CMS Region V, Upper Midwest
  • James P. Sharp, JD, MPH, Special Assistant, Policy and Strategy, Center for Medicare and Medicaid Innovation (CMMI)

CAPG Speakers:

  • Mark Schafer, MD, Chief Executive Officer, MemorialCare Medical Foundation
  • Bill Wulf, MD, Chief Executive Officer, Central Ohio Primary Care Physicians

For more information, please contact Dr. Amy Nguyen, or 213.239.5051.

Invitation to participate in Medicare Quality Payment Program Website Testing

CMS wants the Quality Payment Program website to meet the needs of the clinician community, by providing streamlined access to information and minimizing undue burdens for program participation. CMS invites representatives from organizations of all sizes to assess current and future functionality of the website, as well as make recommendations for improvements. 

They are looking for:

  • Medicare clinicians;
  • Practice managers;
  • Administrative staff; and
  • EHR and Registry vendors.

If interested, please email to participate in a one-on-one feedback session.

Annals of Family Medicine article proposing Chief Primary Care Medical Officer role for hospitals

From Healthcare Finance, Beth Jones Sanborn, Managing Editor, 

A proposal written by two physicians published in the Annals of Family Medicine suggests creating a "executive-level physician" charged with creating,managing primary care connections across the hospital system. The role would be known as chief primary care medical officer, and the authors proposed that the role be filled by a primary care physician who would work 25 percent of the time in an outpatient clinic setting, another 25 percent as a hospital clinician, and the remaining 50 percent in administration at the hospital leadership level.


PCPCC Conference Scholarships Available for TCPI participants!


Conference Scholarships Available!


Calling all providers, patients/patient advisors, and
quality improvement coaches participating in TCPI:

You're invited to join us at our Annual 'Primary Care Innovations' Conference in Washington, DC on October 11-12, 2017! This year's conference features innovators in primary care that exemplify the Shared Principles of Care, and we want you to be included in this groundbreaking event. 

As a TCPI scholar, you will have the opportunity to dialogue with subject matter experts on implications of these innovations for person and family engagement (PFE). You can also gain access to attend our post-conference workshop that will examine application of PFE strategies with Choosing Wisely recommendations. 


For more information and to apply for a scholarship, click here!

*Teams that include patients/patient advisors, providers, and QI coaches will be given scholarship preference.

Support for MIPS 2018 final rule proposal to help small, independent and rural practices

NCQA Offers Comments to CMS on Quality Payment Program 2018 Rule

Excerpted from article published August 15, 2017 by Rajiv Leventhal, Healthcare Informatics

In June, CMS released the proposed 2018 rule for the QPP, designed with a core focus to simplify the program—especially for small, independent and rural practices. As part of this assistance for smaller practices, CMS is proposing to offer virtual group participation next year, which would allow solo practitioners and small practices to join together to report on MIPS (Merit-Based Incentive Payment System) requirements as a collective entity—which in theory would ease the burden for these physicians. 

In its recent comments to CMS, NCQA said “this is a key step toward helping small practices advance toward accountable, team-based, patient-centered care models. NCQA patient-centered medical homes (PCMHs) and patient-centered specialty practices (PCSPs) have demonstrated commitment to improving cost and quality and therefore make ideal virtual group partners. We look forward to exploring how NCQA can support CMS and clinicians in creating virtual groups. We urge you to provide bonus points as incentive for clinicians to join virtual groups. We also urge you to encourage, rather than prohibit, low-volume clinicians’ participation in virtual groups.”

Click here to read the full article


Announcements of Note from the Medicare Quality Payment Program (QPP)

EHR Incentive Program Hardship Exception Application Due by October 1

Eligible professionals (EPs) who are first-time participants in the Medicare Electronic Health Record (EHR) Incentive Program in 2017 are eligible to apply for a one-time hardship exception by October 1, 2017. A first-time EP may apply for this one-time significant hardship to avoid a 2018 payment adjustment if:

  • The EP is a first-time participant in the EHR Incentive Program in CY 2017 and intends to participate in the Medicare EHR Incentive Program in CY 2017
  • The EP is transitioning to Merit-based Incentive Payment System (MIPS) for the 2017 performance period
  • The EP intends to report on measures specified for the Advancing Care Information performance category under the MIPS in 2017

For More Information:

  • Quality Payment Program Service Center at 866-288-8292 (TTY 877-715-6222) or
  • EHR Information Center at 888-734-6433 (press 1)


Quality Payment Program Hardship Exception Application for 2017 Transition Year Open

The Quality Payment Program Hardship Exception Application for the 2017 transition year is available on the Quality Payment Program website. Merit-based Incentive Payment System (MIPS) eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score and can submit a hardship exception application for one of the following specified reasons:

  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of Certified EHR Technology (CEHRT)

There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or exempted in the case of MIPS eligible clinicians participating in a MIPS Alternative Payment Model) and do not need to submit a Quality Payment Program Hardship Exception Application.


Quality Payment Program: Explanation of Special Status Calculation — Correction

CMS recently sent a message incorrectly stating that clinicians considered to have “special status” would be exempt from the Quality Payment Program. These circumstances are applicable for rural, non-patient facing and hospital-based clinicians, as well as clinicians in Health Professional Shortage Areas and small practices. Special status affects the number of total measures, activities, or entire categories that an individual clinician or group must report. Individual clinicians or groups with special status are not exempt from the Quality Payment Program because of their special status determination.


Join the discussion! How does primary care impact practice transformation?

Patient Centered Primary Care Collaborative (PCPCC) Special Event!

On Wednesday, August 16 from 4-5:00 pm ET, the PCPCC will host a special webinar to review new evidence that links the patient-centered medical home (PCMH) and other forms of advanced primary care with improved outcomes-- as highlighted in our released report, "The Impact of Primary Care Practice Transformation on Cost, Quality, and  Utilization". 

The report reviews PCMH results from 45 peer-reviewed reports and additional government and state evaluations.

Dr. Yalda Jabbarpour, primary author of the evidence report, from the Robert Graham Center and Georgetown Department of Family Medicine, will lead the discussion.


Don't miss the HealthDoers Network Transformation Event August 15, 2017!

We're inviting you to attend this event hosted by our trusted TCPI Network for Regional Healthcare Improvement SAN partners and the HealthDoers Network to learn more about how transformation efforts can improve health. The summit will provide leaders, senior executives, quality improvement and population health professionals theory and insights to help build or sustain cultures that support transformation. Also be sure to attend the opening reception the night before!

Click here to register for this event!          
And don't forget to tweet on Twitter #Transform17

This event is made possible through the funding of the Robert Wood Johnson Foundation. 

CMS wants to get direct feedback from you at two upcoming virtual events!

TCPI Transformation Clinician Forum

The purpose of the August clinician events is for CMS to be in dialogue with TCPI-enrolled primary care and specialty care clinicians. CMS wants to hear reactions from the TCPI Clinician community as to how they feel about practice transformation and where they are in their transformation progress and moving into QPP. The topics for these calls are driven by the TCPI AIMs – clinical and operational improvement for patients and clinical practices. Specifically, in August 2017, the calls will be focused on:

·        QPP and the resources available to clinicians to master QPP (TCPI!)

·        The most important changes a practice must make to thrive in the future and practice readiness to participate in TCPI (The TCPI drivers)

·        Addressing the U.S. opioid crisis and the significance of medication management.  How will my practice be engaged?


TCPI Clinician Event 1: Click on the dates below to register

August Primary Care Clinician Events

·        Tuesday, August 22nd 6:30pm - 7:30pm ET

·        Tuesday, August 22nd 8:00pm - 9:00pm ET

August Specialty Care Clinician Events

·        Wednesday, August 23rd 6:30pm - 7:30pm ET

·        Wednesday, August 23rd 8:00pm - 9:00pm ET


TCPI Clinician Event 2: Click on the dates below to register

November Primary Care Clinician Events

·        Tuesday, November 7th 6:30pm - 7:30pm ET

·        Tuesday, November 7th 8:00pm - 9:00pm ET

November Specialty Care Clinician Events

·        Wednesday, November 8th 6:30pm - 7:30pm ET

·        Wednesday, November 8th 8:00pm - 9:00pm ET

Webinar: Coordinating Mental Health Care with Psychiatrists

Wednesday March 22, 2017, 12:00 pm ET

In this free webinar, presented by the American Psychiatric Association, primary care physicians will be introduced to the Collaborative Care Model – an evidence-based integrated care model that can help your practice increase access to quality behavioral health care while improving outcomes. In January 2017, CMS released payment codes specifically for this model of care. Join the webinar and learn more about the model, the reimbursement codes, and how to connect with a psychiatrist in your area.  See more information on this flyer. 


  • ƒƒKristin Kroeger, APA’s Chief of Policy, Programs, & Partnership and Tristan Gorrindo, M.D., APA’s Director of Education
  • ƒƒJohn Kern, MD, AIMS Center at the University of Washington
  • ƒƒRay Rion, MD, Packard Health


Date:       Wednesday, March 22, 2017
Time:       12:00 pm – 1:00 pm (EST)
Sign Up:

Meet us in Orlando at FMX 2016-PRIME SAN in the Expo Hall Sept. 21-23

Come visit with the PRIME Support and Alignment Network team in person at the Family Medicine Experience (FMX), the largest annual meeting of family physicians, September 20-24, in Orlando, FL.

We'll be in booth #543, in the Expo Hall Sept. 21-23, answering your transformation questions and demonstrating the PRIME Registry dashboard tool!

Come see how our PRIME Registry population health and performance improvement tool can help your practice move through the phases of transformation and prepare to succeed in a value-based reimbursement environment!

 Exhibit Hall Hours

  • Wednesday, September 21st, 2016 Grand Opening! 4:30 p.m. - 6:30 p.m.

  • Thursday, September 22nd, 2016 10:00 a.m. - 4:00 p.m.

  • Friday, September 23rd, 2016 10:00 a.m. - 3:00 p.m.

Georgia Academy of Family Physicians Chapter President promotes TCPI, PRIME SAN, and COSEHC PTN

GAFP Chapter President, Dr. Mitzi B. Rubin writes chapter members with details on the benefits available to GA family physicians and their practices, through the Transforming Clinical Practice Initiative. PRIME SAN Program Manager, Dr. Elizabeth Bishop, and COSEHC PTN Program Director Debra Simmons will be presenting on a TCPI panel at the GAFP Summer CME meeting in Hilton Head – June 10th and 11th. 


Ohio Academy of Family Physicians-Weekly Family Medicine Update Spotlights PRIME Support and Alignment Network

The Ohio Academy of Family Physicians teamed up with us to promote the PRIME Support and Alignment Network Community to Ohio family physicians. Through the landmark, Transforming Clinical Practice Initiative (TCPi), the PRIME SAN adds some great benefits to the free practice-level assistance provided through the Practice Transformation Networks. This initiative was designed to help practices successfully transition to new CMS reimbursement models and reporting demands under the Medicare Access and CHIP Reauthorization Act (MACRA).