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."
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 MIPS_VirtualGroups@cms.hhs.gov 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?
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.
- Angela Foster, Health Insurance Specialist, Division of Electronic and Clinician Quality, CMS
- Dr. Paul Rosen, Medical Officer, CMS
- 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.
- 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)
- 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, email@example.com or 213.239.5051.
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 Partnership@cms.hhs.gov to participate in a one-on-one feedback session.
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.
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.
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.”
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 QPP@cms.hhs.gov
- 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.
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.
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!
This event is made possible through the funding of the Robert Wood Johnson Foundation.
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
August Specialty Care Clinician Events
TCPI Clinician Event 2: Click on the dates below to register
November Primary Care Clinician Events
November Specialty Care Clinician Events
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.
- Kristin Kroeger, APA’s Chief of Policy, Programs, & Partnership and Tristan Gorrindo, M.D., APA’s Director of Education
- John Kern, MD, AIMS Center at the University of Washington
- Ray Rion, MD, Packard Health
Date: Wednesday, March 22, 2017
Time: 12:00 pm – 1:00 pm (EST)
Sign Up: http://APApsy.ch/PCPwebinar
Last month, the American Board of Family Medicine published a special edition of The Phoenix newsletter highlighting the PRIME Support and Alignment Network and the PRIME Registry. Click here to open (PDF)
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.
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.
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).