MACRAandtheNewQualityPaymentProgram:MostFrequentlyAskedQuestions

November2,2016

MACRAandtheNewQualityPaymentProgram:MostFrequentlyAskedQuestionsNovember2,2016

[Facilitator]Welcome,Bobbie.

[BobbiBrown]Hi.Goodafternoon.It'sabeautifuldayhereandweareinSaltLake.(00:06)apollontheWorldSeries.IfeltweshouldhavedoneapollonbecauseIamrootingfortheCubsandIjustwanttogetoutofthewebinarandgotowatchthatgame.Iwillseethatgame.Butanyway,becauseIhavebeensobusysinceOctober14th,allI'vedoneisreadthoseregulations,2400pages.SoIhopethatyouhavenotdonethat.Ihopeweareheretodaytosharesomeofwhatwehavelearnedandwetitledthissession'MostFrequentlyAskedQuestions'because,asTylermentioned,weareacompanythatworkonoutcomesimprovementsandweworkwithalotofdataandourclientsofcoursehavebeenaskingaquestion.Sowewantedtosharewhatwehaveheardfromourclientswithyouandalsoupdatesomeoftheregulationsandallthenewoutcomesfromthisandseewhatisgoingon.

Okay.Tyler?

HowreadyareyoutoparticipateinMACRA?[01:03]

[TylerMorgan]Wehavegotanotherpollforyou.HowreadyareyoutoparticipateinMACRA?Notatall,somewhat,unsure,ready,orveryready?NowBobbi,thisisaquestionthatweaskedinourpreviousMACRAwebinar,right?

[BobbiBrown]Yes,wedid.Andso,wewanttocomparethetworesults.SowedidthewebinarbackinMay2016.Soonceyourespondtothis,wewillputitupandthenwewillshowyouwhattheresponsewasinMay.

[TylerMorgan]Alright.Letusgoaheadandshowourresultsfortodayanditislookinglikewehaveover40percentsayingunsure.Aspeoplearestillenteringinwith'somewhat'about27percent,11percentissayingready.

Areweready?[01:46]

[BobbiBrown]Okay.ThisiswhatwesaidinMay.Howreadyareyoutoparticipate?58percentunsure.So,similar.

October14–WallStreetJournalArticle[02:00]

TheWallStreetJournal,IalwaysthinkwhenevertheWallStreetJournalpicksthisupandtheAPonOctober14th,theytookitup,andIalwaysliketoseehowtheyexplainedit.TheysaidthisisanewruleonhowMedicareisgoingtopaydoctors.SotheyarealwaysgoingtogettothesimplestwayofexplainingitanditisabroaderpushtooverhaulFederalspendingandthereisgoingtobepenaltiesandbonusestiedtoperformance.SothoseweretheirthreemaintakeawaysintheWallStreetJournal.AndalsoInoticedtheyquotedsomeonefromDeloittewhosaid"it'sadisruptivelaw"andtheydidnotelaboratealotonthatbutitwasjustwhatwasinthere.SoIjustthoughtI'dbringthatforwardandseehowtherestoftheworldviewsusandgoforwardandtalkaboutsomenewregulations.

AimsofQualityPaymentProgram[02:55]

IthasMACRA,ithasanewthreeletter(02:57)sayingthequalitypaymentprogramwhichisreallyhowtheyaretryingtounifyallthepoliciesthatgoin.Andagain,theaimsareverygoodonthis.Wearetryingtogetbetteroutcomesforpatients.Theydomentiondecreasedproviderburdenandpreservetheindependentclinicalpractice.Sothatwaswhattheyweretryingtodowiththis.Andaswegothroughthisattheend,wecanreflectandseeifwethinktheydidthis.

Theywanttopromotealternativepaymentoptionsandmakesurethatourdeliverysystem,thatwecanreformourdeliverysystemsothatwearegivinghighquality,good,efficientcare.

Whatisagoodsource?Qpp.cms.gov[03:35]

Iwilltellyouthatthebestsource,averygoodsourceisqpp.cms.gov.Youjusttypethatinandyouwillsee.Andonthere,youmightnotbeabletoseeitrealwell,buttheyhave'explorethemeasures'andtheyhaveeducationthere.Andalsoattheendofthewebinar,wehavesomeprofessionalsocietiesandassociationsthathavedoneareallygoodjobatprovidingeducationalmaterialsforeveryoneandtheyarefreeandtheyareoutthereontheirwebsite.

Areweatatippingpoint?[04:03]

Soareweatatippingpoint?WellinabookthatIreadsaid'well,disruptionsignsareanewfuture,anewlanguage,aneweconomics'andtomethisjustfitsexactlyinthere,especiallythenewlanguage,thenewwordsandtheacronymsthatyouhavetolearnareamazinginthis.Theneweconomics,yes,thereisgoingtobe–youarestillpaidthesamewaybutyoucangetplusesorminusestothatpaymentbasedonwhatisgoingonandhowyouperformonallofthesedifferentmeasuresthatwearegoingtotalkabout,andwearegettingtomoremeasurement.AndIthinkyouneedtothinkaboutwhatkindofnewcapabilitiesdoyouneedinthisnewenvironmentandwhatexistingcapabilitiesdoyouhavethatyoumightneedtoreshapealittlebit.Andshouldwethinkaboutlimitinganythingthatwearedoingormoveanythingaroundthatwearedoing,becausethisis,there'salotofchangeinhere.LetmejusttalkaboutthetwotracksthatMedicareisgoingtoputyouin.

TwoTracks[05:07]

Through2019,wearestillgettingahalfpercentannualupdate.2017isthebaseperformanceyearandthenafterthatyougointooneortwotracks,eitheraMIPSoranAPMqualifiedprovider.IfyoufitinthatAPMqualifiedprovider,youaregoingtogetabonus,automaticparticipationbonusto5percent.So,ifyoudonot,thenyouareupintheMIPSandmostpeoplewillbeintheMIPSanditwillbeplusorminus4percentandthepaymentwillstartin2019.So,wearestartingnow,wearestartingrightawayactually,andthenyouhavethisplusandminusesthatgothroughouttheyears.AndIevenpurposelyleaveoutanythingafter2023butitisjusttoofaroutthereforme.Icannotthinkthatfarahead.So,plusorminus,andyoualsohavethispotentialofbonus.Ilovebonuses.Ilovebonuses.Whatcouldbemorefunthantogetabonus?

Whyis2017soimportant?[06:02]

2017isthetransitionyear.Thatisgoingtobetheperformanceperiod.Andbelieveitornot,thatstartsin59daysfromnow.SoIusuallyjustcountdowntoChristmasbutthisyearIamgoingtocountdowntothebeginningofMACRA.WhatkindofapersonamI?Soanyway,2017,likeIsaid,thatistheperformanceperiod.Wearegoingtogointomoredepthonwhatyouhavetoreportduringthatperformanceperiod.

CMSExpenditures[06:29]

IjustwantedtogivealittlebackgroundaboutbreakoutofCMSexpenditures.Wehavetheinpatient,theoutpatient,thepost-acutecarearea,andthenthephysicianandthewaytheyhaveitbrokenout,itsphysicianE&Mcodes.Andrightnow,thatrepresents26billionofthepayments.Itisabout11percent.AndIlookedandsawthatinthis,forMedicare,therateis13,000encounterspereverythousandofbeneficiaries.Soitisusedalot.And89percentofthebeneficiariesusedinE&Mcode.Sothisisanareathathitsalotofpeopleandalotofphysicians.

PotentialforBonusPoints[07:08]

Ilovethispart,reportcards.AtonetimeIwasaschoolteacherandIjustlovedbeingabletohavebonuspoints,andIloveditwhenIwasinschooltoo.So,youknow,Ididnotfocusonalotofthis(07:19)allthetime.Ifocusedon,wellifIgotothemuseum,Icanget(07:25).HowcanIgetextrapointsinsteadofjuststudyingwhatI'msupposedtostudy.ButyoucangetextrapointsandDorianisgoingtogothroughthatandtherearesomeareaswhereyoucangetmorepointsbecausetheygiveyouamedianhigh.Andso,there'slotsofareas.Itstilladslikealittlebitoffuntothisandalittlebitofconfusionandalittlebitofextraworkthatweallhavetothinkabout,butDorianisgoingtomakeitsosimpleforyou.Youaregoingtoloveit.

CostPerformance–Weighted0%[07:50]

So,costperformance.Nextyear,thisone,itisnotinfornextyear,itwillbeweighted10percentthefollowingyear,anditwillbebasedon10episodesandtheCMSisgoingtocalculatethisfromtheforms.AndsoIalwaysloveandyouknow,andCMSsayswearegoingtocalculatethisforyou.Itisverygood.Butyouaregoingtohavetolookatyourattributionandyouaregoingtohavetolookatthisandyouaregoingtohavesomethatisgoingtobeweighted10percentandgrowingupto30percentovertime.Youaregoingtohavesomeinterestinthismeasure.

Didyouknowthisdataisavailable?[08:25]

ThereisnothingrightnowthatIcanpointyoutobutthereisawebsiteoutthereundergeographicvariationonCMSandtheydoit.Itisafilethatyoucandownloadandyoucangetthecountyspendingandyoucanalsogetitbystate.Thestatehasthisnicespending.AndIpickedastatethatwasred,Florida.SoifanybodyisonthephonefromFlorida,Ijustpickedyoubecauseyouarered,andjusttoshowyou,andthey(08:55)positioningwithoutpatientandtestandimaging.Soyoudonotgetarealpercent.ButyoucanseethestateofFloridaoverall,youknow,19percenthigherthanthenationalaverage.Thephysician,also19percenthigherthanthenationalaverage.Theinpatientsideis7percenthigher.Soyoucanseethatthosepeopleinthatstatearegoingtohavetobeworriedalittlebitabouttheirspending.Thatmaynotbeyoubutthatisgoingtobecomingup.

IamgoingtoturnitovertoDorianDiNardonow.Sheworksinproductdevelopment,andIlovetoworkwithher,andweareworkingonproductsandservicestohelpyouthroughthis.Andsowejustwanttotalkabout,again,whatwehavelearnedfromclientsandprospectsandhelpyouunderstandsomeoftheregulations.

Dorian?

WhendoIneedtoreportfor2017?[94:47]

[DorianDiNardo]Thankyou.

MIPS–Merit-basedIncentivePaymentSystem[09:47]

SoMerit-BasedIncentivePaymentSystem,MIPS,isthesectionthatIamgoingtobecoveringtoday.

Statusquo[09:55]

Sowhatishappeningtoday?Abi-annualsurveyfromthePhysiciansFoundationshowed46percentofphysiciansplantoacceleratetheirretirement.Cutbackonpatientsorseeknon-clinicalrole.14.4percentofphysiciansaresayingtheywillretireinthenextonetothreeyears,comparedto9.4percentin2014.Meanwhile,21percentwillcutbackthroughhoursandanother13.5percentwillseeknon-clinicaljobs.Doctorsarebeingdoggedbypoormoraleandinvasiveregulations,accordingtothesurvey.

InterestingFact#1[10:32]

Inanothersurveyconductedrecently,itfoundthephysiciansspendanaverageof15.1hourseveryweekprocessingqualitymetrics.

InterestingFact#2:[10:43]

Andanotherinterestingfactinthesamesurvey,thetimephysiciansspendprocessingthesequalitymetricstranslatestoanaveragecostofover$40,069perphysician,peryear.

CMSexpectsMIPStoevolveandchange[10:56]

So,CMSandMIPS.Well,CMSdoesexpectMIPStoevolveandchange.Theyarelistening.Andwiththat,theyaretalkingaboutcombiningthreeexistingprograms.SotheyarecombiningMeaningfulUse,theEHRIncentiveProgram,ValueBasedPaymentModifier,andthePhysician'sQualityReportingProgram.Theyareaddingtheclinicalpracticeimprovementactivitiescategory.So,betweenapproximately592,000and642,000eligibleclinicianswillberequiredtoparticipateinMIPSinthetransitionyear.Practiceswithfewerthan15providersandinruralareasmaybequalifiedfortechnicalassistance.Thisisnewandveryimportantbecausereallytakeadvantageofthatopportunity.Estimateof14percentofproviderswillbelowvolumeandexcluded.

TheruledefinesagroupasasingleTaxpayerIdentificationNumber(TIN)…[11:52]

TheruledefinesagroupasasingleTaxpayerIdentificationNumber(TIN)withtwoormoreMIPSeligibleclinicians,asidentifiedbytheirindividualNationalProviderIdentifier(NPI),whohavebeenreassignedtheirMedicarebillingrightstotheTaxIDNumber.

ForMIPSdoIneedtoreportindividuallyorasagroup?[12:11]

SoforMIPS,doIneedtoreportindividuallyorasagroup?Well,areyoupartofthatexclusioncriteria?Soareyouinthatlowvolumethreshold,areyouanewlyMedicareenrolledeligibleprovider,orareyouaqualifiedprovideraspartoftheAPM?

Additionalconsiderationsforreportingasanindividualoragroup:[12:27]

OtherconsiderationsforreportingasanindividualoragrouparedoyoureporttootherexternalagenciestodayforyourTaxIDNumberoryourNPInumber?DoyouparticipateinMeaningfulUse,PQRSorotherreportingagencytoday?Ifso,youshouldreallyreviewthatperformanceandlookathowsuccessfulyouaretothoseorganizations.

ThesubmissionrequirementsforGroupsandindividualsaredifferent.Forexample,CMSwillapplythereadmissionmeasuretogroupsofmorethan15whomeetthecasevolumeof200cases.YoumustparticipateinMIPSasawhole,soeitherasagrouporasanindividual.Itisnotmixed.Thereisnotan'and'inthere.GroupreportingperformancewillbeassessedandscoredacrosstheTaxIDNumberandMIPSpaymentadjustmentsapplytothegroupleveloftheeligiblecliniciansinthatgroup.

YoucanjoinvirtualgroupsinthefutureyearsonceCMShasdeterminedthatdefinition.Weshouldseemoreaboutthatdefinitionafterthefirstoftheyear.

CompositePerformanceScore(CPS)[13:27]

SotheCompositePerformanceScoreinMIPS,howdoesthatwork?There'sthefourareas–quality,cost,improvementactivities,andadvancingcare,whichwastheMeaningfulUse,andyoucouldseetheweightfor2019.Now,thoseweightsdochange,asBobbitalkedabout,infutureyears.So,beawareofhowthoseweightschangeandthatmighthelpwithwhatyouselectinthistransitionyear.

Pickyourpacein2017[13:57]

Sothetransitionyearispickyourpace.So,youhavefouroptions–stayinthepitandgetapenalty,tryonelap,triponelapfor90days,orgofortheentirerice.SowhatdoImeanbythat?

FullvsMinimalParticipation[14:11]

So,fullparticipationisgoingthatentirerace,andminimalparticipationistryitout.So,fullparticipationisreporton6qualitymeasuresOR1specialtyspecificorsubspecialtyspecificmeasureset.Reporton4mediumweightedactivitiesor2highweightedactivities,andreporton5advancingcaremeasuresforthefullyear.

Minimalparticipationisreporton1qualitymeasureand/oronehighweightedmeasure,and/or5requiredadvancingcaremeasures.Youshouldtrytodothe90daysminimalbutyoudonothaveto.Thenumberoffullparticipationwillpotentiallyqualifyclinicianforthe4percentbonuswhileminimalparticipationwillavoidanegativeadjustment.Thebonusesandpenaltiesriseinthesubsequentyears.Themoreyoudoin2017,theeasierthatsubsequentyearswillbe.

ScoringforMinimalParticipationforthefirstyear[15:15]

So,inthisexample,individualAsubmitsonequalitymeasurewithlowperformanceandnoimprovementactivitiesormeasuresspecifiedfortheadvancingcareinformationperformancecategory.Thisindividualwouldhavethefollowingperformancecategoryscores–thequalityperformancecategoryscoreis3pointsoutofthepossiblepointsor5percent,3dividedby60equals5percent,improvementactivitiesiszeroandtheadvancingpairiszero,justlikeinparticipatinginthosetwocategories.Sothefinalscoreoftheperformancecategoryscoreistimestheperformanceofcategoryweight,thatis5percenttimes60percent,plusthezeropercenttimesthe15percent,plusthezeropercenttimesthe25percenttimes100,equals3points.Gee,thisyeteligibleclinicianwouldreceiveaneutralMIPSadjustmentbecausetheperformancethresholdissetat3points.

ScoringMinimalParticipationforthefirstyear[16:16]

Nowletuslookatthegroupthatisdoingminimalparticipationforthefirstyear.Thisscoreisreporting16ormoreclinicianswouldreceiveatleast3.7pointsforsubmittingatleastoneimprovementactivity.Theydidnotsendanythinginthequalityorintheadvancingcarecategory.SothisisalsoaneutralMIPSadjustmentbecauseoftheperformancethresholdat3.

ScoringFullParticipationforthefirstyear[16:45]

Next,letuslookatfullparticipationfortheyear.Sothiscouldbeanindividualoragroupinthisexampleandwearelookingatagroupwheretheydidnotgetall60pointsinquality,theydidnotgetallthe40pointsinimprovement,andtheydidnotgetthefull100percentoutoftheadvancingcarecategories.Andthroughthistheygot50outof60,30outof40,and60outof100.Sotheyget76points.Whatisimportantaboutthisisclinicianswhoachievedafinalscoreof70orhigherwillbeeligiblefortheexceptionalperformanceadjustment,whichisfundedfromapoolof$500million.

WhatQualityMeasuresshouldyoureport?[17:24]

Sowhatqualitymeasuresshouldyoureport?Whatisyourorganizationcurrentlydoing?KeepinmindthattherearealignmenteffortswithCMS.TheyarelookingattheMedicaidmeasures.Theyarelookingatcorequalitymeasures.Theyarelookingatotherpayermeasuresandaligningallthesemeasureswithotherpayers.SowhatsuccessfulmeasurescanyoucontinuedoingthatyouarealreadydoingaspartofMACRAmeasures?Forexample,doyouhavequalityinitiativesaroundscreeningsorimmunizations?Thesemeasuresmaybeeasytoincorporateintoyourexistingworkflow.Thereareabout26specialtyandsubspecialtymeasurestepstoreview.Justasanexample,ifyouareadermatologygroup,youmaywanttolookatthespecificdermatologymeasuresratherthanreviewingtheapproximately270individualmeasuresfromitsqualityreporting.Anditis60percentofyourcompositescoreinthefirstyear.

ImprovementActivities[18:22]

Inthenextcategory,improvementactivities,thereare13highqualitymeasuresandatleastonemustbeselectedfromthese8subcategories.Themostimportanttakeawayonthisslideiswhatareyoualreadydoingtoday?Areyouinaregistry?MillionHearts,CMS,TransformingClinicalPracticeInitiative?Areyouinhealthinformationexchange?Areyoudoingsurveyssuchasthepatientexperience,satisfactionsurvey.Areyouavolunteerformorethan60daysintheyearthatthoseautomaticallyareinthehighqualityimprovementactivitymeasuresandyoucanjuststarttoalignwithstuffthatyouarealreadyworkingonorthatyouwantedtostartworkingon.

AdvancingCareInformationPerformanceCategory[19:09]

IntheAdvancingCareInformationPerformanceCategory,thisfocusesonthesecureexchangeofhealthinformationandtheuseofthecertifiedelectronichealthrecord.Sointhesidesthataretoprequiredmeasuresoratthetopthereandatthebottomyoucanseethebonusquestion.Theseareyesornostatements.Soifyouareinthereansweringthesequestions,goforthebonusquestions.Whynot?Theyareyes,noandthisis25percentofyourscore.

MeasureAlignment[19:41]

Inyourview,lookatwhatyouarealreadydoingandwhereyoucanincorporatethoseeffortsinyourMIPSmeasures.Ontheslideyoucanseeoneofourclients.Whatwedidwaswelinedupsomeoftheircontractswithsomeoftheirmeasuresandsomeoftheirinternalinitiativesandwhattheyaredoing,lookingacross,welituptheirdatatolookathowtheyaredoingagainsttheirbenchmarkanditwassurprisingbecausewheresomeoftheareastheythoughttheyweredoingreallywell,theyactuallyweren't.Andso,reviewyourperformanceonthesemeasuresandmakesureyoushouldnotstrategicallyalignwiththedifferentmeasure.

WorkTowards[20:20]

Finally,2017isthetransitionyear.CMSexpectsthisprogramtoevolveandchange.Stayawareofthechanges,especiallyifMIPScontinuetoworktosupportmulti-payeralignment.CMS'goalsarealigningreimbursementwithvalueandthiswayrewardsproviderforefficiencyinachievinggoodoutcomeswhilecreatingaccountabilityforsubstandardcare.

Andwiththat,IamgoingtoturntheslidebackovertoBobbitotalkabouttheAPM.Thankyou.

AdvancedAPM[20:51]

[BobbiBrown]Sure.Ithinkyougotalittlefeelingthereforthetypomeasuresthataregoingtobeimportantforthewaitingofthemeasureswhereyoushouldspendyourtime.Doriangavesomegreatideasonhowtogetstartedandhowtolookatthisandnowwewilltalkabouttheadvancedalternativepaymentmodel,alittlemorecomplicated.Ibelievethatiscomplicated.

GoalsofCMS[21:13]

Medicare,again,theyhaveannouncedandtheymayhavegoneonrecordthattheyreallywanttomoveby2018,50percentofthepaymentshiftingovertoalternativepaymentmodel.Sothisispartofthatprogress.Theyreallyareencouragingparticipationintheseadvancedpaymentmodels.Thereisverymuchapotentialtheyaregoingtobeexpandingintootherpayers,thefirstyearnotsomuch,butaswegetintothoselateryears,definitely.Andagain,thegoal,bettercare,smarterspendingandhealthierpeople.So,itiswhatwearetryingtodowithallofthese.

AdvancedAPMrequirements[21:52]

Now,MedicareisessentiallyaregoingtotellyouwhatanAPMisbuttheseweretheirrequirementsandtheycameoutwithanotherlist.Thegoodthingaboutthisis,well,Idon’tknowifyouthinkitisgoodornotbuttheyreleasedtherigsonOctober14th.ThenonOctober25th,theyreleasedalistoforganizationsthattheyaregoingtodesignateaseligibleentitiesinthisarea.Sotheyarecontinuingtoupdate,whichmeansyouhavetostayontopofthings.Andifyoudosignupforthatqpp.cms.gov,thereisaplaceintheretoputyouremailandyouwillbeonanemaillist.Sothenyouwillknowallthesewonderfulnewthingsthatarecomingout.

Soyouhavetoparticipate.Generally,thesearewhattherequirementsaregoingtobe,buttheyaregoingtotellyoutheorganizations,thattheseorganizationsfellintothesecategories,thattheparticipantsareusingacertifiedhealthrecord,thatthepaymentsthataregoingoninthesealternativepaymentmodels,someofthemarebasedonqualitymeasuresthatarecomparabletothequalitymeasuresunderMIPS,andthatthereisariskintherethatyouhavetobeabletobearamonetarylaworbewhatIcall–itisnotcalledthe"MACRA"MedicalHome,buttheydidcomeoutwithdefinitionsofmedicalhomemodelinthislegislationandintheregulation.

So,therewerealotofandusually,therewerealotofcomplicatedformulasinthis.Now,theymadeitprettyaloteasierfororganizationstomeetthis,butalotofpeopleweredisappointedwhenthetrack1MedicareSharedSavingsProgramdidnotmakeitanditmainlyhadtodobecauseagain,youdidnotmeetthatcriteriaofbearingriskforamonetaryloss.

ModelsthatQualifyforAdvancedAPM[23:50]

Andithastobemorethanjustanominalamount.Andso,again,theyaresayingthat8percentofyourpartAorpartB,thatwhatyouwouldowebacktoCMSwillhavetobeatleastthatmuchorIwillsetnowwhattheyconsiderednominal.Soagain,theyhavegonethroughtheseprogramsandsaidthesearetheonesthatqualifyandthentheyareaddingontothisandtheyaregoingtopublishafinallistby2017.

StandardProvisionsforFinancialRisk[24:19]

So,whatdotheycall,again,provisions,whatisthisfinancialriskthattheyarecallingthis,andithastodowith,again,thatitistwo-sided,thatyouhavetoupanddown–so,youractualexpendituresversusanexpectedexpenditure,andwhenyoulookatitandifyouractualwasaboveexpected,youeitherwouldgetpaymentswithheldorpaymentsreducedoryouowebackmoneytoCMS.Andthentheyhavecomeupwiththistotally–thismedicalhomemodelandgonethroughandthereisalotofcriteriaforthemedicalhomemodel,alotofqualificationsforthat,mainlyhavingaprimarycarefocusandthepatientsneedtobeinpanelstooatprimarycliniciansandthenyouhavetohaveelementsinthere,again,thatyoucanshowthatpatientaccess,thatyouhavecoordinationofcare,thatyouhavecaremanagement,thatyouhaveshareddecision-making,.Andthepaymentarrangements,again,whattheyaregoingtouseis2.5percentofMedicareperdieminpartBrevenuebutithastobeatriskforthis.

Pathwaystoperformance-basedrisk[25:32]

Andtheydidjustcomeoutandannouncedanewonethisweek.TheVermontAll-PayerACOModelisapprovedanditwillcountforMACRO.Soagainthatwouldbeanentity.Ifyouareparticipatingwiththem,thatyouwouldparticipateandbeeligibleforthis.Theyhavealsowantedtohave,theyknowtheyneedtohavemoremethodsforpeopletogetin,tobeabletogetintothisalternativepaymentmodel.

So,thislistisgoingtogrow,andtheyforecastby2018thattherewillbe25percentofthephysicianstherebuttheyaregoingtohavethisnewMedicareACOtrack1+.I'veseen1.5onthings,theylike1+better.Butanothernewoneisavoluntarybundledpaymentprogram.Andthentheyaretalkingaboutwhatwealreadyhave,thebundledpayment.Sothejointcare.Butagain,ithastobeundercertifiedtechnologyandadvancingcarecoordinationthroughdifferentepisodes,againcertifiedtechnology,andthisMedicalHomeModelthatItalkedabout.

Process[26:37]

Sothiswholeprocessisaniceonetodoacharton.First,ithastobeanalternativepaymentmodelandthenanadvancedalternativepaymentmodel.Thenyouhavetobeanentityinthatadvancedpaymentmodel.Andthennextyouhavetobeaqualifiedparticipant.Again,theyaresettingupcriteriaforallthissothatotherpayerscanjoininonthis.

AdvancedAPMEntry[27:01]

TheQP,thisissomethingthatyoucancalculateonceyouareintheadvancedprogram.ThenyoucangotothenextstepandseeamIaqualifiedparticipantornotandtheyareestimatingthisnumberwentupfromwhentheyfirstdidthisbecausetheyloweredsomeoftherestrictionsalittlebit,70,000to120,000providersin2017willbeinthis.

QualityParticipants(QP)Thresholds[27:25]

Anditisdone.Thequalifiedthresholdsaredonewiththepaymentamountformula.So,doIhaveatleast25percentofmypaymentthatIamgettinginoneofthesepaymentmodels,advancedpaymentmodels,andyoucandoeitherapaymentamountorapatientcountamount.

YoucanalsobeapartialQP.IfyouareapartialQP,youcouldelecttoselectMIPSandtheyalsohavesomenicearrangementsinherefortheirCriticalAccessHospital,allowingthemtoparticipateanddothepatientformula,countformula,andtheygetalittlemoreflexible.Sofairlyqualifiedhealthcentersandtheruralhealthcenters.IfyouareanACOinthose,youcanalsopotentially,ifagainonthepatientcount,qualifytobeaqualifiedprovider.

Metallcriteria[28:20]

Now,whywouldIwanttodothat?WellthenIdonothavetoparticipateinMIPSandyouwillautomaticallygetthe5percentincreaseinthefeeschedule.Butyouaredoingwork,youdohavetofillout,ifyouareinanACO,youdohavetocomplete,youhavetowalkthroughandmakesurethatyouarecompletingthequalitymetricsthatareforthatparticularorganization.Andagain,theyhaverequirementsforqualityorganizationsacrossmultipleorganizations.

SoIamgoingtoturnthetimeovertoDr.Oshiro.Wedidmentionthatheisaphysician.Heisapracticingphysicianandthisweekendhewasdeliveringbabiesandreadingregulations.Imeanwhatmorecouldweaskfor?Soheisgoingtosharesomethoughtswithyou.Butbeforewedothat,IwillturnitovertoTyler.

Whichofthefourreportingoptionsareyouplanningonparticipatingin?[29:01]

[TylerMorgan]Thanks,Bobbi.Wedohavethepollquestionup.Whichofthefourreportingoptionsareyouplanningonparticipatingin?Areyouagoingtosubmitsomedatatothequalitypaymentprogram,submit3monthsofdata,submitdataforthefullyear,participateinanAPM,ordonotplanonreporting?

Wewillleavethisupforafewmoments.Wehavehadalotofquestionsregardingtheslides.Yes,wewillbemakingtheseslidesavailabletoeveryoneaftertheevent.WealsohadaquestionregardingtherecordingandslidesofthepreviousMACRAwebinarearlierthisyearandyes,thatisavailableondemandonourwebsiteatHealthCatalyst.com.

Alright.Letusgoaheadandsharetheresultsofthispollquestion.Itlookslike33percent,athirdofeveryonearesuggestingtheyaregoingtosubmitdataforthefullyear.

[BobbiBrown]Yeah.Thatisgreat.

[TylerMorgan](29:57).

[BobbiBrown]Yeah.Sothat'sfantastic.Yeah.

Physicians[30:07]

[Dr.BryanOshiro]Okay.So,hi,thisisBryanOshiro,Iamaperinatologistbytrainingandhavebeenworkinginthefieldofhealthcarequalityimprovementforover20yearsnow,andithasbeenreallyafunjourney.ButnowIwasgettingpaidforthequalitythatweactuallyhavebeenprovidingandsoforth.Andnowitisuptoustogetinvolvedhereanddosomethingofit.

WhoareeligibleclinicianssubjecttoMIPS?[30:34]

AndtheotherthingIjustwantedtoaddisthatitisnotjustphysiciansthataregoingtobeeligibleunderMIPS.ItisPAs,nursepractitioners,clinicalnursespecialists,certifiedregisterednurseanesthetists,andgroupsthatincludeclinicianswhogounderPartB.Anditisveryinterestingandaswegoforward,itisgoingtoincludemorepeopleaswellsuchascertifiednursemidwifeandsoforth.However,thereisavolumethreshold.Soitisnoteverybodythatisgoingtohavetoparticipate.TheydidmakeitsuchthatpeoplethathavelowvolumesorlowbillingsunderMedicarePartBaregoingtobeexemptinthisprocess.However,Iwouldnotholdmybreathandsay,thatisgoingtocontinueforever.

DefiningProvidersinUniqueSituations[31:19]

Sotherearesomeuniquehospital-basedornon-patientfacingcriteriathatthefinalruleactuallyhaschanged,andithasthechangesontherightsideofthatcolumnthere,therightcolumn,thechanges.Andtheyloweredtheeligiblecliniciansfrom90percentto75percentofthehospital-basedpatientvolumesandsoforth.Andtheyhavealsochangedalittlebitthenon-patientfacingcliniciansandthisincludespractitionersandyouthink,welltheyreallydonotdopatientcarenecessarilybutradiologistwhodointerventionalcardiology,forexample,ormaybetelehealthservices,theyarealsogoingtobeincludedinthis.Andtherulechangesthatthethresholdfordeterminingnon-patientfacingstatushasincreasedfrom25to100encounters.Sothatisanewchangethathasjustoccurred.

HowmanyclinicianswillbeeligibleforMIPS?32:21]

Andhowmanyestimatedclinicians?Well,youknow,itisquiteafew.Soitishalfamillionplusprovidersandsoforthareactuallygoingtoberequiredtoparticipateinthisfor2017.

WhatdoctorsaresayingaboutMACRA[32:35]

AndthisiswhatreallyIhaveheardorreadaboutintheliteratureandactuallyquery.Physicianswhoarepracticinginbig,well-organizedorganizationswerenotworryingaboutMACRAandifhewereinasmallpractice,"therewouldbenowayIcoulddealwiththis…Itrequiresscaleandleadershipandmanagementtorespond."ThisisbyTomasLee,ChiefMedicalOfficerforPressGaneypatientexperienceconsultingfirm.Andthisisquitetrue.Ihavespokenoverthelastmonthbecausetheyaresointerestedandwhatphysiciansfeltorheardortheirthoughtsonthisisthatmanypeopleinlargeorganizations,suchasKaiserandsoforth,theyhaveactuallyexpressedtome,Ithinktheorganizationistakingcareofit.Iwouldsaythatifyoudonotknowforsureitbehoovesyoubecauseofthereportingrequirementsthatreallytalktotheleadershipandmakesurethatyouknowwhatyouarereportingonbecauseyouaregoingtohavetoactuallyparticipateinthisreporting.Itisnotallgoingtobeautomatic.

AfamilypractitionerinGeorgiawrote,"MIPSandAPMareverybadforthesolopractitioner.Theylikelysignifythedestructionanddeathoftheone-andtwo-doctorpractices,particularlyprimarycarephysicians."AndIhavespokenwithalotofmycolleaguesastheytravelacrossthecountryanditjust(33:53)themiftheyareinsmallpracticesandtheyhaveactuallysaidthattheyareactuallyplanningonretiringearly,thatmaybefor2017theywillnotevenreportonMIPSbecausetheyaresodiscouragedaboutallthereportingrequirements.AndinSouthernCalifornia,thatisexactlywhatIheardaswellaroundmyneckofthewoods.WhenItalkedtopeopleinmyorganizationorpeopleinthecommunityandsoforth,that'swhatthey'replanningondoing.

HowdidMACRAbenefitpractitioners?[34:21]

However,IthinkmostpeopledonotreallyrealizethatwithoutthepassageofMACRA,thattherearesomenegativesforthat.So,physicianswouldhavebeensubjecttoanegativepaymentadjustmentof11percentormorein2019asaresultofmeaningfuluse,PQRS,value-basedprogramsandsoforth,withevengreaterpenaltiesinthefuture.Andso,withtheadventofMACRAandinstitutionofMACRAandarepealofFDR,therehasbeenalotofstabilitythatactuallyhasbeenbroughtforthinthereimbursementlandscape.Sothelargestpenaltyanybodycanactuallyreceiveis4percent.Sothisreallyisawaytoincentivizetherightbehaviors,cost-efficiency,andnotpenalize,makeittooonerous,forallofuspracticingphysiciansandsoforth.

Anotherreasontoreport:It'sallreportedpublicly[35:22]

Andtheothersthatarethinkingabout,"wellIamnotgoingtoreportatall."Butitmaybeharmfulandthatthisisallgoingtobepubliclyreportedinformationanddataandsoforth–sothroughphysiciancompareandstuff.Soifyouaretryingtogetajobwithanotherhealthcareorganization,forexample,ifyouareleadingaprivatepracticeoryourpatientsarelookingatonyourperformanceacrosstheboard,manypatientstodayaresosadthattheylookedatDr.Google.Sobythetimetheycomeandseemeintheoffice,theyhavealreadyhadseveralconsultswithDr.Google.Sothismaybesomethingthatsocialmediaisreallygoingtotakeaholdofandsoforthwhentheyaredoctorshopping.

IsCMSListening?[36:04]

Andtheotherthingthat'sreallykindofencouragingformeisthatwheneveryoudealwithpoliticsorwiththegovernmentoragenciesorsomethingofthatnature,youfeellike,youknow,nobodyeverlistenstome,butitisreallyinterestingthattheyactuallyheardallthesepubliccommentsandthat'swhythisflexibilityfor2017actuallygotrevisedinthefinalrule.It'sbecausetheyheardthatdoctorshaveurgedCMSto"makethetransitiontoMACRAassimpleandasflexibleaspossible."So,itmaynotseemallthatflexibletoeverybodyanditmaynotseemallthatsimplebutitisalotmoreflexiblethanwhateverwasproposedtobe.Sotheyaremovingintherightdirection.

AMACommendsCMS[36:47]

AndtheAMAactuallyalsoweighedinonthis.AndrewGurman,whoisthepresidentofAmericanMedicalAssociation,statesthat,"AMAbelievesthattheactionsthattheadministrationannouncedwillhelpgivephysiciansafairshotinthefirstyearofMACRAimplementation.Thisistheflexibilitythatphysicianswereseekingallalong."

So,Iwouldnotlookatitintermsof,boy,thisistheworstthingthat'severhappened,butthattherearesomemajorconcernswithregardstohealthcareexpendituresinourcountrywhilewherethenumberonehealthcareexpendingcountrypercapitanearlydoubledthenextclosestindustrializedcountryandsoforth,andwehavetodosomething.

WhataretheMainBenefitsofParticipationinMIPS?[37:30]

SowhatarethemainbenefitsofparticipatinginMIPS?Therearenewopportunitiestoearnincentivepaymentsforabove-averageperformancesandyouknow,thisissupposedtobeacostneutralventuresothatthelowertierpeoplearegoingtobesubsidizedandtheuppertierpeople,butinessence,thereisgoingtobesomegapsinthat.So(37:51)actuallyappropriated$500millionayearfrom2019to2024tomakeupthatdifferenceinexpectedcostfortheprogramandsoforth.Andthereisgoingtobesomeseparatebonusesaboutthe10percentforexceptionalperformance.Sothemainthingthatwehavetoconsideriswehavetoparticipatesothatyoudonotgetnegativelyaffected.WouldnotthatbegreatifeverybodyparticipatedandnotgotanegativeweepholefromtheirCMSreimbursement.

Italsogivesastreamlinedperformancereportingsystem,whichshouldbemoreeasilymanagedthanthemultipleexistingreportingsystemsthatareouttherecurrently.Sointhatway,theyhavereallystartedtosortofstreamline.So,itbehoovesustotakealookatwhatwecandoacrossreportinglinessothatitmakesitalsoeasieraswell.

Andthenthecurrentimprovementsinperformancescoringovercurrentqualityprogram,there'stheslidingscaleassessmentandtheflexibleweightingandthenewmeasurements.Andalso,smallpracticeswillreceive$100millionintechnicalassistance.ThatisnotdirectlytheyaregoingtogivemoneytoyoubutthatmeansthatthereisgoingtobemoneysetasidefortrainingforsmallprogramsandsmallpracticessothattheycancomplyandparticipateinMIPS.Sothat's$20millionperyeartoassistwithpracticeupto15professionalsparticipatinginaMIPSprogramand/ortransitioningtothisnewpaymentmodel.

HowReadyarePhysiciansforMACRA?

Andjustasintheside,IwasabletokindofreviewtheDeloitteHealthSolutionsCentersurveyin2016attheUSPhysiciansandthisishowreadytheywereaccordingtothesurvey.Fiftypercentsaythattheyhaveneverheardofalawwhichisreallyastoundingand32percentrecognizeitbynamebutarenotfamiliarwiththisrequirement.

Twentypercentofself-employedorindependentphysicianssaythattheyaresomewhatfamiliarwiththelaw,comparedtoninepercentofphysiciansemployedbyhospitals,healthsystemsormedicalgroupsownedbythem.

Soitreallyisamazingthatifyoucanjustreadthroughthatonyourown,andtheslideswillbemadeavailable,isthattherereallyisambiguityinthemarketplaceamongstphysiciansastoexactlywhatthismeansandwhatthisactuallyentailsandhowmuchworkisactuallygoingtogointoparticipatinginMIPS.Sothatiswhywe,fromourcompany,wedecidedweneedtoeducateourpopulationaswell.

SoIamgoingtogoandtransitionovertoTyler.Tyler,wehaveanotherpollquestionhere.

Basedonthefinalregulations,howdoyouthinkyourorganizationwillfairunderMACRA?[40:30]

[TylerMorgan]Right.Thankyou,Bryan.Sobasedonthefinalregulations,howdoyouthinkyourorganizationwillfairunderMACRA?Itwillbreakeven,doyoubelieveyouwillreceiveabonuswithpositiveadjustment,receiveapenaltyornegativeadjustment,youdon'tknow,ornotapplicable?

Iwillleavethisopenforafewmomentstogiveeveryoneachancetorespond.Iwouldliketoremindeveryonethatwearerecordingthiswebinarandthatwewillbeprovidingalinktotherecording,aswellasthepresentationslides.

Alright.Letusgoaheadandsharethoseresults.Wehavegotaboutathirdoftheindividualssaytheydon'tknowbutwebelievethatabout27percentbelievetheywillreceiveabonuswithpositiveadjustment.

[DorianDiNardo]Wellifyouaregoingtodoafullyear,youshould.

[BobbiBrown]Yeah.Yeah.

[Dr.BryanOshiro]Right.Whylistmynameonthetableandwhyletsomebodytakemoneyawayfromyou?

AssistanceNeeded![41:29]

So,likeIsaidearlier,thereissomehelpavailableandyouknow,takeadvantageofit.Thegovernmentreallydoesnotwanttoleavephysiciansinthelurchherebecausetheintent,again,isnottosavemoneyforoursavingmoneyspace.Thewaythatthegovernmentprogramisactuallysettingupistoactuallyincorporatefinancialincentivesinordertotakecareofpatientsinamoreefficientway,inamorebeneficialwayforpatientsandsoforthtoobtainthebenefitofourexpertiseasitis.Soagain,thereissometrainingavailableandtherearesomeadditionalwebsites,whichwehaveactuallyputattheendofthispresentationandinthereferencessothatyoucanfindthemafterthepresentationisordered.

Whatarestepscanwetaketoprepare?[42:21]

Sowhatstepscanwetaketoprepare?Well,IthinkweallneedtoevaluatewherewefallunderMACRA.ArewegoingtobeinMIPSorarewegoingtobeAPMorareweexempt?SotheAMAwebsiteactuallyhasapaymentmodelevaluatorandIactuallywentononlinetotakethatforourgroupanditturnsoutthat,yes,wearesubjecttoMIPSandwearenotexempt.Sowehavetoreportonsomethinginthiscomingyear.Soanyway,itisapre-calculator,thereisnosign-upandstuff.IdonoteventhinkyouhavetoactuallybeanAMAmembertotakeitbutIamnotquitesureonthatbutyoucanactuallyperusethatwebsite.

Andareyouparticipatinginaqualifiedclinicaldataregistryalready?Ifnot,therearespecialtysocietiesthathavetheseregistriesandsoforthandtheycanreallystreamlineyourreportingandassistyouwithMIPSperformancescoring.Andifyoupracticewithmorethanoneeligibleclinician,asDoriansaidearlier,youknow,theaskthequestions,decidewhetherornotitisbeneficialtoyoutoreportindividuallyorasagroup.Now,theotherdownsideisthatifyoureportasagroup,youarenotgoingtobeabletoreallyhavepickingandchoosingwhichmeasureyouaregoingtobeworkingonasanindividual.Youhavetodetermineitasawholeandsoforth.

Soreallyyouhavetokindoflookatyourpracticeandevaluateandseewhatisreallybeneficialforourgrouporwhatarewedoingwellalready.

Andthendeterminewhetheryouneedtherequirementsforsmall,ruralornon-patient-facingphysicianaccommodationsaswell.SolikeIsaidearlier,ifyouhaveahundredencountersormore,thenthatissomethingthatyouhavetobepromisingof.Andifyouareinahospital-basedpractice,youmayqualifyunderMIPSanywayfromthat.

Stepstotake–continued[44:21]

Sonumber5stepisaccessandreviewthe2014annualPQRSfeedbackreportstoseewhereimprovementscanbemade.Again,ifthere'ssomethingthatyoucurrentlyaren'treportingonoryoudonothavedataon,itisreallygoingtobehardforyoutogetstartedin2017because2017isonlylessthantwomonthsaway.Sopicksomethingthatyouarealreadyreportingon.

AndyouhavetohavesomecostdatatoreviewthecostdatafromCMSinthesummerof2017forongoingthings.Again,youshouldlookat2017asnotonlyparticipatingforthesakeofnotlosinganymoneyandpotentiallygainingalittlebitextramoney,but2017isanopportunitytotestyoursystems,totestyourprocesses,suchthatgoingforward,wherethereisgoingtobeincreasinggains,rewards,andpenalties,thatyoureallyneedtohaveyoursystemsinplaceforthat.

Andthenconsiderhowyouplantoreportthroughclaims,electronichealthrecord(EHR),clinicalregistries,qualifiedclinicaldataregistries,orothermeansandsoforth.TheGPROWeb-interfaceisonlyavailableforphysiciansinlargerpractices,forexample.Somakesurethatyouknowhowyouaregoingtoreport.

Resources–MACRAREADYprograms[45:42]

ThenextstepsthatIkindofsummarizedhereasyoucantakealookattheresources,there'sreallykindoffourstepsinsummarythatIwouldliketosay–isthatyoushouldfocusonevaluationandstrategicplanninginthefollowingareas–financial,whichwehavesortoftalkedabout,clinical,technical,andstafftraining.So,reallyforthenext2017year,stabilizeandoptimizeyourregistriessothatyouensurethatyourpracticeisnotneedingmoneyonthetable.Somakesurethatyoudostaffaudits,thatyouareworkingon(46:20)managementtohelpcloseyourrevenueweeksandsoforthandhelpingyourselftoreallyknowandscrutinizeyourreimbursementsandsoforth.

Withclinicalsuccesses,becausethere'ssuchabigemphasison2017,60percentofyourscorethroughMIPSisbasedonqualitytargetsandthatiswhereyoushouldbeputtingonalotofyouremphasison.Sotakeadvantageofthemeasuresthatappearacrossmultiplecategoriesandthingsthatyouarealreadyreportingon.AndrememberthatpopulationhealthandcarecoordinationarereallyattheheartoftheQPPmodelsandsoforth.Sofocusonexpandingcommunicationwithyourbeneficiariesandpatientcareteams,aswellasspecialists,perse.

Andthentechnologicalsuccessissokeytothis.SomakesurethatyouareabletoaccessinformationthroughyourEHRtemplates,yourworkflowcustomized,andthatmaybeyouhavesomedashboardsthatyoucancreate,oryouneedtocreate.Andthenfinally,whatIwouldsayisthatreallyyouhavetotrainyourstaff.So,practicesreallyneedtohavesomehelpinthismanytimes,soyoumayneedtoalignwithpartnerswhocanhelpyoushowtheburdenofhavingexpertiseandimplementationandeducatingyourstakeholdersallalongthecontinuousandthings,andstillreallyfocusinginon,thepatientisprobablynumberone.ThisisquiteevidentwiththenewMACRAlawsandsoforth.So,involvetheentirestaff.

Soanyway,IamgoingtoturnitbackovertoTylerforawrap-uphere.

[BobbiBrown]Okay.Thankyouverymuch.Igotsomegreatideasjustlisteningtothat.Ihopeyoualldidtoo.IhadoneslideinthereIamreportingandIprobablyskippedrightbyitinmynervousness.Butanyway,youwillbereportingfor2017.YouwillhavetoreportbyMarch31stof2018.Igotmyyearsrighthere.andyoucangothroughthereportingoptionsthatDorianmentioned.Soagain,youmaynotbereportingafullyearbutyoumayjustbereportingthe90daysinthereorthefullyear,whateveryoudecidetodo.

Questions[48:38]

AndthenCMSiscommittedtogiveussomefeedbackreportsinthenextsummer,whichthoseof,Iamjustwaitingtogettoseesomeofthose.Andagain,theywillnothaveallofourdataintherebuttheywillhavesomedataintherethattheyhadpulledalotfromclaim.Andgetstarted.

Andwehavesomequestionsnowwewanttogetinto.

[TylerMorgan]Thatisright.Wehavegotalotofgreatquestions.

UpcomingWebinar[49:05]

Beforewegettothequestionsthough,Iwouldliketohighlightthatwedohaveanupcomingwebinar,'IntroducingtheNewHealthCatalyst®CareManagementSuite',providedbyRussStaheli.Wedidannounceearlierthatwehaveacoupleofwebinarseriescomingupinpopulationhealth,aswellaspredictiveanalytics,andthisisthefirstwebinarinthepopulationhealthseries.

HowinterestedareyouinsomeonefromHealthCatalyst®contactingyouaboutademonstrationofoursolutions?[49:23]

Buttheotherthingisthatbeforethequestions,youknow,ourwebinarsaremeanttobeeducational,butsometimeswedogetquestionsaboutwhoweareandwhatwearedoing.So,ifyouareinterestedinsomeonefromCatalystreachingouttoyouaboutademonstrationofoursolutions,pleasefeelfreetorespondtothispollquestion.

Whileyouareresponding,letusgetrightin.Sowehavehadmultiplequestionsaroundthistopic–wherecanIfindthosequalitymeasures?Quiteafewfolksareveryinterestedtoknowwheretheycanfindthose.

[DorianDiNardo]SoyoucanfindthosequalitymeasuresattheQPPwebsiteandthatwason,Ibelieve,slide62,whenyougettheslidedeckback,qpp.cms.gov.Youcanwalkrightthroughthatwebsiteanditisveryguided.Itisagreatwebsite.Youcandownloadinformation.Itwillshowyouwhatkindof,howyousubmitthosemeasures,canyoudoittoyourclaimsand/orregistryand/oryourEHR.IfyouareagroupandreportingthroughtheCMSwebinterfaceoraGPRO-typesubmission,itwalksyouthroughallofthat.So,itisveryeducational.

[BobbiBrown]AndyouhaverightinthereisthelistofeachmeasureandIamprettysurethereisadownloadfeature,thenyoucansortindifferentwaysandsay,Ionlywanttoseethesemeasures,Iwanttoseeallover200ofthem,andtheyarelistedwithatitleandverydescriptive.Andlikeshementioned,theqpp.cms.govandupontheright-handsideIthinkit'salltheexploremeasures.Sotheyarerightthere.Oryoucanofcoursecangotothe(51:13)thepagesoftherigsbutyoudonotneedtodothat.Justgotoqpp.cms.gov.

[TylerMorgan]Wehavealsohadalotofquestionsaroundmultispecialtygroups,questioningaboutwhatdowedo,dowereportasagroup,dowereportindividuallybasedonhowwearesetup.There'salotofquestions,agoodaroundhowmultispecialtypracticesaresupposedtofunctionunderMACRA.

[DorianDiNardo]SoyouhaveachoiceunderCMSwithmultispecialtyclinics.YoucanreportasagroupthroughtheTaxIDNumberandalloftheNPIsandthatTaxIdNumberwillbeinthatgroup.IfyouarechoosingnottouseyourTaxIDnumbertoreport,thenyouwoulddo,eachNPInumberwouldgoin,andanswerthequestionsatastation,attheadvancingcarequestionscategory,ifyouarewantingtodothefullthing.Ifyouarejustwantingtotestthatprogramoutanddo90days,figureitout,submissionanddoyourclaimsdataorsomethinglikethat,thatworksgreat.

[Dr.BryanOshiro]WellIthinkformostgroups,itwouldbebeneficialtoreportasagroup,becausesomeoftheeasiestonestodoaresomethinglikecarecoordination,forexample,whereyoureallykindofaremakingsurethatthere'scommunicationsbetweenprovidersandpatientsandspecialistsandsoforth.Sothosethingscangoacrossandeverybodycanparticipate.Ifyoudoanindividualtypeofreportinginamulti-specialtygroup,itisgoingtobequitedifficultandIthinkoneroustoaddressthoseissuesandsoforth,anditisgoingtobequiteconfusingforthestaff.Sowhatyouwanttodoisyouwanttoactuallysetupasystemfortheentireclinicenterpriseratherthandoingindividualoneoffbecausethatisnotgoingtohelpyousetupasystemforthefuture.

[TylerMorgan]Alright.Thankyou.Wellournextquestionistogetthemaximumpossiblescorefornextyear.Isittoyourunderstanding,youmustreportforthefullyear,thenewQPPsiteCMSseemstocontradictitself,sayinginoneplacethatyoucando90daysforthemaximumoptionthentheothersidetofullyear.

[DorianDiNardo]Sothatdependsonthedataqualityofwhatyouaresubmitting.Ifyouhaveexcellentdataqualityforthemeasuresthatyouaresubmitting,youcouldpotentiallygetabovethe7pointsrequiredforfullparticipation.Itreallydependsonhowgoodyourdataqualityis.

[Dr.BryanOshiro]Sothe90-daythreshold,again,youknow,thisisagreatwaythatifyouaregoingtoreportforgreaterthan90days,thatyoumaynotbequitereadyatthebeginning.SoCMSactually,throughthisprogram,hasallowedandgivenflexibilitytoclinicianswhosaywewerenotquitereadyinJanuaryof2017butwe'regoingtobereadysometimeintheinterim.Sothenyoucanstartreportingandtocontinuewiththe90-dayprocess,fromwhereIunderstand.Sotheycouldbealittlebitlater.Youcouldstarttheprocessearlyonbutyouaregainingthatexpertise,youaregainingthatunderstanding,orgettingtheprocessesinplace.SoIthinkthisisagreatflexibilityelementthattheyhavebuiltin.

[TylerMorgan]Alright.Thankyou.OurnextquestioniswiththebabyboomofpopulationjustgettingintoMedicare,thisistheworsttimetobeusingpractitioners,asslide49noted.HasCMSacknowledgedthispossibility,thiscasescenario?

Dr.Oshiro,wouldyouliketo(55:09)first?

[Dr.BryanOshiro]Yeah,Iamnotsureifactually,youknow,theyknowthatthereisabighumpinthisgroupofindividualsthat'sagingandsoforth.ThatisgoingtocomprisethelargestgroupintheMedicarepopulation.Sotheydorealizethatitisthepatientpopulation,thatthereisgoingtobeagreatneed.Theyalsoknowthatthereisagreatmismatchwithanumberofcliniciansthatareabletotakecareofthem,primarilyprimarycaredoctors.Andso,thatiswhytheyhaveactuallysaidthisisnotaprogramjustforphysiciansbutanybodythat'spatient-facing,includingPAsandnursepractitionersandsoforth.Andyouknow,becauseofthelargecaregapsthatmaydevelop,andweknowfrommodelingthatCMSisgone,thatthisispotentiallygoingtoastronomicallyincreasetheprocessofcare.Sothisisreallyadesperateattempttohandlethislargeinflux.Andso,that'sespeciallyoneofthereasons,abigreason,whytheyareactuallydoing.

[TylerMorgan]Alright.Thankyou.Weareverynearthetopofthehour.Sowejusthaveonelastquestionthatwecanfill.Ifwedidnotgetyourquestion,BobbiandDorianandDr.Oshirohavecommittedthattheywillreachoutandrespondtoeveryquestionthat'sbeenasked.SothisquestionthatwecanfillquicklyiswhatwebsitewastheAMAPaymentModelEvaluatoron?AndIbelievewehaveituphereonthisslide.Bobbi?

[BobbiBrown]Yeah.Yes.Thatisthegeneralandunderthatyouwillfindthepaymentevaluator.

[TylerMorgan]Alright.Well,thankyoueveryone.

[BobbiBrown]Thankyou.

[TylerMorgan]I'msogladyoumakeit.Shortlyafterthiswebinar,youwillreceiveanemailwithlinkstotherecordingofthewebinar,thepresentationslides,andtheaudiodownload.Also,pleaselookforwardtothetranscriptnotificationwewillsendyouonceitisready.

OnbehalfofBobbiBrown,DorianDiNardo,BryanOshiro,aswellastherestofushereatHealthCatalyst®,thankyouforjoiningustoday.Thiswebinarisnowconcluded.

Appendix

Acronyms

Whatdowehavetoreport?

ReportingOption1:NoReporting

ReportingOption2:MinimalReporting

ReportingOption3:PartialReporting

ReportingOption4:FullReporting

ReportingOption5:AdvancedAPM

[ENDOFTRANSCRIPT]