10/10/2017. Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP

Size: px
Start display at page:

Download "10/10/2017. Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP"

Transcription

1 Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP 1

2 Disclosures Amina Abubakar, PharmD, AAHIVP, RX Clinic Pharmacy and Olivia Bentley, RX Clinic Pharmacy declare no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Learning Objectives Discuss prescriber quality programs and how to have a conversation with prescribers that speaks to their pressure points Described workflow and billing in a prescriber s office Quantify community pharmacy revenue opportunities in primary care and how to negotiate financial agreements Illustrate the path for community pharmacy s role in primary care 2

3 Navigating Through Industry Challenges 3

4 Rethink Pharmacy s Role Allow Medical Providers to provide Episodic Care Focused on treatment, treatment, treatment Pharmacists to provide Preventative Care Comprehensive evaluation Development of Care Plans Implementation and coaching of Care Plans Remote Progress Check ins and Accountability Evaluation and Coordination of Care Update Care Plans Practice Sites: Rx Clinic Pharmacy #1 Independent Community Pharmacy Medication Synchronization 100% Community Pharmacy Enhanced Services Network (CPESN) Pharmacy MTM Program Pharmacogenetic Personalized Medication Review Program AADE Accredited Diabetes Education Program URAC Accredited Specialty Pharmacy Point of Care Testing Rapid Flu BHRT Saliva Testing Diabetes Screening Cardiovascular Risk Screening Blood Pressure Cholesterol HIV HepC 4

5 Practice Sites: Rx Clinic Pharmacy #2 Independent Medical Practice Within House Pharmacy Clinical Pharmacist Embedded in a Medical Practice Collaborative Practice Agreement Annual Wellness Visits Chronic Care Management Intensive Behavioral Therapy for Obesity BHRT HIV Specialty Pharmacist Pharmacist led Acute/Urgent Care Clinic Travel Health & Immunizations Clinic Yellow Fever Certified Pharmacogenetic Personalized Medication Reviews Allergy Testing Other Practice Sites Primary Care Medical Practices Similar Pharmacist led Clinical Services Pharmacist spends part time at different medical practices Assisted Living Facilities Federally Qualified Health Centers (FQHC) Training and Education Platforms Pharmacogenetics Community Pharmacy Implementation Hospital System Implementation Pharmacist led Clinical Services in Ambulatory Care Practices Community Pharmacy and ACO Integration 5

6 Pharmacy Redefined Management Service Organization Prescriber Quality Programs Join the health care team as a high level clinician bringing quality patient care and value to the medical practice 6

7 Important Terms from the CMS Quality Payment Program for Providers Old Terminology Meaningful Use (MU) EHR Incentive Program Physician Quality Reporting System (PQRS) incentive program for reporting quality measures (CQM) Clinical Quality Measures (CQM) tools that measure the quality of health care services 2017 Terminology MACRA name of the law that established a new way to pay providers MIPS Merit based Incentive Payment System Quality measures EHR related measures APM Advanced Payment Models e.g. ACOs CMS Quality Payment Program for Providers MACRA passed in 2015 Medicare Access and CHIP Reauthorization Act Created MIPS and APM By 2019 PQRS, MU and CQMs will collapse into MIPS Fee for service will be fixed Physicians accepting Medicare must either do MIPS program, value based (pay for performance) or ACO Value based contract for all providers by

8 CMS Quality Payment Program for Providers Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Who is in the Quality Payment Program (QPP) in 2017? Providers in an Advanced APM or Providers that bill Medicare more than $30K per year AND Provider care for more than 100 Medicare patients per year For MIPS, you must also be one of the following: Physician, PA, NP Clinical nurse specialist Certified registered nurse anesthetist *Must submit data on at least 50% of applicable Medicare and non Medicare patients on at least 6 quality measures 8

9 MIPS Performance Payment Adjustment Timeframe How Will MIPS Impact Medicare Payments? 9

10 Advanced APM Payment Adjustment Timeline and Impact What are Alternative Payment Models (APM) and Advanced APM? Incentive payments for high quality care and cost efficient care May apply to specific condition, care episode, or population Advanced APM Higher risk with potentially higher reward 5% incentive payment 2017 Example Advanced APMs Comprehensive Primary Care Plus (CPC+) Next Generation ACO Model Shared Saving Program Track 2 Shared Saving Program Track 3 10

11 How Are Pharmacist led Clinical Services Making an Impact for Medicare Providers? Quality = PQRS Most: up to 6 quality measures for a minimum of 90 days Group: 15 quality measure for a full year APMs: report through APM and do not need anything else for MIPS quality ACI = Meaningful Use Report through certified EHR Improvement of Activities Most: Attest to 4 for minimum of 90 days Groups <15: attest 2 for minimum of 90 days PCMH: automatically earn credit APMs: automatically earn credit through APM How Are Pharmacist led Clinical Services Making an Impact for Medicare Providers? 271 Quality Measures Most: 6 Group: 15 Medicare Annual Wellness Visit 30 measures addressed Chronic Care Management At least 7 linked to appropriate medication therapy management Transition of Care Management Medication reconciliation postdischarge Examples: Adults MDD: Suicide Risk Assessment Colonoscopy Screening Breast Cancer Screening Medication management STD Screening Cognitive Assessment Fall Risk Assessment Tobacco Cessation Counseling Osteoporosis Screening Urinary Incontinence Screening 11

12 Example MIPS Quality Measure Benchmarks Measures which give 10 points with performance <100% Point System within a single quality measure HepC screening >=20.02% Colonoscopy >=80.33% Breast Cancer screen Colorectal Cancer screen Pneumonia Vacc >90% Controlled BP >=91.07% Influenza >=91.84% CAD: DM or LVEF<40% + ACE/ARB >=96% BMI screen + f/u plan >97.34% Post MI or LVEF<40% + BB therapy >=97.92% Breast Cancer Screening 3 points 12 24% 4 points 24 25% 5 points 35 46% 6 points 46 55% 7 points 55 63% 8 points 63 74% 9 points 74 87% 10 points % PCMH Incentive Example from Commercial Payer Increased reimbursement in all codes by 5% Assigned NC AHEC Quality Improvement practice coach PCMH recognition is a mandatory component of the BQPP (double digit increase to fee schedules) 12

13 Pharmacist s Role in PCMH Assist in developing Care Plans Following up with patient s care plans counseling, coaching, monitoring and adjusting Meeting quality metrics submitted to NCQA Coordinating care amongst the healthcare team Monitoring quality measures and using care plan interaction to meet those measures HEDIS Measures for Commercial and State Payer Programs National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data & Info Set (HEDIS) 81 measures 5 domains Medicaid Core Set of Adult Health Care Quality Measures 2017 Primary Care Access and Preventative Care Maternal and Perinatal Health Care of Acute and Chronic Conditions Behavioral Health Care Experience of Care 13

14 14

15 Why Should Pharmacists Care About the Quality Measures for Medical Providers? Medical Providers do not have the time Medical Providers still do not understand what they are supposed to do Medical Providers are in denial that this is happening 15

16 16

17 Having Transplant Conversations with Medical Providers Showing a pharmacist s value in solving problems and pressure points. 17

18 Potential Revenue Opportunities Once they see the value in pharmacist led services, how can they afford to have you? Negotiating Financial Agreements Select the model that satisfies both the practice and pharmacy needs 18

19 Negotiating Financial Agreements Productivity Based Fixed Rate Incentive Based Workflow and Billing in a Medical Practice Understanding where a pharmacist fits in a new environment 19

20 The Path for Community Pharmacist s Role in Primary Care Using your strengths, abilities and pharmacy resources to impact quality patient care for medical providers 20

21 Choose Your Path Amina Abubakar PharmD, AAHIVP Olivia Bentley PharmD, AAHIVP, CFts Rx Clinic Pharmacy 21

22 22

Dimmy Sokhal, PharmD 9/28/2016. Clinical Pharmacist, Hayat Pharmacy. Building Enhanced Services into Your Existing Medication Synchronization Program

Dimmy Sokhal, PharmD 9/28/2016. Clinical Pharmacist, Hayat Pharmacy. Building Enhanced Services into Your Existing Medication Synchronization Program Building Enhanced Services into Your Existing Medication Synchronization Program Sponsored by Merck Dimmy Sokhal, PharmD Laura Patterson, PharmD Amina Abubakar, PharmD Dimmy Sokhal, PharmD Clinical Pharmacist,

More information

WELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association

WELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association

More information

Goals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE

Goals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures

More information

MACRA Fall into Place. By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof

MACRA Fall into Place. By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof MACRA Fall into Place By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof About the Presenter https://www.linkedin.com/in/stephaniececchini 2 Introduction Love it Hate it Don t know a

More information

Understanding Medicare s New Quality Payment Program

Understanding Medicare s New Quality Payment Program Understanding Medicare s New Quality Payment Program Your introduction to MACRA and getting started with MIPS 1 Understanding Medicare s New Quality Payment Program 2016 Mingle Analytics. All Rights Reserved.

More information

MACRA The shift to Value Based Care and Payment. Michael Munger, M.D., FAAFP

MACRA The shift to Value Based Care and Payment. Michael Munger, M.D., FAAFP MACRA The shift to Value Based Care and Payment Michael Munger, M.D., FAAFP Current State Silos of Care Over Utilization Volume over Value Push Towards Value and Quality 85% Medicare Payments tied to quality

More information

CMS Transforming Clinical Practices Initiative and. The Southern New England Practice Transformation Network (SNE PTN)

CMS Transforming Clinical Practices Initiative and. The Southern New England Practice Transformation Network (SNE PTN) CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS 2017- Selecting Performance Category Measures and Reporting Requirements 1/31/2017

More information

The New Frontier: Value- Based Payment Models

The New Frontier: Value- Based Payment Models The New Frontier: Value- Based Payment Models Target Audience: Pharmacists and Pharmacy Technicians ACPE#: 0202-0000-18-026-L04-P/T Activity Type: Knowledge-based Target Audience: ACPE#: Activity Type:

More information

A Roadmap to Working with Prescribers: Making Theory Into Practice. Amina Abubakar, PharmD, AAHIVP Olivia Bentley, PharmD, CFts, AAHIVP

A Roadmap to Working with Prescribers: Making Theory Into Practice. Amina Abubakar, PharmD, AAHIVP Olivia Bentley, PharmD, CFts, AAHIVP A Roadmap to Working with Prescribers: Making Theory Into Practice Amina Abubakar, PharmD, AAHIVP Olivia Bentley, PharmD, CFts, AAHIVP Disclosures Amina Abubakar, PharmD, AAHIVP, RxClinic Pharmay and Olivia

More information

2015 Annual Convention

2015 Annual Convention 2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 10 Title: Activity Type: Speaker: Opportunities

More information

Decoding the QPP Year 2 Quality Measure Benchmarks and Deciles to Maximize Performance

Decoding the QPP Year 2 Quality Measure Benchmarks and Deciles to Maximize Performance Decoding the QPP Year 2 Quality Measure Benchmarks and s to Maximize Performance Leila Volinsky, MHA, MSN, RN, PCMH CCE, CPHQ Senior Program Administrator New England Regional Lead Quality Payment Program

More information

MACRA Open Call December 5 th, 2016

MACRA Open Call December 5 th, 2016 MACRA Open Call December 5 th, 2016 Leila Volinsky, MHA, MSN, RN Quality Reporting Program Administrator This material was prepared by the New England QIN-QIO, the Medicare Quality Innovation Network-Quality

More information

The Patient-Centered Medical Home Model of Care

The Patient-Centered Medical Home Model of Care The Patient-Centered Medical Home Model of Care May 11, 2017 Louise Bryde Principal Presentation Outline Imperatives for Change Overview: What Is a Patient-Centered Medical Home? The Medical Neighborhood

More information

Here is what we know. Here is what you can do. Here is what we are doing.

Here is what we know. Here is what you can do. Here is what we are doing. With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the

More information

MACRA Frequently Asked Questions

MACRA Frequently Asked Questions Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.

More information

United Medical ACO Participation Criteria

United Medical ACO Participation Criteria United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average

More information

Beyond Meaningful Use: Driving Improved Quality. CHCANYS Webinar #1: December 14, 2016

Beyond Meaningful Use: Driving Improved Quality. CHCANYS Webinar #1: December 14, 2016 Beyond Meaningful Use: Driving Improved Quality CHCANYS Webinar #1: December 14, 2016 Agenda The Current State Measuring Monitoring & Reporting Quality. Meaningful Use 2018 and Beyond The New Quality Payment

More information

The Healthcare Roundtable

The Healthcare Roundtable The Healthcare Roundtable MACRA Update Jayme R. Matchinski Greensfelder, Hemker & Gale, P.C. April 7, 2017 New Orleans, Louisiana This presentation and outline are limited to a discussion of general principles

More information

MACRA and MIPS. How Medicare Meaningful Use and PQRS are Changing

MACRA and MIPS. How Medicare Meaningful Use and PQRS are Changing MACRA and MIPS How Medicare Meaningful Use and PQRS are Changing Link to recorded session: https://attendee.gotowebinar.com/recording/1305549490878052097 Presenting Today: Molly Goodhart Joined Quatris

More information

Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting Requirements

Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting Requirements Creating Clinically Integrated Health System-Based Medical Groups Collaborative Case Study Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting

More information

Here is what we know. Here is what you can do. Here is what we are doing.

Here is what we know. Here is what you can do. Here is what we are doing. With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the

More information

From Surviving to Thriving in the QPP World

From Surviving to Thriving in the QPP World From Surviving to Thriving in the QPP World Today s Objectives Brief MACRA Overview Where are we going?: Advanced Alternative Payment Models (APMs) Where are we now? Merit Incentive-Based Payment System

More information

QPP in the Real Word: How Your Peers Are Achieving Success. Monday, September 25, :00 4:30 PM ET

QPP in the Real Word: How Your Peers Are Achieving Success. Monday, September 25, :00 4:30 PM ET QPP in the Real Word: How Your Peers Are Achieving Success Monday, September 25, 2017 3:00 4:30 PM ET Meet Your Speakers Leila Volinsky MHA, MSN, RN Senior Program Administrator-Quality Payment Program

More information

MIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017

MIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017 CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS 2017- Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017 2 Review Determine

More information

MACRA and the Quality Payment Program. Frequently Asked Questions Edition

MACRA and the Quality Payment Program. Frequently Asked Questions Edition MACRA and the Quality Payment Program Frequently Asked Questions 2018 Edition What is MACRA?...3 What is the Quality Payment Program?...3 How do payments work under the QPP?...3 What is at risk under

More information

Reimagining PCMH Recognition

Reimagining PCMH Recognition Reimagining PCMH Recognition August 2016 Michael S. Barr, MD, MBA, MACP Executive Vice President Quality, Measurement & Research Group Re-use without permission is prohibited 1 Where is PCMH in future

More information

INTRODUCTION TO POPULATION HEALTH. Kathy Whitmire, Vice President

INTRODUCTION TO POPULATION HEALTH. Kathy Whitmire, Vice President INTRODUCTION TO POPULATION HEALTH Kathy Whitmire, Vice President 1 Learning Objectives 1. Provide an overall framework for population health 2. Allow clinics to understand why population health is important

More information

ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, :00 5:00 PM

ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, :00 5:00 PM ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, 2017 3:00 5:00 PM ACPE UAN: 0107-9999-17-105-L04-P 0.2 CEU/2.0 hr Activity Type: Knowledge-Based Learning Objectives for Pharmacists: Upon

More information

Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act

Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act Ashby Wolfe, MD, MPP, MPH Chief Medical Officer, Region IX Centers for Medicare and Medicaid Services

More information

2016 PQRS and VBM for Anesthesia and Pain Management

2016 PQRS and VBM for Anesthesia and Pain Management 2016 PQRS and VBM for Anesthesia and Pain Management 2016 PQRS and VBM for Anesthesia and Pain Management 1 Table of Contents PQRS 1 Definitions 2 PQRS Basics 2 MAV 3 Claims-based vs. Registry-based Reporting

More information

CMS Quality Payment Program: Performance and Reporting Requirements

CMS Quality Payment Program: Performance and Reporting Requirements CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,

More information

The Quality Payment Program Overview Fact Sheet

The Quality Payment Program Overview Fact Sheet Quality Payment Program The Quality Payment Program Overview Background On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the

More information

Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.

Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that

More information

2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.

2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018

More information

Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare

Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate

More information

The Future of Physician Reimbursement

The Future of Physician Reimbursement The Future of Physician Reimbursement EBG (PQRS-Quality Measures) yield Outcome Report Yield Increased Quality Yield Decreased Cost yield Increased Patient Satisfaction - CAHPS Consumer Assessment of Healthcare

More information

CMS Priorities, MACRA and The Quality Payment Program

CMS Priorities, MACRA and The Quality Payment Program CMS Priorities, MACRA and The Quality Payment Program Ashby Wolfe, MD, MPP, MPH Chief Medical Officer, Region IX Centers for Medicare and Medicaid Services Presentation on behalf of HSAG November 16, 2016

More information

Weaving Expanded Roles of the RN into Population Management

Weaving Expanded Roles of the RN into Population Management Weaving Expanded Roles of the RN into Population Management Lois K. Andrews, DNP, RN-BC, CNS, ACNS-BC, CCRN Sentara Quality Care Network (SQCN), Norfolk, Va. Objectives: Explore the evolution of healthcare

More information

Physician Quality Reporting System & VBPM, 2015

Physician Quality Reporting System & VBPM, 2015 Physician Quality Reporting System & VBPM, 2015 Andrew Bienstock Transformation Support Services Manager 1 Agenda 1. PQRS Penalty 2. PQRS Eligibility 3. PQRS Reporting Options 4. Value Based Payment Modifier

More information

MACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care

MACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care MACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care AMERICAN NEUROLOGICAL ASSOCIATION October 17, 2017 Marc R. Nuwer, MD PhD Professor and Vice Chair UCLA Lyell K. Jones,

More information

Benchmark Data Sources

Benchmark Data Sources Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable

More information

Meaningful Use 2016 and beyond

Meaningful Use 2016 and beyond Meaningful Use 2016 and beyond Main Street Medical Consulting May 12, 2016 Meaningful use, MACRA, MIPS? Whaaaaat? 1 Reporting Period and Timeline In 2016 all providers are required to use CEHRT versions

More information

MACRA FLEXIBILITY & THE MACRA FINAL RULE. Compliance & Opportunity for Your Practice

MACRA FLEXIBILITY & THE MACRA FINAL RULE. Compliance & Opportunity for Your Practice MACRA FLEXIBILITY & THE MACRA FINAL RULE Compliance & Opportunity for Your Practice CONTENTS Overview... 5 What s new... 5 Advancing Care Information... 8 Major changes... 9 Proposed rule vs. final rule

More information

2016 MEANINGFUL USE AND 2017 CHANGES to the Medicare EHR Incentive Program for EPs. September 27, 2016 Kathy Wild, Lisa Sagwitz, and Joe Pinto

2016 MEANINGFUL USE AND 2017 CHANGES to the Medicare EHR Incentive Program for EPs. September 27, 2016 Kathy Wild, Lisa Sagwitz, and Joe Pinto 2016 MEANINGFUL USE AND 2017 CHANGES to the Medicare EHR Incentive Program for EPs September 27, 2016 Kathy Wild, Lisa Sagwitz, and Joe Pinto Agenda Meaningful Use (MU) in 2016 MACRA and MIPS (high level

More information

Advancing Care Information- The New Meaningful Use September 2017

Advancing Care Information- The New Meaningful Use September 2017 Advancing Care Information- The New Meaningful Use September 2017 ACO Announcements Reminders: ACO Notifications PECOS-Maintain active enrollment 2017 Patient Prospective Lists Upcoming provider/office

More information

Michelle Brunsen & Sandy Swallow May 25, , Telligen, Inc.

Michelle Brunsen & Sandy Swallow May 25, , Telligen, Inc. MIPS Survive and Thrive: Advancing Care Information Michelle Brunsen & Sandy Swallow May 25, 2017 2016, Telligen, Inc. Objectives Quality Payment Program Updates Advancing Care Information (ACI) Category

More information

Stage 3 and ACI s Relationship to Medicaid MU Massachusetts Medicaid EHR Incentive Program

Stage 3 and ACI s Relationship to Medicaid MU Massachusetts Medicaid EHR Incentive Program Stage 3 and ACI s Relationship to Medicaid MU Massachusetts Medicaid EHR Incentive Program September 19 & 20, 2017 Today s presenters: Brendan Gallagher Thomas Bennett Agenda Stage 3 Meaningful Use (MU)

More information

The Merit-Based Incentive Payment System (MIPS) Survival Guide. August 11, 2016

The Merit-Based Incentive Payment System (MIPS) Survival Guide. August 11, 2016 The Merit-Based Incentive Payment System (MIPS) Survival Guide August 11, 2016 Speakers Nina Marshall, MSW, Senior Director, Policy and Practice Improvement, National Council for Behavioral Health Elizabeth

More information

The Role of Pharmacy in Alternative Payment Models

The Role of Pharmacy in Alternative Payment Models The Role of Pharmacy in Alternative Payment Models July 15, 2015 Disclaimer Organizations may not re use material presented at this AMCP webinar for commercial purposes without the written consent of the

More information

MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD

MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD Outline of Presentation Introduction Overview of MACRA/MIPS Clinical Practice Improvement Activities

More information

Value-Based Psychiatric Care

Value-Based Psychiatric Care Value-Based Psychiatric Care North Carolina Psychiatric Association Annual Meeting September 15, 2017 Grace E. Terrell, MD Mission: To be your medical home Vision: To be the model for physician-led health

More information

Quality Payment Program and Alternative Payment Models. Brian R. Bourbeau, MBA COA Administrators Network April 11, 2018

Quality Payment Program and Alternative Payment Models. Brian R. Bourbeau, MBA COA Administrators Network April 11, 2018 Quality Payment Program and Alternative Payment Models Brian R. Bourbeau, MBA COA Administrators Network April 11, 2018 Speaker Background Associate Director, Business Metrics & Analysis Clinical Affairs

More information

Note: Accredited is the highest rating an exchange product can have for 2015.

Note: Accredited is the highest rating an exchange product can have for 2015. Quality Overview Accreditation Exchange Product Accrediting Organization: NCQA HMO (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product can have for 215.

More information

Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems

Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems Dr. Ashby Wolfe, Chief Medical Officer Centers for Medicare and Medicaid Services,

More information

New Models of Care: Diabetes and the Triple Aim

New Models of Care: Diabetes and the Triple Aim Robert Gabbay MD, PhD, FACP Chief Medical Officer Joslin Diabetes Center Harvard Medical School Boston, MA The Triple Aim New Models of Care: Diabetes and the Triple Aim Healthcare is changing, what does

More information

Population Health and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson

Population Health and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson Population Health and the Accelerating Leap to Outcomes-Based Reimbursement Craig J. Wilson Agenda / Goals Define Population Health Management Review emerging reimbursement landscape eg MACRA Review why

More information

2017 Transition Into Value Based Care

2017 Transition Into Value Based Care 2017 Transition Into Value Based Care Provider Meeting August 3 rd, 2017 Objectives Define MACRA, MIPS, and APM Overview of MIPS Performance Categories within the Quality Payment Program (QPP) Provide

More information

The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015

The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015 The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com

More information

Updated 2017 Medicaid EHR Incentive Program Requirements For Eligible Providers (EP)

Updated 2017 Medicaid EHR Incentive Program Requirements For Eligible Providers (EP) Updated 2017 Medicaid EHR Incentive Program Requirements For Eligible Providers (EP) 1 Illinois Health Information Technology Regional Extension Center (ILHITREC) SUPPORT PROVIDED BY ILHITREC: The Illinois

More information

MACRA Quality Payment Program

MACRA Quality Payment Program The American College of Surgeons Resources for the New Medicare Physician System Table of Contents Understanding the... 3 Navigating MIPS in 2017... 4 MIPS Reporting: Individuals or Groups... 6 2017: The

More information

10/20/2016. Working within the Value-Based World

10/20/2016. Working within the Value-Based World Working within the Value-Based World MGMA Annual Conference Roundtable Discussion Orthopedics Urology Surgery Monday, October 31, 2016 1 Learning Objectives Summarize key solutions used by other specialty

More information

TO BE RESCINDED Patient-centered medical homes (PCMH): eligible providers.

TO BE RESCINDED Patient-centered medical homes (PCMH): eligible providers. ACTION: Final DATE: 09/21/2018 3:40 PM TO BE RESCINDED 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model

More information

2017 Transition Year Flexibility Improvement Activities Category Options

2017 Transition Year Flexibility Improvement Activities Category Options The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2017 Transition Year Flexibility Improvement Activities Category Options 1 P a g e Ad MEDICARE

More information

Kate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016

Kate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016 Kate Goodrich, MD MHS Director, Center for Clinical Standards & Quality Center for Medicare and Medicaid Services (CMS) May 6, 2016 THE MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 Quality Payment

More information

2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES

2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES 2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES 2017 Physician Fee Schedule Impact on Medicare ACOs 1. Allowing ACO Participants to report PQRS separately from ACO 2. ACO Quality

More information

MACRA, MIPS, and APMs What to Expect from all these Acronyms?!

MACRA, MIPS, and APMs What to Expect from all these Acronyms?! MACRA, MIPS, and APMs What to Expect from all these Acronyms?! ACP Pennsylvania Council Meeting Saturday, December 5, 2015 Shari M. Erickson, MPH Vice President, Governmental Affairs & Medical Practice

More information

Quality Measurement, Population Health and Payment Reform

Quality Measurement, Population Health and Payment Reform Quality Measurement, Population Health and Payment Reform The Move from Volume to Value Dale W. Bratzler, DO, MPH, FACOI, FIDSA Professor, Colleges of Medicine and Public Health Associate Dean, College

More information

MIPS Program: 2018 Advancing Care Information Category

MIPS Program: 2018 Advancing Care Information Category MIPS Program: 2018 Advancing Care Category The 2018 Quality Payment Program (QPP) Year Two final rule continues to implement the programs authorized under the Medicare and CHIP Reauthorization Act of 2015

More information

The Quality Payment Program: Overview & Roles and Responsibilities

The Quality Payment Program: Overview & Roles and Responsibilities The Quality Payment Program: Overview & Roles and Responsibilities National Tribal Health Conference Susy Postal DNP, RN-BC Chief Health Informatics Officer September 27, 2017 INDIAN HEALTH SERVICE / OFFICE

More information

Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care

Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care Introduction This white paper examines how new technologies are creating a fully connected point of care

More information

Value-Based Reimbursements are Here: Are you Ready?

Value-Based Reimbursements are Here: Are you Ready? Value-Based Reimbursements are Here: Are you Ready? White Paper ELLIS MAC KNIGHT, MD Senior Vice President/CMO Published by Becker s Hospital Review April 2016 White Paper Value-Based Reimbursements are

More information

Slide 1. Slide 2 Rural Princeton. Slide 3 Agenda Rural ACO RURAL ACOS CAN WORK AND LEAD THE WAY

Slide 1. Slide 2 Rural Princeton. Slide 3 Agenda Rural ACO RURAL ACOS CAN WORK AND LEAD THE WAY Slide 1 RURAL ACOS CAN WORK AND LEAD THE WAY Nebraska Rural Health Association September 20, 2017 Slide 2 Rural Princeton Slide 3 Agenda Rural ACO Illinois Rural Community Care Organization (IRCCO)/Statewide

More information

INTEGRATING CHRONIC CARE MANAGEMENT INTO COMMUNITY PHARMACY PRACTICE

INTEGRATING CHRONIC CARE MANAGEMENT INTO COMMUNITY PHARMACY PRACTICE INTEGRATING CHRONIC CARE MANAGEMENT INTO COMMUNITY PHARMACY PRACTICE ACPE UAN: 0107-9999-17-101-L04-P 0.1 CEU/1.0 hr Activity Type: Knowledge-Based Learning Objectives for Pharmacists: Upon completion

More information

Quality Payment Program MIPS. Advanced APMs. Quality Payment Program

Quality Payment Program MIPS. Advanced APMs. Quality Payment Program Proposed Rule: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models The Department

More information

Improving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018

Improving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018 Improving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018 David Cloyed, MS, RN-BC, Applications Manager, Nebraska Medicine Tammy Winterboer, PharmD, BCPS, Director, Clinical

More information

MACRA Implementation: A Review of the Quality Payment Program

MACRA Implementation: A Review of the Quality Payment Program MACRA Implementation: A Review of the Quality Payment Program Neal Logue, Kirk Sadur Centers for Medicare and Medicaid Services, Region IX, September 15, 2017 Disclaimer This presentation was prepared

More information

Pharmacists' Impact on Quality Measures and Opportunities for Pharmacy Enhanced Services

Pharmacists' Impact on Quality Measures and Opportunities for Pharmacy Enhanced Services CONTINUING EDUCATION Pharmacists' Impact on Quality Measures and Opportunities for Pharmacy Enhanced Services by Blair Thielemier, PharmD, and Alexander Tu, PharmD May 1, 2017 (expires May 1, 2018) Activity

More information

SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation

SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation 2017-2018 SVS QPMC Quality and Performance Measures Committee Policy and Advocacy Council (Chair Sean Roddy) Chair: Brad Johnson,

More information

Accelerating the Impact of Performance Measures: Role of Core Measures

Accelerating the Impact of Performance Measures: Role of Core Measures Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair

More information

Overview of Quality Payment Program

Overview of Quality Payment Program Overview of Quality Payment Program Policies for 2017 & 2018 Performance Years The Medicare program has transformed how it reimburses psychiatrists and other clinicians for providing services, under the

More information

Billing Opportunities in Ambulatory Care: What Pharmacists Need to Know

Billing Opportunities in Ambulatory Care: What Pharmacists Need to Know Billing Opportunities in Ambulatory Care: What Pharmacists Need to Know Stuart J Beatty, PharmD, BCACP, CDE Vice Chair for Clinical Services Associate Professor of Clinical Pharmacy The Ohio State University

More information

Texas Medicaid Electronic Health Record (EHR) Incentive Program: Federally Qualified Health Centers (FQHCs)

Texas Medicaid Electronic Health Record (EHR) Incentive Program: Federally Qualified Health Centers (FQHCs) Texas Medicaid Electronic Health Record (EHR) Incentive Program: Federally Qualified Health Centers (FQHCs) Julia Alejandre, Medicaid / CHIP Health IT Jason Phipps, Medicaid / CHIP Health IT July 20, 2012

More information

11/14/2016. A few simple questions. MACRA Regulations. Congress & CMS Game Changer MIPPA CMS Quality Publications

11/14/2016. A few simple questions. MACRA Regulations. Congress & CMS Game Changer MIPPA CMS Quality Publications A few simple questions Don t Lose Your Pants (or Your Sanity) Over MIPS An ODs Survival Kit for MACRA and Registries Jeff Michaels, OD, FAAO, Diplomate, American Board of Optometry Will Medicare funding

More information

Steps toward Sustainability with the second year of the Quality Payment Program

Steps toward Sustainability with the second year of the Quality Payment Program Steps toward Sustainability with the second year of the Quality Payment Program Deanna Graham, QI Consultant, Qualis Health March 27, 2018 Speaker Deanna Graham QI Principal Qualis Health 2 Qualis Health

More information

MIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities

MIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities MIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities Today we will cover: 2 General review of the Quality Payment Programs as per the final rule. Who is Eligible/Exceptions

More information

Advancing Care Information Performance Category Fact Sheet

Advancing Care Information Performance Category Fact Sheet Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced three quality programs (the Medicare Electronic Health Record (EHR) Incentive program, the Physician Quality Reporting

More information

How to Align Quality Reporting Across PQRS, MU, and VBPM

How to Align Quality Reporting Across PQRS, MU, and VBPM Health Care IT Advisor How to Align Quality Reporting Across PQRS, MU, and VBPM Anantachai (Tony) Panjamapirom Senior Consultant, Health Care IT Advisor Debe Gash CIO, St. Luke s Health System March 10,

More information

Strategic Implications & Conclusion

Strategic Implications & Conclusion Kelly Court Chief Quality Officer Wisconsin Hospital Association Brian Vamstad Government Relations Consultant Gundersen Health System Overview and Key Takeaways of the Medicare Quality Payment Program

More information

Using Updox to Succeed with MIPS

Using Updox to Succeed with MIPS Using Updox to Succeed with MIPS Who is Updox? A Communications Platform built by physicians, for physicians 56,000+ providers and more than 300,000 users--and growing 100+ EMR integrations 72 million

More information

Making Sense of What s Next: Value Based P4P Measurement & MACRA. Mike Weiss, DO September 23, 2016

Making Sense of What s Next: Value Based P4P Measurement & MACRA. Mike Weiss, DO September 23, 2016 Making Sense of What s Next: Value Based P4P Measurement & MACRA Mike Weiss, DO September 23, 2016 Making Sense of What s Next in VBP4P Background Drivers and Imperatives 2016-2021 Measure Set Strategy

More information

A Systematic Approach to Performance Improvement Under MACRA s Quality Performance Program

A Systematic Approach to Performance Improvement Under MACRA s Quality Performance Program A Systematic Approach to Performance Improvement Under MACRA s Quality Performance Program White Paper ELLIS MAC KNIGHT, MD, MBA Senior Vice President/CMO May 2017 CONTACT For further information about

More information

Submitted electronically:

Submitted electronically: Mr. Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-5517-FC P.O. Box 8013 7500 Security Boulevard Baltimore, MD 21244-8013

More information

Quality Measurement and Reporting Kickoff

Quality Measurement and Reporting Kickoff Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER

More information

QUALITY PAYMENT PROGRAM

QUALITY PAYMENT PROGRAM NOTICE OF PROPOSED RULE MAKING Medicare Access and CHIP Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Executive Summary On April 27, 2016, the Department of Health and Human Services issued a Notice

More information

MACRA & Implications for Telemedicine. June 20, 2016

MACRA & Implications for Telemedicine. June 20, 2016 MACRA & Implications for Telemedicine June 20, 2016 Presentation Overview Introductions Deep Dive Into MACRA Implications for Telemedicine Questions Growth in Value-Based Care Over Next Two Years Growth

More information

OUTCOMES IMPROVEMENT AND ROI THROUGH EHR INTEGRATED HEALTH CALCULATORS

OUTCOMES IMPROVEMENT AND ROI THROUGH EHR INTEGRATED HEALTH CALCULATORS QUAL Y OUTCOMES IMPROVEMENT AND ROI THROUGH EHR INTEGRATED HEALTH CALCULATORS galenhealthcare.com 2016. All rights reserved. Background ecalcs are health calculators seamlessly integrated with Allscripts

More information

Thank You to Our Sponsor!

Thank You to Our Sponsor! AMCP Webinar Emerging Physician Payment Models: What Does it Mean for AMCP Members and Medication Management? April 19, 2017 Thank You to Our Sponsor! 1 Disclaimer Organizations may not re use material

More information

The MIPS Survival Guide

The MIPS Survival Guide The MIPS Survival Guide The Definitive Guide for Surviving the Merit-Based Incentive Payment System TABLE OF CONTENTS 1 An Introduction to the Merit-Based Incentive Payment System (MIPS) 2 Survival Tip

More information

ACO Update. LVHN Scholarly Works. Lehigh Valley Health Network. Lehigh Valley Health Network. Spring 2017

ACO Update. LVHN Scholarly Works. Lehigh Valley Health Network. Lehigh Valley Health Network. Spring 2017 Lehigh Valley Health Network LVHN Scholarly Works ACO Update Newsletters Spring 2017 ACO Update Lehigh Valley Health Network Follow this and additional works at: https://scholarlyworks.lvhn.org/acoupdate

More information

Patient-centered medical homes (PCMH): Eligible providers.

Patient-centered medical homes (PCMH): Eligible providers. ACTION: Final DATE: 09/20/2016 8:11 AM 5160-1-71 Patient-centered medical homes (PCMH): Eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary

More information