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Custom Reports Are Essential to Your Revenue, Here’s Why
The decision to use custom reports provides a significant financial return, not only by increasing the positive payment adjustment that you receive for each PFS service, but also by decreasing the man hours needed to continuously audit inaccurate reports. eHealth has written the Promoting Interoperability reports as well as many of the Clinical Quality Measure reports to provide you with accurate performance data based on your workflow. We make sure to adhere to the specification documents and the regulatory guidance in development and implementation of our reports while giving you the ability to follow a natural workflow that fits your practice.
Pricing starts at $1500.00 for the first Promoting Interoperability report and additional PI reports are $1200.00 OR you can purchase the entire PI package for $4800.00 – that’s a $300 savings! Many of our clients that have a server on site are using these reports so they can accurately report to CMS and ultimately receive a higher MIPS payment adjustment. We have MIPS reports, HEDIS reports, and financial productivity reports that pull data from both your EHR and PM systems into consolidated reports. Let us know what you need for your quality programs and we will assist you!
A Testament From One of Our Specialty Practice Clients
"I absolutely think participating in MIPS is worthwhile. Our positive payment adjustment will likely be higher in 2020 based on our 2018 score, especially as the thresholds get higher and fewer practices meet the exceptional performance threshold. I think it’s easy to look at the “pick your pace” solution CMS came up with and feel like it’s not that much money on the line, but long-term, it is. A potential 9% loss in revenue is significant, and that goes on year after year. I know that most small practices, especially family practices, don’t have the resources to devote to this program, but with the potential loss in revenue in future years, I don’t think those smaller practices can afford not to devote some time to it. Their margins are typically really tight as it is and losing 9% of their Medicare revenue isn’t something most small practices can afford to do. It doesn’t have to take a large cash investment to participate; most EMRs have something built in to track the required measures. It also doesn’t have to take a full-time employee to do the work. I certainly don’t spend even half of my time working on MIPS, probably even less than a quarter of my total time, if we look at the whole year. Of course, I have your team helping me with the heavy lifting!"
-From Maria Eddings, Clinical Analyst at Renal Care Consultants
The purpose of the Performance Feedback Report is to provide a summary of your performance in the four MIPS categories which equate to your Final Score and the Payment Adjustment that will be applied. The accuracy of these reports directly impacts your bottom line. It is important to review the report to make sure it is accurate as well as to make projections for scoring this year. This data is used to reflect your image on the Physician Compare Website. A guide for reviewing your Performance Feedback Report is included below.
I cannot say enough about the importance of accurate data. This is the primary reason eHealth started offering custom reports. Here are some comments from customers that use our custom reports:
From Maria Eddings, Clinical Analyst at Renal Care Consultants:
If you are ‘Server On-site’ or hosted by an independent company, please let us know if you would like assistance with your reports. We generate accurate reports for Quality measures and Promoting Interoperability and submit through a registry.
Performance Feedback Report Guide
Several repetitive questions have come up recently, so we have compiled them here for the benefit of everyone.
Q: What do I need to participate in MIPS this year?
A: With Allscripts, you need the 2015 CEHRT package and you need to be onPro EHR version 17.1.x or newer. All other services are optional and here is what they represent, per Allscripts sales descriptions and the presentation provided by Allscripts on 1/17/2019:
MIPS Reporting: This is a subscription $359. per provider that gives access to a dashboard that includes Quality, Cost, Improvement, and Promoting Interoperability. It also includes clinician ranking, data submission tools, and your estimated MIPS score. There may be other services associated with this program that are not listed here. I do know that if you choose to use EHR submission, you are limited to the EHR measures. This is very limiting if you are a specialist. It is very easy to submit using a registry, so I would encourage you to explore this if you are a specialty practice or multi-specialty. The registry we use charges $100./ provider for submission of quality, improvement, and promoting interoperability.
Success Monitoring Program: The Success Monitoring is a program where a Service Analyst is assigned to the client and will review their reports. Depending on which Monitoring Package you select determines the level of review. This is a minimum of a $5000. line item.
*Comparably, eHealth’s QPP Monitoring Program is $3500.
Professional MIPS Services: This package includes consulting services for MIPS.
Q: Electronic Prescribing of Controlled Substances – what is needed for the upcoming vendor change?
A: Allscripts is changing to an easier identity proofing provider late next week. You should receive documentation related to this change in vendors; however, I did want to make sure you know that everyone will need to re-enroll in order for their EPCS privileges to work. Allscripts is projecting an effective date of 3/21/2019 for this change.
Q: What is the deadline for submitting data to CMS for 2018?
A: April 2, 2019 at 8 PM EST
Q: Am I limited to one method of submission for Quality Measures in 2019?
A: No, you can use multiple methods. This is especially important if you are a specialty practice and are interested in participating in measures that cannot be submitted via the EHR. You could use claims, registry, and EHR to cover the quality measures you would like to track for 2019.
Q: Do I have to use the numbers generated by my EHR for the Quality and/or Promoting Interoperability reports?
A: The short answer is No. Here are some things to be mindful of – you do need to use a vendor that adheres to the specifications based on your Submission Type (registry, QCDR, claims registry), you also want to use your CEHRT to document the clinical information related to the measure specification. If this is something you are interested in, please ask for additional information. It takes more than just a few sentences to make sure you have a compliant plan for your numbers. Remember – ACCURACY DIRECTLY EFFECTS YOUR BOTTOM LINE!
To dos prior to 2018 submission
Know your deadline: you can submit up until April 2, 2019, 8 pm EDT
Validate the information on file in the PECOS system:
Make sure that the NPIs affiliated with your Tax ID Number are current.
Verify your financial information to ensure your bank and account numbers are correct. This can hold up your payment.
Think about whether you meet the Data Completeness definition for your 2018 data
Data completeness means that you are reporting on a high percentage of the patients that meet the denominator criteria. This is currently set at 60% for 2018.
If you have lots of charts for which the billing level has not been assigned, typically unsigned encounters, then these patients and their clinical data may not be pulled in the ETL and may not be included in your AAP reports. This impacts your data completeness.
Save all supporting data in a secure location, this could be electronically or on paper.
Quality reports including the initial patient population (IPP), denominator, numerator, exclusion, and exception numbers.
Your performance feedback report for 2017.
Supporting documentation of your Improvement Activities.
Your Security Risk Assessment from the 2018 calendar year.
Reports reflecting your Promoting Interoperability measures, including evidence of Active Engagement with public health registries.
MIPS in 2019
If you are using Allscripts Professional EHR, you will need different things dependent upon the method of submission you choose.
EHR Submission – You need both the 2015 certification package and the MIPS reporting package
Registry Submission – You need only the 2015 certification package
ACO Submission – You need only the 2015 certification package
QRDA upload to CMS website – You need both the 2015 certification package and the MIPS reporting package
Here is the difference based on what we have learned from Allscripts:
The 2015 CEHRT package provides all needed elements to attest that you are using a 2015 CEHRT EHR. It also gives you access to your Quality and PI reports through AAP. If you are part of the Quality Payment Monitoring program and submitting through the registry, this is all you need.
The 2015 MIPS package provides the 2015 CEHRT package in addition to the ability to view your dashboard, create QRDA files, and have access to Allscripts services and submission on your behalf.
Security profiles must be set up for the following functions to work:
Prescription Price Transparency: All providers must set up their security profile in order to activate the use of prescription prices. Clinical staff assigned as prescriber agents will automatically have access to prescription prices due to providers’ enrollment and have no need to create individual
Images Clinical Application: All users (clinical/providers) that will need to take images using the Images application (on tablets only) will need to set up security profile.
Info Button Patient Education: All users (clinical/providers) that need to access patient education in Assessment & Plan need to set up a security profile.
Security profiles need to be set up by each individual user and require an email address. Please follow the instructions below:
Security Profile Set Up Instructions
1. In the Clinical Module, click on ‘Menu’
2. Enter your email address
3. Click on ‘Yes’ to create a new security account
4. Enter your existing Clinical Module password
5. Create a new password for your security account (it cannot be the same as your Clinical Module password)
6. Click OK
Validate the eligibility for NPIs associated with your practice
Remember to note any other TINs that NPI is associated with
If you are part of an ACO, check for QP designation
Review the Physician Compare Report that will be posted early in 2019
If anything is incorrect, you need to report it as soon as possible to prevent it being posted publicly
Prepare for Submission
Know your numbers
Pull your data together at the individual and/or group level
At the end of the year, make sure you save copies of supporting data for the final numbers you approve for submission to CMS
Your performance for the cost measures are listed on the Performance Feedback Report
Know your numbers and how they impact your final score
There isn’t any supporting documentation to save in this category
AAPM participants are already meeting this category and nothing additional is required
Identify which Improvement Activities one or more providers actively participated in during 2018
Save the list of activities as well as any report documentation that tracks your participation and progress related to each activity.
AAPM, ACO, and PCMH participants are already meeting this category and nothing additional is required.
Pull your data together at the individual and/or group level
You must complete the Security Risk Assessment update in the 2018 calendar year. Let us know if you need help ASAP!
You must perform at least one event in each of the base measures to get any points in this category. Base participation completion = 50 points plus any additional points you receive from performance and bonus points.
At the end of the year, make sure you save copies of supporting report data for the final numbers you approve for submission to CMS.
Choose a Submission Method
You may already be signed up with your vendor to submit your data. This needs to happen prior to the deadline of March 31, 2019. Make sure you have a meeting to approve the data being submitted on your behalf!
If you are submitting via an approved Registry or QRDA, you should already have a contract in place and know what to expect. If you don’t, you will want to act on that pretty quickly.
You are still able to get the end-to-end submission bonus with some registries.
Registries give you access to MANY measure choices that you don’t have with other submission methods.
CMS Web Interface
If you have not already registered for this method of submission, it is not available to you for 2018.
Register by June 30, 2019 if you have 25 providers or more and are interested in this method for 2018.
Meet the deadline - MARCH 31, 2019
If you need help, we are here for you.
It is time to update the diagnosis codes in the Practice Management System. This is a task you must do every year if you are an on-premise client. New codes are effective as of 10/1/2018.
Access the instructions on Client Connect https://allscripts.fluidtopics.net/viewer/document/NIkud2nsyQLtJUuRyIQ~AQ
Go to Downloads to get the actual files you need per the instructions above.
Complete your MIPS targeted review if needed. – 10/15/2018.
Make sure you have an upgrade plan to be on a 2015 certified EHR technology application prior to January 1, 2019. 17.3 is acceptable, 18.2 is available and has some cool features as well.
Hopefully, you have already reviewed and potentially downloaded your Performance Feedback Report from the Quality Payment Program website. I would like to encourage you to log in again and review updates made to scores and most importantly payment adjustments on September 13, 2018.
Many practices have submitted Targeted Reviews to CMS and because of identified issues and resulting corrections, the Performance Feedback Reports of all practices impacted have been updated, not just those who submitted the Targeted Review.
If you have not filed a Targeted Review, please log in to the Quality Payment Program website and review your Performance Feedback Report again.
Validate that the facility associated with the TIN is correct. If not, you can correct this in the Targeted Review submission.
If you reported as an individual, validate that the TIN/NPI combination is correct. If not, you can update this in the PECOS system, but I would still encourage you to submit a Targeted Review so that any adjustments can be made on the QPP side as well.
Validate that the score in each section matches the score you originally submitted for each section, and that your overall score is correct. If there is any issue, submit a Targeted Review.
If you find any discrepancies or numbers that look concerning, submit a Targeted Review.
Due to the number of identified issues, CMS is extending the timeframe for submission until October 15, 2018 – 8:00 pm EST. The sooner you get your targeted review request submitted, the more likely it will be completed and thus your payment adjustment calculated and applied accurately for the 2019 payment year.
Final Scores for 2017 have been released!
Sign in at https://qpp.cms.gov/login with your EIDM credentials to retrieve your final score!
If your score isn’t quite what you wanted it to be, don’t hesitate to contact us to discuss what we can do to help you.
Perhaps your quality measure percentages were lower than they should have been. Our custom reports would be a great option. They allow providers to continue their normal documentation patterns while still capturing that data and aggregating it according to the latest specifications.
Maybe your overall score is still below 70. Our QPP Monitoring Program is still available if you need some additional assistance with understanding or workflow. **100% of our practices were above 70 when they reported last year, a few were even at 100**.
Practices depending on their EHR vendor or other third parties for submission can run into problems if the vendor is unable to submit in a timely manner. This could be for any myriad of reasons. I just wanted to make sure you know you are not stuck. You may have started the year thinking you would submit through your EHR, for example, but it isn’t too late to change your mind! Remember, MARCH 31, 2018 IS THE DEADLINE.
Quality Measures: You can still submit your quality measures through a registry. What do you need to do next?
Gather the following data for the reports you are using:
IPP – Initial Patient Population
Find a registry to use. The one we used is $100./provider for group reporting if you have a relationship with us. But, there are others, the list is here: 2017 Qualified Registries . Some specialty organizations provide submission at no cost. **You may still be able to get the End to End reporting bonus even if you use a registry.
Improvement Activities and ACI: The registry we used allowed for submission of all 3 categories in the same file. However, you can also attest through the QPP website. What do you need to do next?
Know your EIDM log in information
Go to the QPP website and sign in
Complete the required fields
Submit your data
**Some of the information on the QPP website is old such as the providers linked to your account. If this is correct in the PECOS system, you are good to go.
**Some of the information is wrong, such as giving double points to small practices for improvement activities. CMS will fix this as they pull the data to begin incentive payments in 2019.
Need help or additional information? Contact us so we can help you.
1. Log into EIDM website. Directions below from CMS:
Make sure that the NPIs affiliated with your Tax ID Number are current
Pull your 2016 Annual QRUR reports (Needed for 2018 cost performance category)
Verify your financial information to make sure your bank and account numbers are correct. This can hold up your payment.
2. Think about whether you meet the Data Completeness definition for your 2017 data
Data completeness means that you are reporting on a high percentage of the patients that meet the denominator criteria. This is currently set at 50% for 2017.
If you have lots of charts that the billing level has not been assigned, typically unsigned encounters, then these patient/charts are not being pulled by the ETL and are therefore not being reported on. This impacts your data completeness.
Making sure you prepare for an audit BEFORE the audit…
This strategy makes audits as stress free as an audit can be. So, while you are preparing your MIPS data for submission, make sure you have copies of the following:
The Certification ID for the CEHRT version(s) you used during the performance period. This could be a 2014 and/or a 2015 certified version.
Using the website, https://chpl.healthit.gov/#/search
Search for Allscripts Professional
Click the Cert ID+ to add all EHR versions used during the performance period to your cart
How can you tell which versions you were on during the reporting period?
Go to back office reports
Create and run the Allscripts Product Install report for the same performance period
Click the Get Certification ID button to generate the ID. Print a copy for your records.
Whether you are MIPS, an APM or an AAPM, you will need the actual report data validating the Denominator, Denominator Exception, Denominator Exclusion, and Numerator for each individual NPI (if you are submitting for your individual providers) or for the group (if you are submitting as a group). I have not ever had to submit the actual patient details, but technically, they could ask for them.
Since your reports are run electronically, you are not excluding patients from those reports and are therefore reporting on 100% of your patients. This is your data completeness number. Consider a notarized statement or attestation letter that includes your level of data completeness.
Evidence that your practice has implemented one or more improvement activities.
This evidence might be written meeting minutes from reviewing patient satisfaction surveys, reports from back office reports to prove same day access to care, or other improvement activities that are customarily tracked by Patient Centered Medical Home.
Advancing Care Information (MIPS only)
A copy of each report to validate the data you are submitting to CMS.
A summary of your security risk assessment and date of review.
Proof of active engagement with the Immunization Registry if you have a live interface.
Proof of active engagement with a Specialized Registry Reporting if you have a live interface.
Proof of active engagement with a Syndromic Surveillance Reporting if you have a live interface.
Active Engagement is the process of moving towards sending “production data”. There are 3 options: 1) Registration complete and waiting to submit, 2) Testing and Validation, and 3) Production.
We will offer classes in January to discuss submission and documentation in more detail and to answer any additional questions you might have.
The Quality Performance Category of the Merit-based Incentive Payment Program counts for 60% of your final score. You accumulate points for each measure based on your performance compared to the benchmark of others that submitted via the same method last year in PQRS. Let’s look at some examples:
Controlling High Blood Pressure – QID 236 (EHR Submission)
If my performance score is 59%, I would only get 4 points instead of 5.
Preventive Care and Screening: BMI and Follow-Up – QID 128 (EHR Submission)
If I have been following up all year, but couldn’t get patients to count in the numerator because I was not following a prescribed workflow, my numbers are not accurate and I am losing points. Perhaps my reported percentage is 0, when I know it should be at least 50%. That is a difference of 6 points. It is possible to report accurate numbers even if you didn’t use the correct workflow.
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan – QID 134 (EHR Submission)
Did you copy the depression screening tool and impact the number of patients in your denominator? Again, it isn’t too late to get accurate numbers to report to CMS.
The accuracy of the data you submit directly impacts the number of points you receive which directly impacts the positive reimbursement you could be eligible for in 2019.
It isn’t too late in the year to get accurate data or to get a final score above 70, putting you in the exceptional performer tier of eligible clinicians that will share in the 500 million allocated for disbursement in 2019.
Do you have confidence in your numbers?
Do you know what your final score is?
We can help you with both of these if needed!
Many of you may have attended the Medicare MACRA/MIPS Year 2 Proposed Rule Overview this week. I just wanted to highlight a few of the major points:
Low Volume Threshold: Increase to >= $90,000 in Medicare claims or >= 200 Medicare patients
- Additional Bonuses
- Small Practice Bonus <= 15 providers (5 points)
- Health Care Shortage Area Bonus (5 points)
- Potential adjustment for patient complexity (1 – 3 points)
- Scoring Improvement Bonus (up to 10 points)
- Virtual Groups – Allow small practices with 10 or less clinicians and different TINs to come together in a group for reporting purposes. This must be declared before the beginning of the performance period, so prior to December 1st, 2017 for a virtual group in 2018.
- Performance Categories
- Quality – Remains at a 60% portion of the final score with a 12 month reporting period
- Cost – Proposed to be 0% again
- Improvement Activities
- 15% towards final score,
- can choose a 90-day period,
- more activities will be added to the list of those eligible for the 10 ACI bonus points
- Advancing Care Information
- 25% towards final score,
- allow 2014 or 2015 CEHRT again for 2018; however, bonus points for providers that use 2015 CEHRT,
- can choose a 90 day reporting period
- additional bonus points for registry reporting (10 instead of just 5)
- Quality – Remains at a 60% portion of the final score with a 12 month reporting period
These are just some important tidbits. MACRA/MIPS money is so accessible this year, do not miss your opportunity!
Additional Resource: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Proposed-rule-fact-sheet.pdf
Professional Content Update (PCU) 17.4 was recently announced Generally Available (GA) by Allscripts. It includes the updated Advanced Beneficiary Notice (ABN) form approved by CMS in March 2017. This revised form explains beneficiary rights regarding non-discrimination and how they can request an ABN in an alternate format. The effective date for using this new form is 6/21/2017.
In addition to the ABN, the following enhancements are also included, along with a few fixes for reported issues.
- New CHADIS questionnaires:
- Vanderbilt Initial Parent Informant (with Medication Supplements)
- Vanderbilt Follow-Up Parent Informant
- Vanderbilt Follow-Up Parent Informant (with Medication Supplements)
- Screen for Child Anxiety Related Disorders (SCARED) Parent Version (To be filled out by the PARENT)
- Screen for Child Anxiety Related Disorders (SCARED) Child Version (To be filled out by the CHILD)
- Brenner 'Families in Training'
- Mood Disorder Questionnaire, and
- Report criteria:
- Lab Result, Most Recent, Date Range (Lab Catalog)
- Lab Result, Most Recent, Date Range (LOINC)
- Lab Result, Most Recent, Days (Lab Catalog)
- Lab Result, Most Recent, Days (LOINC)
Resource: Allscripts Professional EHR Professional Content Update (PCU) 17.4 Client Release Notes
You can receive bonus points based on how you submit data to CMS in both the Quality and ACI categories. These points will increase your final score and assist you in attaining the highest reimbursement possible in 2019.
The Quality category allows for bonus points for end to end electronic reporting as defined below:
“The end-to-end electronic reporting bonus point is not specific to certain CQMs, but would apply in any case where the submission pathway maintains fully electronic management and movement of patient demographic and clinical data once it is initially captured in the eligible clinician’s certified health IT. Where a registry is calculating and submitting the Quality Payment Program-accepted measures on the MIPS eligible clinician’s behalf, this means that: (1) the MIPS eligible clinician uses certified health IT to capture and electronically provide to the registry clinical data for the measures, using appropriate electronic means (for example, through secure access via API or by electronic submission of QRDA documents); and (2) the registry uses verifiable software to process the data, calculate, and report measure results to CMS (in CMS-specified electronic submission format). In order to qualify for a bonus point, submission via a QCDR or the CMS Web Interface would need to adhere to these principles. Any submission pathway that involves manual abstraction and re-entry of data elements that are captured and managed using certified health IT is not end-to-end electronic quality reporting and is not consistent with the goal of the bonus.”
If you are utilizing a third party registry, verify that CMS has approved their process for meeting the direct end to end submission criteria. In the Quality category, bonus points can equal up to 10% of your total possible quality score.
In the Advancing Care Information or Advancing Care Information, Transitional category, you can receive up to 15% bonus points.
5% bonus points are allocated for practices that submit to a specialized or syndromic surveillance registry. This could be the CDC, an HIE that you participate with and receive feedback reports from, or submission of your quality data electronically.
10% bonus points are allocated for practices that utilize their certified EHR technology (CEHRT) to participate in Improvement Activities (regardless of submission method) selected from the 18 approved bonus measures. These measures are:
For more information, access the fact sheet on the QPP website.
Greetings from eHealth Consulting!
Meaningful Use is officially over and we are almost 3 months into MIPS! I hope you have an idea of how your practice is doing. Practices we are monitoring have a projected final score between 50 and 70 points. These practices are now able to strategically focus on specific workflow implementation so they are eligible for their portion of the 500 million dollars of additional reimbursement! Do you know what your projected final score is? If not, consider our Quality Payment Program monitoring.
Speaking of Quality – It is so important that your quality data is accurate now that you are getting paid based on performance. Are you confident that your numbers are correct? I know it is hard sometimes to get everyone to conform to the prescribed workflow, especially if it is really outside the norm of documentation patterns. To help you improve the accuracy of capturing your work, we are now offering custom SQL report packages for clients that are able to provide access to their database server
6 reports @ $1000 per report - $6000
8 reports @ $900 per report - $7200
10 reports @ $850 per report - $8500
This package includes meeting with you prior to writing the reports in order to understand your workflow for each measure, report validation, and training on how to run the reports and view the data. In other words, it will still be a prescribed workflow, but you will be writing the prescription. This meeting also results in a workflow document for staff - an added bonus!
Are you interested in Practice Management training? We can offer classes for Allscripts PM now and need to know what topics you would like us to provide. Please email us with topics for PM or EHR. Don’t forget to check out this month’s calendar. There are a lot of great classes to attend!
Quality Payment Program
Thursday, March 16th
1:00 - 2:30 PM EST
Quality Payment Program
Wednesday, March 29th
1:30 - 3:00 PM EST
Have a great week,
Trisha Conway |Principal Consultant
919.696.0371 | C
I have been reading several posts on Client Connect and it seems there are some very mixed up messages floating around the Professional EHR community. I thought I would share a recent post with all of you since I am not sure how many of you are avid Client Connect users.
Here are some key points for the Merit-based Incentive Program/Quality Payment Program:
- CEHRT - In 2017, 2014 CEHRT (ideally you would be using Pro EHR version 15.x or higher) can be used. In 2018, 2015 CEHRT must be used (v17).
- Performance period - 90 days up to the full calendar year, the longer the better for positive payment adjustments
- Advancing Care Information (ACI) Performance Category - there is a path for Modified Stage 2 and a path for Stage 3 meaningful use requirements. The maximum number of points is the same regardless of which you choose. Electronic patient education is a Stage 3 measure.
- You can self-monitor your performance or have another vendor/consulting firm do this for you. You do have choices!
- A submission vendor will be necessary for the Quality Measures, other performance categories can be submitted via attestation. You will need the Allscripts 2015 package for Pro EHR or Touch Works.
Most importantly, don't panic. It is highly likely that you are already well on your way to preventing a negative payment adjustment in 2019. In fact, you may already be in the positive adjustment pool without changing any workflows. Why don't you find out where you are? You can evaluate yourself against the performance category or we could do it for you either as a one-time evaluation or as part of our Quality Payment Program Monitoring.
PCMH 2017 Program new Redesign - What You Need to Know
On March 31, 2017, NCQA will launch the Redesigned PCMH 2017 Program. PCMH 2017 is slated to simplify the documentation and reporting requirements and includes ongoing support from a designated NCQA representative. The new program offers a single recognition level with annual check-ins with your NCQA representative to evaluate and build on progress to meet the new NCQA PCMH 2017 objectives. All practices will eventually move from the traditional three-year recognition as a level 1, 2 or 3 PCMH.
The PCMH 2017 program will align with MACRA’s Quality Payment Program. As health care shifts to a value-based payment system, practices which are PCMH or PSRP recognized will have some advantages. Under the MACRA legislation there are two new payment tracks for practices:
Merit-Based Incentive Payment System (MIPS): The MIPS track includes a category called Clinical Practice Improvement Activities (CPIA) that is worth up to 40 points and contributes 15% of each provider’s MIPS final score. Providers in practices that earn NCQA PCMH recognition (either 2014 or 2017) would automatically get full credit for the CPIA category.
Alternative Payment Models (APM): Criteria for participating in eligible advanced APM programs, such as Comprehensive Primary Care Plus (CPC+) or certain Medicare ACOs (such as Next Gen), include being a PCMH.
PCMH 2017 Redesigned Recognition Process
The redesigned program will retain the principles of the PCMH model of care. The redesigned program’s recognition process will have three parts:
Commit: During this step the practice will complete a self-assessment and work with their designated representative to develop a plan.
Transform: During this time, practices show their progress by submitting documentation and data to NCQA through a new system designed to reduce paperwork and administrative hassles. Along the way, NCQA conducts virtual reviews—online check-ins—with the practice to gauge progress and to discuss next steps in the evaluation.
Succeed: Once the practice has earned recognition, it will continue to implement and enhance their PCMH model. There will be an annual check-in with their designated representative to attest to certain policies and procedures and submit their quality data.
Where to start
It is very important to begin your PCMH Renewal 9-12 months before the expiration of your current PCMH recognition. New Applicants should start 12 or more months before they intend to submit as this will allow time to educate your staff, implement new workflows and create or update required policies/procedures.
Practices looking to move to the PCMH 2017 program from the PCMH 2011 or PCMH 2014 program have a couple of options. Practices that want to stay with or become certified under the 2014 recognition levels should keep in mind that March 31, 2017 is the deadline to purchase PCMH 2014 survey licenses with a submission deadline of September 30, 2017.
Practices Currently Recognized Under PCMH 2011
· Renew under the 2017 redesigned process
· Convert to PCMH 2014
o Conversion is an option for practices with significant time left on their recognition (at least 12 months when the conversion Survey Tool is submitted) and requires submission for 6 Elements instead of 27.
· Renew under PCMH 2014 standards
o Renew is for practices with an expiring recognition who are renewing for another three-year recognition period.
For more information click here
Practices Currently Recognized Under PCMH 2014 Standards:
· If you are a Level 3 2014 recognized practice, NCQA is offering a direct entrance into the “Sustain” process of the PCMH 2017 program when your recognition expires.
· If you are a Level 1 or 2 2014 recognized practice you have three options:
· Complete an Add-On Survey to earn PCMH 2014 Level 3 Recognition
· “Transform” through the redesigned program.
· Renew under PCMH 2014 for the established three-year period
For more information click here