QPP SURS Newsletter June 2019

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IN THIS ISSUE

Upcoming Events

Doctor Talking to Patient

INFORMATION REGARDING UPCOMING EVENTS, ALONG WITH REGISTRATION INFORMATION, CAN BE FOUND BELOW:

Please note, there are no LAN Webinars scheduled for July 2019.

August 2019 LAN Webinar:

Additional Upcoming Events and Links to Past Events

Upcoming and past CMS events related to MACRA, MIPS, and APMS will be listed here starting in the new year: https://qpp.cms.gov/.

Past QPP SURS events: https://qppsurs.wordpress.com/resources/

Preliminary Performance Feedback on 2018 MIPS Data Submission Now Available!

If you submitted MIPS data in 2018, you can now access your preliminary performance feedback data on the Quality Payment Program (QPP) website. Keep in mind that this is not your final score or feedback. CMS anticipates that final scores and feedback will be made available in July 2019. Your score could change between now and then based on a number of factors, including:

  • Special status scoring considerations (e.g., hospital-based clinicians)
  • All-Cause Readmission Measure for the Quality performance category
  • Claims measures to include the 60-day run out period
  • CAHPS for MIPS Survey results
  • Advancing Care Information Hardship Application status
  • Improvement Study participation and results
  • Creation of performance period benchmarks for Quality measures that didn’t have a historical benchmark 

You can access your preliminary feedback using the same HCQIS Access Roles and Profile (HARP) credentials that allowed you to submit and view your data during the submission period. For more information on how to set up or access your HARP account, refer to QPP Access User Guide and this video for step-by-step instructions.

If you have questions about your preliminary 2018 MIPS feedback, contact the Quality Payment Program at QPP@cms.hhs.gov or (866) 288-8292. You can also reach out to your Technical Assistance Contractor for free support to discuss your feedback and any quality improvement strategies that you can implement in the current performance year. Find your Technical Assistance Contractor here: https://qpp.cms.gov/about/small-underserved-rural-practices.

Small Practice Spotlight: Manatee Internal Medicine

How do you successfully participate in MIPS in a small practice with limited staff and resources? Practice managers can play a central role, according to Lynda Canelakes, the retired office manager for Manatee Internal Medicine, a small internal medicine practice in Bradenton, Florida. In 2017, Lynda chose to report her practice’s MIPS data via claims so she could personally monitor the process instead of relying on her clinicians to check the correct box in the EHR. Careful coding and other staff engagement techniques resulted in Lynda’s practice scoring an average of 93 across her three MIPS-eligible providers! Do you want to achieve the same success as Lynda? See her tips for MIPS reporting below:

  • Make MIPS reporting easier for your clinicians: Lynda created MIPS forms to help nurses prepare patient charts and flag needed tests for the clinician. This saved the clinician time during the patient visit so they didn’t have to search the patient’s health record for this information. She also created templates in her practice’s EHR to ensure the clinician was populating the correct information into the patient’s record to get full credit for MIPS measures.
  • Provide services during existing patient visits whenever possible: Lynda encouraged her clinicians to complete needed screenings and immunizations during patient wellness visits (or other visits as necessary). Patients can’t always remember if they received certain vaccines, so Lynda would utilize the Florida immunization registry (Florida SHOTS) to check on the patient’s immunization status and see if patients were up-to-date on their needed immunizations. Lynda’s practice provided necessary shots during patient visits instead of making follow-up appointments.
  • Schedule follow-up appointments for patients with chronic illnesses for enhanced support: Patient compliance is a big issue at Lynda’s practice. Patients with hypertension and diabetes do not always follow through with prescribed medications and treatment plans. Lynda decided that instead of verbal reminders, she would schedule follow-up appointments every three months for patients with chronic illnesses so that the doctors could better manage care for this population. Lynda noted she quickly saw these patients’ health improve as a result of better managing their care! For example, diabetic patients had improved hemoglobin A1c screening results after coming in to the office more frequently. Note that your practice can get credit for proactively managing chronic and preventive care for patients by reporting the Chronic Care and Preventative Care Management for Empaneled Patients Improvement Activity (IA_PM_13). For more information, see the 2019 Improvement Activities Inventory.

Remember that if you report your quality measures via Medicare Part B claims, you can get real-time feedback on your performance every month on the QPP Portal using your HARP log-in credentials. For more information on reporting via claims, see the 2019 Claims Data Submission Fact Sheet.

MIPS Best Practice: Daily Huddles to Proactively Improve Patient Care!

Many small practices with exceptional MIPS scores have found that starting their day with a “huddle,” or a quick meeting with clinicians, nurses, and front office and billing staff, can greatly improve the quality of patient care provided, office communication and coordination, and successful MIPS reporting!

Daily huddles are short 10-15 minute meetings at the start of each workday that bring together practice staff and clinicians to prepare for the day ahead. Specifically, the huddles provide an opportunity for the team to proactively manage quality of care, anticipate patient needs, and provide clinicians with information they might need prior to their appointments, such as recent hospitalizations, lab results, or necessary follow-up exams.

Some examples of helpful activities or discussion topics in a huddle meeting could include:

  • Scan the day’s appointments to identify needed treatments and follow up-care. For example, is there a patient who has not had their annual wellness visit yet? Has a patient with a chronic illness received necessary screenings and checkups? This proactive planning helps clinicians provide quality care and ensures they are reporting on their selected MIPS measures.
  • Prepare a snapshot of the patient’s health status for the clinician. Include current medications, previous medical issues, the patient’s immunization status, and flag any needed exams. This enables clinicians to spend more time with their patients instead of searching the patient’s electronic health record for this information.
  • Coordinate staffing and scheduling to ensure that an appointment for a patient with complex needs or chronic conditions does not cause disruptions for later appointments. This helps the practice operate smoothly and ensures that patients receive comprehensive care during their visit.
  • Huddles can also be a good time to address any MIPS measures that the practice needs to improve upon. It may be helpful to introduce a checklist to help clinicians understand what data they need to collect from patients. For a resource on how to lead a daily huddle, check out the American Medical Association’s sample huddle checklist.

Many practices have shared how the relatively small time required for huddles have led to immense improvements in MIPS measure progress, staff communication, and ultimately patient care.  One practice manager, for instance, noted that the huddle sheet is improving patient care by increasing the rate of mammograms and colonoscopies performed at her practice. If you want to implement huddles at your practice, the American Medical Association offers a step-by-step guide for how to organize huddles at https://edhub.ama-assn.org/steps-forward/module/2702506.

April 2019 LAN Notable Q&As

The following questions were asked by the audience during the April 2019 LAN webinar titled “Lessons Learned: How to Succeed in MIPS for Solo and Small Group Practices.” For access to the full Q&A document and previous LAN webinar presentations, see the QPP SURS WordPress website: https://qppsurs.wordpress.com/resources/.

Q: Is using a registry to submit your data good or bad?

A: Submitting your data via a registry is a choice you can make based on your specific situation. One important consideration is whether the measures you want to report on are eligible for reporting via a registry. Not all quality measures are available to be reported through all submission mechanisms. Accordingly, if your preferred measures are available to be reported via registry, but not through other mechanisms, using a registry may be in your best interest.

For both the 2018 and 2019 performance years, MIPS-eligible clinicians, groups, or virtual groups can work with a third-party intermediary, like a Qualified Registry (QR) or a Qualified Clinical Data Registry (QCDR), to submit data for MIPS. A QR is an entity that collects clinical data from an individual MIPS-eligible clinician, group, or virtual group and submits it to CMS on their behalf. Clinicians work directly with their registry to submit data on the selected measures or specialty set of measures. A QCDR is a CMS-approved entity that collects clinical data on behalf of clinicians for data submission. Unlike QRs, QCDRs are not limited to standard measures within the Quality Payment Program, and can offer additional measures relevant to their specialty, which count towards MIPS scores. For a list of registries, please see the 2019 Qualified Registries Qualified Posting and the 2019 Qualified Clinical Data Registries (QCDRs) Qualified Posting.

Please contact your local Technical Assistance Contractor for help deciding if submitting your MIPS data via a registry is the right option for you. Information for your region’s Technical Assistance Contractor can be found at https://qpp.cms.gov/about/small-underserved-rural-practices.

Q. How is checking the PDMP database tracked?

A: The prescription drug monitoring program (PDMP) is an electronic database that tracks prescriptions of controlled substances at the State level. To meet the Promoting Interoperability category measure, “Query of Prescription Drug Monitoring Program (PDMP)”, for at least one Schedule II opioid electronically prescribed using Certified Electronic Health Record Technology (CEHRT) during the performance period, the MIPS eligible clinician must use data from CEHRT to conduct a query of PDMP for prescription drug history, except when prohibited and in accordance with applicable law. Your EHR vendor may be able to incorporate the PDMP into your CEHRT to allow for easier tracking of the database. For more information on this measure, please visit the 2019 Promoting Interoperability Measure Specifications.  

Q. How do you reduce the weight of the Promoting Interoperability (PI) Performance Category if you don’t have an EHR?

A. Clinician or groups may submit a Promoting Interoperability (PI) Hardship Exception Application, citing one of the following reasons for review and approval:

  • MIPS eligible clinician in a small practice
  • MIPS eligible clinician using decertified EHR technology
  • Insufficient Internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of CEHRT

For the 2019 performance year, if your PI hardship exception is approved, then the PI category will be reweighted to 0 and will not be included in calculating your final score. Instead, the 25% PI performance category weighting is reallocated to the Quality performance category, thus making the Quality category worth a total of 70 points. For additional information on PI, please visit the QPP website at https://qpp.cms.gov/mips/promoting-interoperability?py=2019.

Monthly Observance: Men’s Health Month

June is designated as Men’s Health Month and is a good time to check in with your male patients on their physical and mental health. According to the CDC, men are less likely to visit the doctor for annual examinations and preventive services than women. When treating male patients, clinicians can take the opportunity to encourage annual examinations and preventive services. MIPS offers several measures and improvement activities that are relevant to men’s health, including measures of appropriate follow-up care for prostate cancer and heart disease, as well as mental health screenings. By reporting on MIPS measures related to early detection and treatment of disease and injury, you can play your part in celebrating Men’s Health Month. To find applicable MIPS measures that relate to men’s health, check out the Explore Measures tool on the QPP website. For more information on Men’s Health Month, click here.

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