IN THIS ISSUE
- Upcoming Events
- Small Practice Spotlight – Family Medicine of Malta, NY
- MIPS Information for Small Practices During the COVID-19 Pandemic
- How Your Electronic Health Record (EHR) Can Support Telehealth
- Physician Compare Preview Period is Now Open
- COVID-19 Resources for Specialists
- Monthly Observance – Alzheimers Awareness Month
INFORMATION REGARDING UPCOMING EVENTS:
Upcoming Webinar: Maximizing your Performance in the Promoting Interoperability Category for Solo and Small Group Practices
Additional Upcoming Events and Links to Past Events
- Upcoming and past CMS events related to MACRA, MIPS, and APMs: https://qpp.cms.gov/about/webinars
- Past QPP SURS events: https://qppsurs.com/webinar-resources/
- CMS Podcasts and Transcripts of Coronavirus COVID-19 Stakeholder Calls: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts
Small Practice Spotlight – Family Medicine of Malta, NY
In April 2020, the American Academy of Family Physicians (AAFP) held a webinar with Dr. Marc Price, the head of a small practice in upstate New York called Family Medicine of Malta, to share his experience during the COVID-19 pandemic. Although his practice has only seen a few positive COVID-19 cases, Dr. Price has had to restructure the office’s workflow to keep his staff and patients safe. During this time, sick patients are seen in alternative settings rather than the office, and the practice has increased the use of telehealth. Below are a few of Dr. Price’s strategies for how to maintain a small practice during the pandemic.
1) Hold “tent visits” for sick patients: Dr. Price’s office screens patients over the phone before their appointment to see if they are experiencing any COVID-19 symptoms, such as fevers, or have had any recent travel outside of the country. Asymptomatic patients can continue to be treated in his office or receive care through a telehealth visit. For patients experiencing symptoms, Dr. Price created a free-standing urgent care tent to deliver in-person care to sick patients. Referred to as “tent visits,” Dr. Price instructs patients to pull into the parking lot near the tent, call the office and check in over the telephone, and enter the tent one by one to receive care. Dr. Price noted that many emergency departments and urgent care clinics in his area are not admitting sick patients, making it even more important for him to provide a setting for his sick patients to receive care.
2) Keep administrative staff busy: Dr. Price is determined to avoid staff layoffs and furloughs at his small practice. He has instructed his staff to catch up on billing during this time and find patients who are due for a physical exam and reschedule appointments for a few months from now when it will be safe to come in for an appointment. The office is limiting orders of supplies and use of overtime in order to hold costs down. Dr. Price has also applied for a Paycheck Protection Program (PPP) loan with his local bank.
3) Transition to telehealth: Dr. Price noted that while he and his patients are still adjusting to telehealth, many of his older patients enjoy receiving a call from their doctor and have been pleased to speak with him directly. Dr. Price is aware that many older patients do not prefer telehealth or may not have the video and audio technology to engage in a telehealth visit. In these cases he conducts an audio-only (telephone) visit. Dr. Price is pleased to have a venue to safely care for his patients and hopes to keep holding virtual appointments even after the pandemic.
Dr. Price shared that, although his practice has taken a big financial hit from the pandemic, practices need to constantly change to remain in business. His practice has had to make significant workflow adjustments to become a Patient-Centered Medical Home (PCMH) and participant in the Comprehensive Primary Care Plus (CPC+) program, so his team has become nimble at implementing changes to day-to-day operations when necessary. Change is the only constant, and Dr. Price is willing to go the extra mile to ensure his patients receive the care they need during this uncertain time.
To learn Dr. Price’s story and receive CME credit from AAFP, check out the webinar here.
MIPS Information for Small Practices During the COVID-19 Pandemic
Small practices may find that there is an overwhelming amount of information on COVID-19. It can be difficult to stay up to date on the latest updates while focusing on serving your patients. For information about the impact of COVID-19 on Quality Payment Program (QPP) participation, see the Quality Payment Program COVID-19 Response fact sheet and subscribe to QPP updates by scrolling to the bottom of the QPP website and entering your email address. Additionally, to make sure your practice gets the critical information you need, check out the following resources.
1) Centers for Medicare & Medicaid Services (CMS) Current Emergencies website – For the most up-to-date information, visit the CMS Current Emergencies website. This page includes recently updated telehealth guidance, billing and coding guidance, and Medicare Learning Network videos, as well as links to CMS Open Door Forum stakeholder call podcasts and transcripts. You can view recent CMS press releases on this website to stay abreast of the latest announcements.
2) Technical Assistance (TA) Contractor – TA contractors provide free technical assistance to small practices across the country. To find your TA contractor, click here. TA Contractors are hard at work gathering the latest information on COVID-19 and publishing new telehealth resources, webinars, and podcasts specifically designed for solo providers and small practices. For example:
- Healthcentric published a resource on preparing for telehealth implementation, including tips and workflows for your practice.
- Quality Insights produced a Telehealth 101 flyer, as well as a chart showing telemedicine coverage changes before and after the pandemic (Telemedicine Before and After COVID).
- Qsource is reminding clinicians to check out their state health department websites and state medical society resources, some of which offer free telehealth platforms.
3) Specialty Societies and Professional Associations – Many national organizations are producing COVID-19 resources for their members to keep them abreast of the latest updates for their specialty. For example:
- The American Medical Association is producing resources, including a Telehealth Implementation Playbook and a patient take-home prep sheet.
- The American Academy of Family Physicians (AAFP) is providing resources on financial relief for family physicians, in addition to telehealth and virtual care tools.
- The American Association of Nurse Practitioners produced a webinar, entitled “Telehealth: What Nurse Practitioners Need to Know,” as well as state telehealth policy updates for their members.
Additionally, the QPP Small, Underserved, and Rural Support (QPP SURS) Central Support Team held a national webinar in late May, entitled, “Understanding How to Implement Telehealth Services: Implications for Solo and Small Group Practices.” To access the slides or a recording of this webinar, click here.
Whether you’re a family physician, nurse practitioner, or specialist, you may be able to access relevant COVID-19 updates and information from your national specialty organization.
How Your Electronic Health Record (EHR) Can Support Telehealth
In light of the ongoing COVID-19 pandemic, many small practices are increasing their use of telehealth or exploring how to implement telehealth at their practice for the first time. Some telehealth technology regulations have changed, and new products are being introduced. If you are interested in offering telehealth services at your practice, it may be beneficial to review what functionality is already available through your EHR. Consider the following steps to discover what your EHR has to offer:
- Does your EHR have video conferencing tools? Many EHRs offer secure video conferencing tools for an additional fee. Although the U.S. Department of Health and Human Services (HHS) has relaxed HIPAA regulations for telehealth technology for the duration of the emergency, allowing clinicians to use popular free platforms like FaceTime, Zoom, and Skype for telehealth visits, it may be helpful to think about the long-term advantages of an integrated telehealth platform. For example, EHR video conferencing is more secure and may facilitate documentation and billing after virtual visits.
- Does your EHR offer a patient portal to support provider-patient messaging? If your EHR offers a patient portal, you can utilize it to conduct “E-visits,” one of the approved virtual services reimbursed by Medicare. You can also securely send emails and images with patients through these portals and discuss clinical matters virtually to decrease unnecessary in-person patient visits.
- How do I find a third-party telehealth vendor? If your EHR does not have virtual service functionality, you may consider seeking out a telehealth provider. The Arizona Telemedicine Program and Southwest Telehealth Resource Center maintain a national Telemedicine Service Provider Directory, which you may want to explore. One consideration when choosing a telehealth vendor is the extent to which they are able to integrate with your EHR system. If your EHR and telehealth system have bi-directional integration, you will likely save time on documentation, scheduling, and billing.
Now is a good time to reach out to your vendor to see how they can facilitate your switch to telehealth. Additionally, check out the following resources to make the telehealth transition easier:
- Clinician’s Guide to Video Platforms – National Telehealth Technology Assessment Resource Center
- Telehealth Implementation Playbook – The American Medical Association
- FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency
- COVID-19 Telehealth Toolkit – National Consortium of Telehealth Resource Centers
Physician Compare Preview Period is Now Open
The Physician Compare 60-day Preview Period is officially open as of June 22, 2020 at 10 a.m. ET (7 a.m. PT). You can now preview your 2018 Quality Payment Program performance information before it will appear on Physician Compare profile pages and in the Downloadable Database. You can access the secured Preview through the Quality Payment Program website.
Access the Physician Compare Preview Period User Guide on how to preview your data:
For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov.
To learn more about the 2018 Quality Payment Program performance information that is available for preview as well as the 2017 clinician utilization data that will be added to the Downloadable Database, download these documents from the Physician Compare Initiative page:
- Clinician Performance Information on Physician Compare: Performance Year 2018 Preview Period
- Group Performance Information on Physician Compare: Performance Year 2018 Preview Period
The 60-day Preview Period will close on August 20, 2020 at 8 p.m. ET (5 p.m. PT).
Please note the 2018 performance information is targeted for public reporting in 2020 and will be added to Physician Compare and/or the Downloadable Database after all Targeted Reviews are completed. If you have an open Targeted Review request, you will still be able to preview your 2018 Quality Payment Program performance information through the Physician Compare Preview Period.
COVID-19 Resources for Specialists
While general information about COVID-19 is plentiful, you may find it useful to seek guidance specific to your clinical specialty. Many national professional organizations are compiling resources for a range of specialties. For instance, the Infectious Disease Society of America has a list of COVID-19 resources relating to special populations and settings. However, your best source of specialty information is likely to be your state or national professional association. Below is a sampling of specialty association COVID-19 resource pages that may be helpful to consult:
- Allergy/Immunology: American Academy of Allergy, Asthma & Immunology Resources for A/I Clinicians during the COVID-19 Pandemic.
- Anesthesiology: American Association of Anesthesiologists COVID-19 Information.
- Cardiology: American College of Cardiology COVID-19 Hub.
- Dermatology: American Academy of Dermatology Association Coronavirus Resource Center.
- Endocrinology: Society for Endocrinology COVID-19 resources for managing endocrine conditions.
- Geriatrics: American Geriatrics Society Coronavirus Disease 2019 (COVID-19) Information Hub.
- Nephrology: American Society of Nephrology COVID-19 Information.
- Obstetrics/Gynecology: The American College of Obstetrics and Gynecologists Topics: COVID-19 webpage.
- Oncology: American Society of Clinical Oncology Coronavirus Resources.
- Pediatrics: American Academy of Pediatrics Critical Updates on COVID-19.
- Psychiatry: American Psychiatric Association Coronavirus / COVID-19 Information Hub.
- Radiology: American College of Radiology COVID-19 Resources for Radiologists.
- Urology: American Urological Association Coronavirus Disease 2019 Information Center.
Monthly Observance – Alzheimer’s Awareness Month
June is Alzheimer’s & Brain Awareness Month. According to the Centers for Disease Control and Prevention, Alzheimer’s is the most common type of dementia and as many as 5 million Americans were living with Alzheimer’s in 2014. The disease mostly effects people over the age of 60, and risk increases with age.
In light of the ongoing threat of the COVID-19 pandemic, keeping your patients with Alzheimer’s safe and healthy is more important than ever. Individuals with Alzheimer’s who live in nursing homes may be at increased risk for COVID-19 due to their proximity to others, pre-existing conditions, and potential challenges with social distancing protocols. MIPS includes several quality measures, listed below, that encourage screening for dementia, assessing safety concerns, and educating patients and their caregivers about disease management and behavior changes. You may want to consider including these measures in your MIPS reporting to drive quality care and strengthen your MIPS score:
- Dementia-Associated Behavioral and Psychiatric Symptoms Screening and Management (Quality ID: 283) – Percentage of patients with dementia for whom there was a documented screening for behavioral and psychiatric symptoms, including depression, and for whom, if symptoms screening was positive, there was also documentation of recommendations for management in the last 12 months.
- Dementia: Education and Support of Caregivers for Patients with Dementia (Quality ID: 288) – Percentage of patients with dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND were referred to additional resources for support in the last 12 months.
- Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia (Quality ID: 286) – Percentage of patients with dementia or their caregiver(s) for whom there was a documented safety concerns screening in two domains of risk: 1) dangerousness to self or others and 2) environmental risks; and if safety concerns screening was positive in the last 12 months, there was documentation of mitigation recommendations, including but not limited to referral to other resources.