Paym yment ent Met Methods ods Presen ented ed by: : Michele - - PDF document

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Paym yment ent Met Methods

• ds

Ad Advan anced ced Alt lterna ernati tive

Presen ented ed by: : Michele ele Madison ison, , Partner tner, , Morris rris, , Mannin ning g & Marti tin, n, LLC

A por

• rtion
• n of these

e materials were produc duced ed in partne nershi hip with the Iow

• wa Departmen

ent of Public Health fo for the Iow

• wa Small Hospital Improvem

emen ent Program (SHIP) P) Grant FY 18Cont ntract #5888SH01 and the Georgia State Office e of Rural Health h fo for the Georgia Small Hospital Improvem emen ent Grant FY 18.

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WEBINAR EXPERIE ERIENCE

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As an IACET Authorized Provider, HomeTown Health, LLC offers CEUs for its programs that qualify under the ANSI/IACET Standard. HomeTown Health, LLC is authorized by IACET to offer 0.1 CEUs for this program. In order to obtain these units, you must:

• Attend webinar/view recording in its entirety within 30 days
• Pass online quiz with 80% or better.
• Complete webinar evaluation.

Following this webinar, all attendees who have viewed the recording in its entirety will receive an email with a link to the quiz and evaluation. Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs.

CONTINUING EDUCATION CONTINUING EDUCATION

HTHU provides over 300 courses online, over 100 Webinars a year, and various live training conference and workshops. Accredited Education from the International Association for Continuing Education & Training (IACET). (Who accepts the IACET CEU? Full list at www.iacet.org)

• American Association of Respiratory Therapy
• American Board of Medical Microbiology
• American Society for Clinical Laboratory Science
• American Society for Quality
• American Speech-Language-Hearing Association
• Board of Certified Safety Professionals
• The Child Care Development Associate National

Credentialing Program

• Clinician’s View (Occupational, Speech, and Physical

Therapy)

• Federal Emergency Management Agency
• Georgia, Massachusetts and Ohio Board of Nursing
• Georgia Professional Standards Commission
• Human Resources Certification Institute (for their

Professional in Human Resource Designation)

• National Association of Rehabilitation Professionals in

the Private Sector

• National Association of Social Workers
• National Board for Certification in Occupational Therapy,
• Inc. (NBCOT)
• National Council for Therapeutic Recreation Certification
• National Registry of Emergency Medical Technology

(EMT)

• National Registry of Microbiologists
• National Society of Professional Engineers
• Society for Human Resources Management
• State of Georgia, FL and Iowa Board of Professional

Engineers

• The American Association of Integrative Medicine
• The American College of Forensic Examiners Institute
• The American Council on Pharmaceutical Education
• The American Psychotherapy Association
• The International College of The Behavioral Sciences
• The National Board for the Accreditation of Occupational

Therapy (NBCOT)

4 Closing ng & Announce unceme ment nts

Stephanie Love Client Data Specialist HomeTown Health

Questions ns

Utilize the GoToWebinar panel to submit your questions and comments throughout the webinar.

EDUCA CATIONA NAL L TRAINI NING NG

Michele Madison Partner Morris, Manning & Martin

Welcome me & Introduc roducti tions

• ns

Stephanie Love Client Data Specialist HomeTown Health

AGENDA

Program Goals

Provider Quality Series

The goal of the Population Health Program is to provide training, resources and support on rural population health across the hospital team, and to promote collaboration through the gathering and sharing of best practices and case studies of successful population health initiatives and innovations in rural hospitals across six primary population health focus areas.

The purpose of the Provider Quality Series is to provide training, education, and resources to facilitate rural hospital and provider collaboration to pool technical expertise in quality improvement strategies and respond to required physician reporting. In addition to the training, each webinar will include Case Studies/Peer Best Practices as well as Toolkits and resources to utilize between sessions.

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Morris, Manning & Martin does not have any proprietary interest in any product, instrument, device, service, or material discussed during this learning event. The education offered by Morris, Manning & Martin in this program is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant in Iowa, Georgia and Florida.

Pro roprietar ary y Disclosure ure

Michele Madison is a partner at Morris, Manning & Martin and serves in the firm’s Healthcare Practice, where she provides general legal advice to health systems in various regulatory and business matters. She also works with information technology companies and advises clients on compliance with regulations and industry standards. Michele has specific experience in negotiating contractual agreements between healthcare providers and service providers, interpreting and advising health systems on regulations applicable to the healthcare industry, and providing regulatory advice with a focus on Stark, Anti-Kickback and HIPAA. She also has key experience and expertise in compliance programs providing advice for compliance with state and federal regulations and regularly draws and negotiates agreements with hospitals, physicians, managed care organizations and ancillary service providers, as well as contractual agreements for vendors with an emphasis on information technology, purchasing and lease

• agreements. Michele also works with electronic medical record

vendors and personal health record providers. She is a graduate of Georgia State University and The University of Georgia School of Law.

Michele ele Madison son

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Paym yment ent Met Methods

• ds

Ad Advance nced d Altern rnativ ative

Presen ented ed by: : Michele ele Madison ison, , Partner tner, , Morris rris, , Mannin ning g & Marti tin, n, LLC Re Recal all

Peer hospital feedback on challenges related to APM model transition

Describe be

Implementation steps for physicians

RECOGNIZE GNIZE

practice improvement changes to transition a physician practice from MIPS to an APM

IDENT NTIFY FY

the three critical components of an Advanced Alternative Payment Model

LEARNIN RNING OUTCOME MES

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Alternative Payment Models

Payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode,

• r a population
• 1. MIPS APM
• 2. Advanced APM

MIPS APMS

• APM entities that participate in the APM under an

agreement with CMS;

• APM entities that include 1 or more MIPS eligible clinicians
• n a Participation List
• APM bases payment incentives on performance (either at

the APM entity or eligible clinician level), on cost/utilization, and quality measures.

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MIPS APMS

The performance category weights used to calculate the MIPS final score under the APM Scoring Standard for the 2019 performance period are as follows: Quality: 50 percent Improvement activities: 20 percent ACI: 30 percent Cost: 0 percent

Advanced APM

An Advanced APM is a track of the Quality Payment Program that offers a 5 percent incentive for achieving threshold levels of payments or patients through Advanced

• APMs. If you achieve these thresholds, you

are excluded from the MIPS reporting requirements and payment adjustment

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Advanced APM Criteria

Advanced APMs are APMs that meet these 3 criteria:

• 1. Requires participants to use certified EHR technology;
• 2. Provides payment for covered professional services based on

quality measures comparable to those used in the MIPS quality performance category; and

• 3. Either: (1) is a Medical Home Model expanded under CMS

Innovation Center authority OR (2) requires participants to bear a significant financial risk.

Qualifying Participant for APM

To become a QP, you must receive at least 50 percent of your Medicare Part B payments or see at least 35 percent of Medicare patients through an Advanced APM entity at one of the determination periods (snapshots). In addition, 75 percent of practices need to be using certified EHR Technology within the Advanced APM entity. Partial tial Qualifi lificatio ation: Receive at least 40 percent of your Medicare Part B payments or see at least 25 percent of Medicare patients through an Advanced APM entity at one of the determination periods.

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2019 Advanced APM

• 1. Bundled Payments for Care Improvement (BPCI) Advanced
• 2. Comprehensive ESRD Care (CEC) – Two-Sided Risk
• 3. Comprehensive Primary Care Plus (CPC+)
• 4. Medicare Accountable Care Organization (ACO) Track 1+ Model
• 5. Next Generation ACO Model
• 6. Medicare Shared Savings Program – Tracks 2 and 3
• 7. Oncology Care Model (OCM) – Two-Sided Risk
• 8. Comprehensive Care for Joint Replacement (CJR) Payment Model

(Track 1-CEHRT)

All Payer Advanced APM

The Advanced APM path provides 2 ways for eligible clinicians to become QPs:

• The Medicare Option, which takes into account the

clinician’s participation solely in Medicare Advanced APMs, and;

• The All-Payer Option, which takes into account the

clinician’s participation in Advanced APMs both with Medicare and other payers.

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All Payer Advanced APM

Beginning in 2019, eligible clinicians who do not meet either threshold under the Medicare Option, but meet a minimum threshold under the Medicare Option, may request a QP determination under the All-Payer Option. Eligible clinicians who are determined to be QPs through either option will receive a 5 percent APM incentive payment in the payment year and will not be subject to the MIPS reporting requirements or payment adjustments.

Other Potential Payers

• Medicaid
• Medicare Health Plans (including Medicare Advantage,

Medicare-Medicaid Plans, 1876 Cost Plans, and Programs

• f All Inclusive Care for the Elderly (PACE) plans)
• Payers with payment arrangements in CMS Multi-Payer 4

Models; and

• Other commercial and private payer arrangements that

meet the criteria to be an Other-Payer Advanced APM.

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Requirements for Other Payer Advanced APM

• 1. The arrangement must require use of certified EHR technology (CEHRT). The
• ther payer payment arrangement requires at least 50 percent of eligible

clinicians in each participating APM entity group to use CEHRT to document and communicate clinical care information.

• 2. The arrangement must base payments for covered professional services on

quality measures that are comparable to the MIPS Quality performance category. There must be evidence-based, reliable, and valid quality measures, with at least

• ne outcome measure if available on the MIPS measure list.
• 3. The arrangement must require participants to bear a certain amount of financial
• risk. A payment arrangement meets the financial risk if actual expenditures

exceed expected aggregate expenditures, or be a Medicaid Medical Home Model that meets criteria comparable to Medical Home Models.

• Implementation of Patient Centered

Protocols

• Beneficiary Engagement
• Evaluation of Patient Diagnosis Codes and

Complexities

• Identify Care Opportunities

Practice Improvement Activities

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Implementation

• Information Technology Infrastructure for Collecting and

sharing data

• Specific Patient Centered Protocols and the Types of

Patients must be evaluated

• Examine the size of the practice and external environment of

providers

Implementation

Determine the Type of APM Evaluate Payer Mix Evaluate Medicare vs. Other Payer APM Opportunities Look at both Revenues and Patient volumes based upon payer

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Implementation

Physician Leadership Physician Sub-Committees Development and Implementation of Patient Centered Protocols Hospital Participation ?? Independent Physician Integration

APMs

Critical Features:

• 1. Costs
• 2. Quality Outcomes
• 3. Treating Providers that can make an Impact
• 4. Valid Data to make a decision
• 5. Physician Leadership

15 Re Recal all

Peer hospital feedback on challenges related to APM model transition

Describe be

Implementation steps for physicians

RECOGNIZE GNIZE

practice improvement changes to transition a physician practice from MIPS to an APM

IDENT NTIFY FY

the three critical components of an Advanced Alternative Payment Model

LEARNIN RNING OUTCOME MES

Upc Upcoming

• ming Ev

Events ents & & Consor Consortium tium Announ Announcemen cements ts

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CONSORTIUM RESOURCES

There are on-demand training and certification programs available in HTHU’s:

• School of Revenue Cycle Management
• PFS/BO Certifications
• School of Coding & Documentation
• School of Clinical & Staff Compliance
• School of Physician Office Education
• School of HIT & Transformation
• Board & Governance Training
• School of Behavioral Health

Questions? Contact Meghan Williams at meghan.williams@ hometownhealthonline.com

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