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

Ad Advan anced ced Alt lterna ernati tive Paym yment ent Met Methods ods Presen ented ed by: : Michele ele Madison ison, , Partner tner, , Morris rris, , Mannin ning g & Marti tin, n, LLC A por ortion on of these e materials were produc duced ed in partne nershi hip with the Iow owa Departmen ent of Public Health fo for the Iow owa 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. •All attendees are in “Listen Only” mode • Questions or comments? - Open “Questions” pane in dashboard. - Type in comments or questions - Comments will be monitored - Questions will be addressed at end of the webinar WEBINA NAR R EXPER ERIE IENC NCE 1

• This webinar will be recorded and posted on your program dashboard following the webinar. • Handouts are available for download in the handouts pane and will also be posted on your program dashboard after the webinar. WEBINAR EXPERIE ERIENCE ACTION ITEM: GROUP PARTICIPATION Are you on this webinar with a group? If so, please enter: first/last names & email addresses in the question pane. 2

CONTINUING EDUCATION 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 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 • National Board for Certification in Occupational Therapy, • American Board of Medical Microbiology Inc. (NBCOT) • American Society for Clinical Laboratory Science • National Council for Therapeutic Recreation Certification • • American Society for Quality National Registry of Emergency Medical Technology • American Speech-Language-Hearing Association (EMT) • Board of Certified Safety Professionals • National Registry of Microbiologists • The Child Care Development Associate National • National Society of Professional Engineers Credentialing Program • Society for Human Resources Management • Clinician’s View (Occupational, Speech, and Physical • State of Georgia, FL and Iowa Board of Professional Therapy) Engineers • Federal Emergency Management Agency • The American Association of Integrative Medicine • Georgia, Massachusetts and Ohio Board of Nursing • The American College of Forensic Examiners Institute • Georgia Professional Standards Commission • The American Council on Pharmaceutical Education • • Human Resources Certification Institute (for their The American Psychotherapy Association Professional in Human Resource Designation) • The International College of The Behavioral Sciences • National Association of Rehabilitation Professionals in • The National Board for the Accreditation of Occupational the Private Sector Therapy (NBCOT) • National Association of Social Workers 3

Welcome me & EDUCA CATIONA NAL L Introduc roducti tions ons TRAINI NING NG Stephanie Love Michele Madison Client Data Specialist Partner HomeTown Health Morris, Manning & Martin Questions ns Closing ng & Utilize the GoToWebinar panel Announce unceme ment nts to submit your questions and Stephanie Love comments throughout the Client Data Specialist webinar. HomeTown Health AGENDA Provider Quality Series Program Goals 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. 4

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, Pro roprietar ary y Manning & Martin in this program Disclosure ure is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant in Iowa, Georgia and Florida. Michele ele Madison son 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. 5

Ad Advance nced d Altern rnativ ative Paym yment ent Met Methods ods Presen ented ed by: : Michele ele Madison ison, , Partner tner, , Morris rris, , Mannin ning g & Marti tin, n, LLC IDENT NTIFY FY RECOGNIZE GNIZE Describe be Recal Re all the three critical practice Implementation Peer hospital components of an improvement steps for feedback on Advanced changes to physicians challenges related Alternative transition a to APM model Payment Model physician practice transition from MIPS to an APM LEARNIN RNING OUTCOME MES 6

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, or 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 on a Participation List • APM bases payment incentives on performance (either at the APM entity or eligible clinician level), on cost/utilization, and quality measures. 7

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 8

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. 9