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TRANSCRIPT
PTO Touchbase
Tuesday April 9, 2019 at 9:00 am
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Call Instructions:
Please • Mute your phone, microphone, and speakers on your computer/device• Enter your name/organization in the chat box feature for attendance• We encourage active participation via Chat or audio
• Submit questions via the chat box feature• Questions will be answered as submitted
• Unmute yourself to ask question and participate in discussionsTime to ask questions via audio will be offered for those on the phone
*6 - Toggle mute/un-mute*9 - Toggle raise/lower hand
Agenda
Performance Story Deliverable Requirements - Kristin
APM Next Steps- Matt
APM Summit Questions- Kellyn
BPCI Information and Resources - Kellyn
Timeline through August 2019 - Kristin
TCPi MOC- Kellyn
Reminders/Upcoming Events
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• We know some practices will not meet exemplar status:• In Phase 4, Phase 5, have completed Phase 5, or completed 85% of total PAT score• Demonstrated performance in clinical outcomes, cost and utilization reduction• 2 of 6 Patient and Family Engagement metrics
• Stories for practices that have not met exemplar criteria should include as much “exemplary information” as possible
• What criteria determines what is acceptable for a non-exemplar submission to meet criteria of completed report?• In order to complete the deliverable for a practice that will not meet exemplary criteria:
• performance story narrative: 1-2 pages• include criteria explained in the checklist• Include data for any claims of excellence (citing comparison to benchmarks where they exist)• If any of this information is not available due to the practice, this should be explained• If the practice plans to continue to engage through the end of the program and their story would be
more complete as they continue to improve, stories can be submitted until August 15.
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Document and resources available:http://www.practiceinnovationco.org/tcpi/practice-stories/
Questions and Comments
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http://www.practiceinnovationco.org/tcpi/practice-stories/ has been updated to include examples, guidance, and resources
Evaluations Questions
1. What are commercial and government paying payors doing to accommodate to site of service 11 outpatient procedures?
A: During the meeting a question was asked by a practice about when they go to the ASC since the price would be lower and get the response that they do not want to schedule the procedure because they do not make enough money. The clinician is then having to schedule the procedure at the hospital which is higher prices.
2. I was remote, so not able to ask any at all -- but I don't have any burning questions, except to ask payers if they don't feel a bit motivated to get in gear with the direct to employer options that practices are now able to utilize such as zero card and Remedy-- would payer maybe be willing to offer some VBP options to transformed practices???
A:
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Questions Continued
3. Post TCPi, how can practices calculate estimated cost savings?
A: Post TCPi practices that are Medicare providers will have access to cost data if they participate in the Quality Payment Program. They will still be able to calculate their estimated cost savings if they know the number of services/procedures that do not occur and multiply that by the cost of the service/procedure. The Medicare Physician Fee Schedule is updated annually and available at https://www.cms.gov/apps/physician-fee-schedule/overview.aspx.
The Physician Fee Schedule look-up website is designed to take you through the selection steps prior to the display of the information. The site allows you to:
• Search pricing amounts, various payment policy indicators, RVUs, and GPCIs by a single procedure code, a range and a list of procedure codes.• Search for the national payment amount, a specific Medicare Administrative Contractor (MAC) or a specific MAC locality. Each page has associated Help/Hint available to complete your selections.
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Questions Continued4. I get that is was meant for specialists, but as Fam Med, we wanted and see what was coming and what specialists are involved in this value-based care transformation. WHY wasn’t there more discussion on partnering with the PCP's and discussion surrounding WHOLE PERSON care and developing care compacts and patient satisfaction etc...seemed to only be centered around BPCI and the sales pitches from the consulting firms.
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5. What are the opportunities for alternative payment models for community behavioral health providers? I have approached commercial payers with case rate proposals to no avail.
A: In Colorado, the community mental health system has taken the initiative to formalize a set of core principles and goals for healthcare reform, as well as to boldly venture into collaborative efforts with key stakeholders from other systems. Our Healthcare Reform and Integration section of the CBHC website provides insight into this vision, and presents a rich depth of information demonstrating how the community mental health system is already paving the way for our state to: improve the health of all Coloradans; enhance the patient experience of care (including quality, access, and reliability); and, reduce, or at least control, the per capita cost of care. http://www.cbhc.org/advocacy-resources/integration/
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Questions Continued
6. I only give the summit a 3 because I'm worried the payer panel didn't seem to care what we are doing at TCPI
A:
7. More insight into how clinically integrated networks could work with providers and payers.
A: Article published in OBGYN News Clinically integrated networks: 5 roadblocks and how to overcome them provides more information. https://www.mdedge.com/obgyn/article/142735/business-medicine/clinically-integrated-networks-5-roadblocks-and-how-overcome
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BPCI – Bundled Payment Care Initiative
BPCI-Advanced is defined by following characteristics:
• Voluntary Model
• A single retrospective bundled payment and one risk track, with a 90-day Clinical Episode duration
• 29 Inpatient Clinical Episodes
• 3 Outpatient Clinical Episodes
• Qualifies as an Advanced APM
• Payment is tied to performance on quality measures
• Preliminary Target Prices provided in advance of the first Performance Period of each Model Year
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BPCI Advanced https://innovation.cms.gov/initiatives/bpci-advanced/
• 32 Clinical Episodes• 29 Inpatient Clinical Episodes • 3 Outpatient Clinical Episodes
• Qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program
• 1st Cohort • Started participation in the Model on October 1, 2018• Model Performance Period will run through December 31, 2023
• 2nd Cohort • Application opportunity in the spring of 2019• Start Model Year 3 on January 1, 2020
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Specialty Practitioner Payment Model Opportunities: • The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is
interested in testing new models of care that will focus on specific diseases, patient populations, and specialty practitioners in the outpatient setting to incentivize improved care, better health, and lower costs. Through section 1115A of the Social Security Act, as enacted by section 3021 of the Affordable Care Act, the Innovation Center is authorized to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries.
• Background and details: https://innovation.cms.gov/initiatives/Specialty-Practitioner/
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Timeline through August 2019
PTO Deliverable Timeline 2019- PF
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• Monthly visits to active practices January – August 2019• PAT as due by practice schedule (every six months)
• Telligen performing PATs through mid-July, PATs after July on limited basis• Monthly TIAs: January- August 2019
• Due by the 15th of the following month (Final August TIA due September 15, 2019)• 1 Learning Network note
• Timing up to PTO discretion but note should be submitted by 9/15/2019• March 18 APM Summit filled PF workshop deliverable if at least one PF attendee/PTO• Exemplar Practice Template and Performance Story
• Due no later than August 15, 2019 (including SPLIT attestation)
PTO Deliverable Timeline 2019- CHITA
• Monthly visits to active practices: January – August 2019
• Quarterly CHITA Notes for Q1 and Q2 2019
• Due by 15th of month following quarter (Final Note due July 15, 2019)
• Exemplar Practice Template and Performance Story
• Due no later than August 15, 2019 (including SPLIT attestation)
• CQMs submissions for Q1 and Q2 2019 (including SPLIT task)
• Q1 2019 due April 26, 2019
• Q2 2019 due July 26, 2019
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Reminders
• MOC available for TCPi participation • Complete and submit attestation form by July 1, 2019
• Submitted at least 3 dates for CQMs in 2018 or 2019
• Did not request MOC for TCPi participation in 2018
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Future PTO Events
APRIL
4/16 – CHITA Learning Community; 3-4 pm
4/18 – Learning Features Call; Social Determinants of Health 10-11 am
4/23 – CO QPP Coalition Office Hours; 2019 Eligibility Parameters 12- 1 pm
4/24 – MGMA Practice Webinar; Connect the Dots: Contracts to Revenue Cycle, Moving Into Value-Based Models 12-1 pm
4/24 – SIM PTO Training; Cohort 2 & 3, DISCUSS/REVIEW BB8, BB9, BB10; 9-10 am
4/25-- SPLIT Office Hours 9-10 am
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Resources
• Practice Innovation Program Colorado; http://www.practiceinnovationco.org/
• Events: http://www.practiceinnovationco.org/events/• TCPi Healthcare Communities; http://www.healthcarecommunities.org/• CMS Medicare Quality Payment Program (QPP); https://qpp.cms.gov/• Colorado QPP Coalition; http://www.cms.org/coqpp/• Support and Available Options for Small, Underserved, and Rural Practices;
https://qpp.cms.gov/about/small-underserved-rural-practices• CMMI Bundled Payments for Care Improvement (BPCI) Advanced;
https://innovation.cms.gov/initiatives/bpci-advanced/• Health Care Payment Learning & Action Network (HCPLAN); https://hcp-
lan.org/
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What’s on Your Mind?
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University Practice Innovation Team Contact Information
Practice Transformation – [email protected]
Learning Community - [email protected]
CQMs – [email protected]
e-Learning – [email protected] or [email protected]
TCPi - [email protected]
TCPi Project Manager - [email protected]
TCPI Faculty -- [email protected]
SPLIT/Data Related – [email protected]
Qualtrics/Data Related -- [email protected]
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