NCQA updates the NYS PCMH publication annually to clarify guidance and refine criteria expectations. Download the NYS PCMH Standards and Guidelines (2017 Edition, Version 3) to review.
Highlights of the update include:
Summary of Changes to PCMH Standards and Guidelines
Practices may share evidence for these criteria:
KM 02-KM 05
CC 14-CC 16
CM 04-CM 08
Practices may share examples for CM 04-CM 08, although each site must still provide a Record Review Workbook.
Practices must provide site-specific evidence for QI 06.
TC 01, TC 04
Clarified requirements for these criteria.
Removed the reference to health information exchanges (HIE).
Updated guidance to clarify that participating in an ACO or clinically integrated network does not meet this criterion.
Clarified the criterion language to require practices to periodically remind patients of the roles and responsibilities of the medical home.
Clarified criterion language to require practices to give written care plans to patients electronically or as a printed document.
CC 09/BH 05
Removed text: "The practice must provide a report, log or electronic tracking system as evidence of implementation."
Updated evidence from "Report" to "Evidence of implementation."
Evidence updated from "Evidence of follow-up" to "Evidence of implementation."
CC 18-CC 19
Removed the requirement for practices to provide at least three examples of data exchange (CC 18) and obtaining discharge summaries (CC 19).
Clarified the criteria's language and guidance to further differentiate between QI 05 and QI 07.
Clarified the criterion language to state that practices that have met their appointment availability access goals may focus on improvement in another patient-access area.
QI 15-QI 16
Modified criteria language to clarify that practices may report clinician-level data or practice-level data.
Summary of Changes to NYS PCMH Policies and Procedures
Thank you for your ongoing commitment to delivering high-quality, patient-centered care. If you have questions, submit them through My NCQA.
In case you missed it last week, see below for a link to the webcast of the panel discussion on Evaluation & Management Coding:
CMS is hosting a series of webinars on the Merit-based Incentive Payment System (MIPS) Performance Categories for Year 2 (2018) of the Quality Payment Program. The webinars will provide an overview of the Improvement Activities and Quality performance categories for Year 2 (2018). CMS subject matter experts will cover topics including category requirements, scoring details, and data submission mechanisms.
Below are details for the following webinars and how to register:
MIPS Improvement Activities Performance Category for Year 2 (2018) Overview Webinar
MIPS Quality Performance Category for Year 2 (2018) Overview Webinar
CMS Will Answer Questions about Performance Feedback & Targeted Review During Two “Office Hours” Sessions
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are now available for review on the Quality Payment Program website. If you believe that an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00 pm (EDT).
CMS will be hosting two “Office Hours” sessions over the next few weeks to:
We encourage you to email your questions prior to the Office Hours sessions. If you are interested in submitting a question to be considered, please email CMSQualityTeam@ketchum.com. Please note, this email address is only for office hours questions; do not use this to submit a targeted review request.
Office Hours Details
Title: Performance Feedback and Targeted Review Office Hours Session
Date: Tuesday, July 31, 12:00 – 1:00 p.m. ET
Date: Tuesday, August 14, 2:00 – 3:00 p.m. ET
Please note: Space for these sessions is limited. Register now to secure your spot. The audio portion of the sessions will be broadcast through the web. You can listen to the presentation through your computer speakers.
For more information on performance feedback and targeted review, the following resources are available:
Questions? Contact the Quality Payment Program by:
Updates to the 2018 CMS QRDA III Implementation Guide
The Centers for Medicare & Medicaid Services (CMS) has published an updated 2018 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals. This is an update to the 2018 CMS QRDA III IG for Eligible Clinicians and Eligible Professionals originally published on 11/27/2017 and updated previously on 3/12/2018.
This latest update includes:
Additional QRDA-Related Resources:
CMS is hosting a webinar on Tuesday, July 17 at 1:00 PM ET to provide information about the proposed rule for Year 3 (2019) of the Quality Payment Program.
During the webinar, CMS subject matter experts will:
Title: Overview of Proposed Rule for Year 3 (2019) of the Quality Payment Program Webinar
Date: Tuesday, July 17, 2018
Time: 1:00 – 2:30 p.m. ET
Registration Link: https://engage.vevent.com/rt/cms/index.jsp?seid=1142
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is now available for review on the Quality Payment Program website. The payment adjustment you will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.
MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the APM scoring standard may request for CMS to review their performance feedback and final score through a process called targeted review.
When to Request a Targeted Review
If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00pm (EDT). The following are examples of circumstances in which you may wish to request a targeted review:
Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted.
How to Request a Targeted Review
You can access your MIPS final score and performance feedback and request a targeted review by:
When evaluating a targeted review request, we will generally require additional documentation to support the request. If your targeted review request is approved, CMS will update your final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period. Please note that targeted review decisions are final and not eligible for further review.
For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.
If you have questions about your performance feedback or MIPS final score, please contact the Quality Payment Program by:
Thank you for the difference you make in your patients’ lives. Many of our nation’s best and brightest students go into medicine – the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.
Your dedication and commitment have enabled you to join the profession that makes up the core of our healthcare system. But after years of education, training, and hard work, our system is not fully leveraging your expertise. Instead, doctors today spend far too much of their time on burdensome and often mindless administrative tasks.
From reporting on measures that demand that you follow complicated and redundant processes, to documenting lines of text that add no value to a patient’s medical record, to hunting down records and faxes from other physicians and sifting through them, wasteful tasks are draining energy and taking time away from patients. Our system has taken our most brilliant students and put them to work clicking through screens and copying and pasting. We have arrived at the point where today’s physicians are burning out, retiring early, or even second-guessing their decision to go into medicine.
In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout.
Enough is enough. CMS’s focus is on putting patients first, and that means protecting the doctor-patient relationship. We believe that you should be able to focus on delivering care to patients, not sitting in front of at a computer screen.
Washington is to blame for many of the frustrations with the current system, as policies that have been put forth as solutions either have not worked or have moved us in the opposite direction. Electronic Health Records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake. But the inability to exchange records between systems – and the increasing requirements for information that must be documented – has turned this tool into a serious distraction from patient care.
CMS is committed to turning the tide. President Trump has made it clear that he wants all agencies to cut the red tape, and CMS is no exception. Last year, we launched our “Patients Over Paperwork” initiative, under which we have been working to reduce the burden of unnecessary rules and requirements. As part of this effort, we have proposed an overhaul of the Evaluation & Management (E&M) documentation and coding system to dramatically reduce the amount of time you have to spend inputting unnecessary information into your patients’ records. E&M visits make up 40 percent of all charges for Medicare physician payment, so changes to the documentation requirements for these codes would have wide-reaching impact.
The current system of codes includes 5 levels for office visits – level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5. The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing.
We’ve proposed to move from a system with separate documentation requirements for each of the 4 levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients. Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. If you add up the amount of time saved for clinicians across America in one year from our proposal, it would come to more than 500 years of additional time available for patient care.
In addition to streamlining documentation, under the leadership of the White House’s Office of American Innovation, we are advancing the MyHealthEData Initiative which promotes the interoperability of electronic medical records. Patients must have control of their medical information; and physicians need visibility into a patient’s complete medical record. Having all of a patient’s information available to inform clinical decision-making saves time, improves quality, and reduces unnecessary and duplicative tests and procedures. CMS is taking action to make this vision a reality, including recently proposing a redesign of the incentives in the Merit-Based Incentive Payment System or “MIPS” to focus on rewarding the sharing of healthcare data securely with patients and their providers.
We welcome your thoughts on our proposals, and we look forward to partnering with you to make them successful. Patients and their families put their trust in your hands, and you should be able to focus on keeping them healthy. And to secure the future strength of our system, we must make sure that the nation’s best students continue to choose to go into medicine.
We need your input to improve the healthcare system. Once again, thank you for your service to your patients.
MEIPASS Open for 2017 Meaningful Use Attestations
MEIPASS is now open for Payment Year 2017 Modified Stage 2 and Stage 3 Meaningful Use (MU) attestations! For Payment Year 2017 the full attestation can be completed within MEIPASS.
1. Attest in MEIPASS
2. Deadline to attest in MEIPASS for Payment Year 2017 MU is 10/15/018
Visit MEIPASS to begin your MU Attestation.