All Provider Meeting October 27, 2016 1 Agenda Call to order - PowerPoint PPT Presentation

All Provider Meeting October 27, 2016 1

Agenda • Call to order Richard Gough, MD • Medical Director Update Richard Gough, MD • 2017 New Provider(s) Richard Gough, MD • Shared Savings Overview Richard Gough, MD • 2016 Performance Measures of Primary Focus Richard Gough, MD • Customer Service Johnson Koilpillai, MD • MACRA Final Rule Jennifer Teeter • FIHN Payor Contract -Medicare Advantage Jennifer Teeter • Upcoming Events / 2016 Priorities Richard Gough, MD • Next All Provider Meeting / Adjourn Richard Gough, MD 2

Medical Director Update 3

PY2017 New FIHN Provider(s) Sunil Thadani, M.D., M.P .H. Stephen McKenna, M.D., M.B.A., F.A.C.S 4

Shared Savings Overview 5

Shared Savings Potential • Cost Savings • Benchmark (2016) - $11,446 • Goal (@3.5% savings) - $11,045 • CY2016 (Q2) - $10,942 (4.4%) on track • Quality Measures • Must at least be at 30 th percentile on each measure to earn points • Cost savings shared by CMS depends on Quality Score! 6

ACO Quality Scoring 7 7

Quality Measure Score • CAHPS (Patient / Caregiver Experience) Survey – 25% • Claims & Group Practice Reporting PQRS – 75% (25% each) • Preventative Health - (breast, colon, flu, pneumovax, BMI, tobacco, HBP screen/follow-up, depression screen/follow-up) • At-Risk Population – (diabetes composite – A1c/retina, IVD/asa, CHF/B-blocker, CAD (c Diab or CHF)/ACE or ARB, Depression remission) • Care Coordination / Patient safety – (Fall Risk, Med Rec, %MU, All- Cause admits/readmits (incl SNF), PQI’s) 8

2016 Performance Measures of Primary Focus 9

Clinical Measures • Fall Risk (Annual Wellness Visit or Medicare Screening Questionnaire) 40 th percentile • Depression Screening & follow-up plan – < 30 th percentile (PHQ-2 or PHQ-9) • Influenza Immunization - 30 th percentile (“elsewhere shots”, document refusals) • Pneumococcal Vaccination – 40 th percentile (www.mdimmunet.org) • Diabetes Composite Measure (HgbA1C + Retinal Exam) - benchmark not yet released 10

Patient / Caregiver Experience (Customer Service) 11

Customer Service – ACO CAHPS • 8 Measures are included in CAHPS for ACOs survey • Getting timely appointments and information • How well doctors communicate • Patient’s rating of doctor • Access to specialists • Health promotion and education • Shared decision making • Health status / Functional status • Stewardship of patient resources 12

Customer Service – ACO CAHPS • Heath Promotion and Education – < 30 th percentile • Use educational handouts & pamphlets, align awareness months with reminders (e.g. breast cancer awareness month), maintain a list of free community events that promote health and well-being. • Shared Decision Making - 40 th percentile • Patient rights posters, Be aware of patients’ financial situations and cultural differences, Never dismiss a patient concerns, Encourage patient to bring a family member to an appointment where a surgery or procedure will be discussed. 13

Customer Service Reminder Minute • FIHN Top 4 priority areas • Careful listening • Showing Respect • Knowledge of important medical history • Explaining in a way patients understand 14

Simple recommendations based on Press Ganey best practice - How to improve patients perception of Listening carefully • Sit at eye level, lean in, poised to listen and focus • Acknowledge concerns: “Let’s talk more about your concerns”, validate emotions • Allow the patient to finish without interrupting • Ask, “ Do you understand what we are planning” • Ask about their experience in the office, treatment by staff, comfort. Maximize patient loyalty through asking for feedback and making changes. 15

How well providers communicate • Morning staff huddles to review patients for the day – test results needed, specialist consults, resources • Review chart from last visit and history before entering the room – Tell the patient “you mentioned in your last visit that…”, “I see you have had allergies in the past…” • Engage with staff to handoff information to you from preparing the patient that indicates you are listening to each other. “The nurse Mary indicated you have had pain recently” • Ask – “What do you think is causing this?” or “ • 50% of patients do not understand the plan of care - Use 16 visual aids and teach back approach – having the patient repeat back to you the plan of care/medication use. Give written instructions or handouts.

Take-Aways • Scores below the 30 th percentile rank = no points towards shared savings • Our final Shared Savings rate is determined based on performance compared to National Benchmarks As others get better so must we to achieve shared savings! 17

Items for Discussion • Recent Event - Holly Hills Celebration • Shared Savings Check Dissemination • Website Update • FIHN.org (Public Reporting Page) • FIHNACO.org (Network Resources) • Specialist (c Attribution) Priority – refer patients to PCP; MC Screening Questionnaire (cross-cutting measures) 18

MSSP/ACO PCPs taking new Medicare patients Sajjad Aziz, MD Gaffar A Syed, MD, PA 801 Toll House Avenue, Suite C-3 801 Toll House Avenue, Bldg. H-4 Frederick MD 21701, 301-663-1566 Frederick MD 21701, 301-698-9444 Syed Haque, MD X'cel Primary Care (Saied) 700 Montclaire Avenue 15 W. 7th Street Frederick MD 21701, 301-662-6943 Frederick MD 21701, 301-698-5050 Internal Medicine Specialists of Frederick, LLC Union Bridge Family Practice 70 Thomas Johnson Dr, Ste 101 104 North Main Street Frederick MD 21702, 301-668-9393 Union Bridge MD 21791, 410-775-2622 Sibte Kazmi, MD Parkview Medical Group 814 Toll House Ave 194 Thomas Johnson Drive, Suite A Frederick MD 21701, 301-662-8310 Frederick MD 21702, 240-215-6370 Middletown Valley Family Medicine, PA 7211 Bank Court, Suite 230 300 S. Church St. PO Box 20 Frederick MD 21703, 240-215-6370 Middletown MD 21769, 301-371-9000 504 East Ridgeville Blvd. Primary Medical Services, PC (Zaidi) Mt. Airy MD 21771, 240-215-6370 801 Toll House Avenue, Suite E-1 Frederick MD 21701, 301-662-3229 19 3000-D Ventrie Ct. Myersville MD 21773, 240-215-6370

Medicare Access and CHIP Reauthorization Act 2015 (MACRA) – Final Rule Published October 14, 2016 Overview: https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf 20 20

Key MACRA points • Ended the annual Medicare Physician Fee Schedule update that was unsustainable (-21%) • Medicare physician fee schedule increases held to .5% CY 2016- 2025 • New system called “ Quality Payment Program ” QPP • 2 tracks – • Merit Incentive Payment System (MIPS) concept – “earn” adjustments to future Medicare payment, or • Join Advanced Alternative Payment Models (AAPMs) • January 2017 Performance Year Start Date • Final Rule - Providers in an ACO receive the same MIPS score 21 21

Select MACRA Definitions • MACRA: Medicare Access and CHIP Reauthorization Act of 2015 • MIPS – Merit Incentive Payment System • Advanced APM – Alternative Payment Model with Risk Sharing • MIPS APM – Alternative Payment models without risk • Categories of Providers Subject to MIPS: Physicians, Physician Assistants, Nurse Practitioners, CNS, Nurse Anesthetists • Performance Period : January 1 – December 31, 2017 • Payment Impact Period : January 1, 2019 – December 31, 2019 • Deadline for Quality Data Submission: March 31, 2018 • Non-patient Facing Clinicians - bills 100 or fewer patient facing encounters • Hospital based clinicians – 75% services inpatient hospital, on- 22 campus outpatient hospital or emergency room

MIPS Categories of Performance Measurement • Quality – 50% weight 2017, declines to 30% 2019, 60 points • Report minimum of 6 PQRS measures ACO participants receive the ACO Quality Reporting Score • Resource Use – 0% weight 2017, increases to 30% 2019 • Cost per beneficiary; Cost per episode, claim data used, no reporting ACO Participants meet through ACO cost goals • Clinical Practice Improvement – 20% weight, 40 points • 90 Activities to choose from, must report 4 activities ACO participants meet requirements through ACO activities • Advancing Care Information – 30%, 100 possible points 23 • EHR, electronic access and data exchange requirements ACO participants receive weighted average score for ACO providers

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Transition to MIPS - flexibility CMS recognizes challenge for physicians • 2017 “Transition Year” some proposed requirements relaxed AND opportunities to join Advanced APMs expanded • 3 flexible data submission options for 2017 - • Report fully for a 90 day period or the full year – maximizes opportunity for positive adjustment • Report for at least 90 days and submit more than one of each : quality measure, improvement activity and advancing care information measure, avoid negative adjustment and perhaps receive positive adjustment. • Report for at least 90 days and submit one of each : quality measure, improvement activity and advancing care information measure and avoid negative adjustment. 25 • More reporting is expected of large practices > 100 clinicians

Phased in Reporting options 26