Chronic Care Management
Physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists in groups of all sizes and those who are solo practitioners are subject to the Medicare Value Modifier in 2018, based on performance in 2016. These groups can register to participate in the 2016 Physician Quality Reporting System (PQRS) Group Reporting Option (GPRO) via the Physician Value - Physician Quality Reporting System (PV-PQRS) Registration System.
Avoiding the 2018 PQRS payment adjustment by satisfactorily reporting via a PQRS GPRO is one of the ways groups can avoid the automatic downward payment adjustment (-2.0% or -4.0% depending on the size and composition of the group) and qualify for adjustments based on performance under the Value Modifier in 2018.
More information is available on the PQRS Payment Adjustment Information web page.
Groups can participate in the PQRS program for the 2016 performance period by selecting one of the GPRO reporting mechanisms between April 1, 2016 and June 30, 2016 (11:59 pm EDT):
- Qualified PQRS Registry.
- Electronic Health Record (EHR) via Direct EHR using certified EHR technology (CEHRT) or CEHRT via Data Submission Vendor.
- Web Interface (for groups with 25 or more Eligible Providers [EPs] only).
- Qualified Clinical Data Registry (QCDR)
- Consumer Assessment of Health Providers and Systems (CAHPS) for PQRS Survey via a CMS-certified Survey Vendor (as a supplement to another GPRO reporting mechanism). See CAHPS for PQRS Made Simple for complete details.
Groups with 2 or more EPs that choose not to report via the PQRS GPRO in 2016 must ensure that the EPs in the group participate in the PQRS as individuals in 2016 and at least 50 percent of the EPs meet the criteria to avoid the 2018 PQRS payment adjustment in order for the group to avoid the automatic downward payment adjustment and qualify for adjustments based on performance under the Value Modifier in 2018.
The Registration System can be accessed using a valid Enterprise Identify Management (EIDM) account. Instructions for obtaining an EIDM account with the correct role are provided on the PQRS GPRO Registration web page. Instructions for registering to participate in the 2016 PQRS GPRO are provided in the 2016 PQRS GPRO Registration Guide.
The CMS Transforming Clinical Practice Initiative (TCPI) is designed to support clinician practices through nationwide, collaborative, and peer-based learning networks that facilitate large-scale practice transformation. The initiative is designed to support clinician practices over the next four years with support from Practice Transformation Networks (PTNS) and Support and Alignment Networks (SANS).
The Practice Transformation Networks are peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice transformation in their own practice. PTNS will provide technical assistance and peer-level support to assist clinicians in delivering care in a patient-centric and efficient manner making them eligible for higher reimbursement in the growing alternative payment model market.
The Support and Alignment Networks, comprised of national and regional professional associations, including ACP, will utilize existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development). These will especially support the recruitment of clinician practices serving small, rural and medically underserved. Watch for more information from our Chapter as all of the new alternative payment models develop across New York State.
To help navigate the TCPI and PTNs, CMS is holding Transforming Clinical Practice Initiative Innovation Day on Tuesday, May 24.
To register and listen to the live proceedings on YouTube please click below (which will be held in Baltimore, MD)
- Morning: http://www.youtube.com/watch?v=urOOYMZVJb8
- Afternoon: http://www.youtube.com/watch?v=Nqli93MCQnI
As of April 27, 2016, 101 positive cases of Zika Virus have been identified in New York State, 62 of which are residents of New York City. These are the result of contraction during travel to affected regions or sexual contact, and there have been no confirmed cases of local transmission of Zika virus, either in New York or the rest of the country. 1,299 patients have been registered for testing using the Countermeasure Data Management System (CDMS).
The known Zika vectors are mosquitoes of the Aedes genus, which are present in New York state with distribution currently including New York City and the following counties: Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk, Sullivan, and Ulster, and Westchester.
On March 17, 2016, Governor Andrew M. Cuomo announced a comprehensive six-step action plan to combat potential transmission of the Zika Virus in communities across New York state, which can be read here. The Zika Information line that was set up as part of the plan has received 254 requests for Dunk larvicide from the public, and all associated education materials have been approved and printed. Dunks began mailing on Friday April, 22, 2016 and will continue on a daily basis.
Physicians should check their Health Commerce System account for updates from the Department of Health.
If your practice is in New York City - behavioral health support is available to your practice at no cost!
Funded by the NYC Department of Health (DOH), the Mental Health Service Corps (MHSC) is an initiative to close the gaps in behavioral health services and facilitate the integration of behavioral health services into primary care. Primary care practices, substance use programs, and mental health clinics in high-need communities throughout the New York City (the five burroughs) can receive full-time fully-funded masters or doctoral-level clinicians and physicians to support their practice.
The Corps is committed to working in high need communities that have experienced barriers to access to mental health care. Corps members will have experience and interest to work in diverse cultures (e.g., ability to speak languages specific to the patient population, oriented to ensure highest standard of social service) and will be trained, coached, and supported in the use of evidence-based therapeutic interventions to screen and treat patients for depression, anxiety, and substance use disorders.
To be eligible to receive a Corps member, a primary care practice must have:
- Clinical leaders at the site dedicated to collaborative care
- Exam room with table and chairs for Corps members and patients
- Electronic Health Record access for Corps members
- Panel size of at least 1,500 unique patients per site
- Be located in high-need area and/or serve a high percentage of medically underserved population
- Be willing to participate in site trainings offered by MHSC program to facilitate integration of Corps member services
This effort will give special consideration to small and solo primary care practices that meet the above requirements. Apply now to change how health care is delivered in New York City and participate in MHSC by completing an application, available here.
There are a limited number of Corps members, so submit your application early. Site selection for matching with Corp members begin May 1, 2016. Notification of Host Sites for placement of a Corps member will take place by June 1, 2016.
For more information about MHSC, click here.
Open Payments (Sunshine Act): Physician and Teaching Hospital Review and Dispute Period Began April 1
will last for 45 days
Opportunities to review and dispute data for the June 30, 2016 Open Payments publication date began on Friday, April 1, 2016, and will last for 45 days. CMS will publish the 2015 payment data and updates to the 2013 and 2014 data on June 30, 2016.
In order for any disputes to be addressed before the June 30th publication, physicians and teaching hospitals must initiate their disputes during the 45-day review period, and industry must resolve the dispute before the publication deadline. Review and dispute is voluntary, but strongly encouraged.
If You Have Never Registered In Open Payments Before:
Before you begin, make sure you have your National Provider Identifier (NPI) number, Drug Enforcement Agency (DEA) number, and State license number (SLN). Initial registration is a two-step process and should only take 30 minutes:
- Register in the CMS Enterprise Identity Management System (EIDM);
- Register in the Open Payments system. You can read more about Open Payments here.
For Users That Registered Last Year and Have Used Their Accounts in the Last 60 Days:
Physicians and teaching hospitals who registered last year do not need to reregister in the EIDM or the Open Payments system. If the account has been accessed within the last 60 days, go to the CMS Enterprise Portal, log in using your user ID and password, and navigate to the Open Payments system home page.
For Users That Registered Last Year but Have Been Inactive for More than 60 Days:
The EIDM locks accounts if there is no activity for 60 days or more. To unlock an account, go to the CMS Enterprise Portal, enter your user ID and correctly answer all challenge questions; you’ll then be prompted to enter a new password. For Users That Registered Last Year but Have Been Inactive for More than 180 Days: The EIDM deactivates accounts if there is no activity for 180 days or more. To reinstate an account that has been deactivated, contact the Open Payments Help Desk.
Get Smart Campaign from New York State DOH and CDC Highlights Antibiotic Resistance
The “Get Smart (Know When Antibiotics Work) Campaign” is a collaborative effort between the New York State Department of Health (NYSDOH) and the Centers for Disease Control and Prevention (CDC). CDC has provided grant funding to New York State in an effort to combat antibiotic resistance and the “superbugs” that arise from avoidable prescribing of antibiotics.
To get a handle on where New York stands, the "Get Smart Campaign" analyzed 2013 Medicaid claims data on prescribing for adult upper respiratory infections and found that in 11 counties in New York State, over 55 percent of provider visits resulted in antibiotics being prescribed for adults with upper respiratory infections (URIs). This map shows that data.
Some healthcare providers say they prescribe antibiotics even when they know they are not indicated because of pressure from patients for a post-office visit “takeaway”. There is concern that they might get negative reviews on patient satisfaction forms if patients are denied antibiotics.
If you are interested in joining the “Get Smart” effort in New York State or becoming a “champion” of appropriate antibiotic prescribing (setting an example helps every community), please contact Mary Beth Wenger, Project Coordinator of the New York “Get Smart Campaign" at 518-474-1036 or email her at: firstname.lastname@example.org.
The Sunshine Act, which is part of the Affordable Care Act (ACA), requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.
This system is known as Open Payments (or the Sunshine Act). The next review and dispute period for physicians and teaching hospitals is targeted to start in April 2016 for 2015 payment date. Registering in the Open Payments system is voluntary for physicians and teaching hospitals. However, registering is required if a physician or teaching hospital wants the opportunity to review and dispute data. Only information that has been submitted in the current program year is eligible for review and dispute.
The data is submitted by applicable manufacturers (e.g., Pharma companies) and applicable group purchasing organizations (GPOs) prior to public posting on June 30, 2016. If a physician or teaching hospital registered last year, they are not required to register again this year.
If it has been over 180 days since you have logged onto the Enterprise Identity Management System (EIDM), the account has been deactivated for security purposes. If an account has been deactivated, contact the Help Desk. The Help Desk hours are from 8:30 a.m. – 7:30 p.m. (EST). For new users, the quick reference guide on the EIDM system can be found here. In addition, the quick reference guides on teaching hospital registration can be found here, and the guide for physician registration can be found here.
CMS plans to publish the 2015 payment data and make any applicable updates to the 2013 and 2014 data in June 2016. More information about Open Payments is available at www.cms.gov/openpayments.
There are a number of useful educational materials available to help physicians and teaching hospitals learn more about the Open Payments registration process. These materials are available on the Resources page of the Open Payments website. You may want to begin by reviewing the 2015 Open Payments Program Overview and Enhancements – PDF .
1. Talk to your patient about Zika: At this time, your patient can get tested if they:
- Are pregnant, and travelled to a place where Zika virus was being transmitted while the patient were pregnant
- Are a man or woman who become (or became) ill with symptoms of Zika virus within 4 weeks of travel to a place where Zika virus is being transmitted.
2. Patients can obtain a “Zika virus testing approval form” from Local Health Departments (LHDS): You can work with a patient to get this approval (Contact information for LHDs is available here). They MUST get approval from their LHD before they can get tested. The form can be emailed to you or the patient. The form could also be faxed.
3. Provide a Zika virus test prescription for your patients: In addition to getting LHD approval for testing, you can give your patients a prescription for the lab tests that are needed.
4. Provide your patient with collection site phone numbers if an appointment is needed: A list of hospitals and their laboratory telephone numbers is available to provide to your patient. (Health Commerce System Login is required).
5. Instruct the patient to go to the collection site: A patient will need to bring the approval form from the LHD and the prescription from you provided. The sample collection site is not able to provide any lab testing unless they are given both the health department approval form and the prescription you've provided.
At the collection site, blood and urine samples will be collected and sent to Wadsworth Center, the New York State public health laboratory, for Zika virus testing. There will be no charge to the patient for the blood and urine collection, shipping and testing. Inform the patient to wear short sleeves or sleeves that can easily be rolled up.
6. Results of the patient's tests: Testing for Zika virus infection is a two-step process. The first test results will be available within a few days of the sample collection. However, in most cases, additional testing is required to determine if a patient was infected; these results may take up to 21 days due to the complicated nature of the tests involved. Some people may need additional blood samples collected three weeks after the first samples. Test results will be sent to your office, and your patient can discuss their results with you and ask any questions they may have.
7. Questions? Patients can contact their Local Health Department or the New York State Department of Health at 1-888-364-4723. Instructions for Zika virus testing for NYC residents can be found here.
In addition, patients can call the Zika information line at (888)364-4723 from Monday - Friday, 9 am to 6 pm.
The Medicare EHR Incentive Program Hardship Application Deadline for All Providers is Now July 1, 2016
CMS has extended the application deadline for the Medicare EHR Incentive Program hardship exception process that reduces burden on clinicians, hospitals, and critical access hospitals (CAHs). The new deadline for Eligible Professionals, Eligible Hospitals and Critical Access Hospitals is July 1, 2016. CMS is extending the deadline so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017.
In January, CMS posted new, streamlined hardship exception application forms that reduce the amount of information that eligible professionals (EPs), eligible hospitals, and CAHs must submit to apply for an exception. The new applications and instructions for providers seeking a hardship exception are available here.
Article courtesy of AMA
Prior to adjourning for the holidays, Congress passed the Patient Access and Medicare Protection Act (PAMPA), which directed the Centers for Medicare and Medicaid Services (CMS) to make AMA-supported changes to the Medicare EHR Incentive Program hardship exception process that allows physicians to avoid a Meaningful Use (MU) penalty in 2017.
NYACP encourages ALL physicians subject to the 2015 Medicare MU program to apply for the hardship. CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the hardship will not prevent a physician from earning an incentive. It simply protects a physician from receiving an MU penalty. Therefore, physicians who believe that they met the MU requirements for the 2015 reporting period should still apply for the hardship protection. Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017.
Step-by-step instructions for completing the hardship exception application follow below:
- STEP 1: Access the instructions and download the application. You can type directly into the application on your computer if you plan to submit the application via email (more on this in Step Seven). Note that CMS “strongly recommends” submission via email, but if that is not possible, the application should be printed out and completed using blue or black ink. Do not use pencil.
- STEP 2: In Section 1.1, provide information for the person working on behalf of the physicians to apply for the hardship exception. Note that, for the first time, an individual may apply on behalf of a group of physicians. This individual may be the physician applicant him/herself or the individual filling out the information on behalf of a physician group (for example, a member of the group’s administrative staff). This step is very important because CMS will provide notice of its hardship exception decisions – which are final and cannot be appealed – via the email address provided on the application.
- STEP 3: In Section 2, check the box beside the hardship exception reason that best applies to your circumstances. The AMA is encouraging physicians to apply for a hardship exemption under the “EHR Certification/Vendor Issues (CEHRT Issues)” category (Option 2.2.d in the application), even if they are uncertain whether they will meet the program requirements this year. Because of the delay in publication of the regulation, this category will apply to all physicians. Further, given the delay of the regulations and these updates to the hardship application, CMS has stated that they will refrain from auditing physicians who file under Option 2.2d. A physician who qualifies for more than one hardship exception category may select all of the options applicable to his or her practice; however, one category will suffice.
- STEP 4: Skip Section 3. This section only applies to hospitals.
- STEP 5: In Section 4, list the NPI, first name, and last name for each physician applicant. Again, multiple providers and provider types may apply as a group using a single submission. Failure to provide each physician’s NPI will result in a delayed hardship exception decision by CMS. In addition to listing each physician’s information on the application itself, CMS will accept physician identification contained in the following formats: Microsoft Excel (.xls or .xlsx), comma delimited (.csv), or text file (.txt).
- STEP 6: In Section 5, check the box marked “Confirm” and enter the date of application and the name of the individual completing the form.
- STEP 7: Submit the application to CMS. If you are submitting the application electronically, attach the application to an email addressed to email@example.com. If an electronic submission is not feasible, fax the application to 814-456-7132. If you have listed the required physician identification in a separate file as described in Step Five above, be sure to attach it to your email or include it with your fax. No additional documentation is required to be submitted to CMS; however, physicians should keep a copy of their application and any documentation supporting hardship exceptions claimed in addition to Option 2.2.d.
If granted, an exemption will prevent penalties for the 2017 payment year. This hardship exception application will not affect payment adjustments for 2016. The application must be received by CMS by 11:59PM ET on March 15, 2016. CMS has not said when applicants will be notified of CMS’ decision.
The American College of Physicians and the New York Chapter are asking members to help strengthen the organization by recommending ACP membership to colleagues. By joining the College, your colleagues will enrich their clinical knowledge and skills and have access to all of the ACP and Chapter member benefits that you enjoy.
To thank you for your dedication to our organization, ACP offers incentives to members and their chapters for recruiting new members through the Recruit-a-Colleague Chapter (RACC) Rewards Program.
The RACC Program rewards successful individual recruiters with dues credits for each new full Member or Physician Affiliate member recruited and a chance to win a trip to the annual Internal Medicine meeting. In addition, the RACC Program also provides rewards to the recruiter’s chapter, and complimentary registrations to the annual Internal Medicine meeting.
The 2015-16 Recruit-a-Colleague Chapter Rewards Program runs until March 1, 2016.
To participate, simply forward a membership application found at www.acponline.org/racc to your colleagues. To qualify for the program, your name must be listed on the recruiter line of the application, and the form must include the code “RACC”. We suggest you print the form and add that information to get credit!
Your help with membership recruitment, is a win-win for all!
Medicare / Medicaid
Chronic care management (CCM) is a unique physician fee schedule service designed to pay separately for non-face-to-face care coordination services furnished to part B Medicare beneficiaries with multiple chronic conditions. It applies to practices and patients that are not included in alternative payment models. The code (99490) fills a long-awaited void in treating patients with multiple chronic conditions and was included in the Centers for Medicare and Medicaid Services' final Physician Fee Schedule rule for 2015.
MLN Releases Chronic Care Management FAQ
MLN Matters® Special Edition Article #SE1516: "Chronic Care Management (CCM) Services FAQ" has been released to view and download. This article is designed to provide education on Medicare's requirement for 24/7 access by individuals furnishing CCM services to the electronic care plan, rather than the entire medical record. It includes FAQs regarding billing CCM services to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) under CPT code 99490.
Chronic Care Management Services Fact Sheet
The Chronic Care Management Services Fact Sheet (ICN 909188) was released and is available in downloadable format. This fact sheet is designed to provide background on the separately payable Chronic Care Management (CCM) Services for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. it includes information on eligible providers and patients; Physician Fee Schedule billing requirements; and a table aligning the CCM Scope of Service Elements and billing requirements with the Certified Electronic Health Record or other electronic technology requirements.
Other CCM Resources
Practice Management Tools
Advance decision making and end-of-life care options are unfortunate but necessary conversations for patients to have with their physicians and families. New York Chapter ACP has gathered important resources to assist in making these difficult discussions a reality.
A recently released report from the Institute of Medicine of the National Academies entitled “Dying In America: Improving Quality and Honoring Individual Preferences Near the End of Life” details key findings and recommendations related to the realities of the clinician-patient relationship and how to effectively communicate and facilitate end of life wishes and directives. An excerpt of the recommendations:
“Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care. The majority of these patients will receive acute hospital care from physicians who do not know them. Therefore, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences.”
You can read the document in its entirety here.
In addition, the Department of Health for New York State has a website of resources including the Medical Orders for Life-Sustaining Treatment (MOLST) form.
The DOH has created a portal that contains a wealth of information on advance care decisions, including legal requirements checklists, frequently asked questions, and guidance documents for physicians and patients.
MOLST legal requirements checklists and general instructions for adult patients are:
- MOLST Adult General Instructions and Glossary (3/2012) (PDF, 114KB, 6pg.)
- MOLST Checklist 1 - adult with capacity any setting (5/1/13) (PDF, 49KB)
- MOLST Checklist 2 – adult with health care proxy any setting (5/1/13) (PDF, 91KB)
- MOLST Checklist 3 - adult with FHCDA surrogate (3/2012) (PDF, 95KB, 4pg.)
- MOLST Checklist 4 - adult without FHCDA surrogate (12/1/10) (PDF, 58KB, 4pg.)
- MOLST Checklist 5 - adult without capacity in the community (12/1/10) (PDF, 59KB, 4pg.)
The MOLST legal requirements checklist for minor patients is:
- MOLST Checklist for Minor Patients and Glossary (3/2012) (PDF, 120KB, 7pg.)
Frequently Asked Questions regarding MOLST:
Tobacco use is leading cause of preventable death in the U.S., and as health care professionals we are in a prime position to help our patients successfully quit tobacco, while simultaneously lowering their risk of heart disease, stroke, COPD and other diseases.
Recently, the NYC Health Department has developed an excellent and free online learning module to assist physicians by enhancing your knowledge on how to effectively assess, counsel, and treat tobacco use, greatly improving patients’ chances of successfully quitting. For medical residents, this module meets five of the six Accreditation Council for Graduate Medical Education core competencies and is able to be placed in your learning management system. For attending physicians, this module provides 1 CME credit.
Highlights of the module include:
- The “5 A’s” model of treating tobacco use
- Provider/Patient communication techniques
- Treatment options and guidance, including combination therapy
- New York State Medicaid Benefits
- Billing information for smoking cessation counseling
With approximately 100 million adults in the U.S. suffering from chronic pain, the nonmedical use of prescription opioids has become a public health issue, and prompted the U.S. Food and Drug Administration to establish the Risk Evaluation and Mitigation Strategy (REMS) mandate. A total of 26 Continuing Medical Education (CME) and Continuing Education providers, including ACP, have created educational initiatives to help prescribers ensure that the benefits of a drug outweigh the risks for patients receiving extended release and long acting opioids.
ACP developed online training modules with Pri-Med to educate clinicians about best practices when prescribing opioids to patients and to help prescribers manage risk for abuse and inappropriate use. The REMS training modules provide comprehensive educational information for primary care clinicians, and can be completed for CME credit. Access the online modules for additional information.
A brief video from Steven Weinberger, MD, FACP, executive vice president and CEO of ACP, highlights the initiative’s goal of reducing misuse, abuse and overdose deaths associated with prescription opioids.
Note: an ACP Username/password is required to login)
Managing Your Patients With Diabetes - Tools & Resources
- ACP Smart Medicine
- ACP Quality Connect
- American Diabetes Association
- Bridges to Excellence Diabetes Care
- NCQA Diabetes Recognition Program
- ACP Diabetes Monthly
- Improving Diabetes Through Patient Engagement Webinar (password required)
Learn about NY's information network, Meaningful Use, e-Prescribing, privacy and security and best practices.
The following patient-related resources provide guidance in effectively maintaining and enhancing the doctor-patient relationship.