Fall 2020 Newsletter

If you have not already captured the required Merit-Based Incentive Payment System (MIPS) data for performance year 2020, please note that the final continuous 90-day performance period began on October 3, 2020. The Improvement Activities and Promoting Interoperability categories require you to report data specific to at least one continuous 90-day period (unless otherwise stated).

Complete and accurate submission of data is critical because MIPS performance determines whether you receive a negative, neutral or positive payment adjustment. MIPS performance categories include:

• Quality
• Cost
• Improvement Activities
• Promoting Interoperability

Note: If you participate in the Dignity Health Care Network (DHCN) Accountable Care Organization (ACO), you will need to submit Promoting Interoperability data; all other MIPS performance categories are reported on your behalf or calculated as an ACO member. You will report the required performance category data during the 2020 submission period (January 2, 2021 – March 31, 2021).

Promoting Interoperability Hardship Exceptions

You may submit a Promoting Interoperability Hardship Exception Application, citing one of the following reasons for review and approval:

• You’re a small practice
• You’re using deactivated certified technology
• You have insufficient Internet connectivity
• You face extreme and uncontrollable circumstances such as disaster, practice closure, or severe financial distress
• You lack control over the availability of CEHRT

Hardship applications must be submitted by December 31, 2020 (5 p.m. ET). Learn more.

Next Steps

Additional Resources

• 2020 Promoting Interoperability Quick Start Guide, which contains links to other MIPS category guides
• QPP Participation Status Lookup Tool

St. Rose Quality Care Network (SRQCN) and North State Quality Care Network (NSQCN) earned shared savings payments of more than $2.2 million and $1.8 million respectively, based on performance in 2019. As participants in the Medicare Shared Savings Program (MSSP), CMS calculated that SRQCN and NSQCN generated over $8.8 million in savings while maintaining overall quality scores of 92%.

In 2019, 16 MSSP ACOs across the CommonSpirit Health enterprise served 321,000 Medicare beneficiaries throughout 21 states. Based on performance during the measurement year, 10 MSSP ACOs demonstrated savings and 56% received shared savings payments while maintaining quality scores averaging 94%. In total, CommonSpirit Health ACOs received $37 million of the $70 million that was generated in shared savings.

Learn more in HealthLeaders Media.

Patients encounter many economic, social and cultural barriers and obstacles every day. This success story from the Stockton Ambulatory Care Coordination (ACC) team reflects the importance of having a strong human support system to overcome those obstacles.

Care Coordination strives to meet the comprehensive medical, behavioral health and psychosocial needs of each individual patient while promoting high-quality care and cost effective outcomes — and make a difference in patients’ lives.

About the Patient

The Transitions of Care (TOC) team referred a patient to the ACC team. The patient had a combined hospital and rehabilitation stay of almost a month and a half. This elderly patient was non-English-speaking and had limited literacy in both his native language and English. With the current COVID climate, the patient did not have the literacy to complete a telephonic or video initial visit for primary care.

The Many Roles of Care Coordination

A navigator, Adriana, called several providers and found a provider willing to see the patient for an in-person post-follow-up appointment. Due to his literacy skills, Adriana worried that the patient would not be able to locate the address, so she arranged to meet the patient at his new PCP office, and escorted him into the office to assist him with checking in.

A thorough holistic assessment revealed the patient had limited access to food, lived alone and had declining personal care. A social worker, Andrea, connected the patient to a food delivery program and also with a senior program to check in on the patient.

Another major concern was medication compliance and understanding. The patient was connected with a local pharmacy, and the staff went above and beyond to help the patient in his native language to understand his medication regimen and the importance of compliance. The pharmacy set up deliveries and assists with ensuring he does not run out of refills so the patient receives his medication regularly.

This patient is on the road to success as our Ambulatory Care Coordination team is following him, and we have advocated for the patient for medical care, food and medications. ACC’s continued work will help this patient improve and maintain his health through setting achievable patient-centered goals.

To refer a patient to Care Coordination, contact Intake Coordinator Jazmin Castillo at [email protected].

VIPN understands the challenges each of our providers and office staff have been facing during these extraordinary times. Since March, we have all learned to adapt to the new “normal” and adjust our way of doing things so that we can better care for the members of our community.

We would like to remind our providers of the importance of continuing the commitment of providing excellent care by focusing on the quality measures for the members of our value-based agreements. We currently participate in value-based agreements with Anthem, Blue Shield and United Healthcare.

Below is a list of those quality measures for each of our value-based agreements. There’s still time left to encourage these members to get their appropriate cancer screenings, if due, before the end of the year.