IMPAQ InternationalSeptember 12, 201711:00 AM ESTLAN Webinar

JENNIFER PINDER: Good morning, everyone, and welcome to today's webinar. Choosing quality measures and quality improvement activities for the small group practice. So we're going to start off with just a few week housekeeping announcements if we could go to the next slide. So first please mute your computer speakers to avoid any audio feedback. And if you need operator assistance, you can dial star 0. And if at any point you need to ask a question over the phone, you can press star pound on the phone and you can also enter a question on the chatbox over here on the right. So we're going to start off the webinar with a quick polling question. So we'd like to get an idea of what is everybody's role? So if you want to click the role that applies most specifically to you we can get an idea of who is in our audience. I'll leave this open for another 10-15 seconds here. All right, we'll go ahead and end this poll. Looks like we have mostly non-clinical staff and then I want to ask one more question before we head into the meat of the conversation.

What does plaque your practice's readiness for submitting quality measures so if you want to pick the response that applies most to you. We'll leave this open for another 15 seconds or so. So far it's looking like a pretty even split, looking like most folks appear to be collecting enough quality measures from it. So that's great. Let's go ahead and end this poll. And now I want to pass it onto Brenda with CMS. Brenda?

BRENDA: Great, thank you so much, Jennifer and it's so good to see that information that you are able to submit information to participate in that. So, again, on behalf of CMS and the IMPQ team I would like to welcome each and every one of you today's call. We understand it's not easy to step away from your practice, from your patients so, again, we thank you for joining the call today.

Now I'm also here to let you know that CMS is very committed to helping small group practices particularly those in rural and underserved areas. On our first two national webinars we received many questions about choosing and reporting quality measures and improvement activities. So we've made that topic the focus of this particular event today. We appreciate your interest in this event and are delighted to introduce the four panelists and the moderator for today's call. On the panel we have Paul Babineau, we have Amasa Baldwin, Aaron Hubbard, and David Smith. Moderating today is Dr. Bruce Spurlock. BRUCE SPURLOCK: Thank you very much, Brenda. We're going to spend time learning about the quality measures and the improvement activities and how you make the choices for that so we're excited about doing that we think this data and information is important for those folks getting ready to participate in the program and we want to remind everybody that you can submit questions in the chatbox. That's a great place. We will try to address as many as we can and we will also address them on the website. So just want to let you know we're going to move on with that. Let me set the stage of the kinds of activities we're going to be talking about. We're going to deal with the practical advice for the quality improvement activities. It's not going to be the details and the specifications about everything but about

the practical advice that best fit you and your practice. We want to focus on what's useful for the small group, the underserved, the rural practices and if you're in a group I noticed a few groups larger than fifteen. You're welcome to listen in but there may be some differences applying to your group that we're not addressing today. In usual with these formats if you've been with us on previous webinars we try to look at in the why, who, where, why and what fashion. We're going to spend most of our time in the what. The technical down in the weeds, nitty-gritty, choosing these measures that are going to be appropriate for your patients and your practice and we'll give an a brief overview of the other questions involved with it. At this point I will introduce David Smith and talk about the why. Why this. Why should I participate and what is going on with dealing with that situation David? DAVID SMITH: Thank you, Bruce, I have been thinking about this a lot. I work with a lot of small clinics through the years and I think the reason MIPS matters is because it help to align high quality and efficient care for the health care system. That's something we've been working on for a long time and the MIPS program helps move that Ford. Additionally there are websites like position care, and quality care. It's important to understand what the quality measures are. And for you to realize that there are resources for you to understand how to perform and do well in the MIPS program. Even if you report or participate in a minimal level, there are resources available to help you succeed. So I think those are the reasons why MIPS is so important. BRUCE SPURLOCK: And I particularly like the part that there's a lot of public reputation that gets prepared for that in the future. Let me introduce now Amasa Baldwin who hails from the Texas community but deals with these issues in a lot of different fields and clinicians and practices. Amasa, can you talk about the who that MIPS effects. AMASA BALDWIN: Sure. MIPS affects those in Medicare for over a year and meet the threshold which is seeing more than one hundred patients and having more than 30,000 in charge: I just want to note that clinician types are physicians, physician assistants, clinical nurse specialists and CRNAs is one thing that is really nice about MIPS is there's a little bit of flexibility in that clinicians can be eligible at the individual level but also report out at the group level and next year they'll be able to participate in virtual groups. If you have not checked your eligibility or are not sure go to the website and enter your MPI as your clinician and it will tell you your eligibility and for each HIN that you may practice at and lastly I want to know that even though next year some of the rules may change you really want to start preparing.

BRUCE SPURLOCK: Great, thank you so much, Amasa, now I will ask Aaron who hails from Nevada if he can go over the broader questions of the where, the how and the when of MIPS. Aaron. AARON HUBBARD: So the first thing we decided to do is submit, or choose how you will submit your MIPS data, your quality data. And that can be done either through a qualified registry, and those are important if you are a specialty clinic and you're having a hard time deciding which measures to select the QCDR is a good resource for you. Your electronic health record is also a great tool for you to use to submit your MIPS data.

And then you can also use claims data just to know if your going to submit the claims there you have to make sure your G code and your ICD 10 codes are all in line on your claims. Also, when can you submit this data? Begins on January 1, 2018 and runs through the end of March and so that's the time period that CMS has allotted for you to submit your claims data. It is important to note that if you do select a qualified registry or possibly even your electronic health record that some of these dates might be earlier. Depending on what they want from you. So check with them to see when they want your data to make sure you don't miss any of the deadlines. One of the things also to note too is if you are intending to report on 90 days, you need to start working on that now because in 90 days we need to be started by October 1, 2017 and that's just a couple weeks away so we can get the 90 days worth of data. BRUCE SPURLOCK: So October, just a couple weeks away is a deadline to start capturing for the partial year data submission and it looks like for connecting with the registry you need to certify it by January 1st and the data is due March 31st but there may be some other deadlines with the registry. Is that right, Aaron? Did I hear you correctly? AARON HUBBARD: Yes, depending on who and what registry you select they may have their own internal deadlines for you to get data to them. BRUCE SPURLOCK: At this point I will bring in Paul, give us an overview of what needs to be collected. Give us an idea of what are the options and what people are thinking about between that January 1st and March 31st period, Paul, thank you.

PAUL BABINEAU: They divided it into different sections. Quality, which is 60%. Cost which is 0%. Don't worry about costs for right now. Improvement activities is 15%. Your quality measures are if you've been reporting up until now those are your PQRS measures. That's now quality measures.

They want you to choose six. You can do more for extra credit but for now you only have to do six. As far as the improvement activities goes, that's new. That's something that we haven't had to do in the past. There's a bunch of different ones you have to -- you can do high weighted or medium weighted improvement activities and you'll see the list. Pick the ones that work with your company. Also for the advance in care information think of those as your meaningful use measures that used to be there. Right now you need base of four and when you check them, make sure your AHR is at least 2014 certified.

BRUCE SPURLOCK: We have a couple questions in the chatbox. One of them is about where do we need to check about our EHR and I know there's some information on the her in the QPP website. There's a lot of listing of the registries. David, are you able to tell us a little bit about that? Maybe on mute, so -- anybody else on the panel be able to talk about the website for EHRs?

DAVID SMITH: I know there's a listing of certified electronic health records on the ONC website which is -- I'll put that address in the chat but you can check to see if your product is 2014 or 2015 certified and also check on the functionalities that are available to support your participation in MIPS for the different advance in care measures.

BRUCE SPURLOCK: Great, I appreciate that very much, David. Let's go to the first major question then about the what piece.

We're going to drive more deeply into the what. What is the bare minimum I need to do in order to avoid a penalty. That seems to be a popular question. We hear that a lot as we go around the country. I'm going to ask Aaron, can you address this question.

AARON HUBBARD: The first thing you need to do is just submit something. In regards to quality metrics. That would submit any type of quality metric that has a one in the numerator. This is being called the test method of submission. And so this can be done a variety of ways. I covered some of them earlier but using on electronic health record, using a qualified register, using claims data. Someone asked the question of where can you get the information of claims. We're going to be referencing a lot. It's going to be the website that has all of that information on there if you look under the resources tab and we can get that link for you in the chat so that's where you can get that information.

BRUCE SPURLOCK: There's lots of measure to choose but you're saying of the 270 or so measures you need to do one patient one time for one measure. AARON HUBBARD: That is correct and it seems and it is easy. Even though it is easy to do and a lot of people want to avoid the penalty for this year doing more is definitely better.

We want you to be prepared for the future. We want you to be earning bonus money that is available if you are a high performer when you submit just the minimum amount of data it could negatively impact your reputation for your public reporting so the more data you have the more transparent you have the more better it will be. So the patients will see the quality of care you provide. Avoiding the penalty is easy but we definitely recommend you look at either the 90 days or the entire year. BRUCE SPURLOCK: I like that last point you made there it really benefits your patient. That's where we go with this MIPS effort it's not just the requirements we have to do in these practice but ultimately to helping the patients we serve and the communities that we work in so I like that part. Doing more is better and so if you're able to do that it's still time, you have October 1st to start collecting data for the partial year and while it's short and right around the corner it gives you enough to after this webinar go and look at the website. Choose the measures that are most appropriate for you and get start on that data collection. All right, let's go to the next question. This is the hard of what we're trying to talk about. How to pick the best quality measure to collect or report. Really crucial. How do we pick the ones that are the most appropriate for us and our patients and our community. I'm going to ask David to address this one.

DAVID SMITH: I would go to the QPP website and there's a section on there where you can go in and pick and choose from a list of over 270 different quality measures. On that website, you can go and you can filter by high priority measures and also, additionally what data submission method you can choose. You can submit using three different methods. By claims. You can submit using your electronic health record. Some vendors will submit the data for you. Some you can pull the data out and do data reporting by attestation on the website that will be available soon. And then there's also the registry methods and so it will

show you what options are available. You can go in there. You can find outcome measures, make sure you find at least one outcome if you want to do some level of performance the recommendation is you submit at least six measures and you choose at least six measures for your specialty if you're in a specialty that doesn't have six measures you can submit less but the only specialty that I'm aware of that is in that category is electrocardiophysiology. Also you can also take a look at, so a few -- there are a few things that you should be aware of.

You want to look for measures that are not topped out and you can choose measures through what is called a qualified clinical data registry. There are some measures that we call non-MIPS measures that you can submit for MIPS. Many of the QCDRs are part of your academies or specialty academy so if you're a specialist, like an ENT or an ophthalmologist or an allergist your academy may be able to submit the measures for you or with you. You may be working with your academy and not aware that your academy can do this for you. Just at a minimum this website's a very good place to start. I would start by choosing a few measures that you know you can submit or that you know you have a little bit of a handle on or begin to understand that what those measures are all about.

BRUCE SPURLOCK: Thanks, David, Amasa, you've been talking with clinicians and swimming in this field a lot. What would you recommend about picking your measures and what is right for you.

AARON HUBBARD: I would look at the areas that are most important I would also like for benefits to other pairs that you're working with. So you might be working with commercial pairs or state or medicaid pairs where you have to submit quality measures. I would look at measures that also benefit your practice and patients that also align with other payment programs. And many of those programs are looking at at the same measures or very similar ones. So that you can help the clinical care of your patients. So I would, that's the first thing I would do and the next thing I would do is look at the list of measures, find the ones that are best suited and then the third thing I would do is look at the scoring. There's a benchmarks file that's available on the QPP.CMS website where you can see what performance means. That's one of the most difficult things that practices struggle with is, okay, do I have to be at 100% on this measure? Not necessarily. You can be at 50% and be performing in the top 90th percentile so that benchmarks file becomes really important. BRUCE SPURLOCK: I've been seeing a lot of questions in the chatbox. If you hold on a little bit later we're going to talk about resources that are valuable. There's a lot of organizations that are providing information for practices free of charge and Brenda will go over that at the end of the meeting so you'll learn about organizations and other places that will be able to give you help and answer some of your questions quickly. Amasa, can you give us advice on picking quality measures from your perspective. AMASA BALDWIN: One of the best ways to pick up measures is look at how you've done in the past and a good way to do that is to look at your quality and resource use report which also known as your QRUR report. The reports are out for 2015 and those are already available and the ones for your 2016 performance will be coming out soon. If you have never viewed these reports before, you'll have to get set up with an EIDM account and on

this slide we listed a very good resource to walk you through how to set one of those accounts up and how to access this information. But once you get access to them and you start to review them, those QRUR reports and your PQRS reports will provide valuable information on how you performed in the past and compared to others in the field. That's how the benchmarks are set up for the MIPS program and in these reports once you start to review them you'll start to identify some measures that you can do well on because you've done well in the past and also measures you want to improvement so you can see how you performed and if you want you can take those measures on how you did last year and create baseline. Take your scores from last year and put it into the MIPS benchmark to see what your score would be this year and that will give you a good baseline and how you're doing so far and where you need to improve. BRUCE SPURLOCK: If I have never read this before is it easy to do? Is it something that it takes a lot of understanding or drilling down? How easy and user-friendly is this report. AMASA BALDWIN: I think it's very user friendly and the references that we have listed here on the screen are really good for you to kind of get a step by step guide on how to access this information and what it's telling you as well.

And if you do that and still have struggles you can still reach out to your direct support organizations and they can help you walk through and better understand it as well. BRUCE SPURLOCK: There's that word again direct support organizations. You'll learn more about that and you've seen some of our panelists answering some of the questions in the chatbox so we'll grateful for that to keep people current on what's going on in the question. Paul, tell us what you would think about from a strategic standpoint when you think about picking measures for your practice. PAUL BABINEAU: We picked what would make the most sense for your workflow and how we approached our day. We pick measured we did normally. Most things that you see for these measures that are listed are all things that you do on a normal basis. So pick things that are available to you that make it so you're just doing what you normally do. Another thing you can do is be careful on some cases, if you have a registry or you have an EHR system. You want to make sure that they support that measure. So we're with a registry that didn't support one of the measures that we wanted to choose so we weren't able to do that so we had to choose an alternate one. So make sure whoever you're dealing with ends up being able to report the measures you want.

Also we reported QRS in the past. We use the same measures. A lot of those carry forward so we kept doing what we were already doing, our doctors, what they have always been doing and then on that same note we have to make sure that we're always tracking our performance or our clinicians are always available so they always know exactly what they're doing. So you can for our registry does all our reporting for our quality measures so we're able to look at that and we look at that on a weekly or biweekly basis and I send out a report to all the providers so they know exactly where they're standing at all times and it makes it so we're all on the same page and the same team to get done what we need to get done. You mentioned there about sending thing to your providers and getting them to participate.

Can you give us an specific example of what that looks like and how you attained it. What it was to get your clinicians joined in with what you're trying to do?

Yeah, so I created my own spreadsheet that showed that we got all our numbers tracked so we can see exactly where they're standing and falling. If for instance an education document is not happening we can bring that to them and say this is what we're doing for this education document.

We send it out to all the providers. So there may be one that excels as education documents so we can say go to that one provider and say, hey, you know, what are you doing? What is it making it that you're getting the numbers you need to do and all the doctors communicate with each other and go, oh, that's a good idea. I'll do the same thing. It's really just communication. You just have to make sure that you keep talking and keep working together to get to this goal. BRUCE SPURLOCK: That's really fantastic. I like the idea of the bright spots going to where it's really successful. That's a really great strategy. Any other panelists, any other suggestions or ideas you have for getting buy in and participation from the clinicians in your practice s. I think you really need to hone in on what the clinicians feel is important. If you can start with one quality measure that they're really passionate about whether it's diabetes or hypertension or some other specialty related condition, oftentimes you can get them to really focus on some kind of a process based measure where they feel like they can really make something happen.

And then if you can tie it so some kind of outcome that that process measure will benefit in terms of improved health, then they can really start to see some early success with that quality measure. It'll make it a lot easier to make advanced measures and show you can demonstrate improvement month after month or quarter after quarter and you'll see a little bit more excitement in the practice around and engagement around those quality measures. I've seen that in a lot of practices where they start small and branch out. BRUCE SPURLOCK: Another way to think about it is instead of saying CMS making us do it it's about what is important to you as a clinician and your patients and about the quality of care you deliver. There's those kinds of quality measures out there, crosscutting measures that are available. Make it incremental, rather than wholesale, new.

There are new types of visits you can bill for. Things like the transition of care. If you do some of those visits you make a little bit more money on those today. And it also helps the MIPS program in terms of working on care coordination and working on cost outside of your organization. So there are also way to increase your revenue. Not only, you know, improve the clinical care or improve on the clinical care but also increase your revenue in your practice from other sources other than the MIPS incentives. BRUCE SPURLOCK: Yeah there's ways to do the measures that have been modified to ACI and benefit the quality and keep that workflow thing all in one. All right, Aaron, any other thing to think about when working on quality measures?

AARON HUBBARD: One of the things I recommend is that they select quality measures and improvement activities that overlap for example if you are selecting the depression screening as one of your quality metrics, making sure you're implementing a PQ 29 as your improvement activity so you're working on two things at once. So trying to make it as easy as possible for the physician officers.

BRUCE SPURLOCK: How does the MIPS score fit into this? What do people need to think about when they're considering the MIPS score and quality measures? AARON HUBBARD: One of the things I highly recommend you look at is when you -- QPP website is to look at the benchmarking to see which to see how you get scored. This is an example of a depression screening. It shows the three different ways you can submit claims. And it shows you the different scores that you're going to need. One thing that's very important to notice if you want to be in the fourth percentile you need to have between 30% and 52% to get the four points.

But if you're using for an EHR it's a lot lower and for a registry it's a lot different. So making sure that once you select your submission method you know the scoring that's going to be behind and it that can be found in the resource library. One of the things that is important to note that is if you are reporting as a group, all of the scores are going to be combined into one to calendar score. If you're wondering how your scores are going to come together we have the MIPS calculators. We will give a link to two of them here. As you pull your data from claims you can go in and enter your data to see how your score will be and one of the things you need to do is select the measures that are going to give you the highest number of points. That way you can get as many possible points as possible and potentially qualify for that bonus. BRUCE SPURLOCK: That's fine and the two links on there we know there are MIPS calculators out there. Start practicing with it. If you use the one patient, the one time, you probably need to use this in the future so it's worth getting practice at least understanding what it means because it can simplify some of the complexities with the scoring and which measures are right for you.

These are more advanced topics based on the discussion we had before and I noticed there's a lot of questions we're not going to be able to respond to in the chatbox and as I mentioned before we will get responses for these and post them onto our website later this week. All right, Amasa, I haven't asked you specifically give us any other options or recommendations you might have for the listeners this the group, in the session today. AMASA BALDWIN: So I think everything that we have said is really been very valuable advice as far as to net your quality score. You want to check the benchmarks always. You want to find measures that work best for you and really if you're struggling with it or if this is new to you, always, always, always try to reach out for help. There are a ton of resources out there for you that can assist clinicians in planning the best quality measures for their practices. You can reach out to QPP service contractors. There are QIN-QIOs out there as well. You can reach out to medical associations and other people who are in the field who can really help support you in this.

BRUCE SPURLOCK: Yeah I've seen specialty societies help out as well. Lots of resources and place to look for help. You get warm bodies. Let's talk about the hard part. Let's talk about mistakes and go through the next question about common mistakes that you've all been seeing small practices make when they choose these quality measures. How do you avoid these? David.

DAVID SMITH: I would like to start out with claims. The importance of accuracy is it's really important to be accurate in terms of what you're submitting. When you're looking at measures, some measures are topped out. Especially a lot of the claims based measures. So I would take a look at the benchmarks file and try to find measures that are not already topped out. What topped out means is in order to perform and get a high score on those quality measures you might have to get 99.9% in order to get 10 points otherwise you get three points. There's no way to get four, five, or six or seven, eight or nine points. For each one you submit you get up to ten points for each measure so if you're in the 50 percentile you get between five and six points depending on where you land. If you are in the sixth you get six something points for that range and so if your measure's topped out and there are no ranges to perform in the fifth, sixth, eighth or ninth you're not likely to perform. You will get some points which will help you get the minimum but if you decide you want to perform and do really well you want to take a look at those quality measures and make sure they're not topped out. BRUCE SPURLOCK: Aaron, what are your mistakes that you're seeing that people should try to avoid. AARON HUBBARD: One is selecting a quality measure that does not have a benchmark. You want to get as many points as possible and if there's no benchmark you only get three points so you leave points on the table if you select without a benchmark. BRUCE SPURLOCK: Any thoughts from your standpoint? PAUL BABINEAU: I think you have to make sure that you're always monitoring your numbers so for us we had a clinician who we were seeing his education numbers were dropping down and he was saying he was swearing up and down that he had done them and he was missing a screen. Or when a patient was taking no medications he was leaving it blank but there was a teeny box on the left side that said patient does not use medications.

And that's what our program groups were looking for. Whether it be our registry or our actual medical record itself was looking for those boxes to be checked or those things to be checked so it wasn't our doctors weren't doing what they were supposed so. It was just they forgot to click one little button. We monitor it and say this is something we were missing and if you can find that and improve it really quick it's not going to effect you for the whole period of your reporting period. You can fix it right off the bat and you're good to go. BRUCE SPURLOCK: How often is documentation the bane of our existence. This is important to think about so you can collect the data and information correctly. Amasa, how about you, what other things have you seen that we should try to avoid.

AMASA BALDWIN: So the big thing is trying to do it alone, right? There are ton of resources out there. Always reach out to someone if you can. Your direct support organizations, your local plans, medical associations, they have tons of assistance that is free of charge. It can really you like in making sure your measures aren't topped out and making sure your measures are able to be submitted using the same method. All the things you talked about if you reach out to these organizations that are out there. Then help you navigate that. BRUCE SPURLOCK: Fantastic. Let's go to the next polling question. How do you describe the practice's current activities. We're switching gears now from call measure to quality improvement and click one of the buttons there on how you improve activities. All right we're seeing people take time. These are longer statements to see what applies to you. Whether you're just getting started in this process. We see kind of people are all over the map. Most people are, many people have some kind of activity involvement but others are just in a starting up phase we see on the last question we have about 25% of the people in that bucket. So this is really helpful for us and, again, it gives you an idea of what your colleagues are doing out there in quality improvement. Let's go the next question that we have in this area. What do I have to do to meet quality improvement requirements for MIPS. Amasa, can you help us with that question. AMASA BALDWIN: I want to give a disclaimer that this is specifically for small group practices. If you're a larger practice meaning you have more than 15 clinicians your results are a little bit different. These are specifically specifically for those small practices.

For the 2017 performance year you can do one while righted or two medium weighted improvement activities. And the weighting is a little different in that that quality improvement is at a 44 point total and for that your high weighted are worth 40 points and your medium are worth 20 points. For each improvement activity you want to make sure you do it for a minimum of 90 days and just to note that next year you may actually be able to start earning points for showing improvement so that's kind of why this is important. You want to work on these activities and if they are able to help you improve your quality scores then next year in the program you actually will be able to start earning additional points for that as well. BRUCE SPURLOCK: So this year it's if you're participating but next year you have to demonstrate improvement. That's important to know. David, you have some thoughts and ideas on this topic.

DAVID SMITH: For small group practices, hold on just one second so a few things for improvement activities. One thing that a lot of practices failed to realize is you can get extra credit for improvement activities. You can find improvement activity on this website. You can get full credit for improvement activity category by doing things. But certain improvement activities give you extra credit in another category, the advance information care category which add up to potentially another 2-3 points on top of what you get. So it might make sense to look at improvement activities that you can use to advance your score or improve your score. One of those is like, providing 24/7 access to your e electronic health record. That's an easy one especially if it's a web-based system up on the screen there's an example of a systematic anticoagulation program. If you're working on INRs and

you got a program and a process to help patients set goals and capture that information in the way that specified you can participate in that.

That's a high weighted activity. So there's a lot of things that you can do with improvement activities. Again, I recommend working on, with the 18 improvements activity to get you extra credit. You can use your medical home certification if you're NKQA or in some states they have their own medical home model that have been accepted. And, again, here, I would also, Aaron was mentioning to align your improvement activities with the quality measures you're working on so there's also a glycemic management services improvement activity. You could participate in that and it would help your diabetes patients and it would also probably help your A 1C measures, your other diabetic measures that you might be tracking if you're in a family care practice and that's important to you so, again, look at aligning your improvement activities with your quality measures. There's also one that's focused on cost where you look at episodes, so if you treat patients for certain episodes there's an improvement activity that helps that initiative as well and you can start to work on costs related to particular episodes and improving coordination of care for your patients. So there's lots of things that you want to do. Again, you just need to focus on the ones that will be most effective for your clinic, make sure you go to this website and choose the ones that are the most relevant to you. BRUCE SPURLOCK: I like this is already part of your flow. Great themes, great messages to apply with, Paul, do you have any specific examples of how you chose which quality improvement activity you were going to participate in. PAUL BABINEAU: So when we were looking at the listing of all the ones that were there. The first we did was the what's the best for our patients. And then what we start doing is as we started doing all, so, for instance, one of the ones that we chose was to have weekly meetings where we discuss what we knew to do to improve our practice and another one we had done was had an outside contractor come in and give us some ideas about how to improve our practice and improve patient flow so those things have been great. We've been able to make big change to our practice and the way that we do things and it's been better for our patients. So that's really where we chose most of our measures were things that would help our patients.

BRUCE SPURLOCK: When you talk about what David was talking about. It's easy to do. You incrementally add it on. We have a lot of questions in the chatbox about how to do the data commission piece with this I will turn it over to Brenda. We're seeing about how to get the data submitted. Brenda Gentles: Yeah, sure, thank you, Bruce, for the most part if you work with an electronic health record those particular vendors, the registries that everyone's been talking about, they will provide options for reporting your quality improvement activities. If you're just in the very early stages of selecting an EHR or registry you certainly want to verify as one of the panelists was saying before, that the system that you choose can actually report and pull the measures that you select by reviewing the website I think, by now, everybody should have it. The QPP.CMS.gov review and comply what are all the CMS requirements for choosing the quality improvement activities. Again, as many of the panelists have

explained, we have free resources for you. Your quality improvement organizations, your QIN-QIOs, your QPP direct support organizations. They're here to help you. So, again, use them as your consultants. They're free. They're funded by CMS. They help you guys be successful in the program. We also mentioned attestation a little bit earlier. And, again, as CMS we get closer and closer to January. There may be other submission processes that may be developed and we will certainly keep you posted and in the loop on that particular front. So there are a variety of resource to help you again, tap into your medical associations as well as they support some of the registries, etc., they will also be able to guide you in the right direction. BRUCE SPURLOCK: It's a safe bet, Brenda, when you come up with other submission processes there's going to be a lot of communication strategies. The website will always be there but these other support resources that you have out there. The QINs, the direct support organizations, many others will be part of that communication channel so people learn about new ways to submit data. It's really helpful. Let's go the next question we have on here and this is back to our, the don't dos or try to avoid kind of thing and this is the small practices that are making mistakes, maybe common mistakes when they choose quality improvement activities and how these can be avoided. Amasa, what are some of these mistakes and how to avoid these kind of common things that are going on that we should try to avoid with improvement activities. AMASA BALDWIN: The biggest one I have seen is not reviewing the data criteria. I see people post in chat what do I need to document for improvement activities. Well this file on the QPP website tells you exactly that. It tells you what the improvement activity is, what the improvement activity is looking to improve. So what the goal of the actual activity is and then it will tell you what the suggested documentation is that you'll want to keep around in case of an audit or just to be able to kind of show that you've done the work behind the improvement activity so that to me is probably one of the biggest mistakes I see practices making. BRUCE SPURLOCK: Good advice, David, how about you, your thoughts and advice for folks to avoid mistakes.

DAVID SMITH: I'm going to echo making sure you take a look at the data validation file and the interesting thing is the file also includes documentation on what you should maintain for the advance and care information category which I think is also really helpful for example making sure you have your risk security assessment documentation. I know one clinic that decided not to keep any of that information and they were credited. So that data validation file is incredibly important. Also make sure that you choose improvement activities that are in your best interest as well. The fact that you can get extra credit for 18 of those activities where you use your record in some way or fashion it gets you extra credit. It gets you a little bit of -- a few more points. So if you're trying to perform, you know, for any -- for all of you A students out there, all of you physicians, you know, straight A students, you know, that extra two or three percent on your total score can really be helpful to ratchet your score up and possibly put you into a position to actually take part in a bonus with the MIPS program if you get over 70 points so that is a possibility and something that you will want to consider especially if you want to perform.

BRUCE SPURLOCK: That's great, David, I think, Paul, there's one heard I heard many times throughout this webinar is this notion of alignment can you talk about what you did and what to avoid with using alignment as the theme. PAUL BABINEAU: You just align what you do everyday to match what's in the improvement activity list. So a lot of them, the improvement activity for our practice was the easiest one because we were already doing all of this stuff. So it's just you pick something that you're already doing and run with that and I think that CMS has been trying to do that job of saying, look, you guys do this already. Just give credit for it. So just keep doing what you're doing. BRUCE SPURLOCK: That's great. I have been saying a flurry of links in the chatbox. We'll have all of that information on the website towards the end of this week. We promised this early, you've heard us to elude several times about the resources available to you. Brenda, can you talk about the free resources available to practices and clinicians across the country that CMS provides. BRENDA GENTLES: You heard us talk about the QPP website whether looking up a particular document, etc. But if you have not already booked a QPP website please do it and please do it right now. You'll notice once you launch that website in the upper right-hand corner it's going to say about the quality payment program. You want to click that and then you're going to see a tab specifically for the small underserved and rural practices. Also you'll see a resource library that's there. So when we were talking about certified electronic health records there's certainly quality improvement fact sheets that are there. The selector that's there. The quality measure specification package that's list there had so we have a whole toolbox if you will, that has all the resources that you need to get started.

And then secondly, we know the program can sometimes be confusing, we know you need information right away. We made it very, very easy for you to get the resources and the information that you need. You can contact CMS by e-mail and that's QPP@CMS.HHS.gov or use the 18662888292. You can use that number, ask a particular question, they will get back to you or they will answer your request right then and there but when we talk about free, a lot of times, when our CMS leadership is out and about we want to make sure that every region that we have contact with understand that there are organizations that we have funded. Like here we have the direct technical assistant organizations. You might hear it as your QPP direct technical assistance, your QIN, your QIO, these are all people on the ground willing and ready to work with you.

Just like you have a few panelists here today that are also part of our QIN-QIOs and our technical assistants. These folks are here to help you and it is absolutely free. So you know the consultancy can be very, very high but these are the folks that know the rules, that know the program, know how to assist you so that you can get the most incentive back in your practices. And so, again, even if there's folks on the line that are working with more than 15 providers, again, use the QPP website to get the resources in which you need. We had a lot of talk about the QRUR reports the PQRS reports, etc, so peruse the website for those particular items so you can definitely be up to speed on what you need.

Also on the website you'll find different events. There are national webinars that are occurring frequently CMS are putting them on, some of our direct technical assistant organizations are putting them on live events, face-to-face events and webinars and so we do encourage you to use all of this information to make the best decision possible, but if you see all of this information and you are feeling quite overwhelmed, my first suggestion to you is to reach out to one of the direct support organizations. And they can guide you through to make sure that you're successful. CMS, we've made this first transition year extremely simple. I think you've heard the panelists say, yes, you can do one test case but, again, we want to make sure that you can, you know, definitely participate over time, get used to everything that's coming down the pike and more importantly we want you to be improving care in your practices.

And this is just a way to do it. I love it that one of the panelists was saying we were already doing this in our practice anyway. So we want to make sure we are getting credit for it. We want to be transparent with our patients, we want to be transparent in anything that has to do with our practice. So we want to participate and participate fully. So this is the information that you have again if you have questions send them to us in an e-mail, use the telephone number and definitely get to your direct support technical assistant organization to assist you. And, Bruce, I will turn that back over the to you. BRUCE SPURLOCK: Thanks, Brenda, one of the things you pointed out that is worth reiterating and that's the notion that we had a lot of people in the chatbox that are part of an ACO but that information is also available on the QPP website and if a small group thinks about joining they're able to get information on what it does and what it means for them as they contemplate that from a strategic standpoint so all of that is useful information. There may be direct support organizations that are useful. But they're all out there and available and you have to do a little bit of work to find out which one is in your reach and in your area. All right. Let's go to the next polling question. We have been spending a lot of time now trying to help practices prepare for MIPS and we want the folks to be successful. Help us understand the work that you're doing already for that. So you can answer this question, this is looking over the next four months, what describe what is is your plan for MIPS in the transition year 2017. Take the time to answer the question and then we'll go over some of the results. Looks like we have a lot of people taking steps for partial year reporting. A few going to avoid the penalty of going forward.

The last polling question we want to bring out is kind of different. This is a free text polling question and if you're not planning to participate in this first year, please share with what you think are your challenges for successfully participating or if you are having challenging moving forward. We don't typically do these kinds of polls but it gives us an idea of what are the difficulties you have. If you do not plan to participate please pick what you belief are your challenges. And the first answer we got is physicians are not concerned with penalties. That's, clearly something we've heard before. Those will be increasing overtime. The EHR is not capable. They're supposedly going to be ready next year. We are looking at not certified EHR. Short staffed, provider involvement. Not having an EHR. We'll post all these answers and it helps us understand some of the barriers that are happening in this process of MIPS transition year.

BRENDA GENTLES: As they type in some of the challenges they are facing we will look at these back at CMS but just because you don't have an electronic health record for this first year you're able to do something by claims so, again, reach out to that direct support organization so that they can help you figure that piece out and just remember, if you're taking care of your patients, you want to make sure that, you know, we're doing the best as possible by our patients. So it's always an opportunity to improve what we're doing. So those things and those items that get talked about, that become a priority for the practice. Again, that's something else that you can start looking at if you feel like your provider's just not interested. Look at your medical associations, etc., maybe having a peer to peer conversation with another practice who is participating may help move your practice along as well. So I won't take up anymore time on that particular topic but I did want to just be able to let folks know that it's still not too late. Not yet.

BRUCE SPURLOCK: One patient, one measure, one time. Let me do the last wrap up activity and give you a little bit more information as we talk about the future of what we're trying to provide with these webinars. First of all, let me share that the link to this recording of the event is available at the website that is listed on the screen. You'll see it come up here in just a second. But it's QPPSURS. You see it at the top. That website will be, have all of the recordings and all of the information we talked about and will have answer to the questions by the end of the week. The next topics that we're going to be talking about in timeframe October 17th and October 19th. How small group practice consist maximize their MIPS ACI score. We also have November and December events planned and if you don't mind if you can take a minute to give us feedback we really find it valuable to make these meet your needs. You can click on that link right now from your web platform and fill out the form and give us information about how we modify, adapt, make these even better so you get the information that you need. And with that I will ask everybody to thank you very much and we will sign off from the event. We hope you have a good day and thank you very much for participating.