| wsma_reports_yakima_pediatrician_wants_to_make_her_city_the_healthiest_in_the_nation | WSMA Reports: Yakima pediatrician wants to make her city the healthiest in the nation | Latest_News | Shared_Content/News/Reports/2018/wsma_reports_yakima_pediatrician_wants_to_make_her_city_the_healthiest_in_the_nation | <div class="col-md-12">
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<h5>September 24, 2018</h5>
<h2>Yakima pediatrician wants to make her city the healthiest in the nation
</h2>
<p>
BY KATIE HOWARD
</p>
<p>
<em>The following Doctors Making a Difference column was featured in the September/October issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
Yakima County is the jewel in Washington state's agricultural crown, as the leader in production of apples, cherries and pears, and as the country's top producer of hops. Pediatrician Yami Cazorla-Lancaster, DO, aims to make it No. 1 in something else: wellness.
</p>
<p>
Yakima County often falls toward the bottom of the list of statistics on overall health of its population, with high rates of obesity, diabetes and mental health challenges, but Dr. Cazorla-Lancaster has a vision for the region's potential. Through her pediatrics practice, Nourish Health; interactive online courses via her Veggie Fit Kids program; and efforts to bring the Blue Zones Project to Yakima County, she is working to improve the health of children and adults across the region.
</p>
<p>
The Blue Zones Project refers to "zones" of the world, such as Okinawa, Japan, and Sardinia, Italy, whose residents have been found to live the longest. The project partners with communities around the country to improve health by making changes to local policies and infrastructure that encourage healthier eating, higher rates of exercise and greater community involvement. If the county proceeds with implementation, it would be Washington's first designated Blue Zone.
</p>
<p>
Dr. Cazorla-Lancaster talked to WSMA Reports about her approach to wellness and how the Blue Zones Project could jumpstart the region's transformation.
</p>
<p>
<strong>In your pediatrics practice, you focus on overall wellness. What do you view as the components of that and how do you implement them in your approach to caring for kids?</strong>
</p>
<p>
I believe that all children deserve the opportunity to live their very best lives and to live long, healthy and joyful lives. I know that the only way to achieve this is to focus on wellness, not sickness. First and foremost is the importance of nutrition, specifically eating more fruits, vegetables, whole grains, beans, and nuts and seeds.
</p>
<p>
Although I am a primary care pediatrician and routinely encounter the typical childhood infections and medical problems, I am deliberate about discussing nutrition, sleep, joyful movement, and stress as often as possible. I live and breathe lifestyle medicine. I spend the most time discussing these topics during routine checkups, but sneak it in at any opportunity.
</p>
<p>
I also take my passion online by creating content for Veggie Fit Kids via Facebook, YouTube and Instagram and am always quick to accept opportunities to talk to media or speak publicly about the principles of health. I want my families to feel that it is realistic and achievable for them to practice healthy lifestyle habits in our modern culture. By showing them what is possible, I can empower and inspire parents to adopt healthy habits for themselves and their families.
</p>
<p>
<strong>Do you see an opportunity for your approach to be implemented on a larger scale in Washington? </strong>
</p>
<p>
Yes, anybody can practice this way. They just have to find the routine and method that works for them. You develop your practice style like any other habit. You have to become deliberate about discussing these foundational principles that will help keep children healthy and happy for decades and could potentially help reverse chronic disease in adults.
</p>
<p>
<strong>Tell us about the Blue Zones Project and why you think Yakima is a good candidate for it.</strong>
</p>
<p>
I see Yakima as a hidden gem in the Pacific Northwest. Like a diamond in the rough, we have all the raw materials needed to become a thriving locus of health and well-being: plenty of sunshine, a plethora of produce, access to outdoor activities, and a growing desire for change.
</p>
<p>
What we lack is the belief that we can become an epicenter of health and wellness and the organizational structure to get us there. The Blue Zones Project is described as "a community well-being improvement initiative designed to make healthy choices easier through permanent changes to environment, policy, and social networks, which ultimately promotes change in daily healthy habits so that everyone can live longer, feel better and be happier." It is currently active in 10 states and 43 communities and the outcomes have been outstanding.
</p>
<p>
<strong>What kinds of programs or resources would Blue Zones bring to Yakima? </strong>
</p>
<p>
The Blue Zones Project is specifically tailored to the needs and desires of each community, but the overall goal is to make the healthy choice the "easy" choice by changing the environment around community members. We know that people spend most of their time within a five- to 10-mile radius, which they call the "life radius."
</p>
<p>
Although we spend a lot of time at home, we spend most our time at work, school, and other places around the community. Increasing the opportunity for healthy choices outside of the home nudges people into wellness.
</p>
<p>
It would include things like optimizing city streets to improve walkability, working with grocery stores and restaurants to increase healthy offerings, working with schools, and engaging individuals with purpose workshops and connecting them with volunteer opportunities.
</p>
<p>
They also help communities affect public policies. The great news is that the Blue Zones Project has seen great success so far. In the beach cities, the incidence of childhood obesity is now down 78 percent since the start of the project. This is incredibly powerful.
</p>
<p>
<strong>What outcomes would you hope to see at the completion of the project? What would make it a success in your perspective?</strong>
</p>
<p>
I like to dream big because why not? I would love for Yakima to become the healthiest city in the United States! I would love to see the prevalence of obesity and diabetes drop significantly, see an increase number of our community members walking and biking, eating more fruits and vegetables and our overall well-being index increase. I know it is possible and I know that we can do it. But I think the greatest success would be for Yakima to blossom into her true potential.
</p>
<p>
<strong>What can physicians in other communities do to promote healthier lifestyles? </strong>
</p>
<p>
Lead by example first and foremost. When you take care of yourself by nourishing your body with vibrant and health-promoting foods, make it a point to move joyfully, get plenty of sleep and decrease your stress, your own light shines brighter. You then begin to inspire and empower others.
</p>
<p>
Learn how to bring more joy and wellness into your own life and you will see how those around you will believe that it is possible for them, too. The amount of influence you have as a health professional is more powerful than you realize, and you can affect your patients' lives just by being healthy and joyful yourself.
</p>
<p>
<em>Katie Howard is WSMA's social media and content specialist.</em>
</p>
</div> | 9/24/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |
| Practice_Alerts_September_20_2018 | Practice Alerts: September 20, 2018 | Latest_News | Shared_Content/News/Practice_Alerts/Practice_Alerts_September_20_2018 | <div class="col-md-12">
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<h5>
September 20, 2018
</h5>
<h2>Practice Alerts</h2>
<p>
In this issue, you'll find information on new Medicare payment codes for flu vaccines, education on value-based payment models and much more.
</p>
<p>
For personal assistance, contact the <a href="https://wsma.org/WSMA/Services/Physician_Practice_Helpline/WSMA/Services/Physician_Practice_Helpline/Physician_Practice_Helpline.aspx?hkey=fc908a57-5820-41dc-8a1f-e2a7b1498e3b">WSMA Physician Practice Helpline</a> by emailing Bob Perna, MBA, FACMPE, at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a> or Michelle Lott, CPC, CPMA at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.
</p>
<p>
To receive an email notification when a new issue of Practice Alerts is published, <a href="mailto:mml@wsma.org?subject=Subscribe%20to%20Practice%20Alerts">email Michelle Lott</a>.
</p>
<p>Jump to section:</p>
<p>
<a href="#help">
WSMA Physician Practice Helpline</a>
</p>
<p>
<a href="#healthierwa">
State Agencies – Healthier Washington
</a>
</p>
<p>
<a href="#hca">
State Agencies – Health Care Authority
</a>
</p>
<p>
<a href="#coding">
Coding: Evaluation / Management Reform
</a>
</p>
<p>
<a href="#clinical">
Clinical Issues</a>
</p>
<p>
<a href="#value">
Value-based Payment
</a>
</p>
<p>
<a href="#tricare">
TRICARE
</a>
</p>
<p>
<a href="#medicare">
Medicare</a>
</p>
<p>
<a href="#qpp">
Medicare / MACRA Quality Payment Program / MIPS</a>
</p>
<a name="help"></a>
<h3>
<span style="color: #4bacc6;">WSMA PHYSICIAN PRACTICE HELPLINE (formerly the WSMA Coding Hotline) </span>
</h3>
<p><strong>– Michelle Lott, CPC, CPMA </strong>(<a href="mailto:mml@wsma.org">mml@wsma.org</a>)</p>
<h3>New! Updated payment amounts and new influenza vaccine code</h3>
<p>The Centers for Medicare &amp; Medicaid Services has released information to Medicare administrative contractors (MACs) about payment allowances for influenza virus vaccines, which are updated on Aug. 1 of each year. The new amounts are <a href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html">posted online</a>, and practices should make sure their billing staffs are aware that the payment allowances are being updated.</p>
<p>Payment allowances for products not yet approved will be provided upon approval and once pricing information becomes available to CMS. MACs will reprocess any previously paid claims for the current flu season that were paid using allowances other those published in the influenza vaccine pricing website for the 2018-19 season that began on Aug. 1. This reprocessing should occur by Nov. 1, 2018.</p>
<p>Effective for claims processed with dates of service (DOS) on or after Jan. 1, 2019, influenza virus vaccine code 90689 (influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use) will be payable by Medicare.</p>
<p>This new code will be included on the 2019 Medicare physician fee schedule database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update. The new influenza virus vaccine code 90689 is not retroactive to Aug. 1, 2018. No claims should be accepted for influenza virus vaccine code 90689 between the DOS Aug. 1, 2018, and Dec. 31, 2018. If claims are received in Jan. 2019 with code 90689 for DOS between Aug. 1, 2018, and Dec. 31, 2018, MACs will follow their normal course of action for codes billed prior to their effective date.</p>
<h3>Payment, coding or other practice issues? Let the WSMA help </h3>
<p>WSMA's staff experts understand the unique challenges of medical practices. For your practice to succeed, your services need to translate into revenue. From simple to complex issues, we have the know-how, connections and expertise to help make that happen.</p>
<h4>Physician Practice Helpline</h4>
<p>The WSMA <a href="https://wsma.org/WSMA/Services/Physician_Practice_Helpline/WSMA/Services/Physician_Practice_Helpline/Physician_Practice_Helpline.aspx?hkey=fc908a57-5820-41dc-8a1f-e2a7b1498e3b">Physician Practice Helpline</a> is now available to help your practice run more efficiently while avoiding errors and ensuring that you receive accurate and appropriate payments. The helpline provides advisory services to resolve payment, coding or practice management issues.</p>
<p>The helpline is a free service to WSMA member physicians and their practice staff. Get help today: Contact Michelle M. Lott, CPC, CPMA, at 206.441.9762, 800.552.0612 or <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
<h4>Chart Review Service</h4>
<p>For direct assistance on issues related to coding and documentation, use WSMA's <a href="https://wsma.org/WSMA/Services/Chart_Review_Service/WSMA/Services/Chart_Review_Service/Chart_Review_Service.aspx?hkey=871ad332-db71-42b0-abca-1cebfa3e724f">Chart Review Service</a>. This service provides expert review, recommendations and preventive post-review education to improve your coding and chart documentation; protect you against allegations of coding errors and inappropriate payments; and help you avoid costly refunds of payments received. As a component of your practice's compliance program, this service detects, corrects and ultimately prevents errors by helping you achieve significant improvement in your coding and documentation activities.</p>
<p>For more information, contact Michelle M. Lott, CPC, CPMA, WSMA's health insurance coding specialist at 206.441.9762, 800.552.0612 or <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
<a name="healthierwa"></a>
<h3>
<span style="color: #4bacc6;">STATE AGENCIES – HEALTHIER WASHINGTON</span>
</h3>
<h3>Public forums showcase Medicaid Transformation vision, progress, and why it matters</h3>
<p>The Health Care Authority is convening public forums, both in-person and via webinar, to update the public about the progress of the Healthier Washington Medicaid Transformation project and provide opportunities for meaningful public comment. At this time, only the webinar date is still available:</p>
<p>"Transforming Medicaid: Why it matters to all of us":</p>
<ul>
<li>Thursday, Oct. 11 webinar: noon to 1:30 p.m. <a href="https://register.gotowebinar.com/register/8066955576474714113">Register online</a>.</li>
</ul>
<a name="hca"></a>
<h3>
<span style="color: #4bacc6;">STATE AGENCIES – HEALTH CARE AUTHORITY</span>
</h3>
<h3>Online prior authorization submission now available in ProviderOne</h3>
<p>The Health Care Authority has completed a system update to <a href="https://www.waproviderone.org/">ProviderOne</a> which allows physicians and other providers to submit prior authorization requests for medical services online.</p>
<p>Until now, physicians had to submit requests via fax or paper submission. This update will increase efficiency by allowing physicians to submit direct data entry and include color photos, X-rays and all other required documentation. Physicians and providers may continue to submit requests by fax or mail. Visit HCA's <a href="https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/prior-authorization-pa#step-4-submit-pa">prior authorization webpage</a> for instructions on these processes.</p>
<p>Reminder: For medical services covered by individual and small/large group health plans, new requirements are in effect this year streamlining insurer requirements and easing administrative burden. Make sure your practice is making the most of these new requirements by visiting the <a href="http://priorauth.wsma.org/">WSMA Prior Authorization Navigator</a>.</p>
<a name="coding"></a>
<h3>
<span style="color: #4bacc6;">CODING: EVALUATION / MANAGEMENT REFORM</span>
</h3>
<h3>CMS proposal on E/M codes: WSMA joins with AMA and other organizations</h3>
<p>The WSMA joined with the AMA and about 170 other medical organizations, signing onto <a href="https://www.ama-assn.org/170-groups-send-letter-proposed-changes-physician-payment-rule">a letter to the Centers for Medicare &amp; Medicaid Services</a> that raised concerns about CMS' proposal to substantially revise the current framework of the evaluation and management codes.</p>
<p>The proposed changes, contained in CMS' notice of proposed rulemaking for the 2019 Medicare physician payment rule, would collapse payment rates for eight office visit services for new and established patients down to two each. A key concern is that these changes would result in the underpayment of services to physicians who treat the sickest patients.</p>
<p>The letter expressed appreciation for CMS' goal of seeking to reduce excessive E/M documentation requirements and urged immediate adoption of these principles:</p>
<ol>
<li>Changing the required documentation of the patient's history to focus only on the interval history since the previous visit.</li>
<li>Eliminating the requirement for physicians to re-document information that has already been documented in the patient's record by practice staff or by the patient.</li>
<li>Removing the need to justify providing a home visit instead of an office visit.</li>
</ol>
<p>To address these concerns, the letter recommended the AMA's creation of a work group of physicians and other health professionals to analyze E/M coding and payment issues, with recommended actions to be presented to CMS in time for implementation in the 2020 Medicare physician fee schedule.</p>
<p>For additional background,watch the videos available on the CMS website.</p>
<ul>
<li><a href="https://www.youtube.com/watch?v=JvoRQfMtPo4&amp;feature=youtu.be">Introduction</a> (3 minutes).</li>
<li><a href="https://www.youtube.com/watch?v=B0BZmGYpYFU&amp;feature=youtu.be">Office visits</a> (2 minutes).</li>
<li><a href="https://www.youtube.com/watch?v=W2QBTQNxfSY&amp;feature=youtu.be">Panel discussion</a> (22 minutes).</li>
</ul>
<a name="clinical"></a>
<h3>
<span style="color: #4bacc6;">CLINICAL ISSUES</span>
</h3>
<h3>Suicide rates in Washington continue rising: September is Suicide Prevention Month</h3>
<p>In 2017, 1,300 Washingtonians died by suicide, and from 2006 to 2017 suicide in Washington state increased by an average of 2.5 percent annually. The national <a href="http://www.bethe1to.com/">#Bethe1to campaign</a> highlights five actions people can take to help prevent suicide:</p>
<ol>
<li>Be the one to ask.<br />
Ask the tough question. When somebody you know shows warning signs, ask them directly: "Are you thinking about killing yourself?" <a href="http://helpyourselfhelpothers.org/">Take an online screening</a>.
</li>
<li>Be the one to keep them safe.<br />
Do they have access to medications, firearms or other means of suicide? Ask if they've thought about how they would do it and separate them from anything they could use to hurt themselves. Learn more from <a href="https://depts.washington.edu/saferwa/">Washington's Safer Homes Coalition</a>.
</li>
<li>Be the one to be there.<br />
People thinking about suicide can feel a burden to their loved ones. If your friend is thinking about suicide, listen to their reasons for feeling hopeless and in pain. Listen with compassion and empathy and without judgement. <a href="https://www.nowmattersnow.org/skill/suicidal-thoughts">Now Matters Now</a> has videos from people who have experienced suicidal thoughts sharing what individuals can do to help manage those thoughts.
</li>
<li>Be the one to help them connect.<br />
Help your friend connect to a support system so they have a network to reach out to for help, whether it's 800.273.TALK (8255), the crisis text line (text "HEAL" to 741741) family, friends, faith-based leaders, coaches, co-workers, health care professionals or therapists. <a href="https://win211.org/search/">2-1-1's online database</a> is another way to find local resources.
</li>
<li>Be the one to follow up.<br />
Check in with the person you care about on a regular basis. Contacting a friend in the days and weeks after a crisis can make a difference in keeping them alive. <a href="https://zerosuicide.sprc.org/toolkit/treat/interventions-suicide-risk">Send a caring contact</a>. This could be a phone call, text, email or letter.
</li>
</ol>
<p>If you want to connect with someone anonymously, call the <a href="https://suicidepreventionlifeline.org/chat/">National Suicide Prevention Lifeline</a> at 800.273.8255, <a href="https://suicidepreventionlifeline.org/chat/">chat</a>, or text "HEAL" to 741741 to text with a trained crisis counselor. More information on <a href="https://www.doh.wa.gov/YouandYourFamily/InjuryandViolencePrevention/SuicidePrevention">suicide prevention</a> in Washington and the state's <a href="https://www.doh.wa.gov/Portals/1/Documents/Pubs/631-058-SuicidePrevPlan.pdf">Suicide Prevention Plan</a> is online.</p>
<a name="value"></a>
<h3>
<span style="color: #4bacc6;">VALUE-BASED PAYMENT</span>
</h3>
<h3>Succeeding in Value-Based Payment</h3>
<p>The WSMA can help our members and their practice staff succeed with value-based payment models through our three tiers of guidance and services.</p>
<h4>Tier 1: Reference materials</h4>
<p>For foundational knowledge on value-based payment, review AMA's online module <a href="https://www.stepsforward.org/modules/value-based-care">Preparing Your Practice for Value-Based Care</a>.</p>
<h4>Tier 2: Educational programs</h4>
<p><a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#vbptakeaction">Value-Based Payment, MACRA/MIPS, Healthier Washington – Take Action Now!</a></p>
<p>Both Medicare's MACRA Quality Payment Program and the state's Healthier Washington initiatives are built around value-based payment models. This free 45-minute OnDemand webinar, presented by the WSMA and Attune Healthcare Partners, provides an overview of the value-based payment models currently in play and focuses on specific actions to consider.</p>
<h4>Tier 3: Practice-specific engagements</h4>
<p>The WSMA and Attune Healthcare Partners have partnered to offer practice-specific consulting engagements to our members on value-based transformation strategies.</p>
<p>Attune's "5-Step Process" provides a path for practices to optimize earnings and simplify daily operations with a mix of traditional and value-based payment methods. Attune Healthcare Partners are experts in practice success under value-based payment and can help practices create a complete and individualized practice solution for mixed payment models.</p>
<p>For more information on the new service, review our free OnDemand webinar <a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#path">Mapping Your Path to Value-Based Care</a>. The webinar addresses: The Problem with Payment Change; The Solution: A Customized Map to Value based care; How the Process Works, Advantages &amp; Results.</p>
<p>For more information on WSMA's value-based payment guidance, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
<a name="tricare"></a>
<h3>
<span style="color: #4bacc6;">TRICARE</span>
</h3>
<h3>Health Net Federal Service and TRICARE: WSMA advocacy on reported problems</h3>
<p>In January, Health Net Federal Services took over the contract for the TRICAREWest Region that was previously handled by United HealthCare. There were some significant challenges with the transition at the beginning of the year and it appears as if these challenges are still impacting practices. The WSMA has been working with HNFS on addressing the challenges impacting physicians and providers. As of July 1, HNFS ended waivers to facilitate this transition.</p>
<p>At this time, we are hearing that problems are still occurring with the TRICARE program and that some of these issues are also impacting Medicare Advantage plans offered by Centene, the parent company of HNFS. The WSMA is communicating these practice-specific concerns to HNFS leadership for their direct intervention in resolving these problems. If you are encountering such issues, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
<a name="medicare"></a>
<h3>
<span style="color: #4bacc6;">MEDICARE</span>
</h3>
<h3>Noridian to end support of dial-up modem technology by Oct. 1</h3>
<p>On April 3, Noridian Healthcare Solutions began efforts to sunset support of modem technologies. Any provider or vendor who uses modems for connectivity and data exchange with Noridian will need to find alternative methods for this transfer.</p>
<p>Noridian notes that many alternative connectivity options are available. Network service vendors offer many affordable, user-friendly connectivity options which allow the use of secure internet connections for file transfers. A list of network service vendors conducting business with Noridian can be found on the <a href="http://www.edissweb.com/cgp/news/modem.html">website</a>. On that list, selecting a link will take you to the respective websites for more detailed information.</p>
<p>Also, some billing services and clearinghouses who submit to Noridian already use network service vendor connectivity as part of their services. Contracting with one of these entities is also an option for any submitter impacted by the modem sunsetting. A list of billing services and clearinghouses is also available on the Noridian <a href="http://www.edissweb.com/cgp/vendors/">website</a>.</p>
<h3>New Medicare card mailing: Update</h3>
<p>CMS started mailing new Medicare cards to people with Medicare who live in "Wave 6" states: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington and Wyoming. If your Medicare patients say they did not get a card, ask them to:</p>
<ul>
<li>Call 1.800.MEDICARE (1.800.633.4227). There might be something that needs to be corrected, such as updating their mailing address.</li>
<li>Sign into <a href="https://www.mymedicare.gov/">MyMedicare.gov</a> to see if CMS mailed their card. If so, they can print an official card. They must create an account if they do not already have one.</li>
</ul>
<p>Your practice can also print out and give them a copy of <a href="https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-and-Education/Tear-Off-for-After-Card-Mailing-Ends.pdf" target="_blank">Still Waiting for Your New Card?,</a> or you can <a href="https://productordering.cms.hhs.gov/">order copies online</a> to hand out.</p>
<p>You can use either the former Social Security number-based health insurance claim number or the new alpha-numeric Medicare beneficiary identifier (MBI) for all Medicare transactions through Dec. 31, 2019.</p>
<p>Check this <a href="https://www.cms.gov/Medicare/New-Medicare-Card/NMC-Mailing-Strategy.pdf" target="_blank">website</a> as the mailings progress. Direct your Medicare patients to <a href="https://www.medicare.gov/NewCard">Medicare.gov/NewCard</a> for information about the mailings and to sign up to get email updates on the status of card mailings.</p>
<p>CMS is committed to mailing new cards to all people with Medicare by April 2019. For more information on the transition to the new MBI:</p>
<ul>
<li><a href="https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18006.pdf" target="_blank">New MBI Get It, Use It</a>&nbsp;MLN Matters<sup>®</sup>Article.</li>
<li><a href="https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf" target="_blank">Transition to New Medicare Numbers and Cards</a>&nbsp;fact sheet.</li>
<li><a href="https://www.cms.gov/medicare/new-medicare-card/nmc-home.html">New Medicare Card information</a>&nbsp;website.</li>
</ul>
<a name="qpp"></a>
<h3>
<span style="color: #4bacc6;">MEDICARE / MACRA QUALITY PAYMENT PROGRAM / MIPS</span>
</h3>
<h3>Guidance on Medicare's Quality Payment Program</h3>
<p>To better your understanding of Medicare's Quality Payment Program (QPP) and its two payment pathways—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), the WSMA, working in collaboration with Qualis Health, recommends these useful resources.</p>
<h4>QPP Participation Status tool</h4>
<p>CMS has updated its lookup tool to include 2018 Qualifying APM Participant (QP) and MIPS APM status. This update uses calculations from the first snapshot of data from APM entities, with data from Medicare Part B claims with dates of service between Jan. 1 and March 31, 2018. To view your status at the individual level, go to the <a href="https://qpp.cms.gov/participation-lookup">QPP Participation Status</a> webpage and enter your 10-digit National Provider Identifier (NPI) number.</p>
<p>To check your group's 2018 eligibility at the APM entity level, log into the <a href="https://qpp.cms.gov/login">CMS Quality Payment Program website</a> with your <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-EIDM-User-Guide.pdf">EIDM credentials</a>. Then browse to the Taxpayer Identification Number affiliated with your group. You can then access the "details" screen to view the eligibility status of every clinician based on their NPI.</p>
<h4>2017 MIPS performance feedback and payment adjustment update</h4>
<p>If you submitted 2017 MIPS data through the <a href="https://qpp.cms.gov/login">Quality Payment Program website</a>, you can now view your performance feedback and MIPS final score. Access your 2017 MIPS performance feedback and final score by logging to the <a href="https://qpp.cms.gov/login">Quality Payment Program website</a> using your Enterprise Identity Management (EIDM) credentials. If you don't have an EIDM account, refer to <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Enterprise-Identity-Data-Management-EIDM-User-Guide.pdf" target="_blank">this guide</a>.</p>
<p>Other resources:</p>
<ul>
<li> <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-Performance-Feedback-fact-sheet.pdf" target="_blank">2017 Performance Feedback Fact Sheet</a> and <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-Performance-feedback-user-guide.pdf" target="_blank">User Guide</a>. </li>
<li> <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-Resources.html">2017 Performance Feedback Instructional Videos</a>. </li>
<li> <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-MIPS-Payment-Adjustment-fact-sheet.pdf" target="_blank">2019 MIPS Payment Adjustment Fact Sheet</a> and <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-MIPS-payment-adjustments-infographic.pdf" target="_blank">Infographic</a>. </li>
</ul>
<h3>MIPS Quality Payment Program exception applications due by Dec. 31</h3>
<p>2018 Quality Payment Program applications for the Promoting Interoperability performance category and for Extreme and Uncontrollable Circumstances are available. Submit a hardship exception <a href="https://cmsqualitysupport.service-now.com/exception_application.do">application</a> by Dec. 31.</p>
<p>For more information:</p>
<ul>
<li><a href="https://qpp.cms.gov/mips/exception-applications">Exception applications.</a></li>
<li><a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Exceptions-FAQs.pdf" target="_blank">2018 Exceptions FAQ. </a></li>
<li><a href="https://qpp.cms.gov/">Quality Payment Program website.</a></li>
<li>Contact the Quality Payment Program at <a href="mailto:QPP@cms.hhs.gov">QPP@cms.hhs.gov</a>&nbsp;or 866.288.8292 (TTY: 877.715.6222).</li>
</ul>
<h3>New webinar: How to Avoid a Negative Payment Adjustment in 2020</h3>
<p>Join Qualis Health staff for an interactive webinar focusing on best practices for avoiding a MIPS penalty in 2020 based on performance in 2018. Become familiar with "year two" of the Quality Payment Program and get guidance on data collection and submission for each MIPS performance category. Also, Qualis will identify best practices for avoiding a negative MIPS payment adjustment in 2020, based on your MIPS performance for 2018.</p>
<p>This free webinar will be held on Monday, Sept. 24 at noon PDT. <a href="https://t.e2ma.net/click/vxeiaf/nzedpb/nb0pu5">Register online</a> </p>
<h3>New webinar: Submitting 2018 MIPS Data; Advice for Solo and Small Group Practices</h3>
<p>This webinar will focus on the methods by which you can submit your 2018 MIPS data, including the CMS portal, an EHR vendor, and registries. You'll learn the step-by-step processes to submit your data for each performance category. This free webinar will be presented twice: on Tuesday, Oct. 16, 12:30 p.m. PDT (<a href="https://t.e2ma.net/click/vxeiaf/nzedpb/330pu5">register online</a>) and on Thursday, Oct. 18, 8 a.m. PDT (<a href="https://t.e2ma.net/click/vxeiaf/nzedpb/jw1pu5">register online</a>).</p>
<h3>CMS updates 2017 MIPS performance feedback</h3>
<p>CMS recently announced updates to the 2017 MIPS performance feedback reports to address several issues related to scoring. Those issues included the application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity credit for successful participation in the Improvement Activities (IA) Burden Reduction Study, and the addition of the All-Cause Readmission (ACR) measure to the MIPS final score.</p>
<p>CMS also extended the targeted review deadline to Oct. 15, 2018 at 5 p.m. PDT. If you believe an error still exists with your 2019 MIPS payment adjustment calculation, the targeted review process is available for you. Qualis Health can help you understand your feedback report! <a href="https://t.e2ma.net/click/vxeiaf/nzedpb/zo2pu5">Contact Qualis Health</a> with your questions.</p>
</div> | 9/20/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |
| Heal_the_business_of_care_with_fair_Medicaid_compensation | Heal the business of care with fair Medicaid compensation | Latest_News | Shared_Content/News/Latest_News/2018/September/Heal_the_business_of_care_with_fair_Medicaid_compensation | <div class="col-md-12">
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<h5>
September 18, 2018
</h5>
<h2>Heal the business of care with fair Medicaid compensation</h2>
<p><em>An opinion column by WSMA CEO Jennifer Hanscom, originally published in the Seattle Times on Sept. 12, 2018.</em>
</p>
<p>
When a business is no longer financially viable, tough decisions must be made. That, regrettably, holds true for health care as well. Even though it is a caring profession, physicians must also care for the businesses they run, and that can even mean closing a practice.</p>
<p>
When a physician has to close a practice, we know that patients not only lose a doctor who knows their history, they also lose access to care, face longer wait times and potentially risk delayed diagnosis during that wait. While all patients in a community suffer when a physician closes the doors, those on Medicaid are further disadvantaged as they very likely will have a challenge finding another practice in their community willing to see them.</p>
<p>
Medicaid reimbursement rates don’t come close to covering the cost of providing care, and many practices—to keep their business afloat—must limit the number of Medicaid patients they can treat. Medicaid provides coverage for eligible low-income adults, children, pregnant women, elderly adults and people with disabilities, and is supported by state and federal dollars. Historically, Medicaid rates have been extremely low, covering just 66 percent of what Medicare, the other government sponsored program for seniors and the disabled, pays for the same service.</p>
<p>
Nationally, policymakers sought to address this conundrum with the Affordable Care Act. Expanding access to Medicaid coverage to more patients also created a need to make sure these patients had access to providers who would treat them. Hoping to sweeten the pot, the federal government agreed to fully cover the cost to increase Medicaid payments to the same rate as Medicare for primary-care services only, and only for the first two years of expansion—2013 and 2014. After 2014, the understanding was to continue at the higher payment rate, the state would have to pay a portion of those costs out of their own coffers. In 2015 the payment rate increase stopped.</p>
<p>
Except for that short-lived bump in rates, Medicaid rates receive only minor adjustments annually, and those are nowhere near on par with the cost of medical inflation. Last year, the state Legislature enacted an increase for pediatric services under the Medicaid program after they realized that the impact of a 35 percent reduction in rates was seriously reducing access to care for children. While a positive and appreciated step, this one-off increase doesn’t address the larger crisis looming.
</p>
<p>
The average cost to a medical practice in Washington for a Medicaid visit is two to three times the amount it costs to provide the service. What business can survive when its receivables are lower than its expenses?
</p>
<p>
This unhealthy consequence of impractical reimbursement rates is a shortage of physician availability for Medicaid patients. In a recent Washington State Medical Association survey of 872 physicians, more than a third of respondents—physicians of all specialty types—reported that they no longer see Medicaid patients, largely due to low reimbursement rates. And when it comes to accepting new Medicaid patients, 49 percent of physicians in small practices said they are less likely to accept new Medicaid patients.
</p>
<p>
With more than 1.7 million Washingtonians enrolled in Medicaid and Children’s Health Insurance Program (CHIP), that affects a significant portion of our population.
</p>
<p>
Even so, physicians do what they can to balance the business of care with caring for the business. They entered this profession to help and to heal. But the miserable reality is that some practices may not be able to bear the losses, which can compel the need to limit what insurance plans they will take—a further loss suffered by both physicians and their patients.
</p>
<p>
There is a ready solution to this problem: Raise Medicaid rates to at least the level Medicare pays—for all physicians of all specialties—which would help ensure that the very real cost of delivering care is at least modestly covered.
</p>
<p>At the WSMA, we want all patients and communities to have access to care where and when they need it. Physicians must be able to viably practice, and fair Medicaid compensation would help.
</p>
<p><em>
Jennifer Lawrence Hanscom is CEO of Washington State Medical Association.</em>
</p>
</div> | 9/18/2018 10:45:08 AM | 1/1/0001 12:00:00 AM |