1. The New World of Physician Payments
Virginia Cardiac Services Quality Initiative

2. Medicare Access and CHIP Reauthorization Act (MACRA)

4. Quality Payment Plan (QPP)
Under MACRA, the QPP is established and creates a fork in the road for physician payment beginning in 2017:
2017

7. Merit-based Incentive Payment System (MIPS)

8. The Merit-based Incentive Payment System The New Fee-for-Service beginning in 2017
PQRS, Meaningful Use and VBM eliminated
A single quality scoring system will be used
MIPS composite score domains:
Quality Improvement: 60%
Electronic health records: 25%
Clinical Practice Improvement Activities: 15%
Resource Use: 0% in 2017, will be added in (previously listed as 30%)

9. MIPS Scoring A score for each domain will be established
Weighting of domains applied
A composite score between 0 and 100 will be assigned
The Secretary will establish a threshold performance score and positive and negative payment adjustments will be assessed based on a provider’s performance relative to the target threshold

11. Alternative Payment Models (APMs)

14. Advanced APMs

16. CMS APM Framework

18. Final Rule for Mandatory CABG Bundle is considered an Advanced APM
Shared Savings Program Tracks 2 and 3
Final Rule for Mandatory CABG Bundle is considered an Advanced APM

20. SUMMARY

21. Rewarding Value: Where We Are Going
30% of Medicare payments in alternative payment models categories 3 and 4 by the end of 2016
50% in categories 3 and 4 by the end of 2018
85% in category 3-4 by end of 2019
Alternative Payment Models
Accountable Care Organizations (ACOs)
Advanced primary care medical home models
New models of bundling payments for episodes of care
Integrated care demonstrations for beneficiaries that are Medicare-Medicaid enrollees.

23. Virginia Cardiac Services Quality Initiative
CMS Transforming Clinical Practices Initiative (TCPI)
Support and Alignment Network (SAN) 2.0

24. Transforming Clinical Practice Initiative (TCPI)
Help clinicians achieve large-scale health transformation.
Support more than 140,000 clinician practices over the next four years in sharing, adapting and further developing their comprehensive quality improvement strategies.
Strengthen the quality of patient care and spend health care dollars more wisely, aligning with the criteria for innovative models set forth in the Affordable Care Act.

25. VCSQI TCPI SAN 2.0 What is the SAN 2.0 Grant?
Launched in Fall 2016, the goal of the Support and Alignment Network (SAN) 2.0 program is to leverage specialty and primary care transformation with learning that will catalyze the adoption of Alternative Payment Models at a very large scale and with very low cost
Goals of VCSQI Support and Alignment Network:
Educational outreach to administrators and clinicians
Practice Assessment Tool
Improved patient and family engagement
App Development to support the above educational efforts
Better Care Coordination through Patient Heart Cards

26. VCSQI Mobile App Specifications and Report Examples Note: Sample Data
Virginia Cardiac Services Quality Initiative

27. Mobile App Development
Patient Education regarding pre-, intra-, post-procedure, and post- discharge expectations including animated films
Resource Library using web-based technology utilizing established resources from STS and ACC
For hospital administrators detailing service line costs, along with individual clinician costs and resource use data (push notifications)
Clinician Data based on individual performance for cost and resource utilization (push notifications)
Dual User Authentication and Mobile App Security

28. Service Line Hospital Resource Use / Costs Isolated CAB, 2014-2015
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Select Report:
Service Line Total
Service Line by Quarter
Surgeon Total
Surgeon by Quarter
Mean Predicted Risk of Mortality
Mean Cost per Case
Procedure Type:
Isolated CAB
Isolated AVR
Isolated MVRR

29. Service Line Hospital Resource Use: O.R. Costs Isolated CAB, 2014-2015
Select Report:
Service Line Total
Service Line by Quarter
Surgeon Total
Surgeon by Quarter
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Mean Predicted Risk of Mortality
Mean Cost per Case
Procedure Type:
Isolated CAB
Isolated AVR
Isolated MVRR

30. Service Line Hospital Resource Use/Costs by Quarter Isolated CAB, 2014-2015
Select Report:
Service Line Total
Service Line by Quarter
Surgeon Total
Surgeon by Quarter
Mean Cost per Case
Procedure Type:
Isolated CAB
Isolated AVR
Isolated MVRR

31. Surgeon Total Resource Use / Costs: Isolated CAB, 2014-2015
Select Report:
Service Line Total
Service Line by Quarter
Surgeon Total
Surgeon by Quarter
Mean Predicted Risk of Mortality
Mean Cost per Case
Procedure Type:
Isolated CAB
Isolated AVR
Isolated MVRR

32. Resources from the Center for Medicare and Medicaid Innovation

33. Healthcare Communities Website http://www.healthcarecommunities.org/

34. Practice Assessment Tool

35. Change Package

36. Learning Networks Available from CMS
Webinars and Pacing Events
Affinity Groups: Data Management, Patient and Family Engagement, Sustainable Business Operations, and more…
Connection with other Support and Alignment Networks and Practice Transformation Networks

37. A few more words about: 1.1 Patient and Family Engagement*
Respect values and preferences (p6)
Listen to patient and family voice (p6)
Collaborate with patients and families (p6)
Be aware of language and culture (p7)
* From the Change Package

38. Communications Outreach Goals
Strategize best communications methods to educate patients
Establish innovative ways to communicate to clinicians and hospital members and provide regular updates to participating clinicians’ primary contacts
Plan, create and distribute educational resources, webinars and publicity materials to maximize impact of VCSQI programs
Evaluate effectiveness of communications efforts
Create educational content and source material for website, social media, print and other media
Assist with patient outreach and education programs to assist with hospital HCAHPS

39. Communications Outreach Goals
Oversee programs to facilitate better care coordination among providers, patients and their families
Assist with outreach to primary care providers and other clinicians through creation of content to help transition providers toward APMs
Assist with patient experience survey development and distribution
Introduce My Heart Card for timely patient records transfer for collaboration of care

40. My Heart Card: For Coordinated Patient Care Delivery
Credit card-sized flash drive to transfer info to patient upon discharge
H & P
Op Notes
Lab Results
Last Chest X-ray
Discharge Summary
Rx List
CT Scan or Cath Video (if determined helpful and possible)

41. Patient Heart Cards
By 2019, hospitals will be required to provide complete discharge records to patients within 24 hours to ensure better care coordination.
Patients will be supplied with credit-card sized USB drives that will contain their hospital records. After discharge, they can carry these cards to their other providers.
Creation of card sleeve with individual institution logo and emergency contact numbers

42. What does this mean for your program?
Education of clinicians and administrators about costs and resource utilization
Better care coordination for patients and reduced readmissions
Access to innovative web apps and report engines with push notifications
Patient Education Portal
Library of Best Practice Protocols
Opportunity to promote your cardiac program as a best practice nationwide
Expanding on the good work that you are already doing!

43. For more information, please contact: Jeffrey Rich, MD Eddie Fonner