1. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Quality Payment Program
Small Underserved Rural Support (QPP SURS) webinar
May 15, 11:00 AM ET AND May 17, 3:30 pm ET
Camie starts presentation. (1 min)
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES

2. HOUSEKEEPING ANNOUNCEMENTS
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
HOUSEKEEPING ANNOUNCEMENTS
If you are listening to this webinar through your phone, please remember to mute your computer speakers.
For assistance, enter your issue in the chat box.
To ask a question, enter your inquiry in the chat box.
Camie (1 min; RT 2 min)

3. POLLING QUESTION What is your role?
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
POLLING QUESTION
What is your role?
A clinician working in a practice with 15 or fewer clinicians
Non clinical staff from a practice with 15 or fewer clinicians
A clinician working in a practice with more than 15 clinicians
Non clinical staff in a practice with more than 15 clinicians
Quality Payment Program (QPP) contractor
Other person helping practices prepare for MIPS
Other
Camie (1 min; RT 3 min) At the start say that the presenters will be better able to tailor their comments to the audience if they have a clearer sense of who’s participating on today’s call.

4. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
POLLING QUESTION
What MIPS topic are you most interested in learning about from your peers?
Camie (2 min; RT 5 min).

5. Cms welcome Brenda Gentles, RN, BS, MS
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Cms welcome
Brenda Gentles, RN, BS, MS
Division of ESRD, Population & Community Health
Centers for Medicare & Medicaid Services
QPP SURS Central Support Contractor COR
Brenda welcomes people to the call on behalf of CMS. Notes that CMS is very committed to helping small group practices, particularly those in rural and medically underserved areas prepare for MIPS. Year two of the MIPS program introduces new opportunities for solo practitioners and small group practices. Although you may know what MIPS requires in 2018, learning how to successfully meet these requirements while continuing effectively serving your community and meeting your financial goals is essential. This event features owners and employees of solo and small group practices like yours that will share their insights and challenges related to succeeding in year two of MIPS. We appreciate your interest in this event and are delighted to introduce the panelists and the moderator for today’s event: Dr. Karen Smith, Robert Mencunas, Erin Shustack and our moderator Dr. Bruce Spurlock. (2 min; RT 7 min)

6. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Bruce thanks Brenda and welcomes the audience. Bruce reminds people to submit comments or questions into the chat box and notes that we’ll answer questions during the event and compile a list of all the questions and answers that will be released along with the slides and the recording for the event. Bruce assures people it’s ok to focus on what the presenters are saying and to ignore the chat since they can review its contents after the event is over if it’s too much information to process during the event 1 min; RT 8 min)
Bruce Spurlock, MD
President & CEO,
Cynosure Health
Robert Mencunas, Senior Program Coordinator. Healthcentric Advisors
Karen Smith, MD, FAAFP, PA
Erin Shustack
North County Initiative

7. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Setting the stage
Focus: Meeting MIPS requirements while effectively serving your community and meeting financial goals.
Strategy: Discussion with panelists from small practices like yours to share their Year 1 MIPS experience, insights, and strategies to overcome challenges.
Topic Overview:
Panelist Introductions and MIPS experiences
MIPS challenges and strategies to overcome challenges
Effectively engaging your staff
How MIPS activities benefit your patients
Setting priorities for MIPS activities
Practical advice for small and solo practices
Using the Chat Box
B Spurlock (1 min; RT 9 min) For today, we will have a roundtable discussion with your peers on their MIPS experiences and how their overcame challenges.
Note that CMS recognizes the challenges that MIPS poses for small practices and is addressing this issue by funding organizations to help them. Then introduce the next slide.

8. RESOURCES FOR free support
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
RESOURCES FOR free support
Technical Assistance Organizations
General information about QPP for eligible clinicians participating in MIPS or Advanced APMs:
Questions to CMS about Quality Payment Program:
Sources of support for larger practices and APM participants described in: QPP_Technical_Assistanc e_Resource_Guide.pdf
B Spurlock (30 sec; RT 10 min) Notes that all these orgs provide free assistance to small practices and that the link provides their full contact information. Also notes that many are participating on the event and will interact with participants that make comments in the chat box.
Free technical assistance and advice available for small practices from CMS-funded organizations. Contact information for each organization at:

9. Panelist introductions and year 1 mips experiences
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Panelist introductions and year 1 mips experiences
Introductions
MIPS Year 1 experiences
Bruce (8 min; RT 18 min) introduces each panelist and asks each to provide a brief summary of their practice, their role and describe their year 1 MIPS experience. Bruce thanks panelists and poses first question.

10. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What did small practices fear most about participation in MIPS?
B Spurlock (30 sec; RT 19 min) Bruce poses this question to each panelist.

11. Mips fears: how these fears turned out
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Mips fears: how these fears turned out
Fear of penalty for incomplete submission
Use of an EHR
Exclusions due to low-volume threshold
Fully understanding the program and changes
Understanding your role
Each panelist (3 min; RT 22 min) provides a overview of their initial fears and if these fears actually played out. Karen first and second bullet points, Erin next 2 bullet points and Rob last bullet point. Bruce thanks the panelists.

12. Question: What parts of MIPS have been the most challenging?
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What parts of MIPS have been the most challenging?
B Spurlock (30 sec; RT 23 min) Bruce poses this question to the panelists, first to Karen.

13. Challenges of a solo practitioner
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Challenges of a solo practitioner
Aligning the quality metrics promoted by your EHR vendor with the needs of your patients.
Getting live data to track your results in real time.
Learning to work with hospitals and insurers.
Karen(3 min; RT 26 min) talks about what was hardest for them and how they overcame these challenges. Bruce thanks Karen and brings in Erin.

14. Challenges experienced in a clinically integrated network
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Challenges experienced in a clinically integrated network
Choosing the most relevant and accessible measures and ensuring data elements are captured in discreet fields.
Regulation changes.
Aligning care coordination efforts between primary care, hospitals and community based organizations.
Erin (2 min; RT 28 min) talks about what was hardest for them and how they overcame these challenges. Bruce thanks Erin and brings in Rob.

15. Challenges observed by an advisor to small practices
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Challenges observed by an advisor to small practices
Rob (2 min; RT 30 min) talks about what was hardest for them and how they overcame these challenges. Bruce thanks Rob and poses next question.
Understanding MIPS in your eyes
Finding measures for Specialty Practices
Creating the EIDM account

16. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What strategies do you use to effectively engage with staff and other clinicians in preparing for MIPS?
B Spurlock (30 sec; RT 31 min) Bruce fields questions from chat if there is time and then poses this question to the panelists.

17. Effective strategies for engaging with clinicians and support staff
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Effective strategies for engaging with clinicians and support staff
Data sharing
Showing value to the practice and your patients
Removing the fear factor
Showing the financial impact
Panelists (2 min; RT 33 min) reviews the strategies they used to engage staff and other clinicians and what worked to encourage staff. Erin starts with bullet 1, then Karen on second bullet and Rob for last 2. Bruce to ask audience to enter their strategies into the chat.

18. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What are some of the benefits and drawbacks to submitting as an individual or as a group?
B Spurlock (30 sec; RT 34 min) Bruce poses this question to the panelists and first calls on Rob to discuss group and individual submission.

19. Group or individual submission
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Group or individual submission
If you report as an individual, your payment adjustment will be based on your performance.
Each eligible clinician participating in MIPS via a group will receive a payment adjustment based on the group's performance.
EHRs make group submission more efficient but using claims data is a simple option for individuals in practices without a usable HER.
Check your participation status:
Rob(2 min; RT 36 min) reviews differences between the options. Bruce thanks Rob and brings in Erin.

20. Accountable care organizations (ACO)
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Accountable care organizations (ACO)
Groups of doctors, hospitals, and other health care providers, who come together to give coordinated care to their Medicare patients.
To participate in the Shared Savings Program, providers must form or join an ACO.
ACOs must have at least 5,000 Medicare fee-for-service (FFS) beneficiaries assigned to their ACO in each of the benchmark years to be eligible for participation in the Shared Savings Program.
For Shared Savings Program ACO locations and contact information, see Program Data.
For more information on eligibility criteria, see Program Statutes & Regulations.
Erin (2 min; RT 38 min) to review what an ACO is, benefits and how to join. Bruce thanks Erin and introduces next slide about making strategic decisions to join a group.

21. WHAT TO CONSIDER WHEN JOINING A GROUP
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
WHAT TO CONSIDER WHEN JOINING A GROUP
Upfront costs
Shared Savings
Benefits of joining a group
What makes sense for your practice
Local circumstances
Karen first 2 bullets, then Erin on third bullet and Rob to discuss last bullet on case by case circumstances (2 min; RT 40 min) Bruce thanks Rob.

22. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What MIPS related activities have benefited your patients the most?
B Spurlock (30 sec; RT 40 min) Bruce takes questions from chat if there is time and then poses this question to the panelists, Karen first.

23. How patients are benefitting
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
How patients are benefitting
Better tracking of patients for example those needing diabetic eye exams
Improved screening for breast and colorectal cancer
24/7 access
Medicaid patience
Opioid monitoring
Karen (first 2 bullets; Rob last 3) (3 min; RT 42 min) discusses where they see the most benefit for their patients/which activities are really working. Bruce thanks Rob.

24. Question: What do you use to set priorities?
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What do you use to set priorities?
B Spurlock (30 sec; RT 43 min) Bruce poses this question to the panelists, first to Erin

25. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Priority setting for 2018
Create a Performance Improvement Plan for Quality Measures
Align multiple quality programs (ACO, payer contracts, PCMH) in order to reduce administrative burden
Being prepared
EMR: continue to document/click correctly for your QM/ACI
Claims: start the process of billing for non-billable codes
Erin first 2 bullets then Rob (2 min; RT 45 min) reviews short goal setting. Bruce thanks Rob and brings in Karen.

26. Priority setting for your practice
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Priority setting for your practice
Using PQRS reports to identify your practice’s needs
Value of having live, current data for priority setting
Working with ACO to perform gap analysis
Karen(2 min; RT 47 min) reviews long term priority setting. Bruce thanks Karen.

27. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
What advice do you have for small practices who are struggling to prepare for MIPS?
B Spurlock (30 sec; RT 48 min) Bruce takes questions from chat if there is time and poses this question to the panelists, Rob first.

28. Practical advice for small group and solo practices
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Practical advice for small group and solo practices
Use free consulting available through Technical Assistance Contractors
Work with others through clinically integrated network
Learn how to work with your EHR vendor to get what you need versus what they think you need
Rob (first bullet-include example), Erin (second bullet, with example), Karen (third bullet) provide practical advice for practices struggling to prepare for MIPS (3 min; RT 51 min) . Bruce thanks Karen.

29. Question: How can small practices prepare for the new cost category?
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
How can small practices prepare for the new cost category?
B Spurlock (30 sec; RT 52min) Bruce takes chat questions if there is time and then poses this question to panelists, Rob first.

30. Preparing for the cost category
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Preparing for the cost category
Review preliminary cost score once released.
Focus on care coordination, not cost cutting.
Learn how to work with hospitals and insurers.
Encourage providers to read and understand their QRUR reports. Our ACO provides cost data on a regular basis.
Focus on disease specific care management to prevent high cost expenditures from occurring.
*March LAN Webinar: How to Prepare for MIPS Cost Scoring:
Rob (first two bullets), Karen (third bullet), Erin (last 2 bullets provide practical advice for new cost category (2 min; RT 54 min)

31. Question: If I need more help, where can I go?
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Question:
If I need more help, where can I go?
B Spurlock (30 sec; RT 55 min) Bruce takes chat questions if there is time and then poses this question to Brenda.

32. Free RESOURCES FOR assistance from cms
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Free RESOURCES FOR assistance from cms
QPP website: information tailored for the needs of small practices MIPS-and-APMs/Quality-Payment-Program-Events.html
Contact the Quality Payment Program at: or call
Support and Available resources for Small, Underserved, and Rural Practices:
Small Underserved Rural Support Technical Assistance Organizations (see list on slide 8)
Contact information is available at:
Available websites of each Technical Assistance Organization
Types of help: needs assessments, webinars, technical support, links to peers you can talk with, assistance getting signed up to report through an approved channel that meets your practice’s needs
FREE Technical Assistance funded by CMS is also available for larger group practices and for clinicians interested in participating in an Alternative Payment Model. More information on those programs is available at: Guide.pdf
Brenda reminds people of the technical assistance organizations reflected on the map earlier and then introduces other free resources. finishes the overview of CMS resources and is thanked by Bruce (last 2 bullets on prior slide plus this slide: 1 min; RT 56 min)

33. Free RESOURCES FOR assistance from cms
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Free RESOURCES FOR assistance from cms
Year 2 Overview Fact Sheet
Improvement Activities Fact Sheet
Data Submission fact sheet
Other national webinars focused on small practices
Other national events about Quality Payment Program
ACO Information:
ACO Shared Savings:
Payment/sharedsavingsprogram/about.html
Payment/sharedsavingsprogram/index.html
Brenda continues with resources (RT 57 min). Bruce thanks Brenda and introduces the final polling question.

34. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
POLLING QUESTION
What do you think will be your biggest challenge in achieving a MIPS bonus in Year Two?
Bruce (2 min; RT 59 min) Bruce comments on challenges noted and turns it over to Camie for wrap-up activities.

35. Wrap-up activities Reminders:
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
Wrap-up activities
Reminders:
Links to the recordings of the event are available here:
June: Using Data and Strategy to Succeed in MIPS Year Two: Advice for Solo and Small Group Practices
June 12, 2018 at 3:30 pm ET: Register
June 14, 2018 at 11:00 am ET Register
Please provide feedback on this event: Feedback Form
Camie (1 min; RT 60 min)

36. SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
References
Some of the materials contained in these slides is drawn from:
Slide decks created by event panelists also provided information reflected in this presentation. The input from project panelists is gratefully acknowledged.
Other documents on the and Program/Resource-Library/Resource-library.html website provide additional detail about the MIPS program.
Disclaimer: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes periodically so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.

37. acronyms APM—Alternate Payment Model
SUCCEEDING IN MIPS: ADVICE FROM PEERS IN SOLO & SMALL GROUP PRACTICES
acronyms
APM—Alternate Payment Model
ACO – Accountable Care Organization
CMS – Centers for Medicare & Medicaid Services
FFS—fee-for-service
MIPS – Merit-based Incentives Payment System
PI– Promoting Interoperability
IA – Improvement Activities
EHR – Electronic Health Records
QPP – Quality Payment Program
SURS - Small Underserved Rural Support