September 2017
Top Story 

Applying for a MIPS Advancing Care Information Hardship Exception

If you are a practice group receiving Medicare reimbursement through the MIPS APM value-based payment system (like most MaineHealth ACO MSSP contract participants), you may be excluded from reporting data for the Advancing Care Information (ACI) category if you're experiencing specific EHR-related hardships.

CMS may grant an ACI reporting exclusion if your group applies for and receives a Quality Payment Program Hardship Exception for the following reasons:
  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances*
  • Lack of control over the availability of Certified EHR Technology (CEHRT)
Learn more here
ACO In Action 

Practice Improvement Team Helps Pilot Patient Engagement Training 

Michele Gilliam and Lynne Siulinski
When Monique Roy-Nuki saw an earnest desire among Maine Medical Partners cardiologists to improve their interactions with patients, she turned to the MaineHealth ACO for help creating a patient engagement pilot project.

"Early in 2017, I reached out to a number of entities for resources and ideas. Through that process, I connected with Michele Gilliam and Lynne Siulinski from the ACO's practice improvement team and presented the pilot idea," says Monique, who was a quality improvement specialist and data analyst at MMP at the time.

"I was immediately intrigued," says Lynne Siulinski. "I've done extensive coaching in primary care settings, but not in specialty care. The pilot seemed like a wonderful opportunity to apply my experience and training to a new provider population."

"Patient engagement can be a challenge," adds Michele. "Creating a custom pilot program for MMP that could then potentially spread to other parts of the MaineHealth system was an exciting prospect."

Measure of the Month 

Annual Wellness Visits (AWV)

Measure of the Month is a series of articles that explores key quality and utilization goals and provides tips and resources to help you achieve success. 

This month we take an in-depth look at an area of priority identified by the ACO's Value Oversight Committee: conducting Annual Wellness Visits and improving clinical documentation. 

Annual Wellness Visits are intended to improve outcomes and reduce the cost of care through prevention and care planning, and reinforcing the role of the primary care provider.  These visits are a valuable checkpoint for your patients, and we are seeing preliminary data that indicate quality measures improve when Annual Wellness Visits occur.  In addition to creating a preventive care plan, this visit is an opportunity to schedule other preventive screenings, reinforce the importance of medication adherence, and ensure chronic conditions are appropriately documented and monitored. 

N eed To Know: Important Updates

Introducing a New Quick Guide to MIPS Just for MaineHealth ACO Participants

Medicare in collaboration with the New England Quality Innovation Network-Quality Improvement Organization, the ACO has published a quick guide to MIPS that's tailored specifically to ACO participants. It provides key info about determining participation status, reporting quality and EHR usage data, and undertaking improvement activities. 

Remember to Complete Providers' Required Annual Medicare Revalidation 

We urge providers to avoid a possible hold on Medicare payments or deactivation of Medicare billing privileges by completing the annual required Medicare enrollment revalidation process. Revalidation can be completed using  PECOS, the Provider Enrollment Chain and Ownership System. To determine a provider's revalidation due date, visit the   Medicare Revalidation List. 
Learn more at the  CMS revalidation website page.

Harvard Pilgrim Make Changes to Sleep Study and Sleep Therapy Prior Authorizations  

On September 1, Harvard Pilgrim made changes to the authorization program for attended and home sleep studies as well as sleep therapies. Changes include transitioning to a new vendor, National Imaging Associates, Inc. (NIA), to oversee utilization management of sleep diagnostic studies and allowing coverage for five additional home sleep study codes.

Martin's Point MA Plan Announces Prior Authorization Process Change for Radiology, Cardiac Imaging and Ultrasound (non-OB) Services

Effective September 18, 2017, eviCore healthcare will administer prior authorizations for certain imaging services. To learn about the changes that this will result, consider attending online orientations that eviCore will be offering throughout this month. 
FAST FIVE: ACO Spotlight

Mark Fulton, MD
Physician Data Scientist, MaineHealth ACO

Each month, we ask an ACO stakeholder five quick questions about their work and life. This month, we catch up with Dr. Mark Fulton

Omar Hasan keynotes this year's ACO-wide Quality Forum
Coming Soon: 2017 MaineHealth ACO-Wide Quality Forum Sept. 19
Join us as we share strategies to promote sustainability and spread of both quality initiatives and efforts to decrease low value care across the MaineHealth ACO. 

Practice leaders, physicians, and care team members will benefit from learning new approaches, sharing their own success stories with others and networking with colleagues from across the MaineHealth ACO network. 
When: Tues., Sept. 19, 2017, 8:30am - 3:30pm
Where: MaineHealth,110 Free Street, Portland, ME 
Keynote Speaker: Omar Hasan, MBBS, MPH, FACP - Senior VP, Chief Quality & Safety Officer MaineHealth, Maine Medical Center 

6th Annual Let's Go National Obesity Conference

On September 28  and 29, join Let's Go! to explore the key role of physical activity to improve your patients' health. Using the National Physical Activity Plan as a framework, we will explore how to use physical activity in the prevention, management, and treatment of obesity and related health conditions. We have an exciting line up of speakers from near and far! 

Medical Assistant Training - Free to All

Due to popular demand, we are working on adding two new MA Advance Training's to our fall schedule - dates below! 

"It was very informative, you don't realize how much you don't know about chronic diseases until someone teaches you! Thank you!"
"I found the program extremely organized"
"Provided great knowledge. Binders are a great 'take home' tool to have in practice to refer back to as reference."

Advanced Medical Training 
October 10th - MaineHealth, Portland - NEW DATES 
November 14th, MaineHealth, Portland - NEW DATES 

Click here for details and registration
Questions? Contact Claire Schreiber, Program Coordinator

MA Foundational  Training 
November 1st & 2nd - Register now - few spots remaining! 

Click here for details and registration
Questions? Contact  Claire Schreiber , Program Coordinator

Care Management Training - Free to MaineHealth ACO Participants & $100 for non-participants

October 3rd, 10th, 17th, 24th, MaineHealth, 110 Free Street Portland
November 28th, December 5th, 12th, 19th,  MaineHealth, 110 Free Street Portland

Click here for registration
Questions? Contact Claire Schreiber, Program Coordinator

New Web Page Details Medicare Preventive Services

The Medicare Learning Network has created an interactive website with coding, coverage requirements and patient cost-sharing info for 28  reimbursable pr eventive services.

Leadership Program to Build Clinicians' Skills for Addressing the Opioid Crisis

Supported by a grant from the Physicians Foundation, Maine Quality Counts is working with the Maine Medical Association over the next two years to help up to thirty medical providers across the state develop leadership skills to impact a range of public health issues, and specifically develop stronger skills to lead practice and policy change to address the opioid epidemic. Applications to participate are due September 30. 


Diabetes Distress: What Is It?

A clinical brief from the MaineHealth Chronic Disease Program

The bidirectional relationship between diabetes and depression is relatively well known.   However, recently there has been more discussion about a "new kid on the block" when talking about diabetes and depression: diabetes distress.   What is this diabetes distress and how does it impact your patients?