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2018 MIPS Reporting: What to Expect
As MIPS reporting for 2017 comes to an end, we want to let you know what to expect for MIPS reporting going forward.
Please note that the following information pertains to TINs
(a stand-alone practice or a group of practices under one legal entity) participating in the Medicare Shared Savings Program (MSSP) with the MaineHealth ACO. By virtue of their participation in MSSP, these TINs report under the MIPS Advanced Payment Model (APM), a preferred model with a smaller reporting burden than traditional MIPS. All clinicians within the TIN must report as the low-volume threshold does not apply at the clinician level in this model.
2018 MIPS Reporting Requirements: Category by Category
Quality Category
On behalf of each TIN, the ACO reports quality data to MIPS through the Medicare Shared Savings Program annually. As in past years, quality data from each TIN will be aggregated to generate one quality score for the entire ACO.
For 2018 reporting, CAHPS scores from MSSP will now be included in the MIPS Quality Score.
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Expanding Adoption of a Promising Heart Failure Protocol
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Ann Cannon, Melissa Caminiti, Beth Wilcox led recent heart failure protocol trainings in Belfast
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To help meet the challenge of reducing admissions and emergency department usage, the MaineHealth ACO and MaineHealth Healthy Aging recently introduced skilled nursing facilities to a heart failure protocol with the potential to reduce the number of emergency department transfers. Data showed that a large number of heart failure exacerbations at skilled nursing facilities led to transfers and readmissions, despite safe, effective and simple treatment that facilities could administer on-site.
The protocol is based on one pioneered by MaineHealth for the home health setting. It establishes a "target weight" for the heart failure patient when his or her condition is well controlled. A gain of four pounds over the target weight triggers the protocol, particularly if the weight gain is accompanied by other symptoms of exacerbation. The patient's provider is consulted and dosage of diuretics is typically doubled from the baseline. In most cases, use of the protocol controls the exacerbation within 48 hours.
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Fast Five: The Interview
 Albert G. Swallow III
Executive Vice President and Treasurer, MaineHealth Treasurer, MaineHealth ACO Board of Directors
Each month, we ask an ACO stakeholder five quick questions about their work and life. This month, MaineHealth's Al Swallow.
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Clinical Corner
Heart Failure and Diuretics: Tricks of the Trade
 The MaineHealth ACO has made reducing heart failure admissions a priority for 2018. In support of this goal, we're pleased to share an article from our partners
at the MaineHealth Cardiovascular Service Line authored by Dr. Samuel Coffin, MD, FACC, Board Certified Heart Failure Specialist at Maine Medical Center and the MaineHealth system.
Diuretics are the primary therapies we use to help get our decompensated heart failure patients back to target weight. There is evidence of significant variation in the use of diuretics and the effectiveness of that use. Our goal here is to support an approach that improves care and outcomes for inpatient and outpatient heart failure patients.
Trick #1: Maintain diuretic threshold levels.
All loop diuretics have a threshold effect where the kidney loses its ability to increase sodium uptake. If a patient who is fluid overloaded receives 20 mg of Lasix and there is no significant increase in urine output in the next few hours, then you have not reached the threshold needed to increase diuresis in that patient. The best way to diurese a patient is to maintain drug levels above threshold for significant portions of the day, using doses that meet diuretic threshold levels and spreading doses throughout the day.
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Events
ACO Insider Webinar
Target Weight at the Center of Heart Failure
Tue., Apr. 24, Noon - 1 PM
Our new ACO Insider webinars are your best source for timely, relevant and useful information about how to succeed as a MaineHealth ACO participant. Look for them at noontime one or two Tuesdays each month.
The April ACO Insider features Heart Failure Specialist
Dr. Samuel Coffin
who will introduce you to the clinical rationale and practical aspects of target weight.
The ACO's Medicare Risk Decision: What it Means for You
This webinar, offered three times during the first week of May, will explore the decision the MaineHealth ACO will have made about transitioning to a Medicare Shared Savings Program (MSSP) track that includes downside risk. How will such a decision impact the providers and practices that participate in the ACO? What's the thinking behind the decision? What will the road forward look like? Join MaineHealth ACO leaders for an in-depth analysis.
May Office Manager Super-Forum with Special Guests Beacon & Martin's Point Health Care
Tue., May 15, 8:30 - 11:30 AM
Online or In-person
The monthly Office Managers Forum is an opportunity for you to hear directly from a health plan representative on important policy updates and administrative tips, tools, and resources. The May forum features h
ealth plan representatives from Beacon & Martin's Point Health Care.
You will also hear from the MaineHealth ACO on the latest news, learning opportunities, and how to make the most out of the agreements that are in place with the featured health plan.
The MaineHealth MORE Conference
May 17, 2018
MaineHealth, 110 Free St
The MaineHealth MORE Conference offers practical clinical approaches to combating Maine's opioid crisis. Join your colleagues and a host of content experts to explore non-opioid pain therapies and innovative opioid use disorder (OUD) treatment modalities.
MNRI® Tactile Integration Course
May 19-20, 2018
Hutchinson Center, 80 Belmont Avenue (Route #3)
Belfast, Maine 04915
Presenter: Pamela Curlee
Course Hrs: 16
CEUs: This course is offered for 1.6 ASHA CEUs (Introductory level, Professional area)
CE Hours: This course is offered for 16 NCBTMB CE Hours
The Tactile Integration course explores in great detail the physiology and psychology of the tactile system, the developmental effects of over- and under-sensitive receptors, and the importance of an appropriately integrated tactile system to the process of integrating all motor reflex movement and patterns.
Let's Go! Advanced Motivational Interviewing Training
May 11, 2018 - Portland
May 22, 2018 - Brewer
Have you taken Motivational Interviewing training in the past and want to advance your skills? Join trainer Stephen R. Andrew, LCSW, LADC, CCS, CGP for this one-day "Advancing the Practice" course. Sponsored by Let's Go!, the training will be held in Portland on May 11th and in Brewer on May 22nd. The two-day MI Basics course (or equivalent) is a prerequisite. $50 for the day, includes lunch.
MaineHealth ACO Care Management and MA Trainings
- all trainings at 110 Free Street unless otherwise noted -
Nurse Care Manager Training
Free to MaineHealth ACO Participants & $100 for Non-participants
April 17, 24
June 5, 12, 19, 26
August 7, 14, 21, 28 at Pen Bay
October 2, 9, 16, 23
November 27, December 4, 11, 18
Medical Assistant Foundational Training
May 2, 3
June 13,14
August 1, 2
September 12,13
October 3, 4
November 7, 8
Medical Assistant Advanced Training
April 25
May 17 at Lincoln County
June 20
August 15
September 19
October 17
November 15
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eed To Know: Important Updates
Population Health Management Tool - April Update
The official launch of our population health management suite of tools is underway! Training on the ACO's Contract Dashboard and Arcadia Portal began in March, engaging super users and other strategic partners from all 10 ACO regions. While the tools provide performance data on a wide variety of measures, the primary focus of training and engagement efforts is contract performance, ED utilization and documentation of patient risk.
Claims data for five out of nine payers is currently loaded in Arcadia. We are actively working to load data from the remaining four payers, with a goal to have the remaining sources live by the end of September. We anticipate beginning to load clinical data once some privacy and security items are addressed. To date, 71 users have elected to be trained from population health and quality analysts to regional executive leadership. In the future, once clinical data is loaded, we anticipate the tool may also be used by select provider leadership and practice staff.
CMS Provider Revalidation Required Every Five Years
CMS provider enrollment revalidation is mandatory every five years to maintain Medicare billing privileges. Check out this
Frequently Asked Questions sheet for more information.
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Resources
Humana Step-by-Step Guides and
Correspondence Information
- Claim payment resolution View here
- Online code-edit and access simulations View here
- Provider payment integrity & escalation View here
- Correspondence addresses & fax information View here
Use These Videos to Teach Somali Patients Chronic Disease Self-
Management
These
health education videos,
created by St. Mary's and MaineHealth ACO care managers, are produced in Somali to easily communicate important health information to Maine's Somali population. The short videos feature care managers discussing health topics such as monitoring blood sugar at home, diabetes, and preparing for a colonoscopy.
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COPD Assist Offers PCPs Diagnosis, Treatment and Referral Tools
COPD Assist is the digital home of three key resources to help PCPs respond to COPD effectively: a guide to care, referral guidelines and an on-demand learning module with CME. COPD Assist was developed by the ACO in cooperation with the MaineHealth Chronic Disease Program and funded by a 2017 Harvard Pilgrim Health Care Quality Grant.
Subscribe to payer newsletters to receive notice of preauthorization changes, policy updates, tool roll-outs and other information that may impact your practice.
Aetna
Frequency: Quarterly (March, June, September, December)
Anthem Network Update
Frequency: Every other month (February, April, June, August, October, December)
Frequency: quarterly (January, April, July, October)
Sign up
for email list to receive periodic updates
Harvard Pilgrim Network Matters:
Frequency: monthly
Frequency: Quarterly (typically Jan, April, July, October)
Medicare Wellness Visit Resources
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