Introduction to the Quality Payment Program NavigatorWelcomeHello everyone. Welcome to the Introduction of the QPP Navigator webinar. My name is Jennifer Ride and I will be your moderator today. Our agenda today is the opening remarks, housekeeping items, we’re going to be doing some polling questions, of course we’re going to have a presentation. You’ll have the opportunity to ask some questions and also we’ll provide some answers. And, we’ll also have an opportunity for closing remarks.

Under the housekeeping items I want to go over today, before we begin I want to let you know that all the phone lines are muted. This really helps us provide a better listening environment for all of us and it does help to mute out the background noises. We will be making it available for you to ask questions throughout the day today or throughout the presentation. We’ll also be using the chat feature.

You may notice, depending on how your screen is setup, that on the right hand side or possibly at the top of your screen you’ll see some things like questions, chat, handouts, things of that nature and so we’ll be using those questions and chat throughout the presentation today. And, we’ll monitor those, so if you have any questions, comments you want to post, feel free to do that. We want this to be very interactive, so keep the comments and questions coming. You can also, if you want to ask a question privately, you’ll notice that you have a little, an option to send it just to one person. And, you can also do that as a chat function as well. You can send it just to the organizer. But, feel free to use those functionalities.

One other thing that I wanted to mention is that you can download the presentation. You should see a download option and you can actually click on the D3 Intro to QPP Navigator in the PowerPoint and when you select, when you press that or select that you can press download and it will download that so you can review it for later. We’re also going to make these handouts available for everyone that attended or signed up for the call, so by all means we’ll make it available one way or another or you can go ahead and download it.

And, one of the things that we’re going to be doing today is polling and some of this is just to get a sense of what where you are in the process and what you may be of interest in, so we can address our audience and your questions accordingly, so we want to start out with making sure that you understand how to do the polling questions and be sure to hit the submit button when you’ve answered the question. So, I’m going to be launching some polls and everybody participate.

Polling Questions 1 and 2So, here we go. Our first polling question is “Have you participated in Meaningful Use?” And, I’ll be launching that question. And, if you will answer yes, no or you’re not sure. Let me know and I’m going to give everyone just a few minutes. Looks like many of you are responding. I’m going to close the poll and I’m going to share the response. Looks like 75% of you have indeed

participated in Meaningful use. 25 have not currently participated in Meaningful Use. Okay. That was it. Thank you for participating.

And, now I’m going to launch or second question. Excuse me, I’m sorry. Have you participated in the Physician Quality Reporting System or PQRS? And again, we just need a yes, no or unknown. Here we go. Poll is open. Another few minutes. The vast majority is yes. And, I’m going to close the poll. And, I’ll share those results. So, 79% of you did participate in PQRS and 21% have not currently participated. So, thank you again for participation and giving us that information. It is very helpful.

Speaker IntroductionSo, now it is my pleasure to introduce our speaker for today, Mike Fondell. Mike is an experienced leader in healthcare management and information technology. He’s a founding partner with BizMed, a healthcare technology and consulting company. BizMed is helping practices, health systems, accountable care organizations and health plans with operational workflow changes and being able to capture revenue potential related to things like patient-centered medical home or pay for performance, shared savings, value based payments. You know things we’re all familiar with, such as QPP. Prior to BizMed, Mike served as in several President roles at Express Scripts for example for 14 years, as well as executive roles at EDS and McDonald’s? Mike has a degree in management and organizational behavior from the University of Missouri in St. Louis and an MBA from Washington University in St. Louis.

And, we also performing our agenda today on the QPP Navigator is Margalit Gur-Arie. Margalit is a cofounder of BizMed and she’s the architect and designer of the BizMed software and educational solutions. Prior to BizMed, Margalit was cofounder and Sr. VP of Operations at Physician Advantage and Sr. Director of Project, excuse me, Product Management at Purkinje/Essence. They’re both ambulatory EHR companies. She was also an HIT Consultant at SSM Healthcare. Margalit has a Bachelor of Science and a Master of Science in aeronautical engineering from Technion Israel Institute of Technology. She’s a leading HIT blogger and she’s an NCQA PCMH certified content expert. And, we’re delighted to have you both. So, take it away Mike.

PresentationWell Jennifer, thank you very much. I appreciate the introduction and more importantly, thank you to all the attendees, the participants on the line. We appreciate you taking a little bit of time out from your evening to allow us to share with you the exciting information, kind of introduction as Jennifer said, about the QPP Navigator software. Found it very interesting, the polling questions, many of you are familiar with QPP components having participated in the legacy programs. So, what we’re really going to be doing here today is hopefully share with you some new information about this tool and more importantly, how it can help you and then really being able to answer some of your questions and with that I hope that we can just go ahead and get started.

In terms of the presentation today, first of all we will cover just a little bit of a background information on QPP. I would say that this is not a deep dive into QPP information or kind of the terminology, who’s eligible, all of that, but at the same time we want to respect and certainly understand that some of the people just you know are now learning more and more about the program. So, give a little bit of basic information, but then spend the bulk of the time on the Navigator and again how it can help and its role and how to assist.

BackgroundQPP—Why do I care?

So in terms of just the background information as most of you are aware I'm sure that the quality payment program is a result of legislation passed in 2015. The Medicare access and CHIP reauthorization act or MACRA, which is really was intended to repeal the flawed SGR or sustainable growth rate legislation that was in the past. Many of you are familiar with the circus that would occur every year issuing the required legislative action in order to issue the fee schedule for the upcoming year and so really there was ultimately a bipartisan order to repeal that activity and what we're left with is the quality payment program. If there's one real takeaway from this slide, what we want you to be aware of is that this is important to you because it directly impacts your payments.

So, why we are really spending time on an evening like this is because we want to be sure that you have the information you need in order to not be able to have a negative payment adjustment and ideally obviously a positive payment adjustment, so this is information and reporting that you are required to complete in the first quarter of next year so really what we're talking about is preparation for reporting has to occur in really four to six months away. So, I'm going to again in the interest of just background we'll move through this quickly.

So if I must report

If we're talking about the quality payment program and indicating that you must report really you may be aware that all the quality payment program really has two tracks. Most every all of the physicians and certainly the physician group that Qsource was looking to help support will need to report under the MIPS program, which is the merit based incentive payment system. That is one of the two tracks the other being the advanced alternative payment model track. So, we will spend really the bulk of our time on the details of the MIPS program given that that's who the bulk of the people we have will report on. Longer term, the goal of the QPP Navigator is to also assist you if your practice is ready or to prepare you to be in positioning for advanced payment program advanced alternative payment methods if that makes sense to you. There are actually some added financial benefits albeit downside of potential risks associated with advanced alternative payment models. So, the idea is ultimately to position practices to be able to take that on if that makes sense for them, but certainly first and foremost, we must go ahead and prepare for submittal for MIPS. We want to make certain that you're aware that Qsource is available as a resource to help you with MIPS and that over time also a resource to assist with the advanced alternative payment models.

So now I report MIPS?

Again, one more set up slide and get something from MIPS in the polling questions there were the comments about whether or not you had participated in PQRS or the need we'll use what's listed here on the screen is EHR program. What can you can see is that really the QPP is really a consolidation of three legacy independent programs that were a part of the Medicare reimbursement models that were in place before QPP and they are you know a very similar so I think that you will find that there is familiarity with what it is that is expected but it's really kind of combining these all into one program. The QPP does introduce a new component so there are four components to QPP. The three that are listed on the screen quality, cost and advancing care information, but there's also an additional one around clinical practice improvement activities or an abbreviation improvement activities. We'll touch on that as well, so the it's really just trying to I guess make you at least comfortable that you're familiar with the components of this, but there are some nuances. And, again just trying to ensure that we're sharing with you information that's important to you.

Polling Questions 3, 4 and 5We do have a couple additional polling questions that Jennifer is going to tee up and so we're just want to kind of gauge whether or not you have made a decision first of all around your plans around participation if you're going to participate or not or if you haven't decided yet perhaps on this first payment year or first reporting season. Like people are voting. We'll give them just a few minutes. Absolutely. Okay, I think everyone's voted. I'll go ahead and close the poll and share the results. Wow. Very good. Interesting. Couple of unknowns. That's certainly understandable. That's certainly understandable. And, hopefully we can share some information today that will help you learn as to whether or not at a minimal learn more so we want to be able to assist with that.

And, I think we have another polling question. Excuse me. Go ahead Mike. No, please Jennifer. No, I was going to say our polling question is "Do you consider yourself an expert, advanced, intermediate or novice on the quality payment program?" And we're collecting some responses. Looks like everyone's voting. So, I'll go ahead and close the poll and share the results. So, some people just now learning information about QPP. We've got a number of people who view themselves, I guess the majority view themselves as having certainly a level of familiarity with it, but don't feel quite advanced, but then again a number of you do. So, looks like a great mix and one of one comment I guess is that as we go through this please use again that chat box.

We're going to have another commenter too. I guess background information on QPP just again to set the stage to make the discussion about the Navigator meaningful, but please ask questions if we're glossing over information that is doesn't make sense or this would be helpful for you to know. We've got a panel of experts here that we hope to be able to answer the majority of all your question. Good.

Okay, and one last poll before we proceed. Which area are you most interested in learning more about? Quality? Improvement activities? Or, advancing care information? I'll watch the poll.

And, now you're all experts at polling questions, so thank you. Alright. I'll close and I'll share the results. Interesting. Okay, so that's interesting. It appears that improvement activities in that is because that was the new category right albeit there are many of the things that are within that category that maybe practice activities that you already have underway. But that is the new component of the QPP program so it's not surprising that that's an area that you want to dive into additional information. Really with all of us certainly the quality and quality measurement is, I would say, one of the more complex and the most heavily weighted so that too makes a lot of sense. We'll try to touch on all of that. As we get into the details of the Navigator and selecting measures and again we want to make this beneficial to you so please use that chat box and help us make sure that we're getting you information that's going to be beneficial.

So, was there another? I think that was it, wasn't it Jennifer? The polling questions? That was the last one. So, we switched back to the slides. I'll make one more comment if I may on the polling question. About really the I guess you more your love of expertise and why we well we hope the QPP Navigator does is for the individuals on the call who have identified themselves as perhaps intermediate level of understanding or certainly some familiarity. We hope that the tool really provides you pragmatic information. Take information that you're already aware of and really actually simulating the reporting that you're going to have to do so that we really view that by I guess trying this in beginning to get an estimated MIPS score we think that that's the most pragmatic way to help you actually learn what it means and make it information that will help answer additional questions and you may find that actually you have got more knowledge about the program than perhaps what you're aware, but perhaps just because of the information that's been shared in the past wasn't really couldn't directly apply it may I say to your practice, so we hope to fill a void in that area.

Qsource Providing Free Support and ToolsSo now moving into a little bit more of the background information on QPP before we get into the details of what Navigator can do. First and foremost what I want to highlight on this slide is that Qsource is providing free support and tools. We'll share with you more about the Navigator but first and foremost we want you to be aware that that is a free resource that you have available to you along with their expertise and consulting assistance through their call center as well as individuals that can follow up with you on a personal basis. In terms of QPP as an introduction, 2017 is viewed as a transition year or is a transition year there may be more but this is certainly the first year that you've had to report and Congress in really CMS has identified that it is important that allow practices to be able to be able to report at a level they can. So they coined the phrase Pick Your Pace, which really denotes that you are able to participate at various levels of where our breath of detail so to speak.

So, there is an alternative available to you that, perhaps, because I know 25% of you have not submitted Meaningful Use or PQRS, and what you may find is that this year as a transition year you certainly want to begin getting in to avoid as the box at the bottom indicates a negative adjustment of 4%. So you want to avoid that, but you may find that all of this is a little bit overwhelming and I want to go ahead and at least submit some data so as to avoid that penalty of

begin getting familiar with the program overall so that is an alternative available to you and it's called the test piece or the test submission option and we'll touch on that a little bit more in terms of what that means.

For those of you a little more prepared, the QPP program also offers a ninety day or three consecutive months of data reporting, so in particular for the folks that are reporting quality measures oftentimes they find that they may not be prepared or fully prepared in 2017 report data for the full year. We could touch on that a little bit as well, but we believe that will want to at least do a partial submittal because of the full year requirements or reporting. And so, what that positions you to or is, you know, potentially at a minimum a neutral option, or potentially a small positive payment adjustment. So, depending upon your score and again we'll touch on that in detail. And, then finally those who are most well positioned leveraging your experience in Meaningful Use and PQRS being fully prepared to submit a full calendar years’ worth of data for 2017 and not only being able to obtain a positive payment adjustment, but potentially positioning you for actually a bonus as well. So, there are alternatives. All of them require a level of reporting. It really goes to the depth of detail or breath of detail that you'll be reporting.

How to Succeed with MIPSOkay, so as a transition year really a message from the team at Qsource is really don't take this year off. You know, please be prepared to go through and understand the dollar impact. We'll touch on that again terms of point’s scores and how you can translate that back into a dollar impact. Go ahead and get your data together. Really that's what the QPP Navigator is going to be all about- helping you to organize and be in the best position possible to be able to submit or what is best representing your practice. Many of you are already doing lots and lots of good work that there may not be a new name or activity that you need to kind of tag it as in terms of reporting, but what we hope to be able to do through the Navigator is to let you go through and understand what the measures are, select them if you can, provide background data around that and then ultimately getting in to understand what your score is. So as you can maximize your potential positioning for 2017, but also being even more prepared for 2018. So, that's what we hope to be able to help.

Your Data, Final MIPS Score and ImpactSo, again this may be a little bit of a repeat or some of you. Bear with me just a moment, I've touched in the past about a four components you can see listed on the screen here. There's the quality performance category, the advancing care information, a new name for meaningful use, the improvement activity performance category and then costs. Let me first of all say that cost the very last column component you can see is weighted as zero in 2017 that isn't also something that you do not need to report against. It's calculated for you based on your claims submittal to CMS. So, the bulk of the reporting is really around the first three components, but we want you to be sure you understand kind of a collection of how all of these come together to create a MIPS, final MIPS score, and then the bottom of the page really just goes through and it points out that if you choose not to participate that does get into a 2017 the negative payment

adjustment. The test submittal that we talked about earlier at least submitting a couple of a single measure submission three points in that MIPS score will result in a neutral payment adjustment so you'll have understood how to report and avoided a penalty but what we hope you really consider through this is again reporting on the good work that you're doing within your practices and we believe that there is you'll be able to very easily be able to report and get at a minimum you know a potential moderate payment adjustment or a higher level payment adjustment. And, we're going to show some examples of what the point accumulation is and how that might work and that's really the role of the QPP Navigator.

So that's the components and the point accumulation. Actually, there was an article that again came out from ACP around the quality payment program and the comments were that you know because of the familiarity with the components that make up the payment program really it is a scoring methodology in the complexity around the scoring mechanisms and curates really the most troublesome aspect for the position practices. It's really trying to understand what my score is and it's this idea of being able to give you an estimate of your MIPS score is the void that the QPP Navigator is going to fill for you. So, it will allow you to simulate your score.

Qsource Helps You Access QPP NavigatorAs I talk a little bit more about the details of the QPP Navigator one of the things again that we want to highlight is that this is a tool and is available from Qsource and if there was an analogy that I would use to maybe introduce this just to help frame it is that I would indicate that the QPP Navigator is like a Turbo Tax for MIPS. So, you're familiar with the capabilities of a Turbo Tax walking you through the requirements for filling out your 1040 every year and then ultimately being able to file. That is kind of the intent behind the QPP Navigator.

So, Qsource can help you get access to it and what's on the screen right now is actually a screenshot of the home page so, Qsource will help you obtain your log in credentials. There will be a user ID and a password issued to you. And, you'll be able to just to save the URL and kind of put it as a favorite and when you enter in your log in ID and credentials this is the page that first comes up. Just a couple of comments about this home page- there's you know some extra information on here you can see on the right hand side of the page there's boxes or access to information about patient centered medical home or some of you maybe be familiar on the bottom with the transforming clinical practice initiative. The point here is that there's other resources out there we're not going to talk about them this evening, but really I guess if there was a message here is that this software has been out and used by medical practices, actually hundreds of medical practices, over the course of the last five years or so or helping them actually obtain patient centered medical home recognition or specialty practice recognition or working through the clinical transformation the TCPI clinical transformation program initiative which again is a CMS initiative. Some of you may be participating in that and if you are you'll actually be able to get credit for that as a part of QPP.

So, the software has been in existence it's a Turbo Tax like tool to helps you, and really for QPP, you can see the arrow here on the home page and if you can read that it says My MIPS

Dashboard. It's a button that you can actually click. There's some other resource guides available to you or it can actually take you right out to the CMS QPP website which is also a free tool or help you get assistance in your state but when you click on that button the My MIPS Dashboard what's going to come up for you is what's on this next page.

QPP Navigator Estimates MIPS ScoreOne thing I didn't touch on and probably should have just comment this is a web-based application. I said that you'll get log in credentials and a URL. You can actually access the QPP Navigator from any internet browser or in your internet device, so, you could potentially access it off of an iPad or certainly your desktop or laptop at work. But, I wanted to just comment on some of the information that's going to be available to you.

MIPS Dashboard

Now this MIPS dashboard, so, we've highlighted a couple of things on this screen. And, first of all let me just highlight the information on the left hand side so you can see that there is a practice identifier. Your practice name up in the upper left hand corner and in this example if you can read the screen it shows that it's a triple A QPP task Qsource, so that is the practice name and certainly your practice name would show up. If you go just beneath that what I'm wanting to highlight here is the QPP Navigator will also support multiple sites. So, if your practice has more than one location it can support all of the sites for your practice and you put in information associated with each of them. In this test example that you can see is that the QPP test Qsource practice actually has four sites. The arrow actually on the PowerPoint goes over the first site name is ABC Internal Medicine and underneath that if you click that little icon around tools what opens up underneath that is the dashboard.

When we click on that MIPS dashboard button on the home page it's going to bring you right to this dashboard. It'll look just like this, but again just wanting to point out the Navigator supports multiple sites. In this example there's an internal medicine site. There's the DEF Cardiology site. You can read just going down the page on the left, as well as a site for GHI Gastroenterology. That site could be opened up in the same way internal medicine is or JKL Primary Care. So, click on the little button and it opens up kind of the dashboard or the site that you are wanting to look at. So, I'm going more into the body of the page highlighted here the dashboard that is what opens up and the buttons across that you can see quality or improvement activity, ACI, cost. Those are navigation buttons.

Tab Navigation

We've landed on the dashboard button, but you're able to move your cursor along and click on quality and get into the details of quality or the same with ACI as an example. So, those are the navigation buttons and we're currently on the dashboard button. You'll be able to come back to that every time you hit that dashboard button what you're going to see what's highlighted in the box in the body of the page there in the red box is the current total score.

Dashboard Scores

So in this example the current MIPS score is 78.6 as we commented before on the previous slide based on that points there's a possible payment adjustment as positive. If that point accumulation was at three it would say neutral or if it was zero it would say negative. And, in this example given that this has 78.6 points currently based on the information that's been entered in this test example it shows up where it is eligible for a possible quality bonus. So, that's kind of quickly it shows you kind of as it would indicate you would suggest a dashboard that gives you kind of the summary results. Right above the possible quality bonus I just want to kind of call out you can there's an underlying score you can switch to detailed dashboard and that will really open up a little more detail view of the how those points were actually calculated and each of the three quadrants. We can talk a little bit about that, but just showing you on this example, as we said before under the quality it's weighted at 60%. There's a little bit of information that's listed here in this example the ABC Internal Medicine site has selected seven measures they've at this point have chosen to report all seven of those and the estimated contributing score or the quality component is 45.6 and we'll show you where that detail comes from. But, that's all information that you can put in and model then is the point of this that you can model what your calculation would be. What your miscalculation would be.

Other Scores

It's the same for improvement activities. You can see it just highlights the weighting there. It indicates that a minimum requirement of one high or two medium weighted activities must be recorded. One was selected good and the estimated score because of that was fifteen points and advancing care information again you can see that so, this is just kind of how it opens up and what's needed then in order to really calculate and model the score is to actually navigate across the top you know move more towards what we're going to show in the next example is the quality component and how to add detail and end up getting that 45.6 points score. Then we've encouraged you to answer ask any questions.

QPP Navigator—Enter DataShow the next slide then if I may. I'll probably double click it and it'll go flying by a couple slides here. I want to open up and show you the actual quality measures and you can see a screen shot on that next once my computer catches up.

Mike, this is Jennifer. Let me see if I can do this for you. Hold for a minute. I am sorry. So, you know again what we're going to show is that as if we would have taken our cursor and there we go. Thank you Jennifer. I appreciate that.

And now, this is another screen view within the Navigator and we're moving into bubbles of detail. This is so where as the dashboard showed the summary results it's this is showing you how those how you get the data into the system and be able to enter measurement detail. It says on the left hand side, so we're in this example showing a little bit more of the measurement detail for quality. To the right on that top navigation button you can see you can click on that button and then you do improvement activities or ACIs like I commented before just going down the

page I want to point out that you're able in the Navigator to select either reporting at a group level or at a clinician level, so in this example there's a drop down box it says select group or clinician.

And, in this example it's reporting at a group level. If all of if you have loaded in each of the clinician names you could hit that dropdown button and each of the individual clinicians names would show up what you can do we're not going to cover that in the detail you kind of do that in the setting tabs above, but if you have entered that information which we provide guides on how to do all of this and you can end up picking to report at a clinician level. One of the often questions that is asked is "are you going to report at a group or individual level?” And, it's oftentimes difficult to answer that question and you say well how do I know well this would be a method by which you can actually answer that question that perhaps model it in either way.

Selecting MIPS MeasuresQPP Navigator—Select Measures and Enter Data

What I did, well didn't comment on as we move down the page just right underneath the quality but you can see some icons that are listed across the page we won't go into the details of that but there they are intended just to help you select measures. So, as you select a measure you know whether or not it is an outcome measure under quality or a high priority measure that kind of thing. So, we try to provide you useful aides that allow you to help select and put forth the best measures that make sense for you. So as I commented before we're submitting as a practice, ABC Internal Medicine, again that's one of our sites.

Submission MethodThe submission method that we have chosen is registry. As you're aware there are different methods by which you can report your information to CMS. In this example it's indicated because it's a quality component you could report it as this as a registry or you could report it via claims as you did in the past, PQRS or perhaps directly from your EHR. The system allows you to model the MIPS score because you do get different results based on the type of submission method that you choose to report your data. So, we give you the various alternatives that are available and then with that alternative and now the reporting period seen there right below. You can see that in this case it's selected a full year. It started in January and it's ending in December. So, what we're going to do a full year reporting.

Measures DetailsWe've now gone through and we're looking at the details of some measures that we have selected for quality measures. So, in the example that's highlighted we've selected diabetes A1C under poor control. So, the information it's showing for the diabetes measure and really what I want to comment on is that all of the measures that you may have seen out on or have played with out on the QPP website are available in the QPP Navigator. We're actually using the same CMS software, a sophisticated version of the CMS software, that's driving the QPP website, so you're able to select from all of the 272 measures that are out on the website could be selected and reported through the QPP Navigator.

So, we're just showing you an example of a couple that were selected. In this example you can see where it's an outcome measure, a high priority outcome measure, and it's able to be reported through your registry or claims or your EHR. The start date and end date for this measure are the same as what was listed above. That's actually they will be defaulted as for all quality measures the same submittal method that same date ranges that you put in the start date range right at the top of the heading there. And, then what you enter in it is actually a numerator and denominator for that for that measure. So, similar to what you may have reported in for PQRS you would have had a report from your EHR. We had a report on diabetic control diabetic measures and then from that report actually gone through and just taking the numerator and denominator not the patient detail and just putting in that summary data two numbers enter those in and then the system will calculate the percent and the decile. So, it actually obtains that from CMS.

I didn't touch on this in my comments earlier on the dashboard, but every time you hit on that dashboard button it's going to take the latest information that you have entered in the detail of all of the measure detail like what we've been showing on the screen and it's going to go back to CMS and actually calculate the measure using the same scoring methodology the same scoring software that CMS will use in the first quarter of 2018 when they calculate your final score. So, we believe that this is a big advantage to some other perhaps Excel calculator or things that are out there. So, we're, you don't have to worry about having the most up to date information either available in terms of measures or nuances that CMS is continuing to play with in terms of or adjust probably a better term as they continue to refine how they're ultimately going to score this. We're using the same software that they're using so that's a big advantage of using the Qsource capabilities that we're sharing with you.

So, you enter in those two pieces of information. It calculates you can see it's yellowed out here that information it calculates the percent and decile, and because we've clicked it as a MIPS active it's going to show up in the calculation when the dashboard is collected selected next. There's an opportunity to delete the measure if you've added it and you want to later remove it you can do that off of your scorecard. What's not shown on the page at the bottom of the screen on the same page that we're showing just visually we're unable to show it because there's as you may recall there were seven measures that we scroll down at the very bottom of it you're able to go out and add or select new measures. So, if you got seven and you want to add a new one, perhaps around you know some other measure that's important to your practice perhaps a specialty measure of some type you could do that and so you can do that all through the system and the system allows you to make multiple selections based on what you know is the higher universe of alternatives alternative measures that you can report.

So, that is really the method by which I enter in the detail and the improvement activities in ACI look all very similar. It's the same kind of method by which you would select the measures or the other categories as well. I did overlook or didn't touch on the validation button that will be something that will be important later in the year as you get closer to actually reporting. You're able to hit that button it will become active then you can actually upload to the QPP Navigator backup documentation that supports the numerator and denominator that you entered. So, in the

example on the diabetes we talked about having run a report or a screenshot from your EHR that shows how you obtain that numerator and denominator you're able to upload that data or that report directly to the QPP Navigator and that will be retained for ten years. So, what you're gaining here is a built-in audit trail for how you're actually substantiating the numbers that you're reporting to CMS. And, we think that's a big advantage as well.

Question 1

Mike, this is Jennifer. There are some questions in the question and answer box. Would you like to take those now? Yeah, if they relate to the screen I think that would be best. I believe they do. So, first question is does the Navigator take into account diagnostic radiology as a specialty, which is it exempt from advancing care information?

That's a great question and I want Margalit do you want to comment on that, but there are different exemptions for advancing care information. The QPP Navigator allows you to click a box in that selection in that category the ACI you could indicate you are exempt from that category and then the QPP Navigator automatically reweights the components so that it shifts that from the 15% that's typically allocated to an ACI over to the quality measure. It fully weights that at I said fifteen its twenty five and it weights it then at 85%. I don't know if that let me, also it's indicate that for specialists under the quality as you add measures that is a selection criteria or a filtering criteria how to select measures. I don't know if I commented on that before but that is what I am thinking of related to specialists that may also be a useful feature. I don't know if that answered the question or if anybody else wants to add something to that comment. If that if you have additional questions or if that answered your question feel free to put that in the chat box or to again to enter another question.

Question 2

We have another one another question here. It says does the QPP Navigator integrate with our EMR to harvest data or measured data to be entered manually?

Again, that's a great question and there will be additional capabilities added to the Navigator over time, but right now it does not integrate with your EHR. I mean we're looking we have not gone through the expense candidly. We're working mostly with small practices many of them aren't able to afford interfaces like so one of the things that we have on the drawing board is to be able to take a download of those measures and be able to parse it, but, that's not currently available so you do need to be a right now if you have to enter in the two numbers the sum of your detail report that you pull so you have to enter in your numerator and denominator. That's where we're at today. We have plans to have those, but those are the future capabilities.

Thank you Mike. There are no more questions currently.

How To Select Measures

Okay. I did have just on the next slide. There we go. Just kind of perhaps a bit of an editorial it goes back to the comment around specialists in terms of how to select measures and really I

guess the thought process here is that. You can certainly go through the Navigator and in in select the measures that have may be easy or what you want to report on or kind of ad hoc or you may just consider you know again what it is that my EHR can report against. Certainly not all quality measures not all EHRs can report on all quality measures. So, that certainly is a consideration, because as you put it in your numerator and denominator just so you know you want to be able to substantiate how you arrived at those numbers. The other thing I guess again more broadly on QPP that you want to consider is that well are there other quality initiatives that you already have underway perhaps you're doing work around more with patient engagement or working on your portal and really we encourage you to take activities that you're already engaged in or are important to you and use the QPP Navigator and QPP reporting in general as you know again focus areas on those same things that you're already trying to work on within the practice. And, certainly another consideration is where perhaps there's P for P bonuses available or incentives from carriers and perhaps you want to consider some of those measures as some things that you want to look at least initially because if you can improve upon those perhaps that'll help you not only with your Medicare and your MIPS score but perhaps it would also put you in better position to align with incentives on commercial carriers. So, I guess kind of a summary messages is you know please select measures that are meaningful to you that are important to your practice and not make this just an administrative burden or an administrative exercise.

QPP Navigator Support ToolsAnother thing that we want to highlight is that Qsource and BizMed have come together and we've prepared for you and we'll be adding various tools and resources that are imbedded right within the QPP Navigator that will be germane to you for different initiatives or improvement efforts maybe just a video clip on wanting to learn more about MIPS or drill down activities one of your improvement efforts are around for example how to improve access, how to think about your scheduling and improve access. There are many resources imbedded in the BizMed toolbox, because of our work around patient centered medical home that are all very very applicable to considerations around Meaningful Use improvement activities in your quality scores.

We'll be adding that information as we go, but and one of the things that's out there right now and we can make available to you is a two page little document its listed here on the screen shot. It says get your MIPS score in five easy steps. So, this is just a two page PDF you could print out and have on your desk and it walks through the various steps and you'll recognize based on what we've already talked about here today a couple screenshots that are already look familiar to you. I commented before we didn't show the screenshot on the log in page, but I mentioned you'll get your credentials through Qsource. They'll provide those to you. You log in can actually click on the MIPS dashboard as we touched on go to the MIPS dashboard to step two. It goes on to the other three, four, five steps and help you actually figure out how to fill in the QPP Navigator to get that initial MIPS score, which again we hope is helpful for you to know how best to submit.

Why Use the QPP Navigator?

Wanted to comment a little bit more on just you know the idea why I might use the QPP Navigator and one comment is that actually Qsource is using this as well, so this is a web based platform as I mentioned earlier and you can log into it and enter your information, but Qsource is using this same tool, so if you had a particular question or wanted to model something Qsource can actually log and see the same information that you have and be able to assist you real time with that. The system really does pull together really all the components of what you need to ultimately be able to submit and move towards the advanced alternative payments. There's a MIPS assessment. We didn't touch on that. That's in the system. It'll help Qsource better understand, so again some examples like polling questions like how you did meaningful use or enter in your practice demographic data. Putting all of the information in the system, so that is really kind of beneficial. Again, going back to that Turbo Tax analogy all the information you would need. I commented on the resources in support tools and again I want to highlight that if you upload the backup documentation the QPP Navigator can actually create for you an audit trail supporting your documentation as you go.

One of the things that we are very excited about and something that Qsource was promoted in BizMed was able to actually make an arrangement with a registry company, so that you can actually directly submit from the QPP Navigator to CMS. So, the QPP Navigator itself right now is not an approved registry, but one of the enhancements that we're working on and will be there for you at the end of this year is a method by which to take your final MIPS measurement criteria for the three components based on the score that you've calculated and actually submit it directly to CMS to fulfill your first quarter 2018 reporting requirements. There's a there is a fee if you will choose to do a partial year or a full year, but we were able to negotiate a substantially reduced cost. Generally the fees to report through your EHR or registry typically are in $300+ range per clinician and submitting through the QPP Navigator the cost is going to be $75 per clinician. And, if you choose to submit as a task submittal for 2017 you can report your IA and Meaningful Use measures through that at no cost.

So, we really feel like this is a one stop shop. It allows you to model put forward the documentation and put your best foot forward and then hit a button like using the Turbo Tax analogy that we opened this up with you'll be able to kind of e-file so to speak directly to CMS at the point in time when you need to do that during the first quarter of 2018.

Next StepsSo, what are some next steps? We want to certainly answer any more questions that you may have but one of the first things we would encourage you to do is to contact Qsource at either the email address that's listed here, techassist@qsource.org or their toll free number and you can obtain the practice credentials your practice your secure logon credentials through Qsource. So, that would be one call to action that we would highly recommend that you begin not only getting your credentials, but begin playing with the system. We don't believe it's too early to begin getting your ducks in a row so to speak, to begin trying to estimate what your score is, understanding what you're going to report against and have an idea of what does this is really

mean to practice in terms of the payment adjustment that we should expect. So, those that are really kind of the two big call to actions.

One of the other thoughts that I had that is not listed on the page here it was actually my omission is that we would encourage you to tell your colleagues, tell your friends or business associates, people that are within your association meetings that you attend if f they're in Tennessee or Alabama we would encourage you to let them know that the QPP Navigator exists. One of the big challenges that we have is just getting the word out and we certainly want to be able to best help you as well as we can and we think that with this tool it does that.

I mentioned before that we're going to continue to make enhancements to this system, adding tools and documentation and certainly the detailed information on how to submit it is it's not it's currently not in the system but it will be available by the end of the year, so you can expect additional details on future releases. And again, support is available either from Qsource directly around QPP or MIPS or questions you have about that or if you have any technical questions, forgot my password, I don't kind of get it, either Qsource or BizMed can answer those questions.

Question and AnswerSo, I went through that kind of quickly, but I hope that there are some additional questions, comments or ideas that you may have that we our panel would be happy to address.

Thank you Mike and at this time there are no additional questions, but we'll give everyone a few minutes to either post something in the chat or to again ask the question. Thank you so much for joining us today. Again, if you have any questions feel free to start posting those. Again, here's our help desk number and also our email address and also our Providers.Exchange, so email or access the site.

Mike, Margalit so far we haven't heard from you very much but I know you are on standby to answer questions. Thank you for providing that detailed overview and thank you to all that have been on the call today participating and listening. Again, we are all here to help you, Qsource and BizMed have a partnership here and please contact us if you have a question or just need some technical assistance with anything that we talked about today.

ClosingThere is going to be a survey that's going to be available as you exit the webinar, so we really appreciate it if you'll take a minute to complete that. It really helped to shape the future of any kind of learning event that we provide. Your honest feedback is really welcome and just as a reminder this call was recorded. It is going to be posted on the Qsource.org website and the transcript will also be available as well the handouts.

So, with that we'll give you all a few minutes to post anything in the chat or I will also make sure that you have your questions answered. So, we'll be here for a few more minutes and thank you all for your participation.

Well Jennifer, this is Mike again and on behalf BizMed we want to just thank Qsource and all of the participants they have chosen to hang in there with us through this part of their evening and we appreciate the opportunity. We're very excited about trying to help make this an easy transition year for all of the practices in Tennessee and Alabama.

And, we appreciate that Mike that that's what we're here for as well, so well thank you all. It looks like quite a few people have left the webinar and so, if there are no more questions we will log off, but again I think we have posted multiple ways to get in touch with us and feel free to reach out to us. We look forward to hearing from each of you. Thank you all so much. Thank you everyone.