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Accepted for CMS Primary Care First? Here’s how to prepare your practice

You received your acceptance letter for CMS’s Innovation program, Primary Care First.  How exciting! But wait, you now need to review 95+ pages of contracting and the other documents sent with your acceptance.  You and your staff might be thinking, “What else do we need to do now to be prepared for the program to start in January 2021?”

As the PCF program lead at Mingle Health, I’d like to share several things you can do to be better prepared for PCF and the advanced delivery of comprehensive primary care.  Start now with some tasks to maximize your performance, attribution, and monthly per beneficiary per month payments.   The more you prepare now, the better your performance will be in 2021.

1. List your Qualified Registry or QCDR vendor for reporting.

The Advance Care planning measure is part of the quality gateway to receiving a Performance Bonus.  Verify that the vendor understands PCF, the measure, and when the program requires the information.  ** Due September 25, 2020 ** If you need a vendor, Mingle Health is here to help you.

2. Complete as many AWV’s as possible in 2020 and beyond!

The AWV, annual wellness visit, ensures correct patient attribution and provides the opportunity to attach diagnosis codes for chronic medical issues; thus, maximizing the HCC for each patient.

3. Start talking with patients about comprehensive primary care.

When should your patient go to urgent care, ER, or a hospital?  Introduce your care manager to patients with needs.  How can patients get help or advice without coming into the office? Do you have telehealth visits or same-day visits available?   Do you have the right people able to respond to questions and calls (i.e. care manager, MA, office staff, or other support staff)?

4. Review your current performance for primary care quality measures.

Understand your performance on A1c>9%, Blood pressure control, Colonoscopy screening, and Advance Care Planning metrics. If your performance does not match what you are expecting, contact your EHR and quality management vendors, talk through workflows, and make sure documentation is accessible for the electronic clinical quality measures.

5. Update your billing or revenue cycle management company.

Discuss any changes in billing and coding.  Make plans for maintaining patient HCC coding or improving it.  Plan for changes in how the RCM or biller will be compensated if needed.

6. Maximize the care management team.

Discuss what percentage of patients should receive care management and how they will be identified.  Identify a dedicated person or team to deliver care management on a consistent basis to those patients.  Clarify and communicate roles and expectations to team members across the practice.

7. Clarify and expand care plans.

Identify what it is you really want the patient to do between visits.  Is that documented somewhere?  Care managers should not have to be mind-readers to know what you are thinking about and planning for the patient!

8. Plan to review your improvement progress on the quality gateway measures.

Do you have analytics for those measures now?  Can you slice and dice the data to individual providers and the practice as a whole?  Who should be involved in reviewing the data?  Mingle Health has tools and expertise to mine your data and the CMS “data dump” for the information you need.

After reading our tips, how prepared is your practice? If you do not feel ready for the program, we can help. If your data analytics are less than helpful, we are here for you. We are the data experts you rely on for MIPS and quality program reporting and we will be your data and program support partner in this innovative program too. We have decades of experience across our team in managing practices, improving outcomes, and implementing care management programs. Get in touch with us if we can assist you with this exciting program.


MIPS and ACO Reporting under the Quality Payment Program

Dr. Dan Mingle and members of the team share their insights on how to maximize your success and payments for MIPS and APMs.

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