All right, it just turned 145, so let's start. I hope you had a great first session and a great start to AOE Conference 2023. Thank you all for coming. I know half of you had to beg to come here. I'm just kidding. I try to volunteer for introducing a speaker and since I'm the speaker, I said it's easy for me to introduce myself. Today's session is value-based approach to MIPS. And now we hear a lot about value-based, value-based on all the bundles and stuff. So I thought I'll title it that because I want to tell you how much you can, how much effort you need to do to actually avoid the points. That's why I call it value-based. I have to read certain slides. Some of you, like the green badges might not, I know that by those, all the other badges would know. We are supposed to give you a housekeeping. Please turn your cell phones off or to vibrate. Exit signs in case there's a fire. Don't worry, I'll be the first one out. I don't know how many, like some of you here might have been in the AAOE Educational Council. It is a lot of work. I've been there two years in a row. So I know it is a lot of work. Some of you have done it. They look for your feedback. We actually look at all the scores at every session at every speaker. Your app is easy. You can rate your speaker and I'll be like the guy at the bank and say, please make sure you give me a five star. But make sure whatever it is, make sure you, because they're looking for the type of topics you're looking for and the type of speaker. So give your honest opinion. They really value it. They read every review. I don't do social media. So I wouldn't know what this means, but please continue. Like even though you're on silent, you can use hashtag AAOE2023 if you want to post during the session or afterwards. Some of you get CEU codes for this, your check-in, your check-in code. Please pay attention, it's 643905. 643905. And the topic for today's session is value-based approach to MIPS, improving your MIPS score. Some of you might already know me. I'm Joseph Matthews. I'm the administrator for Advanced Orthopedics. I'm a physical therapist by education. Don't have a formal business degree, but I try to figure out how to make things easier for me and my staff. I have done educational council. I've done advocacy for AAOE since 2010. I'm on the board and I'll be president-elect next year. For Ravi, Ravi is the founder and CEO of Simple Interact, a business-to-business, B2B software as a service, healthcare technology company that serves physician groups, hospitals, and FQHCs. Simple Interact's comprehensive front office automation platform speeds up the patient workflow while reducing staffing needs. Customers review Ravi as a trusted partner who can quickly comprehend business problems and suggest keep it simple solutions that are effective and easier to maintain over time. Apart from investing his blood, sweat, I don't see that, but, and smiles into Simple Interact, Ravi occasionally finds time for his favorite pastimes, travel, golf, and motorcycling. So, please join me in welcoming me and Ravi. Please join me in welcoming me and him. Okay. There is another housekeeping we are not supposed to sell, so I'm gonna put this out there up front. You're not supposed to sell, any speaker or presenter is not supposed to sell from the podium, so if you feel like any of the companies being sold, then there is a complaint line right there, email at info at aaoe.net. So, you got the check-in code for anyone who came late. The check-in code is 643905. I only have maybe 20, 25 functional slides, so you can ask questions as you go along. I like to bring it and keep going. So, please let me know if you need to stop at any time. Okay, sorry, go ahead. Okay, so you got that. You got the housekeeping rules. I can code, I already gave it to you. I'll give you the checkout when you're done. So, I do have financial disclosure. He did give me macaroons one time, so I have put that in there. And then he has the same. All right, so the learning objectives. If you've known me, I try to do my research on the front end so that the back end is always easier for me and my staff. So, I just wanted to find a simple and practical way to do MIPS to reduce the negative payment. Do you pay attention? I didn't say to get a bonus. I said to reduce the negative payment adjustment. The trick is the strategy for automatic practices to select the measure, selecting it and implementing. So, if you're trying to select a measure that you had to work really hard for, it's too much work. Then the other thing is how do you do it to where your staff doesn't have to click stuff? And how much can you automate it? So, that's the simple. So, I'm gonna keep it like expectations really low. You're just trying to avoid a penalty. And hopefully at the end of session, you will find a way to do it without, or you should find a method to where you can implement it easier in your practice than what you're doing today. And I tried to make it interactive. So, there should be a poll. It wasn't backwards. Oh, yeah, I don't know why they had the third one. Yeah, now you have it. Please, if you can scan that or go to that slides, I really took time to prepare the questions, very thoughtful. It just opens up a poll for you to select from. And we'll be starting one by one. My son says his goal in life is to be the class clown. And I think I know where he gets it from. It's not working? Yeah, I've seen it. You only let five people do it. Damn it. What? I only thought five people would attend. No, I'm kidding. I participated. Shoot. No, this is a... Hmm. All right. So, go ahead to the next. Can you go to the first answer? We'll see. Yeah, let me see. Let's wing it here. You're the IT guy, right? You better make it work. I'll try. How many of you know what MIPS actually stands for? I know CMS loves the acronyms. Did you know that if those who saw the poll, did you know that only one of those answers is actually wrong? All the other three words are actual acronym for MIPS. One was a physics based acronym, but it's actual true short forms of MIPS. But yes, it is merit-based incentive program. At least we'll have people see what the polis okay yeah please see what the polis and then you can shout it out if you need to. How many of you actually, what is your end goal with MIPS? Is it to avoid a penalty, get a bonus, contribute to the wealth of knowledge CMS has on us? Avoid a bonus. Okay, yes. Then you're in the right spot, because if you were in the other two, I wouldn't be able to help you. Do you think at the end of doing all the MIPS in the past two years, you are budget neutral, budget negative, or you actually made money? You made money on MIPS? How many of you actually watch your CMS EOBs to see if you have that negative adjustment for MIPS? And do you see the negative and positive or positive adjustments? Okay. So because sometimes if you're not tracking that you're actually getting a negative adjustment, which is funny because the MIPS adjustment, negative means positive and positive means negative CMS. I'm trying to get back to the slide deck. By the way, how many of you are able to go and get the actual slides from, you're able to, it's on the AOE website? It's on the app? Okay. I'm not very tech savvy. So one of you might have to show me. How do we get the... Okay, thank you. Just keep doing this. Is that where you were? Yeah, we'll just skip this slide. Yeah, skip this slide, okay. Let me see. So if you're able to have a say in the process, you would advise CMS to shove it, no, scrap the program, continue the program as is, and accelerate March to MIPS. How many of you know the MVPs? Or you care about the MVPs yet? Well, we just started, right? Yeah, but are you looking forward to joining the MVP program? Whatever's easier. Whatever's easier, okay. Excellent. So, sorry for the hiccups in the IT, let's continue. The poll was supposed to try to be funny, but it didn't work out, that's okay. It was funny in its own way. In its own way. It didn't work, right? Is the juice worth the squeeze? Is the effort that you put into MIPS worth it? So a simple way to think of this is, let's say a practice is making 10 million in revenue, and about 30% of their patients are Medicare patients. Then 9% penalty on that would come to about 270K in revenue that could be saved. If you think in terms of a provider, and let's say there's a provider who's making 900K per annum, then that translates to about $270K per annum. Now, if you're having to spend, for that saving 270K, if you're having to spend 200K or 250K, would you do it? Obviously not. But if you could get away with 50K or less, then yes, it's worth it, right? So that's the math here. And again, we're looking at all, not just the software costs, we're looking at the actual people clicking the buttons and the time it takes to click those buttons. So I know there is like experienced MIPS people, like it looks like you know what you're doing in MIPS, but you know that there is the MIPS, and then there's the APMs. Those who are qualified providers in the APMs, you don't have to do MIPS, you get an automatic 5% bonus. And then if you're a partial APM, then you can choose to go or not to go into the MIPS. So how do you get lucky to be in MIPS? One is you have to exceed the low volume threshold. And the low volume threshold is, you get to be more than, I think it is 90,000 in payments of Medicare, or 200 unique Medicare patients for the year. So how do you know that? You go to the QPP website and you search your providers. So what I do is I keep a list of all my providers every year, did they qualify, did they not, to get a pattern. So you can decide to then take the risk whether you do it or not do it. But it's still a risk and I'll tell you why. And the second thing is APM. How do you know you're an APM? You know you're an APM if you get at least 50% of the Medicare Part B revenues, or at least 35% of patients through the APM entity. I would go to guess that not many of you are actually in an APM, you actually have to do a work on MIPS. Next. All right, so low volume threshold. And the second one is, do I really have to do this? Check your doctor and the QPP provider stuff. Second one is EUC. You can see if you can exempt your doctors by any or all offers. And that's the easiest way to get out of it. As of this morning, I checked. The Medicare still has, CMS still has COVID as a valid exception for 2023. For 23, yes. 2022 was easy. I just said, no, no, no. COVID just made my staffing levels terrible and they accepted everyone. Now, my only concern, which you will see on the unexpected list is, the COVID emergency is gone. What happens if they turn around and change the rules in the last minute? You might say they won't, but I'll give you an example of how they do, right? So, low volume thresholds, my doctors, I'll give them full control. I'll tell them, hey, docs, you have not qualified in the past four years. It is your choice. You can either do this, or you can decide to take the risk. Maybe this year in October, you decided to get, you got a bunch of Medicare patients and you exceeded that. I can't go back and change everything in the past nine months. So, it's your call. So, I'll give them the choice and they make the choice for me to make it easier for their staff or not. Next slide. So, quick facts. The points to prevent a penalty this year are seven. To prevent a penalty. How many of your doctors have to get more than this to actually pass medical school? They can get these and go through medical school, but we have to get 75 to prevent a penalty. Of course, there is a graded, so it's not a scare tactic. You don't get 9% for getting 74. It's a graded from zero to 75 of the percentage loss that you have. Exceptional performance bonus. We used to, when it started, have a carrot. The carrot's gone. Now, it's only the state. It's only 0%. Data completeness, that is the number of eligible people that you reported on. The number of people you reported on divided by the total number of people, 70%. And guess what? Next year is 75. So, they're making it a little harder next year. The baseline points. You had participation trophies before. You could get three points for everything, but now this year, it is zero to start. And then you work your way up. In preparation for this, and what I do normally in November and December is attend a bunch of MIPS webinars from the CMS and from other people. One of the good sessions I saw was reporting MD. And they showed an actual graph of what was promised by CMS and what was actually received by the practices. Only 31% of your promised number was received because it is a neutral game. The penalties go in to pay the bonuses and people like me found a way to get out of the penalty, which means that the bonus people didn't get a lot of payments for their effort. So, when I look at all that, I'm like, you know what? I'm not going to work for that 31%. I'm going to work on avoiding my penalty. So, you know, there's four again, this is for the basics nuts and bolts. There is four sessions and I arranged it this way for a reason. And you saw that there's improvement activities. There is a 15 point maximum, aim for 15 points. If you have a reasonable EMR, you can get 15 points. Most of the EMRs will do it for you. So you have this year, you have 104 measures, four are new, five are existing. Does it matter? No, there's a bunch of nonsense stuff in there. You can pick the few that you need. But one thing that has changed from the past is before I would pick my pain doctor and make them do the PDMP. Do another doctor does another point. Now, 50% of the practice doctors have to be involved in that one to attest yes or no. So 50% of if you pick PDMP, 50% of your doctors have to check PDMP to get that point. So what I've chosen, which is easy is patient report outcomes, tobacco use, closing referral loop, 24 seven access, telehealth, decision support. And there are things, for example, PDMP checks now is required in the PI. So things that go for both, I will pick those. That way it makes it easier for you to get points for double dipping. PI, promoting interoperability, depending on which EMR you have, some are harder, some are easier. I can't name names, but the previous one that I had, we had to do all the work. So I may be between 15 and 20, but now with the new company that I am, it's much easier to get 20. So PAs, NPs and CNAs would get an automatic reweighting of your PI. No longer there this year. PTs still, therapists will get automatic reweighting of PI. Now, with the COVID exemption last year, you could decide to exempt the whole MIPS or just a part of the MIPS. And you could do your math to figure out if you'll make a bonus or not. There were some changes in measures and points, not a lot, but there was some small changes in the PI this year, if you want to pay attention. The quality measures, I'm gonna skip and go to the cost. And you see that I didn't put aim for. And you know why? Because no one else knows how to measure it. Nobody else knows how to measure it. It's a black hole coming from the government and that's why I put dice in front of it. You're rolling the dice if you hope to get 20 points. We do BPCI really well. So we think that our cost is reasonable, but that is the actual formula that they're using for some of those things. I have no idea what those look like or what these are. Is it calculus? I don't know. I did science, pure science. I have no idea what that is, but that is the measures. And if you have to argue the government's rules, how am I supposed to argue that? So I don't even worry about cost. That's okay. That is a black hole. I'm gonna pray to get 20 points. Then come back to quality. So quality is the easiest measure, in my opinion, that is under my control and a control figure that I am. I know that I can fight for that points. Now you can aim for higher, but I'm reasonable and say 25 or 30 because they make it harder every year to get the same amount of points for the same amount of work. So there's different methods, eCQMs, CQMs and claims. Web-based interface goes away this year. So these are only three ways you can do it. You have to have 70% qualifying measures. Remember next year is 75. My way is to strategize. Actually, I flipped it. I think I'm dyslexic too. Six to nine. So strategize to pick six to nine so that six are the ones that you report on. And you're trying to get to the maximum level of points that you can. So how do I strategize? How many of you know the benchmarking report? CMS benchmarking report? That is the key. That is where you should start. It is an easy one on QPP resources. It will tell you, if you gave me the answer sheet, I would take it every time, right? Benchmarking report will tell you which measure is going to give you which points, which is what makes me decide which measures to target. Go ahead. So, again, this is where I've written to some Congress people. They still don't have the 2023 benchmarking report on. So how am I supposed to prepare for this year? Because some of the measures of last year that they scored me on no longer exist. But it's okay. I use the 2022 benchmarking that I'm trying to, and I have more than nine, just in case something drops off. So that is where I would start, is it is very easy. Go to QPP resources, go on the dropdowns and go to 2020. You won't find it in 23, but go to 23 quality, and it'll say benchmarking report, year benchmarking report. 2022 is what it is there. Last time it came out in February. I have it as April, but I went back and checked this morning. It came in February. So this year, I guess work from home is not working very well for CMS. They don't have the data yet. The second thing is look at the national benchmark. So the benchmarking report is the measure, the national average score. And based on the national average score is what they are giving the points on the deciles. And then what I do is, I take my previous year's average score, put it next to it and say, okay, last year I got these many points, doesn't matter. But if I have the same measure score this year, how many points would I get? Will I hit the 25 that I'm aiming for? If not, I will pick up another measure. Was that a helpful tip? So benchmarking report, take your measures that you need, that you feel give you the best bang on the buck and I'll show you how it looks. Not only look at the national benchmark score, but look at your own performance from last year to see if you will make it this year. And it can be non-ortho. You will see some of my measures, your doctors are gonna flip. My doctors don't give a lick. They just don't wanna touch it. Try and use patients to fill in their own mix. Six of my nine measures I don't touch. Patients enter all the data. Try and ask the right questions so that it makes it easier for the patients to enter the data, don't overwhelm them. Integrate with your EMR. Don't, so there's, for example, there is a well-known software that integrates into this EMR. You can see that the patient put in the date of the immunization, but it doesn't show up in EMR. Which means that now you have to go in and type that in to get the point. So try and find one where actually it fully integrates. Yes, it integrates, it's not enough. Doesn't take the whole information through. Try and find double-dependent. Like for example, false screening, tobacco, depression screening, go either in IAPI or quality. Try and find something that integrates Try and find something that cross-matches. So you're doing less work for more money. You know, I'm an Indian. I have to find more value for everything that I do. And then make sure that your understanding of the measure is accurate. Because there's two versions. One is the CMS has PDFs and I can send you all the PDFs. So I take every measure that I think is okay. I will go take the PDF and I will read it. And I will highlight stuff that most of it doesn't change a lot. If you had a new measure, then you had to read a lot. But I highlight and say, can I do this in my thing? And then I match it with my EMR because my EMR might have a totally different understanding and implementation of that measure. So you have to say, okay, if I do this, will this EMR give me the points? And if the understanding is totally different, you've seen some companies get penalized for faking this. So if you think that it's not intending the way CMS said, then you will report it to the company and say, hey, I don't wanna get screwed on this two years down the line. So make sure that your CMS and the EMR company's documents match. Next slide. Next. All right, this is how it looks. Actually, this is like a hundreds of rows down. And then you will see the measure on that side. You will see the measure number. You will see the type. You will see what it is. And this is important, at least one of the measures needs to be a high priority. So I know that I have gotten one out of my six in there. Here is a national score. And then on this side, actually, I have my score from last year to see where I would have fit in this. And I said, okay, how much points would I get for this? So if I say, if I'm just a national average, I would be here. Of course, this year is different. This is three. We'd have two, one, and zero. So what we see here is most people do this. You have to do it every visit. You gotta click that button. And unless you get to 85%, you get zero. Did you know that? Oh, I got 84. Doesn't matter. You got zero. Flu, until last year, of course, flu is no longer there. 40% would have given me six points. So it's not how well I do in that measure. It is how much does that measure give me? So this is where I start. I download this first, review the list and say, how many points can I get to get to national average? And if I've done this before, what did I actually get? Can I make it? Because in the past, osteoporosis, I thought was easy. My previous EMR was easy. I could make it. It was great scores. But it required a click from my staff. Didn't make it. Luckily I had nine and I had other measures. So then I don't pick it as a measure. But in the new EMR, it is very easy to make it because the way this EMR understands or interprets that measure is very different from the other EMR. So I can make more points easier this time. So if you look at the first six, cervical cancer screening, breast cancer screening, colorectal cancer screening, the reason I picked this is it's a yes or no question. Done. Patients get in, it is also based on age and sex. So not everybody gets that question. As long as, for example, a 45 to 75 year old woman answered that question, my data completeness is how many of that age group, that gender, answered the question. So now not everybody's answering every question. You make it to a very small subset of people that have to answer the question, and it's a yes or no question. No repeat questions. Advanced care plan. One question, yes or no, you're out. So all of these are yes or no. Statins was an accidental discovery last year. So we are a bigger group now. So another group had an endocrinologist. I'm like, man, you're getting 100 points on that, and that's equal to 10 points. How are you doing it? So I activated it for my own group. I don't have an endocrinologist. I was getting 100 points. I'm like, what the hell is this? So I asked the EMR company, they couldn't figure it out. And so then I was like, okay, reading their documents, the EMR somehow figured out that the patient's medical history had high cholesterol, or one of those diagnoses, put it as a diagnosis, patient was entering past the medications, and somehow we tied it up, I didn't even know it. And I can get points. And that is actually, if you look at it, it gives you, and then 85 is enough to get 10. And it's easy, because most high cholesterol people like me, take statins. So you have to kind of look, electronic screening, dual purpose, I'm PT, we have PT in the office. You do this 10 questions, patient get a risk score, easy to tell the patient, hey, you need to go to PT. But the patient feel the question themselves. And it's also a subset of people, the older age group. So this is a very simple way, in my opinion, to automate everything based on the scores. How much can you get back for the effort you put in? And this six, apart from the initial reading of the document, which I do, my staff don't touch it. So if something is going wrong, I hold him accountable. I send like every month at the end of the month, I get a report that said, where am I? Am I going up or down? And if I'm not going up significantly, I'm okay. Check your interface, it's all an interface. Can you go back and pulling all the data from the past? The other things I have there, so controlling high blood pressure. Okay, I'm not supposed to give you, don't please don't report me. Controlling high blood pressure, this is how the measure reads. So it's about how you read the measure. The measure says, someone who had a diagnosis of high blood pressure, who had normal blood pressure when you recorded it. So if someone had a diagnosis of high blood pressure, and you were measuring the blood pressure and that day it happened to be normal, you just got 0.5. So if your staff are doing blood pressure, but a lot of people are not doing it, I say, if you're recording it, record it the day it's normal, at least. Somehow they're giving, I didn't do anything for it. But the measure, this is a matter of look at it, this is yellow. I have to have a touch. I wouldn't do it, so my scores on these four are gonna be low. But this is, if the patient had a normal blood pressure, the scoring is much easier to look at. You can get much more points on this one easier than some of the other ones, like medication. Screening for osteoporosis, again, it's a much easier yes or no question, but you have to have a follow-up, so that's why I put it on yellow, but it's still one click. Any questions on this method? So if you collect blood pressure, is it gonna have normal reading? Are you recording the document? Yes. That you advise the patient that they should, okay. Yes. There's another step, right? But you have, there is two measures on blood pressure. One is blood pressure screening. That has zero points. Zero points, that's how we start doing. So you can do all the advice, go to a PCP, reduce your salt intake, it is zero points. At least in 2022 benchmark. This is controlling high blood pressure. Somehow I'm getting credit for controlling their blood pressure when it became normal accidentally. Right? That's dominant logic. Juicy. So, I don't know if you're wanting us to ask specific questions on these measures, but the one for osteoporosis, orthopedics, we're not treating their osteoporosis. They manage that through their primary care. So the measure required a DEXA scan to then come in and tie into the chart. So are you guys ordering those? Yeah. So if you have a rheumatologist who does a lot of DEXA readings, a lot of orthopods actually have bone clinics that this is a great measure for those people who have bone clinics. Because once you identify, you send them for DEXA, get the scores, do the bone clinic. So that might be great for some orthopedic groups. The other thing that you can fight with your EMR company is this. If you look at it, they will say, I can only do an eCQM. But the MIPS CQM for advanced, so advanced care plan does not have an eCQM. But it's an easy one to get. So if I can get that easy, then I tell my EMR company, you have to report it as a registry for me. And if you're large enough, they'll do it for you. What EMR do you trust? Athena. I'm not trying to help anybody here. Either I like them or not, or I hate them. Joseph, there's one more question. So some pushback I get from my doctors is from the liability aspect. Therapeutics, why are we asking these questions? And then what happens if somebody down the road, you screen them, you didn't recommend that they get a mammogram, but you ask the question, they end up with the correct answer. So a lot of them, they don't wanna touch stuff like that. Again, my doctors, as soon as they get a yes on this, they say, go to your PCV. And we document that, go to your PCV. It's off our hands. We told you, you have a problem, you didn't do it, go to your PCV. Now, would they rather go sit and click the wait? Take your weight in the office, take the BMI. Add that order, send the education to Portland. That's a lot of work. Okay, sorry. Athena is a known entity over here. And have you found any use of the patient care summary document of putting just some disclaimers on the cover sheet of that? If you had a positive, please contact your PCV. And have you had any issues with that? No, I mean, will Athena do it? I don't know, or you can put it as a macro. Yeah. So what we used to do is we have a, just do a macro, but you can do it as a, that's fine. That's good too. So you can have a hard-coded stuff that says, if you're positive on any of these, or if you have not done this in any time, please make sure you contact your PCV. So it takes a liability off of you. Again, remember, influenza and pneumonia are both gone for this year. That was kind of popular with orthopedics. Next one. So considerations is, are there measures that are available to govern as many points as possible, 10 if possible, if not, as much as you can? Are there, some of the measures are capped out at seven. You will see that, you know, if you take the measure, it'll stop here, and then it's dot, dot, dot, dot, dot, dot. So it caps you at a certain number. Are there measures that you can avoid? Those are the ones I would avoid. And of course, the one that have dots all through, which means that there's no benchmark, I would not do it, because they might give you a three at best. Can you earn more with lower performance rates like your statins? If you have a new measure, so it'll tell you new measure, see if you can do it, because they will give you a free seven points. So if you have a new measure that year, try and see if you can implement it, because you get seven points for the first year, five for the second year. And of course, as soon as people figure it out, they're gonna drop the points. Remember, you are doing compliance for all insurances, your penalty is for Medicare. Right, it's not that you only do it for Medicare. I was just gonna say, it's fun to work with very smart people and problem solving. Sorry. I was talking about Noah. I know, I know. But going back to that original question, would you spend 200,000 to save 270,000? No, and that's what happens when you're relying on manually having to do all this, collecting information, relying on staff to remember these things, knowing whom to ask when and so on and so forth. And that's where it's easier to automate some of this. And the key here in one of the things Joseph mentioned was making it very simple. If you're asking the patient to fill some of this information, make it easy for them to understand and make it easy for them to select an answer. Yes, no, that sort of thing. Also only ask relevant questions to relevant people. So based on age and gender, present the proper questions and know when to ask it. So certain questions, they're supposed to be asked only once a year. Some of them are supposed to be asked multiple times a year. So that, again, how does a staff member who has so many other 100 things to do, how do they remember all this context? It's very hard. Remember that I've talked to actually two different companies MIPS starts day one, January one. The problem is the software programming is 365 days. Don't ask the question in another 365 days. Patient came in December, came back in January, MIPS has to start again. So the code is not supposed to be 365 days. The code is 365 days from January one of that year. And it's important to ask these questions of both new patients as well as established patients, because the way that formula is, the denominator is essentially counting both new as well as established. So when do you ask, present these kinds of questions both for new patients, it would be during the intake and for established during check-in. Back to you. Okay, so surprises. I don't know how many of you got that surprise in January of 2023, that some of your measures that you worked so hard for in 2022 are not valid. Not your fault, but CMS says too bad. So surprises can happen. That's why you make sure that you have more than six. These three, somehow because of an ICD-10 update and it's deja vu because when it was PQRS, I-10, which is a freeway in Texas, whenever they updated that code, it messed up my PQRS measures and I got a penalty that year because I was only picking the six. So just watch for trunk either. There'll be surprises that you never know of that come, it's the first time I heard of that one. Benchmarks for 2023, I don't know what it looks like. So what you saw was 2022. So keep looking for it and see if you can get that report and then use your logic to pick the measures or change your measures. I am waiting for that change, the ball to drop and they say, oh, by the way, we had completed the PHEs and COVID is no longer PHE, so the waiver is gone. Right now it says until the end of 2023. Or they might deny all your applications in the end, I have no idea. The low exemption is, as I said, it's a risk. The doctor might end up with a bunch of Medicare's in the end and he might go over the threshold. So in summary, is it worth it? Yes, if I had to report versus if I could get an exemption, I'll take the exemption every time. But if I don't get the exemption, then I have to find the bare minimum to avoid the 9%. I try to find like really cool words, action words. It's not complicated if you have a plan, strategize. And my strategy starts with the benchmarking report, seeing how many points you can get for the least amount of work. How you can automate and optimize it, like how you can make the questions, how you can get the target audience really small so that your 70% of people is easily met. Educate your staff. So I have a staff clinicians meeting in January when I make this and present to them saying, you don't have to worry about all of this. You just worry about these three. But here's what you have to watch for. And if a patient asks, why are you asking me cervical cancer? Tell them CMS is very interested in population health and is asking our help to make sure that you remain healthy. With COVID, there was a lot of people who skipped their tests and stuff. So we want to make sure that we are supporting you in that program. So we try and give them a spiel. They can tell it to their patients. Evaluate. Every month when I get the report from Athena, I take last month and it blasts out to the entire group. Here's your last month's data. Here's your this month's data. And since I'm competitive, you wouldn't know that. I have six groups in Ortho Lone Star. I will put my group in front of the others and say these measures we got less in. Then I'll take my individual doctors for those measures and say, these are the guys who made me go lower than the other group. So it'll be highlighted in red. So then immediately the next day, I'll say to the doctor calling, can you talk to my clinician? I said, I can't come every time, but I'll do it once a month for everyone, but it will be done every month. Then it is not labor intensive. So we have better acceptance from our staff because the few clicks that they have to do, they complain. I'll say you can do more if you want, but there's a bare minimum that I've gotten you to. Next. And I think we're done. Questions. So just to follow up on her question earlier about the patient summary, because I don't use colorectal cancer for legal, right? Because if we don't catch it or document it, if something happens, can we have a default saying that says it is a recommended by something that everybody over the age of 50 receive a colorectal screening. If you get the PDF. It goes on everybody's. Yep. It's on the PDF, on the CMS PDF document. On the end, it'll have the clinical research or statistics on why this is a measure. This association recommends this to be done every two years to avoid death and blah, blah, blah, blah. Right, but if we put it on everybody's patient summary, and then if my doctor doesn't have to worry about putting it on my clinicians, because they're going to forget. It's a hundred percent. Automate. Automate everything. Don't let them do it. They'll screw it up. It says if you have an abnormal blood pressure, at least you're afraid. So that'll cover you as far as medical legal. They'll screw it up. Just do it on the bottom. Would it make sense to also include in an intake form? You could do it in an intake form, but you want to, intake form is not recorded in the system. So on the note, but the patient can always access on the portal. It's there. You should have gone and read it. It's not my problem. So on the fall risk, that's like how many questions? It's 10 to 12. It's easy 10 to 12. So with the other questions in your intake, how long does it take people to work through their intake? I have a 91% completion before the patient comes into the office. That's way up 85. Yeah. How long does it take them? Like I design or redesign a form together so I can finish it in five to 10 minutes, but the Medicare patient takes a lot longer. So that's why we're lucky that they do it at home, not in our clinic. Sorry, Asan. Yes, have you heard anything about MVPs and what the low volume threshold will be for that? I have not paid a lot of attention to MVPs because when I looked at the MVPs, it is a lot harder to achieve. Anytime that you can figure out something and you do it well, they're bound to screw you up. So I'm not interested in MVPs until they really push me into it. I know this game and I've played well. Not Medicare operational, to my understanding. It depends on, yeah. Then you have to look at your percentage mix of Medicare versus and see if it's worth all this effort. The denominator qualification of a unique encounter for a unique patient visit. Is that unique to the provider or unique to the practice taxidermy number? I think it's practice taxidermy. Okay, even if they report as an individual? Between, oh, if you're doing individual, it might change. We report as a group, but we have some providers who do really great. So they qualify to then report as an individual. So does that then make them- Probably under the individual. So it's a great trick. Reporting as a group will save those guys who are not doing well. But what we tell my doctors is you're all doing individual. Because otherwise it will be like the dinner that the king sponsored and asked everyone to bring wine, but everyone brought water. Because they want somebody else to pull the load. So we tell the reporting individually. You can do both. We can do both. I won't tell them I do both. I tell them you're doing individual. And then the group is pulled up. What providers actually know how you even report? Yeah, they don't know. So I just say, you're going to be on your merit. So, and you're going to lose 9%. So, any other questions? One of the things I forgot to mention, I think you did was when the data is captured, some of them require the date to be captured. And that's super important to do that. And also enter that into the EMR. All right, thank you all for attending. I thought there'd be five people. There's more than 55. So thank you so much for coming. The checkout code is very important. I know you came to see me, but this is more important. 067354. Checkout code is 067354. And if you are AAPC member, it looks like it's an ICD-10 number. Just one second. It's 83588XQI. AAPC? AAPC is 067354. AAPC code is 83588XQI. Checkout code is invalid. I will let AAOE know, because right here on the previous one, it says didn't work. 354. I will write didn't work again on this one. How are you? I'm good. How are you? Good. Did you? I should. Did you? I need your business card. Uh-oh. How much is it going to cost me for a one-on-one session? If you're an AOE member, not a lot. I am. I'm just kidding. With me otherwise, I will be reaching out to you. Sure. Because I need help. Sure. I have 15 sub-inductors. No, I can't help you there. I can help you with the measures. They need to hear it. You need to tell me how to automate this stuff. Yes, I will. Because I have your program. I do? Yeah. OK. I'm new to the website. Who's your intake? That's the problem.

MIPS

value-based approach

AOE Conference 2023

strategizing

automating reporting

benchmarking report

compliance

individual reporting