Today's session is value-based approach to MIPS. The reason we say value-based is I know you do bundles, you do all of that stuff. The whole point is how much money are you spending to save money or make money? So that's why we say value is cost plus results is outcome. Same concept. So I wanted to present the speakers for the session. You already know me. Ravi is the founder and CEO of a business-to-business software, SAS Healthcare Technology Company that serves physician groups, hospitals, and I don't want to say this, I'll go really slow, FQHCs. I don't know what that is. It was in my accent, it would have come out as something else. Their comprehensive front office automation platform speeds up the patient workflow while reducing staffing needs. Customers view Ravi as a trusted partner who can quickly comprehend business problems and suggest keep-it-simple solutions, hence Simple Interact, that are effective and easier to maintain over time. Apart from investing his blood, sweat, and smiles into his company, Ravi occasionally finds time for his favorite pastimes, travel, golf, and motorcycling. I had a picture of my family in the other one because along with the financial disclosures, I tell people my biggest disclosure is I waste a lot of time outside my house and my kids grew up 10 years really fast. So my disclosure would be don't be stupid. Stay home, spend more time at home. So the learning objectives. You have a job to do. I thought it's easier if I just keep clicking. So all we're trying to do here, like he said, we came up with this word value-based MIPS. We're not yet sure if all these rules are leading to value-based care or better care for patients. But at the end of the day, these are rules that have been set and you have to play by the rules. So now the question is, how do you do it efficiently and effectively? And our goal today is mainly to talk about how do you follow simple and practical methods to keep your negative adjustments low and just certain strategies that we have followed by not focusing so much on staff members doing things versus using automation to help you out. The question here is, do you want to spend $8 to save $10? Or do you want to spend $10 to save $10? $10 or do you want to spend $2 to save $10? So we thought it'd be fun to do a poll. The last time we did it, it didn't work. So we made sure that when we gave you a test, it didn't work. So we don't mind either scanning the QR code or going to the slides. You don't ever want the technical guy not to get it, right? So first question is, what does MIPS stand for? Next question, as a practice, what is your end game with the MIPS program? Sure, we all want to provide meaningful data and CMS. Back when you were a team member, you get a manual that only take your address. And it's right at the hooker, so that was not a practice. Yeah, a lot of people want to make a bonus. Bring a real one? Recording. There's more than 20 people in the room, so I already accomplished. There's about 34. Yeah. No, we were on the poll. Yeah, perfect. Thank you. No worries, man. A lot of hopeful folks over here clearly looking to make a bonus. Next one. Hang on. Next question. In the past year, have your physicians commented on dropping out of Medicare because of MIPS? That's a significant percentage. Simple, don't take meetings. Next question, do you feel like, do you feel that there are adequate and appropriate measures for orthopedics? This is a concept that I thought of. It's just the IMBC council that you're part of, if you want to join. MGA, AOE, AOF, we all are involved. Less than 5%, great vote of confidence. And last question, I think, is my practice has switched to MVPs this year. Anyone who's done MVPs, let us know, because that's a new thing coming. I've got a track record. Quite a few, actually. There you go. If you get traction on your writing, there you go. Got it, guys. Oh, all right. During the past, have you tried to put your costs, true costs into how much time it's taken to go MIPS or any additional software that I could do? And is that value neutral? No. It's hard to keep track of this mouse. Hang on one second. It should be up to a quick one. If I were able to have a say in the process, I would try and see if I still. So re-imagine the program. All right. All right, back to the slideshow. We should hopefully not be in MIPS 101 because it's been with us for quite some time. But, you know, the traditional MIPS you get qualified into whether you like it or not. If you exceed $90,000 in billing and you see more than 200 covered Medicare Part B lives, and if you do not qualify for an APM or partial QP. And I'm going to go this way. And since that's the other one that was available, APMs. This year, they actually raised the thresholds for APMs. They all talk about value-based, but then they make value so hard. And the APM structure where they took away all the bonuses and they gave a higher threshold. 75% of your practice has to use an EHR. The bonus was actually zero. Luckily, the March update, that section gave APMs a 1.80%. Otherwise, it was going to be zero. So you do all the work for nothing. Payment rates under Medicare fee schedule will be updated by 0.75. So that is the advantage for APMs if you can achieve that. But who wants to have 75% of your revenue coming from Medicare? So MVPs started, I think, last year. It has subset of measures that you can follow. It's the same thing, rehashed. If you've looked through PQRS, meaning meaningless use, all of these things just get rehashed. Somebody needs a job, they rename it something and put it into a new one. MVPs are the same thing. They just put a bunch of different criteria into little boxes. The two that I found for orthopedics are improving care for lower extremity joint repair and advancing rheumatological care. Please. So traditional MEPS, again, you have the improvement activities. I'm not going in order. Improvement activities is 15 points. 50% clinical engagement. I did so much work to change the whole slides into different colors, but it's okay. They still have the older slides, sorry. 50% clinical engagement. They have some of the measures over there. And if you have a good EMR, it should come automatically. The promoting interoperability, there's a max of 25 points. What I'm finding is you're not getting the whole 25 points all the time. So I'm saying at least shoot for 20. Your EMR should take care of most of it. The e-prescribing, all of those things are so easy still, the criteria. The one thing that they've made it harder in this section is last year, automatic reweighting for PAs were taken away, but this time they took it away for PTs. And a lot more people that are not mentioned in this. I think it's a nutritionist, OT and SLP are taken away from automatic reweighting, which means their PI scores matter. A good EMR, again, should help you achieve most of this. So the one that truly you can affect or you have to affect is the quality. Because as you can see, cost, I didn't even put into the blue factor. That is another thing that we advocate for is because it's like rolling the dice. You're hoping that government gives you X amount, but their formula, that is actual formulas that I pulled from the cost structure. And I don't even know what those squiggly lines mean. So I'm not even gonna try. They give me a score, they give me a score. I'm just gonna bend over. But the quality measures, sorry, the max points, 30 points, aim for 20. 20 is what I'm hoping for. Because if you don't get a 20, you're not hitting 75. In the quality, on the cost, you can't do anything. And they give you the feedback in February of the next year when you can't do anything. So they're very smart. So in the, you have the, I'm sure you know the quality. So you have eCQM, CQMs, claims are going away slowly. Your EMR has to decide whether they will support some CQMs. So every measure that they give you has an eCQM point score and a CQM point score. Sometimes the CQM point scores are better than the eCQM point scores. And you will see that as a strategy that you have to look at. And you have to fight with your EMR company to see if they will support it. They will report it as a registry. So capture measures, it's actually 75% of qualifying patients. And you strategize to pick nine to six measures. So this was done, this original presentation, I don't like to procrastinate, was done in December, January. And then the new section of the new act that they did in March changed some of this. So we did it with pretty colors and it didn't come up. The new one, I uploaded the new one on that one, but they didn't upload it here, but sorry. So the new one that you can follow online and have a PDF has everything. The PDF has everything fully updated. Next slide. So what is at stake? You can do it. But I like the record with that. And I can, my heart can do it. And then I can push on them. The question here is, is the juice worth the squeeze? Like, is this worth it for you to take all the trouble? So let's boil it down to some numbers. Let's say there's a practice where the annual revenue is 10 million, about 30% of your revenue is from Medicare reimbursements. So in the worst case scenario, if it was a 9% negative adjustment, that's quarter a million dollars. I think that's worth fighting for. Another way to look at it is a provider level making 900K, that's 24K in revenue. Obviously, this is on a sliding scale. Of negative adjustment. The likelihood that you'll actually make a bonus, marginal maybe, is very little. At least what you're trying to do here is reduce your negative adjustment. And now the question becomes, how much do you want to spend on it? Train staff as staff turnover happens, or do you want to automate some of this? So the reason I said that is yes, that is, oh, you will get a 9% penalty is all that you'll hear. But remember, it's a sliding scale. So it's not like you will get a 9%. You do something. If your EMR at least gives you IA and PI, you might get 5%. So it's better than 9% cut. The bonus of penalties for this year is from 2024. So when I got a nice check for 15,000 for one of my doctors who was not even with me, I was happy. But that was because she was at an APM in another state and got a good bonus. But remember, that was a good positive for me. It could also have been a negative. So some of these hits are coming from, so when you're interviewing candidates, just see where they're coming from too. If it's not a big number, but still these things do come two years later. So you can look at your slides there that should not have been like that. But I hate when things don't turn out the way I want it to. But your slides, they should have all the right information. It's 75% is to prevent the penalty. There is no exceptional bonus this year. Until last year, they gave you a little bit. They threw a bone, but there's no more money according to Medicare. They said, again, I go on my advocacy rants every once in a while. When I went to the Hill, they said, you need 335 million to fix Medicare payments. And they didn't have it. And then they passed a few laws recently that they're giving billions to other people. I'm like, fix our people. They said they didn't have money to give us for exceptional bonus and that you should have already changed all your systems. Data completeness threshold is actually increased to 75%. And then I think they're holding it steady for two years, thankfully. And I told my doctors, you could become a doctor with a lower percentage than this. But baseline points is no longer three. So before you did something, you got three points. I think last year or the year before they made it zero, which means unless, for example, how many of you do medications? Great. You know, what's the threshold for that? You can get an 85% score, 84.9% score and get zero. You get your first point at 85%. So when you pick measures, that's the trick. When you pick measures, pick one that you'll actually have a realistic chance of achieving. 52% will receive. So if you actually read the proposed rules, which we have to do in Advocacy Council, they actually put it there. That's 52% of eligible clinicians will receive a negative adjustment. So they have no problem telling you that this is what you'll get. 2.93% is the estimated MIPS return on investment according to the rulemaking. And they're proud of that kind of profit margin to you. Next. So the barriers to success. So when you add a new thing to your practice, I'm sure that everyone welcomes the change and does it right. But this is what I felt. The regulatory burden is these measures and scores change every year. There's a comment period that starts in April until June. Final rules come out usually. Like they'll say, okay, this is the final rule, maybe September, October, but they'll give you the final criteria in December. Mid-December, early December, so that you can go live January 1. So that's the time you have to prepare, right? So much time that they give us. So November, December for me is usually reading all the rules and trying to get my criteria right. The rules are complex. So it's not just knowing that, oh, I did BMI last year. Okay, BMI is no longer measured. I just threw that out. But then inside the BMI PDF, you have to kind of scan and see if they have changed any of the criteria, the rules. There's lack of orthopedic specific Excel for the 5% referral, that's good. Patience is lack of health literacy. They're like, why the hell am I answering these questions and clicking all those buttons? That's always there. I've always like, I didn't like COVID, but I always say, you know what? COVID has caused a lot of health problems in the country. And I'm trying to look at your overall health because you will see some of the questions I ask is not orthopedic. Social determinants of health. A lot of people don't take care of themselves as much. So some of that can be a barrier to your success. Staffers, they don't want to do it when we were doing before automation, the medical assistance. My biggest failure points are two measures, which you will see where there's automation, semi-automated, and then they have to go hit a button. They're so spoiled that they don't want to hit the button. Everything else is automated. Lack of adequate training and support. Every month, all the physicians get their scorecard on MIPS. And that kind of worries them because I'll have bold letters here. You are on target to have 9% penalties. And then there's, what do I need to change? Let's have a meeting. Let's talk to your MA. I have a whole manual printed out. I've trained you more than once, but here you go. Intuitive software. So you need a software that will integrate into your EMR. So I had a, so I've worked with Simulink for some time, but the previous, in my previous group called Centricity, that was beautiful. It would actually go in and click the buttons for me too. But Athena doesn't allow you to do it. So it's limited. You have to still click in a couple. So if you have a great integration with your automation software, then it will, it will help you. So there's a method to my madness. And again, it is not hard and I'm giving you the whole thing. If you do the steps one by one, it's pretty easy to do it. That's the link that you can go to and check periodically as if there's any updates. It will give you the MIPS measures. It will give you the PDFs. You can download it and start reading if you want. It does take time, but you download your benchmarks. That is the starting point for any strategy, in my opinion, because you want to see what you're going to get for each of these measures. So I look at all the measures and say, okay, I can do this. I can do this. I can do this. Then go to the side and say, here's the scores. Nope, nope, nope. And then here's the good ones. So that's how I look at my benchmarking scores. Even though you only need six with one high priority or outcome measure, I pick nine because what you think is going to be successful, sometimes is it. You leverage patient as a resource. Heck, the attendant at United didn't even touch my luggage. I had to go check it in and put it on the weight scale for them to throw it into the slide, right? Let the patient do it. They're used to doing it everywhere else. See two, four measures. So there are measures, which I'm finding the lesser and lesser of that you can get quality and improvement activity, right? And so I'm doing separate things. You touch this, you get this. So for example, closing the referral loop. Tobacco used to be one. Review both CMS and EMR documents. So one thing I realized is, oh, CMS had the PDF, which I thought would be the golden standard, but your EMR might interpret it differently and make you do it differently. In the end, it's the EMR that is pushing the scores out. So make sure you look at, once you find a nine, compare it with your EMR to make sure your EMR is accepting how you're going to do it. Next. This is the key. And I post this on the listserv as a collaborate. If you want to pick it up, usually I post it there as soon as I finish it. And the way I do it is, so I find, like I said, I go through all my measures and see which ones I can do. It's usually pretty long. It's about 25, 30. And then I go to the right side and look at the scores. So if you look at the scores here, I'm doing this for the cameras. So you see the greens, right? Greens are like I really like because the scores are good. And then you see a 30% I'm going to get 90 points, 30% performance. These when you want to, anything with a dash, you want to see how much work I have to do to get that same point. So is medications in here? The average score is 88. It's going to be hard to get. That's the average score. And then what Medicare will say is, okay, here's the average score. I'm only going to give you this much points. So you want to do something that is 30, 40, 50. Those are the better ones. And then I just highlight the green just because I'm visual and say, okay, here is where I will get. If I get to the national average, which again, I'm hoping I'll be better than national average, but that's my starting point. Then I find out which one of these can I can automate. So the ones with that check mark is completely automated. And my two weak points are the ones that are in the other logo because it involves my staff touching it. And monthly reports show that those are usually lower, but I can print a report from the EMR and say, doc, you want to fix this? Go and hit this buttons. So that's, you can do that later on, you can catch up, but try and figure out which you can automate. Advanced care planning, asking someone if they have made a decision. Sure. Not everyone's going to say yes. Someone said, I don't want to answer your question, but if you look at that score, 71%, I usually get 70, 75%. If I can get at least five, six, seven points, I'll be happy. I'm not looking for 10. So that's how I make these. This is the key. If anything you take from this session, start here, this is how you make your decision. I make my decision. Next. Oh yeah. Cervical cancer screening, I'm not talking about this body part. So before this, I had mammography and people look at me weird, but I'm like, you know, you didn't do a lot of checks during COVID. So we're just trying to make sure you're healthy. You take care of yourself. Ball risk screening is easy. It's a 12 questions squared. That is orthopedics. And it can also, if you're trying to get people into PT, that's justification for PT, push them in there. So ball risk assessment, you get a score and let's say the score is they're susceptible for a ball and you don't act on that score. I asked, they said, they said, no, you're trying to screen. And then on the, on the results, you can have a disclaimer or saying, Hey, you need to ask a physical therapy. We put it in there on, on the patient's quarter, but we also educate our doctors saying, Hey, if you see that score, please do something. No, the medical assistance and stuff. Yeah. We all, you can pull up a report and say all of the scores, like if your EMR is good and because it goes into the EMR as a score, you can say all of these people, the score capture them into PT or send them out. I can't fit them into my PT. So usually sending out. I think I can't pull on that score though, so we can't report. We can. Athena, right? So it's, yeah, we can. So it depends on your intake form. So I've seen a lot of intake people who cannot pull in dates, which was painful when I had immunizations, flu, and which is no longer valid, flu and pneumonia went away last year. A lot of people will show up in the PDF, but not in the system. So find a software that can actually pull in dates because otherwise your staff have to go and enter dates without the data was not giving you points. And things that pull the score into it is also important. So coronary artery disease was new this year. Sorry, real quick, there's other ways to get reports. If you want a separate report for the risk assessment scores and such. So you can pull it from the system from, it also can be done outside the, outside the EMR. Coronary artery disease is new this year. So if you're looking at last year's thing, there is some changes. You lost pneumonia, influenza, BMI, you lost, statins is there? Let me see. Let me see. The statin's not there? No, the number three, I pulled it. That's there. Okay. Okay. Yeah. I got 10 from statins and I'm hoping to get the same from coronary artery disease. But statins, I got the measure. I pulled it. I pulled it. Yeah, you can, you can reach out later. But again, these are all non-orthopedic measures, but they're actually giving you good, good points. Let me see if there's anything else that started this year. Early alcohol use is also pretty easy, but it requires a touch about education. Tobacco is also good. Okay. Next slide. All right. So what is this? Okay. Check with the EMR vendor if they will assist with reporting CQM measures, because if you look at my list, some of them are CQMs. And there are some that I requested and they said, put it on the improvement list. I said, by the time you approve it, it's next year's measures. So we got what we could, but CQM measures sometimes give you more points. You need one high priority and outcome. There is a lot of high priority and outcomes. So that I don't think that's hard to meet. Pick something that you don't expect. Pick something, statins you got 10, but pick something that you can get close to 10. If there is a new measure, social factors in the recent administration has been big. I didn't pick any, but if you pick something that is brand new measure, you'll automatically get seven. Second year, we'll get five. As long as you have benchmarks on it. So if you can do it, social data, how do you improve for certain classes of people? How do you improve healthcare? And you have to show them stuff and you will get points. So if you pick some of those, you can get more points. So look at new measures that came up, because in the documents, they'll tell you new measures. And then you can see, can you fulfill those? Avoid cap measures. You will see some of them will end at three. At three, you get a hundred percent and that's all you'll get, right? So you will only get three points at a hundred percent performance. So that's not good. You want that to be here. And then the way, the easier method is to look at the average of the country. And based on the average of the country, how much points are giving you the lower the average, the better it is, which means it's either a not known measure and people are not jumping on it. And if they jump on it, then Medicare will automatically reduce it because it's just averages. So look at measures that you can automate and it does not have to be orthopedic specific. Now you can die on the sword, but my doctors don't care. They just don't want the penalty. Next. Remember, this is not just Medicare. You measure it on everybody and the penalties for Medicare. So if your doctors think I only do it for Medicare population, no, you do it for everybody. And then the penalties for Medicare and the penalty comes two years after, or the bonus comes two years after. So anytime you ask staff to do one more thing, it just won't get done or it won't get done consistently. Right. And we boiled down all the stuff that Joseph went through into simple steps. So for example, here, what you're trying to do is during intake or during check-in, you're trying to capture questions based on the criteria. If the female is about in a certain date range, then you want to ask the text of the question. And on top of it, it's not just a yes, no, but you also, like he said, you also need to capture the date when they got that scan done. And if they say no, then the next time they come back in, you have to ask it again, right? If they say yes, then there's no need to, because you already captured the fact that they did get a scan done. And these are just different examples of those. So the thing is that not everybody gets asked every question. So it's based on the age groups. So they're only measuring what was made up 65 year old plus females are doing this. So nobody asks everybody, and then you only ask those and you'll see it upon. And imagine having to train your staff to remember these things and say, okay, who do I ask which question when? And then you have staff turnover, you need to train the next person to do the same thing. Whereas if you just rely on software to do it, it's much, much faster and more consistent. And not only do you need to ask these questions of new patients, but you also need to do that with established patients, because the way the score is calculated is on your entire patient population, new and established. So when you look at, you already mentioned that the cervical cancer screening or mammography, I didn't do it, the answer is no. But then you ask them, hey, you do a DEXA scan, oh, I'm sure DEXA scan, so they go to the DEXA scan. If you don't ask the question again, then you get a point, you actually got a negative on that score, right? So you're trying to say, you ask it again, I'm done here, I don't want to say yes, or it says no, it's fine. But you can actually not answer the you, but then the software should know that, hey, this person might know. Every time they come, they ask them, hey, by the time, from the last time to this time, did you do your test? Your turn. So these are the other things they made harder, PI became 180 days, and it's 180 consecutive days. It used to be 90. The PDMP query still, they gave them an exclusion, they made it easier there. The safety assurance factor is a yes or no response. So your EMR should say, here's the five things you need to say, yes, yes, yes. And then you can go to jail, because as the person attesting, you're agreeing to follow all the Medicare rules. By the way, if you scan my badge, it went to Department of Defense. I think they heard that I'm presenting on this QR code. Automatic reweighting continues for clinical social workers, ASCs, hospital-based, non-patient facing, small practice. So that automatic reweighting continues, but they took out from PGOTs, SLPs, keep going, nutritionists. Yeah, these are people now have to do the PI, which means they have to invest in expensive softwares if you have them, or be part of your software. I don't know why their individual associations are not fighting this, but I'm sure they are. Again, 200 measures available, no longer available, these measures, which breast cancer and colorectal were actually good performing for me. So I'm hoping we'll see what my scores are this year, because my average is about 84, 85, and it is the cost that pulls you down. So then cost factor, you can, there is an Excel spreadsheet, of course, I didn't include it here. What I did is I took the cost out, and I did my scores with an imaginary 20 points to see which is better. This year. This year. Yes, it's exempt. So you don't have to do the PI, you can reweight the PI. So you have quality PI with COVID, they say, oh, you know what, it's so hard to do these things. So we will, of course, yeah. And they will, you can take this 30 and say, it's gone. But then they say, now, if you take out this 30, now we had to make up 100, now quality becomes 50, or cost becomes 40. So they will change. And if you don't take cost, then something else becomes a bigger number, quality, I think it's 55%. So if you did good on quality, then you got a better score. So what I did is I had a spreadsheet with, here's my scores and all the measures. Of course, cost is, I don't know. And I said, if I take out cost and I reweight this to, instead of 30, what is it, 30, 15 and 25, and I make it 55 something and something, what will be my score? And then I, that's what I picked, is there anything close to 80? I said, get out. Anything after 80, I said, sure, let's see what we can get. Not this year, you can't adopt, there's no exemptions. Yeah, this year, there's no exemptions right now. So that's when you pay for a hurricane, an ice storm, because that's every year, for several years, they've given you exemptions if you had one of those disasters in your area. I was just joking, please, hopefully nothing happened. Data completion increases 75%. Next. Improvement activities kind of stayed relatively the same. They added some measures, changed some measures, keeps you on your toes. Next. So by the way, appropriate use criteria has been gone. All of you invested all that expensive software additions for appropriate use. The thing is now the IT companies got their money, they don't need to implement that measure anymore. Summary is, have a plan, strategize again. I would start at that Excel spreadsheet. Strategize which measures you want and how you want to achieve it. Know the game, it is a game. If I think I'm going to get people better asking those questions. Change technology is try and find something that integrates into your EMR that gives you the ability to ask those specific questions so people are not getting annoyed at you for asking too many questions. Automate, automate, automate. My doctors would blow a ... They don't even know what MIPS is. They know it because the scores come out. But if they have to do something, they will get annoyed. So automate if you can. Optimize so that you can get the best bang for your buck. Your staff, I do ... By December and January, I've built my manuals. I have a staff and clinician meeting, usually January because you already lost a month now. You do a staff meeting, buy them some lunch, show them what it is. Hopefully not much has changed. Then every month that you send the scores out, usually I don't even worry about it until March, because your scores are calculated from January. They only started in February. By the end of March, I'm like, okay, here's your score. Then you start going back and retraining the people who are not doing what they're supposed to do. Avoid 9%. Now, if you want to go at least to zero, that'll be great. I think 75 is achievable. You have to spend energy and money, but 75% score to get a 0% penalty is achievable. It depends on how much Medicare you take. So we can ask questions, but the checkout code is on the screen. There was a lot of changes this year compared to last year, because I looked at my last year's presentation and completely changed it out, because the rules did change. And I think a week before I came, I checked the MIPS resource website. There is no exemptions yet for 2024. Questions? So, on the tobacco now, you mentioned you're an Athena, you do a macro with a template that with a CPT code in there, whatever it's called, because I don't do operations anymore. The G codes, but it's included into autosets or something where you have that, you have your language. So we do the education in there and we send it to the portal. We say, hey, by the way, I see you're a drunkard, which I'm like five drinks one time in a year. I do that most of the year, right? So that is supposedly an alcoholic, women is four, you got to break. But then you say, man, don't worry, man, I do that all the time. Sending something to your portal, read it at your leisure. There's time requirements, it's three minutes, you can BS and shoot the ball and then send them that stuff. Do you report each of your decisions individually or group? I tell them I'm reporting as an individual, because if I say group, it'd be like the king who invited everyone to the party and asked them to bring wine. They all drank water. So I tell them it's all group and it's all individual and I put them their scores, but then it's group. They help me, it'll help each other. I don't tell them that. Right now, 19, but all of OLS is 175, so we're on the same program. Okay. I looked at it and it's something new, I don't want to change like everybody else, but it's also not easy to achieve and I don't know how, I don't want to be the one doing the guinea pig beta test. I want to see what they got first before I jump into it. I know this. Yeah. Just a tip on that. If you're going to go into MVPs and you're going to use patient report outcomes for low extremity, you have to start putting your patient report outcomes in this year so that it will benchmark to go against the next year. So we're thinking about putting them in MVPs next year or putting in patient report outcomes this year. So they're in there. We did. We put them in last year. Okay. Yeah. BMI is included. Yeah, it's BMI and breast cancer models are in MVPs, they're out. Yeah. They'll transition. That's all. It's a reshuffle here, there. Yeah. So they will slowly squeeze you out of MIPS into MVPs. That's what they've been doing all along. But I asked the associations, you know, we, as advocacy council, you meet with MGMA, AOS and ask them what their suggestion is. They're like, it's too new. We don't know what to tell you. So I don't want to risk it, but you know, I would love to get your scores and see how you do before I jump in. Usually March, April, like, so January is when they, you're supposed to finish certain criteria. March is when you finish the second criteria to report and sign off. I hope you did because the date's done. Right. And then they'll give you your scores, QPP by June or something. Then you have two years to wait for that penalty. Sweet. How do you find them? QPP website. You have a login, you go in, find your scores. Oh, by the way, there's another trick that I didn't tell you, but it's a dangerous trick. In January, you go in and you check all your providers, if they're eligible or not. Most of your sports guys are not. Most of your PTs are not, unless you're a heavy Medicare. So my PT, I voted for them and they said, we don't want to do this. I said, okay. Don't worry about it because it won't affect, they don't qualify. Now I say this, it worked for a long time and then one of my sports guys and hand guys qualified last year. I said, see, I told you, you should do this. It's automated anyways, because I gave him the choice, but I warned him it might change because they will do one at the beginning of the year, tell you you're not qualified. And in November they say, yeah, by the way, you now qualify. They don't stick to their guns. They also changed sometimes criteria we stated last year after the year was done. So all things to love about MEPS. Anything else? Questions? Again, my, so you got your checkout code, please, for your CEUs, AAPC code, can you go to the next one? My email should be on here, feel free or collaborate is a great source. If you go to collaborate and type in MEPS, you will get a lot of the spreadsheets. Feel free to reach out individually or through collaborate, use collaborate. You know what? I'm going to be like the physician office and say, go to the portal. I've sent you stuff there.

value-based approach

MIPS reporting

cost implications

automation

patient data collection

EMR integration

technology

performance categories