New York State Practice Transformation Network (NYSPTN)

 

Medicare, Medicaid, and commercial health insurance payers are changing how they pay healthcare providers.

Are you ready?

Enroll in the New York State Practice Transformation Network (NYSPTN) and prepare your practice to thrive in a value-based payment environment.

 


              Finger Lakes Health Systems Agency      

What is the Transforming Clinical Practice Initiative and the Practice Transformation Network?

The New York State Practice Transformation Network (NYSPTN) is a statewide learning network designed to coach, mentor, and assist clinicians in developing core competencies necessary to transform their practices and thrive in an emerging healthcare environment that emphasizes value of care. The NYSPTN embraces and supports the "quadruple aim" of better care, better health, lower costs, and greater provider satisfaction.

Funded by the Centers for Medicare and Medicaid Services (CMS), the NYSPTN is part of the Transforming Clinical Practice Initiative (TCPI), which will work with more than 140,000 clinician practices nationally over the next four years. TCPI will help practices develop quality improvement strategies, and navigate the complex healthcare environment and multiple transformation-related initiatives currently underway.

NYSPTN is informed by the structure of the highly successful Regional Extension Center (REC) program that assisted physicians to adopt and meaningfully use electronic health records as well as several successful practice transformation initiatives.

What are the benefits for my practice?

The effort you put into practice transformation not only positions you to better respond to this changing healthcare landscape, but with time, will benefit your patients, your practice, and your bottom line.

Benefits for Your Patients

  • Systematic inclusion of patient and family engagement and patient self-management support
  • Better coordinated, more comprehensive, and personalized care leading to better outcomes

Benefits for Your Practice

  • Increase clinician and staff member satisfaction
  • Participate in new payment/reimbursement models
  • Improve practice efficiency
  • Improve clinical efficiency
  • Integrate the care management function into your practice
  • Concrete opportunities for improvements in patient care
  • Maximize the practices' health information technology investment and use of EHR data

Benefits for Your Bottom Line

  • More efficient care delivery and practice operations
  • A practice that is prepared to succeed once primary care payment reform has become widespread (e.g., value-based payment or global payment)
  • Coaching to increase billing opportunities related to Wellness Visits, Chronic Care Management Codes, and Transitional Care Management Codes
  • Positions practices to negotiate value-based contracts with payers willing to reimburse for demonstrated quality of patient care, and prepares practices for upcoming CMS payment reform initiatives

The estimated value of participation to a solo physician practice is over $92,000* annually, including additional fee for service from:

Wellness visit training:

~$30,000

Transitional care training:

~$14,000

Chronic care training:

~$36,000

Penalty avoidance:

~$12,000

Total:

~$92,000

Estimate for a 3-5 physician practice is more than $300,000.

*Calculation based on National MSSP, Medicare TCM payment rules, charge codes and ratios from similar other initiatives.

Why does this matter?

Healthcare delivery and reimbursement in the United States are undergoing massive change. Medicare, Medicaid, and commercial health insurance providers are changing how they pay healthcare providers. Reimbursement is moving away from fee-for-service to new models that emphasize performance on quality measures, including clinical outcomes and cost savings. Participating in NYSPTN will help prepare for new payment models.

The Transforming Clinical Practice Initiative (TCPI) will help healthcare practitioners prepare for and thrive in this emerging healthcare environment. Major legislative initiatives such as the Medicare Access and CHIP Re-Authorization Act and Affordable Care Act (MACRA), recently passed into law in 2015, are changing the focus for providers to become value-based. There is also a restructuring underway of the various incentive programs. Performance on quality measures, including clinical outcome, will determine reimbursement levels. Transitioning a practice through TCPI will result in significant benefits as reimbursement becomes more and more quality-based.

How will the New York State PTN prepare practices for new payment models?

Through the PTN, participating practices will receive:

  • Coaching and guidance related to transformation
  • Skilled transformational assistance provided through a combination of remote and on-site training and support
  • Peer-level support
  • Access to a faculty of nationally-recognized experts and online modules (providing CME and MOC credits) related to the transformation process

Services include, but are not limited to, assistance with maximizing incentives from payer contracts, avoidance of penalties, care management, quality improvement, networking, and more.

Who can participate?

NYSPTN seeks to enroll primary care or specialty care practices that:

  • Want to prepare for major payment changes
  • Use a 2014 Certified Electronic Health Record
  • Are not currently participating in a Medicare Shared Savings Program, Pioneer ACO program, Multi-Payer Advanced Primary Care Program, or Comprehensive Primary Care Initiative

*Note: Practices participating in some other practice transformation programs may be excluded from participation.

What will it cost practices to participate?

Participation is completely free for all eligible practices! However, success depends on your effort and willingness to adopt new methods of practice.

For more information regarding TCPI from CMS, visit: healthcarecommunities.org

"Nondiscrimination Notice"

The Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.

How to file a complaint

If you believe you’ve been subjected to discrimination in a CMS program or activity, there are 3 ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

  1. Online
  2. By phone
    Call 1-800-368-1019. TDD users should call 1-800-537-7697.
  3. In writing
    Send information about your complaint to:
    Office for Civil Rights
    U.S. Department of Health and Human Services
    200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, D.C. 20201