Sponsored by:

SpeakersModerator:Sue Pelletier, Content Director, MeetingsNet

Panelists:Thomas SullivanPresident/CEORockpointe Corp.Editor/Policy and Medicine

Andy RosenbergSenior AdvisorCME Coalition

Amy SmithSenior Manager, CME Credit Systems & ComplianceAmerican Academy of Family Physicians

Patricia AndradeVP of Marketing, Communications & Community RelationsABTS Convention Services

TODAY’S AGENDA

• MACRA Quality Payment Program and the 2018 QI CME Measure

• AAFP Blended Learning Format Option• Medtech Europe’s Attendee Policy on US

CME Meetings

MACRA QPP (MIPS) –Improvement Activities

Value Based CareTriple Aim

• Improving the experience of care,

• Improving the health of populations

• Reducing per capita costs of health care

Seems simple (but…)• Insurance Company/Payor• Health System• Provider• Staff• Patient• Families

Information overload

We have to move to

Value-BasedPayment How do we

align quality and

cost-savings? Quality

Measure development

Patient-centered

ness

How do you

measure quality?

Comparative effectivenes

s

Access is expensiveNeed to

education docs

Fee for service was

EZ!Who does the

measuring?

How do we create the

right incentives?

Quality means

something different to

me

Is this just another

fad?

At what price

innovation?

How do we avoid over-burdening

docs?

Improving Quality is Confusing

Value Based Purchasing Industry Trends

MACRA – MIPS • 676,722 clinicians

$199-$321 million in ±adjustments in 2017

• Decrease by 134,000 clinicians in 2018

MACRA – Advanced APMs• 70,000-120,000

clinicians in 2017

• 5% lump sum incentive

A-APMs 2018> than double with MSSP Track 1+

Aetna• Merck – Januvia and

Janumet rebates for T2DM

• Driven by treatment outcomes

• Cigna

• Sanofi and Amgen –Praluent and Repatha– Cholesterol PCSK9 inhibitors ~ $14K/year

• Discounts linked to LDL reduction benchmarks

BCBS Plans VBP• 1:5 dollars spent of

$65BN directed towards VBP

• Anthem (14 states), 58% VBP – 75% shared-savings contracts, 159 ACO contracts

• BCBSMI – 1,500 PCMHs, 4,500 MDs, “Organized Sys. Of Care”

UnitedHealth Group• $49BN/year through

VBP contracts (33%)

• Goal to raise to $65Bn by 2018

Medicare Advantage• Seeking data on 4

categories of VBP

• Included in MACRA A-APMs thresholds PY2019

Managed Medicaid• 5 state approaches

− MCOs used state developed VBP model

− % of payments must be VBP

− Evolving VBP over years− Multi-payer VBP

alignment− State approved VBP

pilots

Sources: CMS MACRA Final Rule; Forbes UHC Article, Aug. 4; Aetna Press Release, Oct 11, 2016; Fortune, Jun 21, 2016; UnitedHealth Group, May 25, 2017; Forbes, Anthem BC, Apr. 11, 2017; AIS Health, 2017 Blues Outlook, Dec. 29, 2016; UHC website, May 16, 2017; MA Call Letter; CHCS Brief, Feb. 2016

Quality Payment Program

Two Payment Paths

• Alternative Payment Models (APMs)

• Differential FFS based on measured performance (MIPS)

MACRA Payment Transition Strategy

CMS, Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models, Final Rule, Released to Office of Federal Register, October 14, 2016

MIPS – Penalty Avoidance

MIPS – Delayed Start

MIPS – Ready to Go

Advanced Alternative Payment

Model • Submit by Mar. 31,

2018− 90 days of data

between Jan. 1 and Oct. 2, 2017

− 1 Quality Measure,− 1 Clinical Practice

Improvement Activity, or

− 5 required Advancing Care Information measures

Req

uire

men

ts

• Submit by Mar. 31, 2018− 90 days of data

between Jan. 1 and Oct. 2, 2017

− > 1 Quality Measure,− > 1 improvement

activity, and/or − > 5 required

Advancing Care Information measures

• Submit by Mar. 31, 2018− “Full Year” of data− 6 Quality Measures (1

outcome) – MIPS APM Groups report 15;

− 4 improvement activities; or 2 for small, rural, HPSA or non-patient facing

− Required or up to 9 of advancing care information measures

• Significant portion of Medicare patients or payments− Qualified Participant

(QP) determination “snapshot” and inclusive

− Driven by patient or payment thresholds

Opt

ions

APMs

MIPS APMs

Advanced APMs

MIPS Composite Performance Score

CMS, Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models, Final Rule, Released to Office of Federal Register, October 14, 2016. CMS, Medicare Program: CY 2018 Updates to the Quality Payment Program, Proposed Rule, Federal Register, June 30, 2017.

Performance Year / Application Year Quality Measures Resource Use or 

CostImprovement Activities

Advancing Care Information

DescriptionReplaces CMS Physician Quality Reporting System (PQRS)

Replaces ACA Value‐based Payment Modifier

New category of measurement; Medical Homes and NCQA PCSR receive full credit; 93 activities available

Replaces CMS EHR Incentive Programs f/k/a Meaningful Use; 

Reporting Methods

Claims, CSV, Web Interface (for group reporting), EHR, Qualified Clinical Data Registry (QCDR)

Claims Attestation, QCDR, Qualified Registry, EHR Vendor 

Attestation, QCDR, Qualified Registry, EHR Vendor, Web Interface (groups only)

2017 / 2019 60% 0%* 15% 25%

2018 / 2020 60% 0%* 15% 25%

2019 / 2021 30% 30% 15% 25%*Measured for feedback only in 2017

Improvement Activities

• More than 90 Improvement Activities• Range from Participation in PCMH or Registry to Extra

Office Hours

Groups of 15 or More

2 high weighted activities

1 high weighted and one medium weighted activities

4 Medium weighted activities

Groups of 15 or Fewer

1 high weighted activities

2 medium weighted activities

MACRA and CME

• CME Working Group• CME Coalition, ACCME,

ACEHP, AMA, AAFP, CMSS…• Designed and submitted a

proposed Improvement Activity for QI CME

• Hundreds of public comments• New 2018 Improvement Activity Adopted by CMS in Proposed Rule in June

• Final Rule due October 30, 2017

Performance/Quality Improvement CME

The QPP proposed rule includes an Improvement Activity for quality improvement (QI) CME:

Proposed Rule Language

Title: Completion of an Accredited Safety or Quality Improvement Program ActivityDescription: Completion of an accredited performance improvement continuing medical education program addresses performance or quality improvement according to the following criteria: The activity must address a quality or safety gap that is supported by a

needs assessment or problem analysis, or must support the completion of such a needs assessment as part of the activity;

The activity must have specific, measurable aim(s) for improvement; The activity must include interventions intended to result in improvement; The activity must include data collection and analysis of performance data

to assess the impact of the interventions; and The accredited program must define meaningful clinician participation in

their activity, describe the mechanism for identifying clinicians who meet the requirements, and provide participant completion information.

Opportunity for Education

• QI CME Improvement Activity • Supports collection of data

• Contribute to Advancing Care Information Credit • Combined with other Improvement Activities

• Data Registry, Claims data…..• Can contribute to 40% of the composite performance score for earning

more than fee schedule reimbursement• Can also qualify for MOC Part 2 & 4

• We are teaching medical professionals how to utilize their own data for clinical quality improvement

For More Information

CME Coalition www.cmecoalition.org

Andrew Rosenberg arosenberg@thornrun.com

Blended Learning

AAFP Credit System Overview• Set the standard for family physician lifelong learning• Accredit individual CME activities• Prescribed and Elective credit

What is Blended Learning?

http://bartsblackboard.com/i-will-not-flip-the-classroom-upside-down/season-17/816/

What is Blended Learning?• Blends one or more educational formats into one learning experience.

• Sometimes called “flipped classroom because…

• Lectures are recorded and consumed during learners’ study time.

• Traditional “homework” activities like projects, working problems, or working in groups take place in live classroom.

• Design varies depending upon subject matter, learning goals, learner motivation, and practical considerations.

Benefits for Learners• Incorporates proven approaches of blended and spaced

learning.• Reduces/spreads out cognitive load over time.

• Increases faculty/learner interaction time during the live part.• Makes most of time spent with faculty and co-learners.• Greater flexibility - at their own pace and on their own time.• Encourage learners to drive their own education.

“The challenge for educators in every discipline is for them to transition from being dispensers of facts to being architects of learning activities. Critical in this process is designing experiences that facilitate students developing into active learners rather than passive receptacles of information.” – Pierce, 2012

AAFP’s New Blended Learning Activity TypeBlended Learning is a single educational activity designed for the same learner(s) that is delivered via multiple formats.

Blended learning activities are delivered in two or more formats which can include…

• Live Courses• Enduring Materials• Medical Journals• Performance Improvement• Point-of-Care

Repurposed Content

23

Additional Benefits

• One activity• One application for credit• One letter of participation

Resources

25

More questions?

26

• Call us at 800-274-2237• Email us at cmecredit@aafp.org• Resources are located at: www.aafp.org/cmecredit

and US Meetings

What are MedTech Europe & APACMed

MedTech Europe is the European trade association representing themedical technology industries. MedTech Europe was created withvia joint venture between EDMA, representing the European in vitrodiagnostic industry; and Eucomed, representing the Europeanmedical devices industry and promotes a balanced policyenvironment that helps the medical technology industry meetEurope’s growing healthcare needs and expectations.

APACMed, the Asia Pacific Medical Technology Association, wasfounded in 2014 and represents manufacturers and suppliers ofmedical equipment, devices and in vitro diagnostics, industryassociations and other key stakeholders associated with the medicaltechnology industry in Asia Pacific.

The Medical Technology industry is still fully committed to support independent medical education, at arms’ length, and through independent third-parties.

Changing the Playing Field

1 IMAGE & PERCETION- No luxury hotels, luxurious dinner, resorts, etc.

TRANSPARENCY- Informing institutions / superior of any interaction.

EQUIVALENCE- Setting fees for services following strict FMV Methodology.

SEPARATION- Decision-making is not primarily sales-driven.

DOCUMENTATION- Signing the contract and documenting expenses.

2

543

MED DEVICE COMPANY

The Current Process

Med Device company chooses

attendees and contacts travel

agency

Agency contacts Healthcare

Organization and their International

Group Housing Department to

arrange for international group

housing and registration

International delegations attending US medical meetings are usually sponsored byeither a Pharmaceutical or a Medical Device Company. This means that groups ofinternational attendees are invited and all their travel and meeting expenses are paidby the sponsoring company.

As of 2017, MedTech Europe will require meetings to be vetted through itsConference Vetting System. Only vetted meetings will be eligible to receive fundsfrom MedTech Europe member companies, — and only through educationalgrants or commercial activities.

Changes for 2017 and beyond…

2016 2017 2018 2019Geographic

Location

Hospitality

Communication

Support

ScientificProgramme

RegistrationPackages

Conference Venue

The Old vs. the New –Adding to the Workload!

1. Conferences supported by medical device companies will need to apply and be incompliance with the Conference Vetting System.

2. Healthcare Organizations will need to write and submit grant requests to eachmedical device company that sponsors delegations to their medical meeting.

3. Once awarded the grant, Healthcare Organizations will be responsible for choosingthe HCPs that will receive support, following the guidelines as set forth on the grantrequested.

4. Healthcare Organizations will be responsible for the management of the sponsoredHCPs, including figuring out how to contact them, gather their information, managetheir travel requirements, etc.

5. Medical Device Companies will need to submit reconciliation and disclosure reportsto MedTech Europe transparency platform.

MedTech EuropeHealthcare Organizations MUST APPLY for

grants from Medical Technology Companies to fund travel, hospitality, and registration for international attendees to

attend the medical meeting.

ACCME

Healthcare Organizations ARE NOT ALLOWED to use funds received from

Medical Technology Companies to fund travel and hospitality of attendees without jeopardizing their ACCME Accreditation.

A third-party non-profit may apply for grants from the Medical Technology Company and use funds to fundtravel, hospitality, and registration for international attendees to attend the Healthcare Organization’smedical meeting without jeopardizing the Healthcare Organizations ACCME Accreditation.

SOLUTION

ACCME Standards For Commercial Support–Even More Complexity!

The CME provider may not use commercial support to pay for travel, lodging, honoraria, or personal expenses for non-teacher or non-author participants of a CME activity.

MED DEVICE COMPANY

The NEW Process

A third-party nonprofitrequests and is awarded

grant from Medical Device Company

Medical Meeting

Third-party nonprofit assigns a grant

manager to provide services

While MedTech Europe confers with ACCME regarding the interaction between their codes, this process allows international attendees to continue attending US-based medical meetings.

1

2

3

MED DEVICE COMPANY Medical Meeting

Third-party nonprofit prepares the educational grant. Grants are submitted to Medical Technology Company, following their preferred grant request format. Grants will detail how they meet requirements not only to the EthicalMedTech and APACMed guidelines, but also to any local law and regulations in effect based on location of Medical Technology Company and/or origination of proposed HCP beneficiaries.

Third-party nonprofit requests and is awarded grant from Medical Technology Company. Funds from the Medical Technology Companies are transferred to Third-party nonprofit to execute the contracts. Third-party nonprofit assigns a grant manager to provide services.

Third-party nonprofit creates and submits the application to The Conference Vetting System

Third-Party nonprofitrequests and is awarded

grant from Medical Device Company

Third-Party nonprofit assigns a grant manager to provide

services

4

5

6 Third-party nonprofit prepares and provides grant reconciliation reports for Medical Device Company. May also provide any reports needed based on required laws as per the location of Medical Device Sponsor grant office or origin of HCP beneficiary.

Third-party nonprofit oversees the secretariat process and airline arrangements through partner travel agencies. The third-party nonprofit engages and pays Medical Association for registration and housing through current international housing and registration process.

Third-party nonprofit choose international healthcare professionals (HCPs) that will attend the annual meeting, meeting grant guidelines- will provide an online Grant Application process adhering to all grant guidelines, via an approved website. HCPs may apply to participate as a grant beneficiary and, if they meet the criteria as specified in the grant, are chosen and invited on a first-come, first-serve basis.

MED DEVICE COMPANY Medical Meeting

Third-Party nonprofitrequests and is awarded

grant from Medical Device Company

Third-Party nonprofit assigns a grant manager to provide

services

MedTech Europe & APACMed Members

APACMed Corporate MembersMedTech Corporate Members

Questions?Thank you for joining today’s webinar Risk and Opportunities in Today’s Challenging World of Medical Education

A big thank you our sponsors: