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Telemedicine is coming! - Mar 24th 2020
Posted by Jose Ortiz on 11 May 2020 04:10 PM
Dear Praxis Client,
First of all, let me thank you not just in our name, but in the name of all patients for the amazing work that you are embarking on. I have personally communicated with many of you in the last few days and have learned first-hand what this unfortunate situation means us all.
Yet, every cloud has a silver lining, and we are going to discuss Telemedicine today, which we believe will become a strong silver lining to your professional life. Clearly, for most clinics the Coronavirus will affect the way you work and handle your visits. Your patients are reticent to come to see you in person or are being asked to stay home. Also, of concern is having large volumes of patients in your waiting room. 
For these reasons, this is the time for Telemedicine if there ever was such a time. In our view, this is just like what World War I was to the emergence of the airplane. The airplane was a novel toy until that war turned it into a vital every-day practical transport. You may not have thought about this silver lining, but it will actually liberate you from being strapped to your office. You could actually work at any time from any place you wish. This pandemic, for better or worse, will teach doctors and patients alike that telemedicine is a liberator. As of now the government has eased not only the HIPAA compliance requirements for us, but more importantly, the fees it will pay you for an online practice. And, although HIPAA will most probably be restored to what it was before this epidemic began, the increased fees you will receive for telemedicine will most probably remain, and that is good thing!
We will make the new Telemedicine CPT codes available to you as fast as humanly possible, most certainly within the week.
As you have guessed, we have various clients who have already added this feature to their practice. One of them is Clayton Reynolds MD (yes, he is very real!). Doctor Reynolds was an early user of Praxis. He is not only a practicing Endocrinologist, but more importantly, he was boarded in Quality Medicine, and was in charge of Utilization Review all the three Hospitals in the Antelope Valley, California when we met him. So, it was natural that we asked him be one of the first doctors to try the Praxis Concept Processor when it was first released. We knew that Praxis charting would be amazingly fast, but we were not so sure that such different technology would really provide quality care. So we felt that if it passed Doctor Reynolds' muster, this concept processor idea would be validated. When Doctor Reynolds enthusiastically approved the Praxis method, we knew this technology would work. Later Reynolds was the brain behind the elegant Three Rs of Quality Medicine currently used to meet the MIPS regulations. Please click on the following link for more information:  < Three Rs of Quality Medicine > 
So, when two years ago, Reynolds became our first client to embark on a one hundred percent Telemedicine Practice in his hometown of Vancouver, Canada, we were not surprised. The reason for his taking up Telemedicine may be obvious to anyone that knows Canada's unique geography, where most of civilization lies near its southern border, leaving long stretches of territory that requires long-distance travel to cover. Indeed, Doctor Reynolds tells us he used to spend hundreds of hours driving to small towns to provide his Endocrinology care. Having to face this issue early on, the Canadian Government approved Telemedicine reimbursements payments, and that was the game changer. Doctor Reynold's practice has become so successful that Cisco Systems asked him to travel to the Middle East to train other local physicians on how he does it. And since that time, we have spent countless hours  working with Dr. Reynolds learning how the EMR and telemedicine could best complement each other, and the answers are here:
What do Telemedicine and EMRs have in Common
The central issue to telemedicine has to do with scheduling patients and the virtual waiting room. The actual visual communication is straightforward. It goes without saying that all transmissions have to be HIPAA compliant, but that is relatively easy to accomplish with most video systems. The important issue is the patient ought to be able to schedule a telemedicine visit with you and then log on at the right time in the easiest possible way while he or she waits for you to connect. Several video applications allow for this:
Microsoft's Skype is the best video conference system in the market today. If you don't believe so, just watch CNN or many other television news channels. You will soon see the SKYPE logo displayed during a transmission. Clearly if there were a better system for professional news networks, they would use it.
Skype comes in two flavors: A Regular version that you and your patients may download and use free of charge ( ..
...and a Skype for Business version that has more features and, more importantly, is HIPAA compliant. During this pandemic the government has relaxed the HIPAA requirements so you and your patients may use the regular Skype, but of course you may use any other video conferencing system today. Another popular telehealth system is Zoom. Facetime is also a very easy system for your patients to use. Please don't purchase until you have received our next newsletter in a few days and in the meantime you may use the free Skype.
So, at this moment, our team is creating the interfaces which should be available very soon. It is priority number 1 for us. We will also encrypt the regular Skype to make it HIPAA compliant. 
2. We will be interfacing the scheduler with Simple Visit ) What is fascinating about this application, is that they resolved both the HIPAA and the actual call to the patient, via simple applications like Facetime.
In essence, your patient downloads the app on their cell phone, tablet, or desktop computer and then the application instantly links the patient to a human medical receptionist within seconds when they are ready for the call. Then they are placed by the Simple Visit "front office" person in a virtual waiting room while you are seeing other physical or telemedicine visits.
When you are ready, the Virtual Visit receptionists instantly passes the e-visit to you. Both you and the patient need to click but one button and you are both seeing and talking to each other.
We have other solutions in the pipeline, and we are sending you this newsletter today because this important information cannot wait! 
Virtual Transfer of Documents
Skype and other visual applications also have the ability to transfer files across the internet from and to the patient during the tele-encounter. Therefore, Praxis will also be able to generate files and "print" them directly into those systems for you and your patient to access during your tele conference.
Finally, a slew of new gadgets, ranging from electronic thermometers to blood pressure devices to glucose monitoring devices, will have the ability to automatically send their data to Praxis during the tele-visit, soit can appear under Clinical Parameters. Our team is currently working on these integrations.
We are sending you this note to inform you what you can do today (i.e. download the free Skype) or the video conferencing system of your choice, We know you must be under lots of stress at this time, and things are not likely to get easier any time soon. Our aim is to make Praxis part of the solution and a stress reliever by making telehealth simple and easy.
We will keep you posted on all developments, including MACRA and MIPS. As you might know, Praxis completed MACRA 2019 and our certification will be posted to the website hopefully in the next two days (this is what the federal agency has promised us). At this same time, deadlines are likely to be laxed with all that is happening. Please see the Note from CMS below our note.
As you embark on telehealth in your clinic you are not alone. At Praxis, we are now dedicated to enabling the best teleconferencing options possible. Whether you see patients in your office, or whether you connect to your patients at home, please think of Praxis as a part of your clinical team.
My Best Regards to all,
Richard M. Low, MD
Infor-Med Corporation - Praxis(r) Electronic Medical Records
5800 S Eastern Ave Suite 500, Commerce, CA 90040, USA
Direct: (818) 264 4032 Office: (818) 592-2900 x 5
Direct fax: (818)743-7759
*    CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 <>
*    2019 MIPS Submission Deadline Extended: Submit 2019 Data by April 30, 2020 <>
*    2019 MIPS Automatic Extreme and Uncontrollable Circumstances Policy Update <>
*    For More Information <>
CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 The Centers for Medicare & Medicaid Services (CMS) is supporting clinicians on the front lines by getting red tape out of the way so the healthcare delivery system can focus on the 2019 Novel Coronavirus (COVID-19) response.
CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming quality measure reporting and data submission deadlines for the following CMS programs:
Provider Programs
2019 Data Submission
2020 Data Submission
Quality Payment Program - Merit-based Incentive Payment System (MIPS) Deadline extended from March 31, 2020 to April 30, 2020.
MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.
CMS is evaluating options for providing relief around participation and data submission for 2020.
Medicare Shared Savings Program Accountable Care Organizations (ACOs)
Hospital Programs
2019 Data Submission
2020 Data Submission
*    Ambulatory Surgical Center Quality Reporting Program Deadlines for October 1, 2019 - December 31, 2019 (Q4) data submission optional.
If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate). If data for Q4 is unable to be submitted, the 2019 performance will be calculated based on data from January 1, 2019 - September 30, 2019 (Q1-Q3) and available data.
CMS will not count data from January 1, 2020 through June 30, 2020 (Q1-Q2) for performance or payment programs. Data does not need to be submitted to CMS for this time period.
* For the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program, if data from January 1, 2020 - March 31, 2020 (Q1) is submitted, it will be used for scoring in the program (where appropriate).
*    CrownWeb National ESRD Patient Registry and Quality Measure Reporting System
*    End-Stage Renal Disease (ESRD) Quality Incentive Program
*    Hospital-Acquired Condition Reduction Program
*    Hospital Inpatient Quality Reporting Program
*    Hospital Outpatient Quality Reporting Program
*    Hospital Readmissions Reduction Program
*    Hospital Value-Based Purchasing Program
*    Inpatient Psychiatric Facility Quality Reporting Program
*    PPS-Exempt Cancer Hospital Quality Reporting Program
*    Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals
Post-Acute Care (PAC) Programs
2019 Data Submission
2020 Data Submission
*    Home Health Quality Reporting Program Deadlines for October 1, 2019 - December 31, 2019 (Q4) data submission optional.
If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate).
Data from January 1, 2020 through June 30, 2020 (Q1-Q2) does not need to be submitted to CMS for purposes of complying with quality reporting program requirements.
* Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1, 2020 through September 30, 2020 (Q1-Q3) does not need to be submitted to CMS.
*For the Skilled Nursing Facility (SNF) Value-Based Purchasing Program, qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for Q1-Q2.
*    Hospice Quality Reporting Program
*    Inpatient Rehabilitation Facility Quality Reporting Program
*    Long Term Care Hospital Quality Reporting Program
*    Skilled Nursing Facility Quality Reporting Program
*    Skilled Nursing Facility Value-Based Purchasing Program
CMS is granting exceptions and extensions to assist health care providers and suppliers while they direct their resources toward caring for their patients and ensuring the health and safety of patients and staff. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional based on the facility's choice to report. In addition, no data reflecting services provided January 1, 2020-June 30, 2020 will be used in CMS' calculations for the Medicare quality reporting and value-based purchasing programs in order to reduce providers' data collection and reporting burden as they are responding to the COVID-19 pandemic.
CMS recognizes that quality measure reporting may not be reflective of performance for measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for data during this period. CMS will continue to monitor the situation and adjust reporting periods and submission deadlines accordingly. More detailed information about changes to each of these quality reporting programs will be provided soon.
2019 MIPS Submission Deadline Extended: Submit 2019 Data by April 30, 2020
The 2019 Merit-based Incentive Payment System (MIPS) data submission deadline will be extended by 30 days to April 30, 2020. If you have already submitted MIPS data or if you submit MIPS data by April 30, 2020, you will be scored and receive a MIPS payment adjustment based on the data you submit. Many MIPS eligible clinicians have performed very well in the MIPS program in previous years. If you need to revise any data that has already been submitted you can still make changes by logging into > by the new deadline.
2019 MIPS Automatic Extreme and Uncontrollable Circumstances Policy Update
MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four MIPS performance categories for these clinicians will be weighted at zero percent, resulting in a score equal to the performance threshold, and a neutral MIPS payment adjustment for the 2021 MIPS payment year. However, if a MIPS eligible clinician submits data on two or more MIPS performance categories, they will be scored and receive a 2021 MIPS payment adjustment based on their 2019 MIPS final score. CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to clinicians and their staff so they can focus on caring for patients.
For More Information
Please reference the <  2019 QPP Data Submission User Guide > . CMS also has up to date information about its programs and response to COVID-19 on the <  Current Emergencies > page.
For Quality Payment Program questions you can contact 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: <  > .
*    Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.  

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