Dr. David Lechuga:
Hi, this is Dr. David Lechuga. I’m a member of the NAN PAIC, and we’re excited about new project we’re in, we’re doing a short video introduction to a, to an upcoming webinar. And today we have Dr. Nick Bott, who has an expertise in the Medicare’s quality payment program. I’ll let Dr. Bott introduce himself. And also introduce the program Dr. Bott, if you don’t mind, I’d like to ask you a few questions as you go along.

Dr. Nick Bott:
Absolutely. And, and thanks David for the opportunity to be here, uh, by way of intro. Uh, I’m a clinical neuropsychologist, uh, by training. And I also have a background in, uh, the area of value based care. So in addition to my clinical training, I completed a fellowship in, uh, high value healthcare, uh, delivery design, uh, including in the areas of mental and behavioral health. And I also am a part of the N P a I C. And I’m excited that, um, this is part of the, the work that the N N P I C has really been spearheading in, in thinking about how neuropsychology can engage in this value-based care conversation. That’s really kinda accelerating across, uh, all of healthcare. And, and then I’d briefly add that in addition to the, to the N P I C I also am a member of APAs measurement based care and the mental and behavioral health registry committee, um, which also is engaging in issues around both measurement based care and, and value based care for psychologists, as well as other mental and behavioral health professionals.

Dr. David Lechuga:
Excellent. Helpful background. So why measure quality, uh, Nick? Why, why is that so important these days?

Dr. Nick Bott:
Yeah, it, it’s a great question. Um, and a good one to start with, and I think, um, you know, to start it, it’s important to underscore that there is a growing body of evidence that’s showing the clinical effectiveness of the role that measurement based care can play and across a lot of different areas of, of outcomes, whether that’s reducing symptoms, uh, increasing patient satisfaction with, with different aspects of healthcare. And this is it’s important to know that this is broadly across, you know, various areas, uh, of healthcare. We obviously in, in our field are, are very interested in how that the question of quality is impacting aspects of mental and behavioral health. But I think it’s important to start there that really, this has been an area of research that’s, that’s continuing to grow, uh, the evidence base to show that this matters. And then, you know, secondly, what I would add is that, um, you know, and more practically that demonstrating quality of care is becoming more and more, uh, of a requirement, um, for reimbursement. And, and so depending on the type of provider you are in, in your practice setting, um, this is a reality that we’re gonna have to contend with

Dr. David Lechuga:
Yes. And, and help us understand what are the current quality measurement requirements.

Dr. Nick Bott:
Yeah. So you, you know, there, depending on your setting, there, there can be different ones. But the one that I, I think is important to note, um, uh, for the purposes of today’s conversation is Medicare’s quality payment program, uh, which is the merit based incentive payment system. Or it’s also known as MIPS for short and specifically for, for mental healthcare providers and, and, and psychologists who serve, uh, Medicare beneficiaries. Those psychologists are eligible and depending on a couple of factors, they may be required to participate in MIPS and, and briefly to kind of call out some of those requirements. Um, you know, part our, uh, uh, providers are required to participate in MIPS unless they fall under what is known as a, a low value threshold, or also known as an L V T. So, um, if a psychologist falls under the L V T, um, that means they’re either billing less than, than $90,000, uh, of services provided it, or they provide care for less than 200 Medicare part B patients, or they have less than 200, 200 covered patient services. Now you can still be a psychologist who, who, um, engages in MIPS or participates in, in, in, uh, MIPS measures, um, because you may decide that it’s valuable to receive reimbursement that are associated with MIPS. Um, but those are the criteria that would exclude you from, from engaging in MIPS.

Dr. David Lechuga:
OK. So tell us again, what does this all have to do with neuropsychology and neuropsychologists specifically?

Dr. Nick Bott:
Yeah. So this is, this is what’s exciting. Uh, you know, for me in particular, because, you know, as I, I given my background in value based care, I’ve been very intrigued in how this conversation has been, uh, maturing and, and specifically how, um, neuropsychologists, which represent, you know, a very specific subset of the broader field of, of, um, psychology providers, how they fit into this, you know, growing and, and maturing landscape. And so, you know, to start, what I will say is, you know, APA has a mental and behavioral health registry known as B R and that includes 20 MIPS identified measures as well as, um, 15 specialty measures that, um, are exclusive to the MBA R so these are really purpose built for, or psychologists and other behavioral health, uh, practitioners, and, and they’re meant to be used to help track patient outcomes, meet some of these quality reporting requirements, including those in MIPS.

Dr. Nick Bott:
But, but as I said, what’s exciting is while those have been very broadly based for, um, you know, for psychologists, um, we’re now able to talk specifically new measures, uh, that are now, um, live in 2022 that have been purpose built specifically for neuropsychologists and other assessment oriented psychologists. Um, that really kind of allow, uh, us in our field with all of the particularities of the way that we practice, um, to enable us to, to engage in quality reporting measurement. Um, so, so that’s really exciting to me. It also means that that there’s a, there’s an opportunity, but also I would say strong motivation for those assessment, um, focused psychologists and neuropsychologists to engage in the, in these measures, because it’s the, it’s the sort of thing where if you don’t use ’em, you lose ’em. And so we really wanna get the word out that now that these measures are here, that, that we, as a, as an assessment kind of focus community can really take, uh, uh, take a hold of them and, and make the most of them.

Dr. David Lechuga:
Of course, it makes a lot of sense. What, what are these measures, Nick, if you could share that with us, please?

Dr. Nick Bott:
Yeah, well, um, just in brief and, and we will certainly have more, more to say, um, at, at the webinar that we’ll, we’ll briefly preview, um, at the end of our conversation here, but, but briefly there are five measures, uh, now that can be utilized that are much more focused on assessment and, and, and, uh, psychologists focused, uh, in, in the neuropsychology space. So the first, um, is known as MB R 11, which focuses on cognitive assessment with counseling on safety and risk. Uh, and this allows, uh, providers to document the successful completion of a cognitive assessment that includes, uh, informing, uh, potential patient safety risks. There’s B HR 12, which is the provision of feedback following a cognitive or mental status assessment with documentation of understanding of the test results and subsequent healthcare plan. So that’s a mouthful, but, um, it’s really a way to document that after an assessment has been completed, there’s been appropriate, um, feedback, um, of results to pay and the caregiver, as well as corresponding documentation, the receiver of the information has really understood and, and been, has been able to make sense of those results.

Dr. Nick Bott:
Um, there’s M B R 15, which is cultural linguistic and demographic factors and cognitive assessment, which I think is a really important one. Um, this really speaks to how we can do document as providers, that there’s been a successful completion, um, of an assessment that includes the integration of relevant, um, patient related cultural linguistic factors, um, BHR 16, which is comprehensive cognitive assessment, um, assisting with differential diagnosis. So this is a way for us as providers to document that when we administer cognitive assessment and we’re recording the results, that includes clarification of relevant diagnostic factors, and then finally MB R 17, which is improving efficiency, uh, time interval for reporting results of cognitive assessment. So, so this measure is really about documentation of the feedback loop in terms of timing from when, um, a cognitive assessment, um, has been delivered, uh, to when the completion of that evaluation is, uh, or the results of those evaluation are a return to the patient or, or another, uh, referral source.

Dr. David Lechuga:
Uh, they all sound very helpful and timely, well, well, how can we find out more?

Dr. Nick Bott:
Yeah. So as I mentioned, you know, this is just a, a high level preview, and we are really excited that there’s a much, um, more in depth webinar that we’re gonna be hosting, uh, Thursday, April 14th at 12:00 PM Eastern. And it’s really going to allow, um, participants to learn more about these measures in particular, but also the broader landscape of value based care and the MI system more at large, we’re gonna be discussing MIPS at length. We’re also gonna be, um, walking through a tool that will allow practitioners to, to more easily and efficiently track quality outcomes and report MIPS from a set centralized, um, location. And then, and then we are gonna go much further into depth on each of the five measures that I briefly previewed, uh, in our conversation today, uh, with some relevant case scenarios, as well as some additional guidance on, on how we can best document these measures, um, for those who are gonna be, uh, participating in submitting them to Mets.

Dr. David Lechuga:
Excellent. Excellent. Anything else you wanna add Nick, before we close?

Dr. Nick Bott:
No, just great to great. To have the chance to talk with you, David, and, and hope, uh, those who are interested can, can join us on April 14th.

Dr. David Lechuga:
Great. Good. See you then. Thank you very much.

Dr. Nick Bott:
Thanks, David.