When you brushed your teeth this morning or ate your breakfast, odds are you used your right hand to drive the toothbrush or the spoon or fork. Roughly 85-90% of the world’s population is right handed. The minority of us (including yours truly) are southpaws.
The source of “handedness” is far from clear. I’ve read genetics are thought to play a role. Anecdotally, that’s a tough one for me to swallow as my parents are right handed and my two siblings are also lefties. Given the predominance of right-handed folks in the world, it’s not surprising that lefties face the occasional unintended discrimination. If you are right handed, pick up a pair of left-handed scissors and give it a go. Of course, you will spend more for the leftie version, so you might want to borrow a pair.
Many years ago (more years than I am willing to share), with rare exception the desks in the elementary school I attended were designed for right-handed students. To this day I believe that’s one of the reasons older (I mean, more experienced) lefties tilt the paper they are writing on in a most peculiar way, attacking the page from the top instead of the side. Sure, there was the issue of “smudging” we lefties were taught to avoid back in the day, but I think it was the race for the single leftie desk in the room that accounts for poor penmanship. Thankfully, reading this blog does not subject you to the handwriting of this left-handed nephrologist!
There are some benefits to preferring the left hand over the right. For example, lefties seem to have an advantage in certain sports. In games where you face your opponent (think tennis, baseball pitchers and hitters, and basketball), southpaws are substantially over represented at the professional level. Lefties are also fond of bragging about “being in their right mind.” However, the times I have used this line are usually met with a laundry list of not so flattering southpaws who have held public office, but I digress.
ESCOs and QPs
The impetus for today’s post is another common handedness euphemism, one that’s particularly apropos for an important aspect of the Quality Payment Program. As you may recall, one of the most attractive practice-facing benefits of participating in an Advanced Alternative Payment Model (AAPM) like an ESCO is the opportunity to achieve the Qualifying Participant (QP) designation. As a QP, the eligible clinician (i.e. the physician, nurse practioner, or physician’s assistant) not only avoids MIPS for the year, but 2 years from now they will collect a lump sum payment equivalent to 5% of next year’s Part B book of business. All in all, a very attractive carrot designed to entice as many docs as possible to join an AAPM. As we recently noted, each of the 34 two-sided risk ESCOs have received the QP designation for 2017. So the 1,200-plus eligible clinicians on the participant lists for those ESCOs are excluded from MIPS in 2017 and will collect the 5% AAPM incentive in 2019. So, what does this have to do with left and right hands?
The left and the right
Most of your received a letter from CMS earlier this year announcing that you are subject to MIPS. In fact, as Diana Strubler recently highlighted for us, you can go out to the CMS website, enter your NPI number and receive the same message. Those of you in an ESCO will note that this website is a bit out of date. If you enter your NPI it will still state you are subject to MIPS. A couple of weeks ago, a new website was launched to identify Qualifying Participants (remember these are folks who are excluded from MIPS). Enter your NPI number here, and you can confirm your QP designation.
This discrepancy can be a bit unsettling. On behalf of QPs around the country we’ve submitted questions to both CMMI and the QPP help desk. We’ve been assured by CMMI the QP status is accurate, and QPP help desk tells us they have answered our question and closed our help desk ticket (twice actually). The upshot? The left hand does not know what the right hand is doing. Based on the responses we have received, my sense is the QPP site will reflect the QP status at some point this year. Exactly when that will occur is anyone’s guess. This situation is almost as frustrating as being a leftie using right-handed scissors while seated at a right-handed desk!
We will keep track of this minor inconvenience and keep the large number of nephrology QPs in the loop. In the meantime, pick up a pair of leftie scissors. It may take your mind off this fiasco.
Terry Ketchersid, MD, MBA, practiced nephrology for 15 years before spending the past seven years at Acumen focused on the Health IT needs of nephrologists. He currently holds the position of Chief Medical Officer for the Integrated Care Group at Fresenius Medical Care North America where he leverages his passion for Health IT to problem solve the coordination of care for the complex patient population served by the enterprise.
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