• Safe and secure

  • Quick and easy

  • web-based solution

  • 24/7 Customer Service

Rate form

4.0 Statisfied

792 votes

The Key Elements of Writing Omb No 0938 0242 Form on the Website

Look into and custom-make the perfect Omb No 0938 0242 Form in the CocoSign template library to improve your productivity and simplify the signing process. If you are still wondering how to fill out Omb No 0938 0242 Form , you can check out the below instructions to start.

Notice the signing area

Type your signature

Click "done" to email the form

  1. At first, you should notice the right form and open it.
  2. Next, check the form and note the required steps.
  3. Then, you can come into beginning to write down the background in the blank form.
  4. Choose the check box if you fulfill the condition.
  5. View the form once you edit it.
  6. Put down your esignature at the bottom.
  7. Press the "Done" button to save the document.
  8. Download the form in Word.
  9. Email to the support team to get more data to your queries.

Choose CocoSign to simplify your workflow by filling in Omb No 0938 0242 Form and putting your esignature right away with a qualified template.

Thousands of companies love CocoSign

Create this form in 5 minutes or less
Fill & Sign the Form

CocoSign's Explanation About Writing Omb No 0938 0242 Form

youtube video

How Do You Get Omb No 0938 0242 Form and Sign It from Computer?

good morning and welcome to this meeting.of the physician focus payment technical.advisory committee.known as ptac welcome to our first ever.virtual public meeting.we've been working very hard over the.last few months and chose to hold our.meeting virtually.rather than further delay evaluating.submitted proposals.we will begin that work later on in our.agenda but first.we are very excited today to be joined.by administrator by the administrator of.the centers for medicare.and medicaid services seema verma.in her role as the administrator she.oversees a trillion dollar budget.representing about a quarter of the.total federal budget.administrator administers health.coverage programs for more than 130.million americans.and oversees the quality and safety for.all providers participating in medicare.nominee nominated by president trump on.november 29th of 2016.the seventh seventh nomination by the.president-elect.and confirmed by the u.s senate on march.13 2017.she is one of the longest serving.administrators in modern history.administrator verma is a graduate of the.university of maryland.and holds a master's degree in public.health from johns hopkins university.modern healthcare ranked her as the.number one most.influential person in healthcare in.2019. and with that it is my pleasure to.welcome administrator vermont.thank you jeff i appreciate the.introduction and thank you all for.joining us virtually today.i'm excited to kick off a new phase of.partnership between.cms and ttac before we get into.value-based care i'd like to take this.opportunity to talk about cms's response.to the coronavirus pandemic.and how we're responding in the context.of value-based care.first of all i want to extend my sincere.gratitude to everyone on the front lines.of this crisis.caring for both the physical and mental.health.is challenge time like this and america.is grateful.for our front frontline service.those of you that have been working.around the clock in that capacity.deserve.every ounce of support that we can.monitor and that's why at cms.we've been working to provide healthcare.workers with the tools that they need.unprecedented time during the pandemics.cms has explained.expanded flexibility across the board.and the first and best example of this.is telehealth telehealth has been.nothing short of a lifeline it's allowed.seniors to access care that they need.without leaving their homes and risking.potential exposure to the virus.and it's also protected health care.workers and preserved ppe.we've increased access to telehealth.visit a total health visits including by.expanding the types of television.telehealth visits we cover and never.before has the health system.adopted so rapidly to any change.especially one that so dramatically.transforms.how care is delivered since mid-march.nearly.7.3 million medicare fee-for-service.beneficiaries have used telehealth.and that's up from approximately 136 000.from january to mid-march and over 4 000.percent.increase and we continue to hear very.positive feedback from both providers.and patients.and we've also removed regulatory.regulatory barriers so that.the healthcare workforce can practice at.the top of their license.consistent with state laws this effort.was ensuring that health systems across.the country could have.all hands on deck and we've allowed.physicians.affiliated with hospitals to provide.care in places like skilled nursing.facilities and inpatient rehab.facilities.and we've also changed some of the.requirements for nurse anesthetists.under the cms's hospitals without walls.initiative.we've taken multiple steps to allow.hospitals to provide.services and other health care.facilities and sites.that aren't necessarily a part of the.physical existing hospital and to set up.temporary expansion sites to address.patient needs.for example ambulatory surgery centers.with capacity can register as.hospitals for the duration of the.emergency and receive.comparable compensation and we've also.changed our testing policies.so we're allowing labs to go out to.nursing homes to collect samples.and we've also expanded access to.testing and pharmacies.and finally we have lifted scores of.regulations across the board to help our.health systems.and provide more flexibility anything.from just removing some of the reporting.requirements.to give our systems more flexibility and.we're also working hard to support.states as they seek to use new tools.available to them in order to respond to.the pandemic.cms has approved over 365 requests from.states for waivers.amendments and flexibilities and.medicaid state plans.and most of these were done in a matter.of days.when it comes to our existing payment.models we have announced.important flexibilities on.implementation dates.as well as data reporting requirements.to ensure providers can focus on.patients instead of paperwork during the.pandemic.we've also made adjustments to payment.methodologies including mitigating.risk during the emergency and modifying.cost targets and benchmarks.to adjust for the response to the virus.so providers aren't at risk for costs.solely.due to this unprecedented pandemic and.you're going to hear more about this.from brad smith later on today.and of course this just scratches the.surface we continue to solicit feedback.from providers such as you.and we have ongoing meetings weekly.meetings with provider types across the.board.and as we reopen the country we are.considering the impact of these.flexibilities and what should be a.permanent part.of our medicaid program for medicaid and.medicare programs.and some of those changes will require.congress to act but we are looking at.what we can do through our regulations.as well i've been very clear that i.think that telehealth and the.flexibilities around telehealth should.be maintained.and as we assess the changes made to our.programs we will also be looking at the.flexibilities we offer in alternative.payment models.and how to continue to encourage.value-based care.this crisis brought to light numerous.vulnerabilities in our health care.system.including how a fee for service payment.in a time of falling non-cova demand.left many providers with serious revenue.declines.by contrast alternative payment models.such as population based payment models.may buffer such abrupt revenue losses.and as you know improving value is a top.priority at cms.a central plank of our agency-wide.agenda.we want to deliver high quality outcomes.at the lowest cost.a major component of the transition to.value-based care is the models we.develop and release.the process of crafting a model is.complex and requires significant.investment of time and resources.ptac plays a vital role in our.development.of these models by providing practical.well-vetted input.and we are deeply grateful for that and.conversations with submitters who have.gone through the ptac process have.informed and enriched our thinking on.these issues.going forward we want to continue to.hear from stakeholders and what they.believe to be care delivery issues and.how.how they think we can use value-based.care to address those issues especially.after their experiences during the.public health emergency.and we want to leverage ptac as the.place to gather.valuable public input on provider.adoption of alternative payment models.boosting participation in our existing.models and future ones.that we plan to release as a top.priority right now the application for.direct contracting is open and the.primary care first and kidney care.choices model applications recently.closed.we expect that these new models will.bring in many new providers to.value-based payments.and alternative payment models when they.begin next year.and we look forward to providing.additional opportunities as more mods.are announced again this year we will be.reviewing a lot of the models that.started at the beginning of cmmi.are now coming to fruition in terms of.their evaluations and we'll be taking a.long look.at the results of these early models and.try to apply lessons learned.to the models that we develop in the.future so thank you again for being here.your willingness to take time out of.your busy schedule.to serve the american people and its.mission to improve.the health and well-being is invaluable.and so thank you and have a wonderful.conference.thank you administrator irma and welcome.my name is dr jeff balet.i'm the chair of the ptac committee and.we're incredibly thankful to the.administrator for joining us and giving.us.her public remarks we appreciate you.taking the time out of your very busy.schedule.to articulate your vision for this.renewed sense of cooperation between.p-tech and cms and we are here as eager.and willing partners.i would like to welcome members of the.public.who are participating today whether it.be webex phone or live stream.thank you all for your interest in.today's meeting.should you have technical questions.during the meeting or decide you would.like.to make a public comment on one of the.proposals during the meeting please.reach out to the host.by the chat function.in webex or email or call ptac at the.registration stat.ptac registration staff for your.logistics email.and your name will be added to the end.of the pre-registered list of.commentators.for the specified proposal you can also.email.ptac registration at.norc.org with any questions.again that's p-tac registration at.norc.org.we extend a special thank you to the.stakeholders who have submitted proposal.proposed models especially those who are.participating in today's meeting.we recognize that many ptac stakeholders.are directly involved in responding to.the pandemic and we are grateful for.your service.to our communities across the nation.especially to those on the front line.we're also thankful for the privilege of.your time and attention today.ptac has long been committed to.supporting a submitter-driven process.and we recognize that our stakeholders.and potential future submitters.may have their focus directed in other.areas presently.so i would remind anyone who's.considering submitting a proposal.that ptac accepts proposals on a rolling.basis.so you don't have to worry about.submitting a proposal within a certain.timeline.in addition to the future to the.frontline providers we also want to.thank the multitude of other providers.support staff caregivers family members.and other supporting patients during.this crisis.this pandemic has highlighted many.challenges within.our health care system that we knew.existed to varying degrees.but but really were brought to the.forefront.the inconsistent resilience of our.health care system.and the many gaps that exist some.involve payment reform and clinical.redesign.work that is the focus of the models.ptac is evaluating and can play a.significant role.in addressing this public health.emergency has taught us much about our.current fee-for-service system.and that value-based alternative payment.models.as the administrator has said can play a.significant role in addressing those.weaknesses.in a fee-for-service system providers.must rely on their patients ability to.present for appointments and procedures.in order to support their financial.business model.the pandemic challenged this delivery.structure with a sudden staggering.decline in revenue.for many types of providers across the.country.a variety of alternative payment.methodologies such as capitation.or value-based payments offered.providers continued revenue in the face.of declining patient visits.alternative payment models are an.important part of healing the health.care system.accentuated during this crisis.as are other key solutions that have.played an important role in supporting.patients and providers.such as telehealth now.is most certainly an important time for.ptac to ensure that our processes and.approach to model evaluation are well.designed.to encourage stakeholders to engage with.us to strengthen the resilience.of our health care system in addition.in addition to submitting proposals for.alternative payment models we are.exploring new ways of sharing your ideas.with the committee that will be.announced in the coming months.although today's meeting is being held.virtually ptac members are actively.engaged participating from their various.parts of the nation and eager to hear.from.our submitters today.while our goal is for a seamless virtual.experience.the potential exists for technical.challenges such as sound delays.or background noise so we appreciate.your understanding.should such challenges arise.i want to note that this is ptac's 10th.public meeting.that includes deliberations and voting.on proposed medicare physician-focused.payment models submitted by members.of the public ptac has been working hard.since our last public meeting in.september.and i would like to walk through some of.that work before we begin our.deliberations.first i would like to introduce our.newest ptac member.as we begin dr charles de chaser was.appointed by the u.s government.accountability office in october of last.year.he is an internist by training who joins.us from highmark health.plan in pittsburgh and we are pleased to.have him serving on the p-tech.committee welcome charles thank you.we are expecting three new appointments.to p-tac in the coming weeks and we will.be sure to welcome those new members at.our public meeting.uh at our next public meeting.this september i would also like to take.a moment to reflect on the work of ptac.and how it has evolved over time.dtac was created within the medicare.access and chip reauthorization act of.2015 known as macra.the first phase of the committee's work.involved many public meetings that were.that where we sought public feedback.about how best to design the committee's.proposal review process we also attended.briefings about the government's work in.the alternative payment model space.the secretary of hhs then released the.macra final rule.which included the 10 criteria we.were to apply to our review propos to.our review of proposals.in december of 2016 we began receiving.proposals from the public.for physician-focused payment models.moving us into the next phase of our.committee's work.we have received 36 models.delivering reports to the secretary on.24 of them.each report represents significant.effort by the submitters.drafting the proposal and the committee.in its subsequent review.ptac has been receiving models for three.and a half years.long enough that we wanted to reflect on.the different models we've reviewed.including evaluating who has submitted.ideas.what payment and care delivery issues.have they identified across the health.care system.and what solutions have been proposed to.this end.aspects contractor norak has compli.compiled two reports that summarize and.provide an inventory of the proposals.that have been submitted.and the extensive evaluating reviews.provided by ptac.you can find these reports on the ask.pptac website.at the top of the resource page the.first report highlights themes and.common elements.across proposals regarding issues.targeted.and the proposed solutions the second.report describes.patterns in how ptac has assessed the.proposals.that have been submitted to the.committee taken together.the reports provide a comprehensive look.into the breadth.objectives and variation of alternative.payment models submitted by stakeholders.and the findings derived from the.committee's analysis.of the proposals relative to the.secretary's criteria.i believe these reports synthesize the.extensive evaluative.work conducted by our committee as we.review the proposals designed to address.important issues in health care delivery.as raised by stakeholders in the field.these combined efforts can inform.stakeholders who may want to submit.proposals to ptac.policy developers the ptac itself and.the public.at large later today.after we have voted on the two proposals.the contractor will offer a short.presentation on these two reports that i.think you'll find very interesting.looking to the future we reflected on.the history and the work of ptac.taking into account the tremendous and.tremendous and important stakeholder.input.on care delivery and alternative payment.models.we want to incorporate these reflections.to further.activate and encourage stakeholder.engagement.as we continue to evolve our work as a.committee.we drafted a vision statement to better.communicate to the public.how our work fits into the transition to.value-based care.i would like to read that statement now.ptac was created to contribute to a.national priority.to improve the efficiency and.effectiveness of the u.s health care.delivery system.we believe that proposed solutions from.front-line stakeholders.in our delivery system can substantially.enhance quality.improve affordability and influence.policy development.and system transformation ptac provides.a forum.where those in the field may directly.convey both their ideas.and their concerns on how to deliver.high value care.for medicare beneficiaries and other.seeking health care services.in our nation ptac is committed to.ensuring.our stakeholders have access to.independent.expert input and their perspectives.and innovations reach the secretary of.health and human.services ptac will continue to submit.comments and recommendations regarding.physician-focused payment models.submitted by stakeholders to the.secretary.as required by statute in addition we.will expand our communications with the.centers for medicare and medicaid.services.cms and stakeholders to identify our.opportunities.to further inform and prioritize the.work cms.including the center for medicare and.medicaid innovation cmmi.and other policy makers are undertaking.to modernize.health care this statement.serves as the framework for our for.other changes you will see.both today and in the future.we want to remain thoughtful and.leverage collaborative opportunities.that encourage stakeholders.to provide their ideas on how to address.care delivery challenges.through expanding value-based care we.also want to broaden our knowledge.foundation.including gathering information through.public dialogue.on various cross-cutting themes and.topics.raised across proposed models such as.telehealth.we believe such input will serve to.better inform our recommendations.to the secretary also.shortly we're releasing an updated.version of our proposal submission.instructions.that are designed to expand the number.of and types of proposals that are.submitted to ptac.we have found that while certain.proposals may have.strengths within some criteria and.weaknesses in other.when evaluated as a whole these.proposals may raise important care.delivery.payment or policy issues therefore ptac.encourages stakeholders to submit.physician-focused payment.model proposals that address the.innovative approaches in care delivery.regardless of the level of.sophistication of the payment.methodology.these updated instructions reflect the.committee's vision to encourage.engagement and to activate stakeholders.who wish to convey care delivery and.payment challenges.along with proposed solutions we are.eager to elicit real-time input.to help inform the committee about.specific issues.stakeholders are experiencing in the.field.we hope that these new instructions will.encourage more submissions.as the vision statement expresses.submitting to ptac is an opportunity to.help inform the policy community.about what you have experienced on the.front lines and suggest potential.approach.approaches to address any issues.in addition these efforts we are looking.forward to having theme-based.discussions.during future public meetings to foster.dialogue and insights.on specific broad-based challenges whose.impacts are not limited to a single.proposal.these discussions will occur in addition.to the current deliberative public.process.which happen after proposals on any.topic have been reviewed by a ptac.preliminary review team and then by the.full committee.i want to be very clear that we will.continue to accept all proposals.on any topic at any time ptac is always.open for business we are hard at work.preparing for our first theme based.discussion.which we are hoping to hold in september.and this will be.excuse me focused on telehealth.included in this session will be.holistic reflections on previous.proposals that included elements related.to telehealth.tying together how alternative payment.models in telehealth may play a more.important role.as features that can further transform.our health care system.we also intend to invite public input on.this topic in the future.as well as continue to evaluate.submitted proposals.that are ready for deliberation as has.been done in the past.as today's comments convey your input is.very important to us.in addition to the efforts i just shared.at the end of the day we will pose some.questions about challenges.in care delivery payment model design.and other important challenges members.of the public are experiencing.a detailed list of these questions will.be posted on the ask ptac website.comments by email will also be accepted.your input will inform our future work.and we will report.out the comments receive related to this.inquiry at a future public meeting.together all these efforts just.described serve to further inform p.work and help enhance our efficiency and.effectiveness.on behalf of the stakeholder community.and the beneficiaries they support as we.continue to evaluate alternative payment.and clinical redesign models.as a reminder in order to receive.updates about three.these various opportunities to engage.with p-tech.please join the ptac list serve which.you can find.on the contact page of the aspie ptac.website.moving on ptac published a report to the.secretary with our comments and.recommendations on the proposal entitled.access telemedicine an alternative.health care delivery model for rural.cerebral emergencies.that we deliberated and voted on last.september.which had been submitted by the.university of new mexico.health sciences center our preliminary.review teams have also been working hard.to review multiple proposals.two of which we are scheduled to live to.deliberate and vote on today.to remind the audience the order of.activities for review of a proposal is.as follows.first ptac members will make disclosures.of any potential conflicts of interest.we will then announce any committee.members not voting.on a particular proposal second.discussions of each proposal will begin.with a presentation from the preliminary.review team or prt.charged with conducting a preliminary.review of the proposal.after the prt's presentation and any.initial questions from.ptac members the committee looks forward.to hearing comments from the proposal.submitters.and the public the committee will then.deliberate.on the proposal as deliberation.concludes i will ask the committee.whether they are ready to vote on the.proposal.if the committee is ready to vote each.committee member will vote.electronically on whether the proposal.meets each of the secretary's ten.criteria.after we vote on each criterion we will.vote.on our overall recommendation to the.secretary of health and human services.and finally i will ask p-tech members to.provide any specific guidance to aspie.staff.on key comments they would like to.include in ptac's report to the.secretary.a few reminders as we begin discussions.of today's.first proposal first if any questions.arise about ptac please reach out to.staff.through the ptac hh.gov email.again that email address is ptac at.hhs.gov we have established this process.in the interest of consistency.in responding to submitters and members.of the public and appreciate everyone's.cooperation.in using it i also want to underscore.three things the prt reports.are reports from three ptac members to.the full ptac.and do not represent the consensus or.position of the ptac.second prt reports are not binding.the full ptac may reach different.conclusions.from those contained in the prt report.and finally the prt report is not a.report to the secretary of health and.human services.after this meeting ptac will write a new.report.that reflects inputs from the public as.well as p.tax deliberations and decisions today.which will then be sent to the secretary.etac's job is to provide the best.possible comments and recommendations to.the secretary and i expect that our.discussions today will accomplish this.goal.i would like to thank my ptac colleagues.all of whom give countless hours to the.careful and expert review of the.proposals we receive.thank you again for your work and thank.you to the public for participating in.today's first ever virtual meeting.let's go ahead and get started the first.proposal we will discuss today is called.i.care emergency department avoidance this.proposal was submitted by the university.of massachusetts medical school.ptac members let's start the process by.introducing ourselves.and at the same time excuse me read your.disclosure statements on this proposal.because this meeting is virtual i will.prompt each of you.i'll start jeff bailet ceo of alteas.nothing to disclose next is grace.grace carol ceo of aventis whole health.nothing to disclose paul.paul casal cardiologist and executive.director of new york quality care the.aco for new york presbyterian.columbia and wild cornell nothing to.disclose.charles uh charles d schazer.chief medical officer for highmark inc.nothing to disclose.veda kavita patel internist and fellow.at the brookings institution nothing to.disclose.angelo.angelo may be unmute well i'm sorry.uh angelo sinopoli a pulmonary critical.care physician and chief clinical.officer for prisma health from south.carolina.bruce who's steinwald a health economist.here in washington d.c.and finally jennifer jennifer weiler.chief quality officer.uc health denver metro and.professor university of colorado school.of medicine.in denver colorado nothing to disclose.thank you i would now like to turn the.meeting over to the lead of the.preliminary.review team for this proposal dr paul.casell.to present their findings to the full p.tech paul.thank you jeff before i get started on.the.presentation i wanted to uh.state that harold miller who as you can.see was a member of the.uh ert for this proposal he resigned.from the ptac on november.19 2019. he did participate.in the prt as input is reflected.in the report that is about to be shared.next slide.next time so.just as a reminder how prt works.the ptac chair and vice chair assigns.two to three ptac members including at.least one physician to each.complete proposal to serve as the prt.the prt identifies additional.information needed from the submitter.and determines to what extent any.additional resources.or analyses are needed for the review.the prt determines at its discretion.whether to provide initial feedback.on a proposal after reviewing the.proposal additional materials are.gathered and public comments received.the prt prepares a report of its.findings to the full.p tax as jeff already mentioned the prt.report is not binding on p-tac.ptac may reach different conclusions.from those contained in the prt report.next slide so.some background on the ieda proposal.it's based on a transforming clinical.practices initiative.award assisting over 1600 optometry.practices across the u.s.to increase the number of patients with.eye related symptoms.you make visits to a practice rather.than an emergency.department for urgent eye conditions.the submitter asserts this approach.improve the quality of care for patients.and reduce the cost.of treating urgent eye related.conditions for both payers and.patients because the payment for an.office visit.is significantly less than the payment.for an ed visit.the goals of the ieda proposal.is to encourage treatment of selected.eye related symptoms through office.visits with optometrists and.ophthalmologists.rather than visits to hospital eds.the alternative payment model entity.are licensed optometrists and.ophthalmologists.as well as organizations employing.optometrists and.ophthalmologists next slide.the core elements of the proposal of.financial risk.is in the form of an eight percent.reduction for all urgent care visits.these are identified by icd-10 diagnosis.codes.relative to payments under the normal.physician fee schedule.shared savings payment at the conclusion.of the performance years based on the.participating provider or practices.number of qualifying urgent office.visits relative to a target level and.the reduction in e.g.visits in area hospitals with the same.diagnosis.relative to a base year period.performance on two quality measures are.also taken into account.patient experience and patient safety.these are a quality threshold.in order to participate in the model and.receive shared savings payments.next slide the eight percent reduction.for initial office visits will be.for specified icd-10 codes.in the categories of the avoidable.conditions such as conjunctivitis.corneal injury corneal injury with a.foreign body.a sty acute posterior vitreous.detachment eye pain and other eye.conditions.the submitter believes that the number.of patients making urgent care visits to.the practice instead of the ed.will increase by educating patients.about the.desirability of receiving urgent eye.care from optometry or ophthalmology.practices.and by expanding the office hours for.those providers.the pros model does not however require.that participating practices.use any specific approach to encourage.these visits.next slide.in terms of the payment model in order.to receive shared savings.bonus payments providers must meet.minimal thresholds on the two quality.measures they include patient experience.assessed through a patient survey and.patient safety.which is defined as the seven day.adverse event rate for the icd diagnosis.codes for which they were seen.adverse events include unscheduled ed.visits.hospital admissions or observation stays.blindness or permanent visual impairment.or death.the target number of visits for each.participating practice or provider would.be developed based on historical.volume of visits for these conditions.which would then be increased by some.percentage.practicing sorry participating practices.or providers.could receive shared savings payments if.they're a reduction in ed visits for the.proposed urgent eye related conditions.the proposal does not specify the.percentage of the savings that would be.shared or the method for identifying the.service.area each participating physician or.practice would receive a share of the.savings for distribution based on the.increase in urgent care visits at that.practice as a percentage of the total.increase in urgent care visits across.all participating practices.next slide.the experience with the tcpi program.provided technical assistance.as i mentioned to over 1600 optometry.practices nationwide.from october 2017 through may of 2019.optometrists enrolled in ntcpi reported.more than 330 000 visits to the ed were.avoided through same-day office-based.appointments and.after hours triage these reports were.based on icd-9 codes for office visits.rather than tracking the changes in ed.visit rates.feedback from tcpi provider participates.indicates.that many of these optometrists would.participate.in the ieda model.so summarizing uh the prt review.uh is um seen here.um and what i'll do rather than walking.through this slide i will go through.each of the criteria in detail.next slide the key issues identified by.the prt.the eight percent reduction in fees for.urgent care visits may discourage.participation and cause problematic.financial losses for practices that.cannot successfully meet targets for.increased number of visits.payment is still fee-for-service based.on office visits.with no flexibility in payment to.support different approaches to services.payment reductions and visit targets.tied to specific.diagnosis codes could result in.undesirable incentives to code.incorrectly.the model does not attribute patients to.practices the methodology for.determining shared savings and.attributing the savings to participating.providers.is not clearly defined the proposed.model does not require or encourage care.coordination with primary care providers.or other specialists.and many of the problems with the.payment model rise due to challenges.that the submitter faces in trying to.craft the model to meet the requirements.that cms has established for an advanced.apm.next slide.so for criteria one scope which is a.high priority.the prt conclusion was does not meet.this was a majority conclusion.uh in reviewing this criteria no.alternative payment models in the cms.portfolio specifically address eye.related conditions.or focus on care delivered by eye.specialists.so that was one of the considerations in.regards to.scope from a provider point of view.specialty participation apms is.important but should broaden existing.opportunities.the particular clinical issue of urgent.eye visits might be appropriate.in a broader risk based model such as an.aco.or bundle payment model as opposed to a.stand-alone model.the model narrowly focuses on changing.the site of treatment for one particular.set of health problems.rather than taking a more holistic.approach to the patient's needs.and finally ed visits for eye-related.conditions occur primarily among those.under age 65. it's not clear practices.would be able to increase their.provision.of urgent care in the office if the.model is not implemented.for more payers beyond medicare.next slide criteria 2 quality and cost.also a high priority.criteria the conclusion from the prg.is that it meets criteria this was.unanimous.treatment of patients in an office-based.setting for the proposed eye conditions.rather than an eb when appropriate would.reduce costs for both payers and.patients.increased access to care in the most.appropriate setting would potentially.improve.healthcare quality the model includes.two quality measures designed to ensure.that urgent conditions.receive high quality care in an office.setting.however the proposed measures have.limitations that may not adequately.ensure the highest quality care.patients out of satisfaction does not.necessarily ensure that a condition was.treated in the most appropriate way.the patient safety measure captures only.adverse events that occur within seven.days.and only those related to the same.icd-10 diagnosis as the original office.visit.the rate of adverse events is unlikely.to be a statistically valid measure for.small practices.and finally some conditions may not.represent urgent needs but instead are.emergencies.that cannot be safely treated in an.office setting.next slide criterion three payment.methodology also a high priority.the prt conclusion was that it does not.meet the criterion this was unanimous.the proposed payment model would provide.a strong financial incentive to increase.the number of urgent care visits for eye.conditions.however the approach to setting.performance targets raises concerns.it would penalize practices whose.patients already come to them for urgent.care needs.and small practices could have a low or.high baseline rate based on random.variation.the proposal does not require any.mechanism to document the nature of the.presenting symptom or to identify the.reason the visit should be.urgent the shared savings calculation.is based on a reduction in ed visits.without attributing the reduction to.participating practices.the proposal does not specify how.adjustments would be made when eligible.patients in the service area change over.time.and finally the proposal does not.provide any upfront payments to support.the ability of participating patients.deliver more and better urgent care.next slide criteria for value over.volume.the prt concluded that it meets this.criterion.and was unanimous the proposal creates.an incentive for optometry and.ophthalmology practices to encourage.patients to come to their office for.urgent care needs.which would likely decrease ev visits.for eye-related conditions.the proposal includes a measure.indicating whether the ocular problem.was resolved and also tracks.satisfaction in adverse events.however the small size of many practices.will make statistically appropriate.assessment of adverse event rates.problematic payments for urgent care.services and targets are still tied to.office visits with the physician.so practices would not have the ability.to address urgent needs through phone.calls emails or non-physician staff.finally the model forces practices to.increase the number of office-based.visits in order to offset payment cuts.and revisit targets even if more visits.are not needed.next slide flexibility.the prt conclusion was that it met the.criterium for flexibility.and this was a majority conclusion.the proposal would reward optometrists.and ophthalmologists for changes in.their care delivery processes in order.to better respond to patients with.urgent eye conditions without dictating.how the practices should do this however.the proposal does not fundamentally.alter the fee for service structure.payment for eye visits.providers would be paid only for office.visits not for phone calls emails.with patients even if those services.could resolve the patient's needs.and not for care management or other.education activities that would help.patients avoid developing eye problems.the eight percent reduction in visit.payments and an uncertain.shared savings payment would make it.more difficult for practices to provide.services.that do not qualify for fees.next slide criterion 6 ability to be.evaluated.the prt conclusion was that it met this.criterion.and the conclusion was majority.of the prt the proposal's primary.performance measure is quantifiable and.could be compared with other providers.the information is systematically.collected through claims across.providers and over time.the proposal uses standard icd-10 codes.to identify urgent visits so the same.definitions of eligible eligible visits.could be used for non-participating.providers.the adverse event metric could also be.determined from claims for participating.providers.and compared with non-participating.providers.to compare patient experience and.satisfaction between participating.providers and non-participants.patient survey data would have to be.collected from a comparison group of.patients who see non-participating.providers.the lack of attribution of patients or.even visits avoided.to participating providers could make it.difficult to evaluate.whether changes in ed visits were.different between.participating and non-participating.providers.next slide criterion 7.integration and care coordination the.prt.conclusion was does not meet criterion.and this was a unanimous conclusion.the submitter reported that eye care.specialists informally make referrals.among themselves and to other providers.to ensure appropriate care however.participating providers would be.encouraged to see patients for urgent.care needs even if they are not the most.appropriate provider to treat the.condition.there are no formal methods for.integration with primary care physicians.or other providers who may be initiating.treatment.or treating a patient.next slide criterion eight.patient choice the prt conclusion was.that it meets this criterion.and the conclusion was unanimous.the proposed model would make it easier.for patients to receive appropriate.treatment for urgent eye conditions.outside of a hospital ev.it is possible that a beneficiary might.not realize that they have the right to.seek care in another setting.such as a needy even if their.optometrist or ophthalmologist presents.them with access.in the office setting.next slide patient safety.the prt conclusion was it does not meet.this criterion and it was a unanimous.conclusion.the proposed measurement of adverse.event rates and patient satisfaction.scores.would help to ensure that eye problems.are being addressed appropriately during.the urgent care visits.however the proposed diagnosis codes.cover a broad range of eye conditions.some of which are much more clinically.serious than others.patients do not know their diagnosis.when they seek care for an eye.conditions only their symptoms.the same symptoms such as eye pain.impairment of a visual field or redness.can result from conditions across a wide.range of clinical severity.not of all which are appropriate for.care by an optometrist or in an office.setting.as a result patients who need care in.the e.d may not receive it.which has the potential to harm patient.safety.next slide the final criterion criterion.10 health information technology.you're here computer conclusion was that.it met this criterion.and the conclusion was unanimous the.tcpi project on which the proposal is.based led providers to use electronic.health records.more extensively if implemented well the.proposal could encourage providers to.use technology to a greater extent to.inform care.there is potential for providers to.incorporate telehealth services to.expand access and achieve the proposal's.objectives.however the proposed model does not.explicitly require.or encourage enhanced use of health.information technology.next slide.so with that jeff i'm i thought i would.turn it over to kavita for any.additional comments she may have.on the discussion amongst prt.thanks paul kavita i i just wanted to um.just reinforce kind of the process that.we use because.as paul mentioned we had three of us on.the preliminary review committee.and found our interactions with the.submitters and.and all the deliberations kind of back.and forth on the review team.very engaging and despite it being.kind of pre-coveted i feel pretty.confident that we can have a great.conversation.now and wanted to thank paul for leading.the committee as well as acknowledge.harold's.important input and this submitter's.time to.take to propose this important model.and hopefully we can answer any.questions from the committee as well.thanks thanks kavita and thank thank you.paul for leading the prt.um before we have the submitters.um provide their statements and make.themselves available for questions i.just wanted to turn it over to other.committee members that may have.questions of the prt.kivita or paul for clarification prior.to bringing up.the submitters.all right i got a question jeff this is.grace.oh go ahead grace yeah um my question.is related to some of the um.commentary back in fact some of the.criticism back that um was.[Music].i believe from the one of the.associations related to emergency.physicians where they were concerned.about many of the.types of diagnoses that were.listed as being ones that were.appropriate within the.setting of an urgent care.and i i was wondering if there was any.work done either.with the background information that was.um.done by our uh contractors or otherwise.to.look into that as being um something.that was a.uh a concern that needed to be taken.into account.or not because there was a huge number.of diagnoses that were listed as being.potentially appropriate that looked.appropriate to me as far as i could tell.but there was some concern from some.some of the outside public and i'm just.wondering uh how you all thought through.that.yeah we did have a discussion around.that and i'll ask you.to comment as well and i think um yeah.it is a very long list and and many of.them appear appropriate for the office.setting i think.some of the concern was um that.there are uh within that.group of um conditions some that require.obviously emergent care.and that the patient may not be.in a position to uh distinguish.that and that for some of those.particularly time sensitive.uh conditions um.being seen in a in an office setting.rather than the emergency.room may lead to uh adverse outcome.and the only thing i would add grace.there wasn't any.we we just basically had kind of a kind.of a more.transparent discussion i believe it's.probably somewhere in our transcription.minutes with the submitter um but just.to emphasize that part of.of the acknowledgement of this was.because of this work starting in the.tci tcpi program.that there was definitely kind of a more.i would say.hub and spoke model so that there was.kind of an academic.hub with spokes you know this wasn't.just kind of.the idea where this kind of started from.came from.having kind of ed physicians and also.having kind of urgent care.and ophthalmologists and having an.interdisciplinary approach.and that was something that we brought.up that while that.seems like an incredibly robust model.that was.kind of worked out through tcpi that may.not necessarily.scale however it would be something i.think in our comments.to the secretary's report no matter what.the voting is.that looking at that model would be.critical because it did offer something.that was valuable to training.um you know in in the setting of ed.physicians as well as urgent care.physicians.this is bruce i have a question.go ahead bruce um.i'm curious about the proportion of.emergency events that could be.to be addressed um through the model in.the.physician's office as opposed to the.emergency room.um the proposal states that patient.education and expanded hours are going.to.um be the principal means of.um encouraging our patients to see.providers in their office and yet a lot.of these events occur.at evening hours and weekends.and i guess i'm curious as to.what proportion of those events like.object in your mind.could actually be seen in the office.when these events often occur.during times.well i um i i think we would look at the.experience they had in the tpci model.um in which they you know they saw over.330 000.visits i don't believe i i.maybe i don't really believe there was.data around the time you know the time.of day.for those visits that i re that i recall.um.but you're right i think we recognize.that as one of the concerns in terms of.um the education and expanding hours i.mean expanding ours will certainly help.education might but.as you said when even if these happen.during the day.um having um um.easy access um it would be critical but.to your original question i don't um i.don't remember if there was i don't.recall we had data around the time of.day that.these occurred i don't either it'd be.good to ask the submitters that.i i had a this is jeff i i had a.follow-on question.uh um paul it sort of follows on to.grace's initial point.um the uh academy of ophthalmology.uh made made reference again to the long.list.uh and and i think that that is.something that is in the process of.being.reviewed and potentially paired back but.there was also some comments just about.um the the safety you know.creating or conveying a message to.patients that.um for some of their eye complaints.urgent eye complaints.that they could be seen in an office.rather than present to the emergency.room.and they were you know just there were.some strong statements both from the.ophthalmology society and also from even.the optometry.society as well and just i saw some back.and forth in the.in the responses from the submitters to.your prt.um where does that sit and we can get a.further clarification from the.submitters.themselves but there seemed to be a.reference that that sort of.contention between between those two.bodies uh had sort of got ironed out.between the submitters.is that in fact true paul.it's not clear to me that it's been.ironed out i think they would turn to.the tcpi.project and you know sort of the.experience they had there.uh and as a and again i would be.interested.to hear directly from the submitters.because.a particular ophthalmology letter.um also raised this question of safety.but again i think from the material from.the tcpi.project and from the experience they had.there um there were.again i think that the submitters felt.that this model.was uh for um the um you know.overwhelming majority.of patients who would come present with.uh nyson.thanks angelo i'm sorry no go ahead.angelo any discussion.uh during this around the potential for.some virtual real.real-time triage to make sure patients.got directed to the appropriate level of.care.well i think we brought that up in terms.of uh our concern that really it's all.office based.fee for service um in terms of the.how this payment model would potentially.work was all.uh sort of focused around office rates.so you know i think i think we had some.discussion around it but we we didn't um.uh um other than some.uh suggestions as we put in our report.that um both from a triage and.management point of view.virtual care would potentially offer.some.benefits but that i think was the extent.of our discussion.great any other question any other.questions.yes this is charles i i just wanted to.follow up to that too because that.wasn't clear to me is there um.are there strategies embedded within.this model to.to uh kind of get i think to angela's.point as well.uh to to get to a more proactive.approach and be a more flexible.way of interacting with the uh your.patients because i.i do see that as being part of the.challenge also and and uh.a fondness is going to be changing care.seeking.behaviors of the patients and i was just.wondering if there were.thoughts around how you would you'll.create that within this model how that.would support that.yeah again i think it's a good.conversation with these submitters i.think again because the payment model is.really based around.the shift from ed visits to office.visits.again so that's sort of so uh to your.point and angelo's point and certainly.in the in the current.um era that we are in where we're seeing.um um you know back when we first.reviewed this.or or looked at this back in september.until virtual care was in a very.different place.um but having that been even with that.said uh you would.uh see that there would be opportunity.here but again i think.ultimately the payment model was focused.more around office visit e.d visit.um anyone else from the committee have.any questions before.we move on.okay hearing none let's go ahead and.have the proposal submitters join us.produced by the u.s department of health.and human services at taxpayer expense.

How to generate an electronic signature for the Omb No 0938 0242 Form online

CocoSign is a browser based application and can be used on any device with an internet connection. CocoSign has provided its customers with the easiest method to e-sign their Omb No 0938 0242 Form .

It offers an all in one package including validity, convenience and efficiency. Follow these instructions to put a signature to a form online:

  1. Confirm you have a good internet connection.
  2. Open the document which needs to be electronically signed.
  3. Select the option of "My Signature” and click it.
  4. You will be given alternative after clicking 'My Signature'. You can choose your uploaded signature.
  5. Design your e-signature and click 'Ok'.
  6. Press "Done".

You have successfully finish the PDF signing online . You can access your form and email it. Excepting the e-sign alternative CocoSign proffer features, such as add field, invite to sign, combine documents, etc.

How to create an electronic signature for the Omb No 0938 0242 Form in Chrome

Google Chrome is one of the most handy browsers around the world, due to the accessibility of a lot of tools and extensions. Understanding the dire need of users, CocoSign is available as an extension to its users. It can be downloaded through the Google Chrome Web Store.

Follow these easy instructions to design an e-signature for your form in Google Chrome:

  1. Navigate to the Web Store of Chrome and in the search CocoSign.
  2. In the search result, press the option of 'Add'.
  3. Now, sign in to your registered Google account.
  4. Access to the link of the document and click the option 'Open in e-sign'.
  5. Press the option of 'My Signature'.
  6. Design your signature and put it in the document where you pick.

After putting your e-sign, email your document or share with your team members. Also, CocoSign proffer its users the options to merge PDFs and add more than one signee.

How to create an electronic signature for the Omb No 0938 0242 Form in Gmail?

In these days, businesses have transitted their way and evolved to being paperless. This involves the signing contract through emails. You can easily e-sign the Omb No 0938 0242 Form without logging out of your Gmail account.

Follow the instructions below:

  1. Look for the CocoSign extension from Google Chrome Web store.
  2. Open the document that needs to be e-signed.
  3. Press the "Sign” option and design your signature.
  4. Press 'Done' and your signed document will be attached to your draft mail produced by the e-signature application of CocoSign.

The extension of CocoSign has made your life much easier. Try it today!

How to create an e-signature for the Omb No 0938 0242 Form straight from your smartphone?

Smartphones have substantially replaced the PCs and laptops in the past 10 years. In order to made your life much easier, CocoSign give assistance to flexible your workflow via your personal mobile.

A good internet connection is all you need on your mobile and you can e-sign your Omb No 0938 0242 Form using the tap of your finger. Follow the instructions below:

  1. Navigate to the website of CocoSign and create an account.
  2. Follow this, click and upload the document that you need to get e-signed.
  3. Press the "My signature" option.
  4. Draw and apply your signature to the document.
  5. View the document and tap 'Done'.

It takes you in an instant to put an e-signature to the Omb No 0938 0242 Form from your mobile. Load or share your form as you wish.

How to create an e-signature for the Omb No 0938 0242 Form on iOS?

The iOS users would be gratified to know that CocoSign proffer an iOS app to make convenience to them. If an iOS user needs to e-sign the Omb No 0938 0242 Form , make use of the CocoSign application relivedly.

Here's advice put an electronic signature for the Omb No 0938 0242 Form on iOS:

  1. Place the application from Apple Store.
  2. Register for an account either by your email address or via social account of Facebook or Google.
  3. Upload the document that needs to be signed.
  4. Select the section where you want to sign and press the option 'Insert Signature'.
  5. Type your signature as you prefer and place it in the document.
  6. You can email it or upload the document on the Cloud.

How to create an electronic signature for the Omb No 0938 0242 Form on Android?

The giant popularity of Android phones users has given rise to the development of CocoSign for Android. You can place the application for your Android phone from Google Play Store.

You can put an e-signature for Omb No 0938 0242 Form on Android following these instructions:

  1. Login to the CocoSign account through email address, Facebook or Google account.
  2. Open your PDF file that needs to be signed electronically by clicking on the "+” icon.
  3. Navigate to the section where you need to put your signature and design it in a pop up window.
  4. Finalize and adjust it by clicking the '✓' symbol.
  5. Save the changes.
  6. Load and share your document, as desired.

Get CocoSign today to make convenience to your business operation and save yourself a lot time and energy by signing your Omb No 0938 0242 Form online.

Omb No 0938 0242 Form FAQs

Some of the confused FAQs related to the Omb No 0938 0242 Form are:

Need help? Contact support

How can you fill out the W-8BEN form (no tax treaty)?

If there is no tax treaty between your country of residency and the USA, complete only Part I of Form W-8BEN. Part II applies to residents of a tax treaty country. Affirm the Certification in Part III by signing your name and placing a date as required. And you’re done.

Do military members have to pay any fee for leave or fiancee forms?

First off there are no fees for leaves or requests for leave in any branch of the United States military. Second there is no such thing as a fiancée form in the U.S. military. There is however a form for applying for a fiancée visa (K-1 Visa)that is available from the Immigration and Customs Service (Fiancé(e) Visas ) which would be processed by the U.S. State Department at a U.S. Consulate or Embassy overseas. However these fiancée visas are for foreigners wishing to enter the United States for the purpose of marriage and are valid for 90 days. They have nothing to do with the military and are Continue Reading

How can I fill out Google's intern host matching form to optimize my chances of receiving a match?

I was selected for a summer internship 2016. I tried to be very open while filling the preference form: I choose many products as my favorite products and I said I'm open about the team I want to join. I even was very open in the location and start date to get host matching interviews (I negotiated the start date in the interview until both me and my host were happy.) You could ask your recruiter to review your form (there are very cool and could help you a lot since they have a bigger experience). Do a search on the potential team. Before the interviews, try to find smart question that you are Continue Reading

How do I fill out the form of DU CIC? I couldn't find the link to fill out the form.

Just register on the admission portal and during registration you will get an option for the entrance based course. Just register there. There is no separate form for DU CIC.

I have no last name or middle name, how can I fill out an application form?

Contact the Government authorities wherever you live. If a single name is allowed in your culture, you will not be the only one who has had this problem, and the government would have devised a way to handle it.

How do you know if you need to fill out a 1099 form?

It can also be that he used the wrong form and will still be deducting taxes as he should be. Using the wrong form and doing the right thing isnt exactly a federal offense

Easier, Quicker, Safer eSignature Solution for SMBs and Professionals

No credit card required14 days free