2016 GPRO ACO Random Sample Reporting

January 17, 2017 to March 17, 2017

ACO GPRO 2016 Ready to Report Basics

ACO GPRO 2016 Ready to Report Basics

What is an Accountable Care Organization (ACO)?

Which patients am I responsible to report?

What are the GPRO quality measures in an ACO?

What is the reporting timeline?

How do I report the GPRO quality measures?

What is my score (not ACO score?)

How do I mass import EHR data into the tool?

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What is an Accountable Care Organization (ACO)?

The Shared Savings Program ACOs are groups of doctors and other health care

providers who voluntarily work together with Medicare to give high quality service

to Medicare Fee-for-Service beneficiaries. An ACO is not a Medicare Advantage

plan or an HMO.

ACO

ACO Participant Medical Practice

ACO Participant Hospital

December 30, 2016 pg 4

Which patients am I responsible to report?

December 30, 2016 pg 5

GPRO Quality Measures?

Care Coordination Patient Safety

Preventive Health At-Risk Population

18 GPRO Quality Measures

1. ACO-13 (CARE-2) Falls: Screening for Future Fall Risk

2. ACO-39 (CARE-3) Documentation of Current Medications in the Medical Record

3. ACO-14 (PREV-7) Preventive Care and Screening: Influenza Immunization

4. ACO-15 (PREV-8) Pneumonia Vaccination Status for Older Adults

5. ACO-16 (PREV-9) Preventive Care and Screening: Body Mass Index Screening and Follow-up

6. ACO-17 (PREV-10) Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

7. ACO-18 (PREV-12) Preventive Care and Screening: Clinical Depression and Follow-up Plan

8. ACO-19 (PREV-6) Colorectal Cancer Screening

9. ACO-20 (PREV-5) Breast Cancer Screening

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18 GPRO Quality Measures

10.ACO-21 (PREV-11) Preventive Care and Screening; Screening for High Blood Pressure and Follow-up Documented

11.ACO-42 (PREV-13) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

12.ACO-40 (MH-1) Depression Remission at 12 Months

13.ACO-27 (DM-2) Diabetes: Hemoglobin A1c Poor Control

14.ACO-41 (DM-7) Diabetes: Eye Exam

15.ACO-28 (HTN-2) Controlling High Blood Pressure

16.ACO-30 (IVD-2) Ischemic Vascular Disease: Use of Aspirin of Another Antithrombotic

17.ACO-31 (HF-6) Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction

18.ACO-33 (CAD-7) Coronary Artery Disease: Angiotensin Receptor Blocker Therapy – Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)

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December 30, 2016 pg 8

Reporting Timeline?

Description Time Period

Health Endeavors GPRO 2016 tool opens for manual key. January 9, 2017

GPRO 2016 Medicare reporting period January 17 – March, 17, 2017

Last date to safely manually key GPRO 2016 data March 14, 2017

December 30, 2016 pg 9

How do I report GPRO Quality Measures?

Mandatory Patient Defaults

“N/A” if outside age range, gender

“N/A” if patient not diagnosed (looking at all available data)

Carryover prior year responses; e.g. Pneumonia

Deceased and Hospice mark patient as N/A

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Tips & Pitfalls

• Review your QM 2016 Import Chart

• Have a Plan of Action for excessive measure Skips.

• Do not get stuck on 1 record. In the first 10 days complete as many records as possible.

• You can always return to a record.

• Do not spend a lot of time on requested dates in the questions if not legible as CMS allows us to default to December 31, 2016 if date is illegible.

• Do not overwrite data unless you are certain of the data is correct and more recent than the data entered.

• Click Submit Data to CMS daily.

• Be done in 6 weeks (NOT 8 weeks)

• To obtain Shared Savings = GET DONE

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Ranks

• Random Sample Rank File received in January, 2017– NOTE – Has been sent to MFT portal for past 4 years

• Patients Ranked 1 to 616 in each Module– May have less than 616 if not enough patients to fill the module

• Required to complete 1 to 248 consecutively

• 249 to 616 the oversample [Patient or Module Skips]

• Focus on completion of 1 to 248 (Lowest to Highest Rank)– Generally ACOs urge working 350 and below to account for

skips in the first 2 weeks.

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Patient skipped Not Counted for 1-248 - Yellow flag• Medical Record Not Found

– No portion of the medical record can be located

• Patient Not Qualified

– Hospice

– Deceased

– Moved out of Country

– HMO Enrollment

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Measure skipped = individual measure for patient Not Counted for 1-248

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Access GPRO 2016 – Health Endeavors

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Sort Ranks for a Measure Lowest to Highest

Measure skipped = individual measure for patient Not Counted for 1-248

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Click on

Grid

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Data Source

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Claims Data

Expansion

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December 30, 2016 pg 31

What is my practice or NPI GPRO Score?

December 30, 2016 pg 32

How do I mass import EHR data into the tool??

Single and Spec File Mass Imports

Submit a Request

or 1-888-862-0366

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