ACO GPRO 2016 Ready to Report Basics GPRO ACO Random Sample Reporting January 17, 2017 to March 17, 2017

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1 ACO GPRO 2016 Ready to Report Basics 2016 GPRO ACO Random Sample Reporting January 17, 2017 to March 17, 2017

2 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? December 30, 2016 pg 2

3 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 3

4 Which patients am I responsible to report? December 30, 2016 pg 4

5 GPRO Quality Measures? Care Coordination Patient Safety Preventive Health At-Risk Population December 30, 2016 pg 5

6 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 12/30/2016 6

7 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%) 12/30/2016 7

8 Reporting Timeline? Description Health Endeavors GPRO 2016 tool opens for manual key. January 9, 2017 Time Period 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 8

9 How do I report GPRO Quality Measures? December 30, 2016 pg 9

10 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 12/30/

11 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 12/30/

12 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. 12/30/

13 Patient skipped Not Counted for 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 12/30/

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15 Measure skipped = individual measure for patient Not Counted for /30/

16 Access GPRO 2016 Health Endeavors 12/30/

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24 Sort Ranks for a Measure Lowest to Highest 12/30/

25 Measure skipped = individual measure for patient Not Counted for /30/

26 Click on Grid 12/30/

27 Data Source 12/30/

28 Claims Data Expansion 12/30/

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31 What is my practice or NPI GPRO Score? December 30, 2016 pg 31

32 How do I mass import EHR data into the tool?? Single and Spec File Mass Imports December 30, 2016 pg 32

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