2016 GPRO Readiness. January 17, 2017 to March 17, /2/2016

Transcription

1 2016 GPRO Readiness 2016 GPRO RANDOM SAMPLE REPORTING January 17, 2017 to March 17, /2/2016 1

2 GPRO Readiness Agenda What Quality Measures? Projected Reporting Timeline EIDM Access (GPRO WI) 2016 QM Import Chart Data Imports Patient Assignment GPRO 2016 How to Use Interface? QM Performance Scoring QM Total Score Distribution QM Priority Matrix Single File Spec File 12/2/2016 2

3 What Quality Measures? 2016 GPRO RANDOM SAMPLE REPORTING 12/2/2016 3

4 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 12/2/2016 4

5 18 GPRO Quality Measures 10. ACO-21 (PREV-11) Preventive Care and Screening; Screening for High Blood Pressure and Followup 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%) 12/2/2016 5

6 6 GPRO Web Interface: Measure Changes from PY2015 to PY2016 ACO-16 (PREV-9) BMI Screening and Follow-up Plan Medical and patient reason exceptions are now denominator exclusions (i.e., these patients are now removed from the denominator up front) ACO-19 (PREV-6) Colorectal Cancer Screening Documentation of both the results of the colorectal cancer screening and the date of the screening are required. FIT-DNA screening (e.g., ColoGuard) will be considered numerator compliant CT Colonography (i.e., virtual colonoscopy) screening will also be considered numerator compliant.

7 7 GPRO Web Interface: Measure Changes from PY2015 to PY2016 ACO-20 (PREV-5) Breast Cancer Screening 3D mammogram will not be considered numerator compliant. If the beneficiary receives a 3D mammography, submit a ticket for an Other CMS approved reason. ACO-21 (PREV-11) Screening for High Blood Pressure and Followup Documented Patient reason exception is now allowed with respect to the followup plan. ACO-31 & 33 (HF-6 and CAD-7) Beta Blocker Therapy for LVSD and ACE Inhibitor or ARB Therapy: Diabetes and LVSD List of synonyms for moderate and severe with respect to LVSD no longer applicable. Measure only allows the words moderate or severe to describe LVSD.

8 8 GPRO Web Interface: New Measure in PY2016 ACO-42 (PREV-13) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

9 Projected Timeline 2016 GPRO RANDOM SAMPLE REPORTING 12/2/2016 9

10 Description Health Endeavors stop taking new 2016 EHR Import Builds December 2, 2016 Time Period Health Endeavors stop taking 2016 EHR Imports (automation and Submit a Request files) January 31, 2017 Health Endeavors Single and Spec File Mass Imports Last Date to upload March 14, 2017 Patient ranking files are scheduled to be available for download from the Medicare GPRO WI. January 3 6, 2017 A training version of the Medicare GPRO WI is scheduled to be open for the 2016 reporting period. January 9 13, 2017 Health Endeavors GPRO 2016 tool opens for XML data collection. Health Endeavors uploads the XML to Medicare GPRO WI on a weekday daily basis commencing January 17, January 9, 2017 The Medicare GPRO WI opens for quality reporting (data entry and submission) on Tuesday, January 17, 2017, and closes on Friday, March 17, 2017, at 8 pm ET (7 pm CT, 6 pm MT, and 5 pm PT). January 17 March, 17, /2/

11 11 GPRO Web Interface Reporting Requirements The 18 GPRO Web Interface measures are associated with 8 disease modules or patient care measures. The 18 disease module or patient care measures in the GPRO Web Interface are pre-filled with 17 beneficiary samples for each ACO. For each beneficiary sample, the ACO is required to consecutively confirm and complete 248 beneficiaries, or 100% of their sampled beneficiaries if < 248 are available.

12 12 GPRO Web Interface Sampling: Selecting the Sample Each measure will have its own beneficiary sample. In other words, each ACO will have 16 samples of 616 beneficiaries, and one sample of 750 beneficiaries (for the statin therapy measure). The beneficiary s place in the sample (e.g., 1, 2, 3, etc.) is referred to as the beneficiary s rank. Each ACO is required to confirm and complete data entry on 248 consecutive beneficiaries for each measure GPRO Web Interface Sampling Methodology: Instruments/PQRS/downloads/2016_WebInterface_Sampling-.pdf

13 13 GPRO Web Interface Reporting Prior to the opening of the GPRO Web Interface submission period, ACOs will be able to access their Patient Ranking file which includes: The ACO s beneficiary samples for each module/measure, Each beneficiary s rank order number in each module/measure, The TIN or CCN at which the patient received the most care, and 3 NPIs from whom the beneficiary received the most care. This file will be provided both as a download from the GPRO Web Interface, and as an Excel file.

14 14 GPRO Web Interface Sampling: FAQs Q: Why are there so many beneficiaries in each sample (an oversample) if we only need to report on 248? A: CMS provides an oversample for each measure in case medical record data indicate some beneficiaries are not appropriate for the sample. An oversample allows those beneficiaries to be skipped and replaced with another sampled beneficiary, so the 248 beneficiary requirement can still be reached. Q: What if my ACO doesn t have enough beneficiaries for a complete sample of 616, or 750? A: Some ACOs may not have 616 (or 750) eligible beneficiaries for some measures. In those cases CMS provides all the eligible beneficiaries that are available. Similarly, if you do not have 248 beneficiaries to report on, you must report on all the eligible beneficiaries that are available to your ACO.

15 15 GPRO Web Interface Sampling: FAQs Q: Will my ACO really have 10,606 beneficiaries in its sample (616 beneficiaries for 16 measures, plus 750 beneficiaries for the statin therapy measure)? A: No. In order to minimize the resource burden on practices, CMS samples in a way that maximizes beneficiary overlap between each measure s sample. This means a single beneficiary may be sampled for multiple measures. To the extent possible, for a single beneficiary that is sampled into more than one measure, CMS assigns a similar rank to the beneficiary in each of those measures.

16 16 GPRO Web Interface: Skip Reasons A beneficiary is removed from all measures and performance calculations if these skip reasons are chosen: Not Qualified for Sample Medical Record Not Found

17 17 GPRO Web Interface: Skip Reasons Not Qualified for Sample Beneficiary was in hospice during the performance year Beneficiary moved out of the country during the performance year Beneficiary died during the performance year Beneficiary was enrolled in an HMO during the performance year

18 18 GPRO Web Interface: Skip Reasons, cont d Medical Record Not Found (MRNF) It is expected that the ACO make every effort to locate/obtain access to the medical record and that the providers within the ACO share the necessary records/data for the purposes of coordinating care and reporting quality measure information Elevated rates of selecting MRNF is a factor considered for inclusion in the Quality Measures Validation Audit

19 19 GPRO Web Interface: Skip Reasons, cont d A beneficiary is removed from a specific measure (Skip): Diagnosis could not be confirmed Denominator inclusion criteria are not met (age, gender) Denominator exclusion criteria are met Other CMS approved reason requested Must obtain CMS approval before selecting Other CMS approved reason the QualityNet Help Desk (qnetsupport@hcqis.org) to work with CMS for approval Include the beneficiary rank, measure, and reason for request Maintain the approved Help Desk ticket number for entry in the GPRO Web Interface

20 EIDM Web Interface Role 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

21 EIDM Web Interface Role Information needed by Health Endeavors: Security Official Name Security Official Security Official Phone Confirm with Jeffrey Snowden at all Web Interface Submitter roles have been processed by December 16, 2016 or the reason for failure to process. If not processed Health Endeavors will not be able to submit on your behalf. Web Interface Submitter Roles Mandatory Setup* Caroline Wise* Jeffrey Snowden* Vidal Iseghohimen Kris Gates 12/2/

22 NEW Enterprise Identity Management (EIDM) for ACOs User s Tip ACOs in the Shared Savings Program reporting quality measures for performance year 2016 must have the necessary Enterprise Identity Management (EIDM) accounts and roles to access the CMS Group Practice Reporting Option Web Interface (GPRO WI). The 2016 Quality Reporting Guide: EIDM Account and Role Set-up guidance document is available on the SSP ACO Portal under the Announcement, 2016 Quality Measurement and Reporting Guides. This guide provides instructions for setting up your EIDM account and checking your EIDM roles. If you need assistance with your EIDM account please contact the QualityNet helpdesk at qnetsupport@hcqis.org. 12/2/

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26 QM 2016 Import Chart 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

27 Preferences & Defaults QM 2016 Chart Default Applicable Modules/Responses to No or Not Done if no available data. 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 12/2/

28 General Questions - Apply to All Measures ACO Number? Indicate CMS ACO Number. Primary contact person? List the primary contact person for this document. Lock down questionnaires? If locked then NO ability to overide any answers with manual key. Once you unlock you may ONLY manual key. CCLF, EMR, CCDA, Lab, Carry-Over will stop. Default Age and Gender? (Highest Priority) Set answer to N/A if the Quarterly Patient Attribution File indicates that the patient's age or gender is outside of the measure range. Default Date of Death? (Highest Priority) Mark all patients as Not Qualified (Skip - Yellow Flag)if the Monthly CCLF Claims Data provides a Date of Death. Also applies to patients with completed questionnaires. Default Date of Hospice? (Highest Priority) Mark all patients as Not Qualified (Skip - Yellow Flag)if the Monthly CCLF Claims Data provides a Date of Hospice. Also applies to patients with completed questionnaires. Default No Diagnosis? (Lowest Priority) Set answer to N/A if the patient has Monthly CCLF Claims Data with no indication of the diagnosis included in the measure. Applies to: CAD,DM,IVD,HF,HTN Default Not Done? (Lowest Priority) Set answer to the default Negative Response (Not Done) if the patient does not have an answer for the measure. See BRD for applicable responses. Frequency of abstracted data? If abstracting EMR or Lab data, when will the data be provided? Confirmation of Delta File? All provided data is treated as delta file, not a full replacement. EMR Name and Version? Indicate EMR Name and Version. EMR file format? Acceptable formats: xls, xlsx, txt, csv CCDA file format? Acceptable formats: xml as long as we can match up the records within the xml Lab file format? Acceptable formats: HL7 v2 (parsed with multi delimiters) and HL7 v3 (xml) Response [aco number] [name] Default is data is always locked down with priorities applied. Y Y Y Y/N Y/N Daily, Weekly, Monthly, Quarterly, Annual N/A N/A N/A N/A N/A Mandatory Mandatory Mandatory Choose option Choose option 12/2/

29 Data Imports 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

30 Data Imports QM 2016 Chart Review CCLF (claims) Monthly Imports EHR Builds (Custom or EMR BRD) xls, xlsx, txt, csv XML CCDA Health Endeavors Single File Upload Tool Health Endeavors Spec File Upload Tool Manual Key 12/2/

31 Description Health Endeavors stop taking new 2016 EHR Import Builds December 2, 2016 Time Period Health Endeavors stop taking 2016 EHR Imports (automation and Submit a Request files) January 31, 2017 Health Endeavors Single and Spec File Mass Imports Last Date to submit March 14, 2017 Health Endeavors Manual Key Last Date to submit March 14, 2017 Health Endeavors CCLF (claims) January 31, /2/

32 Manual Key Claims (CCLF) Data Imports Health Endeavors Spec or Spec File Upload XML or CCD EHR Imports Lab File HL7 v2 (parsed with multi delimiters) and HL7 v3 (xml) GPRO Central Repository Data Imports HE Business Requirements Document (EHR BRD) automated file submission (xlx, xlxs, txt, csv) 12/2/

33 Patient Assignment 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

34 ACO TIN TIN SubGroup TIN (location) SubGroup TIN (location) NPI NPI NPI NPI NPI NPI NPI NPI NPI NPI NPI 12/2/

35 Patient Assignment Algorithm Primary Care Provider TINs Priority #1 Specialist TINs Assign to Specialist TIN or Assign to PCP Priority #2 Associate the NPIs under the selected TIN (from above) NPI with the greater number of visits in last 12 months Using Part B attribution code visits 12/2/

36 GPRO 2016 Interface 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

37 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 12/2/

38 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. 12/2/

39 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 12/2/

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41 Measure skipped = individual measure for patient Not Counted for /2/

42 Access GPRO 2016 Health Endeavors 12/2/

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50 Sort Ranks for a Measure Lowest to Highest 12/2/

51 Measure skipped = individual measure for patient Not Counted for /2/

52 Click on Grid 12/2/

53 Data Source 12/2/

54 Claims Data Expansion 12/2/

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57 GPRO Performance Scoring 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

58 Quality Performance (Scoring) 12/2/

59 Total Quality Score 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

60 Single and Spec File Mass Imports 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

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62 Single File Upload Tool Only positive questionnaire responses can be uploaded with the Tool. Select the module and related question you would like to complete. Upload the properly formatted file that contains the patient HIC Numbers or Patient First Name, Last Name and DOB. You will provided a review of actions to be taken prior to any updates being committed. The process is limited to 1000 records per upload. 12/2/

63 Single File Upload Tool Overview of Tool 12/2/

64 Single File Upload Tool Excel Format and Module Selection 12/2/

65 Single File Upload Tool Preview of Uploaded Data 12/2/

66 Spec File Import Tool Overview of the Tool All questionnaire responses can be imported using the tool. Select the module and from the sidebar. Upload the properly formatted file that contains the patient HIC Numbers or Patient First Name, Last Name and DOB. Each measure contains a template to be used for the data. An answer legend will be provided for each measure to detail the responses. You will provided a review of actions to be taken prior to any updates being committed. The process is limited to 1000 records per upload. 12/2/

67 Spec File Import Tool Overview of the Tool 12/2/

68 Spec File Import Tool Excel Format and Answer Legend 12/2/

69 Spec File Import Tool Preview of Uploaded Data 12/2/

70 Prev-13 (Statin Therapy) BRD Upload Only (Not available in Spec/Single File) gender (M/F) birth-date MM/DD/Y YYY rc1-confirmed rc2-confirmed rc3-confirmed EXAMPLE EMR BRD IMPORT medicareid patientfirst-name patientlast-name statincomments rc3-ldlconfirmed statinconfirmed OPTIONAL REQUIRED REQUIRED REQUIRED REQUIRED REQUIRED XYZ1234 Kate Simpson F 3/20/1937 6/1/ N/A (Patient is less than 21 years of age) 1 = No 1 = No 1 = No At least one Risk Category: 2 = Yes At least one Risk Category: 2 = Yes At least one Risk Category: 2 = Yes 1 = No OR 2 = Yes 1 = No OR 2 = Yes 1 = No OR 2 = Yes 1 = No OR 2 = Yes 8 = Not Confirmed 2 = Yes 4 = Medical Exception 1 = No N/A (Patient is in no Risk Category or in Risk Category 3 with LDL-C < 70 mg/dl) Patient is taking Statin or was prescribed Statin Patient is NOT taking Statin and was NOT prescribed Statin for medical reasons. Patient is NOT taking Statin and was NOT prescribed Statin - NO REASON 12/2/

71 Discussion Topics 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

72 Health Endeavors Review Session [Jan 2017] Checklist - Topics of Discussion Do you need to update your QM Chart? Is your ACO ready to enable the Save on GPRO 2016 for manual key? What is your EMR import schedule between now and January 15th? EMR data imports must be remitted to Health Endeavors no later than January 31, Confirm - QM Scoring Report Enabled for GPRO One more set of claims data in January, Patient Assignment we use algorithm or custom file Claims data and documentation internal discussion. Click Submit Data to CMS daily. 12/2/

73 Audit Changes 2016 GPRO RANDOM SAMPLE REPORTING 12/2/

74 74 GPRO Web Interface: Quality Measures Validation Audit ACO, Measure, and Beneficiary Selection Shared Savings Program ACOs may be selected for audit In 2016, 10% of the SSP ACOs will be selected for audit Selection will be random or based on data anomalies Anomalies include such things as unusually high skip rates due to Medical Record Not Found Audit Measure and Beneficiary Selection CMS will audit about 200 records per ACO, across 4 to 5 measures All records will be reviewed by CMS Pioneer and Next Generation Model ACOs Information on the 2016 QMV Audit will be provided in the Pioneer Briefing and the Next Generation ACO Newsletter

75 75 GPRO Web Interface: Quality Measures Validation Audit, Process and Impact At the end of the audit, CMS will provide education and feedback regarding the findings. CMS will calculate the overall match rate Overall match rate = 100% Number of matches Number of records audited If the overall match rate is < 90%, the ACO s overall quality score may be reduced proportional to the ACO s Quality Measures Validation Audit match rate, and thus may impact financial reconciliation Example: If ACO earns an overall quality score of 95.00% and has a Quality Measures Validation Audit match rate of 80.00%, their final overall quality score used in financial reconciliation may be reduced to 95.00% 80.00% = 76.00% Please follow the Shared Savings Program ACO Spotlight Newsletter for information on an upcoming QMV Audit Webinar on January 9, Pioneer and Next Generation Model ACOs Please follow the Pioneer Briefing and the Next Generation ACO Newsletter for information on upcoming QMV Audit Webinars.

76 10% of ACOs will be audited for matching documentation to the answer submitted for measure 200 records will be reviewed 4-5 QMs with beneficiaries per QM If ACO match rate is <90%, it will be applied to actual performance rate and that will become the performance upon which Shared Savings is based. Ex: QM performance = 95% QM match rate = 80% 95% x 80% = new performance rate of 76% (So performance drops considerably) Bottom line MUST document exactly where in the medical record the answer was found. Use our comments section to document location of DOCUMENTATION. 12/2/

77 77 Upcoming Web Interface Webinars Webinar Keys to Successful Reporting - Part 2 GPRO Web Interface Education & Outreach Kick Off 2016 Quality Measures Validation Audit Overview Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) Weekly Support Call (Q&A Session) 2016 GPRO Quality Reporting Lessons Learned Date and Time December 6, 2016; 12:30-2:00pm ET December 15, 2016; 12:00-1:00pm ET January 9, 2017; 2:00-3:00pm ET January 19, 2017; 1:00-2:00pm ET January 26, 2017; 1:00-2:00pm ET February 2, 2017; 1:00-2:00pm ET February 9, 2017; 1:00-2:00pm ET February 16, 2017; 1:00-2:00pm ET February 23, 2017; 1:00-2:00pm ET March 2, 2017; 1:00-2:00pm ET March 9, 2017; 1:00-2:00pm ET April 6, 2017; 1:00-2:00pm ET

78 Submit a Request 12/2/

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