Obtaining & Reporting Quality: Preventive Measures
Welcome
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Agenda
1. Introductions2. Housekeeping3. Presentation 4. Q & A5. Follow-up
• Final Webinar in Series: January 8• NAACOS’ Spring 2014 Conference will be on one of the
following dates, check back for more details soon • April 2-4 in Washington, DC or• April 23-25 in Baltimore
Housekeeping
1. Panelists will present for approximately 40 minutes2. Q&As will take the remainder of the hour
• Submit anonymous written questions using the Q/A tab (not chat) on dashboard
3. Webinar is being recorded• Slides and recording will be available at
www.NAACOS.com/webinars.
Today’s Presenters
Carrie Hagan, Coastal Carolina Health Care
Carrie Hagan is the associate administrator for Coastal Carolina Health Care and the associate executive director for CCQC. Ms. Hagan’s responsibilities include support of the work of the organization’s CEO focusing on the establishment and optimization of day-to-day operations in the organization. She plays active leadership role with senior leadership and management team. Ms. Hagan is responsible for establishing a measure of performance, quality improvement, cost controls and efficient utilization of resources.
Today’s Presenters
Sara Falkiewicz, ProHealth Solutions
Sara Falkiewicz is the director of performance excellence for ProHealth Care (health system) and ProHealth Solutions (ACO). Her responsibilities include measurement and monitoring and performance improvement functions for both organizations. Their departments provide all regulatory-required, publicly-reported and payor-driven data for the two organizations including areas like Core Measures, PQRI/PQRS and Meaningful Use, for over 450 physicians and 100 leaders. Ms. Falkiewicz develops key organizational metric sets and serves in a leadership role to drive the development and management of key data assets and business intelligence.
ACO Preventive Health Quality Measures
Carrie Hagan, MBA, CPC, CPCOCoastal Carolina Quality Care, Inc.
Introduction and Background
Carrie Hagan, MBA, CPC, CPCO, Six Sigma Green BeltAssociate Executive Director Coastal Carolina Quality Care, Inc.
• Internal Medicine• Family Practice• Emergency Medicine• Cardiology• Hematology/Oncology• Gastroenterology• Neurology• Pulmonary/CC
50+ Providers (60%
PCP)
12 Clinic Locations
• Imaging Center• Urgent Care• Sleep Lab• GI ASC
Integrated Enterprise-wide EHR
All Providers are Meaningful Users of EHR
Experience with Population Health Management and Reporting
ACO Background
• 100% Owned by Medical Practice• Reporting Period Started April 1, 2012• 11,000+ Attributed Beneficiaries• Advanced Payment Model ACO• Successfully reported 2012 ACO GPRO
Measures
ACO Preventive Health Quality Measures14. Influenza Immunization15. Pneumococcal Vaccination for Patients 65 Years and Older16. Body Mass Index Screening and Follow-up17. Tobacco Use: Screening and Cessation Intervention18. Screening for Clinical Depression and Follow-Up Plan19. Colorectal Cancer Screening20. Breast Cancer Screening21. Screening for High Blood Pressure and Follow-Up Documented
Quality Points and Weighting By DomainDomain Number of
Individual Measures
Total Measures for Scoring Purposes
Total Possible
Points Per Domain
Domain Weight
Patient/Caregiver Experience
7 1 measure with 6 survey module measures combined, plus 1 individual measure
4 25%
Care Coordination/Patient Safety
6 6 measures, plus the electronic health records measure double-weighted (4 pts.)
14 25%
Preventive Health 8 8 measures 16 25%
At-Risk Population 12 7 measures, including 5-component diabetes composite measure and 2-component coronary artery disease composite measure
14 25%
Total 33 23 48 100%
Quality Scoring Sliding ScaleACO Performance
LevelQuality Points (all measures except
EHR)
EHR Measure Quality Points
90+ percentile FFS/MA or 90+percent
2 points 4 points
80+ percentile FFS/MA or 80+percent
1.85 points 3.7 points
70+ percentile FFS/MA or 70+percent
1.7 points 3.4 points
60+ percentile FFS/MA or 60+percent
1.55 points 3.1 points
50+ percentile FFS/MA or 50+percent
1.4 points 2.8 points
40+ percentile FFS/MA or 40+percent
1.25 points 2.5 points
30+ percentile FFS/MA or 30+percent
1.10 points 2.2 points
<30 percentile FFS/MA or <30 percent
No points No points
Challenges of ACO GPRO Reporting• Competing Priorities• Dynamic Metrics• Patient Empanelment• Capabilities
Best Practices- What is the best way to eat an Elephant?
Doing What is Best for
Their Patients
Financial Incentives
Competitive Spirit
Sentinel Effect
What Motivates Physicians?
• While not Required, it is Extremely ImportantImplement Integrated Full Feature EHR
• Problems, Medications, Allergies, Labs, History, Etc.
Need Discrete Data Populated
• Need to Determine Who is AccountableAttribute Patients to Provider
• Medicare QIO• Measure Up Pressure Down
Begin Reporting Quality Measures
• What gets Measured get s ImprovedReport Measures Monthly
• Utilize Medicare Wellness Visit and Transition Care Management Payments to Fund Team Expansion
Utilize Team Approach
• It will Never be CompleteDon’t wait until Everything is Done
Operational Changes and Preparations
Develop Strategy and Structure for Reporting Quality Measures• Develop Purpose• Get Physician Leaders Involved• Establish Clear Measurable Objectives• Create Appropriate Incentives• Make Objectives Easy to Accomplish • Provide Doctors with Resources• Have Staff do as Much as Possible• Educate Everyone on Staff• Celebrate Small Successes and Praise Champions
Develop Strategy and Structure for Reporting Quality Measures• Elaborate systems and HIE are not required• Utilize team approach-Leverage IT, clinical Staff and coders• Use CMS provided Excel templates • Structured data in EHR helps• Some clinical data will need to be abstracted from unstructured notes• Claims data is very useful to determine where preventive services are
being performed to request reports and “backfill” data in to the EHR or paper record
• Be ready to start data collection January 13th, 2014 when CMS will provide your GPRO patient list
• Decide ahead of time whether you will be using XML upload or manually entry into GPRO WI tool
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EHR and Reporting Tools• Allscripts Enterprise E H R• Allscripts Clinical Quality• Actionable at Point-of-care (For all
contracts and populations) • Saves provider and staff time searching
thru chart• Easy to use and train• EHR serves as the main data repository
for the data• Can integrate with multiple EMRs
Allscripts CQS Patient Dashboard
CCQC Mammography Screening
IM 1 IM 2 FP 1 IM 3 FP 20.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Apr 2012Nov 2013
Practice
Perc
enta
ge
CCQC CRC Screening
IM 1 IM 2 FP 1 IM 3 FP 20.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Apr 2012Nov 2013
Practice
Perc
enta
ge
CCQC Pneumococcal Vaccination
IM 1 IM 2 FP 1 IM 3 FP 20.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Apr 2012Nov 2013
Practice
Perc
enta
ge
CCQC Influenza Vaccination
IM 1 IM 2 FP 1 IM 3 FP 20.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CCQC Influenza Vaccination
Apr 2012Nov 2013
Practice
Perc
enta
ge
Best Practices• Provide clinical and system resources
• Communication
• Train and educate everyone in the medical group on Quality Measures; key to success
• Provide hands on training to help staff input, review and coordinate measure reporting
• Promote Annual Wellness Visits for ACO patients
• Develop and Present monthly “scorecards” to create healthy competition among providers and staff
• Share best practices and lessons learned across clinical locations
• Decide ahead of time whether you are focusing on completion rates or measure performance- Oversampling Counts!
• Module Completion rates are calculated by successfully completing data on at least 411 patients
• Measure performance is calculated on data completed for all patients- Oversampling may increase measure rates
• 2013 GPRO is Pay for Reporting
Measurement and Improvement of Preventive Health Within an ACO
Sara Falkiewicz
Background• 475 Physicians, 121 Allied Health in ACO
– PCPs 31 percent (33% independent)– Specialists 69 percent (83% independent)– Independent 66 percent– Employed 34 percent– Allied Health Members 121
• Represent approximately 20 specialties– No Behavioral Health, Anesthesiology
• 50%/50% between Health System, IPA
Background• Health System
– 19 primary care and specialty clinics– 2 hospitals
• One medium size teaching hospital• One small community hospital
– Joint Ventures• Ambulatory Surgery Center• Rehabilitation Hospital of Wisconsin
– Continuum• Home Health, Hospice, Senior Center
Background• ProHealth Solutions
– Formed January 1, 2011– MSSP Program July 1, 2012– 15,000+ Attributed Beneficiaries
Preventive Metrics• Influenza• Pneumococcal• BMI and Blood Pressure
Screening/Follow Up• Tobacco Screening/Intervention• Colorectal and Breast Cancer • Depression Screening
Strategy and Structure to Report• Strong history of clinical reporting
– Health System Medical Group• Voluntarily submitting electronically gathered patient
level data to state collaborative (WCHQ) since 2006– Currently at 32 measures
• Immunization, tobacco, cancer screening
– Independent Physician Association• Measuring at a physician level since late 90’s in a manual
fashion– As of 2012 had been running almost 200 metrics
• Immunization, tobacco, cancer screening
PHS Information Technology Timeline
Secure electronic capabilities for each member practice
Secure comprehensive electronic capture of clinical and administrative data
Epic EMR, Patient Registries, Data Warehouse
Electronically connect members for population management and organization performance
32
ObtainingData
• Started With:– Multiple EMR’s– 20+ Individual Billing Systems
• End With:– One monster warehouse– 83% of providers on Epic– Balance on other EMR or SharePoint
How to Report: Technical
How to Report: Literal
• Studied each measure specification• Identified impacted clinical workflows, and if
discrete data was available (or not)• Prioritized EMR documentation build projects
based on metric needs• Validation and test process for each metric• Engage physicians in reporting manually if
needed
Reporting Challenges• Immunizations
– Capturing out-of-clinic administrations– WIR – Wisconsin Immunization Registry
• BMI and Blood Pressure Screening/Follow Up– Doing the screening, couldn’t discretely capture the
follow up– SmartText in Epic
Reporting Challenges
• Colorectal and Breast Cancer Screening– Capturing out-of-ACO procedures– Accurate documentation of exclusions
• Mastectomies, Colostomies
• Depression Screening– Had to identify a single tool– Rolling out in primary care, adding to rooming
process
Reporting Challenges
• Physician assignment– Specialty versus primary care: “actionable”– Movement of physicians in and out of ACO
• Resources and Organizational “Breadth”– Preparation for ICD-10– Meaningful Use quality measures– Increase in commercial payor metrics– Pressure from specialists for metrics more applicable
to their practice
Strategy and Structure to Improve
• Develop a shared vision– Education
• Measure definitions• Documentation requirements• Supporting clinical evidence
Strategy and Structure to Improve• Mobilize
– During visit activity• Utilize medical record decision support
– Due date calendar– Easy-to-access orders
• Scheduling of testing outlined in care plan and next steps for patient
– Outside of visit activity• Searching charts for old or incorrectly documented testing• Telephone, letter, and patient portal outreach
communication
Strategy and Structure to Improve• Monitor
– Monthly data provided to leaders and clinicians
• Overall rate, numerator and denominator• Patient-level detail on patients missing care or
documentation
Monitoring Tool: Visual Reports
Thank You For Your Time!
Questions?
Submit anonymous written questions using the Q/A tab (not chat) on dashboard
If you did not have a chance to ask a question today or have new questions, please send to [email protected].
Speaker Emails
Carrie Hagan, Coastal Carolina Health CareEmail: [email protected]
Sara Falkiewicz, ProHealth SolutionsEmail: [email protected]
Upcoming
• The final webinar in this series is Wednesday, January 8 at 1:00pm ET. The title for the next webinar is: Obtaining & Reporting Quality, At-Risk Measures. The speakers are Jeff Farber and Jill Kalman, Mount Sinai Medical Center.
• Slides and recording of today’s webinar will be posted on our website, www.NAACOS.com/webinar by tomorrow.
• Watch our website for information about the 2014 Spring Conference and our next webinar series coming soon!
Thank You!
Thank you for attending today’s webinar!
Consider joining NAACOS
The ACO and Business Partner applications can be found at www.NAACOS.com