Playing the Game: Strategies For Completing the ACO Measures June 2, - - PowerPoint PPT Presentation

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Playing the Game: Strategies For Completing the ACO Measures June 2, - - PowerPoint PPT Presentation

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5/18/2017 ACO Quality Scoring Playing the Game: Strategies For Completing the ACO Measures June 2, 2016 1 2 Quality Measure Score Primary Focus on: GPRO (Group Practice Reporting Option) Measures >50% Fall Risk Preventative

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5/18/2017 1

Playing the Game: Strategies For Completing the ACO Measures

June 2, 2016

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ACO Quality Scoring

2

Quality Measure Score

  • GPRO (Group Practice Reporting Option) Measures – >50%
  • Preventative Health ‐ (breast, colon, flu, pneumovax, BMI,

tobacco, HBP screen, depression screen)

  • At‐Risk Population – (diabetes composite – A1c/retina,

IVD/asa, CHF/B‐blocker, CAD (c Diab or CHF)/ACE or ARB, Depression remission)

  • Care Coordination / Patient safety – (Fall Risk, Med Rec);

8 more (c 2 measures above, accounts for an additional 25%)

  • Customer Service – 25%

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Primary Focus on:

  • Fall Risk
  • Depression Screening (c f/u plan)
  • Influenza Immunization
  • Pneumococcal Vaccination
  • Diabetes Composite Measure

(HgbA1C + Retinal Exam)

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SLIDE 2

5/18/2017 2

Measure Selection Criteria:

  • Performance Year 2016 (from Reporting Year 2015)
  • At or below 40th percentile for CMS (2016)
  • Currently at greatest risk for Depression Screening at

<30th percentile for CMS 2016

  • Diabetes Composite performance at 14.5 % (CMS

percentile not yet set – but not likely to be good)

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Quality Score

  • We get NO points (0) in our quality score for anything

below the 30th Medicare percentile rank

  • Get 1.10 points (of 2.00 possible points) for 30th percentile
  • Get an additional 0.15 for every 10% above 30th% (up to a

total possible of 2.00 at 100%)

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SLIDE 3

5/18/2017 3

Quality Score Point System

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Other Factors

  • It already 6/2/16 – nearly half of the reporting year for

2016 is GONE

  • Remember the Annual Wellness Visit exam – helps to

capture nearly all the measures

  • Need to INITIATE CHANGE – What are you doing

now, that you were not doing a year ago?

1

Financial Benefit ‐ 2016

Annual Wellness Visit Initial visit G0438 $176.61 (2.43) Subsequent G0439 $119.93 (1.50) Office Visit (established) 99213 $ 75.15 (0.97) 99214 $110.66 (1.50) 99215 $149.03 (2.11) Advance Care Planning 1st 30 min 99497 $87.66 add 30 min 99498 $76.24

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Annual Wellness Visits – Attribution, Measures, $ revenue

1 2

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SLIDE 4

5/18/2017 4 Transitions in Care – Prevent Readmissions, Revenue $

1 3

Primary Measures

1 4

Fall Screen

  • Must ask the patient: Have you had two (2) or more falls

in the past year, or one (1) or more with an injury?

  • (A) Part of Annual Wellness Visit exam (AWV HRA #17)

‐ OR ‐ (B) Consider using the Medicare Screening Questionnaire for all Medicare patients

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AWV Health Risk Appraisal (p2)

1 6

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SLIDE 5

5/18/2017 5

1 7

Patient Questionnaire

Depression Screening (c Follow‐up)

  • (A) Part of Annual Wellness Visit exam (PHQ‐2 on AWV

Patient Assessment) ‐ OR ‐ (B) Consider using the Medicare Screening Questionnaire for all Medicare patients

  • If PHQ‐2 is positive, please complete PHQ‐9 and

CREATE A FOLLOW‐UP PLAN

1 8

AWV Patient Assessment

1 9

Depression Follow‐up Plan

  • Additional evaluation for depression
  • Suicide Risk Assessment
  • Referral to a practitioner who is qualified to diagnose

and treat depression

  • Pharmacologic interventions (drug therapy)
  • Other intervention or follow‐up for the diagnosis or

treatment of depression

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SLIDE 6

5/18/2017 6

Flu Immunization

  • Flu season runs from Fall (8/1/15) to Spring (3/31/16) –

already done for 2016 report

  • Record date if / when given in EMR
  • If done at a pharmacy / elsewhere record the closest date

possible (eg October 1st) and note that it was given there

  • Vaccine Registry can be accessed:

www.mdimmunet.org (410‐767‐6606)

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Flu Immunization Exceptions

  • Record Vaccine refusals (make sure your EMR has a

“refusal” element if patient declines the shot)

  • Also record if the patient is allergic to flu shots (list

under “Allergies”), or cannot receive it due to other medical reasons

  • (Can also list other System issues, such as the vaccine is

not available, if appropriate.)

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Pneumococcal Vaccination

  • Give Prevnar‐13 or Pneumovax to all pts > 65yo
  • No exceptions or exclusions (for vaccination refusal)
  • May use state Vaccine Registry

www.mdimmunet.org (410‐767‐6606)

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Pneumococcal Vaccination

  • We encourage all practices to give the vaccine
  • Cost (10 doses per box):

Pneumovax (90732) ‐ $76.53 per dose Prevnar‐13 (90670) ‐ $159.57 per dose

  • Medicare Reimbursement:

Pneumovax (90732) ‐ $88.80 Prevnar‐13 (90670) ‐ $177.44 Immun Single Injection (G0009) – $25.67

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SLIDE 7

5/18/2017 7

Diabetes Composite

  • HgA1c (must record, and be <9)

‐ AND ‐

  • Current Retinal Exam

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Diabetes Composite – Retinal Exam

  • Letter sent out to all Optometrists and Ophthalmologists
  • n 5/11/16
  • Check with patients to be sure they have had a yearly

eye exam

  • We will report out to you (~10/16) a list of your

attributed patients with diabetes with an HgA1c and a retinal exam.

  • Must have a copy of the retinal exam / report on the chart

26 27

Eye Exam Referral & Fax Form

Diabetes Composite – HgA1c

  • If send out – please order test BEFORE office visit (to

discuss results of the test)

  • Medicare allows every 6 months for IGT, every 3 months

for Diabetes

  • If pt consistently remains >9, consider Endocrine

consultation

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5/18/2017 8

Diabetes Composite – HgA1c

  • Consider doing the test in your office
  • Cost of test / equipment – we use the A1c Now + test

$160 / 20 tests per box ($8/test)

  • Medicare reimbursement for test / venipuncture
  • HgA1c (83036) ‐ $10.44
  • Venipuncture / Fingerstick (36416) ‐ $0
  • CLIA waived – send in permission

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Diabetes Composite – HgA1c

  • Helps you manage patients with diabetes (especially the

noncompliant ones)

  • Ability to act immediately based upon the results
  • Not all commercial insurers pay for a HgA1c to be done

at the office (list available upon request)

  • Direct lab feed will help with following labs and

avoiding extra work of scanning / reviewing documents

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Patient Questionnaire

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SLIDE 9

5/18/2017 9

Medicare Screening Questionnaire

  • Use in place of the Annual Wellness Exam
  • Have patient fill out the form in the Waiting Room
  • Consider allowing your nurse / MA automatically order

any test that needs to get done (standing order sets)

  • Review by MD, then gets scanned into chart (e.g. Chart

Documents)

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Secondary Measures

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BMI (Body Mass Index)

BMI (65yo and older)

  • If BMI < 23

write a plan to increase weight

  • If BMI 23‐30

no plan needed; weight satisfactory

  • If BMI > 30

write a plan to decrease weight (for under 65yo BMI’s should be >18.5 and < 25; document if patient refuses plan)

35

Blood Pressure

  • Pre‐HTN

120‐139/80‐89 record plan; f/u 1 year (plan must include lifestyle change: DASH diet; increase activity; decrease weight, sodium, or alcohol)

  • HTN

>140/90 create plan; return < 4 wks (if BP remains >140/90 on follow‐up visit, then must initiate EKG, labs, or begin medication)

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5/18/2017 10

Tobacco Use

  • Offer counseling
  • Refer to an established smoking cessation program – FMH

Outpatient Cessation Program (240‐566‐3622)

  • With proper documentation can bill in office 99406

(Smoking and tobacco use cessation counseling visit; 3‐10 minutes) or 99407 (>10 minutes); use modifier 25

37

Mammogram

  • For ages 50‐74 yrs old, within 27 month period.
  • Use Medicare Screening Questionnaire
  • Officially, report does not need to be in chart.
  • Exclusion: Bilateral mastectomies

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Colon Cancer Screening

  • For ages 50 – 75 years old.
  • Use Medicare Screening Questionnaire
  • Officially, report does not need to be in chart.
  • Encourage FOBT (x3) for those who refuse colonoscopy

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HTN / Depression Remission

  • Hypertension Control – must keep BP < 140 / 90; one

exclusion is ESRD

  • Depression Remission – do PHQ‐9 for every visit on a

patient with depression; or schedule on a yearly basis (e.g. at the time of the MC Wellness Visit)

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SLIDE 11

5/18/2017 11

CAD / CHF

  • CAD – need an ACE/ARB for CAD with DIAB or with

LVSD (defined as EF <40%; if range given we will adopt the convention of using the LOWEST number given)

  • CHF – proactively obtain ECHO report
  • Write EF% under CAD/CHF assessment.
  • Document ACE/ARB/B‐blocker allergies/side‐

effects.

41

IVD / Med Rec

Other Measures

  • IVD – document baby ASA, anti‐thrombotics.
  • Medication Reconciliation

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Customer Service

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ACO Customer Service – CAHPS

  • Customer Service is 25% of Quality Measure Score
  • Scores below 30% ‐ no points toward savings
  • FIHN Current Score 22% overall

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SLIDE 12

5/18/2017 12

ACO Customer Service – CAHPS

Priority Recommendations (from Press Ganey) –

1. Sit at eye level when talking to patients, do not interrupt 2. Acknowledge concerns and emotions verbally ‐

“Let’s talk more about your concerns/fears”, “Let’s write down the next steps for you and your family”, “If you have questions please do not hesitate to call the office”

3. Reference information from the last visit and history Demonstrating communication between providers 4. Ask the patient to repeat instructions – teach back approach

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Questions

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