Playing the Game: Strategies For Completing the ACO Measures

Transcription

1 ACO Quality Scoring Playing the Game: Strategies For Completing the ACO Measures June 2, Quality Measure Score Primary Focus on: 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% Fall Risk Depression Screening (c f/u plan) Influenza Immunization Pneumococcal Vaccination Diabetes Composite Measure (HgbA1C + Retinal Exam) 3 4 1

2 Measure Selection Criteria: Performance Year 2016 (from Reporting Year 2015) At or below 40 th percentile for CMS (2016) Currently at greatest risk for Depression Screening at <30 th percentile for CMS 2016 Diabetes Composite performance at 14.5 % (CMS percentile not yet set but not likely to be good) 5 6 Quality Score We get NO points (0) in our quality score for anything below the 30 th Medicare percentile rank Get 1.10 points (of 2.00 possible points) for 30 th percentile Get an additional 0.15 for every 10% above 30 th % (up to a total possible of 2.00 at 100%) 7 8 2

3 Quality Score Point System 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? 9 10 Financial Benefit 2016 Annual Wellness Visits Attribution, Measures, $ revenue Annual Wellness Visit Initial visit G0438 $ (2.43) Subsequent G0439 $ (1.50) Office Visit (established) $ (0.97) $ (1.50) $ (2.11) Advance Care Planning 1st 30 min $87.66 add 30 min $

4 Transitions in Care Prevent Readmissions, Revenue $ Primary Measures Fall Screen AWV Health Risk Appraisal (p2) 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

5 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 AWV Patient Assessment 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

6 Flu Immunization Flu Immunization Exceptions 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 1 st ) and note that it was given there Vaccine Registry can be accessed: ( ) 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.) Pneumococcal Vaccination Pneumococcal Vaccination We encourage all practices to give the vaccine Give Prevnar 13 or Pneumovax to all pts > 65yo No exceptions or exclusions (for vaccination refusal) May use state Vaccine Registry ( ) Cost (10 doses per box): Pneumovax (90732) $76.53 per dose Prevnar 13 (90670) $ per dose Medicare Reimbursement: Pneumovax (90732) $88.80 Prevnar 13 (90670) $ Immun Single Injection (G0009) $

7 Diabetes Composite Diabetes Composite Retinal Exam Letter sent out to all Optometrists and Ophthalmologists on 5/11/16 HgA1c (must record, and be <9) AND Current Retinal Exam 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 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

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 Diabetes Composite HgA1c Patient Questionnaire 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

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) Secondary Measures Review by MD, then gets scanned into chart (e.g. Chart Documents) BMI (Body Mass Index) Blood Pressure If BMI < 23 If BMI BMI (65yo and older) write a plan to increase weight no plan needed; weight satisfactory Pre HTN /80 89 record plan; f/u 1 year (plan must include lifestyle change: DASH diet; increase activity; decrease weight, sodium, or alcohol) 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 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) 36 9

10 Tobacco Use Mammogram Offer counseling Refer to an established smoking cessation program FMH Outpatient Cessation Program ( ) With proper documentation can bill in office (Smoking and tobacco use cessation counseling visit; 3 10 minutes) or (>10 minutes); use modifier 25 For ages yrs old, within 27 month period. Use Medicare Screening Questionnaire Officially, report does not need to be in chart. Exclusion: Bilateral mastectomies Colon Cancer Screening HTN / Depression Remission For ages years old. Use Medicare Screening Questionnaire Officially, report does not need to be in chart. 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) Encourage FOBT (x3) for those who refuse colonoscopy

11 CAD / CHF IVD / Med Rec 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/sideeffects. Other Measures IVD document baby ASA, anti thrombotics. Medication Reconciliation ACO Customer Service CAHPS Customer Service Customer Service is 25% of Quality Measure Score Scores below 30% no points toward savings FIHN Current Score 22% overall

12 ACO Customer Service CAHPS Questions 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