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

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 Health ‐ (breast, colon, flu, pneumovax, BMI, • Depression Screening (c f/u plan) tobacco, HBP screen, depression screen) • At ‐ Risk Population – (diabetes composite – A1c/retina, • Influenza Immunization IVD/asa, CHF/B ‐ blocker, CAD (c Diab or CHF)/ACE or ARB, Depression remission) • Pneumococcal Vaccination • Care Coordination / Patient safety – (Fall Risk, Med Rec); • Diabetes Composite Measure 8 more (c 2 measures above, accounts for an additional 25%) (HgbA1C + Retinal Exam) • Customer Service – 25% 3 4 1

5/18/2017 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

5/18/2017 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 1 0 Annual Wellness Visits – Financial Benefit ‐ 2016 Attribution, Measures, $ revenue 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 1 1 1 2 add 30 min 99498 $76.24 3

5/18/2017 Transitions in Care – Prevent Readmissions, Revenue $ Primary Measures 1 3 1 4 AWV Health Risk Fall Screen 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 1 5 1 6 4

5/18/2017 Patient Depression Screening (c Follow ‐ up) Questionnaire • (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 7 1 8 AWV Patient Depression Follow ‐ up Plan Assessment • 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 1 9 20 5

5/18/2017 Flu Immunization Flu Immunization Exceptions • Flu season runs from Fall (8/1/15) to Spring (3/31/16) – • Record Vaccine refusals (make sure your EMR has a already done for 2016 report “refusal” element if patient declines the shot) • Record date if / when given in EMR • Also record if the patient is allergic to flu shots (list under “Allergies”), or cannot receive it due to other • If done at a pharmacy / elsewhere record the closest date medical reasons possible (eg October 1 st ) and note that it was given there • (Can also list other System issues, such as the vaccine is • Vaccine Registry can be accessed: not available, if appropriate.) www.mdimmunet.org (410 ‐ 767 ‐ 6606) 21 22 Pneumococcal Vaccination Pneumococcal Vaccination • We encourage all practices to give the vaccine • Give Prevnar ‐ 13 or Pneumovax to all pts > 65yo • Cost (10 doses per box): Pneumovax (90732) ‐ $76.53 per dose • No exceptions or exclusions (for vaccination refusal) Prevnar ‐ 13 (90670) ‐ $159.57 per dose • May use state Vaccine Registry • Medicare Reimbursement: www.mdimmunet.org (410 ‐ 767 ‐ 6606) Pneumovax (90732) ‐ $88.80 Prevnar ‐ 13 (90670) ‐ $177.44 Immun Single Injection (G0009) – $25.67 23 24 6

5/18/2017 Diabetes Composite Diabetes Composite – Retinal Exam • Letter sent out to all Optometrists and Ophthalmologists on 5/11/16 • Check with patients to be sure they have had a yearly • HgA1c (must record, and be <9) eye exam ‐ AND ‐ • Current Retinal 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 25 26 Diabetes Composite – HgA1c Eye Exam Referral & • If send out – please order test BEFORE office visit (to Fax Form 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 27 28 7

5/18/2017 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 29 30 Patient Diabetes Composite – HgA1c 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 31 32 8

5/18/2017 Medicare Screening Questionnaire • Use in place of the Annual Wellness Exam • Have patient fill out the form in the Waiting Room Secondary Measures • 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) 33 34 BMI (Body Mass Index) Blood Pressure BMI (65yo and older) • Pre ‐ HTN 120 ‐ 139/80 ‐ 89 record plan; f/u 1 year (plan must include lifestyle change: DASH diet; • If BMI < 23 write a plan to increase weight increase activity; decrease weight, sodium, or alcohol) • If BMI 23 ‐ 30 no plan needed; weight satisfactory • If BMI > 30 write a plan to decrease weight • HTN >140/90 create plan; return < 4 wks (if BP remains >140/90 on follow ‐ up visit, then must (for under 65yo BMI’s should be >18.5 and < 25; initiate EKG, labs, or begin medication) document if patient refuses plan) 35 36 9

5/18/2017 Tobacco Use Mammogram • Offer counseling • For ages 50 ‐ 74 yrs old, within 27 month period. • Refer to an established smoking cessation program – FMH • Use Medicare Screening Questionnaire Outpatient Cessation Program (240 ‐ 566 ‐ 3622) • Officially, report does not need to be in chart. • With proper documentation can bill in office 99406 (Smoking and tobacco use cessation counseling visit; 3 ‐ 10 • Exclusion: Bilateral mastectomies minutes) or 99407 (>10 minutes); use modifier 25 37 38 Colon Cancer Screening HTN / Depression Remission • For ages 50 – 75 years old. • Hypertension Control – must keep BP < 140 / 90; one exclusion is ESRD • Use Medicare Screening Questionnaire • Depression Remission – do PHQ ‐ 9 for every visit on a patient with depression; or schedule on a yearly basis • Officially, report does not need to be in chart. (e.g. at the time of the MC Wellness Visit) • Encourage FOBT (x3) for those who refuse colonoscopy 39 40 10

5/18/2017 CAD / CHF IVD / Med Rec Other Measures • CAD – need an ACE/ARB for CAD with DIAB or with LVSD (defined as EF <40%; if range given we will adopt • IVD – document baby ASA, anti ‐ thrombotics. the convention of using the LOWEST number given) • Medication Reconciliation • CHF – proactively obtain ECHO report  Write EF% under CAD/CHF assessment.  Document ACE/ARB/B ‐ blocker allergies/side ‐ effects. 41 42 ACO Customer Service – CAHPS • Customer Service is 25% of Quality Measure Score Customer Service • Scores below 30% ‐ no points toward savings • FIHN Current Score 22% overall 43 44 11

5/18/2017 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 D emonstrating communication between providers 4. Ask the patient to repeat instructions – teach back approach 45 46 12