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Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

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Page 1: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Dental Government Performance Results Act (GPRA)

Jacqueline L. CandelariaAlbuquerque Area

Program Analyst

Page 2: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

What is GPRA

• Government Performance Results Act• Federal law that – Shows congress how IHS is performing based on

specific measures (9/1997-Clinton)– Has been transformed and now has budgetary

strings (Bush)– Requires a data-supported audit trail from

appropriated dollars to activities and ultimately to customer benefits/outcomes with an agency’s missions

Page 3: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

GPRA Modernization Act of 2010

• Signed into law by President Obama on January 3, 2011– Purpose of the law• To require quarterly performance assessments of

government programs to assess agency performance and improvement• To establish agency performance improvement officers

and the Performance Improvement Council

Page 4: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

GPRA Requirements-Federal Agencies

• Must – document their goals and progress toward goals– Have a 5-year strategic plan in place– Submit a federal government plan and report with

their budget requests

Page 5: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Federal Government Performance Plan

• The Plan must:– Be submitted with each budget cycle– Will be released electronically and updated at

least annually– Description of resources needed to meet the goals– Projected fiscal cost of reaching the indicator goal

as a total % of budget– How data to be reported is verified and validated

(subject to audit by OMB)

Page 6: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Annual Performance Report

• Must include:

– What was actually accomplished in comparison to the goals in the plan

– If goals were not met, why? – A plan for achieving unmet goals or reasons why

goal is impractical or unfeasible

Page 7: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Choosing Performance Measures

• All GPRA measures are determined annually by the GPRA coordinating committee with input from specific subject matter experts in various subject areas

• Emerging areas of clinical concern to IHS are proposed, discussed and refined over several months

Page 8: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

GPRA Performance Measures-Four Main Categories

• Treatment-Diabetes, Cancer Prevention, Oral Health, etc.

• Prevention-Immunizations, tobacco usage, obesity, etc.

• Capital Programming/Infrastructure• Partnerships/Core Functions/Advocacy

Page 9: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Performance Measure Types• Process– Activities and health services that contribute to reducing

mortality and morbidity, e.g. clinic construction, identify disease prevalence, etc.

• Impact– Evidence based link to improved health outcomes by

reducing risk factors, e.g. immunizations; safe drinking water, cancer screening, etc.

• Outcome– Directly reduces mortality or morbidity; reduce obesity

prevalence, diabetic complications, unintentional injury, etc.

Page 10: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Why Is GPRA important?

• Allow for better patient care• Potentially could affect funding• Allow for site reports to be more reflective of

what is actually happening in clinics• Improve patient health-which in turn would

decrease the cost of caring for patients to allow for better quality and quantity of care

Page 11: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Other GPRA Requirements and Uses

• Urban facilities who receive the majority of their funding from IHS are required to report

• Tribal Facilities are not required but are highly encouraged to report– Reports are used for:• Annual budgetary requests• Program Assessment Rating Tool (PART)• Performance Audit Report (PAR)• To show effective utilization of previously appropriated

funds

Page 12: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

How is GPRA Measured

Page 13: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Clinical Reporting System

• RPMS software application that produces reports on demand for GPRA and developmental clinical indicator measures based on RPMS data

• Provides automated local and Area monitoring of clinical performance in a timely manner

• Intended to eliminate the need for manual chart audits for evaluating and reporting clinical indicators

Page 14: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Clinical Reporting System (CRS)

• Each year an updated version of the CRS software is released to reflect changes in the logic descriptions of the different denominators and numerators and/or to add performance measures

• Logic for all facilities is identical• Ensures comparable performance data for all

facilities• Benchmarks are provided to easily identify stellar

performance-as well as opportunities for improvement

Page 15: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

How does CRS work

• Each GPRA Indicator has one or more denominators and numerators defined.

• GPRA Indicator is translated into software logic with the assistance of clinical subject matter experts.

• Logic is based whenever possible on standard national codes– e.g., ICD-9, CPT, LOINC and national IHS standard code sets (Health

Factors, patient education codes)• CRS does a “Scavenger” hunt – utilizing taxonomies from

multiple RPMS packages to extract data from PCC looking for any code that relates to the measure

• Taxonomies contain groups of codes (e.g. diagnoses or procedures) or site-specific terms.

Page 16: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

CRS Disclaimer

• CRS Software is not a solution• CRS Software is only a tool to assist you (and

your facility) in identifying and aggregating comparable clinical information

• CRS Software can help you identify problems (documenting care provided, coding, data entry, business processes, etc.)

Page 17: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

How are you involved?

Page 18: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Critical Activities for Providers/Coders/Data Entry

• Assessing and providing care• Proper documentation of care given or refusal

of care• Accurate and complete coding• Accurate and complete data entry• Utilizing the selected indicator report and

iCare monitor process

Page 19: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Selected Indicator Report

• All indicator topics with all denominators and all numerators

• Displays both active clinical and user population denominators, in addition to any indicator-specific denominators

• Select one or multiple indicators or from predefined group (DM. Women’s Health, etc.)

• User can select population– AI/AN (beneficiary 01) non-AI/AN or both– User can also produce a patient list with the report

Page 20: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

CRS National Measures displayed in iCare

• GPRA measures• Other national measures– Categories• Diabetes• Dental• Immunizations• Cancer related• Behavioral Health• CVD related• Other

Page 21: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Keys to Success

• Use a team Approach• Have an ongoing organization commitment• Evaluate your program throughout the year

and make changes as necessary• Share data with patients, providers, and other

clinic staff to empower them and given them a sense of ownership

Page 22: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

GPRA Measures

• 22 IHS National GPRA Measures– 6 Diabetes related– 3 Dental related– 3 Immunizations related– 4 Cancer related– 3 Behavioral health related– 2 Cardiovascular related– 1 Other clinic related

Page 23: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

ABQ Area GPRA ResultsWhere we are right now

Page 24: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

GPRA Results as of 3/31/2012Dental National

MeasuresCurrent ABQ Area Current 2012 National Goal

General Dental Access

w/in 5% of goal 22.4% 26.9%

Dental Sealants More than 10% from goal

13,862 15,922

Topical Fluoride # of Patients Met 9314 8392

Page 25: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Sealants-Strategies for improvement

• Before patients present for appt. review what GPRA measures have not been met and encourage patients to have regular dental appointment

• Identify patients needing sealants, even adults• Provide appropriate services to patients• Replace defective or lost sealants at recall

appts.

Page 26: Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

Strategies for Improvement-continued

• Train dental assistants to replace dental sealants• Implement school-based programs (either to do

sealants or identify children through screenings with the need for sealants)

• Have dental receptionist send out postcards/letters inviting patients to the dental clinic

• Distribute information at community health fairs about the importance of dental care