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August 14 , 2014 – AMGA WebEx
PQRS – GPRO Submission via Web Interface
Lynette M. Wachholz, MN, ARNP, CPHQ
Quality Improvement Consultant Manager
The Everett Clinic (TEC)
• Largest independent medical group in the Pacific Northwest
• Nine locations throughout Snohomish County
• Fourth largest private employer in county
• 1,700 employees • 500 providers • 300,000 patients • 900,000 annual visits • More than 40 medical
specialties • AMGA member since its
inception in 1996
CMS Quality Reporting
• Physician Group Practice Demonstration Project
– 2006-2010
• Physician Group Practice Transition Demonstration
– 2011
• PQRS 2013
PQRS 2013 – Project Timeline
• Well before September 30
– Create IACS (“Individuals Authorized Access to the CMS Computer Services”) account
• http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/IACS/index.html
• PV-PQRS Security Officer – Approves chart abstractors’ “Submitter Role” requests
• PV-PQRS Group Representative Role
PQRS 2013 – Project Timeline
• By September 30
– Self-nominate/Register via the Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System
• https://portal.cms.gov/wps/portal/unauthportal/home/
• Choose “Web Interface”
PQRS 2013 – Project Timeline
• October - November
– Determine chart/data abstraction method
• IT
• Manual
• Combination
– IT project request
– Determine staffing/space needs
• Abstractors apply for “submitter role”
PQRS 2013 – Project Timeline
• December - January
– IT measure build
– Data validation
• January 27 – March 21
– 8 weeks to enter data
Tips for Successful PQRS Data Submission via Web Interface
• Determine staffing needs early
– 500 hours
• Including “wait time”
• Work closely with IT department to estimate when they will have completed their data “push”
– < 8 weeks for manual chart abstraction
Tips for Successful PQRS Data Submission via Web Interface
• Review individual measure specifications carefully
– Data Guidance document
– Determine/document approach prior to beginning manual chart abstraction
• Participate in CMS training and support calls
• Don’t hesitate to call the Help Desk
Tips for Successful PQRS Data Submission via Web Interface
• Train 1-2 abstractors to become “content experts” on any given measure/module
– Abstract by module rather than by patient
– Refer to Help [?] icon while working in the tool
• Inter-rater reliability
– 1st 10 records and then every 10th thereafter
Tips for Successful PQRS Data Submission via Web Interface
• Be prepared for…waiting:
– Computer compatibility issues
– “Log in” issues
– Getting logged off
– Passwords expiring
– Slowness during peak abstracting hours
– Hours – days wait for answers to questions posed to Help Desk
– Interface unavailable for system maintenance
Tips for Successful PQRS Data Submission via Web Interface
• Track progress visually
• Celebrate along the way
• Provide treats
• Push the “Submit” button
AMGA GPRO Webinar
- Mercy ACO -
Derek Novak
Director of Clinical Integration / Process Improvement
www.mercyaco.org
About Mercy ACO
• Wholly owned subsidiary of Mercy Des Moines
• Formed LLC in February 2012
• July 2012 Medicare Shared Savings Program
• 117k+ beneficiaries in Value Based Agreements
– 50k+ Medicare Shared Savings Program
• Geographic Coverage – Participant Sites
– 26 of Iowa’s 99 Counties
– Expecting significant growth by 2015
• 60+ Participant Organizations
• 1,200+ Providers/Suppliers
– 50/50 Primary Care /Specialists
• Shared Data System – Disease Registry
– 15+ years as part of Mercy Clinics Inc.
• 40+ RN Health Coaches/ Navigators across 2 Chapters
Larry lowered the numbers that
truly mattered with the help of a
Mercy Health Coach
Looking Back - 2012 Submittal
• 5 Participant Organizations (Owned)
• 400 Providers/Suppliers
– 60/40 Primary Care/Specialists
• 25k+ beneficiaries in MSSP
• (New) Shared Data System
– Implementation began April 2012
Hospital
EMR
Clinics
AHER
Disease
Registry
Cardiology
EMR
Manual Data
Collection
Result
• 7 (of 8) weeks to complete
• 1 Dedicated IT Resource
• SQL knowledge
• Coordinated Data
• 7 QualityNet Users
(including IT resource)
• 20 RN Health Coaches @
50% for manual collection
10%
30%
60%
Electronic Data Collection
2012 Process
ACO IT resource re-
downloads patient lists
by measure from
QualityNet and develops
data gap lists by
measure.
5
ACO IT resource
downloads patient lists by
measure from QualityNet.
Submittal Process Detail (2012-2013)
Hospital
EMR
Clinics
AHER
Disease
Registry
Cardiology
EMR
Manual Data
Collection
- Non Discrete Data
Fields
- Paper Charts
- Recently
Purchased
Facilities
- Non-Linked EMRs
(Diabetes Ctr.)
- Care outside ACO
Participants
Manual Data
Download
(XLS)
ACO IT resource
extracts patients based
on lists from QualityNet
1 2 ACO IT resource
matches data points to
measures and submits to
QualityNet
4 ACO IT resource
extracts patients based
on lists from QualityNet
3
Data gap lists are
provided to RN Health
Coaches /Navigators for
data collection.
6
Completed lists are
provided back to ACO IT
resource for submittal.
7
Process steps 5-7 are
repeated until complete
and signoff is completed.
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Submittal
Upload
Electronic Data Collection
Looking Back - 2013 Submittal
• 5 Participant Organizations (Owned)
• 400 Providers/Suppliers
– 60/40 Primary Care/Specialists
• 25k+ beneficiaries in MSSP
• Shared Data System Progress Update
Hospital
EMR
Clinics
AHER
Disease
Registry
Cardiology
EMR
35%
30%
Electronic Data Collection
2013 Process
Result
• 8 (of 8) weeks to complete
• 1 Dedicated IT Resource
• SQL knowledge
• Coordinated Data
• 4 QualityNet Users
(including IT resource)
• 10 RN Health Coaches @
60% for manual collection
Manual Data
Collection
35%
Looking Ahead - 2014 Submittal
• 43 Participant Organizations
– Owned & Independent
• 900 Providers/Suppliers
• 50/50 Primary Care/Specialists
• 50k+ beneficiaries in MSSP
• Shared Data System Still Underway
• Our 2014 Plan
– Increase to 2 dedicated IT resources
– Designate PRN/PT RN Health Coach/Navigator staff by ‘Chapter’
– Work to collect extracts immediately following 01/01/15 for known gaps
– Continue work on EMR/AHER data connections across Participants
• Our Goal - Maintain percentage of electronic vs. manual data collection
– 35% Disease Registry
– 35% Data Extracts
– 30% Manual Data Collection
Looking Ahead - 2015 Submittal
• 68+ Participant Organizations (as of today)
• 1,500+ Providers/Suppliers
• ???k+ beneficiaries in MSSP
• Significant Shared Data System work plan
ahead for Mercy ACO
Closing Thoughts / Lessons Learned • An IT resource / Coordinator is necessary for the ‘group reporting’ option.
• Planning for the submittal period is essential – develop a 7wk work plan with
the 8th week to account for the unknown.
• Establish weekly touch base meetings - to keep the cadence.
• Designate your ‘Security Officer’ and communicate their contact information to
staff in the event of systems issues (while infrequent you only have 8 weeks).
• While intimidating, it can be done!
AMGA
August 14, 2014
Dartmouth-Hitchcock
2013 Pioneer Quality Collection Review
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Dartmouth-Hitchcock Selected Operating
Statistics
Discharges 25,000
Outpatient Visits 1.7 million
Operations Performed 19,000
Emergency Dept. Visits 31,000
Employees 8,500
Annual Revenue $1.3 Billion
3 EMRs
Data Warehouse
Patient Portal
Teamwork • Closing the Gaps
• Care Coordinators
• Patient Data Coordinators
• Data
• Data Warehouse
• Analysts
• NNEACC Project manager
• Quality Team
Closing the Gaps
• Campaign – Fall 2013
• Data team provided registry and gap completion
report
• Care coordinators and patient data managers
worked together with the medical home teams to
review the reports and close the gaps.
• Fall 2014 – Starting the process much sooner
• Co-founders:
• Dartmouth-Hitchcock Health, Eastern Maine Healthcare
Systems, MaineHealth and Dartmouth College
• What is NNEACC?
• A population health management tool that allows for Care
Coordination of patients, risk contract and physician
benchmarking
• Allows users to use predictive risk analytics and to stratify
patient populations
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NNEACC Northern New England Accountable Care Collaborative
• Comprehensive views of risk populations
• Prioritization of work by financial or clinical risk
• Ability to enter transactional data including next
encounter and acuity
• Provides views of patient populations by care
management status
• Access status of populations on quality measures
• Ease of entry for quality measure data
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Benefits of NNEACC for Care Coordinators and Quality Leads
• Under CMS ACO initiatives, an ACO must
demonstrate that it met quality performance
standards to share in savings
• The dashboard provides a patient list with
status on each quality measure
• Patients can be selected to manually attest to
clinical data
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Quality Measure Module
Displays patients in the denominator of one or more quality
measure and their numerator status. Numerator data
validates a patient as having met a measure.
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Quality Measure Dashboard
Initial Notification 12/30/13 -
3/20/14
Perform Gap
Analysis 1/31/14
Estimate staffing req. 1/3-1/10/14
File Transfer 1/13/14
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Timeline
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Timeline
File Quality Check 1/13-
1/31/14
Data Identification
2/1/14 – 3/20/14
Abstraction Work 2/3 –
3/7/14
Inter Rater Reliability Validation
2/24 – 3/12/14
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Timeline
Weekly GPRO
progress reports 2/10
– 3/18/14
Final GPRO submission
3/18/14
Validation Audit per
CMS 4/23 – 5/8/14
Final CMS submission
5/8/14
• Start Early
• Define your work plan
• Constant Communication with all stakeholders
• Daily CMS GPRO calls, weekly internal calls for the audit team
• Resources
• Thorough training for abstractors
• Audit – electronic and hard copy of submitted documentation for future reference.
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Lessons Learned
Contact information:
Shannon Rondeau, RN
Manager Clinical Population Health
ACO Support
Dartmouth-Hitchcock
Phone: (603) 629-1270
Email: [email protected]
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Questions?
