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HASSGNS/4TH QUARTER

Patient Assignment

January 18, 2017 pg 2

Financial Responsibility

Quality Responsibility


Option #1

HASSGN/Q4 - Full

Option #2

HASSGN- Full

Q4 - Partial

Option #3

Q4 – Full

HASSGN - Partial

Partial Process

Fully Process

Defined

Fully process the HASSGN file.

(received)

Fully process the Q4 2016 file. (upon

receipt)

List of New TINs must be provided.

After new TIN list provided and

imported by HE, NPI MGMT Center

must be updated with the individual

and facility NPIs by the client.

Removed TINs/NPIs will remain

displayed unless you provide a list of

the removed TINs/NPIs. After list

provided, HE will remove TINs and

NPIs from the NPI MGMT Center.

Note: lose 2017 attributed patients

(if not in Q4 2016 file) after Q4 2016

processed until Q1 2017 is run.

Fully process the HASSGN file.

(received)

Partial Process Q4 2016 file.

(pending receipt)











Note: You skip over Q4 which

means HASSGN attributed will be

the patients for Q4 2016.

Partial Process the HASSGN

Fully process the Q4 file. (pending

receipt)

Update in Q1 2017:











Partial Process - NOT fully import.

The file will be used to update

patient info and add new patients.

Your configured TIN/NPI

assignment settings (using your

algorithm) will only be applied to

patients with no primary TIN

assignment (i.e. newly added

patients).

Recommendation – You are ready

for QM 2017 NOW and want to

finish 2016 analytics when Q4 is

received then Option #1.

Recommendation – You are ready

for QM 2017 NOW and 2016

analytics not a priority then Option

#2.

Recommendation – QM 2017 is not

an urgent priority with new TINs (as

using QM 2016 population) and

2016 analytics is your top priority

then Option #3.

Fully Process - run algorithm on

entire patient population except

manually assigned)

Fully process exceptions:

-Override manual keyed

-Check if NPI PCP yes/no (NPI

registry may be wrong)

-Use claims to break ties

-Provide assignment file

-Provide list of PCP and SPC TINs

NOTE: TIN/NPI assignment changes processed under any option will not affect the

patient's assignment on the GPRO 2016 tab as that assignment has been locked in.

TIN/NPI MANAGEMENT

Patient Assignment


QM 2017 IMPORT CHART

Preferences, Data Imports & Priorities


Quality Measures

15 measures reported through the GPRO (Group Practice

Reporting Option) Web Interface

1. ACO – 12 (CARE – 1) Medication Reconciliation Post – Discharge

2. ACO – 13 (CARE – 2) Falls: Screening for Future Fall Risk

3. ACO – 27 (DM – 2) Diabetes: Hemoglobin A1c Poor Control

4. ACO – 41 (DM – 7) Diabetes: Eye Exam

5. ACO – 28 (HTN – 2) Controlling High Blood Pressure

6. ACO – 30 (IVD – 2) Ischemic Vascular Disease: Use of Aspirin of

Another Antithrombotic

7. ACO – 40 (MH – 1) Depression Remission at 12 Months


Quality Measures

8. ACO – 20 (PREV – 5) Breast Cancer Screening

9. ACO – 19 (PREV – 6) Colorectal Cancer Screening

10. ACO – 14 (PREV – 7) Preventive Care and Screening: Influenza Immunization

11. ACO – 15 (PREV – 8) Pneumonia Vaccination Status for Older Adults

12. ACO – 16 (PREV – 9) Preventive Care and Screening: Body Mass Index Screening and Follow-up

13. ACO – 17 (PREV – 10) Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

14. ACO – 18 (PREV – 12) Preventive Care and Screening: Screening for Depression and Follow-up Plan

15. ACO – 42 (PREV – 13) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease


Breast Cancer Screening

ACO 20 PREV-5



Measure Description: Percentage of women 50 - 74

years of age who had a mammogram to screen for

breast cancer.


Gender = Female

Age 50-74 years of age

Mammogram to screen for breast cancer


Denominator:

Initial population women 51 - 74 years of age with a visit during the measurement period.

– CMS defines visit as:

• Office Visit: 99201 – 99205, 99212 – 99215

• Home Visit: 99341 – 99345, 99347 – 99350

• Preventive Medicine Services: 99385 – 99387, 99395 – 99397

• Annual Wellness Visit: G0438 and G0439


Breast Cancer Screening The measure’s 27-month look back period applies to women ages 52-74 (the numerator

looks for a mammogram any time on or between October 1, 27 months prior to the

measurement period, and December 31 of the measurement period in order to capture

women who had a mammogram every 24 months per clinical guidelines, with a 3-month

grace period).

• Women ages 50-52 are included in the measure if they had a visit and a mammogram

since age 50, but the 27 month look back period only applies to patients age 52-74.

• For patients that are 51 years of age during the measurement period look back only

to age 50.


Oct, Nov, Dec

2015 (3 months)

Jan-Dec, 2016 (12 months)

Jan-Dec, 2017 (12 months)

Time Period


The following slides contain the Measurement Flow to the

GPRO Web Interface.

There are three steps to the Measurement Flow:

1. Patient Confirmation Flow

2. Measure Confirmation Flow

3. Measure Flow



Performance Met: Mammogram to screen for breast cancer performed during the measurement period or the 15 months prior to the measurement period.

Performance Not Met: Mammogram to screen for breast cancer not performed during the measurement period or the 15 months prior to the measurement period.

Colorectal Cancer Screening

ACO 19 PREV-6



Measure Description: Percentage of adults 50 – 75

years of age who had appropriate screening for

colorectal cancer.


Age 50-75 years of age

Screening for Colorectal

Cancer


Denominator: Patients 50 – 75 years of age with a visit during the measurement period.

– CMS has defined a visit as:

• Office Visit: 99201 – 99205, 99212 – 99215

• Home Visit: 99341 – 99345, 99347 – 99350

• Preventive Medicine Services: 99385 – 99387, 99395 – 99397

• Annual Wellness Visit: G0438, G0439




GPRO Web Interface.




3. Measure Flow



Performance Met: Colorectal cancer screening

current during measurement period.

Performance Not Met: Colorectal cancer not

current during the measurement period.

Preventive Care and Screening:

Influenza Immunization

ACO 14 PREV-7


Preventive Care and Screening: Influenza

Immunization

Measure Description: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.


Age 6 months and older

Visit between 10/1/2016 and

3/31/2017

At least 2 visits or at least 1

preventive visit during

measurement period.

Received influenza

immunization

OR report previous receipt of an influenza immunization.

8/1/2016 to 3/31/2017.


Immunization

Denominator: All patients aged 6 months and older seen for at least two visits or at least one preventative visit during the measurement period and seen for a visit between October 1 and March 31.

CMS has defined visit as:

• Dialysis Procedure with Physician Evaluations: 90945, 90947

• ESRD Related Services: 90951 – 90970

• Home Visit for Hemodialysis: 99512

• Office Visit: 99201 – 99205, 99212 – 99215

• Office Consultation: 99241 – 99245

• Nursing Facility Visit: 99304 – 99310, 99315, 99316

• Domiciliary, Rest Home or Custodial Care Services: 99324 – 99328, 99334 – 99337

• Home Services: 99341 – 99345, 99347 - 99350

• Preventive Medicine Services: 99381 -99387, 99391 - 99397

• Preventive Medicine Counseling: 99401 – 99404, 99411, 99412,

• Other Preventative Medicine Services: 99420, 99429




Immunization



Immunization


GPRO Web Interface.




3. Measure Flow


Pneumonia Vaccination Status for

Older Adults

ACO 15 PREV-8


Pneumonia Vaccination Status for Older Adults

Measure Description: Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.


Age 65 years of age and older.

Ever received a pneumococcal

vaccine


Denominator: Patients 65 years of age and older with

a visit during the measurement period.

– CMS has defined a visit as:

• Office Visit: 99201 – 99205; 99212 – 99215

• Home Services: 99341 – 99350

• Preventive Services: 99385 – 99387; 99395 – 99397


Numerator: Patients who have ever received a

pneumococcal vaccination.



When does the pneumonia vaccination need to be completed?

This measure is to be reported a minimum of once per measurement period for patients seen during the measurement period.

Performance for this measure is not limited to the measurement period.

What setting does the pneumonia vaccination need to be completed in?

The pneumonia vaccination can be provided in any setting.

Pneumococcal vaccination status may be completed during a telehealth encounter.




GPRO Web Interface.




3. Measure Flow


Preventive Care and Screening: Body Mass

Index (BMI) Screening and Follow-Up Plan

ACO 16 PREV-9




Measure Description: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.



Documented BMI during the current

encounter or during the previous

6 months

AND BMI outside normal parameters

has a follow-up plan documented

during the encounter or

during the previous 6 months of the

current encounter.



Follow-Up Plan: Proposed outline of treatment to be conducted as a result of

a BMI out of normal parameters.

A follow-up plan may include, but is not limited to: documentation of education,

referral (for example a registered dietician, nutritionist, occupational therapist,

physical therapist, primary care provider, exercise physiologist, mental health

professional or surgeon), pharmacological interventions, dietary supplements,

exercise counseling or nutrition counseling.




Normal Parameters: Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2

Denominator: All patients 18 years and older on the date of the encounter with at least one eligible encounter during the measurement period.

– CMS defines eligible encounter as:• Office Visit: 99201 – 99205, 99212 – 99215

• Preventive Medicine Services: 99385 – 99387, 99395 -99397

• Psychiatric Diagnostic Evaluation: 90791, 90792

• Psychotherapy: 90832, 90834, 90837

• Health and Behavior Assessment/Intervention: 96150 – 96152

• Physical Medicine and Rehabilitation: 97001, 97003

• Medical Nutrition Therapy: 97802, 97803, G0270, G0271

• Education and Training for Patient Self Management: 98960

• Oral and Maxillofacial Surgery: D7140, D7210

• Cervical Cancer Screening: G0101

• Diabetes Training Services: G0108

• Initial Medicare Examination : G0402


• Behavioral Counseling for Obesity: G0447





GPRO Web Interface.




3. Measure Flow


Preventive Care and Screening: Tobacco

Use: Screening and Cessation Intervention

ACO 17 PREV-10


Preventive Care and Screening: Tobacco Use:

Screening and Cessation Intervention

Measure Description: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.



Screened for tobacco use one or more times within

24 months

AND who received cessation

counseling intervention if identified as a tobacco user.



Denominator: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period.

– CMS defines visit as:• Office Visit: 99201 – 99205, 99212 – 99215

• Home Services: 99341 - 99350

• Preventive Medicine Services: 99385 – 99387, 99395 - 99397

• Preventive Medicine Counseling: 99401 – 99404, 99411, 99412

• Other Preventive Medicine Services: 99420, 99429

• Ophthalmological Services: 92002, 92004, 92012, 92014

• Health and Behavior Assessment/Intervention: 96150 – 96152

• Physical Medicine and Rehabilitation: 97003, 97004

• Psychiatric Diagnostic Evaluation: 90791, 90792

• Psychotherapy: 90832, 90834, 90837

• Other Psychotherapy: 90845

• Special Otorhinolaryngologic Services: 92521 – 92524

• Vestibular Function Test: 92540

• Audiologic Function Test: 92557

• Evaluative and Therapeutic Services: 92625






GPRO Web Interface.




3. Measure Flow


Contact Us

Kris Gates, JD, CEO

Health Endeavors

8955 Pinnacle Peak Rd, Suite 103

Scottsdale, AZ 85255

[email protected]

1-888-862-0366, ext. 220

1/18/2017 73

mailto:[email protected]

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