Planning & Preparing Strategies for 2014 GPRO Reporting

Welcome

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Agenda

1.Introductions2.Housekeeping3.Presentation 4.Q & A5.Follow-up• Next Webinar: Thursday, December 19• Final Webinar in Series: January 8• NAACOS’ Spring 2014 Conference will be on one of the

following dates, check back for more details soon • April 2-4 in Washington, DC or• April 23-25 in Baltimore

Housekeeping

1. Panelists will present for approximately 40 minutes2. Q&As will take the remainder of the 1 hour • Submit anonymous written questions using the Q/A tab

(not chat) on dashboard OR• Click on the “Raise your hand” button for live question

3. Webinar is being recorded• Slides and recording will be available at

www.NAACOS.com/webinars. 4. CMS Update• New ACOs should immediately take steps to establish

your IACs account• Existing ACOs should make sure to keep your

passwords current

Today’s Presenters

Tracey Bower and Heidi Johnson, Summit Medical Group

Tracey Bower is manager of quality reporting and improvement and Heidi Johnson is the manager of decision support for Summit Medical Group. Summit Medical Group, which employs more than 298 practitioners, is recognized as a premier multispecialty medical group serving patients in the East Tennessee area. In 2012, they formed a physician owned accountable care organization. Ms. Bower and Ms. Johnson, along with their teams at Summit were the second in the nation to successfully submit their GPRO submission for 2012.

Today’s Presenters

Frederick J. Bloom, Jr., Geisinger

Dr. Frederick Bloom is the chief, care continuum of the Geisinger Health System and medical director, quality and performance for Geisinger Health Plan. Dr. Bloom has helped lead the CMS demonstrations for Geisinger involving accountable care and is the chief medical officer for the Keystone Accountable Care Organization.

Today’s Presenters

Anthony “Tony” Reed, Geisinger

Tony Reed is the director of operations for the Keystone Accountable Care Organization. In addition to his duties with the ACO, he works in the population health initiatives department at Geisinger Health System. His previous roles at Geisinger include director of business development for Geisinger Diversified Services and program director for VITALine Infusion Pharmacy Services.

Summit Health Solutions2013

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Summit Medical GroupKnoxville, TN Founded in 1995

Started with 37 physicians who were in established practices in Family Medicine and Internal Medicine

Current Network 218 Physicians, 89 Mid-Level Providers 60 Office Locations plus 3 Express Clinics Centralized Clinical Laboratory 10 Ancillary Centers (Imaging, Sleep, Physical Therapy)

Current patient base of 300,000 + Current geographic coverage of 11 counties (Knox, Blount,

Sevier, Anderson, Greene, Roane, Jefferson, Loudon, Monroe, Campbell, Union)

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Summit Health Solutions Physician owned Start date 7/1/2012 37,000 patients attributed to ACO 1 EMR Second in the nation to successfully submit

GPRO for 2012

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2012 GPRO Reporting Team Medical Director Quality Department

Manager 2 specialists Hours spent 8/10hr day 100% for 21 days

Decision Support Department Manager 3 analysts who supplied one FTE during the

process

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2012 GPRO ReportingDecision Support Team Q3 & Q4 2012 - analyst began MS SQL Server coding of discrete EMR data elements using

measure documentation provided by CMS

Each measure coded individually for all patients (our internal GPRO list)

December 2012 – submitted sample XML files to CMS for testing and approval January 2013 - received patient list from CMS, analyst matched CMS list to internal GPRO list

for testing purposes January 2013 - decision to merge the CMS data with the internally generated data into one

MS Access database for review by quality specialists

Coding in SQL and MS Access alerted quality specialists to records which needed further review

February 2013 - received patient list with rankings and medication reconciliation file from CMS

February 2013 - data merged and MS Access database turned over to quality specialists March 2013 - data exported from MS Access and converted to XML for upload to CMS

website by module

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2012 GPRO ReportingQuality Team February 2013, quality specialists reviewed records in Access

database and compared to EMR made corrections to coding, added information not in coding, determined if paper chart was needed for review “signed off” records

Learning curve for quality specialists in interpreting measures

Kept Medical Director informed of progress using reports developed by Decision Support Team

As XML modules submitted to CMS, manager reviewed for accuracy and completeness

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2013 GPRO ReportingChanges Measures-minor changes Determination of patient eligibility for

measures-moderate changes Rework of Access database-moderate

changes XML Quality specialists may spend more time up

front reviewing measures

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Keystone ACO Quality Audit

Manual Abstraction Plan2013 GPRO Reporting

Frederick Bloom MD, Chief Medical Officer Keystone ACOAnthony Reed, Director of Operations Keystone ACO

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

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Geisinger Health System

Multispecialty group ~1020 physician FTEs ~700 advanced practitioners FTEs 78 primary & specialty clinic sites

(44 community practice sites) 2 outpatient surgery centers ~2.4 million clinic outpatient visits ~410 resident & fellow FTEs

Geisinger Medical Center • Danville – includes Hospital for Advanced Medicine,

Janet Weis Children’s Hospital, Women’s Health Pavilion, Level I Trauma Center, Ambulatory Surgery Center

• Geisinger Shamokin Community Hospital Geisinger Northeast • Geisinger Wyoming Valley Medical Center

includes Heart Hospital, Henry Cancer Center,and Level II Trauma Center

• Geisinger South Wilkes-Barre includesAdult and Pediatric Urgent Care, Ambulatory Surgery Center, Inpatient Rehabilitation, Pain Management, and Sleep Center.

• Geisinger Community Medical Center Geisinger-Bloomsburg Hospital Marworth Alcohol & Chemical Dependency

Treatment Center Mountain View Care Center Bloomsburg Health Care Center >79K admissions/OBS & SORUs 1,623 licensed inpatient beds

~463,000 members (including ~77,000 Medicare Advantage members and 112,000 Medicaid members)

Diversified products ~37,000 contracted

providers/facilities 43 PA counties

Note: Numerical references based on fiscal 2014 budget.

Geisinger Health System - ProprietaryNot for reuse or distribution without permission

ProviderFacilities$1,760M

ManagedCare Companies

$2,093MPhysician

Practice Group$825M

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Geisinger Health System coverage area

Revised 6-28-12. Geisinger PR & Marketing Department

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Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

About the Keystone ACO

Wayne MemorialHonesdale, PA

Evangelical Hospital Lewisburg, PA

Geisinger Hospitals: Danville, Bloomsburg, Scranton, Shamokin,

Wilkes-Barre

Highland, LTD

Evangelical Medical Services

Organization

Wayne FQHC

HOSPITAL PARTNERS

Physician GroupPartners

Locations Providers Bene’s

1 5 2440

Locations Providers Bene’s

15 30 1213

Locations Providers Bene’s

17 81 3604

GeisingerPopulation HealthCare Management

Data AnalyticsAdministrative Services

Total:7257 Beneficiaries

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Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Geisinger Reporting with GPRO Tool

2005-2010 Physician Group Practice Demonstration• 32 quality measures for PGP Demo and PQRS

payments• Pay for performance, not just reporting2011-2012 CMS Transition Demonstration• 46 quality measures and 2 Composites• 38 measures required reporting via GPRO

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

KACO Quality Audit Plan

• Manual Abstraction• Audit Coordinators & Audit Associates Positions• Audit Planning• Auditor Training• Audit Tool Kit• Data Collection Strategy

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Manual Abstraction

• Manual review of patient medical records

• Chart abstractors should review relevant outpatient medical information documented in the patient medical record during the 2013 reporting period. These records include but are not limited to visit notes, progress notes, physician's letters, procedure summaries, discharge summaries, consultant notes, medication records, history and physical notes, problem lists, diabetes education notes, and lab or other test reports.

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Auditor Positions• Flex/Part time auditor positions were recruited and trained to

complete the manual chart abstraction

• Two types of audit positions were created to allow for flexibility in education requirements and relevant work experience– Audit Coordinators– Audit Associates

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Quality Audit Coordinator

• Associate's degree plus minimum five years experience in managed care or health care environment required

• Serves as the supervisor and assists auditors in decision making and interpretation of chart notes during manual chart audit review sessions

• Assists with the training for audit associates

• Performs manual chart audits for ACO quality reporting

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Quality Audit Associate

• High School diploma or equivalent required. Prior healthcare and electronic medical record experience preferred.

• Knowledge of medical terminology and prior medical office or medical assistant experience preferred

• Two years experience in community based outreach or demonstrated progressive advancement in responsibilities in a healthcare setting such as clinic, hospital, etc. preferred

• Performs manual chart audits for ACO quality reporting

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Quality Audit Projected Hours

• 1500 Auditor Hours• 450 Coordinator Hours• Six hours training for both Coordinators and Associates

Position Number of EE's Training hours Audit Hours Per Week Audit Weeks

Audit Coordinators 3 6 25 6

Audit Associates 10 6 25 6

Total

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Quality Audit TrainingTasks Coordinators Audit Associates Timeline

EMR Training 1-2 hours 1-2 hours 3-4 weeks prior to data collection

CMS Quality Measure Definitions

2 hours 2 hours 2- 3 weeks prior to data collection

Audit tool including EMR samples

1 hour 1 hour 2- 3 weeks prior to data collection

Distribution of patient Assignments

Ad Hoc Ad Hoc After patient file is available from CMS

Weekly update meetings

30 to 60 minutes 30 to 60 minutes Weekly Starting January 20th.

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Audit Tool Kit• Face to face training sessions with Coordinators and Auditors– CMS requirements and tools– Group training sessions with each partner audit group to

orient to EMR variances. • Reference binders for all Coordinators and Audit Associates to

include– Cheat Sheets, algorithms for each quality metric – Screen shots of auditing tool with directions– EMR Screen shots for those unfamiliar with formatting – Contact information for team members

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Data Collection Strategy• Plan to import Patient and Patient Discharge XML files and

convert to central Access database accessible on secure server– Will not use direct entry into GPRO Web Interface for

submission• Simple Access user form under development for patient

record retrieval and data entry– Form will be accessible by all quality auditors working

from assigned patient lists– Form will enforce XML specifications for data formatting

• Plan to export data from Access to XML format to upload updated files to CMS

Not for reuse or distribution without permissionKeystone ACO Confidential and Proprietary

Data Collection Strategy

Questions?

Submit anonymous written questions using the Q/A tab (not chat) on dashboard OR

Click on the “Raise your hand” button for live question When it is your turn to ask, you will be unmuted and the

moderator will ask you to state your question If you did not have a chance to ask a question today or have

new questions, please send to info@naacos.com.

Speaker Contact

Tracey Bower, Summit Medical GroupEmail: tebower@summithealthcare.com

Heidi Johnson, Summit Medical GroupEmail: hjohnson@summithealthcare.com

Frederick J. Bloom, Jr., Geisinger Email: fbloom@geisinger.edu

Anthony “Tony” Reed, GeisingerEmail: areed@geisinger.edu

Upcoming

• Next webinar in the series is Thursday, December 19 at 1:00pm ET – this is to avoid conflict with a CMS webinar. The title for the next webinar is: Obtaining & Reporting Quality, Preventive Measures. Speakers are Carrie Hagan, Coastal Carolina Quality Care, Inc. and Sara Falkiewicz, ProHealth Solutions.

• Slides and recording of today’s webinar will be posted on our website, www.NAACOS.com/webinar by tomorrow.

• Watch for information about our 2014 Spring Conference and our next webinar series coming soon!

Thank You!

Thank you for attending today’s webinar!

Consider joining NAACOS

The ACO and Business Partner applications can be found at www.NAACOS.com