2017 ACO Kick-off Webinar - Health Endeavors · PDF file2017 ACO Kick-off Webinar ... Annual...
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2017 ACO Kick-off Webinar Playing to Win in MSSP 1
Transcript of 2017 ACO Kick-off Webinar - Health Endeavors · PDF file2017 ACO Kick-off Webinar ... Annual...
2017 ACO Kick-off Webinar
Playing to Win in MSSP
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Education Series - Complete
Medicare ACO Essentials Learning Series
GPRO Quality Measure 2017 Deep Dive
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Agenda
CMS Portals & Administrative Tasks
ACO Goals
Organizational Structure
Quality Metrics Plan (GPRO)
Data Analytics (Medicare Claims Data Utilization)
Patient Case Management & Care Coordination
Compliance
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CMS Portals & Administrative Tasks
Who is Responsible
MFT, HPMS, ACO Portlet, QNET, EIDM, CAHPS,
Public Reporting Website
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EUA – Password Reset for MFT/HPMS/ACO Portlet, Annual Certification
https://eua.cms.gov/iam/im/pri/
MFT – CCLF, Assignment & Aggregate Reports
https://eftp2.cms.hhs.gov:11443/cfcc/login/login.jsp
HPMS - Participant (TIN, CCN, NPI) Management, Application
https://hpms.cms.gov/app/login.aspx
ACO Portlet - CMS Webinar Recordings, File Retrieval
https://portal.cms.gov/wps/portal/unauthportal/home/
CMS UserID – EUA, MFT, HPMS, ACO Portlet
For help with Form CMS-20037 and CMS User ID: [email protected] or (800) 220-2028
EIDM/QNET – PQRS/GPRO (September, 2017) (used to be IACS/QNET)
https://portal.cms.gov/wps/portal/unauthportal/home/
CAHPS (Patient Surveys) (August, 2017)
http://www.pqrscahps.org/en/approved-vendor-list/
Public Reporting Guidance (January, 2017)
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/sharedsavingsprogram/Downloads/ACO-Public-Reporting-Guidance.pdf
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Quality Improvement
Program
GPRO/PQRS
Control
Out-of-Network
Migration
Achieve Shared Savings
Targeted Spend
Reduction
Missed Revenue
Opportunity
Patient Engagement
Provider Participation
MACRA Compliance
MIPS
APM
CCM 99490
Annual Wellness Visit
After Hours Program/ER Alternatives
Specialist Outreach Clinics (Access to
Care)
Redirect Out-of-Network Spend
Preventive Care Services (Gaps in Care)
Stop the Admit VisitStop the ER VisitPreventive Care Services (Gaps in Care)Patient Case Management (CCM 99490)Patient Follow-up & EducationAggregate Expenditure & Utilization Trends
Re-admit, ED, MRI, CT, Home Health
Triple Aim
Improve Patient ExperienceImprove population healthReduce cost of healthcare
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Clinically Integrated Network (CIN)
Quality Population Health
Management
What is your historical
benchmark?
Disease & Wellness Gaps in CareEHR Gap Analysis
Organizational Structure
ACO/Division/TIN/Subgroup/NPI
NPI/TIN Management (Patient Assignment Algorithm)
NPI Management (Out-of-Network)
QM Import Chart (Preferences & Priorities)
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ACO
• Patients Assigned and Assignable to ACO
Division• Grouping of
TINS
TIN
• ACO Participants: Facilities, Medical Practice, Hospital
TIN Sub-Group
• e.g, 2,000 patients in 1 TIN grouped by locations
NPI
• Each patient assigned to individual provider for financial and quality accountability
Organizational Structure & Patient Assignment
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Identify all primary care services with primary care,
mid-levels and specialists
Primary Care NPI greater
number of visits = Assignment
No Primary Care then Specialist greater number
of visits = Assignment
Unassigned
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Goal = NO Unassigned
Primary Care Attribution Codes
• 99201 through 99215
• 99304 through 99340 and 99341 through 99350
• G0402 (the code for the Welcome to Medicare visit)
• G0438 and G0439 (codes for annual wellness visits)
• Revenue center codes 0521, 0522, 0524, 0525 submitted by FQHS (prior to 1/1/2011) or by RHCs
• 99495, 99496 Transitional Care Management (TCM) Services
• 99490 Chronic Care Management (CCM) Services
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Stop Patient Turnover/Churn
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NPI Management Tool
Total Population LESS In-Network
Facility and Individual
NPIs = Out-of-Network
Spend
Total Population
In-Network Facility and Individual
NPIs
Define Out-of-Network
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2017 Quality Metrics
CAHPS/Claims-Based/GPRO
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GPRO Quality Measure 2017 Deep Dive
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15 GPRO Quality Measures
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
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
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2017pg 16
GPRO Quality Measure 2017 Deep Dive
Approaches to GPRO
1. Do nothing and hope for the best
2. 8 weeks of manual chart abstraction (hope for better)
3. Year Round Plan of Action (good to great)
Provider & Staff Education
EHR Gap Analysis
Central Repository of Data
Distribution of Performance Scorecards to NPIs
Patient Gaps in Care
Readiness for Physician Compare Public Posting
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Data Integration
API/SSO/Patient Match
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EHR/Health Endeavors Integration Options
Quality Measures via
Single/Spec File
Client Upload to Health Endeavors
Quality Measures Extract, Transform & Load (ETL)
Continuity Care Document (CCD)
Secure File Transfer Portal (SFTP)
Application Program Interface (API)
Quality Measures Extract, Transform & Load (ETL)
Business Requirements Document (BRD)
Secure File Transfer Portal (SFTP)
Application Program Interface (API) Claims Data display
in EHR via Patient Match
(API/SSO)
Patient Profile
Patient Chart
Patient Gaps in Care
Patient Care Coordination Events
Care Coordination Tool
Templates mapping of EHR and
Claims data.
Secure File Transfer Portal
(SFTP)
Application Program Interface
(API)
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2017pg 20
Gap Analysis
January 20,
2017pg 21
Performance
Scoring
January 20,
2017pg 22
Quality Measures
Completion Progress
January 20,
2017pg 23
Claims Data display
in EHR via Patient Match (API/SSO)
Patient Profile
Patient Chart Care Coordination Events
Patient Gaps in Care
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CCLF Data display in EHR - Application Program Interface (API)/Patient Match
EHR – Patient Match IntegrationPatient Profile, Patient Chart Summary, View Case Management
Events
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January 20,
2017pg 26
January 20,
2017pg 27
January 20,
2017pg 28
ACO Alignment with
Quality Payment Program
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2017 Transitional Year
MIPS or APM or Advanced APM
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MIPS APM Advanced APM
Not APM MSSP ACO Track 1
Not Qualifying APM Participant (QP)
CJR CEHRT Track
MSSP ACO Track 2
MSSP ACO Track 3
NextGen ACO
CPC+
OCM 2-Sided Risk
ERSD 2-Sided Risk
After 2017 Transitional Year
MIPS or APM or Advanced APM
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MIPS APM Advanced APM
Not APM MSSP ACO Track 1
Not Qualifying APM Participant (QP)
CJR CEHRT Track
AMI, CABG, SHFFT, CR (2018)
MSSP ACO Track 1+ (2018)
MSSP ACO Track 2
MSSP ACO Track 3
NextGen ACO
CPC+
OCM 2-Sided Risk
ERSD 2-Sided Risk
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Advanced APM
Incentive Payment
MIPS
Adjustments
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Data Analytics
Medicare Claims Data Utilization
Interactive Tools, Flat File Quick Reports, Query
Builder
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Medicare ACO Essentials Learning Series
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Drill Down to Risk Stratification
• #No. of Patients
• #No. Costly Patients
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HCC Risk Score every patient
Start HCC comparison 2015
vs. 2016
Monthly Success TaskTIN and NPI (Resource/Structure Dependent)
#No. of Costly PatientsEnroll in Chronic Care Management (CCM) 99490 program
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HCC Coding Audit
Are all HCC diagnoses for each ACO Participant being remitted to Medicare during billing process?
Alternative/Track 1 Risk Preparedness Plan – start a patient chart audit of a specific population (CCM 99490 eligible) and compare patient clinical chart to the CMS Claims data.
Health Endeavors Copyright 2016
[email protected] 1-888-862-
0366
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HCC Coding Audit – Every Provider
• Capture the HCC Diagnosis Codes
• Patient Superbill Diagnosis Codes Billing Company Submission of Diagnosis Codes
• ICD10-1 ICD10-1
• ICD10-2 ICD10-2
• ICD10-3 Missing Code
• ICD10-4 Missing Code
• Not capturing the codes results in lower HCC score for patient and lower benchmark for ACO.
• Takes minimum of 12 months for this to create impact on your benchmark.
• Compare your office Superbill to Patient Profile for 10 Charts.
• 52% of ACOs have encountered this issue.
Health Endeavors Copyright 2016
[email protected] 1-888-862-
0366
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Actual Benchmark vs. Goal Benchmark (based on Historical Spend) – NPI Level
Establish NPI goal benchmark based on historical spend
ACO Distribution Model
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Example Distribution Criteria Example Distribution Point System
TIN Benchmark2 – met benchmark
1 – did not meet benchmark
Quality Measures2 – successful reporting of quality measures to ACO
0 – did not successfully reporting quality measures to ACO
Patient Survey Results
2 – Satisfied successful percentage per CMS Standards
0 – Did not satisfy the percentage per CMS Standards.
EMR Use and Integration
2 – stage 2 MU attestation
1 – stage 1 MU attestation
0 – no stage 1 MU attestation
Leadership and Participation
2 – took on leadership role
1 – participated on committee
0 – no leadership or committee involvement
2017 Chronic Care Management
(CCM) 99490 Program
January, 2017
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What is CCM 99490?
• In-office care planning reimbursement for initiating visit.
• 20 minutes non-face-to-face time with patients who have 2+ chronic conditions. Average reimbursement $42 per patient per month (Initial 20 minutes).
• Additional higher reimbursement codes for 60 minutes and additional 30 minutes of non-face-to-face time.
• On average 2/3 of Medicare beneficiaries are eligible for the program.
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What changed in 2017?
• Verbal consent of patient
• New billing codes for in-office care planning reimbursement.
• Complex CCM higher reimbursement codes for 60 and additional 30 minute intervals.
• FQHC and RHC direct supervision requirement changed to general supervision.
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Benefits of CCM 99490 Program
Quality Measure
Completion
ACO Shared Savings
Patient Attribution
Revenue Generation
Improve Patient
Experience
Improve Patient Health
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Code Description 2017
Projected
Payment
Service Period Do NOT
G0506 Comprehensive assessment and care planning for patients requiring chronic care
management services (billed separately from monthly care management
services). The care plan that the practitioner must create in order to bill G0506
would be subject to the same requirements as the care plan included in the
monthly CCM services (99490 or 99487). Report G0506 when extensive
assessment and care planning outside of the usual effort described by the billed
E/M code is performed by the billing practitioner.
$63.88 Once per billing
practitioner for a
given beneficiary
at the onset of
CCM. On,
before or after
E/M visit.
Do not count G0506 time
towards 99490, 99487 or
99489 time.
99490
20
minutes
Chronic care management services, at least 20 minutes of clinical staff time
directed by a physician or other qualified health care professional, per calendar
month, with the following required elements: multiple (two or more) chronic
conditions expected to last at least 12 months, or until the death of the patient;
chronic conditions place the patient at significant risk of death, acute
exacerbation/ decompensation, or functional decline; comprehensive care plan
established, implemented, revised, or monitored.
$42.71 Once per
calendar month
Do not Bill with 99487,
99489, 90951 – 90970.
98960 – 98962, 98966 –
98969, 99071 99078 99080
99090 99091 99339 99340
99358 99359 99362 99364
99366 – 99368, 99374 –
99380, 99441 – 99444,
99495 99496, 99605 -99607
99487
60
minutes
Complex chronic care management services, with the following required
elements: multiple (two or more) chronic conditions expected to last at least 12
months, or until the death of the patient, chronic conditions place the patient at
significant risk of death, acute exacerbation/ decompensation, or functional
decline, establishment or substantial revision of a comprehensive care plan,
moderate or high complexity medical decision making; 60 minutes of clinical
staff time directed by a physician or other qualified health care professional, per
calendar month.
$93.67 Once per
calendar month
Do not Bill with
99490
99489
Each
additional
30
minutes
Each additional 30 minutes of clinical staff time directed by a physician or other
qualified health care professional, per calendar month after the initial 60 minutes
of time under 99487 (List separately in addition to code for primary procedure).
$47.01 Once per
calendar month
Do not Bill with
99490
Do not Bill without
99487
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Compliance
1. Do not use unsecure text or email of Patient Health Information (PHI).
2. Do not send CMS TINs or NPIs in a non-secure email.
3. Conduct Conflict of Interest annually.
4. Prepare an ACO Compliance Plan and require Hospital/Medical.
5. Practice Compliance Plans of ACO Participants.
5. Conduct mandatory HIPAA education.
6. Manage your contracts.
7. Conduct Physical & Technical Security
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Q & A
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Contact Us
Kris Gates, JD, CEO
Health Endeavors
8955 Pinnacle Peak Rd, Suite 103
Scottsdale, AZ 85255
1-888-862-0366
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