Tip:
Highlight text to annotate it
X
Physician Quality Reporting System (PQRS) 2013 Group Practice Reporting Option (GPRO)
and SSP Accountable Care Organization (ACO) Web Interface Reporting Web Interface Measure
Specifications/ Supporting Documents Part 3 Program Year 2013
• Slide 1: Physician Quality Reporting System 2013 Group Practice Reporting Option and Shared
Savings Program Accountable Care Organization Web Interface Reporting Web Interface Measure
Specifications and Supporting Documents Part 3 Program Year 2013
• Slide 4: In part 1 of this presentation, we discussed the 2013 GPRO Web Interface helpful
specifications documents, patient confirmation, the Patient Care module and the Coronary Artery
Disease composite module. • Slide 5: In part 2, we discussed the Diabetes,
Heart Failure, Hypertension and Ischemic Vascular Disease modules. In part 3, we will discuss
the Preventive Care measures. • Slide 6: This presentation will cover
information related to the GPRO Web Interface Reporting Mechanism. If you are submitting
data through another reporting mechanism, please visit the PQRS website on CMS.gov for
more information on how to submit data for PQRS.
• Slide 7: There are eight preventive care measures: PREV-5: Breast Cancer Screening,
PREV-6: Colorectal Cancer Screening, PREV-7: Influenza Immunization, PREV-8: Pneumococcal
Vaccination for Patients 65 Years and Older, PREV-9: Body Mass Index Screening and Follow-Up,
PREV-10: Tobacco Use: Screening and Cessation Intervention, PREV-11: Screening for High
Blood Pressure and Follow-Up Documented, and PREV-12: Screening for Clinical Depression
and Follow-Up Plan. Each preventive care measure is sampled separately.
• Slide 8: PREV-5: Breast Cancer Screening. This measure is the percentage of women aged
40 through 69 years who had a mammogram to screen for breast cancer within 24 months.
Patients are eligible for random sampling into the PREV-5 measure if they have been
assigned to the GPRO and they are female and age 40 through 69 at the beginning of the
measurement period. Patients may be removed from the measure if a "CMS Approved Reason"
has been granted. • Slide 9: In the Web Interface, has a breast
cancer screening performed during the measurement period or year prior to the measurement period?
Select "No" if the patient was not screened for breast cancer. Select "Yes" if they were
and select "No-medical reasons if there was any documentation the patient
had a bilateral mastectomy or two unilateral mastectomies. If there is evidence of two
separate mastectomies, this patient may be excluded from the measure. The bilateral mastectomy
must have occurred by the end of the measurement period. Screening includes breast imaging,
breast x-ray, breast cancer screening, diagnostic mammography, digital mammography, mammogram,
or screening mammography. Use the Evaluation and Exclusions tab in the Supporting Document
to find codes specific to this measure. • Slide 10: PREV-6: Colorectal Cancer Screening.
This measure is the percentage of patients aged 50 through 75 years who received the
appropriate colorectal cancer screening. Patients are eligible for random sampling into the
PREV-6 measure if they have been assigned to the GPRO and they are age 50 through 75
years at the beginning of the measurement period. Patients may be removed from the measure
if a "CMS Approved Reason" has been granted. • Slide 11: In the Web Interface, is the
colorectal cancer screening is current during the measurement period? Select "No" if colorectal
cancer screening is not current. Select "Yes" if it is current. Select "No-medical reasons"
if colorectal cancer screening is not current due to medical reasons. Note: Current colorectal
cancer screening is defined as performing fecal occult blood test within 12 months,
flexible sigmoidoscopy during the reporting period or the four years prior to the reporting
period, or colonoscopy during the reporting period or the nine years prior to the reporting
period. FOBT includes ColoCARE, Coloscreen, EZ Detect, Fecal occult blood test, flushable
reagent pads, flushable reagent stool blood test, guaiac smear test, Hemoccult, Seracult,
or stool occult blood test. Medical Reasons may include: diagnosis of colorectal cancer,
total colectomy, terminal illness, other reason documented by practitioner for not performing
colorectal cancer screening. Please refer to the Supporting Document tabs.
• Slide 12: PREV-7: Influenza Immunization. This measure is the 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. Patients are
eligible for random sampling into the PREV-7 measure if they have been assigned to the
GPRO, they are age 6 months or older at the beginning of the measurement period, and they
were seen for a visit between October 1, 2012 and March 31, 2013. Patients may be removed
from the measure if a "CMS Approved Reason" has been granted.
• Slide 13: In the Web Interface, was the patient seen for an office visit between October
1, 2012 and March 31, 2013 and received an influenza immunization or reported receipt
of an influenza immunization? Select "No" if the patient did not receive an influenza
immunization. Select "Yes" if they did. Select "No -- Medical Reasons" if they did not receive
an influenza immunization for medical reasons. Select "No -- Patient Reasons" if they did
not receive an influenza immunization for patient reasons and Select "No -- System Reasons"
if the patient did not receive an influenza immunization for system reasons.
• Slide 14: Previous receipt is defined as receipt of the current season's influenza
immunization from another provider or from the same provider prior to the visit to which
the measure is applied. Typically, prior vaccination would include influenza vaccine given since
August 1, 2012. Patients are not sampled in to the measure unless a primary care office
visit was found attributed to the ACO or PQRS GPRO between October 1, 2012 and March 31,
2013. • Slide 15: PREV-8: Pneumococcal Vaccination
for Patients 65 Years and Older. This measure is the percentage of patients aged 65 years
and older who have ever received a pneumococcal vaccine. Patients are eligible for random
sampling into the PREV-8 measure if they have been assigned to the GPRO, and they are age
65 years or older at the beginning of the measurement period. Patients may be removed
from the measure if a "CMS Approved Reason" has been granted.
• Slide 16: In the Web Interface, has patient ever received a pneumococcal vaccination?
Select "No" if they've never received a pneumococcal vaccination. Select "Yes" if the patient has
ever received a pneumococcal vaccination. Select "No-medical reasons" if the patient
has never received a pneumococcal vaccination for medical reasons. Refer to the Supporting
Document Evaluation, Exclusions and Drug tabs for coding for this measure.
• Slide 17: PREV-9: Body Mass Index Screening and Follow-Up. This measure is the percentage
of patients aged 18 years and older with a calculated BMI in the past six months or during
the current visit documented in the medical record and if the most recent BMI is outside
of normal parameters, a follow-up plan is documented within the past six months or during
the current visit. Normal Parameters for those age 65 years and older is a body mass index
greater or equal to 23 and less than 30. For patients age 18 to 64 years, BMI greater than
or equal to 18.5 and less than 25. Patients are eligible for random sampling into the
PREV-9 measure if they have been assigned to the GPRO and they are age 18 years or older
at the beginning of the measurement period. Patients may be removed from the measure if
a "CMS Approved Reason" has been granted. • Slide 18: In the Web Interface Data, has
the BMI calculated within the past six months or during the current visit? Select "No" if
the patient has not had a BMI calculated. Select "Yes" if they have. Select "No-medical
reasons" if the BMI measurement was not performed for medical reasons or select "No-patient
reasons" if the BMI measurement was not performed for patient reasons. Is the most recent BMI
is within normal parameters? Select "No" if it is outside of normal parameters. Select
"Yes" if it is within normal parameters. Was a follow-up plan documented if the BMI is
outside of normal parameters? Select "No" if there was no follow-up plan documented.
Select "Yes" if there was a follow-up plan documented.
• Slide 19: Body mass index expressed as weight divided by height is commonly used
to classify weight categories. Calculated BMI requires an eligible professional or their
staff to measure both the height and weight. Self-reported values cannot be used. BMI is
calculated either as weight in pounds divided by height in inches squared multiplied by
703, or as weight in kilograms divided by height in meters squared. Medical reasons
may include patient is pregnant, patient is receiving palliative care, or patient is in
an urgent or emergent medical situation where time is of the essence and to delay treatment
would jeopardize the patient's health status. Patient Reasons may include patient refuses
BMI measurement or if there is any other reason documented in the medical record by the provider
explaining why BMI measurement was not appropriate. • Slide 20: Follow-up may include, but is
not limited to: documentation of a future appointment, education, referral such as,
registered dietician, nutritionist, occupational therapist, physical therapist, primary care
provider, exercise physiologist, mental health professional, or surgeon, pharmacological
interventions or dietary supplements, exercise counseling or nutrition counseling. Refer
to the Supporting Document Evaluation, Exclusions and Drug tabs for coding for this measure.
• Slide 21: PREV-10: Tobacco Use: Screening and Cessation Intervention. This measure is
the 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. Patients are eligible for random sampling into the PREV-10 measure if
they have been assigned to the GPRO and they are age 18 years or older at the beginning
of the measurement period. Patients may be removed from the measure if a "CMS Approved
Reason" has been granted. • Slide 22: In the Web Interface, was the
patient screened for tobacco use at least once within 24 months and identified as a
tobacco user? Select "No" if the patient was screened for tobacco use and identified as
a tobacco non-user. Select "Yes" if the patient was screened for tobacco use and identified
as a tobacco user. Select "Not Screened" if the patient was not screened for tobacco use.
Select "No for Medical Reasons" if the patient was not screened for tobacco use for medical
reasons. If "Yes", did the patient receive tobacco cessation intervention? Select "No"
if the patient did not receive tobacco cessation intervention. Select "Yes" if they did.
• Slide 23: Tobacco use may include any type of tobacco: tobacco smoking, cigarette/tobacco
pipe smoking/smoker, cigarette dependence, tobacco use disorder, chew tobacco, smokeless
tobacco, or snuff. Within 24 months is defined as the 24-month look-back period of time from
the measurement period end date. If there is more than 1 patient query regarding tobacco
use, use the most recent. Cessation counseling includes brief counseling of 3 minutes or
less and/or pharmacotherapy. Refer to the Drug Code tab in the PREV Supporting Document
for list of tobacco cessation agents. • Slide 24: PREV-11: Screening for High
Blood Pressure and Follow-Up Documented This measure is the percentage of patients aged
18 years and older seen during the measurement period who were screened for high blood pressure
and a recommended follow-up plan is documented based on the current blood pressure reading
as indicated. Patients are eligible for random sampling into the PREV-11 measure if they
have been assigned to the GPRO and they are age 18 years or older at the beginning of
the measurement period. Patients may be removed from the measure if a "CMS Approved Reason"
has been granted • Slide 25: In the Web Interface, was the
patient screened for high blood pressure and follow-up recommended? Select "No" if the
patient was not screened for high blood pressure. Select "Yes" if the patient was screened.
Select "No-medical reasons" if the patient was not screened for high blood pressure for
medical reasons. Select "No-patient reasons" if the patient was not screened for high blood
pressure for patient reasons. • Slide 26: Patients with a Medicare claim
indicating a history of hypertension prior to the first day of the measurement period,
January 1, 2013, will not be included in your sample for this measure. A normal blood pressure
reading, less than 120 systolic and less than 80 diastolic, requires no documentation of
follow-up. Recommended follow-up based on blood pressure classification includes: recommending
screening interval follow-up, lifestyle modifications, referrals to alternative/primary care provider,
anti-hypertensive pharmacological therapy, laboratory tests, or an electrocardiogram.
You will need to link the recommended follow-up to the elevated blood pressure using guidance
provided. Pre-hypertensive blood pressure reading, first hypertensive blood pressure
reading and second hypertensive blood pressure reading are defined and appropriate follow-up
noted for each in the Narrative Specifications and Data Guidance provided. Recommended follow-up
has been explained in much more detail. This information is in both the Narrative Specifications
and the Data Guidance. • Slide 27: PREV-12: Screening for Clinical
Depression and Follow-Up Plan. This measure is the percentage of patients aged 12 years
and older screened for clinical depression during the measurement period using an age
appropriate standardized depression screening tool and if positive, a follow-up plan is
documented on the date of the positive screen. Patients are eligible for random sampling
into the PREV-12 measure if they have been assigned to the GPRO and they are age 12 years
or older at the beginning of the measurement period. Patients may be removed from the measure
if a "CMS Approved Reason" has been granted. • Slide 28: In the Web Interface, was patient
screened for clinical depression using an age appropriate standardized tool during the
measurement period? Select "No" if the patient was not screened for clinical depression using
a standardized tool. Select "Yes" if the patient was documented as having been screened for
clinical depression using one of the standardized tools. Select No-medical reasons if the patient
was not screened for clinical depression using a standardized tool for medical reasons. Select
"No-patient reasons" if the patient was not screened for clinical depression using a standardized
tool due to a patient reason. If the patient was screened, was the screen positive? Select
"No" if the patient's screen was not positive for clinical depression. Select "Yes" if the
patient's screen was positive for clinical depression.
• Slide 29: If the screen was positive for clinical depression, was a follow-up plan
for depression documented during the measurement period? Select "No" if a follow-up plan for
depression is not documented. Select "Yes" if the plan is documented. Screening includes
completion of a clinical or diagnostic tool used to identify people at risk of developing
or having a certain disease or condition even in the absence of symptoms. This measure requires
the screening to be completed in the office of the provider filing the code. The follow-up
plan may include a proposed outline of treatment to be conducted as a result of positive clinical
depression screening. • Slide 30: Follow-up for a positive depression
screening must include one or more of the following: additional evaluation, suicide
risk assessment, referral to a practitioner who is qualified to diagnose and treat depression,
pharmacological interventions, or other interventions or follow-up for the diagnosis or treatment
of depression. Use a normalized and validated depression screening tool developed for the
patient population where it is being utilized. Examples of depression screening tools include
but are not limited to: adolescent screening tools for those between 12 and 17 years, Patient
Health Questionnaire for Adolescents, Beck Depression Inventory-Primary Care Version,
Mood Feeling Questionnaire, Center for Epidemiologic Studies Depression Scale, and PRIME MD-PHQ-2.
Refer to the Supporting Document Evaluation, Exclusions and Drug tabs for coding for this
measure. • Slide 31: Look for these other 2013 PQRS
GPRO Webinars on the CMS YouTube site at this link: 2013 PQRS GPRO 101 Parts 1 and 2, GPRO
Reporting Mechanisms Parts 1 and 2, GPRO Value-Based Modifier, Public Reporting, Measures Overview
and Individuals Authorized Access to the CMS Computer Services or IACS.
• Slide 32: Please also check the CMS YouTube site for these upcoming webinars: Web Interface:
Assignment and Sampling and CAHPS Overview. Note that CMS will host live training sessions
on GPRO Web Interface reporting. • Slide 33: For assistance with questions
related to ACO GPRO and PQRS GPRO quality measure specifications, please contact the
QualityNet Help Desk, Monday through Friday, 7:00 am through 7:00 pm Central Time, via
e-mail at qnetsupport@sdps.org, via telephone at (866) 288-8912, via TTY 877-715-6222, or
via fax at (888) 329-7377.