2013 Pqrs Gpro And Aco Web Interface Measure Specifications/ Supporting Documents Part 3

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.