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  1. #1
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    Default ACO Measures - Documentation Items

    For those participating in an ACO, there is a consolidated list of pick lists available to use within documentation templates and workflows. This list also addresses many of the HEDIS measures as well. After downloading all items in the cloud library containing CarePlanMU, search on aco# to get the list of ACO-related items. There is also a pick list with a shortcut of ACOm and description of "ACO Measures." It includes:

    ACOm.JPG

    ACO Measures:
    Age > 6 months
    "Influenza Vaccine: " (A>6m, HEDIS-FSO, FSA, ACO#14)
    Age > 12
    "Depression screen/plans: " (A>12, HEDIS-AMM, ACO#18)
    Age > 18
    "BMI/Obesity: " (A>18, HEDIS-ABA, ACO#16)
    "Tobacco: " (A>18, HEDIS-MSC, ACO#17, ACO #25)
    "BP Control: " (A18-85, HEDIS-CBP, ACO#21, ACO#28)
    "Diabetes: “ (A18-75, HEDIS-CDC, ACO#22, #23, #24, #25, #26, #27)
    "HbA1c Tests: " (A18-75, HEDIS-CDC, ACO#22, ACO#27)
    "Diabetes - LDL-C: " (A18-75, HEDIS-CDC, ACO#23)
    "Blood pressure control: " (A18-75, HEDIS-CDC, ACO#24)
    "Tobacco: " (A18-75, HEDIS-MSC, ACO#17, ACO#25)
    “Cardiovascular” (A>18, ACO#29, #30, #31, #32, #33)
    "LDL-C screening: " (A>18, ACO#29)
    "Aspirin or Antithrombotic for Ischemic Vascular Disease. “ (A>18, HEDIS-ASP, ACO#30)
    "Beta-blocker Rx for heart failure. “ (ACO#31)
    "LDL drug therapy: " (A>18, ACO#32)
    "ACE/ARB for LVSD or Diabetes” (A>18, ACO#33)
    Age > 50
    "Colorectal Ca screening: " (A50-75, HEDIS-COL, ACO#19)
    Age > 50 Female
    "Breast Ca – Mammogram: " (FEMALE: A50-75F, HEDIS-BSC, ACO#20)
    Age > 65
    "Elder Care: " (A>65, HEDIS-COA, ACO#12, ACO#13)
    "Falls risk management: " (A>65, HEDIS-FRM, ACO#13)
    "Med recon post- discharge: " (A>65, HEDIS-MRP, ACO#12)
    "Pneumococcal Vaccine: " (A>65, HEDIS-PNU, ACO#15)


    Each of the above is a header for pick lists of more specific quality measure documentation items. An Implementation Guide is available upon request that also addresses additional HEDIS and PQRS measures not included within the ACO reporting requirements.
    Attached Images Attached Images
    Last edited by roates; 05-21-2015 at 12:30.

  2. #2
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    Here is a next draft of the ACO-related quality measures that are being organizing into ACO-specific pick lists based on the patient's age/gender:
    The pick list items contain the CPT, G-codes, SNOMED, LOINC, ICD-9/10 codes, etc. they are looking for:

    ACOPickLists2.JPG

    If used within the Preventive Health section of the CarePlanMU, We are hoping they will then upload into our C-CDA to be increasingly consumed by the ACO analytic tools where the Population Health Management (PHM) is destined to eventually occur.

    Again, each of the above are headers for the specific pick list items containing the codes sought for reporting. To review these, first download all SMARText items with the keyword CarePlanMU. Then a local search on ACO# will retrieve all the above pick lists.

    We welcome the opportunity to work with you and your ACO team so that this can prove to be a minimal disruption in order to excel in performance reporting without taking too much of your attention away from your patients.
    Last edited by roates; 05-25-2015 at 05:59.

  3. #3
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    Default

    I can see the value of having pick lists to load the codes so that if and when health plans start accepting CCD-A they can read them.

    But what progress is being made toward automatically compiling this data (eg automatically entering the codes for mammogram when a mammogram report is put in the chart) ?

    Andy

  4. #4
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    Quote Originally Posted by ageorge View Post
    I can see the value of having pick lists to load the codes so that if and when health plans start accepting CCD-A they can read them.

    But what progress is being made toward automatically compiling this data (eg automatically entering the codes for mammogram when a mammogram report is put in the chart) ?

    Andy
    Progress is being made toward more automation. In fact, auto-insertions are one of the available Actions within SMARTflows. So, we have the foundation to eventually automate many tasks that are now requiring manual action. The if/when is directly proportional to the amount of revenue/resources we have to develop them out. Additionally, the rapidity of changes within gov mandates, rules and specifications we are forced to address going forward could slow automation down as well. Hopefully, and in spite of these two main obstacles, we can be one of the first systems to actually automate a lot of what is now manual work. Ironically, if the gov would shift to assisting the development of useful standards (i.e. encourage consistent means of identifying report types such as "This is a mammogram") instead of being focused on developing algorithms for reporting "performance," this could greatly accelerate progress.

    Progress will be incremental, and we are starting out with what we have available and are attempting to optimize that. Your valuable feedback helps greatly.
    Last edited by roates; 05-20-2015 at 07:14.

  5. #5
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    I like the idea of having all this information together in one spot, much needed.


    A few comments though, many times this information comes in between visits, so when a mammogram comes in, where do we store this information? To reclick through the list each time is tedious.


    We need a way to store the information, that it is visually easy to look at and easy to bill or send to what ever agency wants it. We need a way to easily see if an item was billed out for the year or quarter.


    We also need a way to pick patients by insurance plan and to see if an item was or was not billed out already.


    James

  6. #6
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    Quote Originally Posted by DoctorW View Post
    I like the idea of having all this information together in one spot, much needed.


    A few comments though, many times this information comes in between visits, so when a mammogram comes in, where do we store this information? To reclick through the list each time is tedious.


    We need a way to store the information, that it is visually easy to look at and easy to bill or send to what ever agency wants it. We need a way to easily see if an item was billed out for the year or quarter.


    We also need a way to pick patients by insurance plan and to see if an item was or was not billed out already.


    James

    There is the option of putting the Preventive Health items in one spot. Not elegant, but it can work if the pick lists contained within CarePlanMU are used. In this example (see image), the patient decided to agree to Preventive Health Measures of Influenza Vaccinations and Breast Cancer Screenings. This is tracked in the CarePlanMU framework which is copied-pasted back and forth within a Summary field (such as Interventions) as patients return for follow up. This provides the framework so that SMARTreports could be performed based on when the events occurred in the past. A filter can be to also select by Insurance coverage as well as that is one of the current SMARTflow Activities available.

    ACOexample.JPG



    The copy-paste transfer can be expedited by a double click on CARE PLAN:; Control-C: Click in the other field: Control-V. Some are now doing this with a single command using Macro Express Pro.
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    Last edited by roates; 05-21-2015 at 12:21.

  7. #7
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    Having these items visually appealing is very important. Looking down a list , to find items missing is difficult when it is too cluttered.

    Having a list such as below is much easier to keep track of.

    Preventive Health: Adult: Influenza Vaccine: 2015
    Female: Mammogram: 2015

    Having the ACO, billing codes built in , but not displayed would be very helpful.

    James

  8. #8
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    Quote Originally Posted by DoctorW View Post
    Having these items visually appealing is very important. Looking down a list , to find items missing is difficult when it is too cluttered.

    Having a list such as below is much easier to keep track of.

    Preventive Health: Adult: Influenza Vaccine: 2015
    Female: Mammogram: 2015

    Having the ACO, billing codes built in , but not displayed would be very helpful.

    James

    Your suggestions are great. We eventually would like to develop a more intuitive dashboard to consolidate the management of many tasks associated with Population Health Management (PHM) such as this. This should prove far more efficient and useful than the legacy Health Maintenance, Data Explorer and other tools in use. User demand, and the resources available to us will determine the if/when. For at least the next 6-12 months, we are going to need to take what is available now and make it work it even if not very elegant. Starting with what we have now for the documentation items we can now create the logic within new SMARflows and SMARTreports that can largely drive the dashboard. This is the incremental process in order to get to what will hopefully be more ideal.

    BTW, keep in mind that anther reason that now is not the time to build out the more intuitive dashboard is the moving target of gov mandates defining how this information is going to have to be formatted, presented to the user and then electronically shared. Currently, these standards are in great flux, and are now being defined within the second version of the C-CDA within its expanded care plan sections. It appears that the C-CDAs of the future will likely involve sharing and transmissions via FHIR-based APIs more than via Direct messaging. This capability will be required not just for "Meaningful" Use but will be necessary for most, if not all, health plan participations.
    The level to which you are managing these sorts of faux-quality measures is actually being tracked by most health plans now via those often obtuse billing codes on claims. Your profile on this will likely determine any increases in payments you might receive going forward and "poor performers" will likely be excluded from many panels. Also, Medicare is going to make your performance, based on what they receive on claims or PQRS reporting, publicly available in 2016. It is time to get started.
    Last edited by roates; 05-21-2015 at 07:29.

  9. #9
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    Thanks for your response, is there a way currently to have items not displayed in the intervention section, but still coded to be included when sending out a claim.


    For example, the above item, in the intervention section


    Female: Breast Ca - Mammogram; Performed date/time 5/21/2014


    but when I copy and paste it into the note


    Female: Breast Ca - Mammogram: diagnostic Mammography, digital, bilateral. cpt#G0206 Performed Date/ Time 5/21/2014


    James

  10. #10
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    Quote Originally Posted by DoctorW View Post
    Thanks for your response, is there a way currently to have items not displayed in the intervention section, but still coded to be included when sending out a claim.


    For example, the above item, in the intervention section


    Female: Breast Ca - Mammogram; Performed date/time 5/21/2014


    but when I copy and paste it into the note


    Female: Breast Ca - Mammogram: diagnostic Mammography, digital, bilateral. cpt#G0206 Performed Date/ Time 5/21/2014


    James
    Great question, but this is not currently possible. I agree this is the sort of clinical presentation we need to strive toward. Actually, my dream is for this to be presented in a Timeline-Grid view so that the visual presentation itself almost instantly creates an awareness of statuses on items. If/when we can get to that, it will be an incremental process that has to incorporate standards not yet defined that will mandate what elements we have to display to the clinical users.
    Last edited by roates; 05-21-2015 at 07:54.

 

 

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