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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.

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    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

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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.

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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

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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.

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    Quote Originally Posted by roates View Post
    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.
    Just playing around I decided to try to auto-insert 3 of the ACO items. I chose ACE/ARB, BP>140, Mammograms.

    I added a Site custom code that identifies Lisinopril as an ACE (kooacearb) and created a Plan Item with Header "On ACE/ARB". I then created a When-Check-Do Smartflow that inserts "On ACE/ARB" when custom code kooacearb is present.
    I similarly created a When-Check-Do Smartflow that inserts "BP Systolic >140" when Systolic >140 in Vital Signs.
    I created a When-Check-Do that looks for "Mammograms reviewed" in Interventions and moves to Plan.

    They all work BUT the Triggers are an issue. The Triggers seem to ignore Constraints. Once the triggers work properly this is really going to automate things.

  8. #8
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    Quote Originally Posted by jmcalpine View Post
    Just playing around I decided to try to auto-insert 3 of the ACO items. I chose ACE/ARB, BP>140, Mammograms.

    I added a Site custom code that identifies Lisinopril as an ACE (kooacearb) and created a Plan Item with Header "On ACE/ARB". I then created a When-Check-Do Smartflow that inserts "On ACE/ARB" when custom code kooacearb is present.
    I similarly created a When-Check-Do Smartflow that inserts "BP Systolic >140" when Systolic >140 in Vital Signs.
    I created a When-Check-Do that looks for "Mammograms reviewed" in Interventions and moves to Plan.

    They all work BUT the Triggers are an issue. The Triggers seem to ignore Constraints. Once the triggers work properly this is really going to automate things.
    That is way cool.
    I will ask the experts to weigh in on the Triggers ignoring Constraints. I will also ask if an Activity can be created that would allow a SMARText item to be inserted into the Preventive Health item in the CARE PLAN. We need to ensure that data can be uploaded to the C-CDA as that, increasingly, is the way things are going to be shared-transferred.
    Thanks so much for the feedback.



    Addendum: I've been brainstorming on this and can't get past some deficiencies of needing to have a framework that can be more automated-updated over time and have the structure to create patient recall lists and alerts when patient encounters occur. In your example, there is no structured date to indicate timing of when the Mammogram was reviewed. Further, just putting "Mammogram reviewed" into the Plan does not enter the G-code needed for reporting. This is really the minimal information to be able to satisfy all needed functions, rules and mandates -

    Breast Ca - Mammogram: Diagnostic mammography, digital, bilateral. CPT#G0206 Performed Date/Time: 05/23/2015

    The challenge is that in order to have what is visually easier to use with existing tools, it will end up requiring more manual steps. As a result, I'm concerned it will be little better than the current Health Maintenance workflows.

    Brainstorming for future – Possible Preventive Health Grid that could be displayed from using the existing SMARText in existing workflows:

    PreventiveHealthGrid.JPG

    Could we collaborate in order to get the necessary workflows and data flows in place with intent to make it more graphically appealing in time?
    Last edited by roates; 05-24-2015 at 09:38.

  9. #9
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    Timely blog about the challenges ACOs are having collecting and reporting their data - http://thehealthcareblog.com/blog/20...-data-problem/

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    Quote Originally Posted by roates View Post
    Timely blog about the challenges ACOs are having collecting and reporting their data - http://thehealthcareblog.com/blog/20...-data-problem/
    Here is the problem with "Value Based Care". Lisa isn't a doctor. She is just collecting data. She has no idea why. The CMS bean counters who review the data aren't doctors. They think < 141 beans are the perfect number of beans. My BP went up to 142 beans just reading that article.

    http://www.uspreventiveservicestaskf...ome-monitoring

    http://www.kevinmd.com/blog/2014/01/...uidelines.html

    And good luck preventing falls. Maybe give everybody Vitamin D? Oh yeah. That will work. The CMS bean counters will likely next collect data on how many patients have Vitamin D levels <30. Good luck with that one Lisa.


    http://www.uspreventiveservicestaskf...ive-medication
    Last edited by jmcalpine; 05-21-2015 at 20:10.

 

 

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