Planning & Preparing Strategies for
2014 GPRO Reporting
Welcome
The webinar will start at 1:00 pm ET.
It is interactive, so please make sure that you have connected
via phone with your audio pin. Call-in information is shown on
your dashboard, right side of screen.
Agenda
1.Introductions
2.Housekeeping
3.Presentation
4.Q & A
5.Follow-up
• Next Webinar: Thursday, December 19
• Final Webinar in Series: January 8
• NAACOS’ Spring 2014 Conference will be on one of the
following dates, check back for more details soon
• April 2-4 in Washington, DC or
• April 23-25 in Baltimore
Housekeeping
1. Panelists will present for approximately 40 minutes
2. Q&As will take the remainder of the 1 hour
• Submit anonymous written questions using the Q/A tab
(not chat) on dashboard OR
• Click on the “Raise your hand” button for live question
3. Webinar is being recorded
•
Slides and recording will be available at
www.NAACOS.com/webinars.
4. CMS Update
•
•
New ACOs should immediately take steps to establish
your IACs account
Existing ACOs should make sure to keep your
passwords current
Today’s Presenters
Tracey Bower and Heidi Johnson, Summit Medical Group
Tracey Bower is manager of quality reporting and improvement
and Heidi Johnson is the manager of decision support for
Summit Medical Group. Summit Medical Group, which employs
more than 298 practitioners, is recognized as a premier
multispecialty medical group serving patients in the East
Tennessee area. In 2012, they formed a physician owned
accountable care organization. Ms. Bower and Ms. Johnson,
along with their teams at Summit were the second in the nation
to successfully submit their GPRO submission for 2012.
Today’s Presenters
Frederick J. Bloom, Jr., Geisinger
Dr. Frederick Bloom is the chief, care continuum of the
Geisinger Health System and medical director, quality and
performance for Geisinger Health Plan. Dr. Bloom has helped
lead the CMS demonstrations for Geisinger involving
accountable care and is the chief medical officer for the
Keystone Accountable Care Organization.
Today’s Presenters
Anthony “Tony” Reed, Geisinger
Tony Reed is the director of operations for the Keystone
Accountable Care Organization. In addition to his duties with
the ACO, he works in the population health initiatives
department at Geisinger Health System. His previous roles at
Geisinger include director of business development for
Geisinger Diversified Services and program director for
VITALine Infusion Pharmacy Services.
Summit Health
Solutions
2013
8
Summit Medical Group
Knoxville, TN

Founded in 1995
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
Current Network

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
Started with 37 physicians who were in established practices in
Family Medicine and Internal Medicine
218 Physicians, 89 Mid-Level Providers
60 Office Locations plus 3 Express Clinics
Centralized Clinical Laboratory
10 Ancillary Centers (Imaging, Sleep, Physical Therapy)
Current patient base of 300,000 +
Current geographic coverage of 11 counties (Knox, Blount,
Sevier, Anderson, Greene, Roane, Jefferson, Loudon,
Monroe, Campbell, Union)
9
Summit Health Solutions
 Physician
owned
 Start date 7/1/2012
 37,000 patients attributed to ACO
 1 EMR
 Second in the nation to successfully submit
GPRO for 2012
10
2012 GPRO Reporting Team
 Medical
Director
 Quality Department



Manager
2 specialists
Hours spent 8/10hr day 100% for 21 days
 Decision
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
Support Department
Manager
3 analysts who supplied one FTE during the
process
11
2012 GPRO Reporting
Decision Support Team

Q3 & Q4 2012 - analyst began MS SQL Server coding of discrete EMR data elements
using measure documentation provided by CMS
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December 2012 – submitted sample XML files to CMS for testing and approval
January 2013 - received patient list from CMS, analyst matched CMS list to internal
GPRO list for testing purposes
January 2013 - decision to merge the CMS data with the internally generated data into
one MS Access database for review by quality specialists
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Each measure coded individually for all patients (our internal
GPRO list)
Coding in SQL and MS Access alerted quality specialists to
records which needed further review
February 2013 - received patient list with rankings and medication reconciliation file
from CMS
February 2013 - data merged and MS Access database turned over to quality specialists
March 2013 - data exported from MS Access and converted to XML for upload to CMS
website by module
12
2012 GPRO Reporting
Quality Team

February 2013, quality specialists reviewed records in
Access database and compared to EMR
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made corrections to coding,
added information not in coding,
determined if paper chart was needed for review
“signed off” records
Learning curve for quality specialists in interpreting
measures
Kept Medical Director informed of progress using reports
developed by Decision Support Team
As XML modules submitted to CMS, manager reviewed
for accuracy and completeness
13
2013 GPRO Reporting
Changes
 Measures-minor
changes
 Determination of patient eligibility for measuresmoderate changes
 Rework of Access database-moderate
changes
 XML
 Quality specialists may spend more time up
front reviewing measures
Keystone ACO Quality Audit
Manual Abstraction Plan
2013 GPRO Reporting
Frederick Bloom MD, Chief Medical Officer Keystone ACO
Anthony Reed, Director of Operations Keystone ACO
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Geisinger Health System
Provider
Facilities
$1,760M
 Geisinger Medical Center
• Danville – includes Hospital for Advanced Medicine,
Janet Weis Children’s Hospital, Women’s Health
Pavilion, Level I Trauma Center, Ambulatory Surgery
Center
• Geisinger Shamokin Community Hospital
 Geisinger Northeast
• Geisinger Wyoming Valley Medical Center
includes Heart Hospital, Henry Cancer Center,
and Level II Trauma Center
• Geisinger South Wilkes-Barre includes
Adult and Pediatric Urgent Care, Ambulatory
Surgery Center, Inpatient Rehabilitation,
Pain Management, and Sleep Center.
• Geisinger Community Medical Center
 Geisinger-Bloomsburg Hospital
 Marworth Alcohol & Chemical Dependency
Treatment Center
 Mountain View Care Center
 Bloomsburg Health Care Center
 >79K admissions/OBS & SORUs
 1,623 licensed inpatient beds
Managed
Care Companies
$2,093M
Physician
Practice Group
$825M




Multispecialty group
~1020 physician FTEs
~700 advanced practitioners FTEs
78 primary & specialty clinic sites
(44 community practice sites)
 2 outpatient surgery centers
 ~2.4 million clinic outpatient visits
 ~410 resident & fellow FTEs
 ~463,000 members
(including ~77,000
Medicare Advantage
members and 112,000
Medicaid members)
 Diversified products
 ~37,000 contracted
providers/facilities
 43 PA counties
Note: Numerical references based on fiscal 2014
budget.
15 without permission
Not for reuse or distribution
Geisinger Health System - Proprietary
Keystone
ACO
Confidential
and Proprietary
Not for reuse or distribution without permission
Geisinger Health System coverage area
Revised 6-28-12. Geisinger PR & Marketing Department
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
16
About the Keystone ACO
Physician Group
Partners
HOSPITAL PARTNERS
Highland, LTD
Locations
Providers
1
5
Bene’s
2440
Wayne Memorial
Honesdale, PA
Evangelical
Medical Services
Organization
Locations
Providers
17
81
Geisinger
Population Health
Care Management
Data Analytics
Administrative Services
Bene’s
Evangelical Hospital
Lewisburg, PA
Total:
7257 Beneficiaries
3604
Wayne FQHC
Locations
Providers
15
30
Bene’s
1213
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Geisinger Hospitals:
Danville, Bloomsburg,
Scranton, Shamokin,
Wilkes-Barre
17
Geisinger Reporting with GPRO Tool
2005-2010 Physician Group Practice Demonstration
• 32 quality measures for PGP Demo and PQRS
payments
• Pay for performance, not just reporting
2011-2012 CMS Transition Demonstration
• 46 quality measures and 2 Composites
• 38 measures required reporting via GPRO
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
KACO Quality Audit Plan
•
•
•
•
•
•
Manual Abstraction
Audit Coordinators & Audit Associates Positions
Audit Planning
Auditor Training
Audit Tool Kit
Data Collection Strategy
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Manual Abstraction
• Manual review of patient medical records
• Chart abstractors should review relevant outpatient medical
information documented in the patient medical record during
the 2013 reporting period. These records include but are not
limited to visit notes, progress notes, physician's letters,
procedure summaries, discharge summaries, consultant
notes, medication records, history and physical notes,
problem lists, diabetes education notes, and lab or other test
reports.
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Auditor Positions
• Flex/Part time auditor positions were recruited and trained to
complete the manual chart abstraction
• Two types of audit positions were created to allow for
flexibility in education requirements and relevant work
experience
– Audit Coordinators
– Audit Associates
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Quality Audit Coordinator
• Associate's degree plus minimum five years experience in
managed care or health care environment required
• Serves as the supervisor and assists auditors in decision
making and interpretation of chart notes during manual chart
audit review sessions
• Assists with the training for audit associates
• Performs manual chart audits for ACO quality reporting
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Quality Audit Associate
• High School diploma or equivalent required. Prior healthcare
and electronic medical record experience preferred.
• Knowledge of medical terminology and prior medical office or
medical assistant experience preferred
• Two years experience in community based outreach or
demonstrated progressive advancement in responsibilities in
a healthcare setting such as clinic, hospital, etc. preferred
• Performs manual chart audits for ACO quality reporting
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Quality Audit Projected Hours
Position
Number of EE's
Training hours
Audit Hours Per
Week
Audit Weeks
Audit Coordinators
3
6
25
6
Audit Associates
10
6
25
6
Total
• 1500 Auditor Hours
• 450 Coordinator Hours
• Six hours training for both Coordinators and Associates
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Quality Audit Training
Tasks
Coordinators
Audit Associates
Timeline
EMR Training
1-2 hours
1-2 hours
3-4 weeks prior to
data collection
CMS Quality
Measure
Definitions
2 hours
2 hours
2- 3 weeks prior to
data collection
Audit tool including 1 hour
EMR samples
1 hour
2- 3 weeks prior to
data collection
Distribution of
patient
Assignments
Ad Hoc
Ad Hoc
After patient file is
available from CMS
Weekly update
meetings
30 to 60 minutes
30 to 60 minutes
Weekly Starting
January 20th.
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Audit Tool Kit
• Face to face training sessions with Coordinators and Auditors
– CMS requirements and tools
– Group training sessions with each partner audit group to
orient to EMR variances.
• Reference binders for all Coordinators and Audit Associates to
include
– Cheat Sheets, algorithms for each quality metric
– Screen shots of auditing tool with directions
– EMR Screen shots for those unfamiliar with formatting
– Contact information for team members
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Data Collection Strategy
• Plan to import Patient and Patient Discharge XML files
and convert to central Access database accessible on
secure server
– Will not use direct entry into GPRO Web Interface for
submission
• Simple Access user form under development for patient
record retrieval and data entry
– Form will be accessible by all quality auditors working
from assigned patient lists
– Form will enforce XML specifications for data
formatting
• Plan to export data from Access to XML format to upload
updated files to CMS
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Data Collection Strategy
Not for reuse or distribution without permission
Keystone ACO Confidential and Proprietary
Questions?
 Submit anonymous written questions using the Q/A tab (not
chat) on dashboard OR
 Click on the “Raise your hand” button for live question
 When it is your turn to ask, you will be unmuted and the
moderator will ask you to state your question
 If you did not have a chance to ask a question today or have
new questions, please send to info@naacos.com.
Speaker Contact
Tracey Bower, Summit Medical Group
Email: tebower@summithealthcare.com
Heidi Johnson, Summit Medical Group
Email: hjohnson@summithealthcare.com
Frederick J. Bloom, Jr., Geisinger
Email: fbloom@geisinger.edu
Anthony “Tony” Reed, Geisinger
Email: areed@geisinger.edu
Upcoming
• Next webinar in the series is Thursday, December 19 at
1:00pm ET – this is to avoid conflict with a CMS webinar.
The title for the next webinar is: Obtaining & Reporting
Quality, Preventive Measures. Speakers are Carrie Hagan,
Coastal Carolina Quality Care, Inc. and Sara Falkiewicz,
ProHealth Solutions.
• Slides and recording of today’s webinar will be posted on
our website, www.NAACOS.com/webinar by tomorrow.
• Watch for information about our 2014 Spring Conference
and our next webinar series coming soon!
Thank You!
Thank you for attending today’s webinar!
Consider joining NAACOS
The ACO and Business Partner applications can be
found at www.NAACOS.com