172016Mar

Important CMS Audit Complete

Every year, KentuckyOne Health Partners network providers who are a part of our Accountable Care Organization (ACO) participate in a CMS audit called the group practice reporting option (GPRO). This is our third year participating and with each audit we see steady and significant improvements.

We audit 33 measures, eight of which are ACO-CAHPs. Others include chronic conditions, prevention, safety and utilization. There were several new measures introduced in 2015.  Most notably was a mental health measure called “depression remission.” This measure requires the use of the PHQ-9 depression screening tool at appropriate times.

Our number one priority is to support you in providing the highest quality care possible for your patients. We want to help you to keep them engaged in their care, safe and healthy. Through our ACO, we are responsible to show CMS that we are accountable for the care our providers give. It’s our “report card” and together with you, we want to achieve the highest possible score.

Our team reviews nearly 4,000 of our ACO providers’ patient records, all randomly chosen by CMS. We are asked to review different measures for different patients – making this more challenging than audits that use a set formula.

As in years past, we are expecting significant improvement again this year. Preliminary results indicate an improvement of more than 10 percent, but official results will be released after the CMS review.

Also, we know we have some opportunities. We ask our ACO physicians and APCs to please regularly use the PHQ-9 depression screening tool and conduct fall screenings on patients. Additionally, we will continue to work with our providers to educate on the measures, what is required to close the measure, and how we can streamline the documentation.

Congratulations to all of our ACO providers for your continued hard work and dedication.  Our innovative care management system coupled with your focus on prevention and optimizing health will lead us to a future of better care, better health, better experience at lower costs.