ACCOUNTABLE CARE ORGANIZATION QUICK-REFERENCE SETUP GUIDE

Transcription

1 ACCOUNTABLE CARE ORGANIZATION QUICK-REFERENCE SETUP GUIDE V 9.0 eclinicalworks, All rights reserved

2 Contents CONTENTS ACO SETUP 3 Demographics 3 ACO 12 4 ACO 13 6 ACO 14 7 ACO 15 8 ACO 16 9 ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO ACO APPENDIX A: NOTICES 43 Trademarks 43 Copyright 43 Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 2

3 ACO SETUP The following information is related to setting up the eclinicalworks system for reporting on Accountable Care Organization measures. All possible setup options are presented here, and not all are required for every measure. For more detailed information on all available methods of satisfying each measure, refer to the 2013 Accountable Care Organization Users Guide. Demographics Some patients do not qualify for the sample data. Structured data must be created in order to indicate the patient should not be included in the sample data. This is to ensure that they are not counted against your compliance percentages. Structured data setup: Patient Information > Additional Info > Structured tab > Reason patient not qualified for sample (ACO Reporting): Structured (single select): In hospice Moved out of country HMO Enrollment Deceased Patient Information > Additional Info > Structured tab > Date of Ineligibility (ACO Reporting): Date Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 3

4 ACO Setup ACO 12 ACO 12 Denominator All patients aged 65 years and older discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician providing ongoing care Structured data in HPI >Interim History > Transition of care visit from hospital > [questions]: (Q1) Date of admission to hospital: (Type: Date) (Q2) Date of receipt of hospital admission report: (Type: Date) (Q3) Date of discharge from hospital: (Type: Date) (Q4) Date of receipt of hospital discharge summary: (Type: Date) OR Structured data in HPI > Interim History > Transition of care visit from other inpatient facility > [questions]: (Q1) Type of other inpatient facility other than hospital: (Type: Structured single select) Rehabilitation Facility Skilled Nursing Facility Other Inpatient Facility (Q2) Date of admission to inpatient facility: (Type: Date) (Q3) Date of receipt of admission report: (Type: Date) (Q4) Date of discharge from inpatient facility: (Type: Date) (Q5)Date of receipt of discharge summary: (Type: Date) Note: The denominator is satisfied by entering information for either of the structured data options in bold above. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 4

5 ACO Setup ACO 12 Patients who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented. The Medical Record must indicate that the clinician is aware of the inpatient facility discharge medications and will either keep the inpatient facility discharge medications or change the inpatient facility discharge medications or the dosage of an inpatient facility discharge medication. Structured data in HPI >Interim History > Transition of care visit from hospital > [questions]: (Q5) Discharge medications reviewed and reconciled from hospital: (Type: Structured multiselect) OR Medications left unchanged Medications changed (e.g., discontinued, changed or added) Structured data in HPI > Interim History > Transition of care visit from other inpatient facility > [questions]: (Q6) Discharge medications reviewed and reconciled from inpatient facility: (Type: Structured multiselect) Medications left unchanged Medications changed (e.g., discontinued, changed or added) CPT* II Code: 1111F Discharge medications reconciled with the current medication list in outpatient medical record. Note: The numerator is satisfied by either recording the structured data information or the CPT II code. *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 5

6 ACO Setup ACO 13 ACO 13 Denominator All patients aged 65 years and older Exclusions Patients who were screened for future fall risk at least once within 12 months Note: Patients are considered at risk for future falls if they have had two or more falls in the past year or any fall with injury in the past year. Documentation of medical reason(s) for not screening for future fall risk (e.g., patient is not ambulatory) Note: Exclusions only apply if the patient was not screened for future fall risk. Structured data in Preventive Medicine > Screening > Fall Risk Screening > Fall Risk Assessment > (Type: Structured multiselect): No falls in the past year One fall without injury in the past year Two or more falls with injury in the past year Two or more falls without injury in the past year One fall with injury in the past year CPT* II Codes: 3288F Fall risk assessment documented 1100F Patient screened for future fall risk Note: The numerator is satisfied by either recording the structured data information or a CPT II code. CPT II Code: 3288F 1P Risk assessment for falls not completed for medical reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 6

7 ACO Setup ACO 14 ACO 14 Denominator Exclusions All patients aged six months and older seen for a visit between October 1 and March 31 Patients who have received an influenza immunization or who reported previous receipt of influenza immunization Note: 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 1st). Documentation of medical reason(s), patient reason(s), or system reason(s) for not receiving an influenza immunization during the flu season (e.g., patient allergy, patient refused, immunization not available, etc.). Note: Exclusions only apply if the patient did not receive influenza immunization during the flu season. Map the Influenza immunization to the following CVX codes: 111, 135, 140, 141, 144, 149 CPT* Codes: 90653, 90654, 90655, 90656, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, CPT II Code: 4037F Influenza immunization ordered or administered ICD Codes: V04.81, V06.6 Note: The numerator is satisfied by recording an immunization, CPT code, CPT II code, or ICD code. ICD Codes: V15.03 CPT II Codes: 4037F 1P Influenza immunization not ordered or administered, medical reason 4037F 2P Influenza immunization not ordered or administered, patient reason 4037F 3P Influenza immunization not ordered or administered, system reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 7

8 ACO Setup ACO 15 ACO 15 Denominator Exclusions All patients 65 years and older Patients who have ever received a pneumococcal vaccination Documentation of medical reason(s) for not ever receiving pneumococcal vaccination Note: Exclusions only apply if the patient did not ever receive a pneumococcal immunization. The Pneumonia vaccination must be mapped to the following CVX codes: 100, 133, 33 CPT* Codes: 90669, 90670, CPT II Code: 4040F Pneumococcal vaccine administered or previously received Note: The numerator is satisfied by recording an immunization, CPT code, or CPT II code. CPT II Code: 4040F 1P Pneumococcal vaccine not administered or previously received, medical reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 8

9 ACO Setup ACO 16 ACO 16 Denominator All patients aged 18 years and older at the beginning of the measurement period Patients with BMI calculated within the past six months or during the current visit and a follow up plan is documented within the last six months or during the current visit if the BMI is outside of normal parameters Note: Normal parameters are defined as: Age 65 and older BMI > 23 and < 30 Age BMI > 18.5 and < 25 Configure Height, Weight, and BMI fields from EMR > Vitals > Configure Vitals (Mandatory) > BMI Structured data in Preventive Medicine > Counseling > Provider to provider communication > Dietary consultation order provided (Data type: Boolean) Structured data in Preventive Medicine > Counseling > Care Goal Follow Up Plan > BMI management provided (Data type: Boolean) Follow Up BMI Plan: CPT* Codes: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 97802, 97804, 98960, 98961, 98962, ICD Codes: V65.3, V65.41 HCPCS Codes: S9449, S9451, S9452, S9470, G8417, G8418 Medications: Weight loss and weight gain medications Note: The numerator is satisfied by recording vitals and, if applicable, one of the following: structured data, a CPT code, an ICD code, a HCPCS code, or a medication. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 9

10 ACO Setup ACO 16 Exclusions Documentation of medical, or patient reason(s) for not having a BMI measurement performed during the measurement period (e.g., patient is receiving palliative care, patient is pregnant 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 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, etc.) Note: Exclusions only apply if a calculated BMI was not documented as normal or was outside parameters with a follow up not performed during the reporting period. Structured data in Preventive Medicine > Counseling > Provider to provider communication > Palliative Care > (Data Type: Structured single select): Admission by palliative care physician Admission to palliative care department Referral by palliative care physician Referral to palliative care physician Referral to palliative care service ICD Codes: V66.5, Pregnancy Dx HCPCS Codes: G8422 Patient not eligible for BMI calculation G8938 BMI is calculated, but patient not eligible for follow up plan *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 10

11 ACO Setup ACO 17 ACO 17 Denominator All patients aged 18 years and older Patients who were screened for tobacco use at least once within 24 months and who received tobacco cessation counseling intervention if identified as a tobacco user Note: Tobacco Use includes use of any type of tobacco. Cessation Counseling Intervention includes brief counseling (three minutes or less) and/or pharmacotherapy. Recording Tobacco Use: Structured data in Social History > Tobacco Use > Smoking > are you a: (Data Type: Structured single select): Current Smoker Former Smoker Non Smoker Current Everyday Smoker Current Someday Smoker Smoker current status unknown Unknown if ever smoked Structured data in Social History > Tobacco Use > Tobacco Use Other than smoking > are you an other tobacco user: (Data Type: Boolean) AND Recording Tobacco Cessation Counseling: Structured data in Preventive Medicine > Counselling > Smoking > Patient counselled on the dangers of tobacco use and urged to quit > (Data Type: Date) Structured data in Preventive Medicine > Counselling > Communication to patient > Counselled the patient on pregnancy smoking effects; education provided > (Data Type: Date) Structured data in Preventive Medicine > Counselling > Communication to patient > Counselled the patient on smoking cessation; education provided > (Data Type: Date) Structured data in Preventive Medicine > Counselling > Communication to patient > Counselled the patient on smoking effects; education provided > (Data Type: Date) (continued on next page) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 11

12 ACO Setup ACO 17 (continued) Exclusions Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy or other medical reasons) Note: Exclusions only apply if the patient was not screened for tobacco use during the reporting period or year prior. Structured data in Preventive Medicine > Counselling > Communication to patient > Counselled the patient on tobacco use; cessation provided > (Data Type: Date) Structured data in Preventive Medicine > Counselling > Communication to patient > Referral given to patient to a stop smoking clinic > (Data Type: Date) Structured data in Preventive Medicine > Counselling > Communication to patient > Referral to smoking cessation advisor was given to patient > (Data Type: Date) Structured data in Preventive Medicine > Counselling > Communication to patient > Smoking Cessation Assistance Provided > (Data Type: Date) CPT* II Codes: 4004F Patient screened for tobacco use AND received tobacco cessation and intervention Medications: Smoking cessation medications Note: The numerator is satisfied by recording information for both structured data options under Recording Tobacco Use and, if applicable, recording one of the following: a structured data option under Recording Tobacco Cessation Counseling, a CPT II code, or a medication. CPT II Code: 4004F 1P Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other reason) *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 12

13 ACO Setup ACO 18 ACO 18 Denominator All patients aged 12 years and older at the beginning of the measurement period Patients screened for clinical depression during the measurement period using an age appropriate standardized tool and, if positive, have had a follow up plan documented on the date of the positive screen Depression Screening Structured Data: Structured data in HPI > Depression Screening > Intervention> Depression Screening Findings > (Data Type: Structured single select): Positive Negative Depression Screening Intervention Follow Up Structured Data: Structured data in HPI > Depression Screening > Intervention > Follow Up for Depression > (Data type: Structured multi select): Case management follow up Completion of mental health crisis plan Coping support assessment Coping support management Crisis intervention with follow up Discharge by mental health primary care worker Emotional support assessment Emotional support education Emotional support management Implementation of measures to provide psychological support Management of mental health treatment Mental health care assessment Mental health care education Mental health care management Mental health history taking assessment (continued on next page) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 13

14 ACO Setup ACO 18 (continued) Mental health history taking education Mental health history taking management Mental health promotion assessment Mental health promotion education Mental health promotion management Mental health screening assessment Mental health screening education Mental health screening management Mental health treatment assessment Mental health treatment education Patient follow up to return when and if necessary Psychiatric follow up Note: A screening is defined as the 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. A Standardized Clinical Depression Screening Tool is defined as a normalized and validated depression screening tool developed for the patient population where it is being utilized. Depression Screening: Smart Forms: PHQ2, PHQ9 ICD Code: V79.0 HCPCS Code: S3005 Screen and Plan Codes: G8510 Negative screen for clinical depression, follow up not required G8431 Positive screen for clinical depression with a documented follow up plan Positive for Clinical Depression: Screen and Plan Code: G8431 Smart Form: PHQ9 Depression Follow Up Plan: Screen and Plan Code: G8431 Medications: Medispan Antidepressant medications Multum Miscellaneous Antidepressant medications Note: The numerator is satisfied by recording Depression Screening structured data, recording a Smart Form, or an ICD/ HCPCS/Screen and Plan code under either the Depression Screening or Positive for Clinical Depression sections, and, if applicable, recording one of the following: a Depression Screening Intervention Follow Up structured data option or coding/medication under the Depression Follow Up Plan section Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 14

15 ACO Setup ACO 18 Exclusions Documentation of medical or patient reason(s) for not having a screening for clinical depression performed during the reporting period (e.g., 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, situations where the patient s functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tools [e.g., certain court appointed cases or cases of delirium], or patient has an active diagnosis of depression or bipolar disorder; patient refuses to participate, etc.) Note: Exclusions only apply if the patient did not receive a screening for clinical depression using an age appropriate standardized tool. ICD Codes: Depression/Bipolar Dx codes HCPCS Codes: G8940 Screening for clinical depression documented, follow up plan not documented, patient not eligible/appropriate G8433 Screening for clinical depression not documented, patient not eligible/appropriate Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 15

16 ACO Setup ACO 19 ACO 19 Denominator All patients aged 50 through 75 years Patients who had at least one or more screenings for colorectal cancer during or prior to the reporting period Note: Patients are considered to have had an appropriate screening for colorectal cancer if any of the following are documented: Fecal occult blood test (FOBT) within the last 12 months Flexible sigmoidoscopy during the reporting period or the four years prior to the reporting period Colonoscopy during the reporting period or the nine years prior to the reporting period Map the Colonoscopy diagnostic imaging test to the community Colonoscopy ID from: EMR > Community Mapping > DI > Colonoscopy CPT* II Code: 3017F Colorectal cancer screening documented and reviewed Flexible Sigmoidoscopy: CPT Codes: 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, ICD Code: Colonoscopy: CPT Codes: 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391, HCPCS Codes: G0105, G0121 ICD Codes: 45.22, 45.23, 45.25, 45.42, Fecal Occult Blood Test: LOINC Codes: , , , , , , , , , , CPT Codes: 82270, HCPCS Code: G0328 ICD Code: V76.51 Note: The numerator is satisfied by recording a colonoscopy, flexible sigmoidoscopy, FOBT, CPT code, HCPCS code, ICD code, or CPT II code. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 16

17 ACO Setup ACO 19 Exclusions Documentation of medical reason(s) for not performing colorectal cancer screening (e.g., total colectomy or other medical reason) Note: Exclusions only apply if the patient was not screened for colorectal cancer. ICD Codes: 45.81, 45.82, 45.83, 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 197.5, V10.05, V66.5 CPT Codes: 44150, 44151, 44152, 44153, 44155, 44156, 44157, 44158, 44210, 44211, CPT II Code: 3017F 1P Colorectal cancer screening results not documented and reviewed, medical reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 17

18 ACO Setup ACO 20 ACO 20 Denominator All female patients aged 40 through 69 years Patients who had a mammogram at least once within 24 months Map the Mammogram diagnostic imaging test to the community Mammogram ID from: EMR > Community Mapping > DI > Mammogram Screening EMR > Community Mapping > DI > Mammogram, Diagnostics EMR > Community Mapping > DI > Mammogram, Uni Left EMR > Community Mapping > DI > Mammogram, Uni Right HCPCS Codes: G0202, G0204, G0206 ICD Codes: V76.11, V76.12, 87.36, CPT* Codes: 77055, 77056, CPT II Code: 3014F Screening mammography results documented and reviewed Note: If using an ICD/CPT/HCPCS code to indicate a mammogram was performed, documentation in the medical record MUST also include a diagnostic imaging test for a mammogram with both of the following documented: The date the breast cancer screening was performed The result of the findings Note: The numerator is satisfied by recording a mammogram diagnostic imaging test, a HCPCS code, an ICD code, a CPT code, or a CPT II code. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 18

19 ACO Setup ACO 20 Exclusions Documentation of medical reason(s) for not performing a mammogram within 24 months (e.g., women who had a bilateral mastectomy or two unilateral mastectomies) Note: Exclusions only apply if a mammogram was not performed within 24 months. ICD Codes: 85.41, 85.42, 85.43, 85.44, 85.45, 85.46, 85.47, CPT Codes: 19303, , 19304, , 19305, , 19306, , 19307, CPT II Codes: 3014F 1P Screening mammography not documented and not reviewed, medical reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 19

20 ACO Setup ACO 21 ACO 21 Denominator All patients aged 18 years and older at the beginning of the measurement period Patients who were screened for high blood pressure and a recommended follow up plan is documented as indicated if the blood pressure is prehypertensive or hypertensive Configure the blood pressure vital from: EMR > Vitals > Configure Vitals (Mandatory) > BP (1) Structured data in Preventive Medicine > Counseling > BP Management > Pre Hypertensive BP Follow Up Plan (Type: Structured single select): Follow Up 1 day Follow Up 2 3 days Follow Up 4 6 days Follow Up 1 week Follow Up 2 weeks Follow Up 3 weeks Follow Up 1 month Follow Up 6 weeks Follow Up 2 3 months Follow Up 4 6 months Follow Up 6 months Follow Up 7 11 months Follow Up 1 year (continued on next page) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 20

21 ACO Setup ACO 21 (continued) (2) Structured data in Preventive Medicine > Counseling > BP Management > First Hypertensive BP Follow Up Plan (Type: Structured single select): Follow Up 1 day Follow Up 2 3 days Follow Up 4 6 days Follow Up 1 week Follow Up 2 weeks Follow Up 3 weeks Follow Up 1 month (3) Structured data in Preventive Medicine > Counseling > BP Management > Referral to alternative/primary care provider > (Type: Structured multiselect) Urgent referral Referral to general medical service Referral to general practitioner Referral to hypertension clinic Referral to service Referral to doctor Referral to general physician (4) Structured data in Preventive Medicine > Counseling > BP Management > Physical Activity > (Type: Structured multiselect) Recommendation to exercise Exercise education Given encouragement to exercise Exercise promotion: strength training Exercise promotion: stretching Nutrition therapy Prescribed activity/exercise education Exercises education, guidance, and counseling (continued on next page) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 21

22 ACO Setup ACO 21 (continued) (5) Structured data in Preventive Medicine > Counseling > BP Management > Weight Reduction Recommendation > (Type: Structured multiselect) Follow up obesity assessment Weight reducing diet education Target weight discussed Refer to weight management program Weight control education (6) Structured data in Preventive Medicine > Counseling > BP Management > Dietary Recommendation > (Type: Structured multiselect) Patient referral to dietitian Diet education Dietary regime Dietary prophylaxis Low carbohydrate diet prophylaxis Low calorie diet prophylaxis Unsaturated fat diet prophylaxis Low fat diet education Low carbohydrate diet education Vegetarian diet education Vegan diet education Sugar free diet education Dietary treatment for disorder Obesity diet education Dietary education for disorder Referral to dietetics service Prescribed dietary intake Dietary needs education Prescribed diet education Dietary compliance education Nutrition care education Special diet education Nutritionist education, guidance, and counseling (continued on next page) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 22

23 ACO Setup ACO 21 (continued) Nutrition / feeding management Feeding regime Dietary management education, guidance, and counseling Lifestyle education regarding diet Nutrition education (7) Structured data in Preventive Medicine > Counseling > BP Management > Moderation of ETOH Consumption Recommendation > (Type: Structured multiselect) Alcoholism counseling Patient referral for alcoholism rehabilitation Referral to community alcohol team Alcohol abuse prevention education Counseling about alcohol consumption Referral to community drug and alcohol team Referral to specialist alcohol treatment service BP Follow Up Plan: Dietary Recommendations: HCPCS Codes: S9452, S9470 ICD Codes: Z71.3, V65.3 Physical Activity Recommendation: HCPCS Code: S9451 ICD Code: V65.41 Weight Management Classes: HCPCS Code: S9449 Second Hypertensive Reading Interventions: Map one of the following LOINC codes from EMR > Labs/DI/Procedures > Labs: , , , , , , , , 80047, 80048, 80050, 80053, Medications: Anti Hypertensives Map one of the following LOINC codes from EMR > Labs/DI/Procedures > ECG: , (continued on next page) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 23

24 ACO Setup ACO 21 (continued) Exclusions Documentation of medical or patient reason(s) for not receiving screening for high blood pressure (e.g., patient has an active diagnosis of hypertension, patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient s health status. This may include, but is not limited to severely elevated BP when immediate medical treatment is indicated; patient refuses BP measurement, etc.) Note: Exclusions only apply if the patient did not receive a screening for high blood pressure during the measurement period. Note: No follow up is needed for a normal BP reading. The following readings require follow ups: Pre Hypertensive Reading Structured data (1) + (one or more) Structured Data (4), (5), (6), (7) OR Structured data (3) only 1st Hypertensive Reading Structured data (2) + (one or more) Structured Data (4), (5), (6), (7) OR Structured data (3) only 2nd Hypertensive Reading (one or more) Structured data (4), (5), (6), (7) + (one or more) (Anti Hypertensive Medications, Lab tests, or ECG) OR Structured Data (3) only Note: The numerator is satisfied by recording vitals and, if applicable, one of the following: structured data, a medication, a CPT II code, or an ICD code. ICD Codes: Hypertension Dx HCPCS Codes: G8784 Blood pressure not documented, patient not eligible/not appropriate G8951 Pre hypertensive or hypertensive blood pressure reading documented, indicated follow up not documented, patient not eligible/not appropriate Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 24

25 ACO Setup ACO 22 ACO 22 Denominator Exclusions Patients 18 to 75 years of age with a diagnosis of diabetes mellitus with two or more face toface visits for diabetes in the last two years and at least one visit for any reason in the last 12 months Patients with most recent hemoglobin A1c <8.0 percent Diagnosis of polycystic ovaries, gestational diabetes or steroidinduced diabetes ICD Codes: Diabetes Dx The Hemoglobin A1c lab attribute must be mapped to one of the following LOINC codes: , , Note: Hemoglobin A1c lab should be ordered during the reporting period. Lab results must be entered in the yellow grid on the Lab Results window and the Received box must be checked. IMPORTANT! Do not enter special characters in the results field. Only numbers and the percentage sign (%) are recognized by the system when calculating measure compliance. ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, or Steroid Induced Diabetes Dx Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 25

26 ACO Setup ACO 23 ACO 23 Denominator Exclusions Patients 18 to 75 years of age with a diagnosis of diabetes mellitus with two or more face toface visits for diabetes in the last two years and at least one visit for any reason in the last 12 months Patients with most recent low density lipoprotein <100 mg/dl Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes ICD Codes: Diabetes Dx Map the following LOINC codes to the LDL C lab attribute: , , , , , , , , Map the following LOINC codes to the Total Cholesterol lab attribute: , Map the following LOINC codes to the Triglycerides lab attribute: , , , Map the following LOINC codes to the HDL lab attribute: , , IMPORTANT! All four components of LDL, Total Cholesterol, HDL, and Triglycerides must be linked to a corresponding LOINC code and their values entered into the Lab Result window to satisfy this measure. Note: The LDL C lab should be ordered during the reporting period. Lab results must be entered in the yellow grid on the Lab Results window and the Received box must be checked. IMPORTANT! Do not enter special characters in the results field. Only numbers and mg/dl are recognized by the system when calculating measure compliance. ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, or Steroid Induced Diabetes Dx Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 26

27 ACO Setup ACO 24 ACO 24 Denominator Exclusions Patients 18 to 75 years of age with a diagnosis of diabetes mellitus with two or more face toface visits for diabetes in the last two years and at least one visit for any reason in the last 12 months Patients with most recent blood pressure <140/90 mmhg Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes ICD Codes: Diabetes Dx Configure the blood pressure vital from: EMR > Vitals > Configure Vitals (Mandatory) > BP Note: The BP value should be ordered during the reporting period. IMPORTANT! When entering a BP value on the Vitals window, special characters should not be entered right next to numeric values (e.g., BP 120/80 AH). The only allowable special character is unit of measure mmhg. ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, or Steroid Induced Diabetes Dx Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 27

28 ACO Setup ACO 25 ACO 25 Denominator Exclusions Patients 18 to 75 years of age with a diagnosis of diabetes mellitus with two or more face toface visits for diabetes in the last two years and at least one visit for any reason in the last 12 months Patients who were identified as non users of tobacco Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes ICD Codes: Diabetes Dx Structured data in Social History > Tobacco Use > Smoking > are you a: > (Data Type: Structured single select): Current Smoker Former Smoker Non Smoker Current Everyday Smoker Current Someday Smoker Smoker current status unknown Unknown if ever smoked Structured data in Social History > Tobacco Use > Tobacco Use Other than smoking > are you an other tobacco user: > (Data Type: Boolean) Note: The numerator is satisfied by recording information for both structured data options. ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, or Steroid Induced Diabetes Dx Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 28

29 ACO Setup ACO 26 ACO 26 Denominator Patients 18 to 75 years of age with a diagnosis of diabetes mellitus with two or more face to face visits for diabetes in the last two years and at least one visit for any reason in the last 12 months and a diagnosis of ischemic vascular disease Patients with the diagnosis of diabetes and ischemic vascular disease with documentation of taking daily aspirin or antiplatelet medication or have a documented contraindication in the measurement year Note: The following are accepted contraindications for this measure: Anticoagulant use, Lovenox (enoxaparin) or Coumadin (warfarin) Any history of gastrointestinal (GI)* or intracranial bleed (ICB) Allergy to aspirin (ASA) Gastroesophogeal reflux disease (GERD) is not automatically considered a contraindication but may be included if specifically documented as a contraindication by the physician. The following may be exclusions if specifically documented by the physician: Use of non steroidal anti inflammatory agents Documented risk for drug interaction Uncontrolled hypertension defined as 180 systolic, 110 diastolic Other provider documented reason for not being on ASA therapy eclinicalworks Data Points No eclinicalworks setup required. ICD Codes: Diabetes Dx and Ischemic Vascular Disease Dx No eclinicalworks setup required. ICD Codes: Diabetes Dx and Ischemic Vascular Disease Dx Note: The numerator is satisfied by recording an ICD code and a medication. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 29

30 ACO Setup ACO 26 Exclusions Patients may be excluded for one of the following reasons: Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes Note: This exclusion only applies if the patient was not prescribed daily aspirin or antiplatelet medication. Documentation of medical reason(s) for not prescribing daily aspirin or antiplatelet medication eclinicalworks Data Points No eclinicalworks setup required. ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, or Steroid Induced Diabetes Dx CPT* II Code: 4086F 1P Documentation of medical reason(s) for not prescribing Aspirin or Clopidogrel *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 30

31 ACO Setup ACO 27 ACO 27 Denominator Patients aged 18 through 75 years with the diagnosis of diabetes Exclusions Patients with most recent hemoglobin A1c level >9.0% Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes ICD Codes: Diabetes Dx Map one of the following LOINC codes to the Hemoglobin A1c lab attribute: , , Note: The Hemoglobin A1c lab should be ordered during the reporting period. Lab results must be entered in the yellow grid on the Lab Results window and the Received box must be checked. IMPORTANT! Do not enter special characters in the results field. Only numbers and the percentage sign (%) are recognized by the system when calculating measure compliance. ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, and Steroid Induced Diabetes Dx Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 31

32 ACO Setup ACO 28 ACO 28 Denominator Patients aged 18 through 85 years with the diagnosis of hypertension Exclusions Patients whose most recent blood pressure <140/90 mmhg Documentation of medical reason(s) for not recording a blood pressure measurement (diagnosis for End Stage Renal Disease [ESRD] and pregnancy are the only acceptable exclusions) Note: Exclusions only apply if the patient did not receive a blood pressure measurement. ICD Codes: , 401, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Configure the blood pressure vital from: EMR > Vitals > Configure Vitals (Mandatory) > BP Note: The BP value should be ordered during the reporting period. IMPORTANT! When entering a BP value on the Vitals window, special characters should not be entered right next to numeric values (e.g., BP 120/80 AH). The only allowable special character is unit of measure mmhg. ICD Codes: ESRD Dx and Pregnancy Dx CPT Codes: ESRD related procedures HCPCS Codes: G0257 (UNSCHD/EMERG DIALYSIS TX), S9339 (ESRD PT HOS OP NOT CERT) Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 32

33 ACO Setup ACO 29 ACO 29 Denominator Patients aged 18 years and older with the diagnosis of ischemic vascular disease, or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) ICD Codes: , , , , , , , , , , 411, 411.1, , , 412, 413, 413.1, 413.9, 414, , , , , , , , 414.2, 414.3, 414.8, 414.9, 429.2, 433, , 433.1, , 433.2, , 433.3, , 433.8, , 433.9, , 434, , 434.1, , 434.9, , 440, 440.1, 440.2, , , , , , 440.4, 444, , , 444.1, , , , , 444.9, , , , 0.66, 36.06, 36.07, 36.09, 36.1, 36.11, 36.12, 36.13, 36.14, 36.15, 36.16, 36.17, 36.19, 36.2 CPT* Codes: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33140, 33521, 33522, 33523, 33533, 33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937, 92941, HCPCS Codes: S2205, S2206, S2207, S2208, S2209 Note: The denominator is satisfied by recording an ICD code, a CPT code, or a HCPCS code. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 33

34 ACO Setup ACO 29 Patients who received at least one lipid profile (or ALL component tests) with most recent LDL C <100 mg/dl Map the following LOINC codes to the LDL C lab attribute: , , , , , , , , Map the following LOINC codes to the Total Cholesterol lab attribute: , Map the following LOINC codes to the Triglycerides lab attribute: , , , Map the following LOINC codes to the HDL lab attribute: , , IMPORTANT! All four components of LDL, Total Cholesterol, HDL, and Triglycerides must be linked to a corresponding LOINC code and their values entered into the Lab Result window to satisfy this measure. Note: Lipid Panel includes an LDL C lab should be ordered during the reporting period. Lab results must be entered in the yellow grid on the Lab Results window and the Received box must be checked. IMPORTANT! Do not enter special characters in the results field. Only numbers and mg/dl are recognized by the system when calculating measure compliance. *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 34

35 ACO Setup ACO 30 ACO 30 Denominator Patients aged 18 years and older with the diagnosis of ischemic vascular disease, or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) Patients who are using aspirin or another antithrombotic therapy ICD Codes: , , , , , , , , , , 411, 411.1, , , 412, 413, 413.1, 413.9, 414, , , , , , , , 414.2, 414.3, 414.8, 414.9, 429.2, 433, , 433.1, , 433.2, , 433.3, , 433.8, , 433.9, , 434, , 434.1, , 434.9, , 440, 440.1, 440.2, , , , , , 440.4, 444, , , 444.1, , , , , 444.9, , , , 0.66, 36.06, 36.07, 36.09, 36.1, 36.11, 36.12, 36.13, 36.14, 36.15, 36.16, 36.17, 36.19, 36.2 CPT* Codes: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33140, 33521, 33522, 33523, 33533, 33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937, 92941, HCPCS Codes: S2205, S2206, S2207, S2208, S2209 Note: The denominator is satisfied by recording an ICD code, a CPT code, or a HCPCS code. *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 35

36 ACO Setup ACO 31 ACO 31 Denominator All patients aged 18 years and older with a diagnosis of heart failure with a current or prior LVEF <40% Structured data in HPI > Echocardiogram > Left ventricular assessment > Result (%) (Data Type: Number) OR Structured data in HPI > Echocardiogram > Ejection fraction > Result (%) (Data Type: Number) Patients who were prescribed beta blocker therapy either within a 12 month period when seen in the outpatient setting OR at EACH hospital discharge ICD Codes: , , , , , , , , , 428, 428.1, 428.2, , , , 428.3, , , , 428.4, , , , CPT* Codes: 78414, 78451, 78452, 78453, 78454, 78468, 78472, 78473, 78481, 78483, 78494, 78496, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93350, 93351, 93352, 93452, 93453, 93458, 93459, 93460, HCPCS Codes: G8923 Left ventricular ejection fraction (LVEF) <40% or documentation of moderately or severely depressed left ventricular systolic function G8934 Left ventricular ejection fraction (LVEF) <40% or documentation of moderately or severely depressed left ventricular systolic function Note: Both Heart Failure Diagnosis and LVEF % must be documented for the denominator Note: The denominator is satisfied by recording structured data information, an ICD code, a CPT code, or a HCPCS code. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 36

37 ACO Setup ACO 31 Exclusions Documentation of medical, patient, or system reason(s) for not prescribing beta blocker therapy (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons; patient declined; other reasons attributable to the healthcare system, etc.) Note: Exclusions only apply if the patient was not prescribed betablocker therapy. ICD Codes: , , , 458.0, 458.1, , , 458.8, 458.9, , , , , , , , , , , , , , , 440.0, 426.0, , , V45.01 CPT II Codes: 4008F 1P Beta Blocker therapy not prescribed or being currently taken, medical reason 4008F 2P Beta Blocker therapy not prescribed or being currently taken, patient reason 4008F 3P Beta Blocker therapy not prescribed or being currently taken, system reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 37

38 ACO Setup ACO 32 ACO 32 Denominator ACO Definitions All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period ICD Codes: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 411, 411.1, , , 412, 413, 413.1, 413.9, 414, , , , , , , , 414.2, 414.3, 414.8, 414.9, V45.81, V45.82 CPT* Codes: 33140, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536, 92980, 92981, 92982, 92984, 92995, Note: The denominator is satisfied by recording an ICD code or a CPT code. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 38

39 ACO Setup ACO 32 ACO Definitions Patients who have an LDL C result <100 mg/dl OR patients who have an LDL C result >=100 mg/dl AND have a documented plan of care to achieve LDL C <100 mg/dl, including at a minimum the prescription of a statin Map one of the following LOINC codes to the LDL C lab attribute: , , , , , , , , , , , , , , , , , , , , , , , Map the following LOINC codes to the Total Cholesterol lab attribute: , Map the following LOINC codes to the Triglycerides lab attribute: , , , Map the following LOINC codes to the HDL lab attribute: , , Structured data in Preventive Medicine > Intervention/High Risk > Coronary Artery Disease: Lipid Control > Plan of care to bring LDL C under control > (Data Type: Structured multiselect): Discussed lifestyle modification(s) (diet and exercise) Scheduled re assessment of LDL C Medications: Statins IMPORTANT! The documented plan of care MUST include, at a minimum, the prescription of a Statin medication. It may also include the documentation of lifestyle modifications or a scheduled reassessment of LDL C. Note: The LDL C lab should be ordered during the reporting period. Lab results must be entered in the yellow grid on the Lab Results window and the Received box must be checked. IMPORTANT! Do not enter special characters in the results field. Only numbers and mg/dl are recognized by the system when calculating measure compliance. Note: The numerator is satisfied by recording a lab and, if applicable, a statin medication and/or structured data. IMPORTANT! All four components of LDL, Total Cholesterol, HDL, and Triglycerides must be linked to a corresponding LOINC code and their values entered into the Lab Result window to satisfy this measure. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 39

40 ACO Setup ACO 32 Exclusions ACO Definitions Documentation of medical, patient, or system reason(s) for not prescribing statin therapy (e.g., allergy, intolerance to statin medication(s), other medical reasons; patient declined; financial reasons, etc.) Note: Exclusions only apply if the patient was not prescribed statin therapy. CPT II Codes: 4013F 1P Documentation of medical reason(s) for statin therapy not prescribed or currently being taken 4013F 2P Documentation of patient reason(s) for statin therapy not prescribed or currently being taken 4013F 3P Documentation of system reason(s) for statin therapy not prescribed or currently being taken *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 40

41 ACO Setup ACO 33 ACO 33 Denominator All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a current or prior LVEF <40% OR All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a diagnosis of diabetes Structured data in HPI > Echocardiogram > Left ventricular assessment > Result (%) > (Data Type: Number) ICD Codes: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 411, 411.1, , , 412, 413, 413.1, 413.9, 414, , , , , , , , 414.2, 414.3, 414.8, 414.9, V45.81, V45.82, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , CPT* Codes: 33140, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536, 92980, 92981, 92982, 92984, 92995, 92996, 78414, 78451, 78452, 78453, 78454, 78468, 78472, 78473, 78481, 78483, 78494, 78496, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93317, 93350, 93351, 93352, 93452, 93453, 93458, 93459, 93460, HCPCS Codes: G8934 Left Ventricular Ejection Fraction (LVEF) <40% or documentation of moderately or severely depressed left ventricular systolic function G8923 Left Ventricular Ejection Fraction (LVEF) <40% or documentation of moderately or severely depressed left ventricular systolic function Note: The denominator can be satisfied using any of the following methods: record structured data and an ICD or CPT code record an ICD or CPT code and a HCPCs Code record an ICD or CPT code Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 41

42 ACO Setup ACO 33 Exclusions Patients who were prescribed ACE inhibitor or ARB therapy Documentation of medical, patient, or system reason(s) for not prescribing ACE or ARB therapy (e.g., allergy, intolerance, patient declined, lack of drug availability, etc.) Note: Exclusions only apply if the patient was not prescribed ACE or ARB therapy. ICD Codes: 395.0, 395.2, 396.0, 396.2, 396.8, , , , , , , , , , 440.1, 584.5, 584.6, 584.7, 584.8, 584.9, 585.1, 585.2, 585.3, 585.4, 585.5, 585.6, 586, 440.0, , 788.5, V56.0, V56.8, 39.95, 54.98, , , , , , , , , , , , , , , , , , , , , 251.8, 256.4, , , , , , 962.0, Pregnancy Dx codes CPT II Codes: 4010F 1P ACE/ARB therapy not prescribed or being currently taken, medical reason 4010F 2P ACE/ARB therapy not prescribed or being currently taken, patient reason 4010F 3P ACE/ARB therapy not prescribed or being currently taken, system reason *. CPT copyright 2012 American Medical Association. All rights reserved. Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 42

43 APPENDIX A: NOTICES Trademarks eclinicalworks eclinicalworks is a registered trademark of eclinicalworks, LLC. All other trademarks or service marks contained herein are the property of their respective owners. LOINC LOINC is a registered trademark Copyright CPT Copyright Notice CPT only 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association Copyright eclinicalworks, November 2013 Accountable Care Organization Quick Reference Setup Guide 43