As a participant in a Medicare Shared Savings ACO, we are required to complete the MSSP GPRO program administered by CMS which is used to assess our providers’ quality performance and potentially share in generated savings. This alleviates the burden for providers to individually submit PQRS (Physician Quality Reporting System) data to CMS required data throughout the year. On average there are 15-17 quality measures per year (the measures may change from year to year) in 3 domains: Care Coordination and Patient Safety, Preventative Health, and Care of the At-Risk Population.
This is an intense time limited three month reporting period usually between mid-January through mid-March. By the second week of January each year, CMS provides a list of MSSP ACO enrolled patients (for SFHCP this is between 5,000-7,000 patients) who are randomly ranked for quality the measures. The number of ranked measures per patient varies from only 1 measure to all measures. There is very specific guidance in what data is needed to fulfill the measure. The QDS team will review records remotely via Epic, make office visits to review practice specific medical records (if not using Epic), and visit nursing homes to collect the necessary information. All the data collected is then used to complete the questions in the CMS Web Interface tool which is then submitted to CMS.
ACOs can be randomly chosen for an audit of data submitted for GPRO. The ACO will receive a list of patients and measures for which the records are being audited (usually 10-20 patients for 3 – 5 measures). At this time the ACO needs to submit supporting documents indicating how the measure questions were answered. If the ACO does not meet the audit standards, they must submit a corrective action plan to CMS. If the ACO is not chosen for audit or has passed an audit, data is tabulated to determine if the ACO is eligible to share in shared saving by Medicare.