GPRO Audit Season – Measurement Year 2018

As a Nextgen ACO chapter, Affinia Health Network participated in CMS’ annual Group Physician Report Option (GPRO) audit. The GPRO audit is a CMS-mandated audit in which ACOs report clinical quality data on a sample of their patient population. Reporting for this audit requires abstraction: searching for and pulling up patient charts, and searching for clinical documentation to verify services performed in a measurement year or performed within timeframes outlined in CMS’ clinical quality measure specifications. Once the clinical quality data is abstracted, it is reported back to CMS on a weekly basis until the audit is fully completed. The GPRO audit ran from January 22 through March 22, 2019.

This year, over 16 Affinia colleagues contributed 551.5 hours into reporting quality data across 15 GPRO measures. Of those 551.5 hours, 280.5 were spent on abstraction. Approximately 54 abstraction hours were dedicated to abstracting patient charts for our affiliate (independent) practices, and approximately 226 abstraction hours were dedicated to abstracting patient charts for our MHPP (employed) practices.

After completing the GPRO audit, all Nextgen ACO chapters are required to participate in a Quality Measure Validation (QMV) audit. The QMV audit is where the ACO provides the actual documentation of services reported in the GPRO audit for a subset of the sample patient population. Across Trinity Health’s 5 Nextgen ACO chapters, 200 patients were selected for the QMV audit, and 54 of those patients (or 27% of the 200 patients) were attributed to Affinia. All chapters were given less than two weeks to complete this audit. Affinia contributed an additional 33 hours into completing the QMV audit.

Trinity Health’s preliminary calculated performance rates indicate Affinia achieved the highest performance rates within the sample ACO patient population in the Falls Screening (CARE-2) and Diabetic A1c and Eye Exam combo (DM-2 and DM-7) measures compared to the other THACO chapters; Affinia scored in the 90th percentile for these measures as well as the Use of Aspirin or Another Antithrombotic measure (IVD-2). Lower scores which were proven to be statistically insignificant were reported for the Tobacco Screening and Cessation Intervention (PREV-10) and 12-Month Depression Remission (MH-1) measures, although it should be noted that the 12-Month Depression Remission measure score of 29.09% was an increase from 0% in the 2017 measurement year. The Colorectal Cancer Screening (PREV-6) measure was identified as an improvement opportunity.

As GPRO audit season comes to a close, Affinia has already started to plan for next year’s season. Instead of 1 abstractor, Affinia will have a small team of 4 abstractors trained on the GPRO measures as well as all of the applications, tools and resources used this past season. Affinia plans to make reporting for the 2019 measurement year more streamlined and efficient as well as provide more information to leadership to help Affinia grow as an ACO and overall as a CIN.

One Response to “GPRO Audit Season – Measurement Year 2018”

  1. Rick Saier

    Excellent summary of incredibly time consuming work. Congrats to the team

    Reply

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