Download UDS Updates for CY 2015 in Azara DRVS

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UDSUpdatesforCY2015inAzaraDRVS
PediatricDentalSealants,AsthmaPharmacologicTherapyandOtherUpdates
HeatherBuddandEricGunther
January18,2016
InformationinthiswhitepaperisbasedontheCY2015UDSManual,anddiscussionswithmembersoftheHealthResourcesand
ServicesAdministration(HRSA)ortheUDSHelpdesk.ThepurposeofthispaperistoexplainhowAzarawillhandlechangesor
additions,andanymappingdecisionsclientsneedtomaketoenablethesemeasurestoproperlyworkintheirsystems.
OnenewmeasurewasintroducedtoUDSTable6BforCalendarYear(CY)2015:PediatricDentalSealants.Wewilldescribethe
measureandhowitiscalculatedinDRVSindetailbelow.Thismeasureisintendedonlyforpracticeswhoofferdentalservicesto
theirpatients.Ifyourpracticedoesnotofferdentalservices;youshouldnotsubmitnumbersforthismeasure.
Inaddition,ICD-10codingstartedformostpracticesonOctober1,2015thisyear.Toensureasmoothtransition,Azaraswitchedto
usingtheValueSetAuthorityCenter(VSAC)asthecodelibrarytohelpdefinedenominatorsandnumeratorsofmeasuresbycodes.
TheVSACincludesICD-9s(forhistoricalpurposes),ICD-10s,SNOMEDs,CPTs,CDTs,LOINCs,RxNorms,etc.,anditsuseisencouraged
byHRSAinthemanualonpage88:
“Additionally,theuseofofficialversionsofvocabularyvaluesetsascontainedintheValueSet
AuthorityCenter(VSAC)isencouragedfororganizationscapableofappropriatelyusingthisresource
asdefinedbelowtosupportthedatareportingofthesequalityofcaremeasures.”
TheVSACmaystillbeimperfectandevolving,butitrepresentsthemostcomprehensivesetofcodeswithanofficialfederalstamp
ofapproval,aswellasbeingsharedbymultiplemeasuresetssuchasthoseofHRSA’sUniformDataSet(UDS),MeaningfulUse(MU),
andtheAgencyforHealthcareResearchandQuality(AHRQ).Usingthesamevocabularysetformultiplerelatedmeasureshelps
createincreasemeasurealignment,andmakesitsimplerforpracticestomeetrelatedmeasuresfordifferentprograms.
TheshifttoICD-10signaledanotherimportantimpacttotheAzaraversionoftheUDSAsthmaPharmacologicTherapymeasure.The
measurenolongerallowsforuseoftheentireuniverseofasthmaticstreatedbyahealthcenter.Instead,withthespecificitynow
enabledbyICD-10coding,asthmaseverityshouldbeincludedinthediagnosiscodingforapatient,andotherassessmenttools.The
changeinthedefinitionoftheAsthmaPharmacologicTherapymeasuredenominatormakesthemeasuremorecloselyalignedwith
clinicalpracticestandards;generallyonlypersistentasthmaticsrequireacontrollerdrugprescribedconsistently.Inthepast,Azara
usedamethodtodefinethedenominatorofthemeasureallasthmatics,regardlessofseverity,becausesofewpractices
documentedseverity.Anotheroptionwastodefinethedenominatorasonlyasthmaticswithadocumentedseverityof“persistent.”
th
AsofDecember20 2015,theAzaracustomdenominatorusingthewholeasthmapopulationwasdiscontinued,andonly
asthmaticsdocumentedas“persistent”willbecounted.Thechangemayhaveresultedindecreaseddenominatorsforclientsless
consistentindocumentingseverity.ThisisessentialknowledgeifashiftinthedenominatortriggerstheElectronicHandbook(EHB)
topromptyoutoexplainwhathappened.
WhatUsersNeedtoKnow
•
TheseupdatesandadditionsarecompleteinDRVSasofthereleaseofDRVSversion8.0,liveon1/15/2016.
•
Pleasedonotwaittomakecustommappingrequests.Requeststoensurethetwoaffectedmeasuresareaccuratelycapturing
yourpracticeworkflowshouldbemadeassoonaspossibletoensurethesecanbecompletedintimeforUDSreport
submission.Keepinmind,changeswillbemadeintheordertheyarereceived.Pleasesubmitaticketto
[email protected],ratherthanemailingyourfavoriteAzaraemployee.Youcanalways
ccanyoneyouwanttobeawareofyourrequest.
•
MeasuresarestillsubjecttochangeifHRSAchoosestoalterthemeasuredefinitions.Ifthatoccurs,Azarawillmakethechanges
incodeandupdatethemeasuresforclientsassoonaspossible.
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UDS Updates for CY 2015 in Azara DRVS | 2
PediatricDentalSealants*
*Thismeasureusesbydefaultpredominantlydentalbillingcodestocapturediagnosesandprocedures.Thereforeitisonly
viableforAzaracustomerswhosedentalchargesarebeingsentthroughtheirpracticemanagement(PM)system.Iftheyare
beingbilledonpaperorviaanotherelectronicmethod,thedatawillnotbeinDRVS.
CurrentUDSDefinition:
-
Denominator:Numberofpatientsaged6through9(dateofbirthisbetweenJanuary1,2006,andDecember31,2009),who
hadanoralassessmentorcomprehensiveorperiodicoralevaluationvisitduringthereportingperiodwhoareatmoderateto
highriskforcaries.
UDSfurtherspecifies:
•
-
Excludechildrenforwhomallfirstpermanentmolarsarenon-sealable(i.e.,allmolarsareeitherdecayed,filled,
currentlysealed,orun-erupted/missing).
Numerator:Numberofpatientsinthedenominatorwhoreceivedasealantonapermanentfirstmolartoothinthe
measurementyear.
DenominatorinAzara(PediatricDentalSealants)
•
Defaultmethod:Numberofpatientsaged6-9(dateofbirthisbetweenJanuary1,2006,andDecember31,2009),with
atleastonedentalencounterduringthecurrentmeasurementyear,anddocumentedmoderate/highriskever.This
measurespecificallydoesnotuseprimarycareServiceLines,onlydentalpatientsandvisitswillbeincluded.
o
Oralassessmentorcomprehensiveorperiodicoralevaluationduringthepastyear:
§
o
•
CDT:D0191,D0120,D0145,D0150,D0180.
Pre-existingtreatmentofordiagnosisofcaries,orcariesrisk,everdocumented:
§
CDT:D0602,D0603
§
SNOMED:609399004,609401005,609402003,609403008,109568006,109569003,109571003,
109574006,109575007,109577004,163152009,25840002,442231009,442551007,65413006,
80753001,95249000,95252008,95253003,95254009
§
ICD:521.x,525.13,K02.x,K08.13x,K08.43x
Custommethod:CariesRiskLevel(customerrequestrequired)
o Asanexample,someEHRscontaintemplatesfordocumentinglevelofcariesrisk.Aslongasthedatais
structuredwecanincludeit.(seeFigure1)Pleasesubmitasupporttickettoexplainyourmethod.
CariesRisk
Low
Moderate
High
q
q
Figure1:SampleCariesRisk
•
Custommethod:Exclusions:Exclusionsusingthecodesprovidedforthemeasurerequiretoothnumberdata(which
DRVSdoesnotreceiveandthereforecannotcalculate)toensureall4molarsarenoteligibleforsealants.
(customerrequestrequired)
o Manycustomershaveoptedtocreatetheirowndummycodetoindicateapatientshouldbeexcludedfrom
thismeasure,ortheydocumenttheexclusionwithacheckbox,radio-buttonorsomethingelsestructured.
Pleasesubmitasupporttickettoexplainyourmethod.
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UDS Updates for CY 2015 in Azara DRVS | 3
NumeratorinAzara(DocumentingSealants)
•
Defaultmethod:
§ CDT:D1351
§ SNOMED:234713009
•
Custommethod:Manypracticesneedanon-billablecodeorothermethodtodocumentsealants(eithernotapplied
bythecenterorbeingrecordedintheEHRratherthanthedentalrecord).(customerrequestrequired)
§
Ifyourhealthcenterhascreatedadummycodeorothermethodofdocumentingsealants,pleasesubmita
supporttickettoexplainyourmethod
VisualRepresentationofMeasureLogicinDRVS
GeneralComments
ThisisabrandnewmeasurethisyearmostclientsareexpectingrelativelylittledocumentationthisyearandHRSAhas
acknowledgedthatdentalqualitymeasuresareinthebeginningstagesandtheyarehopingtolearnalotfromallofyouinthisfirst
yearofthemeasure.
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UDS Updates for CY 2015 in Azara DRVS | 4
AsthmaPharmacologicTherapy
DocumentingAsthmaSeveritywithICD-10:
ThefollowingspreadsheetshowstheICD-10codesforAsthma.Greenshadedcodescontainaseverity,whichifused,willdocument
severityforanasthmapatient.Greyshadedcodesareconsiderednon-specificandmaynotbebillablewithcertaincommercial
insurancecompanies.Yellowshadedcodesmarkedwitha“!”shouldbeusedwithgreatcaution,becausetheylackseverity,
specificity,andtheyarenotincludedinthevalueset.Wedon’trecommendcodeswithoutaseverityunlessclinicallynecessary.
J45.2Mildintermittentasthma
Intermittent
!
Caution:non-specificcode/billing
J45.20uncomplicated
Intermittent
ü
Good:severity/billing
J45.21(acute)exacerbation
Intermittent
ü
Good:severity/billing
J45.22statusasthmaticus
Intermittent
ü
Good:severity/billing
J45.3Mildpersistentasthma
Persistent
!
Caution:notinpersistentvalueset
J45.30uncomplicated
Persistent
ü
Good:severity/billing
J45.31(acute)exacerbation
Persistent
ü
Good:severity/billing
J45.32statusasthmaticus
Persistent
ü
Good:severity/billing
J45.4Moderatepersistentasthma
Persistent
!
Caution:notinpersistentvalueset
J45.40uncomplicated
Persistent
ü
Good:severity/billing
J45.41(acute)exacerbation
Persistent
ü
Good:severity/billing
J45.42statusasthmaticus
Persistent
ü
Good:severity/billing
J45.5Severepersistentasthma
Persistent
!
Caution:notinpersistentvalueset
J45.50uncomplicated
Persistent
ü
Good:severity/billing
J45.51(acute)exacerbation
Persistent
ü
Good:severity/billing
J45.52statusasthmaticus
Persistent
ü
J45.9Otherandunspecifiedasthma
Unspecified
J45.90Unspecifiedasthma
Unspecified
J45.901(acute)exacerbation
Unspecified
J45.902statusasthmaticus
Unspecified
J45.909uncomplicated
Unspecified
J45.99Otherasthma
Unspecified
J45.990Exerciseinducedbronchospasm
Unspecified
J45.991Coughvariantasthma
Unspecified
J45.998Otherasthma
Unspecified
!
!
!
!
!
!
!
!
!
Good:severity/billing
Caution:non-specific/noseverity
Caution:non-specific/noseverity
Caution:noseverity
Caution:noseverity
Caution:noseverity
Caution:non-specific/noseverity
Caution:noseverity
Caution:noseverity
Caution:noseverity
Updatetomeasurelogic:
-
AsdescribedearliertheAzaraAsthmaPharmacologicTherapydenominatorisnowuniformacrossallhealthcentersand
includesonlythosepatientswhosemostrecentdocumentedAsthmaseverityassessmentwas“persistent.”
•
•
Defaultmethod:
§ ICD-10/SNOMEDcodescontainingpersistentseverity:J45.30,J45.31,J45.32,J45.40,J45.41,J45.42,J45.50,
J45.51,J45.52,426656000,426979002,427295004,427354000,5281000124103,901000119100.
OR
§ ICD-9codeswithoutseverity:493.00,493.01,493.02,493.10,493.11,493.12,493.20,493.21,493.22,493.81,
493.82,493.90,493.91,pluscustommethodtoidentifyseverity.
Custommethod:OtherstructuredseverityassessmentfromanEHRtemplate.(customerrequestmayberequired)
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UDS Updates for CY 2015 in Azara DRVS | 5
§
Ifyouhaveintroducedanewasthmaseverityassessmentworkflowwithinthelastyear,andnotshareditwith
Azara,pleasesubmitasupporttickettoexplainyourmethod,otherwisethisisdoneduringimplementation.
OtherUDSMeasureChanges
ValueSetChanges
Thefollowingchangeshavebeenmadetovaluesets:
• TheICD-9code412andtheSNOMEDcode443502000havebeenaddedtotheCADdenominatorvalueset.
• TheSNOMEDcode111552007wasaddedtotheDiabetesdenominatorvalueset.
• Albuterolhasbeenremovedfromtheasthmacontrollermedicationvalueset.
• NDCcodeshavebeenaddedtothevaluesetforaspirinmedicationsandlipidloweringtherapymedications.
UDSMeasuresorTableUpdates
•
•
•
•
•
IVDUseofAspirin:Thedenominatorofthismeasurewasfixedtolookbackoneyearforaqualifyingencounterinsteadof
thepreviouslookbackoftwoyears.
CADLDL:Theexclusionperiodhasbeenchangedfromafiveyearlookbacktoaoneyearlookback.Thischangewas
instigatedbyarevisioninthemanual.
UDSDepressionScreening(ModifiedEP0418):Achangehasbeenmadetothismeasuresothatdepressiondiagnosesthat
occuronthesamedayasascreeningdonotcountasanexclusion.
CADLipidTherapy:AnallergyexclusionhasbeenaddedwhichchecksforrecordswithanNDCcodethatisaqualified
medicationincludedinthevaluesetintheallergytable.
Table4PatientIncome:Ifapatienthasanincomeof$0,documentedas$0,notblank,itwillnowcountas<100%of
povertylevelinsteadofthe“suspectedbaddatacategory”asinthepast.
Table6AChangesintheManual
ThisyearHRSAaddedsomeclarificationforthecalculationofservicesdeliveredbythehealthcenter.Thefollowingbulletsare
quotedfrompage75oftheUDS2015Manualdescribingtable6Aservicesandhowtocountthem.
•
•
•
•
•
•
“Ifthehealthcenterproviderordersandperformstheservice,theserviceiscounted.Forexample,arapidHbA1ctest
orderedbyaphysicianandperformedinthecliniclabiscounted.(alreadyincludedbyAzara)
IfchildrenareroutinelyreferredtotheCountyHealthDepartmentforvaccinations,thevaccinationsperformedbythe
HealthDepartmentarenotreported.(alreadyexcludedbyAzara)
Ifthehealthcenterproviderordersatest(e.g.,HIVtests),thesampleiscollectedatthehealthcenter,andthensenttoa
referencelabforprocessing,thetestiscounted,regardlessofwhetherthetestispaidforbythepatient,thepatient’s
insurancecompanyorthehealthcenter.(notincludedbyAzarapresentlyunlessdummycodesareusedandweknow)
Ifaproviderasksthepatienttogetatestnotperformedbythehealthcenterfromathirdpartyproviderwhichsendsthe
resultsbacktotheprovidertobeactedonandbillsthehealthcenterwhichpaysforit,thattestiscounted.Thus,ahealth
centerwithacontracttopayformammogramsperformedbyathirdpartyprovideriscounted.(notincludedbyAzara
presentlyunlessdummycodesareusedandweknow)
Ifaproviderasksthepatienttogetatestnotperformedbythehealthcenterfromathirdpartyproviderwhichmaysend
theresultsbacktotheprovidertobeactedonbutwhichdoesnotbillthehealthcenter,thattestisnotcounted.Thusa
healthcenterwhichsendsapatienttotheCountyHealthDepartmentforamammogramwhichtheCountywillfollowup
withthepatientdirectlyisnotcountedorreported.(alreadyexcludedbyAzara)
Ifaprovidersendsapatienttoathirdpartyforaservicenotprovidedbythehealthcenter,suchassendingapatientforan
HIVtesttoaRyanWhiteprogram,wherethereceivingentityperformstheserviceandfollowsupwiththepatient,the
healthcenterdoesnotcountthatservice.”(alreadyexcludedbyAzara)
ThefollowingisaquotefromtheQuestionsandAnswersforTable6Aonpage79intheUDS2015Manual:
“TheinstructionsspecificallysaythatthesourceofinformationforTable6Ais“billingsystemsorEHRs.”There
aresomeservicesforwhichIdonotbilland/orforwhichtherearenovisitsinmysystem.WhatdoIdo?
Referralsforwhichyoudonotpay(e.g.,sendingwomentotheCountyHealthDepartmentforamammogram)
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UDS Updates for CY 2015 in Azara DRVS | 6
arenottobecounted.Whilehealthcentersareonlyrequiredtoreportdataderivedfrombillingsystemsor
EHRs,thereporteddatamayunderstateservicesinthecircumstancesdescribedbelow.Intoday’sElectronic
HealthRecords,virtuallyallofthesediagnosesand/orservicesshouldbecapturedinoneoranotherofthe
templatesavailable.Inordertomoreaccuratelyreflectyourlevelofservice,healthcentersmayalsouseother
codesintheirsystemtoenablethetracking.Forexample,ifachildisgivenavaccinationwhichtheclinicdoes
notchargeforbecausetheyreceiveditfreefromtheVaccineforChildrenprogram,theregularcodewithan
extensionmaybeusedtoindicatethatitisnottobebilledorthecodemayhaveazerochargeattachedtoit.”
ThisquestionperfectlyillustratesthechallengeswithcapturingdatafromtheEHR.Unlessahealthcenterisusingdummycodesor
anothermethod,ofwhichtheyhaveinformedAzara,todocumenttheseservicestheyarepayingforbutnotbillingfor,itwillbe
impossibleforAzaratoreflectitinthecenter’sdata.Inaddition,itisbestpracticetodocumentordersthataremadeoutsideyour
organizationincertaincases(Papsmears,Mammograms,andColonoscopies)forstructuredqualityreportingdata.Naturallythese
shouldnotbereportedon6Abecausethecenterneitherordered,norpaidfortheseservices,sothehealthcenter’smethodology
alsoneedsawaytoexcludethesefrombeingcounted(abenefitoflimitingthedatafor6Atobillingdata).
AzaraDRVScurrentlylimitstable6AforCY2015tobillingdatabecausethisisthebestwaytoensureaccuracyatthistime.One
notableexceptiontothelimittobillingdataisouruseofassessmentsanddiagnosesfromtheproblemlistinordertopopulatethe
SelectedDiagnosesportionofthetable.BecauseICD-9,ICD-10,andSNOMEDcodesareusedhere,theymayalsoimpactnumbersin
theServicessectionforMammogramsandPapsmearswherepracticesuseICD-9,ICD-10,orSNOMEDcodesasassessmentor
problemlistentriestodocumenttheseprocedures.WewillbeexploringwaystoincorporateadditionalEHRdataforservicesinthe
comingyear.KeepallthisinmindasyouareevaluatingwhatyouseeonTable6A.
TipsforSubmittingTickets(Helpushelpyou!)
AsUDSseasonmovesintohighgear,weexpectasignificantincreaseinthenumberofsupporttickets.TheentireAzarateamis
committedtoworkingontheticketstosupportyourUDSreporting.Whenreportingaticket,therearethingsthatcanhelp:
1.
Includethefullnameofthereport/measureyouran.
o
2.
Telluswhatfiltersyouused–reportingperiod,provider,location,etc.
o
3.
Forexample,therearemanyimmunizationmeasuresandtheyallhaveslightlydifferentspecifications.Insteadoftellingusthe
immunizationreport,tellus“ChildhoodImmunizationStatus(NQF0038).”
Apatientmaybeincludeddependingonwhichfilterswereapplied.Sharethefiltersyouused,sowecanrecreatetheissue.
Bespecificinyourdescriptionoftheissue,includingpatientexamples.
o
o
Ifyoujusttellusthereportiswrong,wecan’ttroubleshootit.
Insteadofsayingthatnotallcolonoscopiesarebeingcounted,tellusthatpatient12345hadacolonoscopyon1/12/2014and
shouldbecountedforcoloncancerscreening.Ifpossible,sendascreenshotoftheinformationinyourEHR.AlwayssendPHI
usingasecuremethod.
4.
Grouplikeissuestogether.
5.
Openmultipleticketsiftherearemultipleissues.
o
o
6.
Insteadofopening5ticketswith5differentpatientsforthesameorasimilarissue,open1ticketandgiveusthe5MRNs.
Weknowitiseasiertoputallissuesin1ticket.However,someissuestakeashorttimetoresolveandotherstakealongtime.
Onepersonwillworkonaticketatatime.Iftheissuesareinmultipletickets,multiplepeoplecanbeworkingonyourtickets.
PleasesubmitUDSticketsASAPtosupport@azarahealthcare.com.Ticketswillbeaddressedintheordertheyarereceived.
NOTE:PHIisoftennecessaryfortheresolutionofreportingissues.Atthisveryhectictime,weremindeveryonetoproperly
secure–encrypt--allsupportcommunicationswithAzarathatmaycontainPHI,includingmedicalrecordnumbers(MRNs).