GPRO Questions Answered

Welcome to the "GPRO Questions Answered" page.

Below are questions that have either been posted to the QualityNet Help Desk or asked of Cana Howard, our Lead Abstractor. If you have GPRO questions that were asked and answered and would like to share, please send them to James Malayang. As for emailing questions to Cana Howard, make sure you have the correct address: cmshims@med.umich.edu.

   

GPRO WI System Issues

Unfortunately, there are times when the GPRI WI system is overly slow and/or times out. I wish I could do something or have a solution but CMS doesn’t have an answer for it. On the January 26, 2017, support call there were at least five questions in the question queue complaining about the system. CMS would not verbally answer them but instead wrote the following: “File a ticket with the help desk.” If you're having issues please do file a ticket, however do not expect an immediate solution.

QualityNet Help Desk GPRO WI System Issues Response (Incident # INC000001763187)

Please clear your browsing history:

  1. Click the Internet Explorer icon on the taskbar to open Internet Explorer.
  2. Click the Tools button , point to Safety, and then click Delete browsing history.
  3. Select the types of data you want to remove from your PC, and then click Delete

and,

To clear your Java cache in Windows:

  1. Click Start > Control Panel.
  2. Locate and double click the Java icon in the Control Panel.
  3. Click Settings under Temporary Internet Files.
  4. Click Delete Files.
  5. Select all boxes and click OK on Delete Temporary Files window.
  6. Click OK on Temporary Files Settings window.

These above steps should solve the problem. We regret that it is hindering in your submission time and we do acknowledge these errors. However doing these trouble shoot should be able to solve these intermittent issues.

I greatly appreciate your time and patience

Warm Regards,

Nitin  --2/13/2017

 
 

This happened to Cana, 2/15/2017: When working a PREV-13 patient the PREV screen went down only to PREV-12. The vertical scroll bars were pulled all of the way down to the bottom and there was no PREV-13 to abstract! Cana rebooted, entered and exited the site but to no avail.

Workaround:

  1. Save the PREV screen with empty fields.
  2. Double click the error message for PREV-13 being empty and the first line of PREV-13 shows up.
  3. Tab once from that line to make the who PREV-13 data entry box to show.

I called QualityNet HD and their solution was to use a different browser. --James  --2/15/2017

 
 

When abstracting Care-3, the case is removed from the sample if the patient’s medications were not reviewed at any of the visits listed. Once this happens, is there any way to make the case become “active” again so that I can go back and change an answer? I’ve been unsuccessful thus far.

Please review the coding provided in the Evaluations Codes tab of the 2016 CARE Supporting Document for encounters considered eligible events and used during the attribution process. Documentation in the medical record must support the following if reporting compliance:

To comply with this measure, the eligible professional (EP) attests to documenting, updating or reviewing the patient’s current medications using all resources available on the date of the encounter. This includes documentation of medications the patient is presently taking including ALL prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements with each medication’s name, dosage, frequency and administered route. The EP is to use their best effort to review a current, complete, and accurate list of medications at each encounter. For example, if the EP is unable to verify a route they would still meet performance as long as they use all immediate resources available on the date of the encounter.
If there are missing components, documentation that substantiates the information available was to the best of the EPs ability at the date of the encounter .

Eligible clinicians meet the intent of this measure by making their best effort to document a current, complete and accurate medication list during each encounter. --QualityNet Help Desk  --2/15/2017

 
 

During the February 9th call with CMS/GPRO, it was touched upon for the ACE/ARB that you can use other drugs not listed in the list. What do you know about the Beta Blockers?? I have a patient who is on a BB but it is not listed, Bystolic… Should I put that they are on a BB and just make a note??

No answer yet.

 
 

A practice's office submitted their PQRS reporting via their system. They received an error and the Office Admin is stating that POM ACO needs to resubmit their PQRS reporting in order it to count and not be penalized. I explained that I understood that if a practice submits and is participating in an ACO, the ACO supersedes the practice submission. The only way the practice submission would count is if the ACO failed to submit the data. Please advise on how I should reply to this practice as I already stated the above understanding to the practice, but they wanted it confirmed by POM ACO.

What you said is correct. POM ACO is in the middle of GPRO and will submit, thus obviating the need to resubmit. You can also tell them that if for some reason the ACO fails to submit GPRO, they will have an opportunity to submit their own PQRS data at a later time to avoid a penalty. However, they cannot submit PQRS now.--James  --2/13/2017

 
 

We are having some problems when we enter MH data into GPRO. I am curious if anyone else has encountered the same difficulties as we have.

First, a comment about the measure: MANY of the CMS beneficiaries that fall into this quality measure have had a depression diagnosis for MANY years and so there is not an “index date PHQ-9” during the time period specified (12/1/2014 and 11-30/2015). So I believe there will be a lot of skips. I noticed that MH is not a measure for 2017, which I am happy about!

When we have found a PHQ-9 screening done between 12/1/2014 and 11-30/2015, very often it is less than 9, because they have been diagnosed so long that their meds/therapy are managing their depression. So we answer YES to MH Confirmed since the beneficiary has a diagnosis of depression; we answer YES that a PHQ-9 was performed during the Index period and enter that date it was performed; but, we answer NO to PHQ-9 Index Test was >9 and enter the score (0-8) and we get an error message saying the value entered must be 10 – 27. According to the web Interface Supporting Documentation, if the PHQ-9 is less than 9, we need to stop abstraction. But the tool does not allow us to stop, and if we Save the patient, it tells us that the data abstraction is incomplete. Should we answer NO to the question on whether a PHQ-9 was performed during the Index period, even though it was? The Supporting Documentation does not limit this MH measure to only beneficiaries who had depression diagnosed during the Index period – it says during the Index period or before.

Your suggestions on how we should answer this measure to gain the most credit for POM ACO and the practice?

No answer yet.

 
 

Hi Cana, I have a question regarding the below information from the Webinar yesterday (2/2/2017). Specifically, the third paragraph of the Answer which begins “From the posted Q&A”

Care 3 Q&A

I have several benes which have populated visits outside of IHA. Some patients I have nothing in our EMR and some I am able to find scanned in documents when reviewing consult notes.
Based on the above Q&A – these visits are considered within the ACO

My question is, are we supposed to reach out within the ACO to see if patient’s meds were reconciled for 2 of the 15 dates of service identified or should I be marking No-Visit outside of Practice?

See example below:
Visit Date

  • 1/13/2016 No documentation in patient medical record of visit on this date or +/- 1-2 days
  • 3/2/2016 No documentation in patient medical record of visit on this date or +/- 1-2 days
  • 3/17/16 visit with IHA
  • 4/14/16 No documentation in patient medical record of visit on this date or +/- 1-2 days
  • 5/4/16 visit with IHA
  • 7/14/16 visit with IHA
  • 7/15/16 visit with IHA
  • 8/1/16 visit with IHA
  • 8/30/16 visit with IHA
  • 10/13/16 No documentation in patient medical record of visit on this date or +/- 1-2 days

Unless I know the ACO practice involved, I label such cases as “No-Visit outside of Practice.” If your stats were reversed and there were 15 cases without documentation and only 2 that fulfilled the criteria, I would be more concerned however it doesn’t appear to be the case here. --Cana  --2/3/2017

 

I have an ophthalmic report and my question is: The report says "retinal vessels OD: normal, Retinal vessels OS:normal.” There is nowhere on the report stating NO RETINOPATHY, will this work?

Is there any summary statement on there or something to the effect of exam is normal? --Cana

No, in the assessment "cataracts, etc, Macular edema, Refractive error" is all that is stated…

Because it references information that would appear in a diabetic assessment, I think that you were all set. I would make note of the retina findings in your comments however. --Cana  --2/1/2017

 

Have a lot of people been complaining of the HF measure??? Mine keep skipping due to the LVEF not being under 40%......

CMS wants to know if we are prescribing ACE/ARB meds for HF patients with low EFs. Yes, patients in this measure seem to be skipped rather frequently however it is because patients are preserving more of their heart function. HF skips for higher EFs are not a cause for concern. --Cana  --2/2/2017

 

Are you able to choose yes on this question Type 1 or 2 Diabetes? I can only choose Not confirmed-age.

This happens when the patient is outside the measure age range. In the case of PREV-13, the DM question applies to patients age 40 – 75 yrs and the patient referenced in the original question was 78 yrs, hence the “Not confirmed-age” response.  --1/25/2017

 

I have a question re data entry. I have entered prev-8 info under prev-7 and saved before I realized where it was entered. I can’t undo what was saved. Can you please advise?

The save function allows you to save your work however it doesn’t send that information to CMS until the final submit at the end of the project. As a result, there is no problem with making corrections to answers that you’d already saved and this is true for all of the modules. Please let me know if you have difficulty making changes.  --1/25/2017

Answer from QualityNet Helpdesk, in response to our answer above: That is absolutely correct. Thanks, Tiffany Graves, Business Analyst ll, Tier lll Inquiry Support, CSRA – DECC ADO Team.  --2/3/2017

 

Does pure hypercholesterolemia alone qualify as a CAD diagnosis?

No, it does not quality as a diagnosis of CAD. It actually makes sense because while some people may have hypercholesterolemia, not all of them have CAD, right? Let me know if I’m not making sense.  --1/25/2017

QNet Support Answer: No. Please refer to the EVALUATIONS coding provided for the measure. Coding is provided to assist you with identifying applicable conditions that would confirm a diagnosis of CAD. The supporting documents can be viewed at the following url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/GPRO_Web_Interface.html.  --1/27/2017

 

Have the POM ACO GPRO Status Reports been sent out?

They are being worked on and will be published next week.  --1/24/2017

 

Do I need to keep case notes in addition to what I enter into the comments section of each measure? In other words, are the comments good enough or do I need to place those same comments into a record for myself as well?

Putting notes in the comments section will be good enough. It’s nice to have a point of reference when referring back to pulling the data if needed to.  --1/25/2017

 

Hi Cana, Does carotid stenosis count for IVD measure?

The IVD Evaluation Codes include 433.10 – Occlusion and stenosis of carotid artery without mention of cerebral infarction so I’d say yes. --Cana

Follow up question: Is it me or do I not see on the cheat sheet you made, IVD diagnosis???

Answer: No, IVD diagnoses were not included in the cheat sheet because only HF and CAD were requested during the training session. The IVD Evaluation Codes spreadsheet that contains the information you need is posted here: 2016_GPRO_IVD_EVALUATION CODES only.pdf.   --1/24/2017

 

Hi Cana, I have run into pt’s that don’t have any LDL on file at all that I can find. How would I answer?

If you cannot find an LDL-C, then you would answer “no” for “LDL-C > or = 190 mg/dL?” Just out of curiosity, did the patient have an active diagnosis of ASCVD? I ask because and LDL-C is usually associated with those cases. In any case, you can only enter data that you have. --Cana

Follow up reply: Pt did not have ASCVD but even with No, it opens LDL question.  --1/24/2017

 

Is there a way to download the codes that CMS used to assign patients to certain modules?

The codes for all measure are available in a series of Supporting Document Excel files available here: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/GPRO_Web_Interface.html  --1/20/2017

 

If BMI is low are we to mark as not normal and need FU??

Per CMS-provided PREV-6 data guidance documentation, "If the patient’s most recent BMI was not within normal limits, determine if a follow-up plan was documented.” To that end, yes, you need a follow-up plan for any BMI outside the normal range, either above or below. This was further confirmed via the 1/19/2016 WI Support Call.  --1/18/2017

 

Where is the recording the weekly GPRO Web Interface Education Q&A Session located? During today’s session they said it was on the Quality Net site.

QNet Support Answer: James, For the Web interface Q&Q [sic] sessions, Please go to www.cms.gov/pqrs. On the left side under Physician Quality Reporting System > Click on >GPRO Web Interface. Scroll down to almost the bottom and you will see the following: 2016 Web Interface Support Calls. The presentation will be made available. If you need further assistance, please call QualityNet Help Desk, Phone: 866-288-8912 7:00 am- 7:00 pm central time.  --1/27/2017

NOTE: It appears that audio will not be posted from the Q&A sessions, just the presentation slides.

 

When entering for a patient, for CAD 7 the “CAD Confirmed” drop down box doesn’t have the “Yes” option. There is “confirmed- additional denominator criteria”. Is this correct to not have a YES option?

No answer yet.

 

For the following item, is the date range for the diabetes diagnosis “any time before 12/31/2016” or during the MP? Every other item has the time frame noted. This is from pg. 35 of the 2016 PREV Data Guidance document.

The following information has been provided by the measure steward (QIP): For the purposes of reporting 2016 PREV-13, diagnosis of diabetes can be confirmed with documentation of active or history of diabetes in the patient's medical record at any time up through the last day of the measurement period.  --1/19/2017

Addendum: It’s my impression that CMS wants to make sure that all patients who have ever been diagnosed with DM are included in the measure as long as they still have DM during the MP. If they based the measure on only patients diagnosed with DM during the MP, they would be excluding a large portion of the patient pool. Let me know if you need additional clarification.  --1/25/2017

 

What is the deadline for getting access to the GPRO WI using EIDM?

If you are going to submit the 2016 data then the submission deadline will be February 28, 2017.  --12/16/2016

 

Is there a maximum number of GPRO WI log ins?

You have the Web Interface Submitter role for TIN ending in 2046 - Physician Organization of Michigan ACO. If you will be submitting for a multiple TIN's then you are going to associate to each TIN to be able to submit 2016 data for the providers. Data submissions will be opened in January 1, 2017.  --12/16/2016