January 2015 Newsletter

January 2015 Newsletter

null                                        January 2015    Edition: 1     

 
The TMP Medical Directors Meeting will take place on February 5, 2015.  A “FREE” webinar will be held regarding Documentation/Coding Tips for Practitioners for  ICD-9 and ICD-10.  Dr. Jatin Dave, has approved attendance by our TMP Leaders and for this session has opened the webinar to our NEPHO Physicians who wish to attend.  Please click on this link for dial in information and the necessary participant code.  Click here to print the webinar directions.  Please note: Registration is required.

 

 
In This Issue
MD Orientation
OPTUM CODING CENTRAL
2015 Dates & Policies
Provider Directory
Medical Asst. Training Grant
2015 TUFTS Fee Schedule
2015 Blue Cross Quality Measures
January POD Meeting Recap
Patient Experience Comments
January 15Issue: # Month/Year

PRESENTATION I
OPEN MEETING
January 27, @12:30 p.m.
January 28, @7:00 a.m.
were canceled due to
inclement weather. 
(They will be rescheduled.)
  
FEBRUARY DATES ARE:
February 2, @5:30 p..m.
February 11, 7:00 a.m.
BH Lecture Hall

 RSVP: Lisa Driscoll

Office Manager Meeting
February 4, @12:00 Noon
500 Cummings Center
Suite 6500
Good Harbor Room
RSVP: Judy O’Leary

        
AGENDA
2015 Health Plan Contracting Updates 
     
2015 Quality Measures –
Changes and Updates 
          
Patient Experience:    Sharing Report Result
with Providers and Staff
(Lunch will be provided)

 

MD Orientation
February 10th @7:30 a.m.
500 Cummings Center
Suite 6500
Good Harbor Room
 

 

Effective 2/9/2015
Karen Damico, D.O.
will change practice locations from the Esdale Medical Group
to AGH Primary Care located on the 4thFloor of 298 Washington St. Gloucester, MA 01930
Tel: 978-283-7580
Fax: 978-283-0456

  null
Click link for valuable
information and tips.
OPTUM Coding Central
                       
January is
Mental Wellness Month  
Optum Insider Newsletter
January Focus:
Major Depressive Disorder 
 

2015 Dates and Policies

     JANUARY 2015

PROVIDER IRECTORY

 

 

Click to print
You may need to refresh
your screen.

Northeast Health Systems and NEPHO Awarded Medical Assistant Training Grant

Northeast Health Systems and Northeast PHO are pleased to announce free training for Medical Assistants across Physician practices.

This training will be provided by North Shore Community College at the new state-of-the-art Danvers campus using both classrooms and simulation labs. Twenty two to twenty eight hours of training will include a thorough explanation of skills that are consistent with the Patient Center Medical Homes (PCMH) model, including

  • enhancing access and continuity,
  • identifying and managing patient populations,
  • planning and managing care,
  • providing self-care support and community resources,
  • tracking and coordinating care, and
  • measuring and improving performance.

A substantial portion of the training will revolve around patient simulations, including a geriatric, diabetic, and obese adolescent patient. Small groups of 6 – 8 Medical Assistants will participate in the training at one time, allowing for discussion and learning in a collegial and supportive way. The first training group is tentatively scheduled for March, with training completed for 50 Medical Assistants by Dec. 31, 2016.

This training will not only help physician practices meet PCMH certification, but will also provide valuable skills to Medical Assistants for use in their current and future professional positions.  Ann Cabral will be reaching out to offices to provide additional information regarding start dates and identifying potential candidates for these trainings.

2015 Tufts Fee Schedule
 

The 2015Tufts Health Plan HMO/POS and PPO fee schedules have been published on the Northeast PHO website https://www.nepho.org.  Please take this time to verify that your charges are higher then the published fee schedule to ensure your practice receives the maximum benefit of the negotiated contract.

PHO Fee Schedules can now be downloaded as a .csv file (commas separated values) which is easily opened in Microsoft Excel.  Instructions on how to download these files are posted on the fee schedule page of the website. We hope this new feature will make working with fee schedules much easier.

 

2015 Blue Cross Quality Measures

In 2015 the Northeast PHO, as part of Lahey Clinical Performance Network, enters a new contract with Blue Cross.  For most of the Quality measures, the minimum and maximum rates needed to achieve compliance have increased.

To ensure that we are aligned with current HEDIS quality guidelines, four measures have been eliminated:

  • Diabetic LDL-C Screening
  • Diabetic LDL-C Control (<100mg)
  • Cardiovascular LDL-C Screening
  • Cardiovascular LDL-C Control (<100mg)

 There are four new measures for which we are only reporting data to Blue Cross:

  • Diabetes Care: Adherence to Statins
  • Cardiovascular Adherence to Statins
  • Use of Imaging for Low Back Pain
  • Asthma Medication Ratio, Ages 5-64

For these four measures, data will be collected and sent to Blue Cross but there are no target thresholds and the results will not factor into the Gate Scores. We will share data regarding these measures as we receive it from Blue Cross. The expectation is that eventually these will become pay for performance measures.

The Blood Pressure measures have changed as follows:

  • Diabetic Blood Pressure Control <139/89
    • In 2014 the target for this measure was <139/79
  • Hypertension, Controlling High Blood Pressure <139/89
    • 18-59 y/o, <139/89
    • 60-85 y/o
      • With diabetes, <139/89
      • Without diabetes, <149/89
      • In 2014 the target for this measure was <139/89 regardless of age.

Please contact the PHO Quality team with any questions: Liz Isaac 978-236-1767, Jennifer Andersen 978-236-1747, Laureen Viel 978-236-1746.

January Subgroup Meeting Recap

1. Quality Update: 2015 AQC Measures

   Liz Isaac reported on BCBS changes for 2015 measures. (see Quality section for
detail)

2. Quality Focus: Depression (see attachments) Carol Freedman updated status of
2015 Depression Measures.

   Patient Inclusion: patient is prescribed an antidepressant and then coded for
MAJOR DEPRESSION (311, 296.20 – 296.25, 296.30 -296.35, 298)

   ACUTE PHASE: patient needs to remain on the antidepressant (or another if
changed) for at least 84 days (12 weeks) with no more than 30-day gap in treatment.

   CONTINUOUS PHASE: patient needs to remain on antidepressant for at least 180
days (6 months) with no more than 51-day gap from start date.

   BEST PRACTICES: Avoid using 311 code (Depression NOS, not otherwise specified)
if brief or situational depression Consider: 308.0 Acute reaction to major stress
w/depressive symptoms 309.0 Brief depressive reaction 309.4 Mixed adjustment
reaction with depressive symptoms

         – Consider 60 or 90 scripts once stable on antidepressant

         – Follow-up appointments frequently (ie. monthly at the start)

3. Physician Score Cards with performance through Q3. 2014 were shared with all providers.
Depression Data Example   Depression Charts  Modified Depression Chart
Coding for Depression

Patient Experience Comments

 

Beacon Family Medicine
I always have a good experience when I visit this practice. They try to reduce my medications and they listen to me.                        

Family Medicine Associates – Middleton
Mike Yoon has always been very helpful. Ever since the first day I met him he has been and continues to be concerned with my well-being. I have never been so comfortable with a doctor as I am with Mike. He is honest and tells it like it is.

Family Medicine Associates – South Hamilton
Dr. Gordon consistently makes me feel comfortable and confident about discussing my health concerns.

Internal Medicine of the North Shore
Dr. Demco is extremely kind, caring and professional. I am very pleased. Dr. Cohen, Lori Bergeson and Ashley Nunez as well as Sabrina are the best. The new PA Lisa and Dr. Demco are very professional.

North Shore Pediatrics
Dr. Dufresne is an excellent doctor. I completely trust her and hope to continue to see her as long as my children need pediatric doctor care.

North Shore Preventive HC, P.C.
My experience with Dr. Ruff has always been the best. His loving care of my wife before her death was the absolute best.

Zaven Jouhourian, MD
Dr. J. always has the time to answer all questions and explain all treatments. The staff is wonderful, knowledgeable and courteous.