NEPHO News – July 2018

NEPHO NEWS

July 2018  (click here for pdf version)
OPTUM Newsletter: July Focus – High Blood Pressure & Stroke

PHYSICIAN and PRACTICE CHANGES/UPDATES

New Providers

• Forrest Schwartz, MD has joined Sports Medicine North,1 Orthopedics Drive, Peabody, MA 01960
  978-818-6350 (F) 978-818-6355.

Physician/Practice Changes

• Effective 6/15/2018, Menaham Abraham, MD of Northeast Emergency Associates has terminated
  his NEPHO affiliation.
• Effective 6/27/2018, Michael Moharan, DPM has terminated his affiliation with Cape Ann Medical Center.

SAVE THE DATE

MD Orientation
Date:  August 22, 2018 @7:30 A.M.
Place: 500 Cummings Center, Suite 6500
Good Harbor Conference Room
Beverly, MA  01915
RSVP: Alycia Messelaar at Alycia.Messelaar@Lahey.org  or 978-236-1784

NEW ENGLAND COMMUNITY MEDICAL GROUP ANNUAL MEETING 

The New England Community Medical Group (NECoMG) Annual Meeting was held on June 21, 2018.

Guest Speaker
This year’s guest speaker was Chrissy Daniels, a Partner at Press Ganey, who provided an overview of her research in patient experience trends and the consumerism in health care. She shared data on the increase in patients who search online reviews and comments to select a physician.

One of the key Patient Experience measures is Likelihood to Recommend. It has been shown that patients are more likely to recommend a practice if they have:
1) confidence in the provider
2) the team works together
3) the provider shows concern for their worries

The good news is that these are the areas we focus on as well.

She noted how individual patients look for specific characteristics or practice styles to match their needs. It is important to share details about you and your practice to help patients find you online. It was recommended that you Google your profile to see what patients will find about you.

Ms. Daniels highlighted that top organizations are sharing their patient experience scores and comments online for patients to view. She shared a few helpful articles including one found at this link:
http://uofuhealth.utah.edu/innovation/algorithms/2015/three.php

Election
Dr. Pierre Ezzi reported the results of the NECoMG Board election. Drs. Erin Heiskell and Richard Mugge were re-elected for 3 year-terms as Class P and Class S Directors, respectively. Dr. Eric Sleeper was elected for a 3 year-term as a Class P Director. Congratulations to Drs. Heiskell, Mugge and Sleeper for their appointments to the Board.

We would like to thank Dr. Suzanne Graves for her many years of service as a Board of Director and her role as the Secretary of the Board. We appreciate her dedication to our organization.

IPA / POD MEETING SUMMARIES 

Data/Reports

Dr. Di Lillo, NEPHO Medical Director, distributed the following reports:

• April and May 2018 Out of PHO data by provider;
• Break down of number of patients by risk contract for each practice
  • The goal is to help practices and PHO allocate resources accordingly
• Initial Optum Commercial high risk patient registries were distributed

Efficiency Update

Dr. Di Lillo discussed the following efforts to improve budget:

• Focus on 3 conditions of high prevalence during the rest of the year
• First condition is Morbid Obesity
  • 100 Charts with BMI > 40 were reviewed for capture of Morbid Obesity coding
  • Only 15% were coded correctly
  • Based on CMS HCC tables, correct coding of these patients alone would yield ~$200K in aggregate to the budget
  • Correct capture requires both the morbid obesity code and the BMI code to be on the claim
• The Collaborative Approach to Commercial patients
  • 3 Care Managers will focus on our high risk for admission and cost commercial population
  • A collaborative approach has been put in place with the Pharmacy, Quality Improvement and Population Health PHO clinical teams
    • The team meets weekly and implements integrative care plan for high risk patients from the Optum Commercial registry
    • We have a care manager liaison with preferred SNFs and hospital ER care managers to enhance transitions from the ER and potentially divert some admissions
    • The Population Health NP is available to do home visits, write orders, make phone calls, revise problem lists, and facilitate management plans with PCPs and Specialists

Quality

Alison Gustafson, Population Health NP reviewed “The DO’s” of the acute bronchitis quality measure:

• DO code for Acute Bronchitis, J20.3-J20.9, as appropriate
• DO have a conversation about the why, to reduce patient expectation for an antibiotic  (Many patients have preset opinions that they need an antibiotic wherever they have a respiratory illness.  Addressing these opinions and expectations can be difficult)
• DO address the elephant in the room: It’s not pneumonia (…and this is why it isn’t)
• DO use OTC meds (acetaminophen, dextromethorphan, guaifenesin, Nasalcrom, etc)
• DO offer a contingency plan if symptoms worsen

PHARMACY UPDATES

QVAR Discontinued- Replaced by QVAR RediHaler

Teva recently replaced QVAR (beclomethasone dipropionate HFA) inhalation aerosol with QVAR RediHaler which became available in the first quarter of 2018. QVAR RediHaler contains the same active ingredient as QVAR and comes in the same doses (40 and 80 mcg). QVAR RediHaler uses a breath actuated metered dose inhaler, eliminating the need for hand breath coordination during inhalation.

A new prescription is required for QVAR RediHaler as it is considered a different medication than the original formulation of QVAR. QVAR RediHaler is in stock at pharmacies now.

See attached LCPN Newsletter 2018 July Issue 1 for SP for updates on the following:

• Valsartan recall
• Generic AirDuo is Preferred
• Sildenafil 20 mg vs. Generi Viagra – Update

Please contact Carol Freedman, Manager Pharmacy Services, for more information at Carol.Freedman@Lahey.org
or 978-236-1774

QUALITY

Mid-Year Update on Quality Measures

Here are some overall PHO performance statistics at the midway point in the 2018 Quality measurement period:

• The PHO is ahead of or equal to 2017 YTD performance in 8 of 22 measures
• The Northeast PHO is the top performer in 4 of these same measures compared to our LCPN counterparts (Winchester, Congenial and Lahey ACUs)
• Our current gate score is .89 compared to 1.37 at this time last year (Minimum threshold for Diabetes BP Control was increased from 56.0 to 79.5 in 2018.)

For the second year in a row, the PHO has reached the minimum threshold for 4 of the most difficult quality measures by midyear:

• Acute Bronchitis
• Asthma Medication Ratio
• Acute Phase Depression Medication Management
• Imaging in Low Back Pain.

This indicates a positive long term change in the management of these chronic conditions.  Great work!

The Well Child Visit measures present challenges every year. To reach the minimum thresholds, the PHO needs:

• 400+ physicals in the 3-6 age group
• 1000+ physicals in the 12-21 age group

Please work on scheduling those physical exams this summer and during the end of year holidays, especially the high school and college kids.  These measures are based on the calendar year, not on a 365 day calendar.  The physicals do not need to be 365 +1 days apart to be covered by insurance. The patient lists for the Well Child Visit measures that we provide to your practice are formulated on a calendar year basis so your staff can schedule these appointments whenever it’s convenient for your patients.

PCPs will receive their first individual score cards and patient lists for 2018 this month.  Most gate scores are quite low at this point in the year, but there is still plenty of time for improvement.  The most important action office managers and staff can take is to make sure that patients on the lists with chronic conditions such as diabetes and hypertension have follow-up appointments with a provider.  Physicians, NPs and PAs: please order any labs that are due and/or adjust medications or make referrals to specialists if warranted.

Should you have any questions regarding any of the patient lists or scorecards you receive please contact a member of the Quality Data team.  We are here to help!

Jennifer Andersen, Quality Data Analyst 978-236-1747   or jennifer.s.andersen@lahey.org
Laureen Viel, Quality Data Entry Specialist 978-236-1746  or laureen.viel@lahey.org

PAYOR UPDATES

BCBS – CPT and HCPCS Modifier Updates
Effective June 30, 2018, BCBSMA has updated their payment policy related to CPT and HCPCS modifiers as follows: addition of modifiers JG, JW, and TB; addition of billing guidelines for modifiers 25 and 59; edits for clarify on modifiers 80, 81, 82, and AS.

Click here to view the complete policy.

BCBS – Immunizations
Effective June 30, 2018, BCBSMA has updated their immunization payment policy as follows: inclusion of CPT 90750 and age range, 90620 and 90621; therapeutic injection code range and other vaccines; vaccine administration codes not payable with E/Ms; coding examples and BCBS vaccine compliance position.

Click here to view the complete policy.

Tufts Health Public Plans – Claims Submitted with Supporting Documentations
Effective July 1, 2018, Tufts Health Public Plans (THPP) has clarified the process for submitting supporting documentation for claims being reviewed under Individual Consideration (IC), Coordination of Benefits (COB)/Third Party Liability(TPL) and Durable Medical Equipment (DME)/Medical Supplies.  IC is a designation for codes where neither MassHealth nor Tufts Health Plan have established a specific compensation rate.

Click here to view the complete policy related to IC claims.
Click here to view the complete policy related to COB/TPL claims.
Click here to view the complete policy related to DME/Medical Supplies claims.

United SCO
Although NEPHO does not hold a contract with United Health Plan, we wanted to remind all NMP and LPCO PCP practices that the NMP and LPCO United SCO contracts were terminated effective November 2017.  Again, this applies to PCPs only and only for the SCO product.  Your SCO patients still have the choice of TMP or CCA.  For NEPHO private practices, you hold a direct contract with United and should follow the terms of that contract.  An additional note for the PCPs who are exclusive with TMP, please be sure you are not participating in the United Medicare Advantage HMO product (or the Medicare Advantage HMO product of any other payer, for that matter).

BMC HealthNet Plan announces PCPs: Community Partners Program (Click here to read article)
On July 1, 2018, MassHealth will launch the Community Partners Program. This initiative will impact providers in accountable care organizations (ACO) and managed care organizations (MCO), as well as members with significant behavioral health and Long Term Services and Supports (LTSS) needs across Massachusetts.

How does this affect PCP practices?

Beginning in July, your practice may begin receiving calls from Community Partner care coordinators who want to speak with you about one of your patients. You’ll work with the Community Partner as a member of your patient’s care team and help develop the person-centered care plan. The care coordinator can help you enhance your patient’s treatment experience by:

• Increasing awareness of your patient’s medical and functional needs
• Helping to connect you to your patient’s other health care providers
• Helping your patient carry out goals of your patient’s care plan
• Helping your patient better understand his or her care instructions

Each PCP practice must identify a care team point of contact responsible for communicating updates regarding the member’s care to the Community Partners. In addition, each PCP practice must sign off on behavioral health or LTSS care plans. The required signatures must come from a PCP or PCP designee such as an RN or other licensed medical professional, or a covering MD, nurse practitioner, physician assistant or doctor DO.

As is current practice, the patient’s PCP makes referrals to medically necessary specialty care for which the ACO, MCO or MassHealth requires referrals. Conducting medication reconciliation is part of patient care transitions.

To learn more, go to the Providers section at BMCHP.org to access a Community Partners Program overview.  Or you may call Provider Services at 888-566-0008.

PRACTICE INCENTIVES

PATIENT EXPERIENCE COMMENTS

BEACON FAMILY MEDICINE

• Doctors and nurses at this practice are caring thorough and professional.  “Ditto the clerical staff.”
  Love this practice!
• Dr. Aimee Hromadka is always great! Very caring and understanding.

CAPE ANN MEDICAL CENTER

• I have always been treated with courtesy, professionalism and helpfulness for the past decades. That includes the specialists.
• I have a very good relationship with my doctor, Dr. Shawn Pawson who is very good at listening, he cares, and I never had a doctor like him.

DANVERS FAMILY DOCTORS PC

• Great team at Danvers Family Doctors – always able to see a provider when needed!

LAHEY HEALTH PRIMARY CARE, BEVERLY – 900 Cummings Center – Ste. 111W

• Dr. Emily Chin is very compassionate and her staff is very sweet and caring.

LAHEY HEALTH PRIMARY CARE, BEVERLY – 100 Cummings Center – Ste. 126Q

• Dr. Elsie Diaz-Schroeder is an EXCELLENT provider. I am a huge fan of hers.  She’s very professional and caring.  I will definitely recommend her to others.  Very helpful.
• I feel very fortunate to have Tracey Johnson, NP as my care provider – she is extremely competent, caring and thorough!
• I can’t say enough positive things about Leah Rubin, NP and all of the office help. I appreciate them all.

LAHEY HEALTH PRIMARY CARE,  DANVERS – 480 Maple Street – Ste. 204

• Dr. Kristina Jackson consistently provides professional care for our entire family.
• I have already recommended Dr. Galina Feldman to my family and friends.

LAHEY HEALTH PRIMARY CARE,  DANVERS – 5 Federal Street

• Dr. Margaret Legner and staff were very professional, great service. A+!!

LAHEY HEALTH PRIMARY CARE,  DANVERS – 140 Commonwealth Ave. – Ste. 104

• I have already recommended this practice to others. Very well run and is fantastic!

LAHEY HEALTH PRIMARY CARE, GLOUCESTER – 298 Washington Street – 4^th floor

• Dr. Victor Carabba is very thorough. I trust him.  He is calm, straight forward and he shows genuine concern.

LAHEY HEALTH PRIMARY CARE, GLOUCESTER – 298 Washington  Street – 1^st. floor

• I love Dr. Amy Esdale! She thoroughly listens and my whole family sees her.

LEONARD HOROWITZ, M.D.

• I always feel Dr. Leonard Horowitz carefully listens and considers my concerns and works with me. His suggestions and advice have been helpful and are appreciated.

NORTH SHORE PEDIATRICS

• Dr. Shannon Dufresne goes out of her way to provide the best care for my son and answers all of my questions.

NORTH SHORE PREVENTIVE HC, P.C.

Dr. Roy Ruff and his staff provide me with the best care possible.

PATTON PARK MEDICAL CENTER

• My experience is always positive with questions, and concerns I am always impressed with Dr. Michael Edwards. He is the BEST!!    I have the highest respect and regard for him.

SPENCER R. AMESBURY, M.D.

• I always leave this care provider’s office armed with knowledge and an action plan for improving my health.