Current Newsletter October

NEPHO NEWS October 2018 Edition
October Newsletter – click here to print
OPTUM Insider Newsletter: October Focus – Breast Cancer Awareness

PHYSICIAN and PRACTICE CHANGES/UPDATES

New Physicians

• Harish Raja, MD has joined Microsurgical Eye Consultants 31 Centennial Drive Peabody, MA 01960
  978-531-4400  (F) 978-531-7106
• Eric Sterne, MD has joined Sports Medicine North 1 Orthopedics Drive Peabody, MA 01960
  978-818-6350  F) 978-818-6355
• Timothy Woodward, MD has joined Beverly Anesthesia Associates 480 Maple Street Suite C233 A Danvers, MA 01923
  978-304-8690 (F) 978-304-8697

Physician/Practice Changes

• George Kacoyanis, MD and Joan Tryzelaar, MD will be opening a Wound Clinic  on January 4, 2019 located at
  Addison Gilbert Hospital 298 Washington Street, 4^th Floor Gloucester, MA 01930
• Carol Martini, MD of Maura McGrane, M.D. has retired effective 9/1/2018
• Mahesh Patel, MD of Premier Plastic Surgery has announced his retirement effective 12/31/2018
• Andrew Lenhardt, MD of Lahey Health Primary Care, Beverly – 900 Cummings has closed his patient panel to accepting existing patients only
• Andrew Schwartzman, MD of Northeast Medical Practice has terminated his affiliation with the Northeast PHO
• Beverly Speech and Audiology has moved from Beverly Hospital 85 Herrick Street Beverly, MA 01915 to a new
  office space in the Parkhurst Building located at 75 Herrick Street Suite 201 Beverly, MA 01915

SAVE THE DATE

NP PA Meeting
Date: November 14, 2018 @12:00 p.m.
Place: 500 Cummings Center, Suite 6500
Good Harbor Room
Beverly, MA  01915
RSVP: Judith O’Leary at Judith.O’Leary@Lahey.org  or 978-236-1739

MD Orientation
Date:  November 29, 2018 @5:30 P.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

OPEN MEETING II SUMMARY

President’s Report

2019 Contract Rate Updates

• Ezzi reviewed the rate increases and changes in contract terms for 2019

Affiliation Update 

• Dr. Ezzi provided an update on the future merger with Beth Israel and the approval process

Physician Membership and Patient Membership Updates 

• Dr. Ezzi reviewed the physician membership within the NEPHO
  The breakdown includes:
• 62 PCPs and 252 specialists, with 45% of PCPs employed and 24% of specialists employed
• As of September 2018 there are 314 providers within the NEPHO
• The NEPHO patient membership has increased by 4%, largely driven by the growth in
  the MassHealth and Connector plans

Quality Score and Financial Performance Update

•  Dr. Ezzi discussed the current Commercial performance for 2017 and Q1 2018

Lahey Medicare ACO Update

• 2017: Lahey ACO generated a surplus for CY 2017
• 2018: Lahey ACO must report on Merit Based Incentive Payment Program-Alternative Payment Method
  (MIPS-APM) measures to avoid a negative payment adjustment in 2020
• 2019: The proposed revisions to the ACO model were reviewed. Lahey will make the decision about
  participation in a new model once the final rule is published

Pharmacy Report 

• Carol Freedman, NEPHO Clinical Pharmacist, provided an overview of pharmacy expense trends

Some highlights of her presentation include:

• The State’s Pharmacy expenses have increased by 5% as compared to 1.6% for all health care expenses
• NEPHO’s Q1 2018 expenses are lower than Q1 2017 by 1.3% as the result of several cost saving initiatives
• A new Drug Search Application (MMIT Formulary) can help providers find alternative/lower cost medications
• Improving medication adherence will result in better outcomes: encourage patients to shop around for
  pharmacy pricing; use coupons; pay cash; consider smart app medication reminders; recommend medication
  home delivery services

Risk Adjustment

Alison Gustafson, FNP NEPHO, provided a presentation outlining the description and importance of
Risk Adjustment Coding:

• The Risk Adjustment Factor (RAF) builds the budget for risk contracts
• A small increase in the risk score can lead to a large increase in reimbursement
• NEPHO is focusing on proper coding for Morbid Obesity

IPA / POD MEETING SUMMARIES 

• Efficiency: 2017 Medicare ACO 
• Dr. Di Lillo, PHO Medical Director, reviewed the 2017 Medicare ACO performance results
• LCP- ACO generated a surplus, which also includes a 50% share with Medicare
• The quality score declined significantly, 81% compared to 90% in 2016 this was driven by
  significant increases and unplanned admissions for Diabetes, Heart Failure and Multiple Chronic Conditions
• Ongoing efforts and new programs for upcoming performance years was discussed

Quality – Year End Push 

• Liz Isaac, Director of Quality and Performance Improvement reviewed the current scorecard and year end “push” efforts and focus
• Updated Well Visits patient lists, integration report, and provider scorecards were distributed at October pods and will continue to be distributed through year end

Patient Experience – 2018 MHQP Preliminary Results

• Liz Isaac reviewed the results of the statewide Adult and Pedi Surveys administered this spring by MA Health Quality Partners (MHQP)
• Adult providers improved in all 4 domains compared to 2017, with Access domain above the max score
• Adult providers earned 61% of available points, up from 26% last year
• There was notable improvement in the Knowledge of Patient domain as the score exceeded the minimum threshold and is comparable to state mean for 2018
• Pediatric providers scored above max for Communication and Access domains and experienced declines in Knowledge of Patient and Integration of Care domains
  • 76% of the available points were earned compared to 90% last year
  • A drilldown of areas of opportunity by practice will be done

Reporting

• POD Attendance record through September was shared
• The Q2 PCP Risk Share Report Card by specialty was shared

WELCOME NEW NEPHO COLLEAGUES

NEPHO is pleased to announce that Shawn Maria Bromley has joined our team as the Director of Contracting and Operations. Shawn has comprehensive experience in various roles in health care reimbursement and coding. She was most recently employed at Commonwealth Care Alliance and North Shore Medical Center where she was involved in billing and coding functions. Shawn will be responsible for the management of day to day operations of the PHO.

We are happy to announce that Jessica Bryan has joined the Northeast PHO as a Referral and Authorization Lead.  Jessica comes to us from Family Medicine Associates in Manchester where she was a Patient Care Coordinator for this practice. As the Patient Care Coordinator, she verified health plan insurance and benefits, provided front desk support and processed referrals.

We are excited to have Shawn and Jessica as our newest team members.  Please join us in offering them a warm welcome!

NEPHO COLLEAGUES RECEIVE SERVICE AWARDS 

The Beverly and Addison Gilbert Hospital Service Award Ceremony was held recently at the Danvers Port Yacht Club.

The following NEPHO colleagues who were recognized for years of service:

CODING TIP OF THE MONTH

2018 CUSTOMER SERVICE SURVEY RAFFLE WINNERS – $50.00 Giftcards

NEPHO is pleased to send gift cards to the following physicians:

Tina Waugh, MD — Lahey Health Primary Care, Beverly 30 Tozer Rd., Ste. 202 and
Daniel McCullough, MD — Lahey Health Primary Care, Beverly 900 Cummings Center, Ste. 111U

Thank you for participating in our survey and happy shopping!

PHARMACY UPDATES

Quality Measure: Acute Bronchitis: Increasing the Denominator and Treatment Options

“Winter is coming” as is peak season for Acute Bronchitis (AB) illnesses!  As you know low denominators for this quality measure have correlated to low performance in the past.  In reviewing YTD August data, we have noticed a 29% decline in the patient population denominator for NEPHO compared to the same time period in 2017.

Here are some thoughts on increasing patient satisfaction when no antibiotic (abx) is prescribed for AB and for improving the results of this measure before year end:

• Do code for Acute Bronchitis, J20.9, as appropriate (will increase the denominator)
• Coding for cough (R05) will trigger J20.9 Acute Bronchitis coding and event will be included in measure;
  (cough = no acute bronchitis diagnois)
• If an antibiotic is needed:use these alternative codes:
  • Use (J22) Chest Cold; Lower Respiratory Infection; Acute Respiratory Infection OR Mycoplasma Pneumonia (J15.7)
• Do offer treatment for AB if appropriate (on OTC script pads)
  • Patient with cough: dextromethorphan, guaifenesin, and/or smoking cessation
  • Wheezing patient: albuterol if appropriate
  • Patient with other cold symptoms: acetaminophen, NSAIDS, cromolyn sodium, antihistamine/decongestant combinations etc
• Do have a conversation about the why to reduce patient expectation for an antibiotic:
  • Viral (>90% of cases) and usually self-limited, not bacterial, so antibiotics don’t work
• Do offer a contingency plan if symptoms worsen

Bottom Line:  AB and/or cough = no abx; Use OTC Script Pad for alternative treatment options!

Contact Carol Freedman 978 236 1774 or carol.freedman@lahey.org for more information or
if OTC Script Pads needed.

QUALITY

Quality Focus for November: Well Child Visits

• Scheduling well child visits during December can be challenging as both patients and providers are often unavailable
  due to the holidays
• November is a better month to focus on this important measure.  Most students do not have school on Veteran’s Day (Monday, November 12th)
  and many college students have the whole week of Thanksgiving
  off from school.  At this time of the year a phone call from the practice, rather than a reminder letter is a more effective way to contact patients who are overdue for their annual well visit.
• For patients who no show or cancel, please call as soon as possible to reschedule
• The PHO well child lists are BCBS patients who need to be seen in 2018. January appointments will not count towards
  this year’s performance
• All BCBS well child visits are calendar year and can be scheduled any time in 2018

BPA Reports

Each month NEPHO sends Best Practice Advisory (BPA) reports to practices on EPIC.  These reports track every instance where a BPA was initiated within the rooming sequence and the rate of completion.   These reports should be reviewed for trends and to identify potential workflow issues.  There are five BPA’s that this report tracks:

1. BMI Screening (Height/Weight)
2. Depression Screening (PHQ-9)
3. Falls Risk Screening
4. Tobacco Screening
5. Hypertension (>140/90)

The report that is shared with the respective administrators shows when a BPA “fired” as well as a date field for that measure.  If there is no date in this field, the measure was not attested to at the visit.  The report also lists the user (typically a medical assistant) as well as payor.  Knowing which user is missing these opportunities during the visit allows us to follow up with more support and training.

Click link for the BPAs inAmbulatory Clinics Tip Sheet

PAYOR UPDATES

Blue Cross Blue Shield of Massachusetts (BCBSMA)

The BCBS base fee schedule was updated as of 9/1/2018. The fee schedule for your specialty is available on the Northeast PHO website: https://www.nepho.org. Once you log in to the website, you can go to Provider Information and Fee Schedules. If you have any questions, please contact Alycia Messelaar at Alycia.Messelaar@lahey.org or 978-236-1784

BCBSMA Claim Updates
Rheumatiod Arthritis  (MO5-Rheumatoid Arthritis with rheumatoid factor)
When assessing for osteoarthritis and rheumatoid arthritis (RA), do not use a “rule-out diagnosis code” until the diagnosis is confirmed. Code the patient’s symptoms (for example, pain in joints M25.50) until the diagnosis is confirmed. Never code “suspected” conditions in the outpatient setting. Instead, base coding on the documented signs and symptoms or the current condition. Rheumatoid arthritis generally is confirmed by an x-ray of the affected joint and lab work to determine the presence of RA factor. To view the complete notification, click here.  on the link below.

PROVIDER RELATIONS

All of the following need to be communicated
to the PHO in advance of effective date:

• New providers (including Nurse Practitioners and Physician Assistants)
• Terming providers
• Changes in a provider’s work schedule and/or practice sites
• Changes in whether the provider is/is not accepting new patients
• Practice site changes (e.g. moving to new location, practice name change)
• Coverage group changes
• Office manager change
• Email address changes for providers and office manager
• Change in billing TIN/Group NPI/Primary Affiliation
• Change in EMR

Please note, the typical effective date timing and expectations are as follows:

• Enrollment for providers new to payor – up to 90 days from submission date
• Demographic changes – between 30-90 days from submission date

If you would like to communicate practice changes, please contact Alycia Messelaar at Alycia.Messelaar@Lahey.org
or 978-236-1784.

PRACTICE  RECOGNITION

We appreciate their efforts in supporting the PHO goal to provide high quality, community health care.
We will deliver gift cards to the winners each month, and they will be announced in the newsletter
and posted on our website.  Be sure to look for the new winners in next month’s issue!

REFERRAL MANAGEMENT

When requesting a referral . . . please allow at least 48 hours for the NEPHO Referral Team to process your request.  We receive a large volume of requests per day and requests are processed in the order in which they are received.  As always, if you have an urgent request and need assistance immediately contact your referral coordinator.  The Referral Team is here to help you and your patients.

PATIENT EXPERIENCE COMMENTS

Spencer Amesbury, MD

• Dr. Spencer Amesbury “I feel very grateful to have a doctor who is respectful, caring and sensitive in addition so competent.  Feel very confident in Spencer Amesbury”

Danvers Family Doctors 

• Dr. Subroto Bhattacharya and his staff ARE THE VERY BEST!!!  The office is very clean.  The magazines are current!”

Garden City Pediatrics

• “My sons sees Dr.John Dean .  He is amazing.  I drive 30+ minutes for visits because I like him as a doctor so much!”
• Dr. Elizabeth Humphreys “We feel SO LUCKY to have such amazing care for our children at Garden City!”
• Dr. Jacob Kriteman “Simply could not be more pleased or grateful with the care provided by Dr. Kriteman.  He is excellent – kind and compassionate.  Highly recommend!!”

North Shore Pediatrics

• “We love Dr. Shannon Dufresne and everyone at North Shore Pediatrics.  We’ve had a great experience each visit.  Thank you!!”

Beacon Family Medicine

• Dr. Aimee Hromadka “Beacon Family Medicine is a top quality office and THE BEST doctor and office personnel I have ever had.”

Thomas Pearce, MD

• Dr. Thomas Pearce and his staff are the best – they are caring and all work together for the patient.  He is #1 in this area!”
  “I am pleased that Dr. Pearce always explains things clearly and listens to any questions or concerns I may have.”

Thompson Medical Associates

• “Always the best care with Dr. Candace Thompson!”