News from NEPHO – DECEMBER 2021 Edition

SAVE THE DATE

PAYOR UPDATES

PROVIDER RELATIONS

Things are constantly changing within NEPHO practices – it truly is inevitable. As a reminder, please reach out to the Provider Relations Department periodically to request updates or assistance in creating provider lists. Examples of frequent outreach we receive include and are not limited to:

• Primary Care Providers with open panels for patients transitioning out of Pediatric care.
• Primary Care Providers with open panels for Special Needs patients transitioning out of Pediatric care.
• NEPHO PCP practice rosters used to update EMR mapping tied to billing/ referral network identification.

Please do not hesitate to reach out to Alycia Messelaar at Alycia.Messelaar@Lahey.org for such requests. We are here to help bring ease to both the practices and the patients you serve.

PROVIDER DIRECTORY

Click here for the PDF version of the updated PHO Directory as of December 2021. For your convenience, click here for the separate Specialists Only PDF directory to refer to as needed.

Please share this directory with your office by printing or showing them how to visit us online for an easy to use directory search tool!

Note: Primary care providers (PCPs) in the BILH Performance Network no longer need to submit an administrative referral to refer Blue Cross Blue Shield of MA, Harvard Pilgrim Health Care, or Tufts Health Plan members to a specialist in the BILH Performance Network. Please reach out to Alycia Messelaar at Alycia.Messelaar@Lahey.org, regarding questions pertaining to providers within the BILHPN Network. 

As a reminder, it is important to use the NEPHO Physician Directory when referring to a specialty physician. 

PODS AND IPA MEETINGS KEY TAKEAWAYS

Informational

• LMI has hired a full time dietician. Appointments needed within 48 hours can be made by contacting Pat Ferreira at Patricia.A.Ferreira@Lahey.org.
• Nutrition and Diabetes Counseling services are also offered in Peabody and Burlington, booking in December. Medical weight loss is booking into end of February.
• New England Baptist Orthopedics Program criteria for elective surgery was shared. Please refer to the meeting packet for details and a copy of the pre-procedure letter that is being sent out listing the criteria.

Follow-up November PODs

• Non-nutritive sweeteners are not shown to help with body weight or glycemic control in patients with diabetes (limited high quality data on this topic).
• Obesity coding (GO447) can be utilized for obesity counseling given for at least 8 minutes.

Efficiency

• Results of a BILHPN pharmacy initiative to improve evidence based prescribing in patients with diabetes show improvement with NEPHO patients.
• Threshold is set at 39.7% for 2022, based on improvement seen across the performance network (FY2022 baseline is 37.7%).

Quality

• Compliance with screening mammograms scheduled through the concierge program is around 80% through November.
• Patients with outstanding Cologuard tests were sent reminder letters to complete the tests. Phone outreach is planned for those who have unread MyLaheyChart messages, and for patients with soon to expire orders/kits.
• Updated commercial quality data (claims processed through August) was shared for BCBS HMO, PPO, HPHC, and Tufts. Final DM Composite data for 2021 Performance Period was shared. Please refer to the meeting packet for details.

Population Health

• Case based questions for Medication Over Prescribing were shared, along with reference sheets for common medication classes to consider deprescribing (and methods specific to those classes).
• To minimize medication overload:
  • Inventory all prescription and OTC medications taken by the patient.
  • Ask about patient values, preferences and goals.
  • Create a plan of action for deprescribing.
  • Communicate the plan to other prescribers, the patient and family.

QUALITY

The NEPHO Quality team has been following up with patients with high blood pressure readings that were documented at recent outpatient visits. Patients were grateful for the outreach; here are some of their comments:

“I’m so glad you called me. My blood pressure was so high at my last appointment and I have been worrying about it ever since. I really appreciate the outreach.” 

“Oh that’s how you are supposed to take a home blood pressure?! I haven’t been doing it right!” (BP at goal after following how to obtain accurate BP directions). 

“Thanks for checking in on me, I appreciate the call.” 

Please continue to take and record a 2^nd BP when the 1^st reading is >139/>89. When adding a 2^nd blood pressure in EPIC, it is important to change the date/time to reflect when the BP was actually taken. See the steps below to update date/time on 1^st and subsequent BP readings in EPIC.

 Steps: 

1. Open Vitals
2. Change ”taken on:” click calendar icon (select date), click clock icon (select time)
3. Insert BP

**When adding a 2nd BP: 

1. Click + New– located above VS fields
2. Change ”Taken on”: change time of second BP
3. Insert BP

Please also continue to enter BPs obtained during a telephone or virtual encounter. Use Ctrl+Shift+V to open the vitals flowsheet in EPIC.

Thank you to everyone who has collaborated with us over the past year on quality initiatives. We are aware of the many challenges that practices have faced and continue to face every day and are grateful for the work that you do.

We wish you all a Happy and Healthy New Year! 

CODING TIP OF THE MONTH

OPTUM Newsletter – December 2021 | Focus on Chronic obstructive pulmonary disease (COPD)

Coding Tip of the Month December

• Hierarchical condition categories (HCCs) Coding Capture: All chronic conditions captured in 2021 will reset as of January 1, 2022.
  • Chronic conditions should be coded and captured on an ongoing basis to support quality patient care.
    • Example: A patient with Diastolic congestive heart failure and hypertension should be coded as follows annually: Chronic CHF: I50.32 and hypertension with CHF: I11.0.
  • Treatment and care for the condition needs to be supported by documentation and diagnosis capture.
    • Example: Mr. Jones is taking lisinopril and following up with Cardiology to manage his CHF I150.32.
  • All diagnoses that receive care and management during a patient encounter should be captured.
    • Example: Mr. Jones depression has been stable taking Celexa and seeing his counselor monthly. Recurrent depression would be coded as patient still on medication treatment: F33.81.
  • Conditions that are no longer active and/or not being treated should not be captured/reported. This should include problem list diagnoses that have be resolved.
    • Example: Mr. Jones Type II diabetes has resolved as he has been following a low salt diet and exercise routine. Diabetes Type II E11.9 should be updated on the problem list as “resolved” as it is no longer an active problem.
  • Capture “history of” and “status” of conditions when there is an impact on patient current care or treatment.
    • Example: Mr. Jones has history of prostate cancer. He has been cancer free for 12 years. History of prostate cancer will be captured as: Z85.46.
  • Diagnoses captured need to be supported by documentation. A diagnosis does not have to be in the assessment portion of the note. Providing a status update is sufficient to capture the diagnosis.
    • Example: Mr. Jones Type I diabetes is stable and is managed by Endocrinology. Type I diabetes E10.9 can be coded as documentation supports diagnosis capture.
• NEPHO 2021 Risk Adjustment Workflow Most Improved Awards – NEPHO will be announcing the 3 most improved NEPHO providers in 2021 in the upcoming coming January 2022 newsletter. Areas of improvement include the following: Risk Adjustment coding workflow, Risk Adjustment coding capture, Diabetes with complication coding capture, Depression/Substance Abuse coding capture, Coding to the highest specificity, Daily pre-visit planning improvement. We are excited in recognizing our providers who worked to make adjustment in their daily workflow to improve Risk Adjustment coding capture in 2021.
• No Surprise Billing Act: Effective January 1, 2022
  • Protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network facilities.
  • Holds patients liable only for their in-network cost-sharing amounts, and requires that the patient’s share cannot exceed in-network rates without patient consent.
  • Provides guidance for how providers and insurers can negotiate fair reimbursement for out-of-network services.
  • Includes the requirements that providers submit Good Faith Estimates to payers and that payers utilize those estimates to create and provide Advance Explanation of Benefits to members.
  • Providers can do the following to meet regulatory requirements:
    • Give patients clear and accurate estimates of authorized services before, or at, the point-of-service, so they feel more in control of their financial obligations.
    • Working with payers rather than patients for payment will be a new practice for providers.
    • The rule will require all providers to reach out to patients prior to a scheduled appointment to solicit the patient’s insurance information and then issue a “Good Faith Estimate” to the patient’s insurance plan. The estimate should include the following:
      • A description of services to be provided, whether the provider is in or out of network.
      • The contracted rate for services (if the provider is in network).
      • A description of how to access in network care (if the provider is out of network).
      • The provider’s estimate of charges and the patient’s responsibility total.
      • The patient’s status regarding deductible and out-of-pocket maximum.
    • Included in the documents released by CMS is a template for providers and healthcare facilities to use to deliver good faith estimates under the No Surprises Act. CMS says one of the documents (CMS-10791 – 11. 2. Good Faith Estimate Template) that providers can “fill in the blanks” with their own information and HHS will consider the use of the template to be in compliance with the No Surprises Act.
    • Click here for more information.

  NEPHO will be providing updated information in these two areas as we move forward into 2022. There will be Coding and Billing Webinars scheduled in mid-January 2022 to help provide guidance and answer questions related to Risk Adjustment Coding and the Surprise Billing Act. Please reach out to Shawn Bromley at Shawn.M.Bromley@Lahey.org if you have questions or would like to have additional education provided to your practice and/or providers.

PATIENT EXPERIENCE COMMENTS

PRACTICE RECOGNITION

Please let us know if you would like to nominate a team member in your practice or another practice for the recognition program. We will deliver gift cards to the winners each month, and they will be announced here and in our website “Hot Topics” section.

Please be sure to look for the new winners in next month’s issue!