NEW PRIMARY CARE PROVIDER
- Eve Amendola, NP of Beth Israel Lahey Health Primary Care Family Medicine Associates, South Hamilton 15 Railroad Ave South Hamilton, MA 01982 Phone: 978-468-7381 Fax: 978-468-6020
- Phone and fax number correction from November newsletter: Effective 1/1/2024, Bruce Smith, MD will be practicing under the name Willow Street Medical 42 Asbury Street South Hamilton, MA 01982 Phone: 978-380-8239 Fax: 978-468-7067
- Gail Ellis, MD of Beth Israel Lahey Health Primary Care, Beverly 30 Tozer Road Beverly, MA 01915 will be terming effective 3/1/2024
- Mark Lewis, MD of Northeast Dermatology Associates will be terming effective 2/1/2024
- Anthony Lomonaco, DO will be opening a private practice in early 2024, Interventional Pain Specialists of Massachusetts 900 Cummings Center, Suite 221 U Beverly, MA Phone: 351-400-6272 Fax: 351- 354-0070
NEWS FROM NEPHO
DECEMBER 2023 EDITION
IN THIS ISSUE:
A MESSAGE FROM PIERRE EZZI, MD – NEPHO AND NECOMG PRESIDENT
As NEPHO and NECoMG merge with LCPN on January 1st 2024, it’s fairly accurate to say that emotions are running high. To me it is best described as mixed feelings. I have felt a sense of sadness, a sense of despair and a sense of anguish. But at the same time, I felt a sense of pride, a sense of confidence and most of all a sense of accomplishment.
NEPHO has been through numerous challenges and changes. Through the decades we’ve been through 2 major system mergers, Lahey Health in 2012, and BILH in 2018. As you can imagine, enough challenges to disrupt the performance of any strong and successful organization. However, through all these hurdles and obstacles, NEPHO has maintained its steadfast outstanding performance.
From the very beginning, and through the years, as the healthcare landscape changed and continues to reshape, NEPHO has transformed and congruously evolved. We quickly adopted the managed care concept, embraced the value care and handled capitation better than any other organization in the field.
Besides executing good contracts and performing well in the value care environment, NEPHO has provided continuous support to all our physicians, employed and private practices alike, and always made sure that all practice’s needs were met.
In January 2024 things will change, but going forward, I can assure you what will not change is our mission and our culture. After so many years of great success and outstanding performance, it’s extremely hard for any organization to close its doors and call it quits. However, as we turn the page to a new chapter, our work might look and feel different, but our goals will remain the same, committing to NEPHO mission and culture. We are committed to foster the same mission, the same culture and to some extend the same performance that we’ve come to witness from NEPHO.
“Change your opinions, but keep to your principles; change your leaves, keep intact your roots.” — Victor Hugo
As I reflect on our accomplishments, what stands out most to me is the incredible impact that our physicians and staff had, and how they made a huge difference in the NEPHO performance. I cannot thank you enough for your unwavering commitments to our patients, to NEPHO and to each other. I hope that you are enjoying the holidays and are able to spend a meaningful time with your loved ones.
BCBS/SHIELDS HEALTH UPDATE
In follow up to the BCBS/Shields Health notice in the last newsletter, we have an update:
We are pleased to inform you that Shields Health and BCBSMA have successfully reached an agreement on a new, three-year contract.
This means that Shields Health will remain in network for BCBSMA. As a result, BCBSMA members can continue to access health services within the Shields network without interruption.
NEPHO EARNS HPHC HONOR ROLL
HPHC’s January 2024 announcements include the Honor Roll list. NEPHO was named to the 2024 Honor Roll based on the 2022 performance. Congratulations to the NEPHO Quality Team!
Click here for more information.
UPCOMING CME OPPORTUNITIES
Dr. Eric Grover, North Shore Neurology will be presenting about EEG’s and Epilepsy on Monday, January 8. Click here to view, download and print the flyer.
Drs. Seymour and Jiang of Harvard Dental School will be hosting and engaging in discussions regarding “Viral Information and Our Patients: Taking the “mis” out of Misinformation.” Click here to view, download and print the flyer.
TUFTS SCO ANNUAL MODEL OF CARE TRAINING
As part of your Tufts SCO contract participation, the completion of an Annual Model of Care Training is required by all providers. You may have already received a memo directly from TMP/SCP directly regarding this ask. If you have not received this memo yet, you should be expecting it within the next few weeks.
Please take a moment to review the following presentation:
The last slide has a link to confirm you have viewed the 19-page slide deck. Without completing the 5-question survey, you will not receive credit for the training.
CAN MY BABY FLY?
Dr. Brian Orr has written a story for stage over the past 2 years. He is working with Gloucester Stage to put it on. The dates are Saturday and Sunday, January 6 and 7, 2024. It is a heartfelt series of stories about Pediatrics and Primary Care.
Please click here to view, download and print a brochure.
BEVERLY HOSPITAL HERNIA CENTER
Leading-Edge Technology for Hernia Repair
The Beverly Hospital Hernia Center is a comprehensive center that offers the full range of hernia care services including surgical care, wound care, physician therapy, diagnostic imaging, pain management and nutrition services. Our board certified surgeons specialize in minimally invasive techniques to hernia repair that use small incisions and result in a quicker recover time, less pain and a smaller scar.
Symptoms of a hernia can include:
- visible bulge
- pain or discomfort
- a feeling of weakness or pressure
- burning or aching sensation in the affected area
We manage the following types of hernias:
- Paraesophageal/Hiatal hernia/Reflux
The surgeons at Beverly Hospital use robotic-assisted techniques to perform hernia surgeries.
Robotic-assisted surgery offers many benefits, including:
- Smaller incisions: The robot camera provides a full, detailed view of the surgical site without the need for a large incision. The surgical instruments are also designed to be used through narrow incisions. That means less discomfort after surgery and smaller scars later on.
- Less tissue damage and bleeding: Smaller instruments and greater precision mean less muscle and connective tissue is damaged during the surgery, and bleeding is also reduced.
- Fewer complications: A recent study found patients undergoing robotic surgery for inguinal hernia repair had fewer complications compared to patients who had open (larger incision) surgery for the same type of repair.
- Faster healing: Less tissue damage and smaller incisions also lead to faster healing times, along with decreased swelling and bruising for a more comfortable postoperative experience overall.
- Quicker return to your routine: Finally, faster healing and less bruising and swelling mean you can get back to your regular routines faster.
Our care team is dedicated to supporting patients with hernias and offering individualized care from their very first visit through treatment and recovery.
Beverly Hospital Hernia Center Hernia Team:
- Meaghan Collins MD
- Peter Gill MD, FACS
- Reuben Shin MD, FACS
Addison Gilbert Hospital
4th floor Specialty Clinic
298 Washington Street
Gloucester, MA 01930
BILH Care Center Danvers
Danvers Medical Specialties
480 Maple Street
Danvers, MA 01923
Appointments may be scheduled by calling 978-712-1570 or EPIC REF27 General Surgery.
BILH LAUNCHES HOSPITAL AT HOME PROGRAM IN BILH HOSPITALS
BILH recently launched an innovative new program – Hospital at Home, in alignment with our commitment to providing extraordinary care in the communities where our patients live.
The BILH Hospital at Home care team – which includes physicians, advanced practice providers, registered nurses and other health care professionals – treats and monitors patients requiring inpatient care using both telemedicine and technology support, as well as in-home visits at least twice each day.
Lahey Hospital & Medical Center (LHMC) was the first hospital to launch the BILH program in August and has seen great success. To date, the Hospital at Home program has served more than 100 LHMC patients, providing safe care with no adverse events.
On November 1, the program launched at Beverly and Addison Gilbert Hospitals. Over the next two years, BILH plans to introduce the program in all of its hospitals.
Patients cared for by the Hospital at Home team, along with their family and friends, have been thankful to have this care option.
Learn more about the Hospital at Home program at LHMC.
Learn more about the Hospital at Home program at Beverly and Addison Gilbert Hospitals.
Please subscribe to the health plan newsletters and updates to receive timely updates from the health plans.
Blue Cross Blue Shield
Changes to the Federal Employee Program Plans for 2024
Beginning January 1, 2024, BCBSMA will make changes to the Federal Employee Program (FEP) plans. These plans are offered to federal and postal employees and their families in Massachusetts. Because of these changes, it is important to always check the patient’s Blue Cross ID card and to verify their eligibility and benefits. To view the complete notification, click here.
Changes to Products and Benefits for 2024
Beginning January 1, 2024, BCBSMA will make changes to health plans and benefits. Because of these changes, it is important to always check patient’s Blue Cross ID card and to verify their eligibility and benefits. To view the complete notification, click here.
Medical Policy Announcements
This document announces new medical policy changes that take effect March 1, 2024. To view the list, click here.
The Claims for Vitamin D Testing
Starting on January 1, 2024, BCBSMA will add frequency claim edits to reinforce the existing policy. This will help BCBSMA processes the claims upfront, reducing the number of claims that need post-payment review. To view the complete notification, click here.
New Specialty Pharmacy will Join the Network in January 2024
AllianceRx Walgreens Pharmacy will join the retail specialty pharmacy network as of January 1, 2024. Members are required to fill specialty medications through an in-network specialty pharmacy when they have a commercial or Group Medex plan that includes pharmacy coverage. To view the complete notification, click here.
Harvard Pilgrim Health Care/Point 32 Health
Pharmacy Coverage Changes
Effective for fill dates on or after Jan. 1, 2024, Harvard Pilgrim commercial, Tufts Health Plan commercial, and Tufts Health Direct formularies will have new or updated quantity limitations for the following medications. For a member to receive coverage for quantities above the new or updated limit, the prescribing provider must request coverage through the medical review process subject to the Pharmacy Medical Necessity Guidelines for Drugs with Quantity Limitations. For additional information and to view the entire notification, click here.
Point32Health Medicare Products: 2024 Benefit Changes
As the annual election period for Medicare Advantage comes to an end, The Plan wants to update providers on 2024 benefit changes related to various Harvard Pilgrim Health Care and Tufts Health Plan Medicare Advantage/Senior Products plans, which are effective for dates of service beginning Jan. 1, 2024, upon each plan’s effective or renewal date. For additional information and to view the entire notification, click here.
Instructions for Downloading the Medicare ZIP Code File for April 2024 Files Trans. R12404CP, CR#13472
The purpose of this Change Request (CR) is to describe the process for updating the two Medicare ZIP Code files (ZIP5 and ZIP9) for the April 2024 quarter. This instruction also describes the revision to and the process for downloading the Calendar Year-End ZIP Code files. The attached recurring update notification applies to chapter 15, section 20.1.5(B). To view the transmittal, click here.
Medicare Physician Fee Schedule: New CPT Codes for RSV Vaccine Administration
If the patient doesn’t have Medicare Part D, CMS will pay for vaccine administration but not the vaccine under Part B. CMS retroactively added 2 new CPT codes for respiratory syncytial virus (RSV) vaccine administration to the Medicare Physician Fee Schedule effective for dates of service on and after October 6, 2023: 1) 96380 – Short descriptor: Admn rsv monoc antb im cnsl; 2) 96381 – Short descriptor: Admn rsv monoc antb im njx. Medicare Administrative Contractors will adjust claims providers bring to their attention. To view the notification, click here.
Tufts Health Plan
Medical Necessity Guideline Update: Non-covered Investigational Services
The policy has been updated as follows: Investigational items updated. To view the complete guideline, click here.
Tufts Health Public Payor Plan
Tufts Health Unify Becomes Tufts Health One Care
Effective Jan. 1, 2024, Tufts Health Unify is changing its name to Tufts Health One Care. By aligning the name with the Massachusetts One Care Program, providers will find it easier to determine which population this plan serves. With a One Care plan, members get the benefits of both Medicare and MassHealth (Medicaid) programs through one health plan. Current Tufts Health Unify members will receive a new member ID card in December to reflect the new product name. The member ID number will remain the same. For additional information and to view the entire notification, click here.
THPP Direct subsidized professional services were reimbursed incorrectly resulting in an overpayment.
THPP reported that the THPP Direct subsidized professional services were reimbursed incorrectly resulting in an overpayment. THPP paid claims at 50% of billed charges instead of a percent of the Medicaid fee schedule which resulted in the overpayment. THPP has been adjusting claims to correct the reimbursement.
Additionally, THPP did not pay the E&M codes at the Enhanced Fee Schedule for the Direct subsidized patients. The Enhanced Fee Schedule is $10 per visit higher. Practices will begin to see a claims adjustment as part of the project to adjust for an underpayment.
Please take a moment to share this newsletter with staff members to ensure they are being kept up-to-date with important information.
Please click here to take a moment to read the Provider Spotlights!
Virtual Networking videos from NEPHO providers can be found here.
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.
Here are the key memos that have been sent out over the last month –
JUST in case you missed it!
- Monthly BILH Pharmacy Newsletters
- Monthly BILHPN BMC WellSense MassHealth ACO Newsletter
- Monthly Beth Israel Lahey Health Performance Network CDI Newsletter
- 2024 MIPS Payment Adjustment for LCP-ACO Providers & 2022 Reporting
- PCP MassHealth ACO – 2024 payment rates
- Boston Children’s Hospital
- Updated BCH Satellite Provider Schedules
- BCHMedEd December Newsletter | See Upcoming Courses
QUALITY DEPARTMENT UPDATE
What to expect in January 2024
As we transition from NEPHO to BILHPN we wanted to outline the plans for Quality over the next few months. From January through March we will continue to operate as we normally would. You will receive gap reports for the following 2024 quality measures:
- HPV immunizations (2 doses by 13th birthday)
- Chlamydia Screenings ages 16-24
- Well Child Visits, ages 3-21 for patients who did not have a Well Child visit in 2023 or patients who are due for a visit January through March 2024
We will also send gap reports for patients with Diabetes and Hypertension:
- Patients with an A1c greater than 9.0 and patients who did not have an A1c in 2023
- Patients with a BP greater than 139/89 as well as patients who did not have a blood pressure recorded in 2023
If you have any questions regarding your reports please reach out to Jennifer Andersen email@example.com or Laureen Viel firstname.lastname@example.org, Senior Population Health Specialists – BILHPN. Please feel free to reach out to us with any other questions you may have.
We wish you and your family a happy and healthy New Year!
CLINICAL DOCUMENTATION IMPROVEMENT
OPTUM NEWSLETTER – December – Focus on Mental Health andSubstance Use Disorders
The 2024 AMA and CMS CPT/HCPCS codes have been released and will go into effect 1/1/2024. Please be sure to communicate with your Billing and Coding Department/EMR Vendors/Third Party billing companies the recommendation to keep deleted codes active for at least two weeks after 1/1/2024 to ensure all billing is captured. Click here to view, download and print a spreadsheet (Master Table of 2024 CPT-HCPCS Changes) outlining these changes. You will find a master summary of all the code changes on the second tab.
Click here to view, download and print the IRI CPT and HCPCS Changes 2024 Manual attached to this email. This is a great resource to understand any of the reasoning behind certain code changes.
ANNUAL WELLNESS VISIT VS. PHYSICAL EXAM
In an effort to aid in education surrounding the difference between Annual Wellness Visits (AWV) and Physical Exams (PE), the Northeast PHO Clinical Documentation team has created two documents with examples, requirements and codes specific to each visit. We thought these documents may be helpful to you and/or your practice staff as you navigate through the beginning to end of day-to-day operations with those visit types.
Please take a moment print and/or share this with staff who may find this information helpful. For further assistance with coding, please reach out to Jessica.M.Bryan@lahey.org or Debra.Houde@lahey.org.
The NEPHO CDI Team
PATIENT EXPERIENCE COMMENTS
Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road
- Always have a satisfying appointment with Dr. Spencer Amesbury. High level of comfort in terms of asking questions, sharing information, discussing options, etc.
- Dr. Karenjeet Chahal made me feel very comfortable and answered all questions. Staff also very nice to deal with.
- I really appreciate Dr. Neeraj Mahajan and the whole team. I have had very good experiences with the practice.
Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203
- I have been with Dr. David Driscoll for years, and have always had a good experience with him. The doctor and the staff have always been respectful, professional, friendly, informative.
- Dr. Deborah Shih took extra time with me during my visit, was thorough, remembered details about my history, I felt well taken care of by Dr. Shih and her staff.
Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center
- Dr. Pierre Ezzi is always pleasant & respectful.
Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center
- Dr. Andrew Lenhardt is fabulous and so is his staff!!!
- Dr. Daniel McCullough – I could not be happier and feel more comfortable with this office! I am very pleased with the care I receive!!!
Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street
- Excellent care from beginning to end. Dr. Brent Fryling listens and treats you as if you are is only patient.
Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street Suite 204
- Dr. Kristina Jackson addresses all my issues with care and professionalism. The staff is wonderful.
- Dr. Timothy Loughran provided the care I needed in a pleasant, professional and clear way. I felt very comfortable talking with him.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 1st Floor
- I am very pleased with my care from Dr. Kathryn Hollett. She has been very good.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- Dr. Victor Carabba is THE BEST!
Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
- Dr. William Medwid is amazing! He is thoughtful, kind and helpful. I feel comfortable bringing up any health needs and am treated with care and respect.
Beth Israel Lahey Health Primary Care, Manchester – 195 School Street
- Dr. Jana Oettinger listens to your concerns and helps you navigate complicated health issues. She’s very professional, thoughtful and caring.
- Dr. Matthew Plosker – Very attentive and thorough! Also the staff were cheerful and made me feel comfortable!
Blackburn Primary Care, Gloucester – 1 Blackburn Drive
- Dr. Jay Isaac and his staff are professional and friendly. They make sure your needs and questions are answered before you leave.
Cape Ann Medical Center, Gloucester – 1 Blackburn Drive
- Dr. Janet Doran – I have been to this practice multiple times. I have always been treated with respect in an efficient manner. Very professional and always on time. I have been given excellent care.
- Dr. Shawn Pawson is a great doctor. He is extremely intelligent and very personable.
EMTAR Healthcare, Inc., South Hamilton – 205 Willow Street
- Dr. Michael Edwards is very professional and makes me feel comfortable at all times, and his staff is always helpful to any questions l may have.
Essex County Primary Care, South Hamilton – 42 Asbury Street
- Excellent as always. Dr. Nicholas Avgerinos is patient, listens to what I have to say, then diagnoses the possible issues. He is very good at discussing the symptoms and clearly explaining the next steps. He is always very attentive and professional. I am so lucky to have him as my primary care physician.
North Shore Pediatrics, Danvers – 480 Maple Street
- Always a great experience with Dr. Shannon Dufresne. We look forward to seeing her.
- We have been visiting Dr. Lance Goodman and his team for over 10 years and have only the most amazing things to say about this practice! We feel incredibly lucky to have found NSP!
- We love coming to NSP, every provider is just wonderful! At this visit, Dr. Maureen Matthews was friendly, knowledgeable, honest and efficient, as always! Thank you!
Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road
- I have been treated by Dr. Candace Thompson for many years, and have always been impressed by her professional approach to my concerns. I trust her judgment completely.
Northeast PHO introduced the Practice Recognition awards in 2018 as a way to recognize the importance of practice team support. We are proud to say that there have been 155 awards to recognize colleagues who help keep care local, support our quality efforts, provide a positive experience for our patients and assist their colleagues.
Congratulations to all the winners over the years. Your support has made a difference!
This month’s winners are:
For your dedication, professionalism and outstanding teamwork you are nominated for this Teamwork Award by Maria Valliere and your peers at BILH Danvers.