News from NEPHO – February 2019 Edition

NEPHO NEWS
February 2019 Edition
February Newsletter – click here to print
Please be aware that due to security issues all links in the print version may not be functional.

PHYSICIAN and PRACTICE CHANGES/UPDATES

New Providers

• Ashling O’Connor, MD has joined Lahey Outpatient Center, Danvers – Breast Health Center
  480 Maple Street Danvers, MA 01923  978-304-8123 (F) 978-304-8123
• Elizabeth Emberley, DO has joined Essex County OBGYN Associates, Inc
  85 Herrick Street Suite 2004 Beverly, MA 01915  978-927-4800 (F) 978-232-5561
• Robert Slocum, DO of Gloucester Family Health 302 Washington Street Gloucester, MA 01930
  has joined NEPHO 978-282-8899 (F) 978-744-0079
• Leroy Kelley, DPM has joined  Cape Ann Foot and Ankle
  1 Blackburn Drive 2nd. Floor Gloucester, MA 01930  978-281-2550 (F) 978-781-255-7905

Practice Changes/ Updates

• Louis Laz, MD of Lynn Women’s Health has retired effective  2/5/2019
• Effective 4/1/2019 Nicholas Avgerinos, MD of Lahey Health Primary Care, Beverly – Tozer Road will be
  relocating to Family Medicine Associates, A Member of Lahey Health 195 School Street Manchester, MA 01944
  978-526-4311 (F) 978-525-2342

SAVE THE DATE

IMPORTANT REMINDER: OPEN MEETING I
For your convenience NEPHO is offering 3 presentation sessions.
Attendance at more than one Open Meeting I session will not provide
additional attendance credit.

Click on the links below to be directed to your attendance policy.
 2019 PCP ATTENDANCE POLICY      2019 SCP ATTENDANCE POLICY

PAYOR UPDATES

Harvard Pilgrim would like to congratulate the 62 physician groups in Massachusetts, Maine, and New Hampshire named to the 17th annual Physician Group Honor Roll. Click here to read the Honor Roll press release   Click here to view complete listing

NEPHO Recognized by HPHC – 2019 Physician Group Honor Roll                          Click icon to enlarge/print
Harvard Pilgrim uses a domain opportunity methodology which combines HEDIS measures Northeast PHO AR 2018 Honor Roll Reportfor both adult and pediatric patients into 3 domains, as listed below.  Click on grid to enlarge/print

• Acute Care Domain
• Chronic Care Domain
• Preventive Care Domain

AllWays Health Partners Update

• AllWays Health Partners, rebranded Neighborhood Health Plan (NHP), contract has been finalized with LCPN and terms are effective January 1, 2019. The Northeast PHO Provider Relations team will be working with individual practices that are currently non-participating or require a Type II NPI to be used for billing purposes due to their affiliation with another risk unit to ensure access to the LCPN contract terms. The estimated credentialing/enrollment processing time for new providers or change submissions is 30-45 days.
• Please contact Alycia Messelaar at Messelaar@lahey.org or 978-236-1784 with questions related to credentialing/enrollment. For questions related to contracting and/or reimbursement contact Shawn Bromley at shawn.m.bromley@lahey.org or  978-236-1704.

IPA / POD MEETING SUMMARIES 

Efficiency/Pharmacy

• Carol Freedman, RPh reviewed 2018 ACC/AHA Cholesterol Guidelines and the Statin Quality Measures.
• The Statin Adherence measure (adherence 80% of time) is used by multiple payers.
• The 2018 guidelines update is the first since 2013; heart-healthy lifestyle is still emphasized, but specific LDL thresholds are recommended for very high risk ASCVD or very high baseline LDL.
• Also shared were the primary and secondary prevention treatment pathways that were published with the updated guidelines.

Reporting

• Dr. Louis Di Lillo, NEPHO Medical Director reviewed detailed results for Q3 OOPHO, Gate Score, Patient Experience and ED Visits.
• Also shared were the results of the specialist incentives.
• The Q3 PCP Report was shared.

Population Health

• Alison Gustafson, NP reviewed a flyer reviewing the health effects of obesity.
• Also included on the flyer is the contact information for NEPHO health coach and other system resources that can be utilized by interested patients and providers.

Patient Experience

• Liz Isaac reviewed 2019 threshold changes to the patient experience measures for the AQC contract.
• Based on the changes and using 2018 performance, 2019 performance is considerably decreased
  for both pedi and adult providers, unless there is considerable improvement over 2018.
• Also reviewed were the patient experience domains and questions that are part of the Medicare ACO MSSP contract.
• An update was provided on the NEPHO transparency pilot intended to drive improvement in patient experience of care.

Quality

• Liz Isaac reviewed the updates/measures for the Medicare ACO quality program.
• Click here for a reference sheet of the measures.

QUALITY

Guidelines for the care of Diabetic Patients
According to the American Diabetes Association diabetes is a complex, chronic illness requiring continuous medical care with risk-reduction strategies beyond glycemic control. Ongoing education and support are critical to preventing complications. The ADA has developed the following set of guidelines to help Primary Care Providers care for patients with diabetes:

• A1C testing twice per year for patients who are meeting treatment goals and have stable glycemic control.
• A1C testing quarterly, (every 3 months) for patients who are not meeting treatment goals or for patients whose therapy has changed.

Patients with an A1C of 8.0 or greater should be scheduled before March 31st to allow for adequate time to address any issues that may be interfering with glycemic control. Those patients should also have regularly scheduled appointments, (preferably every 3 months) with their primary care provider or  endocrinology.

Any patients who have not responded to outreach by the primary care practices or who may need additional support can be referred to Alison Gustafson, Population Health Nurse Practitioner for inclusion in the Diabetes Intervention Program.  Alison can be contacted at Alison Gustafson@Lahey.org or 978-882-2454.

POPULATION HEALTH

Early Action is Important for Heart Attack

•  In a 2005 survey, most respondents—92%—recognized chest pain
  as a symptom of a heart attack. Only 27% were aware of all major symptoms and knew to call 9-1-1 when someone was having a heart attack.
• About 47% of sudden cardiac deaths occur outside a hospital. This suggests that many people with heart disease don’t act on early warning signs.

Morbid Obesity and Heart Disease

• A study of more than 13,000 people done by Johns Hopkins researchers found that even after accounting for such risk factors as high blood pressure, high cholesterol and diabetes, morbid obesity appears to stand alone as a standout risk for heart failure, but not for other major types of heart disease.
• In a report on the research, published online in the Journal of the American Heart Association, the Johns Hopkins team says morbidly obese individuals were more than two times more likely to have heart failure than comparable people with a healthy body mass index.
• After accounting for high blood pressure, cholesterol and blood sugar levels, people with morbid obesity weren’t any more likely to have a stroke or coronary heart disease — the disease of the heart’s arteries.
• There is evidence to suggest that extra body weight exerts a higher metabolic demand on the heart and that fat cells in the abdomen may even release molecules toxic to heart cells. You can find the report here.

References:
www.hopkinsmedicine.org
https://www.cdc.gov/heartdisease/facts.htm

March is Colorectal Cancer Awareness Month

Statistics and Risk Factors

• Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in men and women combined in the United States. The American Cancer Society estimates that this year 95,520 people will be diagnosed with colon cancer, 39,910 will be diagnosed with rectal cancer, and 50,260 will die from this disease.
• On average, the lifetime risk of developing colon cancer is about one in 23 for men and women combined (4.5%); however, this varies widely according to individual risk factors. About 71% of cases arise in the colon and about 29% in the rectum.

Colorectal Cancer Survival Rates

• Since the mid-1980s, the colorectal cancer survival rate has been increasing, due in part to increased awareness and screening.
• By finding polyps and cancer in the earlier stages, it is easiest to treat. Improved treatment options have also contributed to a rise in survival rates.

Survival Rates

• The five-year survival rate for colorectal cancer found at the local stage is 90%
• The five-year survival rate for colorectal cancer found at the regional stage is 71%
• The five-year survival rate for colorectal cancer found at the distant stage is 14%
• There are currently more than one million colorectal cancer survivors alive in the US
• Types of screening
  
  Contact Lucia Kmiec, Health Coach or 978-880-2318for your FIT testing needs.

REHABILITATION AND SPORTS MEDICINE SERVICES

PHARMACY UPDATES

Valsartan Recalls Continue / Valsartan Generic Price Hikes

Recalls continue since July 2018 for valsartan products. Teva and Prinston Pharmaceuticals were primarily affected.
Click here  for the FDA Official Statement updated in January 2019. 

Recently there have been valsartan price increases as a result of numerous product recalls.  Alembic Pharmaceuticals has seized the opportunity to hike its drug prices while market competition is hindered. A recent Elsevier study identified that, by the end of 2018, Alembic had at least doubled the price of 4.4 percent of its generic offerings and increased prices of 17 of its valsartan offerings by 329-469 percent. MacLeods Pharmaceuticals, based out of Mumbai, India, has also increased its valsartan prices. In August, MacLeods’ largest price increase was 305 percent for a 30-day supply of 40 mg tablets, while it’s lowest was a 212-percent price increase for a 90-day supply of 160 mg tablets. In some cases AWP >$3 per tablet.(Drug Topics Feb 7, 2019)

Combination Fluticasone propionate/Salmeterol Dry powder Inhaler Product Update

• Advair Diskus inhalation powder 100/50mcg, 250/50mcg and 500/50mcg fluticasone propionate/salmeterol is now available as generic Wixela Inhub (Mylan) 100/50mcg, 250/50mcg and 500/50mcg OR generic fluticasone/salmeterol inhaler (Prasco Labs) 100/50mcg, 250/50mcg and 500/50mcg dry powder Diskus Inhalers.
  • Both Wixela and Prasco generic product are AB rated, use same Diskus inhaler device but currently have limited availability due to demand. Pricing advantage not yet significant.
• Fluticasone/salmeterol (AirDuo OR authorized generic) inhalation powder RespiClick 55/14mcg, 113/14mcg and 232/14mcg are also currently available.
  • Both the AirDuo and authorized generic Respiclick products are not AB rated (not automatically substituted), use a RespiClick delivery system, have different fluticasone/salmeterol content but dosed similarly to LOW, MEDIUM and HIGH concentration of Advair and also have limited availability due to demand. There is a significant price advantage to patients IF their health plan covers these formulations.
  • Anyone, with or without prescription coverage, can get a GoodRx coupon and pay CASH (~$52) at Walgreens, Walmart ($57) or CVS ($~60) per AirDuo or fluticasone/salmeterol RespiClick device.

                           Advair, Wixela Diskus Inhalers and AirDuo (generic fluticsone/salmeterol) RespiClicks

2018 ACC / AHA Guidelines on the Management of Blood Cholesterol

As a follow up to the February Primary Care POD meetings, see the Guidelines Made Simple  for providers who requested information on the following:

• clear primary and secondary prevention algorithms
• top 10 take-home messages to reduce risk of ASCVD via cholesterol management
• selected examples of candidates for coronary artery calcium (CAC) measurement who
  might benefit from knowing CAC score is zero

For more information on these topics or questions, contact Carol Freedman, Pharmacy Manager at Carol.Freedman@Lahey.org  or 978-236-1774.

CODING TIP OF THE MONTH

OPTUM Newsletter – February Focus National Heart Month

Here are the most recent 2019 coding updates that Physician’s should be aware of to ensure accuracy in coding and billing for MRI Breast Exams and new codes of Chronic Care Management.

• MRI-Based Breast Exams Contrast Updated Codes:

The 2019 change deleted codes 77058 and 77059 and resulted in an expansion associated with
four codes:

• 77046: Unilateral MRI breast exams without contrast
• 77047: Bilateral MRI breast exams without contrast
• 77048: Unilateral MRI breast exams, with/without contrast
• 77049: Bilateral MRI breast exams, with/without contrast

Codes 77046 and 77047 encompass computer-aided detection (CAD), including CAD real-time lesion detection, characterization and pharmacokinetic analysis. This change has eliminated the need to separately add the HCPCS code 0159T for situations involving CAD.

• New Code for Chronic Care Management
  CPT code updates for 2019 include chronic care management (CCM). This update allows providers to bill for at least a half hour of their time.

• 99491: Chronic care management services provided personally by a physician or other
  qualified healthcare professional for at least 30 minutes.
• This code is billed for CCM coordination sessions that are more than 20 minutes but less
  than an hour.

Department of Health and Human Services – Office of the Inspector General
Physicians and practices should be aware of the state compliance initiatives that impact healthcare reimbursement and management of patient care. The Office of Inspector General (OIG) leads these compliance initiatives and provides a detailed monthly work plan that helps provide transparency to these ongoing efforts.

• OIG’s mission is to protect the integrity of Department of Health & Human Services (HHS) programs as well as the health and welfare of program beneficiaries.
• A majority of OIG’s resources goes toward the oversight of Medicare and Medicaid — programs that represent a significant part of the Federal budget and that affect this country’s most vulnerable citizens. To help healthcare providers such as hospitals and physicians comply with relevant Federal health care laws and regulations, OIG creates compliance resources, which are often tailored to particular providers.
• The OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements.

In an effort to help physicians and practices stay in compliance at a federal and state level NEPHO will be providing up to date information monthly on the active work plan items the OIG is working on.

OIG Work Plan Goals

• Promote Positive Change within the Medicare & Medicaid Healthcare System
• Foster Increased Accountability and Integrity at a State Level
• Address Core Challenges to help improve Healthcare Operations
• Fight Fraud, waste and abuse

February 2019 Active Work Plan Focus Include:

OIG Work Plan Items for February 2019

• Medicare Part B Payments for Podiatry and Ancillary Services
• Characteristics of Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose
• Ensuring Dual-Eligible Beneficiaries’ Access to Drugs Under Part D: Mandatory Review

Please contact Shawn Bromley at shawn.m.bromley@lahey.org or 978-236-1704 if you have
questions related to the OIG or active work plan items for 2019.
Federal Website Office of Inspector General
Massachusetts Office of Inspector General  

PATIENT EXPERIENCE COMMENTS

Family Medicine Associates, Manchester – 195 School Street
• I am very satisfied with Dr. Harlow Labarge and FMA.
• Dr. Jana Oettinger is a new PCP for me. This was the first time I met her she was outstanding!

Family Medicine Associates, Hamilton – 15 Railroad Avenue
• I have always found Dr. Gordon Laurence and the doctors and staff at FMA very caring and helpful.
• Dr. William Medwid is an exceptional doctor.
• Dr. Hugh Taylor provides exceptional care, he’s calm, and up on the lates medical informtion. I am grateful for his care.

Garden City Pediatric Associates – 83 Herrick Street
• Always good experience with Dr. Sheryl Silva and GCP.
• We love  Dr. Eric Sleeper !!  No complaints on the entire office.

Lahey Primary Care, Beverly – 30 Tozer Road
• I would recommend  Dr. Tina Waugh to anyone.

Lahey Primary Care, Beverly – 100 Cummings Center, Suite 126Q
• Dr. Pierre Ezzi is one of the nicest doctors I have ever had.  He is very respectful and kind.

Lahey Primary Care, Danvers – 5 Federal Street
• Dr. Mauri Cohen was most patient and informative and spent time dealing with multiple questions and health issues.
• Dr. Margaret Legner always sees me when I call for an appointment. She is very thorough and listens to concerns.

Lahey Primary Care, Danvers – 480 Maple Street
• Dr. Galina Feldman is very accommodating, love Dr. Feldman and her staff.
• The receptionist was extremely kind and upbeat. She always has something kind to say.
• Dr. Feldman is the best provider I have ever had and I am “BLESSED to have her”.

Lahey Primary Care, Gloucester – 298 Washington Street
• Dr. Victor Carabba is the very best primary care doctors I have ever had! He is a wonderful and
knowledgeable  DOCTOR.  THANK YOU!
• I am a new patient meeting Dr. Karen Damico for the first time, I chose the right doctor for me.
• We were pleased with our new doctor, Dr. Kathryn Hollett.  She is very knowledgeable.

North Shore Pediatrics – 480 Maple Street, Suite 3A, Danvers, MA
• Dr. Shannon Dufresne is awesome – knowledgeable, caring and keeps it real. I’m a huge fan!
• Dr. Thomas Seman is by far the best pediatric doctor I have EVER encountered.

PRACTICE  RECOGNITION