News from NEPHO – January 2019 Edition

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

PHYSICIAN and PRACTICE CHANGES/UPDATES

New Providers

• Benjamin Solky, MD has joined Robert O’Brien Jr. M.D. and Associates, P.C. 83 Herrick Street Suite 3000 Beverly, MA 01915 978-969-6929 (F) 978-969-6967.

Practice Changes/ Updates

• Justin Fernandes, MD of Beverly Shafer, M.D. has joined The Wound and Hyperberic Center 500 Cummings Center Suite 1800 Beverly, MA 01915
  978-921-1210 (F) 978-921-1534.
• Anna Petropoulos-Weissleder, MD of Anna Petropoulos-Weissleder, M.D. has terminated her affiliation with the Northeast PHO.
• Katherine (Kasia) Masterpol, MD  has transitioned from practicing with Robert O’Brien Jr. M.D. Associates, P.C. to
  her own practice DermPhysicians of New England located at 83 Herrick Street Beverly, MA 01915. She will be seeing patients as of March 14, 2019  781-272-7022  (F) 781-272-8786.
• Elsie Diaz-Schroeder, MD of Lahey Health Primary Care, Beverly – 100 Cummings Center, Ste. 126Q has resigned effective 5/17/2019.
• Sebastian Aparo, MD of Sebastian Aparo, M.D. has retired.
• Daniel Marcus, DPM of Peabody Podiatry has retired.
• John Ledbetter, MD of Lahey Institute of Urology, Beverly has retired.

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

NEPHO 2018 CUSTOMER SERVICE SURVEY RESULTS

In the fall of 2018, NEPHO sent a survey to all physicians, advanced practitioners, and office managers in an effort to obtain feedback on communication, services and department-specific performance. We received 100 responses which was an increase of 75% from the last survey done in 2016. This year’s response breakdown: 25 responses were from PCPs, 48 responses were from Specialists, 12 responses were from Advanced Practitioners, 15 responses were from Office Managers. Areas of improvement from 2016 include; Pharmacy Services, Referral Management, and Population Health Management. The overall satisfaction with NEPHO services increased 4% from 2016. Results overall rated NEPHO services as “Good” or “Very Good”.

The following detail includes strengths and areas of opportunity for NEPHO:

Strengths of NEPHO:

• Effectiveness of Pharmacist/Patient consults
• Effectiveness of retaining services within the PHO
• Accessibility of Population Health Staff
• Overall effectiveness of website
  

Areas of Opportunity for NEPHO:

• Meaningfulness of physician incentive measures
• Communication of contract terms
• Satisfaction with contract rates/reimbursement
• Accessibility of Provider Relations staff

The NEPHO Team have begun to implement changes and are working to target identified areas for improvement from the customer survey responses and comments.

Glossary of Acronyms
This is located on the NEPHO website under News and Resources/Glossary.

•  NEPHO will continue efforts to define terms and acronyms. Click here

Coding Corner and Monthly Coding Tip of the Month

NEPHO has added the Coding Corner to the NEPHO website – this will have recent coding updates that impact service reimbursement.

• Monthly Coding Tip will be included in the monthly NEPHO Newsletter. Click here

Provider Relations Accessibility

• NEPHO Provider Relations team will be reaching out to practices to offer “Meet and Greet” sessions with practice providers and office staff – these meetings will help address educational opportunities and/or NEPHO service support.
• NEPHO Provider Relations has provided a list of the Heath Plan Provider Relations contacts (phone and email) to all practices to help address some of the wait times. Click here

Satisfaction with contract rates/reimbursement and Meaningfulness of physician incentive measure

• Expand negotiations on Physician rate increases –  Example: AllWays Health Partners, LCPN are in negotiations  for a new contract with better rates.
• NEPHO continues to identify ways to support physicians with incentive measures to improve overall performance.

Improve 2019 Contract Management Communication

• NEPHO will include 2019 contract updates on the website.
• NEPHO Provider Relations will be providing email updates on contract term updates as information is received.
• Contracting updates were provided at the January 2019 POD meetings and will be communicated at future physician meetings.

Providing more NEPHO contact information within the NEPHO Directory

• NEPHO is working on an updated directory of all NP/PA staff within the NEPHO network.  This will be included in monthly directory email updates and the website.
• The Provider directory now has Board of Directors included.

Effectiveness of Quality Reports

• The Quality team will streamline quality reports in 2019.

PAYOR UPDATES

Fallon Health

• Revised Payment Policy: Evaluation and Management
  The Payment Policy will be revised effective January 1, 2019. The Plan added new 2019 codes. To view the entire policy, click here.

Tufts Health Plans

• Payment Policy Update: Preventive Services
  For 1/1/19 effective date – added new CPT codes 81163, 81164, 81165, 81166, 81167, removed deleted CPT codes 81211, 81213, 81214 and updated descriptions for CPT codes 81162, 81212, 81215, 81216, 81217 in BRCA genetic testing section and added CPT code 90689 to adult and pediatric immunization section. The Pharmacy section removed Vitamin D coverage. To view the complete policy, click here.

Blue Cross Blue Shield of Massachusetts

• Payment Policy Update: Diabetic Care
  Inclusion of information on diabetes prevention program effective January 1, 2019. To view the complete policy,
  click here.
• Medical Policy Update: Noninvasive Techniques for the Evaluation and Monitoring of Patients with
  Chronic Liver Disease
  The coding section has been updated with additional codes. To view the complete policy click here.
• Payment Policy Update: Evaluation and Management
  Annual coding update; addition of CPT codes 99451 and 99452; revision of descriptor of CPT codes 99446-9.
  To view the complete policy, click here.

POPULATION HEALTH

IPA / POD MEETING SUMMARIES 

Final Settlement

• Stacey Keough reviewed the details of the 2017 settlement for Commercial and Medicare LCPN and NEPHO risk contracts.
• Ms. Keough also shared the 2018 performance for Commercial contracts through Q2 data as projected by LCPN.

Physician Fee Schedule

• Shawn Bromley shared the 2019 updates to the physician fee schedule for current contracts.

Affiliation Update

• Lou Di Lillo, MD  shared the current updates related to the Lahey Beth Israel affiliation and shared highlights of the Attorney General’s Assurance of Discontinuance.

Quality

• Liz Isaac reviewed the updates to the (BCBS, HPHC,) and Medicare ACO quality programs for 2019.
• Ms. Isaac also reviewed was a new quality program for AllWays Health Partners plan which utilizes many of the quality measures we are familiar with.

QUALITY

 Patients Without Office Visits (PWOV) January 2019

The beginning of the year is a good time to focus on reaching out to patients who did not have appointments in 2018 or who may need help with diabetic or hypertensive control.

Practices should reach out to the following patients:

• Any patient with an overdue Adolescent Well Child visit (ages 12-21)
• Patients who need chlamydia testing (ages 16-24)
• Diabetic patients with an A1c greater than 8.0
• Hypertensive patients with a blood pressure greater than 139/89

The BP target of 149/89 for hypertensive patients over the age of 60 has been removed. In 2019 the blood pressure target for all diabetic and hypertensive patients is less than or equal to 139/89

MHQP SCORES

Patient Experience: MA Health Quality Partners

• On January 23rd MA Health Quality Partners (MHQP) released results of the only statewide survey of patient experience in primary care.
• MHQP is an independent healthcare measurement and reporting organization who has conducted this survey for 14 years to evaluate patient experiences for commercially insured patients.
• The results can be found at www.healthcarecompassma.org.
• Adult and pediatric care topics are explored in the survey.
• Topic areas include: physician communication, integration of care, knowledge of patient, adult behavioral health, self-management support, organizational access, office staff, pediatric preventive care, child development, and willingness to recommend.
• NEPHO high level results are:
  • Patients responding to the adult survey reported improved experiences in Communication, Knowledge of Patient, Integration of Care and Access.
  • Knowledge of Patient represents a significant improvement, as it was statistically below the state mean in the previous year.
  • Although adult behavioral health remains a low scoring category, there was significant improvement with providers asking adult patients questions related to behavioral health.
  • Patients and guardians responding to the pediatric survey reported improved experiences in Communication and Access to Care, while Knowledge of Patient and Integration of Care areas declined.
• Practice level reports have been sent to administrators.
• NEPHO will be visiting practices in upcoming weeks to review practice level results.

If you would like additional copies of your practice reports please contact:
Liz Isaac at Elizabeth.isaac@lahey.org or Stephanie Cunningham at Stephanie K. Cunningham

PHARMACY UPDATES

2019 Statin Quality Measures / 2018 AHA and ACC Updated Cholesterol Management Guidelines
Statin adherence therapy for patients with hypercholesterolemia is measured as a prescription
fill rate of >80% for the treatment period. This quality measure will be a focus for several payers in 2019.

See the attached chart for plan specific measures:

Click to enlarge/print slide and FAQs


The ACC AHA Cholesterol Guidelines were
recently updated, the first time since 2013.
The new guidelines include a greater focus
on individualization of patient treatment,
emphasis on LDL-C targets and non-statin
add-on treatments.  

The following are some key points from the recent guidelines:

• Heart-healthy lifestyle still emphasized
• Specific LDL thresholds recommended for patients with very high-risk ASCVD or very high baseline LDL
• Primary Prevention: In patients with severe primary hypercholesterolemia (LDL-C level ≥190 mg/dL), begin high-intensity statin therapy
• Secondary Prevention: Very high risk atherosclerotic cardiovascular disease (ASCVD), consider augmenting
  high-intensity statins at max dose with ezetimibe and a PCSK9 inhibitor
• In patients 40-75 years of age:
  • With diabetes and LDL-C ≥70 mg/dL, start moderate-intensity statin therapy
  • Without diabetes and with LDL-C ≥70 mg/dL, calculate the 10-year ASCVD risk score
  • A risk is ≥7.5%, risk-enhancing factors* favors statin therapy
    *(include family history, metabolic syndrome, CKD, chronic inflammatory conditions, premature menopause,
    high-risk races/ethnicities, and others)
  • Consider measuring coronary artery calcium** as a “tie-breaker”
    **(CAC score of “0” may indicate that statins can be withheld under certain conditions)
• Reassessment: adherence, response to medications and lifestyle changes with repeat lipid measurement after statin initiation or adjustment.

See the attached algorithms for primary and secondary prevention treatment and the entire 2018 AHA ACC Cholesterol Guidelines.

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 Insider Newsletter: January  Focus – Major depressive disorder (MDD) 

Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services

• CMS has issued its final 2019 Physician Fee Schedule and Quality Payment Program, opening the door to reimbursement for connected care services that enable providers to manage and coordinate care at home. The changes are focused on three new CPT codes that separate Remote Patient Monitoring (RPM) services from telehealth.

The new CPT codes are:

• CPT code 99453:“Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
• CPT code 99454:“Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
• CPT code 99457:“Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
• CMS has finalized two newly defined physician’s services utilizing communication technology. These two services are the brief communication technology based service, or virtual check in (HCPCS code G2012), and the remote evaluation of recorded video and/or images submitted (HCPCS code G2010). These services will allow practitioners to decide whether an office visit or other medical service is needed, improving efficiency and convenience for both the practitioner and beneficiary.
  • HCPCS code G2012: CMS states the code allows “audio-only real-time telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.”
    (Note: telephone calls that involve only clinical staff cannot be billed using HCPCS code G2012 since the code explicitly describes (and requires) direct interaction between the patient and the billing practitioner.)
  • HCPCS code G2010: CMS defines this code as; remote evaluation of recorded video and/or images submitted by an established patient.

Evaluation and Management (E/M) 2019 Documentation Updates

• Beginning January 1, 2019, Medicare will allow ancillary staff to perform and record the chief complaint and history of present illness.
• Additionally, for established patient office/outpatient visits, when the medical record already contains relevant information, Medicare will allow physicians to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and not re-record the defined list of required elements. Physicians will still need to review prior data, update it as necessary, and indicate in the medical record that they have done so.
• These updates were approved to help improve physician’s workflow to provide more focus on the
  patient during the office visit.
• CMS has delayed additional E/M additional documentation changes until 2020 and 2021. Updates will be made available as more information is released from CMS.

Contact the Shawn Bromley at shawn.m.bromley@lahey.org or 978-236-1704 if you are interested in more information regarding the new Telehealth services or need additional guidance on the updated E/M documentation requirements.

2019 BEST OF BOSTON MAGAZINE 

PROVIDER RELATIONS

 

 

 

PATIENT EXPERIENCE COMMENTS

Family Medicine Associates, Manchester

• Dr. Harlow Labarge takes good care of me. Great experience with Dr. Labarge as always!

Family Medicine Associates, Hamilton

• Dr. Laurence Gordon,  and staff are the best health care professionals I’ve been to!
• I have gone to Dr. William Medwid for years and I have recommended him often.
• Dr. Hugh Taylor and his staff are very helpful and professional

Garden City Pediatric Associates

• Dr. Elizabeth Humphreys is incredible. She takes all my concerns regarding children seriously and gives us peace of mind and excellent care.  LOVE HER!
• We love GCPA and Dr. Jacob Kriteman. He is amazing and is always there to listen and give great advice.  We love the office staff too.
• We are always recommending Dr. Eric Sleeper and this practice to others.

Lahey Health Primary Care, Beverly – 30 Tozer Rd.

• Dr. Susan Deluca is a ten-plus! She is what every family practitioner should aspire to.
• Dr. Neeraj Mahajan thank you for all the hard work! Love this office.

Lahey Health Primary Care, Danvers – 480 Maple St.

• Love Dr. Galina Feldman!

North Shore Pediatrics

• Dr. Lance Goodman is an excellent doctor, with great follow up. He really cares about his patients.  Quick wait time, very pleasant staff!
• Dr. David Danis is an excellent doctor, also with great follow up. We love Dr. Danis, he’s been a great doctor and has cared for me since birth.

PRACTICE  RECOGNITION