NEW PROVIDERS
- No new providers this month.
PRACTICE CHANGES/UPDATES
- North Shore Pain Management will be relocating from 900 Cummings Center Suite 221 U Beverly, MA 01915 to 77 Herrick Street, Suite 201 Beverly, MA 01915 effective 8/28/2023. Phone: 978-927-7246 Fax: 978-927-7249
- The Northeast Emergency Department will be undergoing construction of the triage and waiting room areas between the dates of 8/21/2023 – 9/5/2023. During this time, there may be longer patient wait times than usual.
SAVE THE DATE
NP/PA Meeting
Date: August 23, 2023 @ Noon
Speaker: Ali Wiklund
Topics: Weight management resources, Quality Initiatives/Need to know information, Coding updates/tips
Location: Teams Meeting
RSVP: Alison.Wiklund@Lahey.org
NEWS FROM NEPHO
JULY 2023 EDITION
IN THIS ISSUE:
Referral Order Preference List
BILHPN Acuity Training for Epic Users
BILHPN TEXTING CAMPAIGN
Texting Campaign August 2023
The BILHPN texting campaign for August will focus on Cervical Cancer Screening. The text language is included below:
[PRACTICE NAME] @ Beth Israel Lahey Health: One important component of primary care is preventive care. Scheduling a pap smear – the screening test for cervical cancer – with your primary care provider (PCP) or gynecologist can help find cervical cancer early when it’s easier to treat. To update our records or to schedule a visit with your PCP, please call [PRACTICE NAME] at [PRACTICE PHONE]. Reply STOP to cancel.
If you have any questions regarding the BILHPN texting campaigns please contact Laureen Viel at Laureen.Viel@Lahey.org.
PAYOR UPDATES
Harvard Pilgrim Health Care
Referral, Notification, and Authorization-Authorization: Outpatient Advanced Imaging Authorization
Harvard Pilgrim has updated the policy as follows: Removed language about exclusion of Screening CT Colonoscopy, as it is now covered with prior authorization as of 06/01/23. To view the update, click here.
Medicaid
Tufts Health Plan
Update to Integra’s DMEPOS Network: Senior Products
Tufts Health Plans announced in the May 2022 issue of the former Tufts Health Plan-specific provider newsletter that all durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) providers servicing Tufts Health Public Plans Massachusetts members were moving onto the Integra’s Partners Holdings, Inc. (the DMEPOS benefit manager) network. Integra will soon begin to assume management of the DMEPOS provider network for Point32Health’s Senior Products, starting on July 1, 2023 for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options, and on Sept. 1, 2023 for Harvard Pilgrim Health Care Stride (HMO)(HMO-POS) Medicare Advantage. For additional information and to view the entire notification, click here.
NIA Vendor Program Code Updates
In the April issue of Insights and Updates for Providers, Tufts Health Plans announced a number of changes expected to take effect June 1, 2023 in relation to the medical necessity review and prior authorization program that National Imaging Associates, Inc. (NIA) oversees on the behalf for certain procedures. While the updates announced for the Tufts Health Plan commercial and Tufts Health Public Plans products are now in effect, the changes Tufts Health Plans announced for Harvard Pilgrim commercial and Harvard Pilgrim Health Care Stride (HMO)(HMO-POS) have been delayed as a result of the system outage Tufts Health Plans is experiencing. For additional information and to view the entire notification, click here.
Tufts Health Public Plan
Telehealth Reimbursement for Tufts Health Direct Members
Billing Updates for Tufts Health Plan Providers
Point32Health would like to keep Providers apprised of a number of updates and reminders related to billing practices for various services and Tufts Health Plan products: Billing for behavioral health crisis evaluation: Tufts Health Together: As Tufts Health Plan communicated previously, MassHealth now requires acute hospitals to bill directly for behavioral health crisis evaluation for Tufts Health Together members who present in the ED. Hospitals may choose to subcontract out for these services; however, they must submit the claims using per diem code S9485. For additional information and to view the entire notification, click here.
POPULATION HEALTH UPDATE
PHARMACY UPDATE
2023 Patient Prescription Assistance / Cost Savings Tips:
Please click here to view, download and print a brochure that can be provided to your patients for Patient Prescription Assistance and Cost Savings Tips. It includes the contact information noted below for Free 30-day Trials of Eliquis and Xarelto.
30-day Free Trial for Eliquis and Xarelto:
BILHPN Pharmacy Newsletters:
Please see BILHPN Pharmacy newsletters with current pharmacy related issues. You can access past issues here.*
*please note, a password is now required to log into Pharmacy Resources on the www.nepho.org website. If assistance is needed, please contact Alycia Messelaar at Alycia.Messelaar@lahey.org.
For more information, please contact Carol Freedman at carol.freedman@lahey.org or at 978-380-4089.
PROVIDER RELATIONS
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.
If you would like to be featured on the PHO website, please reach out to Alycia Messelaar at Alycia.Messlaar@Lahey.org or 978-236-1784.
The Northeast PHO would like to help our practices utilize social media in the most productive way possible. There is so much at our fingertips, but navigating the best ways to use such platforms can be challenging.
The Massachusetts Medical Society recently shared some social media resources for physicians. Click here to view, download and print them.
The Northeast PHO Office Manager meeting on 9/13/2023 @ Noon will focus on Medical Practice Marketing strategies, which includes the use of social media platforms. In preparation for this meeting, we would like to gather some information from each of the practices. Please take a moment to click here and complete this brief survey.
Click here for the PDF version of the updated PHO Directory as of July 2023. 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.
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
- HPHC Cybersecurity Updates
- NECoMG Annual Meeting Evaluation
- WellSense PCP Cap Payment Details
- Boston Children’s Hospital
- Summer 2023 Satellite Provider Schedules
- BCHMedEd June Newsletter | See Upcoming Courses
Please reach out to Alycia.Messelaar@lahey.org for a specific communication that you are unable to find.
REFERRAL MANAGEMENT UPDATE
Effective July 1, 2023, Point32Health updated the Commercial Group Insurance Commission (GIC) product offerings.
Harvard Pilgrim Quality HMO — Harvard Pilgrim Quality HMO (formerly HPHC Primary Choice HMO and Tufts Health Spirit Plan) is a tiered limited-network HMO, open to Massachusetts residents (except in Martha’s Vineyard, Nantucket, and Cape Cod).
- This plan requires a referral from their PCP
- It includes a deductible, lower PCP copayment, two copayment tiers for specialist office visits, and two copayment tiers for inpatient admissions to acute care hospitals
- Lower copayment for Eye and GI procedures at ambulatory surgery centers
- No Out-of-Network coverage applies
Harvard Pilgrim Explorer POS — Harvard Pilgrim Explorer POS (formerly HPHC Independence Plan POS and Tufts Navigator ) is a tiered full-network product, open to Massachusetts state and municipal employees.
- Harvard Pilgrim Explorer POS — Harvard Pilgrim Explorer POS (formerly HPHC Independence Plan POS and Tufts Navigator ) is a tiered full-network product, open to Massachusetts state and municipal employees
- Members can seek in-network medical care (from their PCP or from Harvard Pilgrim participating providers with a PCP referral)
- Out-of-Network services include care from non-participating providers or Harvard Pilgrim participating providers without a PCP referral
- Harvard Pilgrim Explorer POS offerings include a deductible, three lower-cost copayment tiers for PCPs, and three copayment tiers for specialist visits and inpatient admissions to acute care hospitals
Click here to view, download and print the product guides.
Please note: NEPHO Referral Management guidelines apply to these products. Please reference the Referral Management section on the NEPHO website here.
If you have questions, please feel free to contact Ann Cabral, Referral Manager, at Ann.Cabral@Lahey.org or 978-808-5379 to verify whether providers are available within the BILHPN network.
REFERRAL ORDER PREFERENCE LIST
The NEPHO Referral Order Preference Lists have been updated and can provide your clinician with the full NEPHO Specialist directory to help facilitate the ordering of clinical services for their patients.
As a reminder:
- Enter the name of the person to copy from (Ann Cabral) and the name of the person to copy to (self)
- Select Outpatient to see only the Outpatient Orders.
- Check the box next to Referrals that you would like to copy
- In the “Copy Option” field, select Merge or Replace.
- This option will replace your current Referrals favorites with the new list
- Click copy on the lower right-hand side
- The system may take a few seconds to copy the preference list.
- When the copy is complete, you will see a pop up window indicating that copy is complete and click on OK
EPIC users please contact Ann Cabral at Ann.Cabral@Lahey.org if you have any questions on how to copy the NEPHO Specialty Referral Orders into your EPIC Preference List.
QUALITY DEPARTMENT UPDATE
We are preparing for the year-end push for quality performance. Please see the following notes in this regard.
- Office managers and physicians: look for an email which includes PCP-Specific dashboards showing quality measure performance in BCBS, HPHC, THP, and Cigna. We have highlighted measures with opportunity for improvement and patients to outreach that are specific to each physician.
- Diabetes and Hypertension
- Thank you for booking appointments for patients who have not been seen yet this year.
- Please continue taking 2nd blood pressure readings on patients whose initial readings are greater than 139/89.
- Best practice alert: We are seeing many practices bringing patients back for BP checks (nurse or MA visit) if the 2nd BP remains high.
- NEPHO Quality team can follow up with patients who report normal home BP readings to get home BP readings recorded.
- If you have a POC A1c machine in your office and need to set up staff training to get it up and running, please reach out.
- We can concierge schedule patients who need help scheduling diabetic eye exams.
- Cancer Screenings
- Colorectal Cancer Screenings – If you have FIT tests in your office, please check the expiration dates to make sure they are not expired.
- For patients who are due for a screening mammogram and need help with scheduling, please reach out and we can help get the appointment scheduled.
- Patients due for Cervical Cancer Screening this year have been identified for primary care providers and patients going to GYN providers.
- Screening for chlamydia reminder: non-invasive urine Chlamydia testing is sufficient to screen for chlamydia in sexually active women ages 16-24.
You can contact the Quality/Pop Health teams through the NEPHO Pool if you are on EPIC or via email to laureen.viel@lahey.org. Please let us know if you have questions or suggestions. We are here to support you and greatly appreciate your partnership. Thank you!
BILHPN ACUITY TRAINING FOR EPIC PROVIDERS
Below is a list of dates for BILHPN Acuity Training for Epic users. Click on each date to register.
Arcadia Acuity Trainings
CLINICAL DOCUMENTATION IMPROVEMENT
OPTUM NEWSLETTER – July- Focus on Endocrine and
Metabolic Disorders
Please click here to view the 2023 Optum webinar schedule.
Documentation is a key strategy for improving Clinical Documentation. When coding for Chronic Obstructive Pulmonary Disease, focus on coding to the highest level of specificity due to the significant risk of morbidity and mortality.
- J44.0 Chronic obstructive pulmonary disease with lower respiratory infection
- J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
- J44.9 Chronic obstructive pulmonary disease, unspecified
- Evaluate if the COPD is stable or unstable
- Document the treatment and follow-up plan
- Link diagnoses when appropriate
- Document medications to support the clinical stages of COPD
Proper documentation can aid in accurately diagnosing, treating, and managing this potentially life-threatening condition.
Please reach out to Jessica Bryan at Jessica.M.Bryan@Lahey.org with questions or concerns regarding this clinical documentation tip or any other coding guidance.
PATIENT EXPERIENCE COMMENTS
Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road
- Dr. Spencer Amesbury has excellent listening skills and a very nice manner. His questions were pertinent and professional.
- I have always been treated with respect and courtesy by Dr. Neeraj Mahajan and his staff.
Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203
- Dr. Alyssa Handler answered all of my questions completely. She listened carefully to my concerns and ordered testing that she felt was necessary. I have the utmost respect for her.
- Dr. Alyssa Handler always gives 100% care! She asks so many questions to cover me so well! She is the best!
- Dr. Deborah Shih is a caring, kind provider. I trust and respect her as my doctor. I highly recommend her to anyone looking for a PCP.
- Dr. Deborah Shih is a caring and thoughtful doctor. I appreciate her compassion.
Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center
- Dr. Pierre Ezzi was awesome. He was very professional, answered all our questions, and we never felt rushed. Thank you for being so kind and caring!
Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center
- I feel incredibly lucky to have Dr. Andrew Lenhardt as my primary care provider! He is an excellent doctor and a very kind person who goes the extra mile to care for his patients.
- The office staff, the nursing staff and Dr. Daniel McCullough are all top shelf professionals. The practice has provided me with superb medical care. Frankly, there can be none better!
Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street
- Dr. Brent Fryling was excellent. Listened well and pleasantly answered any questions I had. Great professional.
Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street Suite 204
- Dr. Kristina Jackson is never rushed listens to what you have to say. She is the best and I have been a patient for over 20 years.
- Dr. Timothy Loughran was professional, informative and attentive.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 1st Floor
- My visit with Dr. Amy Esdale was great. Everyone in the office was super nice. I always have a great experience with everyone in the office.
- Dr. Kathryn Hollett and staff are always very smart, kind and very helpful.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- I cannot say enough about the high quality of care I receive from Dr. Victor Carabba. He is on time, prepared for the visit, asks thoughtful questions, listens attentively and outlines treatment options and next steps in clear, concise language. His manner is calming, his humor makes me smile and he follows up quickly. I feel seen, understood, cared for and that I am in the best of hands.
Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
- The care and treatment I’ve received from Dr. William Medwid has been extraordinary! His expertise and character has made such a difference in my life!!!
Beth Israel Lahey Health Primary Care, Manchester – 195 School Street
- Dr. Jana Oettinger is a first class professional. She comes into all appointments well informed of all circumstances involving her patients. She is very pleasant to talk to. She communicates with patients well and has a very caring way about her. I have and will continue to recommend her to all interested parties needing a good physician on the North Shore.
- I can’t say enough about Dr. Matthew Plosker. He is very attentive and takes whatever time is needed. He is a good listener and always explained what is happening and what is needed treatment-wise. Most importantly he helped me tremendously health-wise. A very competent doctor.
Blackburn Primary Care, Gloucester – 1 Blackburn Drive
- Dr. Jay Isaac – Each person I spoke with before, during and after my appointment was very polite, friendly and helpful.
Cape Ann Medical Center, Gloucester – 1 Blackburn Drive
- Dr. Janet Doran is always very attentive to me and my medical visits. She always listens to me and gives me the right information about what I am in the doctor office for. I have had her for many years and I think she is awesome. She knows my personality and respects my insecurities about things. She is great!
- Dr. James Maguire is very responsive to my needs. I appreciate his care very much. I feel safe with him as my primary care physician.
- Always a good visit with Dr. Shawn Pawson.
Cape Ann Pediatricians, Gloucester – 298 Washington Street
- Dr. Jeffrey Stockman – Our family has used this company for many years now. Nothing other than positive experiences.
Danvers Family Doctors, Danvers – 140 Commonwealth Avenue
- Dr. Subroto Bhattacharya – As always, personalized care by talented, expert, caring professionals.
EMTAR Healthcare, Inc., South Hamilton – 205 Willow Street
- We have been with Dr. Michael Edwards for over 38 years and all experiences have been exceptional.
Essex County Primary Care, South Hamilton – 42 Asbury Street
- Dr. Nicholas Avgerinos – Dr. Nick was great as always. He listens and provides thoughtful advice.
- Dr. Nicholas Avgerinos – Dr. Nick was amazing! Took his time, was through and was totally relatable.
Garden City Pediatrics, Beverly – 83 Herrick Street
- Love all the providers at Garden City Pediatrics, but Dr. Sheryl Silva is the best!!
- The visit with Dr. Meghan Weir was great – no complaints. Will recommend to any other mother!
Leonard Horowitz, M.D., Danvers – 7 Federal Street
- Excellent experience with the staff and Dr. Leonard Horowitz. Staff was so patient and understanding. Really went out of their way to help me when I was in a lot of pain and discomfort. Dr. Horowitz asked very pertinent questions and had a caring and concerned attitude. He directed me on how to proceed with caring for my ailment. I was very glad I choose him as my primary!
North Shore Pediatrics, Danvers – 480 Maple Street
- We love Dr. David Danis and the staff is always professional and very helpful.
- Dr. Shannon Dufresne and the nurse Kate were fantastic! Love this office, recommend 10\10.
- We love Dr. Lance Goodman!
Thomas Pearce, MD, Gloucester – 279 East Main Street
- Dr. Thomas Pearce and his staff are exemplary and I recommend them all the time because of the care and service I receive! I cannot recommend them highly enough!!
Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road
- Dr. Candace Thompson always immediately responds to calls and questions. She is caring, informed, explains EVERYTHING, courteous, compassionate, respectful. Hands down – the BEST.
PRACTICE RECOGNITION
The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local, meet our quality targets and support their colleagues.
This month’s winners are:
Joanne Dowling received a Teamwork Award, as she was nominated by Dr. Aanchal Gupta, who wrote, “I wanted to nominate Joanne Dowling our office manager for the award…She is a great team player and fills in for our secretary, nurse, and any other job that’s needed in the hospital. She works well with all the three doctors, good interpersonal skills. Takes care of the team and very encouraging, always great in terms of follow up and getting things organized and arranged for the office and office procedures. I don’t have enough words to express that she is a great asset to our team!”
Ana Gomez shown above with Dr. Andrew Lenhardt for the patient comment which read: “Very congenial staff, particularly Ana in reception!”
Above is Ana Gomez and Dr. Daniel McCullough with Rocio Rosa, who was nominated by NEPHO Quality Department for her work getting second BP readings. Her certificate reads: “For collaborating with NEPHO Quality team to improve care for patients by supporting 2nd blood pressure initiative.”
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 in the newsletter. Please be sure to look for the new winners in next month’s issue!