NEW PROVIDERS
Elizabeth Devlin, MD
Beverly Anesthesia Associates
480 Maple Street Suite C233 A
Danvers, MA 01923
(P) 978-304-8690 (F) 978-304-8697
Catherine Higham, MD
Massachusetts Dermatology Associates
900 Cummings Center
Suite 311 T
Beverly, MA 01915
(P) 978-225-3376 (F) 978-560-1245
PRACTICE CHANGES/UPDATES
- James Chafey, MD of Beverly Radiological Associates has announced his retirement.
- Christine Kannler, MD of Northeast Dermatology Associates will be relocating to 538 Turnpike Street
North Andover, MA 01845. Dr. Kannler will no longer see patients in the Beverly office effective 7/1/2019.
NEWS FROM NEPHO
JUNE 2019 EDITION
IN THIS ISSUE:
SAVE THE DATE
PHYSICIAN ORIENTATION
Date: July 10, 2019 @5:30 P.M.
Place: 500 Cummings Center – Suite 6500
Good Harbor Room Conference Room
Beverly, MA 01915
RSVP: Alycia.Messelaar@lahey.org or 978-236-1784
NECOMG ANNUAL MEETING SUMMARY
The New England Community Medical Group (NECoMG) Annual Meeting was held on June 20, 2019
Guest Speaker
This year’s guest speaker was Reid Plimpton, Project Manager from North East Telehealth Resource Center (NETRC). Reid provided an overview of Telehealth services that are currently being provided within the New England, New York and New Jersey area. The NETRC is federally funded to provide technical assistance to develop, implement, and expand telehealth services within the North East Region. Click here to be directed to his presentation.
Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage patient health care. Telehealth technology has the potential to improve the quality of health care and to make it accessible to more patients. Telehealth may provide opportunities to make health care more efficient, better coordinated and closer to home. Research about telehealth is still relatively new, but it’s growing and helping to provide access to quality health care on another level.
Shawn Bromley, Director of Contracting and Operations provided an update on the Harvard Pilgrim Health Care Quality Grant Award. NEPHO was awarded this grant to provide help funding to implement telehealth services within three NEPHO practices; Cape Ann Medical Center, LOCD Sleep Medicine, and Northeast Dermatology Associates.
Election
Dr. Pierre Ezzi reported the results of the NECoMG Board election. Drs. William Medwid and Stephen Barrand were
re-elected for 3 year-terms as Class P and Class S Directors. Congratulations to Drs. Medwid and Barrand for their appointments to the Board.
IPA / POD MEETINGS SUMMARY
Meet and Greet Dr. Joseph Peppe
- Dr. Peppe was introduced as the new NEPHO Medical Director. Dr. Peppe shared his recent work experiences.
- Pod members greeted Dr. Peppe warmly and introduced themselves and their specialty.
Quality: Performance Update, 2018 and 2019
- Liz Isaac shared the 2018 LCPN and NEPHO score cards for claims paid through January 2019.
- The LCPN gate score is 2.3 and NEPHO is at 3.27 (LCPN dashboard, does not include non-EPIC outcomes data).
- 2019 progress reports comparing current month’s performance to prior month and prior YTD were reviewed for Diabetes HTN and HTN only, A1c control measures, Diabetes process measures, Well Child visits and Chlamydia Screenings.
- Many of these measures are heading in the right direction compared to previous month and at similar rate to last year, same time.
- Need to focus now on a couple of measures, A1c control and Diabetes eye exams, that are behind previous year performance.
- Updated integration reports and Well Child/Chlamydia screening patient lists were distributed for action on patients with no visits scheduled as of yet and for scheduling initial and/or follow-visits for patients with out of range A1cs and BP values.
- One tip shared from a physician was to obtain cell phone numbers from adolescents for ease of scheduling visits and for follow-up calls for Chlamydia test results.
- Questions and Answers that came up at the meetings are below:
- Q: For diabetes eye exam, does retinal imaging count as compliant?
A: Yes, a retinal or dilated exam by an optometrist or ophthalmologist during 2019 counts.
- Q: Does a printout from a patient’s home blood pressure device that is scanned into the EMR count? (Context: This year, BCBS is allowing BP values from patients’ home devices that are “digitally stored and transmitted” to the EMR).
A: This answer is pending clarification from BCBS. - Q: Is the Adolescent Well Child benefit a Calendar year or 365+ benefit?
A: This is a calendar year benefit. - Q. Why should we focus on quality continue if the quality pool has been decreased?
A. Meeting quality targets provides good care and helps reduce overall costs to the health care system. There are two surplus pools: quality and efficiency. Although the quality pool has decreased, there is still the potential to achieve significant quality surplus dollars. Additionally, the quality gate score impacts the percent risk sharing with BCBS, e.g. A quality gate score of 3.0 out of max 5.0 provides access to 55% of the efficiency pool. A quality gate score of 2.0 out of 5.0 provides access to only 40% of the efficiency pool. - Q: Are we sharing best practices across the network to improve performance for all units and raise the overall network performance?
A: Yes, best practice sharing is part of a monthly netwrk level quality discussion.
- Q: For diabetes eye exam, does retinal imaging count as compliant?
Patient Experience
- Liz Isaac provided updated physician star ratings for timeframe January 2018 through March 2019.
- Physicians received their own March patient feedback reports that have been pre-screened for exclusion criteria and had opportunity to review positive and negative feedback from patients, and submit any feedback for Appeals review.
Specialty Meetings Summary
- Carol Freedman shared an update of the specialty meetings that have been completed with Cardiology, Emergency, GI, OB-GYN, Endocrine, and Pulmonology.
- The initiatives that are being worked on to help manage value based budgets were shared at specialty meetings as well as specialty specific initiatives that will help improve quality measures.
Informational
- Ann Cabral provided copies of the new Pediatric Referral Sheet, that was well received. Please contact Ann Cabral at ann.cabral@lahey.org if you would like additional copies for your practice.
- Year to date attendance for each physician was shared.
- Logistics regarding the upcoming Annual Meeting was shared.
DR. SHETH HONORED AT WOMEN OF THE YEAR GALA
The Commonwealth of Massachusetts recognized Dr. Manju Sheth for her contributions to our medical community and her empowerment and promotion of other successful women of South Asian descent throughout Massachusetts. Dr. Sheth is a Primary Care physician practicing at Lahey Health Primary Care, Danvers. Please join us in congratulating Dr. Sheth!
MCSTAP IS UP AND RUNNING
The Massachusetts Consultation Service for the Treatment of Addiction and Pain (MCSTAP), created through last year’s opioid law (Chapter 208), allows providers to call a number and have a consultant give advice on safe prescribing and managing care for patients with chronic pain and/or substance use disorder (SUD). The Grayken Center for Addiction at Boston Medical Center provides medical leadership of MCSTAP, but MCSTAP’s physician consultants are experts from healthcare systems around the state.
MCSTAP is geared now to primary care practices but is able to field calls from hospital emergency departments. When a provider calls, a MCSTAP specialist will gather details and then send a request to a physician consultant, who will call the provider back within 30 minutes.
MCSTAP is a free service to providers funded by the Massachusetts Executive Office of Health and Human Services through its contract with the Massachusetts Behavioral Health Partnership.
The phone number – which is for providers only and not the public – is (833)-724-6783 ((833)-PAIN-SUD), and is available Monday through Friday, 9 a.m. to 5 p.m.
PAYOR UPDATES
AllWays Health Partners
Change in bank related Explanation of Benefits
With the recent re-brand from Neighborhood Health Plan (NHP) to AllWays Health Partners, they now have two insurance licenses:
1. AllWays Health Partners Insurance Company
2. AllWays Health Partners, Inc). Each product falls under one of these licenses.
Currently, providers receive two separate payments/EOPs. One that covers claims for members that fall under AllWays Health Partners Insurance Company and one that covers claims that fall under AllWays Health Partners, Inc. Both payments come from the same bank.
Beginning with check run 6/19/19, providers will still receive two separate checks/EOPs based on the insurance license.
However, there will be a different bank associated with each license:
- Checks for AllWays Health Partners Insurance Company will come from Bank of America
- Checks for AllWays Health Partners, Inc will come from Boston Private Bank
Please contact Alycia Messelaar with questions or clarifications about this change, 978-236-1784 or alycia.messelaar@lahey.org.
POPULATION HEALTH
Sun Awareness and Skin Protection
- Skin cancer is the most commonly diagnosed cancer in the United States, and most cases are preventable.
- Skin cancer greatly affects quality of life, and it can be disfiguring or even deadly.
- Medical treatment for skin cancer creates substantial health care costs for individuals, families, and the nation. The number of Americans who have had skin cancer at some point in the last three decades is estimated to be higher than the number for all other cancers combined, and skin cancer incidence rates have continued to increase in recent years.
- Each year in the United States, nearly 5 million people are treated for all skin cancers combined, with an annual cost estimated at $8.1 billion.
- Melanoma is responsible for the most deaths of all skin cancers, with nearly 9,000 people dying from it each year.
- It is also one of the most common types of cancer among U.S. adolescents and young adults.
- Annually, about $3.3 billion of skin cancer treatment costs are attributable to melanoma.
- Evidence demonstrates that clinicians can play a role in reducing UV exposure through individually directed counseling, particularly among adolescent and young adult patients with fair skin.
- Federal agencies and the independent U.S. Preventive Services Task Force (USPSTF) recently conducted a systematic review of the evidence on the effectiveness of behavioral counseling to prevent skin cancer, and findings from the review indicated that counseling in primary care settings can increase sun-protective behaviors and decrease intentional tanning, including indoor tanning.
- On the basis of these findings, the USPSTF now recommends that clinicians counsel patients with fair skin aged 10–24 years to minimize their UV exposure to reduce their risk of skin cancer.
- Evidence of the benefits of counseling for patients older than age 24 is sparse and insufficient to serve as a basis for a recommendation.
- Some groups recommend periodic skin cancer screening either by a health care provider or by self examination. Consistent and regular screening identifies melanomas that are, on average, thinner than those found during usual care.
- Whether detection of these lesions leads to fewer cases of disease or death is unknown.
- For this reason, the USPSTF has stated that current evidence is insufficient to recommend skin cancer screening by primary care providers among the general U.S. adult population. On May 15, 2014, the USPSTF released a draft research plan, which will be used to guide a systematic review of the evidence by Researchers.
- Although screening is not currently recommended, providers should remain alert to suspicious lesions. You can find the Final Recommendation Statement here
References: https://www.cdc.gov/cancer/skin/call_to_action/index.htm https://www.hhs.gov/sites/default/files/call-to-action-prevent-skin-cancer.pdf
QUALITY
NEW EPIC Best Practice Advisories: Depression Screening & Follow-Up PHQ-9
- Depression screening and follow up PHQ 9 within 3-12 months of initial PHQ 9 greater than 9 is a Patient Reported Outcome Measure (PROM) for BCBS patients.
- Our current data shows that less than 1 in 4 patients who have initial PHQ 9 scores that are greater than 9 have a follow-up PHQ-9.
- There are two new Best Practice Advisories in EPIC which will alert primary care providers, behavioral health providers as well as support staff of patients 12 years and older who score greater than 9 on the PHQ-9 screening.
- BPA for initial score greater than 9 (see first screenshot)
- If a patient’s PHQ-9 is greater than 9 at the time of the current encounter, a BPA will fire to the user with a link prompting them to schedule a follow-up appointment.
- BPA for follow-up PHQ 9 needed but not found during current face to face encounter (see second screenshot)
- If a patient is being seen for a face-to-face encounter and had a PHQ-9 score greater than 9 in the previous 3 – 12 months, a BPA will fire to both staff and providers with a link prompting them to complete a follow-up PHQ-9 for the patient during this visit.
PHARMACY UPDATES
What patients pay for their medications!
- Depending on the health plan, patients can pay varying amounts for their medications during a calendar year.
- If the prescription plan has a deductible, such as a Medicare Part D Plan (see graph below), the patient will pay the full amount of a medication such as Insulin, Lyrica or Xarelto that have an approximate “cost” of $300+.
- If a patient is on two medications that cost $300+ each, the January bill will be the deductible amount, up to $415.
- February – June the patient will pay a monthly copay depending on the Tier of the medication ranging from $20 – $75 each per month. In July, the Coverage Gap or Donut hole is reached and the patient may pay 25% -40% (depending on Tier) of the cost of the medications (~$150 – $240 monthly for the 2 medications).
- In this scenario, catastrophic coverage is not reached therefore out of pocket expenses will range $1600 – $2400 per year for these two medications.
- Patients who have commercial plans with prescription deductibles might have a $300 – $500 out of pocket expense in January and then a monthly copay ranging from $20 – $75 for each medication thereafter.
- Note: this calculation is for only 2 high cost medications; some patients are on 10 – 15 medications.
Click to enlarge
See the attached Patient Medication Cost Savings Tips brochure; (please note: not all links in pdf. are functional) it can be printed and given to patients in need of this information. In addition, here are a few suggestions for patient savings:
For questions or more information contact Carol Freedman, NEPHO Pharmacy Manager 978 236 1774 OR carol.freedman@lahey.org
Medicare Annual Wellness Visits Review
- Annual Wellness Visits (AWV) are covered by Medicare annually, but they are often confused with other types of examinations, so the Centers for Medicare & Medicaid Services (CMS) has published an MLN booklet Click here to help office staff and their providers keep them all straight.
Annual Wellness Visit Components
- AWVs are only provided annually. The AWV is a visit to perform a health risk assessment (HRA) and develop or update a personalized prevention plan.
- The IPPE differs in that it’s a review of the beneficiary’s medical and social health history, and includes preventive services education.
To be able to bill for an AWV the provider should fulfill these steps the first time a patient has an AWV:
- Perform an HRA
- Establish the beneficiary’s medical and family history
- Establish a list of current providers and suppliers
- Measure height, weight, BMI, and blood pressure
- Detect any cognitive impairment the beneficiary may have
- Review the beneficiary’s potential risk factors for depression, including current or past experiences with depression or other mood disorders
- Review the beneficiary’s functional ability and level of safety
- Establish an appropriate written screening schedule for the beneficiary. (CMS recommends a checklist for five to 10 years)
- Establish a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or already underway
- Furnish the beneficiary personalized health advice and appropriate referrals to health education or preventive counseling services or programs
- At the beneficiary’s discretion, furnish advance care planning services
In subsequent years, the provider should follow these steps:
- Review and update the HRA
- Update the beneficiary’s medical/family history
- Update the list of current providers and suppliers
- Measure height, weight, BMI, and blood pressure
- Detect any cognitive impairment
- Update the written screening schedule
- Update the list of risk factors and conditions
- Furnish the beneficiary’s health advices and referral to health education and counseling programs
- At the beneficiary’s discretion, furnish advance care planning services
Coding Annual Wellness Visits
In addition to the appropriate diagnosis codes, report the following HCPCS Level II codes:
Click table to enlarge
Eligibility
Medicare Part B covers the Annual Wellness Visit if:
- The patient had Part B for over 12 months
- The patient has not received an AWV in the past 12 months
- Patient’s cannot receive an AWV within the same year as their Welcome to Medicare preventive visit.
- To be covered, the Medicare beneficiary must have been covered by Part B for more than 12 months.
Please contact Shawn Bromley from NEPHO at shawn.m.bromley@lahey.org or 978-236-1704 if you have questions regarding Medicare Annual Wellness Visits.
PATIENT EXPERIENCE COMMENTS
Addison Gilbert Primary Care – 298 Washington Street
- Karen Damico was professional, caring, friendly and knowledgeable. She listened to me and spoke so I could understand.
Beacon Family Medicine – 130 County Road
- Curtis Ersing’s office is very efficient – no wasted time. Been going here for 20 years and nothing but great things to say.
- Erin Heiskell is the best doctor I’ve had in my 82 years.
Cape Ann Medical Center – 1 Blackburn Drive
- Janet Doran has been my primary care physician over 20 years. She’s absolutely the best primary care physician I’ve ever had. I get outstanding care!
Garden City Pediatric Associates – 83 Herrick Street
- Ian Sklaver always answers questions we have with detailed and thoughtful answers. He is wonderful with our son!
- I feel so lucky to have Elizabeth Humphreys as my daughters pediatrician, she is FANTASTIC! Garden City is always there when we need them.
Lahey Primary Care, Beverly</strong – 30 Tozer Road
- I travel over 40 miles one way to see Susan Deluca. She is very compassionate about her patients. I have referred many patients to her.
- Tina Waugh is excellent! Office is very well run and responsive. Thank you!
- Neeraj Mahajan listens well and provided a prescription to alleviate my symptoms. Only time in my 53 years that a doctor personally called to discuss test results!
Lahey Primary Care, Danvers – 5 Federal Street
- Mauri Cohen is always kind and thorough. He keeps records well and employs a scribe for many of my visits.
Lahey Primary Care, Danvers – 5 Federal Street
- All these years with Steven Keenholtz have been excellent.
Lahey Primary Care, Danvers – 480 Maple Street
- Galina Feldman is very compassionate and listens to my health concerns and addresses them.
- My visit withDr. Manju Sheth was a very good experience. I was pleased to see that I was not rushed and she listened to my concerns.
Lahey Primary Care, Hamilton – 12 Railroad Avenue
- William Medwid is a great doctor. Keep up the great work!
Lahey Primary Care, Manchester – 195 School Street
- Jana Oettinger was a cheerful, informed and supportive presence
- Nicholas Avgerinos – Dr. Nick is excellent. He is knowledgeable and caring
North Shore Pediatrics – 480 Maple Street
- David Danis LISTENS and FOLLOWS up. Love David Danis.
- Lance Goodman is very patient, very professional, compassionate, and discusses the care of my children with me. He is excellent!
PRACTICE RECOGNITION
This month’s winners are:
The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local and meet our quality targets.
This month’s winners are:
Ashley Gleason, Lahey Primary Care Beverly, was recognized for her excellent collaboration & support with the Patient Experience training Initiatives
Denielle Palm, Beverly Hospital, was recognized for partnering with the NEPHO Quality team to improve mammogram screening rates
We appreciate their efforts in supporting the PHO goal to provide high quality, community health care. 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!
Be sure to look for the new winners in next month’s issue!
