News from NEPHO – MAY 2023 Edition

2023 NECOMG ANNUAL MEETING

The NECoMG Annual Meeting will be held virtually via Zoom Meeting on June 15, 2023 at 7:00 a.m. Meeting login information, listed below, was sent to NECoMG Shareholder member emails with a link to the proxy/voting form. Please use the form to submit your response by June 14th. Click here to read the bios for this year’s speaker and Board of Directors candidates.

COASTAL ORTHOPEDIC ASSOCIATES OPEN HOUSE

Please click here to view, download and print this flyer. RSVP to kcutler@coastal-ortho.com by June 7th. 

BEVERLY HOSPITAL RECOGNIZED AS A TOP HOSPITAL

We are proud to share that Beverly Hospital has received an “A” Leapfrog Hospital Safety Grade 23 times in a row, one of only 20 hospitals in the country to be awarded an “A” in every Hospital Safety Grade cycle since 2012. This national distinction recognizes Beverly Hospital’s achievements in patient safety. To read more about this recognition, please click here.

REBRANDING LAHEY OUTPATIENT CLINIC DANVERS (LOCD)

As announced on Friday, May 5, 2023, LOCD will be rebranded to Beth Israel Lahey Health Care Center – Danvers. To view, download and print the notification, please click here. 

POINT32HEALTH/HPHC CYBER SECURITY INCIDENT

On May 24, 2023 HPHC announced that their investigation into the incident revealed that members’ personal information and protected health information may have been copied and taken. The files involved may contain members’ names, mailing addresses, phone numbers, dates of birth, health insurance account information, Social Security numbers, and provider taxpayer identification numbers. Medical history, diagnoses, treatment, dates of service, and provider names, may also have been compromised. HPHC is not aware of any misuse of personal information or protected health information as a result of this incident. For more information, please visit: http://harvardpilgrim.org/data-security-incident.  

Considering this incident, HPHC is providing all health plan members with immediate access to two (2) years of free credit monitoring and identity protection services through IDX. If you are enrolled in a HPHC insurance plan, you can enroll by visiting https://response.idx.us/HPHC and entering one of the following codes: 

• Adult members: QE3U9P6XL  
• Minor dependents: QE3JEO9MZ  

You can also call (888) 220-5517 for assistance. IDX representatives are available between the hours of 9:00 a.m. to 9:00 p.m. EST, Monday through Friday.   

It is also important that you know the following:  

• User Information – If, for some reason, you are able to navigate to an HPHC webpage that asks you to enter your user information, you should not enter that information. Instead, you should reach out to the HPHC Member Services phone number on the back of your card. If you do not have your ID card available, please call (888) 333-4742 (TTY: 711).   
• Access to Care – This outage does not impact your ability to receive care. If you need assistance with matters related to access to care, please call the HPHC Member Services phone number on the back of your ID card.  

The Point32Health website is the best source of information and updates related to the system outage. Point32Health will update the page as information becomes available.  

WELLSENSE MASSHEALTH ACO PHARMACY

WellSense MassHealth ACO Pharmacy Update: Process for Supply Chain Issues

The WellSense pharmacy team has shared the following process for providers if there is a supply access issue. In general, the provider would need to search for an alternative in-network pharmacy by using the pharmacy search tool. The pharmacy search tool is available for both ACO members and providers.

Click here to access the pharmacy search tool reference guide.

If the provider cannot find an in-network pharmacy with access to the medication, they should reach out to pharmacym mailbox. The pharmacym mailbox (pharmacym@wellsense.org) is a resource for providers to reach out to for claims specific escalations, including supply issues. 

When reaching out to the pharmacy mailbox, providers should include:

• Member info (name, DOB, WS ID #)
• Drug info (drug name and strength)
• Pharmacy info (pharmacy name)
• Time/Urgency information (e.g., refill due date)
• Example: I am looking for assistance with a prescription I sent to Accredo for Tadalafil 10 mg for patient Toi Story, DOB 2/2/2022, WS ID#123456789. Patient will be out of medication in two days.

For more information please contact Carol Freedman at carol.freedman@lahey.org or at 978-380-4089.

WELLSENSE MASSHEALTH ACO UPDATES

We understand there has been an influx of communications and meetings surrounding the WellSense MassHealth ACO which went live on April 1, 2023. In an effort to help keep resources consolidated, we have created a tab on our website dedicated to information we are able to share that we believe will be helpful at this time. 

www.nepho.org/masshealth-aco

Check back frequently for additional resources!

Click here to view, download and print a document that will aid in navigating the MassHealth product lines, accompanied by this MassHealth Provider Bulletin that breaks down the ACO exclusivity. Please note: the cheat sheet refers to products that COULD be accepted, but not necessarily ARE accepted by your practice. To determine if your practice is participating in a specific contract through the Northeast PHO, please click here to refer to our Contract Participation Grid or reach out to Alycia.Messelaar@Lahey.org.

TEACHING SELF-COMPASSION IS ESSENTIAL TO TEENS’ MENTAL HEALTH

Please click here to read an article written by Dr. Elizabeth Humphreys, Pediatrician at Garden City Pediatrics. 

BILHPN TEXTING CAMPAIGN

BEHAVIORAL HEALTH RESOURCES

Please visit the new Behavioral Health Resources section on the NEPHO website. We have added information and links that we hope will be helpful to you and your patients. 

For more information, contact Ali Wiklund at Alison.Wiklund@Lahey.org. 

PAYOR UPDATES

PHARMACY UPDATE

For All Senior Patients: Prescription Advantage 

Most of our senior patients have pharmacy coverage by a Medicare Part D plan or a Medicare Advantage plan. As you know, patients have up to a $500 deductible, just for prescriptions, and may be approaching the coverage (Donut Hole) gap where out-of-pocket expenses can be significant. Please see the 2023 Medicare Part D Prescription Drug Coverage Phase Tip Sheet for more information. 

All senior patients should sign up for Prescription Advantage (PA), a Massachusetts state-sponsored secondary coverage prescription drug assistance program, for seniors and people with disabilities, regardless of prescription coverage or income. Call 1-800-243-4696 or www.prescriptionadvantagema.org 

Some key points about Prescription Advantage: 

• No enrollment fee for most seniors ($200 fee for higher income individuals/couples) 
• PA supplements prescription drug benefits for medications covered by Medicare Part D or credible coverage plans based on income and out-of-pocket threshold met 
• > 65 y.o., eligible for Medicare, and meets income guidelines 
• < 65 y.o., works no more than 40 hrs./month and meets Mass Health’s Common Health disability/income guidelines

Helpful information: 

Prescription Advantage Application Form 

Prescription Advantage Overview 

BILHPN Pharmacy Newsletters: 

Please see BILHPN Pharmacy newsletters with current pharmacy related issues. Click here to access past issues*. 

*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. 

POPULATION HEALTH UPDATE

Cervical Cancer Screening and HPV Vaccination

HPV Vaccination: On Time Vaccination Rates (Claims through 3/31/23)

• HPV vaccination rates have increased 14% since 2022!
• Continue to provide confident recommendations for the 2 doses of Gardisil prior to the patient’s 13th birthday.

BCBS PPO – Immunizations for Adolescents : HPV 21.67 %
BCBS HMO – Immunizations for Adolescents : HPV 25.00 %

Tu Salud: Latino Health and Wellness Fair
Fenway Park- DELL/EMC Club
Sunday, June 11th, 2023
12:00pm – 5:00pm

• BILH sponsored event
• Family friendly, Latino health and wellness fair
  • Games, activities, music, entertainment
• Ali Wiklund, FNP-BC and Dr. Reyes will be hosting a table
  • Providing information on the importance of routine cervical cancer screening
  • Providing information on the importance of on time HPV vaccination

For more information, please click here.

DIABETIC EYE EXAM CLINIC

NEPHO and Cape Ann Eye Specialists collaborated to hold a Saturday morning clinic in Gloucester for patients needing diabetic eye exams. Patients were also able to get free blood pressure checks and reminded of upcoming appointments. Pictured is the team who staffed the clinic: Liz Isaac, NEPHO; Jane Sheridan, eye technician; Mercy Njuguna, Office Manager; Dr. Weinstein-Zanger and Ali Wiklund, NEPHO.

Many thanks to Cape Ann Eye Specialists for a successful clinic!

PROVIDER RELATIONS

Virtual Networking videos from NEPHO providers can be found here.

Please reach out to Alycia Messelaar at Alycia.Messlaar@Lahey.org if you are interested in being featured in a Virtual Networking video. 

Click here for the PDF version of the updated PHO Directory as of May 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!

• 2023 Annual Meeting: Vote & Proxy Response Requested by June 14th
• Monthly BILH Pharmacy Newsletters 
• Monthly BILHPN BMC WellSense MassHealth ACO Newsletter 
• Monthly Beth Israel Lahey Health Performance Network CDI Newsletter 
• HPHC Cybersecurity Updates 
• Boston Children’s Hospital  
  • May 2023 Continuing Education Opportunities 
  • Updated Urgent & Emergent Access Guide 

Please reach out to Alycia.Messelaar@Lahey.org for a specific communication that you are unable to find.

DEA Fraudulent Calls

BILHPN would like your staff and providers to be aware of recent reports of fraudulent calls made to BILH primary care practices by individuals misrepresenting themselves as agents with the Federal Drug Enforcement Administration. A recent warning to the public from the DEA has confirmed these bad actors are targeting physicians, providers, and the public, attempting to extort money and Personal Identifiable Information (PII). The caller may reference a provider’s NPI or state license number, in order to appear more credible and influence the provider or staff to disclose the requested information. DEA personnel will never initially contact providers by phone, nor request PII over the phone. Legitimate investigations by the DEA are initiated via an official letter or in person, not phone calls. Please share this information with your staff and providers, and ask them to report any such calls to your Integrity and Compliance department contact or the Northeast PHO.

See link to the DEA press release for additional information: DEA Press Release

As a best practice, when receiving calls requesting data such as this, it is important for staff to ask for a name, company, call back number and direct email and outline the call will be returned. This gives your practice the ability to confirm the call is not fraudulent, as well as track specific calls coming in. 

TELEHEALTH RESOURCES

As the Public Health Emergency (PHE) ended on May 11, 2023, the Northeast PHO wanted to share resources pertaining to TeleHealth.

• Massachusetts Medical Society – What you Need to Know about Telemedicine and Informed Consent https://www.massmed.org/telemedicine-informed-consent/
• HRSA Health Resources & Services – Telehealth policy changes after the COVID-19 public health emergency https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency
• Center for Connected Health Policy – Massachusetts https://www.cchpca.org/massachusetts/
• Commonwealth of Massachusetts Board of Registration in Medicine – Telemedicine policy update https://www.mass.gov/doc/policy-20-01-policy-on-telemedicine-amended-october-6-2022/download
• Massachusetts Medical Society – TeleHealth and Virtual Care https://www.massmed.org/Practice-Support/Telehealth-and-Virtual-Care/Telehealth-and-Virtual-Care/
• Drug Enforcement Administration (DEA) https://www.nepho.org/drug-enforcement-administration-dea/

Please click here to request access to the May 24th Medical Service Conference, presented by Dr. Louis Tramontozzi, Dr. Joseph Peppe and Chad Brouillard, Esq.

REFERRAL MANAGEMENT UPDATE

As a reminder, providers with Ophthalmic Consultants of Boston (i.e., Drs. Tina Cleary, Mina Farahani, Ambika Hoguet, James Hung and Laura Voicu) are no longer participating in the Northeast PHO network. New patient appointments requiring referrals will not be approved.

Please refer to one of the following NEPHO eye care providers for your patients:

OPHTHALMOLOGY (*Sub-specialty)

QUALITY DEPARTMENT UPDATES

Wednesday, May 17 was World Hypertension Day.

To help support our goals and initiatives regarding blood pressure, consider implementing some or all the following best practices:

• Take BP a 2^nd time if greater than 139/89.
• Re-schedule anyone with a high BP for a BP check or follow up appointment before they leave the office.
• Try to take the blood pressure at the end of the rooming process.
• Before taking the BP, ask the patient to close their eyes, imagine a beautiful place, and take 3 deep breaths. Take their blood pressure when they open their eyes.

Many practices across NEPHO already incorporate some or all these best practices. If you have a best practice you would like to share, let us know!

If you have any questions, please reach out to the Quality or Population Health Team. We appreciate all your help. 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 and a link to the recording of the September 12, 2022 Session. Click on each date to register.

Provider Acuity Training Series with CME Credit

Click here to request access to view the Recording for the September 12th Provider Acuity Training Series Session.

July 18, 2023, from 5:30 – 6:30 p.m.

Arcadia Acuity Trainings

August 10, 2023, from 12:05 – 1 p.m.

November 7, 2023, from 12:05 – 1 p.m.

CLINICAL DOCUMENTATION IMPROVEMENT

OPTUM NEWSLETTER – May – Focus on: Arthritis (rheumatoid, osteo and psoriatic)

Please click here to view the 2023 Optum webinar schedule.

Facts About Coverage Post PHE

Here are some highlights of what is changing on May 11, 2023, (or later) for telehealth services billed under Medicare Part B:

• Virtual check-in codes (G2012, G2010, G2252) and remote patient monitoring codes will only be allowed for established patients after the PHE ends.
• Medicare will continue to pay for audio-only telephone services billed with CPT® codes 99441-99443 through Dec. 31, 2024, when appropriate and all required elements in the code descriptions are met. The payment parity to CPT® codes 99212-99214 is also extended through Dec. 31, 2024.
• Behavioral and mental health services (CPT® 90785-90840) are now permanently added to the Medicare Telehealth Services List and may be provided using audio-only equipment through Dec. 31, 2024.
• All other services on the Medicare Telehealth Services list, unless otherwise indicated, require audio-video equipment permitting two-way, real-time interactive communication. CMS will update the list for 2024 using standard protocols.
• Incident-to services via virtual supervision will no longer be allowed after Dec. 31, 2023.
• When the PHE ends, CMS will continue to allow for a total deferral to state law regarding licensure requirements for billing Medicare for services provided outside of their state of enrollment. State laws may override this freedom, however.
• Practitioners must resume reporting their home address on the Medicare enrollment beginning Jan. 1, 2024.
• All telehealth platforms must be HIPAA compliant starting the day after the end of the PHE (May 12). Smart phone video options such as FaceTime and Skype will no longer be an option for telehealth after the PHE ends, per the Office of Civil Rights.
• Place of service (POS) codes will continue to be used based on where the patient would have been seen had they been seen in person. However, POS 02 Patient not in their home when telehealth services are rendered or POS 10 Patient in their home when telehealth services are rendered may be reported, as appropriate. Reporting these specific POS codes will result in facility reimbursement.
• Modifier 95 Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system will continue to be used for audio and video services for Medicare telehealth through 2024.
• Modifier 93 Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system must be used, as of Jan. 1, 2023, for all audio-only services. Many commercial payers have instructed providers to append this modifier to services listed in Appendix T of CPT® 2023.

Remember that this guidance applies to Medicare Part B only. Make sure to check other payers’ policies to ensure compliance.

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 and Specialty Care, Beverly – 30 Tozer Road Suite 203

• I recently changed my PCP to Dr. David Driscoll & am very grateful I did. He was so patient & thorough during the visit. He took the time to review tests I had previously done & answered all questions I had.
• The staff were knowledgeable & helpful. Dr. Deborah Shih is always a pleasure to visit with.

Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center

• Dr. Pierre Ezzi – Everything was very good. I have been a patient in this office for years & have been very happy all of them!

Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center 

• Dr. Daniel McCullough – the BEST! Anything wrong, he’s the fixer.

Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street

• Dr. Brent Fryling is a very good doctor! He takes time to talk & explain what is going on.

Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor

• I couldn’t ask for a more professional, caring, knowledgeable physicians! Dr. Victor Carabba is truly a superior human!
• I consider myself very lucky to have had Dr. Karen Damico recommended to me by 2 nurses who worked at Addison Gilbert Hospital. She is an excellent, caring and thorough physician.

Blackburn Primary Care, Gloucester – 1 Blackburn Drive

• Dr. Jay Isaac is very ‘present’ and interactive. He listens to my concerns and provides relevant medical suggestions and advice. I feel confident in his assessment of my medical journey.
• Dr. Jay Isaac is the best doctor I’ve had the pleasure of being with as well as my family. He is caring, kind knowledgeable and goes above and beyond for his patients.

Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive

• Dr. Brian Orr and his team are so helpful and understanding. He gave a great recommendation/referral and that doctor reached out to us the next day with very wise advice.

Cape Ann Medical Center, Gloucester – 1 Blackburn Drive

• Always professional and respectful. Dr. Janet Doran’s experience is highly respected by me as she utilizes her knowledge in a positive way.
• Dr. Shawn Pawson is a tremendous asset to the CAMC. He is professional as well as very caring. I am very fortunate to have him as my primary caregiver!

Danvers Family Doctors, Danvers – 140 Commonwealth Avenue

• The staff is always helpful and friendly. They accommodate your needs in a timely manner. Dr. Subroto Bhattacharya is so knowledgeable and patient, never making you feel rushed.

EMTAR Healthcare, Inc., South Hamilton – 205 Willow Street

• Dr. Michael Edwards – Always treated with respect. They all make you feel very comfortable and at ease. Love this place

Essex County Primary Care, South Hamilton – 42 Asbury Street 

• Dr. Nicholas Avgerinos – Very good visit – Spent time – No rushed – Answered all questions.

Garden City Pediatrics, Beverly – 83 Herrick Street

• We have always & will always recommend Dr. John Dean & Garden City to our friends & family.
• Dr. Suzanne Graves has ALWAYS been there, available and supportive
• We continue to be happy with Dr. Eric Sleeper and the entire Garden City Ped. Staff – thank you all!

North Shore Pediatrics, Danvers – 480 Maple Street 

• North Shore Pediatrics and Dr. David Danis are an absolute FAVORITE. We cannot speak highly enough of Dr. Danis!!
• We absolutely love Dr. Lance Goodman. We have had nothing but positive experiences with this office.

Thomas Pearce, MD, Gloucester – 279 East Main Street

• Dr. Thomas Pearce is an exceptional doctor and care giver who always takes the time to really understand his patients! I appreciate his expertise and care!

Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road 

• I have always been satisfied every time I have spoken to staff and Dr. Candace Thompson and Amy. They make you feel so comfortable. They take great interest in helping you in any way they can.

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:

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!