Spring 2019 Newsletter
- Annual Wellness Visits Are Not Physicals: Why the Verbiage Matters
- 4 Strategies for Clinical Integration Success in 2019
- Transitional Care Management Toolkit Now Available
- The 2018 Value Report for Physician Integration and Population Health Management
- The Benefits of Using the Medicare Practice Questionnaire
- Identify Breaches with Revised HIPAA Reporting Tool
- Fall Prevention Workshop Announcement
- Stay in the Know with Text Alerts
Annual Wellness Visits Are Not Physicals: Why the Verbiage Matters
When a Medicare patient requests to schedule a “physical,” it’s important to clarify with them whether they are looking to schedule a physical or an Annual Wellness Visit.
Physicals are not covered by Medicare (meaning patients will have to pay out of pocket). But Annual Wellness Visits are fully covered. (Medicare Part B and Medicare Advantage members may have additional coverage for physicals/preventive services.)
A physical involves an exam plus bloodwork or other tests. Meanwhile, an Annual Wellness Visit doesn’t include a physical exam and is focused on developing a “personalized prevention plan” for future issues. And remember to use the Medicare Patient Questionnaire to help collect important information that will help you better serve your patients’ needs while meeting quality metrics.
Make sure your patients understand the difference between these two types of appointments and their payment responsibility. Learn more about these types of visits and their history.
4 Strategies for Clinical Integration Success in 2019
As more Medicare and Commercial ACOs appear on the horizon, focusing on strategies that can help us succeed — along with short-term practical metrics for accountability — is critical. Nicholas Stine, MD, Dignity Health Senior Medical Director, Value-Based Care, Population Health Management, offers these four key strategies that can help drive our success for 2019:
- Proactive engagement of complex and frail elderly patients.
There’s an emerging evidence base that the majority of potentially preventable Medicare spending is concentrated within the frail elderly. We’ve conducted some initial analyses to better characterize them in our MSSP data. Interestingly, while they have high costs, they are not always the same patients we identify using other risk scoring methods.
- Increase the use of Transitional Care Management (TCM) coding.
TCM services, which involve close and careful engagement of patients following hospital discharge to transition them back into continuity primary care, are associated with an impressive 11 percent reduction in total costs and 37 percent lower 60-day mortality (see study attached ). These services are also heavily underutilized. As our updated TCM toolkit is now complete, we have an opportunity to map out the process — particularly in how Care Coordination and primary care practices work together to scale up TCM utilization across the networks.
- Focus on post-acute and skilled nursing care.
Post-acute care is the greatest source of Medicare spending variation nationally. Bringing together the different work and programs impacted by post-acute care spending (particularly SNF and inpatient rehab services) to organize a more comprehensive current state assessment, gap analysis and its corresponding strategy are key for success. This is a complex undertaking, but national data and our BPCI experience clearly demonstrate that PAC is a highly modifiable spending area and must be considered a core strategy.
- Reducing Part B/Specialty Drug costs.
We have an excellent use case in Macular Degeneration and the use of Avastin as a significantly more cost-effective treatment than other anti-VEGF biologics, with no clinically significant differences among them. We must ensure its success while also expanding into a broader strategy for managing Part B/Specialty spending.
Establishing and refining these strategies will be critical for ACO success across our markets.
Transitional Care Management Toolkit Now Available
Transitional care management (TCM) after a discharge from an acute care setting (e.g., inpatient acute care hospital, inpatient rehab facility, SNF) is what patients need. Research shows the use of TCM services is associated with a reduction in mortality and total Medicare costs; however, the use of this service remains low. TCM enhances patient satisfaction, improves care coordination and potentially rewards you for preventing a hospital readmission within 30 days of discharge.
To help your practice more successfully operationalize your TCM services, we have created a Transitional Care Management Toolkit which:
- Will assist you with the understanding, documentation and the implementation of the TCM services
- Explains TCM, the applicable settings and the advantages it offers
- Provides answers to frequently asked questions
- Gives practices a documentation checklist
- Offers TCM background research and resources
The toolkit is a general guide and is designed to be adapted to each market and practice.
The 2018 Value Report for Physician Integration and Population Health Management
The 2018 Value Report for Physician Integration and Population Health Management has been released. Titled From Theory to Action: Executing on the Quadruple Aim, the report highlights how the steps we take to ensure healthier patients — including evolving our clinical workflows, tracking and reporting key quality measures, and developing initiatives that support healthy communities — enhance our ability to care for our patients and our success in value-based programs.
Other highlights include:
- Our success in the Bundled Payment for Care Improvement (BPCI) Program
- The Medicare Shared Savings Program (MSSP) and the work of our five Accountable Care Organizations
- The role of our Clinical Steering Committee and Value-Based Agreements Council in driving our strategy
- How our subcommittees contribute to the work we do
- The value of our digital team, Community Health department, the Foundation and Graduate Medical Education
The 2018 report builds on our inaugural report, which showcased the foundation of the program, and helps educate our internal audiences and leadership on the activities, depth and breadth of Physician Integration and Population Health.
Throughout Dignity Health’s hospitals, medical groups, clinically integrated networks and accountable care organizations, we’ve been focused on collecting actionable data and on setting targets that empower us to achieve the Quadruple Aim. In 2017 and 2018, we saw our strategies take shape as we arrived at key benchmarks. We are optimistic about the opportunities we see on the horizon — and all that we can achieve.
View the digital version of the 2018 Value Report at dignityhealthvaluereport.org.
The Benefits of Using the Medicare Practice Questionnaire
The Medicare Practice Questionnaire is a critical tool that supports preventive care and helps enhance patient outcomes. The questionnaire also satisfies reporting requirements for several MSSP quality measures, including tobacco use, fall risk and depression screenings.
The questionnaire also helps you stay up-to-date on your patients’ health activities — including whether they’ve gotten their flu shots this year or if they are due for a colonoscopy — so you can update their charts accordingly and make recommendations for follow-up appointments or refer them for screenings. We recommend:
- Having patients complete the practice questionnaire during wellness visits.
- For patients who don’t come into the office for their AWV but schedule appointments for acute illnesses or other reasons, the questionnaire can be used to collect the patient-reported data you might otherwise not have the opportunity to capture.
- Saving patients’ answers from the questionnaire electronically in their chart, so that the data can be easily accessed and submitted to CMS.
You can find the Medicare Practice Questionnaire for patients here.
Identify Breaches with Revised HIPAA Reporting Tool
The U.S. Department of Health and Human Services (HHS) has updated its Health Insurance Portability and Accountability Act (HIPAA) Breach Reporting Tool to help health care entities better identify breaches of health information and learn how they are investigated and resolved.
You can access the HBRT here and use it to stay informed about current security threats and in the event that a breach occurs. For additional information on HIPAA breach notification, visit the HIPAA Breach Notification Rule webpage.
Fall Prevention Workshop Announcement
Fall Prevention Workshop: Download the Flyer to Share with Your Patients
Falls are a serious health concern among seniors, with one in four adults over 65 falling each year. To help address falls and the concerns many older adults have about them, we’ll be hosting fall prevention workshops every Thursday from June 6 through August 1 at St. Joseph’s Medical Center. Please help us spread the word by sharing the attached flyer regarding this no-cost series with your patients. It includes all the details they’ll need to register and attend.
Stay in the Know with Text Alerts
Spend less time in your email inbox and never miss important network news by opting in to receive text alerts. With these new alerts, you’ll receive a text when there’s important network news or announcements. (The system is fully HIPAA-compliant, and patient data will never be sent.) So, whether you’re frequently on the go or simply prefer texts, text alerts make it easier to stay up to speed.
If you want to sign up to receive the text alerts, simply use your mobile phone and text “SJQCN” to 797979.