Connect Archives

June 2013

Wednesday, June 26, 2013

ACO UPDATE

The ACCNWFL is making progress, although maybe not as fast as we had initially hoped. As with anything new, there are always bugs, both anticipated and unanticipated, and those just have to be worked out as they come up. There is a quiet spirit of cooperation among all of the participants that is both refreshing and reassuring.

As was anticipated, the flow of data from CMS into the data warehouse of our partner, Collaborative Health Solutions, has not been as smooth as we wanted. As a result, getting really accurate numbers on attributed patients and “clean” claims histories remains a challenge. We are rapidly approaching 10,000 attributed beneficiaries, give or take a thousand. The “opt out of data sharing” and “opt in for the sharing of mental health and substance abuse data” processes are critically important, and are being revised currently to safeguard the patients information. The amount of data that will be available to help coordinate care is huge, and the preliminary reports we have worked with are extremely helpful in identifying high risk patients and utilization trends.

Despite the bumps in the road, ACCNWFL has 3 care coordinators working with the physicians’ offices to identify and contact patients, and we are already seeing success stories based on those efforts. The team is working with the data that is coming through from Houston as well as information from the patients themselves and the physicians and their office staffs that allow critical interventions to be made.
Our ACO is also developing a method for identifying patients receiving inpatient services in real time which will be a great help in coordinating post-discharge care. We are working with our hospitals and Skilled Nursing Facilities to identify ways to improve transitions of care from institution to institution and from institution to home, and also Emergency Department utilization and follow up.

The PQRS data collection and submission was completed successfully all the way through from PCP office to GPRO upload, which assures all of the ACO physicians of the bonus. ACCNWFL learned a lot in the process, and that will be put to good use when this is due again next year. Because the reporting is the responsibility of the ACO, participating physicians do not report individually. Actual performance numbers are not available at this point, and the actual benchmarks have not been published by CMS yet.

As we approach the July 1 anniversary of the first calendar year of operation (our first fiscal “year” ends on 12.31.2013…it’s actually 18 months long…only a month longer than the gestational period of a Killer Whale) the value of the concept is clear: coordination of patient care requires coordination of ALL of the providers, and that’s good for ALL of us.

SEQUESTRATION

HealthSpring has informed HFNI that they will begin taking back funds due to the 2% Medicare payment reduction required as a component of sequestration. Therefore, HFNI will begin recoupment for claims with dates of service after April 1, 2013. For paid claims with dates of service after April 1, 2013, Health First Network will be recouping the 2% from future payments. For out of network providers, Health First Network will be sending a recoupment letter.

DRG PRICING

Effective 7/01/2013, Florida Medicaid will implement a new, mandated inpatient payment method utilizing Diagnosis-Related Groups (DRG’s) for Florida Medicaid admissions. This is a significant transition that will affect the majority of Medicaid inpatient claims. Payment to hospitals will be based on patient acuity, not length of stay, and, like Medicare DRG payments, a single payment is made per admission. The link below contains 4 separate information sheets, and are quick reference guides on the Medicaid DRG changes. They provide basic and detailed information on the payment changes and answer some frequently asked questions (FAQ’s). In addition, this Florida Medicaid bulletin has information about several upcoming webinars on the changes.

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PRESTIGE

Prestige has started enrolling Medicaid beneficiaries in its local managed care plan. Pursuant to Health First Network’s contract with Prestige, these beneficiaries are being assigned to HFNI PCP’s and are being referred to HFNI specialist physicians. Please contact Jenny Caillouet at 850-438-4487 with any questions.

To determine which physicians are participating in Prestige, please check the “Find A Doctor” section on the HFNI website.

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PHYSICIAN INSERVICE

Health First Network will be presenting a CME-Approved Program on Thursday evening, July 11, 2013 at New World Landing, in the British Room, located at 600 S. Palafox Street, for ACO-Contracted Physicians only. The two-part program will feature a presentation by Dr. William Whibbs on “Documenting In A Risk Adjusted World”, and a second topic covering ACO Updates.

Baptist Hospital has approved this educational activity for a maximum of 1.5 hours AMA PRA Category 1 creditTM. A Buffet Dinner will be served. Doors will open at 5:30 PM. The program will begin promptly at 5:45 PM. Target audience is ACO Primary Care Physicians and Specialists only.

For additional information, please contact the Provider Relations Dept. or Health Services Dept. at Health First Network at 850-438-0818.

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HFNI WELCOMES NEW STAFF MEMBER

E.L. Roché, Jr. is HFNI’s new Vice President, Finance. Mr. Roche will be responsible for the financial management of day to day operations for Health First Network. He is a Certified Public Accountant and has broad financial experience in healthcare and public accounting. E.L. proudly holds Bachelor and Master Degrees in Accounting from the University of West Florida. A life-long Pensacola native, he is an avid community supporter and volunteer.


HFNI WELCOMES NEW STAFF MEMBER

Stephanie Allen joined the Health First Network team in June 2013 and is a great addition to HFNI’s Provider Relations Department. Stephanie is a lifelong resident of the Pensacola area. She brings 25 years of outpatient billing, claims and supervisory experience with her. Stephanie’s knowledge of medical office procedures, billing and claims processing enhances the benefit she adds to the Provider Relations Department as she works with our Provider Offices under all contracted lines of business in her new capacity as a Provider Relations Representative.

Stephanie joins Amy Ates in assisting Jenny Caillouet in providing support and direction to Health First Network provider offices.

CONGRATULATIONS TO DR. WILLIAM WHIBBS

Health First Network sends congratulations to Dr. William Whibbs, HFNI Medical Director, on his recent ordination as a permanent deacon in the Catholic Church for the Diocese of Pensacola-Tallahassee.

Dr. Whibbs is one of nine men who were ordained as permanent deacons by Bishop Gregory L. Parkes during a Mass at the Cathedral of the Sacred Heart on June 1, 2013. Church deacons serve in their parishes to assist at worship services and other liturgical celebrations, and serve those in need in their local communities and throughout the diocese. The diocese of Pensacola-Tallahassee serves Roman Catholics in 18 local counties and includes more than 63,000 members.

Studies for the Deaconate include an intensive and structured 5 year academic study program. As a newly-ordained deacon, Dr. Whibbs joins approximately 50 other permanent deacons who serve in parishes from Pensacola to Perry, Florida.

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PROVIDER EDUCATION WEBINAR

Please click on the link below for more information on an Upcoming Provider Education Webinar from Health Management Associates.

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NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:
Robert Marcus, M.D. - Radiology
Richard Livernois, M.D. - Ophthalmology
Howard Heinze, M.D. - Pediatric Endocrinology
Valery Niedermeyer, M.D. - Pediatrics
Jeffrey Wolters, M.D. - Urology
Tamika Ussery-Freeman, M.D. - Hospitalist
Jennifer Driscoll, M.D. - Family Practice
Colette Reahl, M.D. - Pediatrics
Okan Elidemir, M.D. - Pediatric Pulmonology

** To determine which health plans each physician is participating in check the “Find A Doctor” section on the HFNI website.