Connect Archives

August 2013

Tuesday, August 20, 2013

FROM THE DESK OF THE MEDICAL DIRECTOR

ACO Update:
HFNI has reached out to our area hospitals to facilitate better communication and data handling. One of the key data sets that helps improve outcomes and the way care is experienced is the data that is generated by acute inpatient episodes of care. Finding better ways to get the right subsets of data to the right providers of post-hospital care in the right time frame significantly improves the integrity of care that we deliver. As a part of that effort, our Care Coordination nurses will be visiting the ACCNWFL physicians and their office staffs to establish more familiar relationships, and present some of the capabilities that we have to offer to both the patients and the providers. We are excited about how this will impact the quality of care in our community.

WellCare:
HFNI is also working with Wellcare on a project that will allow access to more of the cost and utilization data for our IPA providers. The intention is to be able to identify and impact patterns of practice that either facilitate or hinder high quality care. This will include data on HEDIS measures which determine the plan’s star rating, and are the industry standard for overall quality of care. Because star rating is reflective of performance on specific quality measures, higher star ratings reflect the quality of all of our providers. As this project moves along, we will be sharing the results, and looking for some insight from our physicians to help with further improvement.

As your IPA, we are constantly looking for innovative ways to improve both the quality of, and the access to excellent healthcare for all of the people in our community. We are always grateful for your involvement in what we are doing, and what we are trying to do.

DOCUMENTATION AND REIMBURSEMENT: HCC CHAPTER 3

We are all aware of the relationship between medical record documentation and the capitation payment that is available under a risk adjusted payment model. What sometimes does not connect is how some seemingly minor changes in documentation can have a dramatic effect on the compensation. Click on the link below for the full article.

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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 be retroactively applying these federally mandated reductions for claims paid with dates of service after April 1, 2013. On July 1, 2013, HFNI began reducing payments by the required 2%. For dates of service between April 1, 2013 and July 1, 2013, HFNI will be sending recoupment letters. You can either make a payment to HFNI for the recoupment amount, or HFNI can recoup these amounts from future payments. We apologize for any inconvenience that this causes, but we must comply with Federal law.

EBM PROTOCOLS

Evidence Based Medicine Protocols
A Simple Approach

EBM protocols provide a concise (relatively speaking) distillation of approaches to medical problems that have proven to be most effective, and most efficient. They are designed to give clinicians access to what works in a unified framework. There will always be situations that don’t fit, and even in those cases, the protocols are useful in identifying why they don’t fit, and how they may be approached. They provide a standard within which, or around which, a clinician can confidently construct a plan of attack for a given clinical problem in a particular patient, and document her/his clinical thinking in reference to that plan. As such, the protocols function as a pathway.

The positive impact of the protocols shows up in the quality of the care, and in the quality of the outcomes. The protocols have built into them, either explicitly or implicitly, metrics that are focused on the quality of both the care and the outcomes. If a clinician (group or individual) is able to meet the metrics involved, in a sense, it doesn’t matter if they are following a particular protocol or not. However, if the metrics are not being achieved, the protocol provides a template that encourages behaviors and practices that will allow those metrics to be met consistently. And as advances in understanding and technology continue to take place, the evidence will continue to evolve, and the protocols will be modified to accommodate that ongoing organic growth. Back in the “old days”, we used to call it “cook book medicine”; that was before the evidence base was broad enough and deep enough to trust…now, all that has changed.

Health First Network, Inc. draws its protocols and measures for consideration and adoption primarily from the National Guidelines Clearinghouse (NGC), and its companions, the National Quality Forum (NQF) and the National Quality Measures Clearinghouse (NQMC). All are sponsored by the Agency for Healthcare Research and Quality, and are the repositories for fully vetted documents. They are updated on a regular basis, and provide links and references to sources and organizations responsible for the development of each protocol. Health First Network, Inc. is working with both government-sponsored and commercial payers on incentive programs that are based on large national databases such as HEDIS and PQRS in order to develop methods of displaying and interpreting those data so they have the greatest positive impact on both our patient population and our provider community. HFNI is also working with the organizations and groups involved in developing and deploying Health Information Exchange technologies and strategies that will assure continuous real-time availability of critical clinical information that is necessary for optimally coordinating the care of our patients by our clinicians and institutions in our community.

The clear direction ahead involves the continuous measurement of quality performance; there is tremendous overlap in all of the sources of quality measures, and being able to achieve consistent quality outcomes across all of them is precisely where the advantage of using evidence based protocols resides.

Below is a brief listing of the Evidence Based Protocols HFNI has adopted that are specifically built around the quality measures required for participation in the Medicare Shared Savings Program (MSSP) /Accountable Care Organization (ACO). There are additional protocols that have been approved, and the Clinical Integration Committee (CIC) of HFNI is reviewing and adopting protocols suggested by our physicians, and based on the perceived needs of our community. These will be made available in a similar format. Bear in mind that these protocols are applicable across all delivery and reimbursement models because the focus is on desirable patient outcomes, and the proven means of achieving those outcomes.

The National Guidelines Clearinghouse website www.guideline.gov houses the most recently updated versions of the summaries of the protocols, and each summary has a link to the complete protocol. Likewise, the National Quality Measures Clearinghouse website www.qualitymeasures.ahrq.gov and the National Quality Forum website www.qualityforum.org house the associated quality measures. Additionally, PQRS www.cms.gov/PQRS and HEDIS www.NCQA.org/HEDIS are the sources of the other major quality measurement programs. Each description in this listing will have corresponding NGC, NQF, and ACO identifiers; there is a description of the actual metric as it is designed to be calculated. The bullets are important points extracted from each protocol.

There are a few very basic concepts that underpin all of Evidence Based Medicine:
The highest quality and the best outcomes come about when the patient and their family or care/living unit are as completely engaged and educated as is practical;

Basic lifestyle modifications have significant impact on baseline health and on response to any evaluation and treatment regimen, and should be encouraged and reinforced at every opportunity by everyone involved;

The highest quality and the best outcomes come about when the clinician and the care team are as completely engaged and educated as is practical.

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HFNI SHAREHOLDER MEETING ANNOUNCEMENT

The Annual HFNI Shareholder’s meeting will be held on Monday, September 30, 2013 at 5:30 p.m. at Health First Network located at 2929 Langley Avenue, Ste. 103, Pensacola, FL.

If you are planning to attend, please RSVP to Michelle Hamilton at MHamilton@hfni.com

NEW HFNI SHAREHOLDER PAGE AVAILABLE ONLINE

As part of our continuous commitment to provide access to important information, Health First Network has added a new “HFNI Shareholder’s page” to the website.

If you are an HFNI Shareholder, please take a moment to register.

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MLN CONNECTS

The Center for Medicare and Medicaid Services (CMS) has partnered with the Medicare Provider Learning Network (referred to as MLN or MedLearn Matters) to produce “MLN Connects” monthly Provider e-news bulletins that consolidate all CMS-issued information for Providers. These e-News Bulletins contain updates such as monthly CMS National Provider calls, CMS Announcements and Reminders, Quality Incentive Program Notices, Policy Updates, Claims, Pricer and Coding Updates, and new MLN Provider Education Fact Sheets and Products. Health First Network will be placing these bulletins on the website as they become available.

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NEW HFNI DEPARTMENTAL FAX NUMBERS

Please be advised that HFNI has added additional secure departmental fax numbers.

General Faxes: 850-438-0298
Credentialing Dept: 850-438-0298
Medical Dept: 850-290-4822
Provider Relations Dept: 850-434-8253

NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:
Robert Nichols, M.D. - Family Practice
Bryan Weidner, M.D. - Pediatric Surgery
Jennifer Walker, M.D. - Pediatrics
Surendar Veera, M.D. - Hospitalist
Padmavathi Pendurty, M.D. - Hospitalist
Shalesh Kaushal, M.D. - Ophthalmology
Douglas Bunting, M.D. - Nephrology
Vicente Mendez, M.D. - Internal Medicine

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

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