Connect Archives

September 2015

Friday, September 18, 2015

HEALTHSPRING TERMINATION NOTICE

HealthSpring has notified Health First Network, Inc. that they are terminating their agreement with us effective midnight 12/31/2015.

HealthSpring will be contacting your office to contract directly with them. If you have any questions regarding the termination, please contact Jackie Murph, HFNI Director, Network Development/ Provider Relations/Credentialing at (850) 438-4487.

CHRONIC CARE MANAGEMENT BETA PROGRAM UPDATE

Work is progressing towards the launch of the Health First Network (HFNI) Chronic Care Management Program on 10.01.2015. The initial participating physicians and their potentially eligible patients have been loaded into our data handling program, MirthCare, and Mirth is completing their quality review and process verification steps as we speak. The Event Notification Service (ENS) likewise is loading data on our physicians and patients, and is scheduled to be live on 10.01.2015 as well. These 2 programs are designed to give our providers and support staffs an unprecedented real-time ability to coordinate care for all of their patients, especially the chronically ill, across the inpatient/outpatient continuum. We are pleased to be able to bring these tools on board.

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ACO QUALITY SCORES

The Centers for Medicare and Medicaid Services (CMS) has published the official Quality Measures Performance Scores for organizations participating in the Medicare Shared Savings Program (MSSP) for 2014. As you all know, CMS has (currently) 33 Quality Measures ranging from things like patient satisfaction with their physicians to the percentage of hypertensive patients with blood pressures controlled to below 140/90, and everything in between. To be able to participate in any shared savings, an organization must show consistently high quality across 4 domains of patient care and experience comprising the 33 individual measures. The Accountable Care Coalition of Northwest Florida (ACCNWFL), our Accountable Care Organization (ACO), posted an overall score of 87.71%. This is excellent news, and confirms that the ACCNWFL both delivers, and is able to track, high quality medical care provided to the residents of our communities; with patient satisfaction scores solidly in the 90th percentile, it appears our patients agree. This figure also represents a solid year-over-year improvement compared to last year’s reporting. There is always room for improvement, and there are a number of areas where we will be focusing efforts to improve both our quality and reporting. We are pleased to be able to share the results achieved by specific practices, and we will be doing that in individual meetings over the coming weeks. Thanks to all of our docs and their office staffs for doing such a great job taking care of our families and our friends.

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COMPLIANCE UPDATES

Cancer Care Group, P.C., an Oncology Group in Indiana, has agreed to pay $750,000 in fines related to violations of HIPAA. A laptop computer and non-encrypted storage device was stolen from a Cancer Care Group employee’s care.

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) determined that the breach could have been prevented had Cancer Care Group conducted a system-wide risk analysis and implemented policies related to removing devices containing PHI from their facilities.

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HOME HEALTH AND DME UPDATE

WellCare of Florida is no longer contracted with Univita for durable medical equipment, home health care, or home infusion services. This termination includes Healthease Kids, Staywell Kids, Staywell MMA and WellCare Medicare programs in Florida.

To ensure their members receive the services and equipment they need, please utilize the following:
Standard requests (Fax)
For General DME and Home Health requests: 877-426-7091
For Members being discharged from an inpatient setting in need of Home Health or DME: 855-421-5616
For infusion service requests contact: BioScrip Central Intake Phone: 866-788-7710, Fax: 888-292-1228, or Walgreens Florida Contact at Phone: 800-396-2933; Fax: 888-550-8880

Urgent requests (Phone)*:
Medicaid: 800-351-8777
Medicare: 855-538-0454
*Note: Please utilize the fax number as much as possible, your service will be handled more expeditiously.

Other questions or concerns can be directed to the WellCare Provider Service Department at the following numbers:
HealthEase Kids: 1-800-278-8178
Staywell Kids: 1-866-698-5437
Staywell (MMA): 1-866-334-7927
Medicare: 1-855-538-0454

Active authorizations for Home Health, DME, and infusion services will continue to be honored and paid at the rate providers were previously contracted with under Univita throughout the continuity of care period identified below.
• Staywell (MMA): 60 days after August 1, 2015
• Healthease Kids and Staywell Kids: 30 days after August 1, 2015
• Medicare: 60 days after August 1, 2015

MGMA CALLS FOR EXTENSION OF 2015 MEANINGFUL USE REPORTING PERIOD

Yesterday, MGMA issued a press statement urging the Centers for Medicare & Medicaid Services (CMS) to provide additional time for medical groups and others to report measures for the EHR Incentive (meaningful use) Program in 2015. In an April proposed rule, CMS outlined a number of necessary changes, which would establish a 90-day reporting period, reduce measure thresholds for patient portals, and eliminate a number of redundant and duplicative measures. With no sign of a final rule, the industry is on hold as it continues to wait for CMS to finalize these changes. Medical groups and their EHR vendor partners need these revised specifications before they can move forward. The last day to start the final reporting is October 3rd. The Association is very concerned that there will be insufficient time to transition to the revised meaningful use requirements in 2015. Adding to this challenge is the fact that the industry is facing the transition to ICD-10 on October 1st.

MGMA is calling on CMS to allow medical groups the option of reporting 2015 data in the last 90 days of 2015 or into the first 90 days of 2016. For the 2016 reporting year, MGMA recommends the agency move to a 90-day reporting period--permitting those who elect to report measures in the first 90 days of 2016 to have the three remaining quarters to report 2016 measures.

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OBAMA DRAFTS EXECUTIVE ORDER ON PAID SICK LEAVE: WHO WILL IT AFFECT?

Mandated paid leave continues to be a focus of the Obama administration. But it won’t affect all employers. The latest order, which the DOL is currently reviewing, would require federal contractors and subcontractors to provide their employees with a minimum of 56 hours (seven days) of paid sick leave annually. Who will it affect?

Landrum Professional’s opinion on the topic:
Based on the Department of Labor’s definition of a Federal Contractor, a doctor’s office that accepts Medicare or Medicaid payments does not constitute a Federal Contractor if that is the only relationship with the Federal Government (see below definition):

Is a hospital or other health care provider covered under the laws enforced by OFCCP as a result of the reimbursements it receives for medical care and services provided to Medicare or Medicaid patients?

The provider agreements, pursuant to which hospitals and other health care providers receive reimbursement for services covered under Medicare Parts A and B, and the provider agreements that hospitals and other health care facilities have entered into with State Medicaid agencies, are not covered Government contracts under the laws enforced by OFCCP. Accordingly, a hospital or other health care provider is not covered under the laws enforced by OFCCP if its only relationship with the Federal government is as a participating provider under Medicare Parts A and B and Medicaid. Please note that a hospital or other health care provider may be a covered contractor because of other contractual arrangements, such as providing health care to active or retired military under a contract with the Department of Veterans' Affairs or the Department of Defense. Likewise, a teaching hospital doing research for a university that has a contract with the Federal government may be covered.

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COLLABORATIVE CARE SUMMIT/ACO WEST

The Collaborative Care Summit was held August 20th - 21st in San Diego, CA. The event gave health industry leaders the opportunity to share their strategies and lessons-learned for greater success. Richard Tuten, CEO, HFNI and William Whibbs, M.D., HFNI, Medical Director served as guest speakers at the event.

Mr. Tuten discussed “Value-Based Payment and Shared Savings Distribution Methodologies”. Dr. Whibbs gave a presentation on “Lessons Learned from the First Three Years in the MSSP”.

NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:

Angel Morrobel, M.D. Cardiology/Cardiovascular Disease
David Zielinski, M.D. Family Practice
Tong Duong, M.D. Plastic Surgery
Richard Brunner, M.D. General Surgery
Sean Branch, D.O. Dermatology
Kerrian Hudson, M.D. Family Practice
Steve Jordan, M.D. Orthopaedic Surgery
Aaron Kovaleski, M.D. Vascular & Interventional Radiology
Melinda Graham, M.D. OB/GYN
Claudia Molina, M.D. Family Practice
James Oenbrink, M.D. Otolaryngology
Stephen Phlaum, M.D. Cardiology/Cardiovascular Disease
Anne Piantanida-Whitlock, M.D. OB/GYN
Lamar Robinson, M.D. Radiology
Todd Sanders, M.D. Radiology
Robert Turnage, M.D. Thoracic/Cardiac Surgery
Trevor Turner, M.D. Physical Medicine & Rehabilitation
Taylor Vaughan, M.D. Urology
Sean McWilliams, M.D. Otolaryngology

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

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