QIN-QIO Public Sharing Call How the Annual Wellness Visit and Chronic Care Management (CCM) Can Help Transform Your Practice

Transcription

1 QIN-QIO Public Sharing Call How the Annual Wellness Visit and Chronic Care Management (CCM) Can Help Transform Your Practice Wednesday, July 25, :00 4:30 PM ET

2 Welcome and Reminders Please be prepared for sharing and open discussion Slides and a recording from today s session can be found on: Jane Brock, MD Call Facilitator Kaylie Doyle Chat Manager 2

3 Agenda Event Framing - Strengthening Primary Care Medicare Annual Wellness Visits Overcoming Roadblocks to Annual Wellness Visits Chronic Care Management and the Annual Wellness Visit Lessons Learned Panel Discussion Q&A 3

4 Purpose of the Series Audience: Patients, community and healthcare providers, local partners, federal partners, and Quality Improvement Organization (QIO) Program partners (*registration required) Purpose: Offer virtual training events to help healthcare professionals and QIN-QIO staff stay up-to-date on primary care services affecting the populations they serve Expectations: Participants will gain knowledge that is directly applicable to their work in healthcare quality improvement and acquire information that can be easily shared among their own community, organization, or team Topics: Topics will be aligned with the CMS Quality Strategy goals 4

5 Learning Outcome Understand how to implement the Medicare Annual Wellness Visit into physician practices. Explore at least two ways to implement Chronic Care Management (CCM) and use the CCM codes. 5

6 Things to Think About Will you commit to being Attentive Active Actionable Show your commitment by clicking the green checkmark! 6

7 Continuing Education Credit Continuing education credit is available for: Physicians and Physician Assistants Registered Nurses and Nurse Practitioners Dietitians Pharmacists and Pharmacy Technicians Certificate of Attendance 7

8 Instructions for Obtaining CE Attend the entire event Complete the evaluation that will pop up at the conclusion of the event There is a separate evaluation required for CE that will load in your browser following completion of the general evaluation Once you submit your CE evaluation, you will be provided with a certificate to retain for your records For technical assistance, please Patty Nelson (patty.nelson@qinncc.hcqis.org) 8

9 CE Information CME/CE Credit Provided by AKH Inc., Advancing Knowledge in Healthcare Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for Physicians. AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physician Assistants: NCCPA accepts AMA PRA Category 1 Credit from organizations accredited by ACCME. Pharmacy: AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN L04-P; UAN L04-T. Initial Release Date: 7/25/2018 Nursing: AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. This activity is awarded 1.5 contact hours. 9

10 CE Information, Continued Nurse Practitioners: This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider Number: This activity is approved for 1.5 contact hours which includes 0 hour(s) of pharmacology. Activity ID # Dietitians: AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEU) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at 10

11 Disclosure of Financial Relationships & Commercial Support The planners and faculty do not have any relevant financial relationships to disclose. AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose. No commercial support was received for this activity. 11

12 Disclosure of Financial Relationships & Commercial Support Disclosures: It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review. Disclosure of Unlabeled Use and Investigational Product: This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Disclaimer: This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content. 12

13 Method of Participation You must participate in the entire activity to receive credit. A statement of credit will be available upon completion of an online evaluation/claimed credit form. The link to the online evaluation will be provided after completion of the activity. If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com. 13

14 Who s in the room? What entity or type of organization do you represent? CMS Home Health Agency Hospital Nursing Home/Skilled Nursing Facility Patient, Family, or Caregiver Representative Pharmacy/Pharmacist Provider/Practice QIN-QIO Other (please specify in chat) 14

15 Session Goals By the end of today s call, you will be able to: understand how to implement the Medicare Annual Wellness Visit into physician practices. identify at least two ways to implement Chronic Care Management (CCM) and use the CCM codes. 15

16 Acknowledgements Ryan Brown, HealthInsight Michelle Hoover, atom Alliance Wallace Palmer, atom Alliance 16

17 Meet Your Speaker Mike Silver, MPH CVP Improvement Science HealthInsight 17

18 Strengthening Primary Care Michael P. Silver, MPH, CVP Improvement Science

19 Wellness, Prevention, and Care Coordination Re-orient US health care toward primary care Annual Wellness Visit (AWV) and Chronic Care Management (CCM): Good for patients and care quality Can be implemented to reduce provider burden Enhances the financial viability of the practice Bridge to value-based payment

20 Meet Your Speaker Tonya Latady, MBA Manager Financial Incentive Programs Singing River Health System 20

21 Medicare Annual Wellness Visits Tonya Latady, MBA Manager Financial Incentive Programs

22 What is an Annual Wellness Visit? Opportunity discuss with patient how to stay well or improve their overall health Goal is to decrease the patient s risk of developing or incurring certain preventable illnesses or injuries and hospital admissions NOT the same as a complete physical Note: All Medicare beneficiaries are eligible after 12 months of being on Medicare, who have not received an Initial Preventive Physical Exam or Annual Wellness Visit in the past 12 months.

23 AWV service can be provided by Physician Midlevel provider (NP, PA or CNS) Licensed health educator, Registered Dietitian, Registered Nurse Direct physician supervision requires the physician be in the office and immediately available while the AWV service is performed, and the service be billed using the MD/DO NPI.

24 Keys to success Educate patients about this new benefit prior to arrival at the clinic

25 Market and Communicate to the patients

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27 Attain access via your MAC (Medicare Administrative Contractor) to verify beneficiary eligibility and confirm when/if AWV has been completed

28 Challenges Patients do not want to participate in a visit that is not their specialists, i.e. Honey, it is too hot/cold to get out for another visit, I will just talk to my heart doctor about anything next time I go see him/her. Patients want only to see their Primary Care provider and not a Nurse for their AWV. Providers - MD/DO/NP/PA want to perform these visits as they have the same RVU as a Level 4 visit and their contracts are paid on RVU.

29 New Ideas/Strategies Catch the patient in the Primary Clinic when they are there for another appointment and discuss having the AWV while they are there in another specified room. Identifying patients who are seeing their regular providers who are employed by us, i.e. Rheumatology, Neurology and schedule the AWV the same day since the patient is already out and about. Automatically schedule an appointment when checking out for any visit with any of our employed providers, either PCP or Specialist. Have the Call Center discuss with patients who are enrolled in Chronic Care Management program the need to have an AWV. Explore the possibility of AWV via Tele-visits

30 Summary Singing River Health System will continue to analyze and strategize to increase our number of Annual Wellness Visits as it is a needed program for our Medicare patients from a preventative standpoint as well as to continue to reduce our hospital admissions and readmissions for this population. Additionally this program creates an additional revenue stream between the visit itself and all potential preventative tests and labs recommended for our patients.

31 Meet Your Speakers Kerri Drennan, RN, MSN Population Health Coordinator South Central Regional Medical Center Jan Bates Clinical Director South Central Regional Medical Center 32

32 Overcoming Roadblocks to Annual Wellness Visits Kerri Drennan, RN, MSN, Director Population Health, South Central Regional Medical Center Jan Bates, Clinical Director, South Central Regional Medical Center July 25, 2018

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34 Lack of Provider Buy-In No- Shows Patients perception of lack of benefits

35 IMPROVED PATIENT OUTCOMES PROVIDERS QUALITY MEASURES

36 Wellness Blocks Dual Visits Daily Wellness Appointments

37 Improved Health One-on-One PATIENTS Identifying Risk Factors Creating a Baseline and Complete Medical Record

38 Providers Rack Cards Protocols Intentional Discussions Marketing Community Outreach Programs/Education Radio Social Media Staff Engagement Knowing the Value Identifying Patients Scheduling at Check-in or Check-out

39 Clinic Culture Community Health Culture

40 Meet Your Speaker Casey McClellan, MS Office Manager Cedar Ridge Family Medicine 41

41 Casey McClellan, Office Manager, Cedar Ridge Family Medicine Chronic Care Management and the Annual Wellness Visit Lessons Learned

42 Background Cedar Ridge Family Medicine Independent Clinic in Southern Utah Eight Providers Cedar City, UT Population: ~ 31K Catchment Area ~200k One local hospital Joined a Medicare Shared Savings Program Started AWVs in Q4 2016, CCM mid-2017

43 AVWs Setting the Stage - The providers had reservations; they knew these were involved visits. - AWVs are known to be beneficial for patients, and provide an opportunity to address HCC* coding - Note: many of our payers are increasingly interested in HCC coding. *Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model that was mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997.

44 AWVs Getting Started - Build an AWV template (address quality measures) - Involve the nurses or MAs in the process - Experiment and learn as you refine the process

45 AWVs Notes from Hundreds of Visits - The providers engage in the visits - Address the complexity of the patient s medical problems; wellness focused visit as opposed to a disease focused encounter. - Brought Advanced Care Planning to the forefront. - MAs develop stronger report with patients Warning oh, by the way problems come up during AWVs

46 CCM Setting the Stage - Mid 2016 Our nurse, Kathy, was managing ~6 patients - As a clinic, we decide to develop & expand the CCM service line - Went from 6 to 50+ patients in CCM in 8 weeks

47 CCM Getting Started - Assign someone to lead the program. - In our experience, Kathy (our care manager) sets the vision for the program. - Work with the providers to create a referral pipeline; this is a critical referral source.

48 CCM Notes from Managing 50+ Patients Per Month - The providers value Kathy as a member of the care team she saves provider time. - Kathy helps patients achieve better health outcomes while decreasing unnecessary ER utilization and avoid wasteful, lesscoordinated care. - Kathy makes a big difference in the lives of her patients; the patients feel better about life.

49 On Billing Billing for AWV and CCM has been straightforward. We haven t experienced many issues. There are online resources your local quality improvement network (QIN, e.g.: HealthInsight) can help with any questions

50 Chronic Care Management Services, as of Jan Billing Code Non-Complex CCM (CPT 99490) Complex CCM (CPT 99487) Complex CCM Add- On (CPT 99489, use with 99487) Payment (PFS Non-facility) Clinical Staff Time Care Planning Billing Practitioner Work $43 20 min or more of clinical staff time in qualifying services Established, implemented, revised, or monitored $94 60 minutes Established or substantially revised $47 Each addtl 30 min of clinical staff time Established or substantially revised Ongoing oversight, direction, and management Ongoing oversight, direction and management + Medical decision-making of moderate-high complexity. Ongoing oversight, direction and management + Medical decision-making of moderate-high complexity. CCM Initiating Visit (AWV, IPPE, TCM or other face-to-face E/M) Add-On to CCM Initiating Visit (G0506) $44-$ Usual face-to-face work required by the billed initiating visit code. $64 N/A Established Personally performs extensive assessment and CCM care planning beyond usual effort described by the separately billable initiating visit 51 Source: CMS Hospital and Ambulatory Policy Team, CMS Quality Conference, 2018.

51 CCM in FQHCs and RHCs Note as of January 2018, FQHCs and RHCs have unique codes for CCM. G0511 $62.28 (General Behavioral Health Intgrtn) G0512 $ (Psychiatric CoCM) Source: FAQ - Care Management Services in RHCs and FQHCs, Feb 2018, RHC-FAQs.pdf 52

52 Practitioner Eligibility for CCM Physicians Certified Nurse Midwives Clinical Nurse Specialists Nurse Practitioners Physician Assistants CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an incident to basis (as an integral part of services provided by the billing practitioner), subject to applicable State law, licensure, and scope of practice. The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM. Medicare Learning Network, Chronic Care Management Services Fact Sheet, Dec

53 Annual Wellness Visit Codes, Provider Eligibility G Annual wellness visit; initial visit, includes a personalized prevention plan of service (PPS) G Annual wellness visit, subsequent visit, includes a (PPS) Medicare Part B covers an AWV if performed by a: Physician A physician assistant, nurse practitioner, or certified clinical nurse specialist Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of medical professionals who are directly supervised by a physician Source: MLN Educational Tool, The ABCs of the Annual Wellness Visit, April

54 Resources CCM Toolkit for Health Care Professionals: Information/OMH/Downloads/Connected-Care-HCP-Toolkit-508.pdf Patient video, poster, and postcard: CMS/Agency-Information/OMH/equityinitiatives/ccm/hcpresources.html FAQ - Care Mgmt Services in RHCs and FQHCs, Feb 2018: Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf Medicare s ABCs of the Annual Wellness Visit: Network-MLN/MLNProducts/downloads/AWV_chart_ICN pdf includes beneficiary eligibility, necessary AWV content, and billing codes/instructions 55

55 Further Resources Multiple Fact Sheets for Health Professionals Advanced Care Planning Behavioral Health Integration Chronic Care Management Transitional Care Management Service-Payment/PhysicianFeeSched/Care- Management.html 56

56 Panel Discussion Mike Silver HealthInsight Tonya Latady Singing River Health Systems Kerri Drennan South Central Regional Medical Center Jan Bates South Central Regional Medical Center Casey McClellan Cedar Ridge Family Medicine 57

57 Facilitated Discussion/Q&A with Audience Chat in your questions and comments. Press *1 on your telephone key pad to enter the teleconference queue. 58

58 Connect with Your QIN-QIO Select your state here. 59

59 Call to Action Over the next two weeks, consider one of the services addressed today by discussing with your care team/staff how you would implement it. Please chat in which service you are most likely to implement. Complete the post-event assessment upon exiting WebEx: 60

60 Call For Future Topics We want to hear from you! Do you have a need or desire to hear about a certain topic? Submit your ideas in chat or us at: QINNCC@area-d.hcqis.org The link will remain open for 48 hours. 61

61 Follow the QIO Program on Social Media! 3KliHRoKeozEs-7ohQnw 62

62 Thank you! This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC /20/18