CSM Physician Bulletin September 2015 Volume 5, Issue 7 Quality and Clinical Integration Status of Performance for FY 2016 Goals: July and August Results We continue to be a leader in breast cancer screening in WI. As the only institution committed to all 3dmammography we are screening more women, finding more early cancers, and reducing unnecessary diagnostic work-ups. Our other quality measures are also showing steady improvement. FY16 Measures Jul-15 Aug-15 FY16 FY15 FY16 FY16 YTD Aspiring Baseline Target Benchmark Breast Cancer Screening 84.4% TBD 84.1% 84.4% 84.0% 92.5% Colorectal Cancer Screening 77.1% 77.6% 76.6% 77.6% 79.5% 84.3% Diabetes - A1C Control < 8% 75.2% 75.4% 75.1% 75.4% 75.5% 81.8% Diabetes - Blood Pressure Control ( 139/89) 85.1% 85.6% 84.5% 85.6% 84.5% 90.1% Diabetes - Nephropathy Screening (1 Annually) 78.8% 80.1% 78.8% 80.1% 86.5% 94.0% Diabetes - Annual Eye Exam TBD TBD 28.0% TBD 39.0% 77.0% IVD - Blood Pressure Control ( 139/89) 85.1% 85.4% 84.9% 85.4% 84.5% 85.9% Well Child @ 15 months of life 66.0% 66.7% 79.2% 66.7% 85.0% 85.0% BMI Assessment 96.7% TBD 96.2% 96.7% 87.0% 93.0% Tobacco - Status Documentation 89.5% 90.8% 96.8% 90.8% 99.8% 99.8% Tobacco - Cessation Education Given 85.2% 87.0% 86.1% 87.0% 90.5% 90.5% Medicare Advantage - Wellness & Physicals Completed 34.2% 38.9% 28.0% 38.9% 60.0% 60.0% Medicare Advantage - PCP Visits 78.7% 80.6% 75.1% 80.6% 80.0% 80.0% Diabetes - A1C Poor Control > 9% 10.7% 10.5% 11.3% 10.5% 14.0% 14.0% Hypertension - Blood Pressure Control ( 139/89) 79.7% TBD 77.9% 79.7% 78.5% 80.5% Risk Adjusted Factor (RAF) Score 0.99 0.99 0.99 0.99 1.04 1.07 Risk Adjustment Factor (RAF) - Accurately Coding Clinical Severity For Medicare Advantage, health plans and health systems are judged on how well they manage the health of a population in terms of quality and cost. Keeping people healthy and managing chronic conditions is the name of the game. When health systems are compared the results are risk-adjusted based on the burden of disease in the population. This is determined by the ICD-9 (now ICD-10) codes documented in bills submitted. For example, diabetes with nephropathy has a higher risk adjustment than just diabetes. The challenge is that identifying the relevant codes is not something physicians are used to doing. Our solution is to bring expert resources to the practice to accurately code all the illnesses that patients are dealing with so we are credited appropriately. Beginning on October 1, we will begin rolling out to clinics a new process where coders review the chart before a Medicare Advantage Wellness Visit and Physical Exam and send a route slip with precompleted suggested ICD10 codes to document in the EHR and to bill. The form will have 2 columns. One column will be completed by the Medicare Advantage Analysts reflecting codes that have not been captured. The PCP will complete the patient exam, review the recommendations by the Analyst, check the codes that are appropriate to the visit and sign the Route Slip indicating documentation is completed in the progress note. PCPs will receive $20.00 compensation (applies to both MMA and CP physicians) for the additional work that is necessary to appropriately document in the EHR and on the billing slip.
New and Improved Diabetic Bundle Launched in September In an effort to provide a more rigorous management of our A1Cs > 8, CPC and PDOC have approved the following Protocol for implementation in your clinics: A Diabetes focused visit within 30 days of A1C result with a member of their Primary Care Team (PCP or their NP or their PA or CDE) PCP, CDE or Endo will titrate medication based on patient report on daily blood sugar until A1C is less than 8%. A1C checked every 10 weeks until A1C less than 8% New Tools for 2 New Quality Measures: Diabetic Eye Exams and Well Child Visits Diabetic Eye Exam: Letters are being sent to ophthalmologists and optometrists asking them to always send results to the patient s clinic so we can document these and get credit for them. We have begun to identify preferred partners who are willing to work on this with us. Diabetic eye exam follow up forms are also being created to for patients to give to their eye doctor as a reminder to send the eye exam to the PCP. New rosters are being developed to follow up on those patients who need eye exams. Well Child visits: A new workflow is being created to ensure 6 visits in 15 months. A tool is being created to track. A new roster has been developed to track status of compliance with visits in each clinic starting in September. Diabetic Tune-up The Endocrine division at Madison Medical Affiliates is pleased to offer an alternative to the traditional diabetes consult in the form of a Diabetic Tune-up. This new approach consists of a focused rapid approach to bringing patients into diabetic control. This should provide intensive help for those who need it most, maintain PCP involvement, and help decrease the wait-time for other endocrinology referrals. (Note: The current system of endocrinology referral for long term management of diabetes control and microvascular management will still remain an option.) The new service will involve: An initial visit to a Certified Diabetes Educator and any necessary follow up 2-6 intensive Endocrinology visits, with a frequency every 2-6 weeks, over the course of 2-6 months Periodic nursing navigator phone calls between visits to evaluate progress and adherence The endocrinology visits will be focused solely on blood sugar control and will not address other comorbidities (these will be referred back to the PCP office, e.g. BP rechecks) PCP will remain responsible for blood pressure, lipid, macrovascular, and microvascular screening and management At the end of the treatment period, glucose management will return to the PCP If the patient fails to improve during the program, the PCP may request that endocrinology extend care to see the patient on a long term basis similar to the current existing model. If you place a CPOE order for Diabetic Tune-up your patient will receive a scheduling call from the endocrinology department. You will be able to choose: Evaluate & treat or Manage. Evaluate and treat refers to the Diabetic Tune-up described above while the Manage option is for long-term care. CSM Ranks High in BSG/Health Trends Report on Quality & Efficiency Recently an outside consultant (BSG) reviewed WI health systems on their publicly reported quality measures and on overall health care utilization and cost of services. The chart below shows that CSM is one of the highest value (high quality/lower cost) health systems in Wisconsin. Our success is because of our rapidly improving quality as well as our prudent use of tests and treatments and the overall cost. This puts us in a very competitive position when it comes to contracting.
1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Value Index (Quality/Resource Efficiency) UnitedHealthcare Virtual Visits UHC has begun offering virtual visits to patients. This does not lend itself to integrated care but according to them it is wanted by their members and they think it will improve access and convenience and costs. Below is information on their program. The virtual visit provider groups they contract with deliver care using live audio and video technology. With virtual visits, patients will be able to see and speak to a doctor 24 hours a day/7 days a week using a mobile device or computer. If needed, a prescription* can be sent to their local pharmacy. Virtual visits are integrated into their medical benefits. Integrating virtual visits with medical benefits Virtual visits are covered under member health plans administered by UnitedHealthcare with some member cost share. Member cost share is based on benefits plan set up as follows: Benefit Plan The virtual visit benefit for 2016 High-Deductible Follows standard medical plan rules Health Plan Member pays full cost of virtual visit until deductible is met Virtual visit cost is approximately $40-50 Once deductible is met, member pays their co-insurance or co-pay under their medical plan rules Once out-of-pocket maximum is met, member Co-insurance and Deductible Plans pays $ Follows standard medical plan rules Member pays same member cost-share percentage, pre- and post-deductible Once out-of-pocket maximum is met, member pays $0
Benefit Plan The virtual visit benefit for 2016 Co-pay Plans Can be set to the same co-pay level as an office visit OR A lesser co-pay than standard office visit Wisconsin Physician Licenses Expire October 31st All MD license types in Wisconsin have an expiration date of 10/31/15. CSM and MMA currently employ over 250 MDs. These physicians will receive a renewal reminder postcard from the Wisconsin Department of Safety and Professional Services within the next week. Per the Medical Staff Bylaws, members of the CSM Medical Staff must hold a current Wisconsin license to maintain their membership and privileges. At this time, documentation of the renewal is not needed. However, an email (CentralCred@columbiastmarys.org) or a phone call to the Credentials Hotline (414.326.1895) alerting them to the renewal would be welcomed by their team. Processes are in place to electronically collect the appropriate renewal verifications. Inpatient Influenza Season Starts October 1 st Influenza Season begins October 1, 2015 and ends April 30, 2015. New changes to CSM s inpatient influenza vaccine nursing workflow go into effect the week of September 21, 2015 in order to support nurses in doing what is best for the patient. Per CSM s inpatient vaccination policy, nurses have the autonomy to order influenza vaccines for patients if they are eligible based upon a completed assessment. Influenza vaccination to eligible inpatients 6 months of age and older is a quality measure (IMM-2) which CSM monitors and reports to the Centers for Medicare and Medicaid Services (CMS). The Influenza Vaccine Assessment has been revised to accommodate assessment of pediatric and adult patients. A pediatric influenza process has been developed. If the patient is 9 years of age or older, the nurse can give the vaccine at a CSM hospital. If the patient is < 9 years of age, then the nurse calls the patient s pediatrician for guidance or the Attending, if the pediatrician is unreachable. Please encourage nurses to follow best practice for influenza vaccine assessment and administration. Discuss the risks and benefits of the influenza vaccine with your patient if you have any concerns about the patient receiving the influenza vaccine while inpatient. If the patient declines to be vaccinated, then it should be documented. If there is no such documentation and the patient is eligible, then the immunization will be administered per CSM policy. The default workflow will be for the nurse to administer the vaccine per CSM policy. Thank you in advance for supporting this quality measure. If you have questions, contact Gina Kinsey, Quality and Clinical Data Management, at gina.kinsey@columbia-stmarys.org. EHR Update Copy/Paste Policy This policy was created to assist in using the Copy-Paste functionality. It allows users to benefit from its efficiency without risking the integrity and accuracy of the content of clinical documentation (see attached policy). All Clinician Authors documenting in an EHR (as with other records) are responsible for the accuracy and integrity of their documentation whether the content is original, copied, pasted, imported from another source, reused, or created by voice recognition. Imported documentation of work/care not performed by the Clinician Author of the current note should be annotated to clarify its source. All imported doucmentation must be edited by the author to assure that only accurate and medically necessary information remains as related to the current patient encounter.
Clinician Authors may never copy information from one patient s record to another. The exception to this is the maternal/infant delivery records where it is common practice to share data between the mother and infant s chart. It shall be the responsibility of CSM Physician Leadership to incorporate a mechanism for review to identify potential misuse of CPF including, but not limited to, cloning, and to implement corrective action processes. CSM Physician Leadership may implement EHR CPF system constraints for individuals or groups in order to protect the integrity of the medical records. New Leadership for the CSM Family Medicine Residency Program The Department of Family and Community Medicine at the Medical College of Wisconsin has appointed Camille Garrison, MD as Interim Program Director for the Columbia St. Mary s Family Medicine Residency Program. Dennis Butler, PhD, has been appointed Interim Associate Program Director. Dr. Garrison is a graduate of MCW and the CSM Family Medicine Residency Program and completed a Maternal/Child Health Obstetrics Fellowship at West Suburban Hospital in Oak Park, IL. She has been on the faculty of the CSM Family Medicine Residency Program for 5 years. Dr. Butler is a graduate of Marquette University and has been a faculty member for over 35 years. The Columbia St. Mary s Family Medicine Residency, located at the Family Health Center, 1121 E. North Avenue, Milwaukee, is the medical home for over 7,000 people and has produced hundreds of family physicians over the past 45 years. Currently, the program has 14 faculty and 23 residents, having graduated 6 senior residents and welcomed 9 new interns in June, 2015. The faculty and residents provide care to their patients in both the inpatient and outpatient settings, with 21,613 clinic visits, 724 hospital admissions and 165 newborn deliveries at CSM Milwaukee hospital in the past year.