August 2014 Newsletter
Volume 3 Number 8
August 1, 2014
CMS to Increase Quality Measures for Medicare Shared Savings ACOs
The Medicare Shared Savings Program was established to facilitate coordination and cooperation among Medicare enrolled providers and suppliers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce the rate of growth in health care costs through participation in an Accountable Care Organization (ACO). ¹
On July 3, 2014, CMS announced proposed changes to the Shared Savings Program, which are highlighted below.
The total number of quality measures will increase from 33 to 37. Measures that would be added include depression remission, all cause readmissions to skilled nursing facilities, stewardship of patient resources, avoidable admissions for patients with multiple chronic conditions, diabetes measure for foot exam and eye exam and coronary artery disease symptom management measures.
CMS would retire eight measures that are either redundant, could be replaced by similar measures or did not keep up with clinical best practices. Those that would be removed are:
- ACO #12, Medication reconciliation after discharge from an inpatient facility
- ACO #22, Diabetes composite measure: Hemoglobin A1c Control
- ACO #23, Diabetes composite: Low density lipoprotein
- ACO #24, Diabetes composite: blood pressure
- ACO #25, Diabetes composite: Tobacco non-use
- ACO # 29, Ischemic vascular disease: Complete lipid profile and LDL control
- ACO #30, Ischemi vascular disease: Use of aspirin or another antithrombotic
- ACO #32, Coronary artery disease composite: drug therapy for lowering LDL cholesterol
There would also be an Additional Quality Improvement Reward to recognize and reward ACOs that have an improvement in quality performance scores year over year.
CMS will accept comments on these proposed rules until September 2, 2014 and expect to release the final regulations around November 1, 2014.
(Sources include CMS and Beckers Hospital Review)
Transitions Leadership Committee
A study published in the June 2014 issue of the Journal of General Internal Medicine demonstrated that the implementation of a care transitions intervention resulted in a significant cost avoidance for at least 6 months after discharge from a hospital, as well as a significant reduction in readmissions. The study was conducted on Medicare FFS beneficiaries from January 1, 2009 to May 31, 2011 in 6 Rhode Island hospitals. The intervention was done by Transition Coaches that focused on areas such as the importance of follow up appointments, using a personal health record and recognizing signs and symptoms of decompensation. The coaching began while the patient was in the hospital and continued for 30 days post discharge and included one home visit and one to three follow up phone calls. The cost avoided per patient receiving the intervention was $3,752¹. Six month readmission rates decreased from 931 per 1,000 to 651 per 1,000. ED visits, observation stays, skilled nursing visits and outpatient visits decrease as well but did not achieve statistical significance.
On Thursday, July 31st, SVHP hosted the first Transitions Leadership Committee meeting which included members from SVMC as well as from our post-acute providers: Lord Chamberlain, Jewish Senior Service, St. Joseph’s Manor, Bayada Home Health, Stratford VNA and VNS of Connecticut. The committee has begun to map out processes to coordinate care across the continuum, which will become part of the SVHP Playbook. In essence, we will be working with our PAC partners to assure patients are referred to the most efficient and effective care setting and allow us to prepare the Bundled Payment Initiative which begins January 1, 2015.
Dr. Michael Hunt Receives AMDIS Award
We are proud to announce that Dr. Michael Hunt, CMO/CMIO of St. Vincent’s Health Partners has been selected by the Association of Medical Directors of Information Systems (AMDIS) as the winner of the 2014 AMDIS Award for excellence and outstanding achievement in applied medical informatics. The award honors individuals and/or organizations who have successfully applied information systems and computer technology into the practice of medicine. He is focused on guiding St. Vincent’s Health Partners through its population health journey, including partnering with McKesson and other leading providers of population, risk and provider-oriented care management solutions to drive optimal quality care and business outcomes. Congratulations to Dr. Hunt!
Care Coordination and Clinical Integration
The Value of In-Network Care:
As part of a Clinically Integrated Network, each of the providers in the St Vincent’s Health Partners PHO has committed to working together to create the best possible outcomes for our patients. Do your patients need specialized care? We have specialists in our network that want to work with you to help your patient. As providers within the network, they will provide the best care at the lowest out-of-pocket cost to your patients. Please consider referring to our providers so that our network can collaborate and communicate to provide the best care possible.
Why refer in-network?
Each day we are working towards a more transparent and collaborative medical community. Our network is fostering this change through open communication and coordination. All providers in the network are connected and jointly responsible for the outcome of each patient. Referring in-network means that our medical neighborhood has more access to that patient’s information and can make more of an impact on him or her.
Long-term, St. Vincent’s Health Partners is hoping to establish more standardized referral practices. It’s understood that common pains in the referral process include lack of information and a delay in receiving information back after a consult. Our hope is that by fostering this discussion and moving towards best practice standardization we will achieve a strong medical neighborhood that works together in the best interest of our patients.
Current Research on Curbing Patient No-Shows
There are many different ideas from medical research sites and blogs on various way to curb and react to patients missing their appointments. Some of these involve monetary reinforcement while others do not. There are many ways to handle patients no-shows, below are several notable ones that seem to appear in multiple sources:
- Have a patient put down a deposit anywhere from $10.00 to half the price of the visit
- Track patients that continue to miss appointments. Are there any trends i.e. insurance company or a certain day of the week?
- Develop a list of patients that can come in for short-notice appointments. These patients may be able to fill spots that open up when other patients miss appointments
- Allow patients to pre-pay for their next appointment
- Explore alternate ways of sending reminder notifications such as through text and email
- Hold a gift card drawing for all patients who show up on time in a given month
- Use teach back to ensure that patients know their appointments schedule
- Schedule accurately so patients don’t have long wait times, which may lead them to believe that the practice doesn’t value their time, convincing them to not value yours.
Many practices worry that monetary punishment for missing an appointment will alienate their patients, here are a few ways to minimize that risk:
- Be up front with your fees, have all new patients sign a no-show policy agreement so there are not surprised if they miss an appointment
- Explain to patients the reasoning behind any charges or deposits. The goal is to open otherwise unused appointments for patients that needs then, not to charge unnecessary fees
- Be up front with physicians referring to you about any fees so they can decide if they want to refer to a physicians that charges for no-shows
- Make sure patients are aware that these charges cannot be billed through their insurance
- Be willing to give refunds to patients that have a legitimate reason for missing the appointment but be clear as to how you define legitimate
- Remind patients of their appointment several days before
- Be prepared to terminate patients who continue to miss appointments
[Sources include: AAFP, MGMA, AHRQ]
We are happy to announce that Dr. Elenita Espina-Lee and Dr. Jose Reyes from Affiliates in Women’s Care has joined St. Vincent’s Health Partners! Their office is located on 309 Stillson Road in Fairfield.
Please help me in welcoming Affiliates in Women’s Care to the network!
Lights, Camera, Action!
Some of the SVHP staff got to be actors for a day when representatives from Wellpoint/Anthem came to Bridgeport to do a photo shoot and filming. Over the past year, SVHP has been working with Anthem and has developed a relationship that has translated into a cultural change in the way healthcare is delivered. Because of the success that SVHP has had in working closely with Anthem to improve the care of our patients, Anthem wanted to nationally recognize SVHP through a photo shoot and filming. Anthem will use this filming piece to inspire other organizations on the success of the collaboration.
Dr. Thomas Raskauskas, President/CEO, (203) 275-0202
Dr. Michael Hunt, Chief Medical Officer/Chief Medical Informatics Officer, (203) 275-0203 firstname.lastname@example.org
Anthony Brockman, Director of Information Technology, (203) 275-0206 email@example.com
Colleen Swedberg, MSN, RN, CNL, Director for Care Coordination and Integration, (203) 275-0209 firstname.lastname@example.org
Karen O’Driscoll, Director of Professional Relations, (203) 275-0205
Alvino Williams, Jr., IT Analyst/Clinical Integration, (203) 275-0207
Kyle Lanning, JD, Integration Associate, (203) 275-0204
Erika Foster, Integration Associate, (203) 275-0208
Gretchen Cavaliere, Administrative Assistant, (203) 275-0201