September 2015 Newsletter
Volume 4 Number 9
September 1, 2015
Medicare Shared Savings Program:
As you are aware, we have a Medicare Shared Savings contract with Accountable Care Associates of Springfield, Ma. that will end on December 31, 2015. The Board has chosen to enter into another Shared Savings Contract with Western Connecticut Health Network. This contract will become effective on January 1, 2016. Many thanks to all for returning Group Contracts and Joinder contracts promptly.
As always, should you have any questions regarding contracts, please contact Karen O’Driscoll, Director of Professional Relations at 203-275-0205 or via email at firstname.lastname@example.org.
Continuation of the HUSKY Health Primary Care Increased Payment Policy:
To all Physicians, Physician Assistants, Advanced Practice Registered Nurses and Certified Nurse Midwives: The HUSKY Health Primary Care Increased Payments Policy is being extended for dates of service July 1, 2015 through June 30, 2017. As a result, the Department’s current policy will continue unchanged for dates of service July 1, 2015 through June 30, 2017.
Board of Directors Vacancy Notice
SVHP has received Dr. David Yan’s resignation from the Board of Directors, due to Dr. Yan and his famly relocating to Florida. His position was a specialist physician, and according to our bylaws we need to have the position replaced by a specialist physician.
If you are interested, you will need to submit to Tom Raskauskas, President/CEO of SVHP, your biography and a letter of interest, along with the endorsement of 10 physician members as endorsement of your appointment to the Board.
Nominations that are complete (letter of interest, endorsement letter with signature, and biography/CV) will be forwarded to St. Vincent’s Health Partners Board of Directors for consideration. All candidates will be notified of the decision by the Board.
If you have any questions, or need any assistance in completing the requirements of nomination, please contact Tom by email at email@example.com or phone (203)275-0201.
Bundled Payments for Care Improvement Initiative
St. Vincent’s Health Partners and St. Vincent’s Medical Center have reached another milestone as we embarked on our journey with the Bundled Payments for Care Improvement Initiative!
The Bundled Payments for Care Improvement (BPCI) Initiative was developed by the CMS Innovation Center as a result of the Affordable Care Act. The purpose is to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, or Children’s Health Insurance Program expenditures while preserving or enhancing the quality of care for beneficiaries.
Participating organizations can be hospitals, skilled nursing centers, inpatient rehabilitation facilities, home health agencies. SVMC and our post-acute partners (Cambridge Health and Rehabilitation Center, Jewish Senior Services, Lord Chamberlain, Ludlowe Center for Health and Rehabilitation, St. Joseph’s Center, Bayada Home Health Care, Roy and Aline Friedman Home Care, Stratford VNA and Visiting Nurse Services of Connecticut) are participating providers.
A facilitator (SVHP) is an entity that serves an administrative and technical assistance function in helping participants redesign care. The facilitator does not have an agreement with CMS, bear financial risk or receive payment from CMS. The facilitator assists with financial arrangements made between the participating organization and the convener.
A Convener (NaviHealth) is an entity that bears the financial risk and receives payment from CMS. The Board voted to partner with NaviHealth as our financial convener and therefore, NaviHealth will assume the risk.
On February 14, 2014, CMS announced an expansion of the program to include new hospitals, health systems and provider practices. These bundles started on July 1, 2015, and are comprised of four broadly defined models of care, depending upon where the episode of care initiated. Reimbursement will be based upon services provided to beneficiaries for that episode of care.
SVMC is participating in MODEL 2: Retrospective Acute Care Hospital Stay plus Post-Acute Care
The episode of care is initiated at the time of admission to the hospital and includes all related services during the episode. Participants select when the episode of care will end – 30, 60 or 90 days after discharge. Participants select up to 48 episodes of care.
The Model 2 Bundle includes physician services, care by post-acute providers, related re-admissions and related Medicare Part B services. The rate is determined by historical fee-for-service payments minus a discount. Payments to providers are made at the usual fee-for-service rate and then reconciled against the target price. Any savings that is realized is paid to the participant and may be shared among the providers. Any expense that is above the target price is paid back to Medicare by the participant.
To prepare for this and other transition initiatives, The Transitions Leadership Committee was developed with the objective and focus of discussing opportunities to strengthen relationships, improve transitions of care and ensure successful outcomes within the network. This Committee has met over the past year to map out processes to coordinate care across the continuum and to validate the requirements delineated in the SVHP Playbook.
We anticipate the the work that has and is being done will positively overflow to the transitions of all patients between each of the settings and across the clinically integrated network.
September is Sepsis Awareness Month
The CDC’s definition of sepsis is the body’s overwhelming and life-threatening response to infection which can lead to tissue damage, organ failure and death. It can occur after a minor infection and is often difficult to diagnose and treat. Over 1 million cases occur each year in the United States and over half of those patients die from sepsis. Because of this, the CDC is working with health care professionals to increase awareness of sepsis and thus have designated September as Sepsis Awareness Month.
As was noted above, SVMC is participating in the BPCI Initiative and one of the bundles that was chosen is Sepsis. In reviewing our Medicare data, there was over 2,000 cases of sepsis that were treated at SVMC during a 3 year period and SVMC is committed to conquering this head on.
Use these resources below to learn how you can increase awareness of sepsis.
ICD-10: The Switch
With less then 1 month remaining for the switch from ICD-9 to ICD-10, CMS has continued to provide resources to make the switch a success.
The transitions is going to change how you do business, but it does not have to be overwhelming. Below are resources to assist you with the transition:
• ICD-10 Basics for Medical Practices
• Road to 10
• Online ICD-10 Guide
To help physicians and other providers get quickly up to speed, CMS has launched the ICD-10 Clinical Concepts Series for specialties. Each guide in the series compiles key information from the Road to 10 online tool in a PDF format that can be readily shared, emailed, posted to websites and printed. The guides include common ICD-10 codes, clinical documentation tips, clinical scenarios and links to Road to 10.
• Family Practice
• Internal Medicine
CMS has also made several important changes to the policy to ease the transition.
• During the first year, Medicare will not deny claims based upon specificity of diagnosis codes as long as they are in the appropriate family of codes. Therefore, you will not be penalized because of a coding error.
• An ICD-10 Ombudsman office will be established to assist in problems that arise during the transition.
• If Medicare contractors cannot process claims because of issues with ICD-10, CMS will authorize advanced payments.
Over the next few weeks, CMS will be sending to all Medicare Fee-for-Service providers a letter regarding these changes.
For more details, please visit the CMS ICD-10 website.
SVHP’s Provider membership is growing! Please extend a warm welcome to the following new Physicians:
Virginia Cody, MD
Dr. Virginia Cody is a Primary Care Physician and has joined Goldfarb, Ranno and Associates. She is accepting new patients and can be reached at 203-254-2046.
Denisa Riera, DPM
Dr. Denise Riera, DPM has joined Family Podiatry Center located at 2409 Main Street in Bridgeport and is accepting new patients. To schedule an appointment with Dr. Riera, please call 203-334-6955.
Elina Trofimovsky, MD
Dr. Elina Trofimovsky, specializes in Endocrinology and is now accepting new patients at Endocrine Associates LLC, 3180 Main Street, Suite 105, Bridgeport. To schedule an appointment with Dr. Trofimovsky, please call 203-372-7200.
Scott Smith, MD, Yogesh Kumar, MD and Adam Kaye, MD with Advanced Radiology are now members of SVHP.
Congratulations to Ludlowe Center for Health and Rehabilitation for being recognzied as a 5 star facility on Medicare Nursing Home Compare.
The overall star rating is based upon ratings in 3 categories:
1. Health Inspections
3. Quality Measures
CMS created the rating system to assist patients, their families and caregivers compare nursing homes. The rating system gives each nursing center a rating from 1-5 stars. Nursing home with 5 stars are considered to have higher quality then the nursing homes that score a 1.
For additional information regarding the rating system, please use this link: Five Star Quality Rating System.
Please help us welcome new staff!!
Mary Corazzelli, MHA, BSN, RN, is the Care Coordination and Integration Manager for St. Vincent’s Health Partners. She received her Bachelors of Science in Nursing from St. Joseph College in West Hartford, CT and her Masters of Healthcare Administration from the University of New Haven in West Haven, CT. Prior to joining SVHP, Mary was a Nurse Manager at St. Vincent’s medical Center for 5 years and has experience in the outpatient private practice setting, as well as acute care. Mary is committed to improving patient outcomes and helping to ensure safe transitions of care.
Mary can be reached at (203) 896-0217 or via email at firstname.lastname@example.org
Dr. Thomas Raskauskas, President/CEO, (203) 275-0205
Dr. Michael Hunt, Chief Medical Officer/Chief Medical Informatics Officer,
Anthony Brockman, Director of Healthcare Informatics and Technology, (203) 275-0206
Colleen Swedberg, MSN, RN, CNL, Director for Care Coordination and Integration,
Karen O’Driscoll, Director of Professional Relations, (203) 275-0205
Sophia Jackson, RN, Care Coordination Associate, (203) 275-0212
Mary Corazzelli, MHA, BSN, RN, Care Coordination and Integration Manager, (203) 896-0217 email@example.com
Pani Stanton, MS, PT, Care Coordination and Integration Manager, (203) 896-0216 firstname.lastname@example.org
Kyle Lanning, JD, Information and Integration Manager, (203) 275-0204
Gayathri Muthukumaran, MS, Healthcare Business Intelligence Analyst, (203) 275-0207 email@example.com
Asma Ahmed, Healthcare Informatics Associate, (203) 275-0213
Erika Foster, Integration Associate, (203) 275-0208
Susanne, Salgado, Communications and Operations Associate, (203) 275-0201