February 2015 Newsletter

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Monthly Newsletter

Volume 4  Number 2

February 1, 2015

Bundled Payment for Care Improvement Initiative (BPCI)

Weekly update calls continue to review the status of the project.

Thank you to Dale Danowski, Senior VP, COO and CNO at SVMC for leading the meeting!   A broad map of our network was reviewed and the importance of proper communication between settings and downstream effect of all transitions work was stressed.

An overview of the process mapping activity led to discussion on the following:

  • Mapping should be more patient and family centric. Addressing the needs and wants of the patient and their family; what they are able to manage is very important. Communication to the patient needs to occur from Day 1
  • Repetition and consistency of education and directions necessary throughout continuum and should be emphasized in mapping
  • Health literacy and literacy in general is important. Social factors play a huge role in the continuum and all settings must take this into account
  • Where the patient is coming from (i.e. relationship with PCP, previous medical history etc.) is crucial to mapping
  • Navigators etc. need to be involved from Day 1

A timeline with all identified pain points that the group is working on was collated and sent out to the group for review prior to the meeting. It held the issues, the responsible point person, deadlines, and next steps. This will be further added to and follow up should continue as necessary.

Telephonic Bundle Huddles will be held every Thursday at 12:00 PM.  Dr. Hunt will be running those calls.

Suzanne Malerba from ProHealth APRN group gave an update of the APRN house call pilot.

Amy Kurzatkowski presented part 2 of the Meds to Beds program.

We anticipate that the work that is done in these meetings will positively overflow to the transitions of all patients between each of the settings and across the clinically integrated network

Complex Chronic Care Coordination Coding

Good news for Primary Care Physicians!!  Starting on January 1, 2015, under the new CMS Chronic Care Management Program, CMS will reimburse providers $41.92 for furnishing specified non face to face services to qualified beneficiaries within a 30 day period.  (CMS will be releasing HCPCS code in November.)

A qualified beneficiary is a fee for service Medicare beneficiary with “two or more chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation or functional decline; 20 minutes or more; per 30 days.”¹ The 20 minutes must be non-encounter based follow up care.  The provider must inform the patient of the service being provided, obtain written consent and keep a copy of the document in the patient’s medical record.

Chronic Care Management (CCM) services must contain the following elements:

  1. A Patient Centered Plan of Care that is regularly updated and a copy given to the patient
  2. Access to health care providers (24/7) to allow patients timely contact to address urgent chronic care needs
  3. Offer enhanced opportunities (via telephone, secure messaging) for the patient to communicate with the team and/or caregiver
  4. Continuity of Care with care team and assure access to successive appointments
  5. Medication monitoring and recommended preventive care services
  6. Manage care transitions between settings
  7. Coordination of home and community based services

¹  Source:  Final Rule – The Office of the Federal Register – CMS 1612 FC – Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015

Billing for Transitional Care Management

Effective January 2013, Medicare Pays for two CPT© codes that are used to report physician (or qualifying non-physician practitioner) care management services for a patient following a discharge from a hospital, SNF or CMHC stay, outpatient observation, or partial observation.¹

The two codes are: CPT© codes 99495 and 99496.

Which code should I use?

99495 – For cases with a moderate degree of complexity where a face to face visit occurs within 14 days of discharge

99496 – For cases with a high degree of complexity where a face to face visit occurs within 7 days of discharge.

Are there any time constraints?

YES. To bill for either code, the communication (phone, email or in person) must have occurred within two business days of discharge.

Who can receive TCM services?

Patients with Medicare who have been discharged from a hospital, SNF, or CMHC stay, outpatient observation, or partial hospitalization.

Is Medication Reconciliation and Management required?

YES. Not only is it a best practice, it is also a requirement that TCM medication reconciliation be performed.

It’s Medicare though, so how much money are we really talking?

According to the AMA CPT© Code/Relative Value Source tool, adjusted for Connecticut (assuming non facility), here are the medical payments per code:

99495 – $176.70

 99496 – $249.41

Sounds too hard, why can’t I just bill for an office visit (99214) instead?

You could but you would lose either $60 (99495) or $130 (99496) per encounter.

¹ Source: CMS, “Frequently Asked Questions about Billing Medicare for Transitional Care Management Services.” CMS.gov 21 Aug. 2013. Web 19 Sept 2014. Current Procedural Terminology (CPT©) copyright 2014 American Medical Association. CPT is a registered trademark of the American Medical Association.

Staff Updates:

Please help me in welcoming our new staff members to SVHP!

Karen Julian, RN, BSN
Care Coordination and Integration Manager

Karen received her BSN from Salve Regina University.  After receiving her degree, she was hired by Davita, Inc where she worked 20 years as a Charge RN and then a Clinical Coordinator for the Team.  While at DaVita, Karen had many responsibilities and also participated in direct acute patient care, Quality Assurance, Joint Commission, State reviews, and internal hospital audits.  As the Care Coordination and Integration Manager, Karen will be influential in helping the provider network members continuously improve the care experience of the patient and to improve health outcomes using evidence based practices.


Asma Ahmed
Healthcare IT Applications Support Intern

Joining St. Vincent’s Health Partners team as an Intern, Asma will be working with various applications utilized for population health and risk management. While present here, she will complete her Capstone Project which will include phases of a current project implementation. Asma is pursuing her MA of Science in Healthcare Informatics at Sacred Heart University and will graduate May 2015.

asma ahmed


Contact Information

Dr. Thomas Raskauskas, CEO/President, (203) 275-0202; thomas.raskauskas@stvincentshealthpartners.org

Dr. Michael Hunt, Chief Medical Officer/Chief Medical Information Officer, (203) 275-0203; michael.hunt@stvincentshealthpartners.org

Colleen Swedberg, MSN, RN, CNL Care Coordinator, (203) 275-0209; colleen.swedberg@stvincentshealthpartners.org

Anthony Brockman, Director of Information Technology, (203) 275-0206; anthony.brockman@stvincentshealthpartners.org

Karen O’Driscoll, Director of Professional Relations, (203) 275-0205; karenodriscoll@stvincentshealthpartners.org

Karen Julian, RN, BSN, Care Coordination and Integration Manager, (203) 896-0215; karen.julian@stvincentshealthpartners.org

Sophia Jackson, RN, Care Coordination Associate, (203) 275-0212; sophia.Jackson@stvincentshealthpartners.org

Mina Gasdia, RN, Care Coordination and Integration Associate, (203) 896-0214;  mina.Gasdia@stvincentshealthpartners.org

Kyle Lanning, JD, Information and Integration Manager, (203) 275-0204; kyle.lanning@stvincentshealthpartners.org

Erika Foster, Integration Associate, (203) 275-0208; erika.foster@stvincentshealthpartners.org

Asma Ahmed, Healthcare IT Application Support Intern, (203) 275-0211; asma.ahmed@stvincentshealthpartners.org

Susanne Salgado, Communications and Operations Associate, (203) 275-0201; Susanne.Salgado@stvincentshealthpartners.org