CPT Consumer Friendly Descriptors: Their Use in Engaging Patients in their Health Care

Transcription

1 CPT Consumer Friendly Descriptors: Their Use in Engaging Patients in their Health Care

2 Speakers Nancy Spector, BSN, MSC AMA Electronic Medical Systems Elizabeth Lumakovska, MPA, RHIT, CPEHR AMA Medical Informatics & Healthcare Strategy

3 Objectives Provide an overview of industry patient engagement activities Provide information on the CPT Consumer Friendly Descriptors Demonstrate how the Consumer Friendly Descriptors can be used in patient engagement activities

4 Patient Engagement

5 Importance of Patient Engagement Improves patients health outcomes More likely to comply with the plan of care when they are well informed of their medical condition Better able to communicate important health information to their providers, which can assist providers with their diagnosis and plan of care Can take a more active role in health care decision making when informed and educated More likely to effectively manage their own care

6 2013 WEDI Report Patient Engagement was one of four focus areas for the Report Defined as: Identify ways to enable consumer (patient) engagement through improved access to pertinent healthcare information.

7 2013 WEDI Report Recommendations Standardize the patient identification process across the healthcare system. Expand Health IT education and literacy programs for consumers to encourage greater use of Health IT, with a goal of achieving better care management and overall wellness. Identify and promote effective and actionable electronic approaches to patient information capture, maintenance and dissemination that leverage mobile devices and "smart" technologies and applications.

8 EHR Meaningful Use Program Patient and family engagement is one of five priorities in Meaningful Use Aims to: Improve patients understanding of their health and related conditions so they take a more active role in their health care Encourage involvement of patients families Use technologies to assist with making health information available to patients and their families Involve patients and their families in health care decision making and promote patients management of their own health

9 EHR Meaningful Use Program Stage 2 Objectives Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the Eligible Provider (EP) Provide clinical summaries for patients for each office visit Use Certified EHR Technology to identify patientspecific education resources and provide those resources to the patient if appropriate

10 Office of the National Coordinator Consumer ehealth Program One of their core strategies The empowerment of individuals to improve their health and health care through Health IT Focusing on: Increasing access to health information Enabling consumers to take action based on their health information Shifting attitudes so consumers see themselves as partners in their care

11 S&I Framework Blue Button Plus Initiative Gives consumers the ability to obtain their health care records in both human-readable and machine-readable format Gives consumers more access to and portability of their health care information Consumers want to be able to: Better understand their health and make more informed decisions Help to keep their care team members on the same page Improve the accuracy and completeness of their health information Plug it into apps and tools that make information available

12 AMA Work Improving Health Outcomes Collaborating with other organizations with a focus on heart disease and type 2 diabetes U.S. Department of Health and Human Services' "Million Hearts " initiative Centers for Disease Control and Prevention's National Diabetes Prevention Program YMCA pre-diabetes program Accelerating Change in Medical Education Focusing on bringing innovative changes to medical education Promoting exemplary methods to achieve patient safety, performance improvement, and patient-centered team care Helping patients in making health care decisions

13 Common Goals of Patient Engagement Improve health outcomes Improve understanding of health care Improve compliance with plan of care Improve communication across caregivers Increase access to information Increase participation in decision making Increase family involvement Increase use of technology to support activities

14 CPT Consumer Friendly Descriptors

15 AMA s Current Procedural Terminology (CPT ) As a leader and trusted source of CPT, the American Medical Association (AMA) has developed products to support various market segments. Today s healthcare organizations require interface content to communicate administrative and clinical information to patients. In response to industry demand, the AMA has embarked on a project to provide users with a patient-focused version (Consumer Friendly Descriptors) and a clinicianfocused version (Clinician Descriptors) of the CPT code set that is comprehensive and useful. 15

16 AMA CPT Consumer Friendly Descriptors The AMA s objective was to simplify the highly technical CPT code long descriptors into something more patient-focused and patientfriendly. The AMA developed CPT Consumer Friendly Descriptors (CFDs), which take the complex terminology of medical procedures and services within the official CPT long descriptors and translate them into a language that any patient and/or the caregiver can better understand and use. CFDs may prove useful in any situation where clear communication in non-technical language is important. 16

17 Meaningful Use Requirements Development of CFDs also supports the following objectives in the Meaningful Use Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs: Stage 2 Objectives: Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the Eligible Provider (EP) Provide clinical summaries for patients for each office visit Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient if appropriate 17

18 Development of CFDs The responsibility of developing usable consumer content goes beyond constructing direct translations of the official CPT long descriptors. A consideration of the context of use is an important element in the development process In the context of use for the patient, descriptive information that is relevant in the CPT long descriptor may not be relevant in the CFDs Rules and heuristics were developed to provide writers and reviewers guidance in development of CFDs with relevant information that considers the patient context 18

19 Development of CFDs Acceptance criteria for establishing rules and heuristics for the development of CFDs is that they be useful, understandable and reproducible. Useful in the context of use for the patient Understandable should be capable of being explained to and understood by those that will make the information useful Reproducible - independent subject matter experts (writers, reviewers) should be able to apply the rule or make the revision in the same way (reproducibly) 19

20 Heuristics for Development of CFDs Heuristic Example: Relevant Information and Non-unique CFDs Information that is relevant in the official CPT long descriptor may not be relevant in the CFD. When irrelevant information is removed from the long descriptor, it may result in two CPT codes having the same term that represents the CFD. The fact that terms may be non-unique across CPT codes is a vocabulary industry best practice. CPT Code CPT Code Long descriptor: Arthrodesis, great toe; metatarsophalangeal joint Long descriptor: Arthrodesis, great toe; interphalangeal joint CFD: Fusion of great toe CFD: Fusion of great toe 20

21 Heuristics for Development of CFDs Heuristic Example : Technical or Instructional Language Technical or instructional language may be useful in an administrative context to assist with the selection of an appropriate CPT code. This type of information generally clarifies a procedure or depicts uniqueness. However in a patient context, technical and instructional language may not be useful and therefore deemed unnecessary. Examples of technical or instructional language include: mutual exclusions, exclusion statements, qualifying statements or other types of clarifying language. CPT Code CPT Code Long descriptor: Excision inferior turbinate, partial or complete, any method Long descriptor: Submucous resection inferior turbinate, partial or complete, any method CFD: Removal of nasal air passage CFD: Removal of nasal air passage 21

22 Heuristics for Development of CFDs Technical or Instructional Language Mutual Exclusions X or Y Phrases Mutual exclusions are examples of technical or instructional language that are used to explicitly describe or explain procedures and services. Mutual exclusions can be identified by their primary components, which are contradictory and cannot exist at the same time. For example: male or female partial or complete simple or complete benign or malignant primary or secondary 22

23 Heuristics for Development of CFDs Heuristic Example : Technical or Instructional Language Mutual Exclusions X or Y Phrases CPT Code CPT Code Long descriptor: Excision inferior inferior turbinate, turbinate, partial partial or complete, or any method complete, any method CFD: Removal of nasal air passage CFD: Removal of nasal air passage Long descriptor: Submucous resection resection inferior inferior turbinate, partial or complete, any method turbinate, partial or complete, any method CFD: Removal of nasal air passage CFD: Removal of nasal air passage 23

24 Heuristics for Development of CFDs Heuristic Example: Route of Administration Access to anatomic sites is specified in the CPT code set to identify how/where the drug administration occurred. The route of administration is referenced in the CFD, as this information is important to differentiate the procedure/service in the context of use for the patient. CPT Code CPT Code Long descriptor: Anthrax vaccine, for subcutaneous or intramuscular use Long descriptor: Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft CFD: Vaccine for anthrax injection beneath the skin or into muscle CFD: Injection of agent into vein to assess blood flow of skin graft or flap 24

25 Heuristics for Development of CFDs Heuristic Example: Route of Administration Examples of acceptable translation of terms to be used for consistency in the development of CFDs include: Intramuscular = into muscle Subcutaneous = beneath the skin Percutaneous = through the skin Intradermal = into skin Intravenous = into vein Intraarterial = into artery Intralesional = into a lesion 25

26 Heuristics for Development of CFDs Heuristic Example : Route of Administration CPT Code CPT Code Long descriptor: Long Anthrax descriptor: vaccine, vaccine, for subcutaneous for subcutaneous or or Anthrax intramuscular vaccine, use intramuscular for use subcutaneous or intramuscular use CFD: CFD: Vaccine for anthrax injection beneath the skin Vaccine or CFD: into muscle for anthrax injection beneath the skin or Vaccine into muscle for anthrax injection beneath Concept the skin id: or into muscle CPT Code CPT Code Long descriptor: descriptor: Long Intravenous descriptor: injection of agent (eg, Intravenous injection of agent (eg, Intravenous fluorescein) injection to test vascular of agent flow (eg, in fluorescein) flap or to graft fluorescein) to test vascular flow test vascular flow in flap or graft flap or graft CFD: CFD: Injection Injection of of agent agent into into vein vein to to assess assess blood blood CFD: flow flow of of skin skin graft graft or or flap flap Injection of agent into vein to assess blood flow of skin graft or flap Concept id:

27 CFDs Use Cases Health information literacy for patients remains a challenge in usability of electronic healthcare data. CFDs can assist in realizing the full potential of personal health records (PHRs) by making the information reported with CPT codes understandable for the patients Other use cases: Patient portal of EHRs, Electronic Medical Records (EMRs), or Hospital Information Management System Discharge Summary Payers' Explanation of Benefits (EOB) forms 27

28 AMA CPT Clinician Descriptors (CDs) In addition to CFDs, the AMA developed CPT Clinician Descriptors (CDs) which translate the CPT long descriptors into terms that describe clearly and specifically the procedure or service performed by a physician or qualified health care provider at the point of care. Their purpose is to describe accurately clinical events rather than billable events. CDs have a potential to be used for defining a subset of medical procedures and services within an EHR, documenting medical procedures and services, conducting research, and reporting clinical and statistical data. The CDs also support the following objective of the Meaningful Use Stage 2 of the Medicare and Medicaid EHR Incentive Programs: To allow eligible professionals, eligible hospitals, or critical access hospitals who transition or refer a patient to another care setting or provider to create and transmit a summary care record for each transition of care or referral. 28

29 AMA CPT Clinician Descriptors (CDs) Note: Development of CDs often results in more than one CD per CPT long descriptor. Example - translation of an official CPT code descriptor to its CDs CPT Code Long descriptor: Excision inferior turbinate, partial or complete, any method CDs: 1. Partial Excision of Inferior Turbinate CD ID: Complete Excision of Inferior Turbinate CD ID:

30 Availability of CFDs and CDs CFDs and CDs are provided separately, as well as part of the following downloadable files: CPT Data Files CPT Enhanced Data Files CPT Developer s Tool Kit 30

31 Contact Information Nancy Spector, BSN, MSC AMA Electronic Medical Systems P: (202) Elizabeth Lumakovska, MPA, RHIT, CPEHR AMA Medical Informatics & Healthcare Strategy P: (312)

32 Questions? 32