Practice Administrator Meeting September 19, 2012

Transcription

1 Practice Administrator Meeting September 19, 2012 I. UHC Transparency presentation 9:30 10:00 II. Staff Information 10:00 10:05 III. POD Meetings 10:05 10:10 IV. OSHA Training 10:10 10:15 V. Annual Meeting 10:15 10:20 VI. Malpractice Program 10:20 10:30 VII. PHIC and GPCN 10:30 10:40 VIII. KHF Health Insurance Program 10:40 10:50 Wellness Program UHC Premium Rebate IX. End of Year Dues 10:50 10:55 X. Peachstate Health Plan Checks 10:55 11:00 XI. Mid-Level Information request 11:00 11:05 XII. Child Behavior Study 11:05 11:10 XIII. Quality Management Update 11:10 11:30 Practice QM Standards Risk Management Concussion Program Stong4Life Next PA Meeting will be held on Wednesday October 17, 2012 at 9:30 in the Scottish Rite Auditorium

2 Kids Health First Key Updates Staffing KHF GPS UHC Premium Rebate Peach State Health Plan (PHSP) Check Contract Dues End of Year Strong 4 Life MOC Program Quality Management Practice Standards Risk Management Concussion Well Check Forms and Minimum Standards Adolescent Confidentiality Vaccine Program Flu.75 ASF Merck Malpractice Program Volunteer Policy Premiums Estimated K-1 s PHIC and GPCN Annual Meeting Tuesday, February 26 th, 2013 Physician Stipend POD Meetings North: Thursday, September 27, 2012 South: Tuesday, October 25,2012 Topic Leadership Development Succession Planning Membership Attendance Requirements Wellness Meeting Research Study Fall Cycle is October 15 th - November 16 th Packets by October 1st Mid-level Information Request

3 Risk Management Program 2012 Top Recommendations 1. Test Results Follow-up - fail safe mechanism to assure results returned, timely review, and results given to patient/family. Involves three steps: 1. System to know if results / report not received a system by which a practice would know if they did not receive results/ report back from a test ordered and that system is NOT dependent solely on a return appointment or holding the medical record. 2. Provider review/initial provider review results timely 3. Results to patient all results given to patient, even those that are normal. Relevance or Importance 40% of claims against physicians originating in the physician office involve an allegation of delay or failure to diagnose. 2. Sample Medications noted in Medical Record - When a sample medication given, it is so noted in the medical record. This is separate from maintaining a samples log. Relevance or Importance provides documentation if a patient uses sample and then wants a prescription or if they do not what to use that medication again. You are providing the medication without the safety net of a pharmacist to check interactions with other medications. Physicians have the same duty of care to patients given samples as those to whom they give prescriptions. 3. Documenting After Hours Phone Calls after hours calls to a physician are documented with the patient name, the symptoms reported, and the advice given. Relevance or Importance Critical element in defense of claim. Providing documentation benefits other providers who see or communicate with the patient. 4. Use of Problem List highlight ongoing and frequently occurring problems. The Problem list is a cheat sheet on patient health status that is aimed at controlling complexity and providing concise, relevant data. Relevance or Importance Useful tool for a provider who is not as familiar with the patient. It helps to identify the most important health factors for each patient, identify disease specific populations, and jogs memory of the provider. 5. Use and Update of the History Form the elements of a complete assessment include updating the history. For younger patients you should obtain information about delivery/birth, siblings/family, and environment. As the patient gets older, you add to this basic data. Relevance or Importance Use of a standard history form reduces reliance on memory to obtain standard information and by updating the form we remind parents of the need to provide the latest information.

4 Strong4Life Training Schedule Upcoming Strong4Life Provider Training Sessions Register for an upcoming training session today. Simply visit Oct. 10, Children s Office Park Oct. 24, Children s at Scottish Rite Nov. 7, Children s Office Park Dec. 12, Children s at Scottish Rite All training sessions are from 6 8 p.m. The Children s Office Park training location is Classroom 1 in Building The Children s at Scottish Rite training location is the Mini Auditorium. We can also schedule a private training just for your practice. If your practice is in metro Atlanta and you have 10 or more confirmed providers or if your practice is outside metro Atlanta and you have 50 or more confirmed providers, we can bring this training directly to your practice. Contact Ashley Skorcz at ashley.skorczrd@choa.org or call for more information.

5 Kids Health First Fall 2012 POD Meetings North POD Meeting Thursday, September 27, 2012 Scottish Rite Board Room South POD Meeting Thursday, October 25, 2012 Dekalb Pediatric Center Discussion Topics GA Medicaid Reform Leadership Development Succession Planning

6 STRONG4LIFE PROVIDER TRAINING Maintenance of Certification Key Program Components: Attend Strong4Life Training Session (CME provided) Incorporate standardized history and physical assessment components Submit monthly data to measure quality improvement Complete a six-month online survey Conduct two in-office staff meetings for program implementation and data comparison MOC Point Value: 25 points Incorporating motivational interviewing techniques and setting goals with families to improve the effectiveness of childhood obesity counseling Children s Healthcare of Atlanta has partnered with Kids Health First Pediatric Alliance to create an American Board of Pediatrics Maintenance of Certification (MOC) Program centered around the key training principles of Strong4Life. Participation The program is available to all Board-certified Georgia Pediatricians seeking Maintenance of Certification Part 4 Credit. Description of Program Throughout the six-month program, participants will incorporate motivational interviewing skills and standardized assessment tools to promote evidence-based obesity prevention messages with all children ages Participants will partake in a Strong4Life Provider Training (CME credit provided), and receive a free provider toolkit to support conversations about healthy habits and BMI measurement with families. Participants will set goals with families to improve healthy habits within the family structure. The MOC program requires participants to implement standardized history and physical exam check points for children 6-11 years of age. Participants will be assessed monthly for quality improvement and will have the opportunity to compare their results with their peers. Registration To register, please visit For more information, please call ext. 209 or s4lmoc@khfirst.com Children s Healthcare of Atlanta Inc. All rights reserved.

7 Cost and Quality Transparency Initiative: New myhealthcare Cost Estimator for Members Frequently Asked Questions Q. Why did UnitedHealthcare launch a new cost estimator tool for its members? A. We launched a new member cost estimator tool for several reasons: u All stakeholders we serve (consumers, providers, employers and brokers) are seeking providerspecific cost estimates, such as those displayed by online estimators or calculators, to assist consumers in making informed decisions regarding treatment options, providers, and service locations. u Current benefit plan designs encourage greater consumer engagement in medical care decisions, regarding both quality and cost of services. u Federal and state governments continue to emphasize the importance of consumer price transparency. u Feedback from UnitedHealthcare s Administrative Advisory Councils has highlighted the ability of the tool to help members understand, prior to treatment, their cost contributions for medical procedures. u The new tool will help your patients who are UnitedHealthcare members better predict and manage their health care expenses and benefits, and will empower members with information such as the estimated cost differences for treatments between participating providers, locations and facility types, including estimated member expense and total cost of care. Q. How does the information displayed in the cost estimator tool affect me as a participating physician, hospital or other health care professional with UnitedHealthcare? A. By using our cost estimator tool, members can obtain information about the estimated costs of their care, the services to be provided, and the nature of those services. This can empower our members (your patients) with information that can inform care choices, including the costs of alternatives you may wish to discuss with your patients, or they with you.

8 Frequently Asked Questions Q. How can I find out more about the information displayed in UnitedHealthcare s cost estimator tool? A. Please contact your local UnitedHealthcare Network Management Representative, Physician Advocate, or Hospital and Facility Advocate if you have questions about the costs or services included in the tool. Our efforts are focused on consumer transparency physicians, hospitals and other health care professionals do not currently have direct access to view their costs in the cost estimator tool. We are planning future enhancements that will allow a participating provider to access the tool to view their specific cost estimates, with no access to the data of other providers or facilities.. Q. What is the myhealthcare Cost Estimator? A. Enhancements will be made to our cost estimator tools throughout The first phase of these enhancements was effective Jan. 1, 2012, for those providers in the markets below: u Estimates display as a specific total cost estimate for the services in the treatment episode. u Estimates in myhce are currently based on the applicable All Payer fee schedule or contracted rates in effect as of May 31, 2012, as specified under the terms of the provider s participation agreement. For services where set fees or rates are not applicable or available, estimates are based on historical claim averages (Choice Plus data). Beginning in the third quarter of 2012, estimates will be based on the applicable fee schedule or contracted rate in effect at the time the estimate is generated, supplemented by historical claim averages where needed. u Some services will still utilize the current median claims-based methodology, such as percent-of-charges rates, or in other circumstances where a set fee schedule does not apply or is not available. u Costs are measured at a Care Path (treatment episode) level to help consumers understand the services they should expect to receive. Estimated totals will include medical professional and facility estimated costs, as well as the typical services that make up a treatment episode. These services could include costs for the initial office visit, specific procedures involved, associated follow-up care, etc. Access to treatment descriptions for services in the treatment episode or Care Path. u myhce displays the total estimated costs for the services in the Care Path, as well as a more detailed breakdown of category of service in the treatment episode (e.g., facility and professional). u myhce displays market average costs, facility- or physician-specific estimates, and expected out-ofpocket costs based on the member s benefit plan. u Because quality of care is just as important to consider as cost of care, quality information from the UnitedHealth Premium Designation Program, where available, will be displayed along with cost information. (Note that the UnitedHealth Premium Designation Program is not available in certain states or markets at this time and not available for all provider types. If you have questions about the Program, please visit UnitedHealthcareOnline.com.) 2

9 Frequently Asked Questions The screenshot below displays the information available to members in March There were 119 services or Care Paths included in myhce for the initial release, including procedures for common ambulatory and outpatient services such as radiology, lab, office visits, consultations, preventative services, and outpatient procedures. We continue to expand the scope of services with additional releases in 2012 and beyond. By the end of 2012, myhce is projected to include approximately 180 Care Paths; selected high-volume inpatient services are planned for inclusion in the fourth quarter of Cost bands showing where the estimated total falls along the spectrum of low to high costs are displayed, indicating if the estimate is in the top 25 percent, the middle 50 percent, or the bottom 25 percent of the cost bands for a specific geographic area. Estimated total and out-of-pocket costs based on the member s benefit plan are also displayed. 3

10 Frequently Asked Questions Q. What markets have information in myhce today? A. The table below lists the markets in which myhce is currently available. Central Region: Cincinnati, OH Dallas, TX Milwaukee, WI Chicago, IL Columbus, OH Houston, TX Kansas City, MO Austin, TX Cleveland, OH Detroit, MI Indianapolis, IN San Antonio, TX Springfield, MO St. Louis, MO Q. What other changes are planned throughout 2012 and 2013? A. myhce will continue to evolve to meet the needs of UnitedHealthcare members. The following enhancements are planned for the last half of 2012: u Estimates based on the applicable fee schedule or contracted rate in effect at the time the estimate is generated supplemented by historical claim averages where needed. u Expansion of available Care Paths. New Health Care Cost Estimator 3/31/12 u Deployment of myhce in the following markets: Central Northeast Wisconsin, WI Oklahoma City, OK Tulsa, OK Des Moines, IA Ft. Wayne, IN Eastern TX Beaumont TX Western TX Western KY Eastern KY Northwest KY Southwest IN Southeast IN Grant County KY Northeast KY Toledo Northern KY Border Dayton, OH Nebraska Northeast Region: Fairfield County, CT Hartford (other), CT Northern NJ NYC Long Island, NY Baltimore, MD Boston, MA Buffalo/Rochester, NY Hudson Valley/ Westchester, NY Philadelphia, PA Rhode Island Southeast Region: Atlanta, GA Baton Rouge, LA Tampa, FL Charlotte, NC Florence, SC Jacksonville, FL Miami, FL Monroe, LA Orlando, FL Raleigh/Triangle, NC Wilmington/UCF, NC Q3 myhealthcare Cost Estimator Planned Deployments Northeast Pittsburgh, PA Northeast Pennsylvania, PA Fairfax, VA Richmond, VA Northern Virginia, VA Sub. Maryland, MA Western Maryland Washington DC Southern NJ Southeast New Orleans, LA Greenville, SC Greensboro, NC Little Rock AR Knoxville, TN Nashville, TN 4 West Region: L.A. /Orange County, CA Phoenix, AZ Seattle, WA Denver/Colorado Springs, CO Las Vegas, NV Portland, OR Sacramento, CA Salt Lake City, UT San Diego, CA San Francisco, CA West Tucson, AZ Palm Springs, Riverside and San Bernardino, CA Albuquerque, NM

11 Frequently Asked Questions u Access to myhce by selected UnitedHealthcare affiliates. The availability of access will be communicated via the Network Bulletin as affiliates are added. Q. How often will data in myhce be refreshed or updated? A. With the myhce release at the end of May 2012, data was refreshed to reflect the provider s fee schedule or payment appendix in effect on May 31, In the last half of 2012, data will reflect the provider s fee schedule or payment appendix in effect at time of the estimate s creation, supplemented by historic average claim data if applicable. For services where specific providers are not selected, average market costs based on UnitedHealthcare claims data will still be used; this data will be refreshed quarterly, beginning in the third quarter of Q. Is quality factored into the data displayed in myhce? A. Information for physician specialties included in the UnitedHealth Premium Designation Program is displayed, where available, for the services selected, based on the physician s designation. (Note that the UnitedHealth Premium Designation Program is not available in certain states or markets at this time and not available for all provider types.) Procedures shown by a physician/facility combination will be listed in order based on the following: u Where available and applicable, physicians with UnitedHealth Premium Quality and Efficiency designations will be listed first. Within this grouping, physicians are sorted by estimated cost and will appear in ascending order. u Where available and applicable, physicians with the UnitedHealth Premium Quality designation will be listed next. Within this grouping, physicians are sorted by estimated cost and will appear in ascending order. Physicians with no UnitedHealth Premium designation will be listed last. Within this grouping, physicians are sorted by estimated cost and will appear in ascending order. Q. In geographic areas where we have not yet launched myhce, how do UnitedHealthcare members obtain estimated treatment cost information today? A. In areas where myhce is not yet deployed, UnitedHealthcare provides estimated cost information to our members through the Treatment Cost Estimator available under the Tools section on myuhc.com. This tool is designed to assist members in selecting a treatment option based on estimated cost and location parameters, and help consumers better understand and plan for potential out-of-pocket costs related to their treatment options. The Treatment Cost Estimator calculates and compares treatment-specific cost estimates by participating provider, location and facility type. The estimated total includes the treatment cost, plan responsibility and member responsibility. Member responsibility estimates are tailored to the individual s benefit design and out-of-pocket coverage (copayment or coinsurance, network or preferred provider cost differential). Estimates are displayed as cost ranges for the selected service. For physician and other health care professional services, estimated cost ranges are displayed based on provider-specific costs. For hospital and facility services, cost estimates are based on average costs for the same facility type in the geographic market area, rather than costs specific to a selected facility. 5

12 Frequently Asked Questions The screenshot below provides an example of the information displayed in the Treatment Cost Estimator. Q. Does the information displayed in myhce or the Treatment Cost Estimator guarantee coverage to the member and payment to the physician for the services provided? A. No, this information does not guarantee member coverage or physician payment. Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oregon, Inc., and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc. or its affiliates. Doc#: UHC1631c.4_ M / United HealthCare Services, Inc.