Medical Billing and Data Sharing

Transcription

1 Million Hearts Combined Clinical Data Work Groups Meeting Oct 1, 2104 ATTENDANCE (* = BY PHONE) NAME Bo Greaves, MD Jason Cunningham, DO Michelle Rosaschi Margie Gilford, MD Gary McLeod, MD Eki Abrams, MD Colette McGeough, RN Emily Ash Jennifer McClendon Marshall Kubota, MD Jerry Minkoff, MD * Terry Leach * AFFILIATION Vista Family Health Center/SR Community Health Centers West County Health Centers Redwood Community Health Centers Sonoma County Medical Association/Kaiser Sutter Medical Group of the Redwoods Annadel Medical Group Sonoma County Public Health Sutter Pacific Medical Foundation Center for Well Being Partnership HealthPlan Retired Kaiser physician CHI consultant ACTION ITEMS: TASK/ITEM Set goal to implement quarterly data reporting by end of year, starting with 2014 data as benchmark. Create template for quarterly reporting Review and comment on non disclosure agreement (NDA) used by Be There San Diego for data sharing Respond to doodle poll to select initiative name Request meeting with Rajesh Ranadive, MD (heads EMR task force and best practices committee for Annadel Medical Group) UPDATE: Dr. Ranadive will participate in monthly MH meetings OWNER/FOLLOW UP Emily Ash ALL PARTNERS ALL PARTNERS Eki Abrams Bo Greaves/Jason Cunningham

2 Create community branded guideline aligned with JNC 8 Request meeting with Kaiser CMO Michelle Rosaschi, Margie Gilford Bo Greaves/Jason Cunningham (Mary Maddux Gonzalez) Investigate engaging a representative from pharmacy group Respond to information gathering questionnaire for Cal SIM Accountable Communities for Health pilot opportunity Follow up Right Care Initiative re: potential support and resources Follow up with Partnership HealthPlan re: Innovation Grants Oct 14 presentation to Sutter Medical Group Marshall Kubota/ Jerry Minkoff (Note: Agenda order reversed to accommodate Jason Cunningham s schedule.) Data Sharing & Shared Metrics Data is essential for collaborative learning aspect of this initiative. Partners considered the following questions: What is your organization already tracking and measuring relevant to hypertension (and smoking)? What data sources is your organization using? What format would work best for sharing data? How would this be shared? Is your organization able to report data monthly? Who is the decision making individual in your organization who can be contacted about authorizing this? What are the legal/nda issues for partner organizations? Partners agreed on the need to produce quarterly reports, extracting the following data from their EMR systems: Patient name (First Name, Last Name)

3 Zip code 9 digit or address Most recent vitals Most recent BP reading Primary Care Provider Age/DOB* Gender Race Payer Smoking status (Y/N) Denominator: Active patients age 18 and above defined as seen for primary care visit in your organization within the most recent 12 month period. Still to be discussed: With current HTN diagnosis (specific ICD 9 code 401.9)? OR ever assessed/diagnosed with HTN? Numerator still to be defined. Identified the need for a common set of nomenclature to be used for quarterly reporting. Reports to be produced in Excel spreadsheet format. A template will be developed. Partner EMR Systems Kaiser Sutter Medical Group Annadel Medical Group RCHC Center for Well Being Epic Epic AllScripts eclinicalworks (ECW) ECW and Epic Data reporting status/issues for each organization: Sutter (Emily Ash/Gary McLeod) Already collecting data on managed care population down to provider level that includes tracking blood pressure and smoking. Just starting to collect data on fee for service population.

4 Able to do some information extraction, as long as the data resides in the EMR system. Have provider information for Sutter physicians but not the entire community network Center for Well Being (Jennifer McClendon) NCCWB collects data for diabetes on patients referred to programs Jennifer will look into whether NCCWB could collect partner data if needed (if County s role subjects collected data to Public Records Act inquiries. UPDATE: Spoke with Jennifer on Oct 6. Board members are interested in NCCWB taking on data collection role RCHC (Michelle Rosaschi) Quarterly data collection not a problem for RCHC. Data is already pooled for most member clinics; for two clinics, data will have to be requested directly. Annadel Medical Group (Eki Abrams) EMR system (All Scripts) has data extraction and trending capabilities, however this is not happening yet due to limited resources. Annadel recently formed an EMR task force, headed by Dr. Rajesh Ranadive, as well as a best practices committee. Action: Bo Greaves and Jason Cunningham will ask to meet with Dr. Ranadive. Vista Family Health Center (Bo Greaves) Vista doing monthly data report on controlled vs uncontrolled HTN by site and also aggregated across all of SRCHC. Can add race and smoking status. (Controlled HTN defined as last BP reading less than 140/90.) Denominator is everyone with HTN diagnosis code. EMR system (ECW) default is to add this to problem list. If HTN not diagnosed, not added to list. Kaiser Santa Rosa (Dr. Margie Gilford) EMR System: Epic Kaiser generates a PHASE patient list every day. Hypertensive patients list given to providers quarterly to assess whether patients are at goal and to work the list. Kaiser provides tools to help providers do this but otherwise, there is no supervised management of the list. Kaiser s hypertension algorithm is distributed to providers and staff regularly. Physicians are required to attend evening meetings to go over these lists.

5 Action: Margie to follow up with her direct supervisor and Kirk Pappas, Kaiser Santa Rosa CMO, to: Clarify her role with the initiative (representing SCMA, Kaiser, or both?) Ask what data can be shared Request a meeting with Bo Greaves and Jason Cunningham. Bo Greaves suggested the importance of clarifying with Kaiser that goal of data sharing for this initiative is not comparison of medical organizations but to give the community a report card of how the health system is performing on metrics associated with cardiovascular disease prevention. Patient and organizational information will be de identified and the data will be pooled. Data sharing needed to learn for partners to learn from each other and non disclosure agreement will ensure confidentiality. Jason Cunningham suggested offering reporting tools to organizations to monitor the performance of individual providers. Clinical Operations Workflow & Team based Care Discussed the role of self management and home BP monitoring in hypertension control. By JNC standard, home blood pressure monitoring is useful but should not drive treatment. Kaiser does not record home BP readings in medical record. Home BP readings not allowed/counted for HEDIS. Need to find out whether there are any national standards about this (such as AMA s Measure Up, Pressure Down or Million Hearts). A recent VA study concluded that home BPs with pharmacist readings can be viable source of HTN monitoring. ( Self titration Kaiser asks patients to do own titration until target BP reached, then asks them to make an appointment so this can be documented. HTN follow up/bp re check How can this be made as convenient as possible? The standard practice of a follow up appointment in three months is not effective (many patients don t return for re check within that time frame). Ideas for more consistent and convenient BP re check and monitoring: Saturday BP clinics Pharmacies BP readings (FQHCs embedding pharmacies and labs BP clinics staffed by medical assistants BP readings wherever health professionals interact with public, i.e. Public Health nurses via Care Transitions program Community health worker programs

6 Take BP readings anytime patients come in, even if for other reasons (like Kaiser s approach of addressing outstanding issues even when unrelated to reason for patient s appointment). For any/all of the above, need to establish a way to report BP readings back to providers, such as link to EMRs. RCHC Presentation Presentation on RCHC s cardiovascular risk reduction and hypertension control initiatives Michelle Rosaschi. RCHC has two different initiatives: HTN control being implemented in all clinics; PHASE being implemented only in some clinics. Elements of HTN control initiative include: EMR optimization Shared order sets Training staff on: take accurate BP (including retraining/refreshing), using order set, ensuring uniform documentation Shared tools through RCHC member portal (including AMA s Measure Up, Pressure Down toolkit (see: Bo Greaves noted that this represents the first time all RCHC member clinics have agreed to share, adopt beset practices, and common guidelines. Getting all clinics on board took about a year and represents a major cultural shift. RCHC clinics are just now getting started with implementation. RCHC has adopted the Kaiser s PHASE approach of combination therapy to people to target as quickly as possible, even though this goes against the more traditional phased approach to HTN control. Vista Family Health Center implementation Bo Greaves Providers are focusing on algorithm, treatment therapy but not necessary to train medical assistants with that level of detail. Assembled teams of nurse practitioners, nurses, and MAs and focusing attention on work flow. Dealing with inconsistencies in follow up BP readings and where these are recorded so needed to come up with an approach. Teams came up with the following ideas: Take BP reading at the end of each patient interaction rather than the beginning, so patient has been sitting for a few minutes and is able to relax. When BP reading high, recorded in chief complaint field of EMR (rather than vital signs field) which so provider sees more readily. Also having to educate MAs about where in EMR to record BP, which reading is correct, and need for accuracy (no rounding). Key is to get right team together to look at what is actually happening.

7 Bringing patients with high BP back for re check in 2 4 weeks, self titration at home are elements that not every physician is doing at all or doing consistently. Discussion: Important to determine which field and which reading of each organization s EMR will be used for HTN Control reporting for accuracy. Helpful for physicians to be able to see what MAs see in the EMR. Need to include age in data reporting. Kaiser HTN only guideline not yet age stratified. JNC 8 does add age guidelines. Sonoma County initiative needs to come up with community guidelines version that doesn t look exactly like the Kaiser one. ACTION: Revise Kaiser/RCHC guideline as per discussion and distribute to participating organizations. Funding/Resources for Sonoma County Initiative Sonoma County was not awarded CDC Partners in Community Health grant. Proposal included support for dedicated Million Hearts coordinator. Need to find other sources of funding for initiative. o Marshall Kubota indicated that Partnership HealthPlan innovation grant may be one opportunity. Cal SIM Accountable Communities for Health pilot funding opportunity looking for counties working on specific chronic disease. Sonoma County Dept of Health Services to coordinate response to request for information by Oct 10 deadline. Right Care Initiative: o Leadership summit happening in October for San Diego, Los Angeles, and Sacramento Million Hearts initiatives. Terry Leach looking into whether Sonoma County representatives could attend. [Update: Sonoma County representatives will not be able to attend this conference.] o Potential to partnership for resources and funding. [Update: Outcomes of conference call with Hattie Handley, ED of RCI, on Oct 9, 2014: Invited to Dec 8 Sacramento University of Best Practices Partnership to be further explored after Nov 1 st. NEXT MEETING: Wed, Nov 5, :00 10:00am Wisteria Conference Room 490 Mendocino Ave, Suite 101, Santa Rosa