Spring 2020 Newsletter
- CommonSpirit COVID-19 Page and Other Resources
- Shared Savings in the South Region
- Review of SCICN-VC Contract Highlights
- Reducing Hospital Readmissions for COPD Patients
- Welcome, New SCICN-VC Providers
- Care Coordination Helps Patient Stabilize BP and Glucose and Improve Health
- SCICN-VC Aligns with CommonSpirit Health’s HTN Initiative
- GPRO Process Complete for Measurement Year 2019
- QPP Website Now Includes 2020 MIPS Measures and Activities on the Explore Measures Tool
- Complete the New Well-Being Index Survey
- In-Person Office Visits Decline in ACO Survey
- Be Featured in a Provider Spotlight
CommonSpirit COVID-19 Page and Other Resources
During this critical time, keeping our teams informed and connected is more important than ever. As we manage the COVID-19 pandemic, there are several resources you should know about.
First, the recently launched Physician Enterprise and Enterprise Population Health COVID-19 resource page provides information and tools, including the Ten Commandments Checklist, toolkits, protocols, tips for coping and more. Check back daily — information is added as it becomes available.
You also can turn to the following CMS and payor resources:
- CMS Resources and News Updates, a comprehensive resource list that is updated regularly. This is the complete source of announcements from CMS. Plus, the agency’s FAQ document is especially helpful and is updated regularly.
- Information from Anthem
- Information from Blue Shield
- Information from United Healthcare, which includes updated COVID-19 testing guidance.
Shared Savings in the South Region
SCICN participates in the Blue Shield PPO ACO as part of the South Region, which also includes the Inland Empire and Bakersfield clinically integrated networks, and received a shared savings payment for the most recent performance period (July 2018 through June 2019).
The South hospitals in this contract include St. John’s Pleasant Valley (Camarillo), St. John’s Regional Medical Center (Oxnard), St. Bernardine Medical Center, Community Hospital of San Bernardino, Bakersfield Memorial Hospital and Mercy Southwest (Bakersfield).
Shared savings are calculated at the regional level (i.e., South), and allocated based on the number of attributed lives during the performance period. SCICN Ventura had 35 percent of the total attributed lives and earned $86,230. Eligible SCICN Ventura participants were notified and received their portion based on the Board-approved physician distribution methodology.
Review of SCICN-VC Contract Highlights
SCICN-VC’s value-based contracts include Anthem Blue Cross, Blue Shield, United Healthcare, Dignity Health Ventura Medical Plan and Health Net. Here are the highlights to know about these five contracts:
Anthem Blue Cross Enhanced Personal Healthcare (EPHC) Program
- Total Cost of Healthcare ACO with Anthem PPO members.
- 57,000 attributed members across all of our California geographies.
- Three-year, upside-only contract with the potential to receive 30 percent of the total of any shared savings.
- Quality measures are the “gate”, completion of 50% of the quality measures required to qualify for any earned shared savings.
- Care Coordination pmpm fees to the network (netted out of any shared savings).
Blue Shield of California
- Total cost of health care, two-tiered contract.
- Three-year, upside-only contract with opportunity to receive up to 20 percent of shared savings based on quality.
- Care Coordination fee to the network (netted out of any shared savings).
- Quality measures are a “multiplier” providing a maximum 20 percent increase if shared savings is achieved. Each qualifying measure weighted equally, must have >30 denominator and included on MY2017 baseline.
PPO Accountable Care Organization (ACO) with United Healthcare
- Three-year, upside-only contract kicked off in October.
- Includes all PPO members and a quality gate the network must meet to achieve savings.
- Care Coordination pmpm fees to the network (netted out of any shared savings).
- United Healthcare also provided a separate opportunity for providers to receive a quality bonus based on quality measure satisfaction.
Dignity Health Ventura Medical Plan
- Total cost of health care with Dignity Health employees.
- Includes 4,200 EPO and PPO plan members.
- Upside-only agreement with opportunity to received up to 50 percent of shared savings based on quality measures.
- Care Coordination fee included.
Health Net Quality Bonus
- Health Net and Dignity Health Clinically Integrated Networks (CINs) entered into a Memorandum of Understanding (MOU).
- Health Net agreed to pay Dignity Health CINs a quality bonus equal to the amount Health Net-contracted CIN physicians would have received if a rate increase was given.
Summary of Quality Measures in ACO PPO Contract
Checklist: Best Practices to Improve Quality Measures
To improve quality measures in our commercial ACO PPO contracts, primary care providers should keep in mind the following:
- Discuss with the patient the importance of preventive health screenings.
- Implement a reminder system to alert office staff when a patient’s health screenings are due.
- Set up reminder outreach to patients who have scheduled appointments.
- Routinely schedule follow-up appointments before the patient leaves.
- Maintain a process to request and retain copies of test results in the patient health record.
- Ensure preventive health screenings are completed in a timely manner.
- Remember proper clinical documentation is essential in meeting the quality measures and improving patient care.
- Submit appropriate claims for services rendered to patients, ensuring claims data is accurate and submitted in a timely manner.
- Consider expanding office hours to increase access for patient health care services.
Reducing Hospital Readmissions for COPD Patients
Working with local medical groups, Dignity Health St. John’s Regional Medical Center and Dignity Health Pleasant Valley Hospital have launched a pilot program that bridges the inpatient and post-discharge care for patients with COPD in an effort to reduce hospital readmissions.
Under the COPD Program, patients are provided with:
Standardized best-practice hospital care. The Emergency Department (ED) and Hospitalist Team have developed standard orders to include Pulmonary, Pharmacy and Respiratory consults for patients admitted with a COPD diagnosis.
Pre-discharge education. Inpatient nursing staff will encourage patients to view COPD videos, which cover the signs and symptoms of exacerbation, the zone tool and the benefit of proactive management. Respiratory therapists provide one-on-one education regarding inhaler use and recommendations for pulmonary rehabilitation. Patients also receive an inpatient checklist to empower them in their care.
Confirmation of outpatient prescription coverage. Pulmonary consultants will document inhaler medications in order of preference for the hospitalist to order prior to discharge.
Nursing staff will ensure that the patient/family check with their pharmacy to see which medication(s) is covered by their pharmacy plan and confirm copay.
Outpatient Respiratory Rehabilitation Program. The respiratory therapist will assess the inpatient for appropriate post-discharge referral.
Follow-up physician appointments. ED/Inpatient staff will assist the patient in securing appropriate post-discharge physician appointments.
Post-discharge support. The patient will be enrolled in a 30-day post-discharge bridge program through IDMSO Care Coordination, which includes:
- COPD assessment
- Weekly follow-up calls
- Evaluation of patient self-management skills
The COPD Program Team meets weekly to address barriers, report successes and work on next steps to standardize care delivery systems through the continuum of care. Team members include:
- Hospital Representatives
- Local Medical Groups
- Pulmonary Physicians Seaview IPA
- Emergency Department Physicians Valley Care IPA
- Nursing Dignity Health Medical Group
- Respiratory Department
- Care Coordination
- Post-Acute Care
Welcome, New SCICN-VC Providers
Welcome to SCICN-VC’s newest providers:
Cabrillo Cardiology Medical Group, Inc.
Alexandra McGlamery, FNP
California Managed Imaging Medical Group, Inc.
Attilio Macrito, DO
Coastal Allergy Care
Melissa Howie, PA-C
Dignity Health Medical Group-Ventura County
Bradley Hiner, MD
Dignity Health Medical Group-Ventura County
Lily Mallare, MD
Obstetrics and Gynecology
Loma Vista Endocrinology
Barbara Holdsworth, FNP
Endocrinology Diabetes & Metabolism
Rose Avenue Family Medical Group, A Professional Corporation
Autumn Edwards, MD
Stroke and Neurovascular Center of California
Akinwunmi Oni-Orisan, MD
Alois Zauner, MD
Ventura Advanced Surgical Associates, A Professional Medical Corporation
Terry Simpson, MD
Ventura Orthopedics Medical Group
Lisbeth Geertsen, OTR
Velia Lozick, OTR
Vista Del Mar Medical Group, Inc.
Chonlada Chivangkul, MD
Care Coordination Helps Patient Stabilize BP and Glucose and Improve Health
CASE: A 55-year-old female with intellectual disabilities came to Care Coordination in January 2019 for diabetes management, blood pressure management and edema. The patient was sleeping on her couch and was spending most of her time sitting and eating. Her caregivers are paid for by Tri-Counties.
ASSISTANCE PROVIDED: The patient’s PCP ordered a glucometer, and Care Coordination provided a blood pressure machine. Care Coordination also provided the caregivers with diabetes and heart disease education, covering the importance of diet and exercise and medication management, and encouraging prevention and screening tests.
OUTCOME: The patient’s blood pressure and blood sugar are stable. She’s losing weight and sleeping in a hospital bed. In addition, the patient is more active and walking independently, bathing herself at times, and has less edema. Her caregivers are cooking healthy meals, monitoring and documenting her blood pressure and blood sugar daily, and assisting the patient with daily exercises. In addition, her mammogram and colonoscopy have been completed, and she receives podiatry care as needed.
SCICN-VC Aligns with CommonSpirit Health’s HTN Initiative
As you know, hypertension is our first National Ambulatory Clinical Goal as CommonSpirit Health. This goal will contribute to our collective efforts to build healthier populations and communities as we advance a coordinated, systematic and customizable approach to serving those with acute, chronic and complex conditions.
Various tools, resources and recorded videos will continue to be created and shared with your practice. Current resources are available on the SCICN-VC secure Provider Portal.
FY20 Ambulatory Quality Measure
|Measure||Hypertension (high blood pressure) management in attributable CommonSpirit Health Clinic patients|
|Description||% of patients 18-85 years who had diagnosis and/or active problem of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during measurement period|
|Numerator||Patients whose blood pressure at the most recent visit is adequately controlled (<140 systolic and <90 diastolic)|
|Denominator||Patients 18-85 years with diagnosis or active problem of HTN who had an encounter during the performance period (E/M CPT codes)|
Measure definition and exclusion criteria aligned with CMS Merit-based Incentive Payment System (MIPS) enables benchmarking against MIPS percentile scale based on measure performance rate
Progress Update on CommonSpirit Hypertension Goal
The one-year ambulatory quality goal is to improve the percentage of patients with a diagnosis or active problem of hypertension and whose blood pressure is adequately controlled (less than 140/90 mmHg).
The latest prevalence estimates show that 46 percent of adults in the United States have high blood pressure. The performance period for this goal is October 2019 through June 2020. During the most recent measurement period (October 2019 – February 2020), CommonSpirit Health data demonstrated a rate of 70 percent, achieving the enterprise Target Level performance goal. This current performance represents the 77th percentile within the 2018 CMS Merit-based Incentive Payments (CMS-MIPs) benchmark results for hypertension control.
Strategies underway to sustain hypertension improvement efforts include enterprise-wide deployment of a video demonstration to support accurate blood pressure measurement and enhanced reporting of clinic and provider level data. In addition, the national ambulatory quality team, in coordination with local leadership, conducted on-site evaluations for high-volume, low-performing clinics in the Greater Sacramento, Tennessee and Kentucky markets to identify opportunities for improvement and resource needs.
GPRO Process Complete for Measurement Year 2019
As participants in the Medicare Shared Savings Program (MSSP), quality team members from NSQCN, SRQCN and SCICN recently completed the Group Physician Reporting Option (GPRO) process for the 2019 measurement year. Team members abstracted quality data from medical records for submission to CMS. This was the third year of program participation, and CMS likely will announce final results in July/August 2020. Each CIN’s overall performance on quality and cost metrics may result in shared savings.
Here’s how the process worked:
- CMS provided Dignity Health with patient lists for each of the three participating networks. Once received, a team of abstractors spent approximately 12 weeks validating and manually abstracting the required data from medical records.
- For each of the 10 Web Interface-reported quality metrics, CMS randomly sampled 616 beneficiaries for inclusion in applicable measures. CINs were required to confirm the patient’s eligibility, verify satisfaction of measure criteria and submit data for a minimum of 248 consecutively sequenced beneficiaries. The athenahealth platform was used to document quality results for submission via the CMS Web Interface.
- Additional quality measures required within the MSSP program were reported through patient satisfaction surveys, utilization and claims data, and other sources.
CMS-GPRO reporting is the culmination of efforts made throughout the year by various clinical and quality teams to provide evidence-based preventive and condition-specific care.
QPP Website Now Includes 2020 MIPS Measures and Activities on the Explore Measures Tool
The Centers for Medicare & Medicaid Services (CMS) has updated the Explore Measures Tool on the Quality Payment Program website for the 2020 performance period. The tool now includes 2020 Merit-based Incentive Payment System (MIPS) measures and activities for the four performance categories:
For additional details on the 2020 MIPS measures and activities, which also include January technical updates to the quality measure specifications, view the following resources on the QPP Resource Library:
- 2020 MIPS Summary of Cost Measures
- 2020 MIPS Cost Measure Information Forms
- 2020 Cost Measure Code Lists
- 2020 Improvement Activities Inventory
- 2020 Promoting Interoperability Measure Specifications
- 2020 Quality Measures List
- 2020 Quality Benchmarks
- 2020 Clinical Quality Measure (CQM) Specifications and Supporting Documents
- 2020 Qualified Clinical Data Registry (QCDR) Measure Specifications
- 2020 Medicare Part B Claims Measure Specifications and Supporting Documents
- 2020 Web Interface Measure Specifications and Supporting Documents
Please contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8 a.m. – 8 p.m. ET or by e-mail at: QPP@cms.hhs.gov.
Complete the New Well-Being Index Survey
CommonSpirit Health is re-launching an enhanced version of the Well-being Index (WBI) and making it available to all SCICN-VC physicians. It is a validated, confidential online tool that provides physicians with an assessment of their well-being, plus confidential online resources to address areas of concern. Physicians can repeat the survey and follow their assessment over time at no charge.
The WBI takes less than five minutes to complete via the link and invitation code below. Again, it is completely confidential; only you will see the results. Physicians should encourage their colleagues to complete the survey as well. Now more than ever, with so many counting on us, we need to take care of ourselves and each other.
If you have questions or comments regarding the survey — or suggestions for encouraging physician colleagues to make this investment in their own health — please send them to Heather Miller at Heather.Miller@DignityHealth.org.
WBI survey link: https://app.mywellbeingindex.org/signup
Invitation Code: CSH Physician
In-Person Office Visits Decline in ACO Survey
The most recent available National Association of ACOs (NAACOS) survey (for the week of May 25) offers a glimpse into how ACOs are seeing their services change due to the pandemic. In the survey, 126 ACOs reported on changes in their in-person office visit volume compared with pre-COVID volume. This latest report shows some improvement in visit volume.
- Of the respondents with in-person visits down by more than 60 percent, their visits continued to fall from 13 percent the previous week to 9 percent during the last week in May, while 50 percent of respondents stated they were currently seeing a 20-40 percent reduction in visit volume.
- Declines remained highest in the Northeast, while visit levels in the South, Midwest and West continue to recover swiftly.
- Declines reported by hospital-led and physician-led ACOs were similar, although they were slightly larger among physician-led ACOs.
Results from April 27 – May 25, 2020
Be Featured in a Provider Spotlight
When you volunteer to be a part of our Provider Spotlight series, you’ll be featured on the SCICN-VC website in the “Provider Spotlight” section and in our social media efforts, too.
This is a great opportunity to showcase your practice and make sure the rest of SCICN-VC knows about your services and providers. To be part of the Provider Spotlight series, please contact Jocelyn Silerio at 805-988-7130 or firstname.lastname@example.org.