July Newsletter > July Newsletter

PCP Incentive Payment
Security Risk Analysis
Medical Reconciliation Post-Discharge
PCP Urgent Care Office Posters
Medicare Shared Savings Program Compliance Beneficiary Notice
Value Added Programs
A Patient Story

PCP Incentive Payment

SOHO HEALTH recognizes the importance of our Primary Care Physicians and Clinicians. Through our Roadmap to Value project, a physician led committee recommended a financial incentive for the year 2017 to recognize the vital work our PCPs do in support of our value-based contracts. In response to this recommendation, the SOHO HEALTH Board of Directors approved a $1 per member per month payment based on the number of lives attributed to our PCPs under value-based contracts. One-half of the incentive payment will be made in August 2017 and the remaining payment will be made in January 2018.

In addition to receiving your check, you will also receive a list of your attributed patients. It is important to note that a patient attribution list is different than a patient panel or roster. Patient attribution is a complex process using multiple variables to determine which patients belong to which PCPs. Patient attribution is an insurance company concept and consequently is heavily based on claims data. Historically, insurance companies cannot see into our records and specifically identify who a patient’s PCP may be; they have had to infer who the PCP is based on claims data. We are not satisfied with that logic alone and consequently we developed a 3-step process to identify a patient’s PCP with greater accuracy.

Some factors are worth nothing:

  1. If more than one PCP saw a patient in a given year, the patient gets attributed to the PCP the patient saw most often. If the patient saw both PCPs an equal number of times, then the one seen most recently is the PCP the patient is attributed to.
  2. Patients are attributed only for covered lives under value based contracts (i.e. patients on Medicaid and some other insurance plans will not show up on this list).
  3. A patient that you consider “yours” may attributed to another PCP. For instance, a patient had a prolonged nursing home stay and was seen by another treating provider more than they saw you.
  4. A patient that you consider “yours” may not be attributed to you if you did not see the patient in the last 12 months
  5. A patient discharged from your practice/moved out of area/switched to a new PCP may remain on your list for a year or more until they become attributed to another PCP
    Because of issues like these, attribution lists will never be perfect. Please review your list of attributed patients and let us know if you see something that cannot be explained by the information provided herein.

Your check (one per group/TIN) and attribution list will be delivered by your Regional Medical Director, Dr. Bansal or Dr. Kimmel. For TINs with multiple providers, funds distribution to individual PCPs will be determined by the group/TIN. For questions, please contact Dr. Bansal (SBansal@stfranciscare.org) or Dr. Kimmel (RKimmel@stfranciscare.org).

To learn more about Patient Attribution, please view the educational session on SOHO HEALTH website Education Center or on YouTube.

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Security Risk Analysis

The Security Risk Analysis (SRA) is a mandatory component of the Advancing Care Information category. Do you know what is required? Do you need some assistance?

The Advancing Care Information (ACI) category is the one category that all providers in the SOHO HEALTH network will need to report under MIPS. You must meet the 4 or 5 components of the Base Score in order to score any points in this category.

One component that is critical in the Base Score is the Security Risk Analysis (SRA). The SRA has essentially three components:

  1. Technical – This includes components of your EMR like encryption, server backups, etc. Contact your EMR vender for a letter certifying that they are compliant with CMS regulations.
  2. Physical – This includes the physical inspection of your office to see do the doors lock, are computer screens viewable by patients walking through the office, does your screen “time out” after a few minutes of inactivity, etc.
  3. Administrative – This includes having written policies and procedures for how Personal Health Information (PHI) is handled, who has access to patient records, what happens if there is a breach, etc.

These policies need to be reviewed and signed by all employees every year or after a change in EMR system/major upgrade.

SOHO HEALTH has engaged two consulting companies, SMC Partners (E-Health Connecticut) and Marcum, to assist physician offices with the SRA process and/or submission of the ACI metrics. Physician offices would be responsible for the cost of these services.

SOHO HEALTH strongly encourages our providers to consider engaging one of these consultants to assist in this complicated process. CMS has already audited a few SOHO HEALTH provider practices and the SRA is one of the first elements they evaluate.

For questions, please contact Ronald Kimmel, MD at RKimmel@stfranciscare.org.

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Medical Reconciliation Post-Discharge

New Quality Measure for 2017: Medication Reconciliation Post-Discharge
For 2017, MSSP and some of our Medicare Advantage contracts require us to perform and document that Medication Reconciliation was performed Post Discharge.

Percentage of discharges from any inpatient facility (hospital, skilled nursing facility or rehabilitation facility) for patients aged 18 years and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record.

Documentation in the outpatient medical record must include evidence of medication reconciliation and the date on which it was performed. Any of the following evidence meets criteria:

  1. Documentation of the current medications with a notation that references the discharge medications (e.g., no changes in meds since discharge, same meds at discharge, discontinue all discharge meds)
  2. Documentation of the patient’s current medications with a notation that the discharge medications were reviewed
  3. Documentation that the provider “reconciled the current and discharge meds”
  4. Documentation of a current medication list, a discharge medication list and notation that the appropriate practitioner type reviewed both lists on the same date of service
  5. Notation that no medications were prescribed or ordered upon discharge

Providers on Epic can use the “.qmupdated” smartphrase to document compliance with this measure. In addition, using the CPT-2 code 1111F can be submitted to get credit for the Medicare Advantage Plans.

If you have any questions, please contact Sudeep Bansal, MD (SBansal@stfranciscare.org).

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PCP Urgent Care Office Posters

SOHO HEALTH’s “Call Us First” Campaign is set to take off this August. Providing quality medical care in the most appropriate setting is critical to the success of a provider network in value based healthcare contracts. The Emergency Department (ED) is appropriate for urgent, life-threatening situations. However, many patients seen in the ED can be successfully treated in a Primary Care office or an Urgent Care center at a much lower cost and often with much greater convenience for them as well.

SOHO HEALTH has developed a poster for each of our PCP office locations that highlight our new “Call Us First” campaign. We want your patients to call your office for their healthcare needs. If you are unable to see the patient, or it is after hours/weekend, then utilizing an Urgent Care center offers a great option for patients to receive non-emergent care.

Your designated SOHO HEALTH Health Coach will be delivering a poster to your office which you can place in the waiting room or exam room. They will also deliver patient education flyers that list urgent care centers in local towns.

For questions regarding this campaign or for more information please contact Ronald Kimmel, MD at RKimmel@stfranciscare.org.

We encourage all PCP offices to display these materials and notify Gina Munson (GMunson@stfranciscare.org) if you need more posters or flyers.

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Medicare Shared Savings Program Compliance Beneficiary Notice

MSSP compliance requirements issued by CMS.

Per Medicare Shared Savings Program (MSSP) compliance requirements issued by CMS, all practices participating in the program are required to display the attached Beneficiary Notification template at all of your practice locations. This notification must be visible in the patient waiting area.

Kindly customize the highlighted areas within the template with your practice information.
For any further questions or concerns, please contact Kathy Strauch at kstrauch@stfranciscare.org.


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Value Added Programs

Don’t Miss Out on the Savings!

SOHO HEALTH members are taking advantage of the fantastic savings in our AdvantageTrust Purchasing Program and CAP-PG Medical Malpractice Savings Program.  Our members have saved more than a quarter of a million dollars in medical and office supplies and over $125,000 on their medical malpractice insurance premiums!  Let SOHO HEALTH help you to reduce spending and control costs.

If you have not enrolled in these programs, please contact Kathy Strauch at 860-714-1245 or kstrauch@stfrancishealthcare.org.

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A Patient Story

I have been in practice for over 10 years.  What has changed and continues to change is the management of patients when they are discharged from the hospital.  We’re not there yet but I can say I am pleased with how SFHCP in particular has managed this.

Not realizing the importance of readmissions until recent years; I can say we have never had a readmission within 30 days with any of our discharged patients.  It’s an easy feat, I believe, for us because we are nurses who know how to micro manage people well enough to get them to the physician before a crisis occurs.

I am a tough customer to please.  That being said I am writing to you to say kudos to all of you for your follow up on your patients. Although there continues to be an extreme need for what we provide with boots on the ground at the time there is a concern I will say that this collaboration has been a joy for us to work.  Having worked in the ER there for years and being a SOHO HEALTH graduate from their school of nursing I do have a fondness for this hospital more than others.  SOHO HEALTH always accepted our practice from the start; as the first patient advocacy nursing practice in Connecticut often hospitals and physician practices did not know what to do with us.  Well, we’ve found our place and work our magic to manage patients when discharged and continue to support them while in the community.  We are not a skilled practice but a private practice to assist with crisis intervention and coordination of care long before the hospitals realized the real importance of care coordination beyond the walls of the hospitals.  Ahead of my time it seems but glad to join forces with all involved.

A particular thank you to Karen Yakabowskas, LPN who has followed one of my conserved clients (we also provide conservatorship of person when needed for complex cases).  Karen not only knew our client as well as we did by being at the facility he was unfortunately placed in after his 3 days stay at the “other” hospital and showed up a train wreck but continued to follow up with him and I when released.  I was delighted.   Hughes as usual provided great care and therapy so I could get this gentleman back to his home in the community.  He is 93 years old and wants to be home, I have been his conservator since 2011 and he is a diabetic.

We don’t often take the time to say thank you.  So I am saying thank you to your ACO for doing your job and doing it well.  Although there are other ACO’s out there SFHCP seems to be the only one that connects. I am happy to be part of the team that is provided with each and every one of our clients who pass through St Francis’ doors from entering to leaving and glad this organization truly cares about patients.  We are all patients at one point or other and as hard as it is to be in that role; support is what they need. So Thank You!!

Best Wishes,

“We Make Healthcare Work for YOU”
Sharon Gauthier RN/MSN/CGM
Geriatric Care Manager
Certified Dementia Practitioner

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