A bi-weekly newsletter from your physician organization
Friday, June 19, 2020
Transitional care management during COVID-19
Patients with c hronic conditions may experience challenges managing their health, especially during the current pandemic. Identifying effective strategies to improve care transitions and outcomes for this population is essential.

Transitional care management is one way to help improve care of patients with chronic conditions. Telemedicine can also be helpful in following up with those recently discharged from the emergency department or inpatient.

The Physician Alliance created a poster to assist practices in promoting telemedicine and a billing and coding tip sheet for transitional care management during COVID-19.
Provider Delivered Care Management expanded, includes pediatric metrics
Blue Cross Blue Shield of Michigan recently announced changes to the Provider Delivered Care Management (PDCM) population management and outcomes value-based reimbursement (VBR), including the introduction of pediatric-specific metrics in 2021.

The following updates are only for measurement year 2020.

For the PDCM population management value-based reimbursement (measurement year 2020; payment period 9/1/2021-8/31/2022):
4% touch rate + 2 touches = 5% VBR
5% touch rate + 2 touches = 7% VBR
6% touch rate + 2 touches = 9% VBR

The outcomes VBR amounts were decreased to 1% VBR for each of these measures:
  • HgA1c control
  • High blood pressure
  • Emergency department encounters
  • Inpatient encounters

To be eligible for outcomes VBR, practices must meet the 1% outreach +2 touches.

A PDCM outcomes VBR will be introduced for pediatric-specific metrics in 2021.

The claims measurement period is Jan. 1 - Dec. 31, 2020 with VBR starting Sept. 1, 2021. The VBR will be awarded on performance OR improvement of five metrics. Changes include:

Quality : 2% VBR for this composite measure
  • Medication management for people with asthma (ages 5-18)
  • Follow-up after emergency department visit for mental illness (ages 6-17)
  • Follow-up care for children prescribed ADHD medication - continuation and maintenance phase (ages 6-12)

Utilization: 1% VBR for each
  • IP encounters per 1000 pediatric members per year (ages 0-17)
  • ED encounters per 1000 pediatric members per year (ages 0-17)

These updates and more are discussed during TPA's monthly quality webinars. View the Events calendar for upcoming dates and registration.
Webinar helps navigate HIPAA/compliance during pandemic
There's still time to register for The Physician Alliance's special webinar focused on HIPAA and compliance during the COVID-19 pandemic. Check out the details and register today!

HIPAA, Compliance and COVID-19: Walking the Line of Enforcement and Discretion webinar
Wednesday, June 24, 2020; 8-9:30am

This webinar will focus on:
  • HIPAA changes and enforcement with COVID-19
  • HIPAA after COVID-19
  • Compliance in light of COVID-19
  • Compliance after COVID-19

  • Q&A time available

Presenter : Lori-Ann Rickard, Rickard & Associates

This complimentary webinar is open to all TPA physicians and practice staff.

Telemedicine and COVID-19: Managing the risk
The COVID-19 pandemic has imperiled our country and the world. As more U.S. patients are diagnosed with coronavirus, the Centers for Disease Control and Prevention (CDC), public health agencies, and a number of industry associations have recognized telemedicine, the practice of using technology to deliver healthcare remotely, as a means to prevent a surge, allow patients access to care, and minimize exposure.

Congress responded by passing the  Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 , (CPRSAA). The CPRSAA is an emergency aid package that, among other things, expands access to telemedicine for Medicare beneficiaries during the current coronavirus public health emergency. The law permits the U.S. Department of Health & Human Services (HHS) Secretary to take action broadening the circumstances under which Medicare will reimburse health care services provided via telemedicine. However, practitioners should bear in mind that changes in Medicare reimbursement are just one of multiple considerations when implementing telehealth.

In the midst of a pandemic, telemedicine can be a compelling option for triaging, screening, and assessing symptomatic at-risk patients. It can also be an efficient way to manage a patient following a confirmed diagnosis.

While telemedicine offers many benefits, the nontraditional mode of delivery can expose the practitioner and the organization to liability. Healthcare practitioners and organizations must be careful to develop and implement a telemedicine program that not only provides quality care, but also minimizes risk to patient and practitioner.

Click here for key issues for planning, developing, and implementing a telemedicine program.

Source : Judy L. Klein, PA, CPHRM, FASHRM, manager, Risk Management, Coverys. Coverys is a partner in TPA’s Affiliate Partners Program, providing medical malpractice insurance and risk analytics.

Article used with permission from Coverys—a leading provider of medical professional liability insurance offering innovative solutions, analytics, education, and resources to help reduce distractions so healthcare providers can focus on patients. Visit coverys.com for more information. This article includes general risk management guidelines for information purposes. It is not intended and should not be taken as legal or medical advice.
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