The PULSE of The Physician Alliance
Friday, August 16, 2019
Resource Stewardship Initiative seeks to decrease utilization
The Physician Alliance participates in Blue Cross Blue Shield of Michigan's Resource Stewardship Initiative to help decrease utilization of unnecessary tests and procedures. The RSI promotes the use of evidence-based medicine when making health care stewardship decisions and also encourages conversations between physicians and patients about appropriate and necessary care.

TPA’s 2019 focus areas are:
  • Decrease the use of imaging for low back pain
  • Decrease women younger than 30 years of age receiving human papillomavirus (HPV) testing, alone or in combination with cytology for cervical cancer
  • Decrease routine annual cervical cytology (pap tests) in women 30-65 years of age
  • Decrease annual vitamin D testing

TPA's current rates are (lower is better):
  • Low back pain imaging – 32.6% (PGIP average is 27.8%)
  • Women under 30 years receiving HPV testing, alone or in combination with cytology for cervical cancer – 20.3% (PGIP average is 14.3%)
  • Routine annual cervical cytology (pap tests) in women 30-65 years of age – 11.4% (PGIP average is 8.0%)
  • Vitamin D testing - 9.4% (PGIP average is 7.4%)

Education materials are available to help stimulate conversations with patients:
  • 6 tips for managing low back pain poster
  • Rx 'non-prescription pad' (low back pain)* flyer
  • Vitamin D testing poster
  • Pap and HPV test poster

Practices can download/print the posters by clicking the links above or order pre-printed materials from TPA by clicking here .
TPA practices complete accuracy audit
Blue Cross Blue Shield of Michigan (BCBSM) selected 12 practices from The Physician Alliance (TPA) to participate in their annual Patient Centered Medical Home (PCMH) audit. The outcome was a 97% accuracy factor for TPA.

The audits are conducted to validate the accuracy of PCMH capabilities within each practice. TPA's audits took place from March 2019- June 2019. Selected practices are randomly chosen by BCBSM, taking the size of the physician organization (PO) into consideration. TPA had two primary care practices and 10 specialty practices participate in this year’s audit. During these audits, BCBSM staff met with representatives from the practices and TPA to review capabilities reported by TPA to BCBSM’s Self-Assessment Data (SAD) tool. Practice resource team and TPA staff members work closely with the practices to implement capabilities throughout the year.

Thank you to participating practices and everyone involved for the time and hard work ensuring a successful audit!
Important deadline for providers with Medicaid patients
Health care providers who prescribe medications to Medicaid beneficiaries must enroll by Oct. 1, 2019 in Michigan's online Medicaid enrollment system to continue to receive payments for prescription drug claims.

The Michigan Department of Health and Human Services (MDHHS) will prohibit payment to any provider who is not enrolled in the Community Health Automated Medicaid Processing System (CHAMPS) by the deadline . The federal Affordable Care Act and the 21st Century Cures Act require prescribers to enroll. The purpose of this requirement is to protect beneficiaries by strengthening program integrity and care quality, according to MDHHS. The requirement applies to all providers who prescribe drugs – including medical residents.

To learn more about the enrollment process and to enroll, visit Michigan.gov/MedicaidProviders and click "Provider Enrollment."
News You Can Use
Featured Affiliate Partner
Kona Medical Consulting offers comprehensive business services to assist with all aspects of operating a successful physician practice. Examples of services include: r ecruiting, training, HR compliance, and human resource services; financial audits, bookkeeping, accounts payable, and payroll; EMR management, documentation conversions, training, and optimization; payroll, human resources, and office management; complete practice management or administrative assistance and more. The Physician Alliance members will receive a 40% discount off the hourly consulting rate and a complimentary initial consultation .

Learn more about these services.
The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians.
www.thephysicianalliance.org - (586) 498-3555