MEDICAL MANAGEMENT UPDATES
HELLO, JUST A REMINDER TO ALL THE PRACTICES – JANUARY 2022
1. Global and outpatient referrals go through Medical Network One’s POD’s system (www.mednetone.net). If you need assistance uploading a referral, send a fax to 248-475-5777 or a secure email to firstname.lastname@example.org.
2. Office managers can add new members to access PODS. Have the office manager log into the site and select “Request a New Account”. Our referral specialist checks the site daily and will set up new accounts as requested.
3. All MRI’s and CT Scans go through AIM now (1-800-728-8008). Per Aim Specialty Health – “Technical issues are resolved”.
4. All PT/OT/ST (physical/occupational/speech therapy) go through EVICORE (1-877-531-9139). (Chiropractic referrals are only good until the end of the year. The initial referral is good for 30 visits, then unlimited after that).
5. Patients with BCN Advantage DO NOT need a global referral to see a specialist. They only need a referral for the procedure that they are having done (e.g. colonoscopy/EEG).
6. Diagnosis codes need to be specific. Please do not submit Z00.00 for any specialist. For example: Knee Pain Unspecified (need specific knee). – If we receive unspecified diagnoses, we will contact you for a different diagnosis.
7. Any practice that cannot get on to PODS and needs a referral completed can print this referral form, fill it out, and fax it to 248-475-5777.
If you have any questions, please contact us, we are here for you. Stay Safe!!!
Christina Pourcho, Referral Specialist
(SECURE EMAIL ONLY)
Welcome to the Blue Cross Blue Shield of Michigan Patient Centered Medical Home (BCBSM PCMH) monthly newsletter update! Each month we will bring together all relevant PCMH news and updates for our participating provider community. This month we will discuss the 5 new PCMH capabilities added into the 2021-2022 interpretive guidelines. Below is a summary of the new capabilities. In subsequent newsletters we will take a deeper dive and discuss the specific requirements of each capability.
2 Anticoagulant capabilities:
2.29 Registry is being used to manage all patients that are identified as taking one of these 5 oral anticoagulants (warfarin, apixaban, dabigatran, edoxaban, rivaroxaban) for such conditions as atrial fibrillation, venous thrombosis and after a myocardial infarction
3.23 Performance reports are generated for the population of patients taking one of these 5 oral anticoagulants (warfarin, apixaban, dabigatran, edoxaban, rivaroxaban)
2 CAPHs-HOS capabilities:
9.13 Systematic approach in place to screen patients for reducing the risk of falling and for monitoring physical activity
9.14 Systematic approach in place to screen all patients to identify those with bladder control issues
Lung Cancer Screening capability:
9.12 Systematic approach is in place to screen for lung cancer for all patients ages 50-80 who are at high risk for lung cancer
Manager of Quality Improvement Strategy
Beginning January 2022, BCBSM will implement changes to the Value Based Reimbursement (VBR) payment structure for Provider Delivered Care Management.
PDCM Outcomes VBR will be placed into a per attributed member per month (PaMPM) fee. The PDCM Outcomes VBR PaMPM fee will be applied to one procedure code (S0281) with diagnosis Z0289, modifier 3P, and submitted via a claim produced by BCBSM for each attributed member. Providers do not need to do anything. This will be done on their behalf. No Explanation of Benefits (EOB) will be sent to members.
What Remains the Same?
There are no changes to VBR for PDCM Patient Engagement. The PaMPM only applies to the PDCM Outcomes VBR. Measurement and VBR eligibility are not changing for PDCM Outcomes. PDCM for Medicare Advantage
members remains unchanged. This change is only for Commercial instate and out of state (Host) members.
Instead of achieving 1% VBR for PDCM outcome measure achieved, beginning 1/1/22, $0.40 PaMPM will be allocated to each measure. The number of attributed members may change each month. Approximately the third Friday of each month, a check/EFT (however the physician is paid today) for all attributed member claims will be sent to their remit address. PaMPM monthly claim will only paid to providers who meet the PDCM Outcomes VBR requirements.
Please see the table below.
Welcome to the quality improvement portion of the newsletter. We will be going over important updates to quality measures and changes that may occur throughout the year.
This month we will be going over end of the year gap closure and what some of the key deadlines are. With December 31st, 2021 upon us, it is important to recognize and capture all data for those patients who still had gaps-in-care, but whose gaps were met prior to the end of 2021. For gaps-in-care to be closed for the 2021 measurement year, the service must be completed prior to January 1st, 2022. On top of this, there are opportunities to enter supplemental data into payer portals, in order to ensure the highest quality scores possible. If you have specific questions about submitting supplemental data on top of entering data into payer portals, please reach out to Andrew or Kathryn. Some of the key deadlines for supplemental data submission or for entering data into payer portals are: Health e-Blue – January 22nd, 2022; Priority – January 31st, 2022.
Director of Innovation, Research, and Improvement Strategy
When Hiring Nobody Is Better Than Hiring Just Anybody
As the exodus of workers referred to as the “great resignation” tolls on, “now hiring” signs are everywhere. These vacant positions often increase the burden on existing staff members, creating the potential for dissatisfaction, burnout, and even more vacancies. Yet the temptation to hire anyone willing to take the job should be tempered by the many potential consequences of making a bad hire.
The past two years have made flexibility a priority for many workers. During the recruitment process, applicants will often express flexibility-related requests, but of course are unlikely to reveal reliability issues unprompted. First, brush up on your reference-checking skills to try to
screen out unreliable workers. Second, it’s important to revisit your interview questions to include behavioral questions that might provide clues — for example, “Tell me about a time when you faced unexpected events and how you managed them.”
Ability to reliably perform tasks at a minimum level of competence is obviously important in a new hire. If your employees are overworked, some help may be better than no help — assuming the new hire requires minimal training. Keep in mind that training is expensive and time consuming. Positions requiring high levels of on-the-job training burden other employees, who spend time and energy helping newcomers learn and fixing their mistakes.
Like germs, emotions are contagious. One negative individual can “infect” others, bringing the whole team down and making the already challenging workload even harder.
Many employees will go as far as to change their workflow to avoid someone they don’t like, which creates all sorts of additional workplace associated costs.
Being able to communicate well with colleagues is important in any work environment but working in virtual teams heightens the importance of frequent communication and trust. Managers can assess basic communication skills during an interview by looking for a variety of factors, including the clarity and coherence of responses.
How to Support an Understaffed Team
So, if you don’t have any qualified candidates right now- what can you do in the meantime?
First, communicate to your employees that the challenge is temporary and that you’re trying to hire good coworkers for them. Many employees would prefer to work a little extra for several weeks rather than deal with a bad hire long term. You may also consider asking your employees to help you recruit with an employee referral program.
It’s also critical to attend to your employees who choose to stay. Consider strategies to manage burnout and boost retention. Your current employees need respect, attention, rewards, and engagement. With increasing numbers of jobs offering hefty signing bonuses, it’s important to try to make sure the grass isn’t “greener” on the other side.
Director of Human Resources