Updates from Dr. Whibbs
Health First Network Medical Director
November 12, 2008
Dear Health First Network Physician Colleague:
Once again, it's that time of year to think about License Renewal, and the current state required CME that goes with it. Since 2006, the rules and requirements have changed, and it’s worth the effort to review what we each need to do.
The easiest approach is to go to the Physician Resources and Education page on the HFNI website (www.hfni.com) and click on the link to the Mecop website. Both the requirements, and links to approved courses are there.
Another option is to access the Florida Department of Health at
http://www.doh.state.fl.us/mqa/medical/me_ceu.html, which has all of the requirements.
I would like to stop for a moment and thank all of the physicians and their staffs for their cooperation, and especially for their help over the past year. The difficult times will continue as healthcare reform taxis down the runway and tries to get off the ground. Health First Network will continue to be a hugely positive influence on healthcare delivery in our community because of the care, the concern, the skill, and the involvement of our physicians…and that makes my job working for you so much easier.
Sincerely,
William J. Whibbs, MD, Medical Director
Health First Network, Inc.
June 13, 2008
Dear Health First Network Physician Colleague:
This memo contains information on several network issues for Health First Network Physicians and their office staff.
Post-Hospital PCP visits for WellCare and HealthEase members
Health First Network has identified a trend in increasing numbers of readmissions following an initial hospital admission among both our WellCare and HealthEase members. In the majority of cases, the patient has had no follow-up with their PCP between admissions. When hospitalists follow these members in-house, often the PCP has no idea their patient has been hospitalized. I encourage you to educate your patients to contact you immediately upon discharge from any hospitalization, and when you become aware of an admission on one of your patients, please make an effort to contact them and arrange for a follow-up appointment within the first 3 – 6 days of discharge.
Generic Medication Usage
Congratulations and appreciation goes out to all Health First Network Physicians on their high utilization rates on generic medication prescribing. A recent pharmacy report showed that of the top 25 of all prescription drugs written for HealthEase and WellCare members, 24 of the 25 were for generic drugs. Our high-performance network leads other IPA’s in the state on the high percentage of scripts written for generic drugs.
ADHD drugs and medications for behavioral health conditions continue to be an area of expense and concern to Health First Network. I would like to ask and encourage you to look at your prescribing habits on these drugs, and, whenever possible, increase the use of generic drugs and approved brand-name formulary drugs for your patients. If you would like the most current copies of Health Plan formularies, please go on-line at the WellCare web site, or contact the Provider Relations Department at Health First Network for a copy.
Case Management Services
The Health First Network/MED3000 Case Management Program is designed to make the PCP’s job easier and more effective. When you have a medically complex patient who would benefit from case management nurse assessment, monitoring and follow-up, with proven interventions, and oversight, please contact the MED3000 Case Management at 478-6060, extension 3231 to refer the member.
Case Management is a collaborative process of assessment, planning, facilitation, coordination, communication for options and services to meet the individual’s health needs. Case Managers work with PCP’s to promote quality cost-effective outcomes. We have available the technical expertise, resources and evidenced-based tools to assist members and apply specific teaching and interventions to decrease their risk of later complications from their illnesses. Case Management protocols along with individual nurse coaching are used to enhance a patient’s knowledge and compliance with their treatment program.
Please feel free to contact me at Health First Network with any concerns. The phone number to my office is 434-8147. I appreciate you taking the time to read this. Thank you.
Sincerely,
William J. Whibbs, MD, Medical Director
Health First Network, Inc.
November, 2007
Dear Health First Network Physician Colleague:
Attached to this memo is a current list of the HEDIS measures pertinent to our WellCare and HealthEase members. This is the first complete and up-to-date list received from the Health Plan of those measures that we, as practicing physicians, are evaluated on. These preventive care services are specific to different age groups, and the attached list includes valuable information on the specific service, the standard that must be met, and the applicable CPT and ICD-9 Diagnosis and Procedure codes that must be used to capture the data. For WellCare and HealthEase members, these apply to services that must be completed by December 31, 2007.
Click here to download the memo (PDF).
WellCare/HealthEase evaluates the performance of our entire Network and of individual physicians by a percentage score that indicates compliance with the completion of these measures on our patients. WellCare is requesting our assistance to achieve a score of 75% or better on each of the measures by December 31, 2007.
On certain measures, WellCare has informed us that Health First Network, as one of their highest performance Physician Networks, has already achieved a score of 75% or better. On other measures, we are below state averages. Concern was expressed over the lower than average scores for Diabetic Eye Exams and Glaucoma screenings.
I’m asking your help to work with me in the upcoming weeks to improve our scores on certain measures; to ensure that your office staff are using the correct codes for billing, and to respond to requests from our Nurse Case Managers for clinical information on some WellCare and HealthEase members. This will allow us to completely and accurately provide data required by the state and federal government to the Health Plan.
Thank you for your assistance.
Sincerely,
William J. Whibbs, M.D.
Medical Director
September, 2007
Take Note: Centers for Medicare and Medicaid Services Announce Reforms
This month, I had the opportunity to attend a conference presenting some of the reforms announced by the Centers for Medicare and Medicaid Services as it further transitions to more accurate payment systems and seeks to promote quality care for all hospitalized patients.
The workshop included information on transition strategies for ICD-10, Medicare Severity-Adjusted DRG’s, and the new Present-On-Admission Standards. The implementation of “Present on Admission” indicators begins as early as October 1, 2007 and affects acute-care hospitals. This includes Escambia and Santa Rosa County acute care hospitals and the Health First Network physicians who admit patients to these hospitals.
I will share information to network physicians on CMS proposals as rulings are released by CMS and published in the Federal Register.
Another recent development of note includes changes in how vaccines are billed and obtained for both Medicaid (including HealthEase) and Medicare (including WellCare) members. Both CMS and the State of Florida are revising billing procedures for reimbursement of immunization services. Within the next two weeks, Health First Network will send out a “Red Memo” detailing some of these changes. Our hope is to provide our physicians with proactive strategies to help ensure compliance, avoid unnecessary denials, and improve bottom-line performance.
Included in this newsletter are links to two documents for physicians who see HealthEase members. Provided by the WellCare/HealthEase Health Plan, these “tip sheets” can serve as quick reference guides.
The first is a WellCare/HealthEase Formulary Reference Sheet, listing common therapeutic classes of drugs, formulary-preferred medications, prices, and suggestions. Click here for this sheet (PDF).
The second is an Otitis Media Treatment Guideline Reference Sheet, which includes treatment recommendations and references. It is meant especially for Pediatrician and Family Practice offices. Click here for this sheet (PDF).
I am now working primarily out of the Medical Director’s office in the downtown Health First Network building on Palafox Street. I can be reached at 434-8147
July 2007
Case management is a process that allows direct contact between our case management nurses and our patients in order to improve patient health outcomes. I recently sent a letter to Health First Network physicians with the following important information regarding our enhanced case management programs:
First, we now have available the technical expertise, resources, and predictive modeling tools to identify high-risk patients from claims data and then to apply specific teaching and interventions aimed at decreasing their risk of later complications from their illnesses. The latest evidenced-based-medicine protocols along with individual nurse coaching are used to enhance a patient’s knowledge and compliance with their treatment program.
For more information on what case management can do and how to access it on behalf of patients, please click here. Or, for contact information, including phone numbers and extensions of MED3OOO case management staff, click here.
The Health First Network/MED3OOO case management program is designed to make a primary care physician’s job easier and more effective, as well as to help educate patients about their disease conditions and empower them to better manage their chronic illnesses.
If any physician or clinical office staff member would like to review any of the case management and/or disease management protocols used by Health First Network, please contact the MED3000 Medical Management Department at 850.478.6060.
May 2007
Recently, Health First Network partnered with a host of leading community organizations to sponsor "Breathe Life, Not Tobacco," an event aimed at educating children and young adults about the dangers of smoking.
This collaborative initiative, which spanned three days, featured Patrick Reynolds, grandson of tobacco giant R.J. Reynolds and national advocate for a smoke-free society. Reynolds underscored that tobacco kills and smoking leads to the premature death of more than 350,000 people annually. Roughly 10,000 students in Escambia and Santa Rosa County, as well as 4,000 Navy sailors, heard his message loud and clear.
Evidence-based research shows this type of intervention, striving to educate people and change their behavior, can be effective in altering lifestyle choices. There is sufficient, concise clinical evidence and systematic reviews that have found simple advice from a physician during routine consultation increased the number of smokers who quick smoking and didn’t relapse for a year.
Several Clinical Practice Guidelines offer valuable information to assist physicians in discussing smoking cessation and the dangers of smoking with patients.
For those who don’t know, Medicare and WellCare reimburse physicians for smoking cessation counseling. Information regarding billing codes is on the web at http://www.cms.hhs.gov/manuals/pm_trans/R562CP.pdf. The billing codes for Medicare coverage of smoking cessation counseling are:
- G0375 - Smoke/Tobacco counseling of 3-10 minutes
- G0376 - Smoke/Tobacco counseling > than 10 minutes
- ICD-9 - diagnosis code for tobacco use disorder is 305.1
Research further reveals that most smokers will make four to seven attempts to quit and that they are often unprepared to deal with the withdrawals and cravings spurred by nicotine deprivation. The silver lining: many resources are available to support patients.
GlaxoSmithKline promotes products such as Commit, Nicoderm CQ, and Nicorette, forms of therapeutic nicotine that can increase patient’s chances of quitting smoking by addressing both sides of their addiction – nicotine cravings and habit. The GSK smoking cessation program, "Way 2 Quit" kit, smoker’s helpline (877-NO-ASHES), and website (www.way2quit.com) are excellent resources for smokers who want to quit.
A pharmaceutical contact interested in working with Health First Network physicians to assist them in counseling patients to quit smoking is Betsy H. Dubose, healthcare specialists with GSK. Dubose is a trained smoking cessation counselor and is happy to provide further information. She can be reached at 800-873-8867, ext. 9571.
We appreciate our physicians’ interest in and commitment to this very important initiative.
March 2007
Health First Network has recently been notified by the Agency for Healthcare Administration, that, effective on and after 04.01.07, coverage benefits for the HPV vaccine for Medicaid eligible recipients, including HealthEase members, has changed.
Medicaid will reimburse the administration fee only for CPT 90649, human papilloma virus vaccine, for 9-18 year olds. The vaccine is available through the Vaccine for Children Program (VFC) for 9-18 year olds. Reimbursement for CPT 90649 is $10 for physicians, $8 for ARNP and PA and $5 for county health departments and federally qualified health centers. Reimbursement for the vaccine and the administration fee will continue for 19-20 year olds with CPT 90649-HA. Please follow the commendations of the Advisory Committee on Immunization Practices for use of this vaccine for Medicaid recipients 9-20 years old. Reimbursement is not currently available for Medicaid recipients 21 years of age and older.
January 2007
One of the best ways we can help patients is to educate them. Fortunately, the local community offers a wealth of resources such as:
- Baptist Cancer Institute offers "Orientation to Chemotherapy" for patients diagnosed with cancer. This class is held every Wednesday, from 10–11 a.m., at Baptist Medical Center Tower III, Suite 233. Free valet parking is available at the entrance of Tower II. To register patients or for additional information, call 850.469.2224.
- The Escambia Community Clinic offers a disease management class for patients living with diabetes. Facilitated by registered nurse case managers, this class is held every Thursday, from 8 a.m. – noon at the clinic: 2200 North Palafox Street. For more information, call 850.416.4150.
- A preferred provider for wound care services/wound vaccinations is HPP, a group with which Health First Network has experienced good results and outcomes. Call Med3OOO’s referral line at 850.478.2960 or 800.492.9634 for referral information.
- For complex patients, Med3OOO case managers can provide up-to-date NCQA approved guideline support for physician and patient educational materials for WellCare and HealthEase patients who have asthma, COPD, diabetes, or heart failure. For details, call Med3OOO at 850.478.6060 and ask for the case management department.
We encourage you to use and share these educational resources with your patients.
