Welcome to Medicare: Exam Overview

Transcription

1 Welcome to Medicare: Exam Overview June 8, 2016

2 Agenda Opening Remarks Housekeeping Polling Questions Presentations Polling Questions Q&A Closing Remarks 2

3 Introduction to the atom Alliance Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies. 3

4 Objectives During this Webinar you will: Learn which preventive and screening services Medicare covers to keep your patients healthy and find problems early, when treatment is most effective. Promote referring Medicare patients to screen for colorectal cancer during the AWV to help improve the rates of incidence and mortality in this population as they age. 4

5 Housekeeping Items: Chat To ensure maximum sound quality, participant lines have been muted; however we welcome ALL questions and comments via the chat board on the right hand side of your screen To submit questions or comments: Use WebEx chat send messages to the panelists or all participants using the chat feature drop down menu 5

6 Housekeeping Items: Polling During today s presentations you may be asked to participate in some polling questions. These questions will come up on the right side of your screen. When you do answer a polling question, be sure to hit the submit button so we can capture your answer. 6

7 Polling Question 1 Which state are you from? Alabama Indiana Mississippi Other? Kentucky Tennessee 7

8 Polling Question 2 Are you a: Medicare beneficiary/patient? Family member of a Medicare beneficiary? Caregiver of a Medicare beneficiary? Healthcare provider? Other (fill-in) 8

9 Polling Question 3 Were you aware of the services that are available and billable for Medicare part B? Yes, I was aware of many Yes, I was aware of some No, I but I am now! 9

10 Polling Question 4 Currently, is your practice encouraging people to get an annual wellness visit? Yes No 10

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12 Identify preventive and screening services that Medicare covers. Identify modifiable risk factors for medical conditions that frequently affect the elderly. Identify education and counseling services for Medicare-covered preventive services.

13 Covered after the first 12 months of Part B coverage and 12 months after the Initial Preventive Physical Exam- Welcome to Medicare exam Subsequent AWV are covered every 12 months

14 Health Risk Assessment and History Physical Exam/Assessment Counseling

15 Demographic information Self-assessment of health status Psychosocial risks/behavioral risks ADLs/Instrumental ADLs Sample-CMS s The ABCs of The Annual Visit appendix

16 All of the tools of HowsYourHealth are PUBLICLY, available without charge (for noncommercial purposes) Health professionals may also use the HowsYourHealth tools without charge but if the health professional wishes to test and customize the tools they are required to register Annually, registrants are asked to voluntarily support continued use of HowsYorHealth.org.

17 Establish a list of current providers and suppliers regularly involved in providing medical care to the patient Establish the patient s medical/family history Review potential risk factors for depression, including current or past experiences with depression or other mood disorders Review functional ability and level of safety. Use direct observation or select appropriate screening questions or a screening questionnaire, to assess, at a minimum, the following topics: Ability to successfully perform ADLs Fall risk Hearing impairment Home safety

18 Height, weight, body mass index (or waist circumference, if appropriate), and blood pressure Detect any cognitive impairment the patient may have. Assess the beneficiary s cognitive function by direct observation, with due consideration of information obtained via beneficiary reports and concerns raised by family members, friends, caretakers, or others.

19 Establish a written screening schedule for the beneficiary, such as a checklist for the next 5 to 10 years The patient s HRA, health status, and screening history (Provided by HowsYourHealthy.org) Establish a list of risk factors and conditions for which the primary, secondary, or tertiary interventions are recommended or underway Any mental health conditions or any risk factors or conditions A list of treatment options and their associated risks and benefits Advance Care Plan (optional) Furnish personalized health advice and a referral, as appropriate Health education or preventive counseling services or programs Community-based lifestyle interventions to reduce health risks and promote self-management and wellness Fall prevention Nutrition Physical activity Tobacco-use cessation Weight loss

20 Alcohol Misuse Screening and Counseling Bone Mass Measurements Cardiovascular Disease Screening Tests Colorectal Cancer Screening Counseling to Prevent Tobacco Use (Asymptomatic Beneficiaries)

21 Depression Screening Diabetes Screening Diabetes Self- Management Training (DSMT) Glaucoma Screening Hepatitis C Virus Screening Influenza, Pneumococcal, and Hepatitis B Vaccinations and their Administration IPPE (Welcome to Medicare visit) Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD IBT for Obesity Medical Nutrition Therapy (MNT) Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

22 Screening Mammography Screening Pap Tests Screening Pelvic Examination (includes a clinical breast examination Screening for Sexually Transmitted Infections (STIs) Screening And High Intensity Behavioral Counseling (HIBC) to Prevent STIs HIV Screening For additional information on Medicare preventive services, visit eventiveservices

23 Cancer screening Colon Lung Breast and Cervical Obesity and related diseases Diabetes Mellitus Type 2 Cardiovascular Disease

24 Second leading cause of cancer death in the U.S. when men and women are combined. Approximately135,000 adults diagnosed with colorectal cancer each year. About 1 in 3 adults between 50 and 75 years old about 23 million people are not getting tested as recommended. Hispanics, American Indians or Alaska Natives, rural populations, men, those 50 to 64, and those with lower education and income are less likely to get tested

25 The National Colorectal Cancer Roundtable 80% by 2018 Initiative The ultimate goal of the Roundtable is to increase the use of proven colorectal cancer screening tests among the entire population for whom screening is appropriate. The Roundtable s 80% by 2018 strategic plan provides a practical blueprint for achieving our shared goal of regularly screening 80% of adults aged 50 and older for colorectal cancer by

26 -education/ Unscreened Rural Low SES Racial/Ethnic disparities If we can achieve 80% by 2018, 277,000 fewer people will be diagnosed with colorectal cancer and 203,000 lives will be saved by 2030.

27 Who Is Covered For colorectal cancer screening using Cologuard a Multitarget Stool DNA (sdna) Test All Medicare beneficiaries: Aged 50 to 85 years Asymptomatic At average risk of developing colorectal cancer Frequency Normal Risk: Cologuard Multitarget Stool DNA (sdna) Test: once every 3 years Screening FOBT: every year Screening flexible sigmoidoscopy: once every 4 years Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy) Screening colonoscopy: every 10 years

28 For screening colonoscopies, FOBTs, flexible sigmoidoscopies, and barium enemas: All Medicare beneficiaries: Aged 50 and older who are at normal risk of developing colorectal cancer At high risk of developing colorectal cancer High Risk: Screening FOBT: every year Screening flexible sigmoidoscopy: once every 4 years Screening colonoscopy every 2 years Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy or colonoscopy) High risk for developing colorectal cancer is defined in the Code of Federal Regulations (CFR) at 42 CFR (a)(3).

29 Age years Asymptomatic (no signs or symptoms) No past medical history of lung cancer Tobacco smoking history of at least 30 pack-years Two cessation attempts per year Each attempt may include a maximum of 4 intermediate or intensive sessions Total of 8 sessions per year Current smoker or one who has quit smoking within the last 15 years Shared decision making

30 Covers all females covered by Medicare age 35+ Age one baseline mammogram Age 40+-annual mammogram Annual pap smear if at high risk for cervical or vaginal cancer or childbearing age with abnormal pap within the past 3 yrs Every 2 yrs if at normal risk

31 BMI >/= 30 Counseling can be face-to-face as an individual or in a group of 2-10 patients 1 st month-weekly Month 2-6-every other week Months-7-12-every other month **

32 Covered Risk factors Pre-diabetes Testing methods Quantitative blood test Post glucose dose Glucose tolerance test-3 hour GTT Two screening tests per year if patient has pre-diabetes Annual test for those with risk factors If diagnosed with T2DM, will qualify for Medical Nutrition Therapy Diabetes Self- Management Training

33 All Medicare Beneficiaries Competent and alert at time of counseling Counseling furnished by PCP in the primary care setting One CVD risk reduction visit per year Copayment waived Coinsurance waived Deductible waived

34 Depression-annual HIV Glaucoma-annual Hepatitis C DM Bone Density Family history African-American >/= 50yrs Influenza, Hepatitis B and Pneumococcal vaccines Hispanic-Americans >/= 65yrs

35 CMS and the Medicare Learning Network National Colorectal Cancer Roundtable American Cancer Society QSource (Medicare Quality Improvement Network-QIN)

36 On-Demand Learning (ODL) Our On-Demand Learning (ODL) area on allows you to participate in archived events when it is most convenient. Live events are usually posted as an ODL opportunity 10 days after the live session. Requirements to participate? Review the list of ODL opportunities Click Go Submit your name and other information for documentation Click Submit and you ll have access to the ODL of your choice. Share the opportunity with your peers! 36

37 Thank you for joining us! Please complete the survey that will come up as you exit the webinar we value your feedback in developing future events! Please visit us at 37 This material was prepared by atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama under a contract with the CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS), a federal agency of the U.S. Department of Health and Human Services. Content does not necessarily reflect CMS policy. 16.ASD

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