PTO Touchbase. Tuesday August 8, :00 am

Transcription

1 PTO Touchbase Tuesday August 8, :00 am Call Instructions: Please Mute your phone, microphone, and speakers on your computer/device Enter your name/organization in the chat box feature for attendance We encourage active participation via Chat or audio Submit questions via the chat box feature Questions will be answered as submitted Unmute yourself to ask question and participate in discussions Time to ask questions via audio will be offered for those on the phone 1

2 Agenda When the Patient Answers YES; Tobacco Cessation PIP & TIA Update Learning Networks Fall Collaborative Learning Session Cost/Utilization Measures Update 2

3 When the Patient Answers YES Implementing workflows to support tobacco cessation Carol Greenlee and Kathy Reims August 8, 2017

4 Improving Tobacco Cessation Counseling and Quit Rates Optimizing the care team Standing orders Scripting Leveraging resources Educational materials Local Resources Colorado Quit Line High level overview of covered services

5 Example of Team Care for Tobacco Cessation MA ASKs about tobacco use and document in appropriate site and ASKs if interest in cessation (see dialogue) Hand-off with Clinician, MOA informs he smokes 2 ppd & says no interest in quitting (verbal or clearly visible documentation) Clinician ADVISES patient on need to stop tobacco use (see dialogue) MA or Health Coach does Shared Decision Making counselling around cessation support options (decision aid) Initiates referral for CO QL if selected as option Clinician must sign referral

6 Standing Orders Standing orders enable all members of the care team to function to their fullest capacity. In order to be effective, Standing orders must be approved by the clinical leadership Staff members must be trained in our how to use the standing order and Staff members must be supervised, so that someone can check to be sure that they are doing it properly Other staff should also learn about the standing orders, so that they can support the new roles Clinicians need to know and buy in to the new roles From UCSF

7 Policy & Procedures and/or Standing Orders Recommend have Policy & Procedures &/or Standing orders for MOA or other team members serving as a Patient Health Educators Recommend that P&P includes for staff to Ask about tobacco and ASK about interest in quitting at each visit as standard of care Recommend counselling patients on options for support based on patient s preference (not routine standard referral to one service) Recommend include relapse prevention: ASK former smokers about smoking and any difficulties (especially during times of stress) Standardize work flows and documentation

8 Can a Patient Health Educator (PHE) provide tobacco cessation counseling under the supervision of a qualified provider? Yes, as long as the qualified provider orders and supervises the counseling, the PHE can provide the service, and be reimbursed under the qualified provider's identification number. The supervision does not require the supervisor to be in the same room where counseling is being provided. Note that the qualified provider must use the correct ICD-10code(s) (for Tobacco Use Disorder or related disorders), which indicates that he or she "ordered" the counseling.

9 The Important Messages Knowing what evidence based help is available for patient CO QL covers counselling and NRT/pills for all patients regardless of insurance coverage Knowing who to call for more help

10 Comparison with The auriculotherapy group achieved a rate of 20.9% abstinence versus 17.9% for the placebo arm after 6 weeks. an initial session with DC Stop Smoking in GJ is $120; follow-up sessions are $60 each.

11 WHAT WILL I SAY?

12 Craft a Message Specialty care why is smoking cessation especially important for your specialty? Primary care what about a person s health status makes it especially important to quit smoking? Some teams craft and prompt messages during huddles

13 Scripting Front desk or MA can respond if in a private setting I see that you are smoking tobacco. Dr. X will want to talk to you about that. We encourage all of our patients to quit because [practice specific reason.] Prompt to physician/clinician to deliver cessation message during verbal or nonverbal handoff

14 Advise to Quit Physician/clinician should include smoking cessation in the visit agenda. Important to deliver a clear quit message One effective strategy is Ask-Tell-Ask Engages the patient in the process We are more likely to do what we hear ourselves say

15 ASK I noticed that you are smoking. Would it be OK if we spent a minute to talk about that? OR What do you know about how smoking affects your risk of? [patient and practice specific reason](examples: surgical complications, oral cancers, complications with pregnancy, accelerated aging, et al.)

16 Tell Based on what they already know, build on that giving a bit more detail. Or give information that is a high priority to their situation Correct misinformation You re right that the risks during surgery are higher for people that smoke. Smoking also leads to more postoperative complications and slower healing.

17 ASK Asking a question clarifies how that information was heard Be clear that the patient has the right to choose but you will support them What do you think about that? What you choose to do is up to you and we are happy to help if you want to quit. What do you think you will do?

18 If the patient does not want help now to quit Respect their right to choose Offer help if they change their mind either directly (if PCP) or suggest that their PCP can help

19 If the patient indicates they want to quit or would consider quitting: Affirm their choice. You are making a choice that will benefit your health by. State that there are many options now that support cessation Discuss options and patient preferences (shared decision making) or hand off to a staff member who has been trained to offer options

20 Helpful Information for Staff Using medicines and nicotine replacement products (patches, gum, lozenges, and inhalers) can double your chances of quitting smoking. They can relieve nicotine craving and withdrawal symptoms. Getting counseling, along with using medicine, can increase your chances of quitting even more. If you smoke fewer than 10 cigarettes a day, you may not need medicines to help you quit smoking. It's rare for someone to get addicted to nicotine medicines, because the nicotine is released slowly at low levels into your bloodstream.

21 More Helpful Information Nicotine replacement products may cause some side effects, such as problems with sleep or red and itchy skin with the patch. Medicines in pill form can cause nausea, dry mouth, and trouble sleeping. For most people, the side effects aren't bad enough to make them stop using the medicines. Nicotine medicines have less than half of the nicotine than cigarettes. And by itself, nicotine is not nearly as harmful as smoking. The tars, carbon monoxide, and other toxic chemicals in tobacco cause the harmful effects. Many insurance companies will pay for all or part of the cost of medicines used to quit smoking.

22 Team member offers options: ASK What do you know about the options to support you to quit smoking? What has worked for you before?

23 TELL Briefly list options the practice has to offer Some people just need information, some people prefer medicines to help them quit and others prefer a coach or counselling. Note: specialty offices need not offer to prescribe medications although primary care practices may

24 ASK What do you think will work best for you? What support would you prefer today?

25 Good Patient Education Resources Posters and brochures NIH/NCI's smokefree.gov suite QuitSTART and QuitGuide mobile apps DA_cards_vs5.pdf

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29 Medications Over-the-counter Medicaid and some plans cover with caveats Covered if enrolled with Colorado Quit Line program Plenty of prescriber resources available

30 Referrals Learn about local community-based programs. Keep information readily available. Some patients will prefer to work with their PCP or medical home Colorado Quit Line has a great reputation for success

31 Referral Options to CO QuitLine Fax referral form Will get progress notes back from CO QL by fax On-line Web referral (secure) Will get progress notes back from CO QL by fax E-referral form Will get progress notes back from CO QL directly into EMR Denver Health & SCL has this set up & ready to use If practice has EMR that is MU stage 2 capable, can set up e-referrals for CO QL with help of Matt and the CHITAs

32 Fax Referral form

33 Page 2 fax referral form

34 On-line / Web-based Referral form

35 CPT codes for billing tobacco cessation counseling services For Practice Facilitators/ Coaches Qualified providers (QP) (physicians, certified nurse-midwives, osteopaths, Would physician not worry assistants, about nurse billing practitioners, and coding and registered The nurses) Biggest can be BENEFIT reimbursed for through the practice Medicaid is for both individual and group tobacco cessation counseling. improved Patient Outcomes from tobacco cessation Tobacco cessation counseling may be offered and billed on the Would focus same on day ensuring as the initial the doctor processes office (including visit. ƒ use of (individual) team care, - Smoking the dialogue, and tobacco the P&P use cessation and the discussion counseling around visit; intermediate, (SDM) and greater the referral than 3 minutes for support) to 10 minutes ƒ (individual) - Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes In CO 70-90% of patients get screened and brief advise to quit Can bill incident to for any member of the care team to screen, advise, Only make 15-30% the referral get referred as long for as they support are & treatment Supervised (QP in same building) The QP signs the referral for and billing under the QP NPI

36 Billing for tobacco cessation counseling services For Practice Facilitators / Coaches Must be 3+ The minutes Need to Know Message is Can be done Regardless incident to of by Insurance team members type, Supervising QP in same building all patients in Colorado Policy & Procedures and/or standing orders to follow Payment Are eligible variable for FREE & complex counselling and NRT and pills Medicaid FFS covers/ Through need new the modifier CO QL Commercial No matter variable what coverage their insurance plan does or Medicare does covers not if cover no tobacco outside associated of the disorder CO QL but patient responsible if they have a condition related to/ caused by tobacco use If more help on actually billing for cessation services Recommend refer to FAQs: Use the FAQ link acco-cessation-faq-august-2016.pdf Or Michelle Lynch is willing & wanting to serve as resource for TCPi practices as part of this effort Or contact Michelle Lynch

37 Reflections and Questions

38 PIP & TIA Update New Qualtrics Links 38

39 Learning Networks Contract Changes SOW changes Content Bursts Updated Healthcare Communities site 39

40 Fall Collaborative Learning Session October Denver Marriott West 10 am to 4 pm Interactive Session in am Planning 40

41 Cost/Utilization Measures Analyzing Survey Responses 41

42 Future PTO Trainings August /16 MGMA Practice Webinar-- Payers Prepare for Value Based Contracts, Payer Panel 8/17 Learning Features Call CANCELLED DUE TO PTO TRAINING 8/22 -- Colorado QPP Coalition Office Hours webinar-analyzing your Data and QPP Scoring 8/23 PTO Training- Opiod Project September /12 TCPi PTO Touch base 9/20 MGMA Practice Webinar-- Budgeting for Success; creating a budget for your practice. Many practices don t know their costs of doing business, much less what their costs should be. Tips and Tools for successful budgeting will be provided. 9/21 Learning Features Call- Quality data available to patients & QRURs 9/26 -- Colorado QPP Coalition Office Hours webinar-qpp Performance Category Reporting 9/27 PTO Training Medicaid Value based payments 42

43 Resources Practice Innovation Program Colorado; TCPi Healthcare Communities; CMS Medicare Quality Payment Program (QPP); Colorado QPP Coalition; Support and Available Options for Small, Underserved, and Rural Practices; 43

44 What s on Your Mind? 44

45 University Practice Innovation Team Contact Information Practice Transformation Learning Community - Kellyn.Pearson@ucdenver.edu CQMs Andrew.Bienstock@ucdenver.edu e-learning Bonnie.Jortberg@ucdenver.edu or Robyn.Wearner@ucdenver.edu TCPi - Allyson.Gottsman@ucdenver.edu TCPi Project Manager - Kristin.Crispe@ucdenver.edu TCPI Faculty -- kreims@spreadinnovation.com SPLIT/Data Related Lauren.Shviraga@ucdenver.edu Qualtrics/Data Related -- Emma.Anderson@ucdenver.edu 45