Mission Health System Pat Brown, MD June 2017 Pediatric WCC CPM
Why focus on child well care? Well Child Care (WCC) is one of the primary means of ensuring that primary care clinicians can provide appropriate screening, immunizations and anticipatory guidance to our pediatric patients (newborns through adolescents 17 years of age) in the ambulatory setting. Pedi WCC CPM 2
Population The recommendations included in this CPM are intended for average-risk patients and does not apply to patients who may need catch-up vaccines or who are otherwise deemed "high risk". The screening recommendations included in the WCC CPM are informed by The American Academy of Pediatrics (AAP) Bright Futures Guidelines for Universal Screening The Center for Disease Control (CDC) Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2017. Pedi WCC CPM 3
WCC CPM Goals The goal of this CPM is to align the delivery of WCC and improve clinical workflows through a combination of: 1) Updated PowerPlans 2) New documentation templates 3) Revised office protocols 4) Guidance for appropriate charge capture Pedi WCC CPM 4
Updated PowerPlans 14 PowerPlans for well child care were reviewed and updated to maximize: Screening for prevention/early treatment Laboratory testing Developmental & Social screening Treating for preventable conditions Oral health Immunization Enhanced charge capture Pedi WCC CPM 5
Newborn & Infant - Laboratory Newborn Metabolic Screening Confirm that newborn screening was performed or perform in the office setting. Bilirubin Infants should be examined at a delivering hospital with further testing as needed. Options for laboratory testing or point of care (POC). Hg/Hct Lead Screen at 12-months Screen at 12- and 24-months Pedi WCC CPM 6
Newborn & Infant Dev & Social Screening Maternal Depression Screening Postpartum depression screening should be performed from newborn through the 6-month visit. Available tools include the PHQ-2/PHQ-9 depression screening forms or the Edinburgh Postnatal Depression Scale (EPDS). Charge code 96161 (Health Risk Assessment Caregiver) Developmental Screening Developmental, behavioral, and psychosocial assessments are recommended for every visit. Specific validated screening tools (e.g. Ages & Stages) should be used at the 9- and 12-month visits. Charge code 96110 (Developmental Screening w/interp+reprt Std Form) Pedi WCC CPM 7
Pedi WCC CPM 8 Newborn & Infant PowerPlan Screenshots
Early Childhood (15-36 months) Laboratory Testing None required Developmental Screening Specific validated screening tools (e.g. Ages & Stages) at - 18-months - 30-months - 24-months - 36-months Charge code 96110 (Developmental Screening w/interp+reprt Std Form) Autism Screening (MCHAT) Screen at 18- and 24-months Charge code 96110 (Developmental Screening w/interp+reprt Std Form) Visual Acuity Screen at 3-years Charge code 99173 (Snellen Chart), 99174 or 99177 (Instrument ocular) Pedi WCC CPM 9
Developmental & Social Screening Developmental Screening: ASQ NC Health Check Recommends Screenings at 6, 12, and 18 or 24 months Paper form with score charted Pedi WCC CPM 10
Developmental & Social Screening Autism Screening: MCHAT 18 months 24 months Paper form with score charted Pedi WCC CPM 11
Oral Health Oral Health Assessment 6-months to 5-years Documented in PCA AdHoc form Pedi WCC CPM 12
Early to Middle Childhood (4-6 Years) Laboratory Testing None required Visual Acuity Screening 4-years to 6-years Charge code 99173 (Snellen Chart), 99174 or 99177 (Instrument ocular) Hearing Screening 4-years to 6-years Charge code 92551 (Screening), 92552 (Threshold), 92567 (Impedance) Oral Health Assessment Document in Oral Health Form Charge code D0145 (Comp Oral Evaluation) Dental Varnishing for at-risk patients Through 5-years Charge code D1206 (Dental Varnishing) Pedi WCC CPM 13
Early/Middle Childhood (4-6 Yrs) PowerPlan Screenshots Pedi WCC CPM 14
Middle Childhood (7-10 Years) Laboratory Testing Cholesterol Lipid Panel beginning at 9-years Visual Acuity Screening 8-years and 10-years Charge code 99173 (Snellen Chart), 99174 or 99177 (Instrument ocular) Hearing Screening 8-years and 10-years Charge code 92551 (Screening), 92552 (Threshold), 92567 (Impedance) Pedi WCC CPM 15
Adolescence (11-12 Years) Visual Acuity Screening At 12-years,11-years if risk factors exist Charge code 99173 (Snellen Chart), 99174 or 99177 (Instrument ocular) Hearing Screening Once between 11 and 14-years Charge code 92551 (Screening), 92552 (Threshold), 92567 (Impedance) Depression Screening 12-years Charge code G0444 (PHQ-A) Health Risk Assessment 13 through 17-years Charge code 96160 for up to 15 minutes(crafft assessment) Pedi WCC CPM 16
Adolescence (13-17 Years) Laboratory Testing HIV: Check once between 15- and 18-year visits Chlamydia/Gonorrhea*: Once between 15- and 18-year visits Lipid Panel: Between the ages of 17-21 years. Visual Acuity Once at 15-years and other years if risk factors exist Charge code 99173 (Snellen Chart), 99174 or 99177 (Instrument ocular) Depression Screening 13 through 17-years Charge code G0444 (PHQ-A) Health Risk Assessment 13 through 17-years Charge code 96160 for up to 15 minutes (CRAFFT assessment) * GC/Chlamydia is a selective screening option in the AAP Bright Futures Guideline Reference the STD CPM (in development) for further guidance. Pedi WCC CPM 17
Health Risk Assessment Health Risk Assessment: CRAFFT 11-17 years Pedi WCC CPM 18
Depression Screening Depression Screen: PHQ-A 11-17 years Located in Ambulatory Pediatric Intake Form Pedi WCC CPM 19
Vaccine Orders The PowerPlans have been amended to match the CDC recommendations for each age group. Because some Plans cover a range of ages, providers should review the patient s vaccine status to determine the appropriateness of each vaccine order (e.g. Tdap & HPV are not required annually) Pedi WCC CPM 20
Vaccine Refusal Handling Vaccine Refusals: It is important to listen to concerns, discuss benefits of vaccines and stress the number of lives saved by vaccines. Documenting vaccine refusal and the discussion about the benefits of vaccines is recommended for the visit notes. Suggested Autotext: Parent refused vaccines at this visit. I reviewed the risks and benefits of vaccinations as well as the risks of not vaccinating their child or delaying the vaccine schedule. Educational information about vaccines was provided to the family. Pedi WCC CPM 21
WCC CPM Metrics Immunization compliance can be viewed on the NC Immunization Registry Measure Definition ACO Goal NCIR Immunizations @ 24months NCIR Tdap (1) @13yo NCIR Meningococcal (1) @ 13yo NCIR HPV(2) @13yo % of Patients aged 24-35mo, who received DTaP (4), HepB(3), Hib(3), MMR(1), Polio(3), Pneumo(4), Varicella(1) by time they were 24 months. % of Patients aged 13yo, who received Tdap(1) by the time they were 13yo. % of Patients aged 13yo, who received Meningococcal(1) by the time they were 13yo. % of Patients aged 13yo, who received HPV(2) by the time they were 13yo. 76% 88% 87% 21% Pedi WCC CPM 22
How to Run NCIR Data for your Clinic All: Select Site (i.e. McDowell Peds). Go to Benchmark Reports NCIR < 36 months. Choose all clients, Select Age range, youngest age 2, oldest age 3, assess clients with sufficient refusal history as covered. Select today's date. Select 431331 @ 36 months. Select Generate. Wait. Click on Benchmark report. TDAP @13. Choose birth date range 5/24/2003-5/23/2004. Assess Clients with sufficient Refusal as covered. Select Today's date. Select Adolescent Complete TD. Click Generate! Meningococcal @13. Choose birth date range 5/24/2003-5/23/2004. Assess Clients with sufficient Refusal as covered. Select Today's date. Select Adolescent Complete TD. Click Generate! HPV @13. Choose birth date range 5/24/2003-5/23/2004. Assess Clients with sufficient Refusal as covered. Select Today's date. Select Adolescent Complete HPV. Click Generate! Pedi WCC CPM 23
WCC CPM Metrics Other metrics identified in the WCC CPM are also measured as part of the organization s Pediatric ACO Quality Measures Measure Definition Goal ACO 14 Flu (Tier 2 only) 6 months and older seen for a visit between October 1 and March 31 who received or reported flu shot. 45% ACO 17 Tobacco Use (Tier 2 only) Percentage of patients aged 18 years and older who were screened for tobacco use AND who received cessation counseling if using 82% ACO 18 Clinical depression + F/up (Tier 3) Percentage of patients aged 12 years and older screened for clinical depression AND follow-up plan 41% ACO 61 Ped BMI (Tier 3) Percentage of patients 3-17 years of age w/ - Body mass index (BMI) percentile documentation* PLUS - Counseling for nutrition PLUS - Counseling for physical activity 76% ACO 60 Asthma Meds (Tier 3) The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year 90% Pedi WCC CPM 24
Documentation Templates Precompleted Note Templates are available for PowerNotes. By default the notes document a healthy child visit. The templates serve as a guide and must be updated for each individual patient visit. Developmental milestone questions are based on the Ages & Stages questionnaire. Pedi WCC CPM 25
Pedi WCC CPM 26 Documentation Templates
Documentation Templates Providers who use Dynamic Documentation can highlight the content of the Precompleted Notes and save this as an Autotext. The Autotext can be used to populate a Freetext Dynamic Doc template. Pedi WCC CPM 27
Documentation Templates Select the text from the PowerNote and right-click to Save As Auto Text Pedi WCC CPM 28
Documentation Templates Add a name in the abbreviation field (description is optional) Pedi WCC CPM 29
Documentation Templates Open up Dynamic Doc and select Free Text Note Pedi WCC CPM 30
Documentation Templates Begin typing the abbreviation you want to use Pedi WCC CPM 31
Documentation Templates The content of the WCC note is now available for you to edit. Pedi WCC CPM 32
Practice Resources Tools and Resources have been uploaded to the Mission Children s Toolbox. The best way to find the Toolbox is to use your favorite search engine and search for Children s Service Line Toolbox http://www.mission-health.org/documents_links.php Pedi WCC CPM 33
Pedi WCC CPM 34 Appendix PowerPlan Screenshots
Pedi WCC CPM 35 Newborn & Infant PowerPlan Screenshots
Pedi WCC CPM 36 Newborn & Infant PowerPlan Screenshots
Early Childhood (15-36 months) PowerPlan Screenshots Pedi WCC CPM 37
Early Childhood (15-36 months) PowerPlan Screenshots Pedi WCC CPM 38
Early/Middle Childhood (4-6 Yrs) PowerPlan Screenshots Pedi WCC CPM 39
Middle Childhood (7-10 Yrs) PowerPlan Screenshots Pedi WCC CPM 40
Pedi WCC CPM 41 Adolescence (11-17 Yrs) PowerPlan Screenshots