BlueCross BlueShield of Western New York Make every visit a preventive visit March 13, 2012
Welcome
Opening Remarks We will cover: Evidence based clinical guidelines about an effective well visit Administration and documentation of immunizations Lead Screening Coding P4P
Dr. Gale Burstein
Children are our future!
Regionally all plans are scoring poorly Let s talk about some Regional statistics The graphs will show the BCBSWNY Medicaid specific statistics and the NYS Medicaid averages Statistics for these issues are similar to both Medicaid and Commercial plans Lets take a look at the data in the next few slides in the context of thinking about changes that could be made to improve care
Regionally 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Childhood Immunizations (2 yrs of age - Combo 3) 80% 69% 2010 2012
Regionally 100% Lead Testing - 3 Year Trend 90% 80% NYS Avg. 89% 70% 60% 50% 40% 30% 20% 10% 0% 84% 84% 80% 2010 2011 2012
Regionally 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Well Child Visits, First 15 months of Life (5+ visits) - 3 Year Trend 81% 84% 85% 2010 2011 2012 NYS Avg. 83%
Regionally 100% Well Child Visits, 3-6 years - 3 Year Trend 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 78% 78% 78% 2010 2011 2012
Regionally 100% Adolescent Child Visits - 3 Year Trend 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 54% 55% 55% 2010 2011 2012
Barriers Systems Providers Patients
Dr. Colleen Mattimore
Best Practice
Components of a well visit Health and developmental history Physical exam Immunizations Lead screening children under 2 yrs Health Education / Anticipatory Guidance
Preparing for a comprehensive well visit Accurate appointment time frame Reminder systems to decrease no shows Optimization of EMR systems Parent preparation for the well visit both the parent and the doctor/office Relationship building with child/parent
Suggestions for combining a well and sick visit Know the components that make up a well visit Determine how much can be covered in one visit how likely is the patient to return for another visit? Know what immunizations can be given when a child presents sick Importance of documentation as it relates to a sick and/or well visit
Barriers Missed opportunities Parental concerns Appointment scheduling Transportation
Sandy Diagostino, RN
Immunizations and more Overview of child and adolescent immunizations changes in the 2013 schedule Importance of following the schedule Importance of entering in NYSIIS immunizations and lead screening VFC program and how to order
2013 updates There is a copy of immunization schedule in your packet Let s review some pertinent updates in this schedule
NYSIIS - New York State Immunization Information System Documentation Documentation Documentation
VFC Vaccines for Children The Vaccine for Children (VFC) Program In your packet there is a reminder on how to order Any questions related to ordering this VFC vaccine? Don t forget to bill for the administration of the VFC vaccine
Kathryn Glasser, CPC
Coding: best practices Choosing codes Coding resources online Coding documents in handout packet After the seminar
The Chicken or the Egg Sick (E&M) vs. Well (Preventive) Provide the services Document what was provided Code what was documented
Coding Resources www.bcbswny.com Provider > Login > Payment and Operations Clinical Editing > Clinical Edit Search - represents the relationship(s) between CPT codes and the supporting clinical rationale for their bundled or unbundled states Code Resources > Code and Comment - provides detailed coverage information for a specific CPT code
Clinical Edit Search Request
Clinical Edit Result
Code and Comment Sample 1
Code and Comment Sample 2
Code and Comment Key Sample
Practice Specific Questions Contact the Provider Relations Department to speak with your representative. BCBSWNY Providers 716-887-2054 1-800-666-4627
BlueCross BlueShield is here to help you! Reminders via phone and mail are made regarding immunizations Pediatric Disease Management nurses available
BlueCross BlueShield is here to help you! P4P what s new in 2013 Implementation of new analytics tool Pinpoint gaps in care Revise methodology Generate reports
BlueCross BlueShield is here to help you! P4P measures Childhood Immunizations Lead Screening Use of Appropriate Medication for People with Asthma Appropriate Treatment for children with URI Appropriate Testing for children with Pharyngitis Chlamydia Screening
Questions
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