2014 Practice FLASH

MiPCT Logo Final

Welcome to the MiPCT Practice FLASH Page!  This newsletter will be emailed and posted monthly to keep MiPCT practice teams informed on MiPCT events, provide you with information on the project’s status, and share tips and articles that can help you enhance your practice’s team-based care.

December 22, 2014

New MiPCT Co-Director!

One of the MiPCT’s three Co-Directors, Carol Callaghan, will be retiring at end of this month after working more than 40 years for the state in the Michigan Department of Community Health. She will be missed!

Taking over as Co-Director will be Sue Moran, Senior Deputy Director of MDCH’s Public Health Administration, formerly with the MDCH Medicaid Program. Sue can be reached via the MiPCT mailbox at MiPCTDemo@michigan.gov. Please join us in welcoming Sue to the MiPCT Leadership group!

Care Manager Sufficiency Ratio for 2015

In 2014, the Care Manager sufficiency ratio was calculated without Priority members included, pending an assessment of membership distribution and care management sufficiency experience. The majority of POs at this point now meet the requirement with Priority members included. Hence, 2015 sufficiency rates will be calculated including Priority Health members.

24-Month Incentive Update

The 24 month incentive metric scores have been finalized and payment reports will be submitted to payers at the end of December for payment in late December or early January. We did find an issue with a registry vendor which resulted in six POs gaining additional registry points and a slight shift in PO rankings.

Updated FAQ from CMS on the New Chronic Care Management (CCM) Code

Since the last FLASH, CMS has issued an update to their original FAQ regarding the use of the Chronic Care Management code for non-face-to-face care coordination (CCM) . Medicare will use CPT code 99490 to operationalize the new code. The updated FAQ provides additional detail about its interface with the MAPCP (Multipayer Advanced Primary Care Practice) program of which the MiPCT practices are a part.

The FAQ provides additional information about when practices can bill the CCM codes and when they cannot. In brief, MAPCP payment (i.e. the $9.50 PMPM equivalent for attributed Medicare members) and CPT code 99490 for Medicare are mutually exclusive for any given beneficiary for any given month.

Key themes in the updated FAQ include that:

• Practices should not assume that because they participate in MAPCP programs that they meet the requirements for billing the 99490 code.

• Practices can bill for nonattributed members. CCM payment will be recouped if billed for a patient that has been attributed (i.e. the Medicare members on the multipayer list).

• Because the new code requires demonstration of patient consent, CMS will give it priority over an MAPCP payment.

• If a practice bills a CCM code for a nonattributed member, CMS will consider this in future attribution. Thus over time, nonattributed patients for whom the new CCM code are billed will become attributed over time.

• If several practices (speciality or primary) bill the new code for the same patient in a time period, payment is issued to the practice that successfully bills first.

Physicians’ Corner: The Gift of Appreciation

By Kevin Taylor MD

Recently I had the opportunity to speak with one of my colleagues, a well-respected internal medicine physician in the community. We were reviewing tools to improve his interaction with his patients. He listened intently with a genuine interest to improve. Later, as we stood in the hallway he asked, “Do you have any tools to help me with burn out?”

Drexel University has provided an excellent interactive program to assist health care providers achieve balance and self-care.

They note that “Burnout” results from chronic overwork, avoidance of renewing and energizing activities, and negative self-judgment. Burnout may manifest as impaired job performance, sleep disturbance, irritability, marital difficulties, fatigue, anxiety, or depression. It can also be associated with poor health, including headaches, hypertension, myocardial infarction, and chemical dependency.

The seeds of burnout are sown in medical school and residency training, where fatigue and emotional exhaustion are often the norm. In mid-career, the reinforcements in the work setting for being a hard worker and placing service to others before self-care maintain the momentum of this burgeoning condition.

Recovery is difficult if one remains in the circumstances that generate the symptoms.

Sir William Osler, in a commencement address to graduating medical students in 1889, had these words to say about balance in our work:

“Engrossed late and soon in professional cares…you may so lay waste that you may find, too late, with hearts given way, that there is no place in your habit-stricken souls for those gentler influences which make life worth living.”

We assimilated the message that our worth as persons is linked to our outward performance. We are trapped by the effects of rewarding overwork. We will continue unwittingly to provide a “hidden curriculum,” in which being a successful clinician entails putting one’s own life on hold. The “hidden curriculum” in medicine teaches that success as a clinician entails suspending any effort to balance your own life.

• The deleterious effects of “judgment” can be counterbalanced by cultivating “appreciation.” Judging and evaluating ourselves is a necessary component of improvement, but it can overwhelm appreciating ourselves.

• We are better at appreciating beauty in art and nature than we are at appreciating ourselves as persons.

• Building a habit of self-appreciation might include journaling about personal successes, allowing compliments to sink in, sharing our satisfactions with others, and cultivating present-moment, sensory awareness.

The pressures inherent in medical training to continuously evaluate performance and judge one’s own competence are oppressive, and can be balanced through cultivation of the capacity for “appreciation.” When we respond to a sunset, to the first flower blooming in the garden in spring, or to the final movement of Beethoven’s 9th Symphony, this is typically not an act of judgment, but one of appreciation. We do not exercise the “judgment” and “appreciation” centers of our minds at the same time.

Here is a poem by Derek Wolcott that is appropriate for our discussion today.

Love After Love

By Derek Wolcott

The time will come

when, with elation

you will greet yourself arriving

at your own door, in your own mirror,

and each will smile at the other’s welcome,

and say, sit here. Eat.

You will love again

the stranger who was yourself.

Give wine. Give bread. Give back your heart

to itself, to the stranger who has loved you

all your life, whom you ignored

for another, who knows you by heart.

Take down the love letters from the bookshelf,

the photographs, the desperate notes,

peel your own image from the mirror.

Sit. Feast on your life.

Over the years I have collected notes from my patients and colleagues. These notes express appreciation for my care and services. During this Holiday Season I will sit down, open this file and read these cards once again. I will give myself the gift of appreciation.

Namaste

From the MI Department of Community Health – Your Public Health Partner

Healthy Staff, Healthy Patients

So much time and energy go into helping patients heal, including the work of committed health care providers. Caring, passionate, and thorough, healthcare workers can work long hours, often through the lunch hour, treating patients in an ever-changing and sometimes stressful healthcare environment. Perhaps helping your staff take care of themselves should be your practice’s New Year’s resolution?

Designing Healthy Environments at Work (http://www.mihealthtools.org/work/STEPSTOCHANGE.asp), from the Michigan Department of Community Health, includes a comprehensive set of tools (http://www.mihealthtools.org/work/) that can make it easy to get started. Simple tools help you register your worksite and answer these questions:

• How healthy is my worksite?

• Do infrastructure, management and policies support worksite health?

• Is the overall environment conducive to health?

• Are there offerings to help employees stay healthy?

• How do we stack up against best practices?

• Are we changing for the better?

• How do things look compared to the last time we assessed?

The tools include a quick, 5-minute Employee Interest Survey. What healthy lifestyle choices are employees making now? What simple programs would they participate in if offered? Where are employees in terms of readiness for change? How do employee interests and choices change over time?

Most of us spend at least half our day and consume half our calories at work. So it only makes sense to create a work environment that makes it easy to make healthy choices. Encouraging an interested group of employees to start a small wellness-at-work program speaks volumes about your top leadership’s concern for the practice team, and supports employee health during an unprecedented time of change in healthcare.

And, making healthy changes within the practice may benefit more than just the staff. Just as a savvy patient has a line-of-sight on the snack box of cookies, chips and candy in the room beyond the front desk window, or the sugary drink on the receptionist’s desk, they will also notice the nurse wearing her pedometer, or overhear a receptionist’s conversation about a friendly walking competition. One of the strongest predictors of health promotion counseling by primary care physicians is practicing healthy habits themselves.1 And when a patient’s New Year’s resolution is to lose weight or start exercising, providers working in a healthy practice environment may find it easier to ask hard questions like, “Can we talk about your weight today?” seeking permission to talk about a sometimes delicate subject.

Supporting your healthcare team and ensuring their health through wellness-at-work is an investment in your practice and your most valuable asset, your staff. And it is likely to pay dividends for the health of your patients. Small steps can make a big difference, not only for the health of your patients, but for the dedicated team that cares for them.

Providing worksite wellness solutions is one of the many functions of public health, working together with you, to create a culture of wellness. For questions about the worksite wellness tools featured, or if your medical practice already has a wellness-at-work program, please contact rodmand@michigan.gov.

For a wide variety of public health information and resources for primary care, please visit www.michigan.gov/primarycare.

1 Physicians’ health practices strongly influence patient health practices (2009). Journal of the Royal College of Physicians of Edinburgh. Dec 2009; 39(4): 290–291. doi: 10.4997/JRCPE.2009.422

From the MI Department of Community Health – Your Public Health Partner

Using EHRs to Improve Diabetes and Hypertension Care

Did you know MPRO, Michigan’s quality improvement organization, created an electronic learning module (or e-book) designed to provide providers and staff information on using EHRs or other health information technology to improve diabetes and hypertension care? MPRO collaborated with staff of both the Heart Disease and Stroke Prevention and the Diabetes Prevention and Control programs at Michigan Department of Community Health to provide current and practical resources and guidelines. “Digital Practice: Enhancing Treatment of Diabetes and Hypertension with Electronic Health Records” is free of charge and can be found at https://digitalpractice.mpro.org.

The diabetes chapter outlines general 2014 recommendations for screening, diagnosing and care of people with diabetes. Glucose monitoring, the role of lifestyle change and prediabetes are also discussed. Information on quality measures and meaningful use related to hemoglobin A1c (NQF 59), foot exams (NQF 56) and nephropathy (NQF 62) is also included.

The hypertension chapter speaks to current recommendations, Million Hearts protocols, lifestyle changes and proper technique for taking a blood pressure reading. Quality measure and meaningful use materials related to controlling high blood pressure (NQF 18), preventive care: tobacco use screening and cessation (NQF 28), and preventive care: BMI screening and follow-up (NQF 421) are reviewed.

In addition to the chronic disease specific chapters, the e-book has short but useful chapters on using your EHR for care management, quality improvement, patient engagement, tips for launching patient portals, social media, workflow design and more. A nice feature is that chapters are short and can be viewed as time and schedules allow.

Please check out “Digital Practice!” It has a number of resources and materials you should find invaluable to your practice. Improving diabetes and hypertension care and metrics is our goal at MDCH. Along with MPRO, we hope this resource helps you meet your goals in diabetes and hypertension care. Find more information about diabetes and hypertension, and public health resources for primary care please visit www.michigan.gov/primarycare.

Care Managers Encouraged to Target ED Overuse

MiPCT Care Managers are encouraged to reach out to eligible patients that have high rates of emergency department utilization.

On the monthly patient lists, there are flags for the number of ED visits in the last 6 months, the number of ED visits in the last 12 months, and the estimated number of potentially avoidable ED visits within the previous 12 month period (as defined by an algorithm developed by New York University). Care Managers and physicians are encouraged to use these data fields to determine which patients may be using the emergency department at a high rate, to address overutilization and/or inappropriate use of emergency room services.

MiPCT Patient Experience Survey: Coming January 2015

Recognizing that the demands of the holiday season may hinder participation, the launch date of the MiPCT patient experience survey has been delayed until January 2015.

The purpose of the survey is to determine whether patients of MiPCT practices report more favorable experiences in comparison to other practices. The adult and child versions of CAHPS PCMH survey tool will be used to assess access, communication, coordination, comprehensiveness, self-management support, and care manager experience. Morpace, an NCQA-certified HEDIS CAHPS vendor has been selected to administer the survey. Nearly 28,000 surveys will be mailed to patients from MiPCT and non-MiPCT comparison practices.

To encourage participation, reminder cards and phone follow-up will be conducted with non-responders. If you have any questions about the patient survey, please contact Jason Forney (jforney@mphi.org).

Statewide MiPCT Patient Advisory Council Member Nominations

The statewide MiPCT Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in MiPCT implementation and operations. We are recruiting additional nominations for this state-wide advisory group, which meets quarterly via conference call. Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at:

https://jodyooo.wufoo.com/forms/patient-advisorycouncil-nomination-form/

Following is a list of upcoming PAC Conference Calls:

  • March 27, 2015, 1-2 PM
  • June 26, 2015, 1-2 PM
  • September 25, 2015, 1-2 PM
  • December 18, 2015, 1-2 PM

MiPCT Complex Care Management Course

The registration for the January 5-8, 2015 MiPCT CCM course will be closed for new registrations on December 29, 2014 at 5PM due to the holiday schedule. If you have candidates for the January CCM please register the candidates before the close of registration at 5pm on December 29, 2014.

To register please go to: https://jodyooo.wufoo.com/forms/january-58-2015-mipct-ccm-training/. Once a candidate registers, automated emails will sent to the email listed on the registration with further instructions on the course including times, location and parking.

Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1 – Live webinar – Introduction of MiPCT CCM course
  • Day 2 – Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4 – In-person training days

 

Upcoming 2015 MiPCT CCM course dates:

January 5-8, 2015 – Introductory Webinar Jan. 5

• January 5-6, 2015 – Total six hours of self-study modules and post-tests

• January 7-8, 2015 – In-person training

February 9-12, 2015 – Introductory Webinar Feb. 9

• February 9-10, 2015 – Total six hours of self-study modules and post-tests

• February 11-12, 2015 – In-person training

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

Attached to this issue of the PO FLASH is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed below include information regarding course date/criteria to schedule.

For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self Management Support Training Programs” at https://mipct.org/care-management-resource-center/.

Stories of Your Care Management Success, Featuring Anita Tuneff, Moderate Care Manager, IHA, IHA-Milan Family Medicine

A Medicare patient LS was originally enrolled in MiPCT Complex Care Management 4/1/13 following a hospital admission for Metabolic Encephalopathy. Although LS developed a good relationship with a Complex Care Manager she did not seem to understand the importance of better blood sugar control. Her A1c was 13.2 and she was not ready to make any life style changes.

LS was transferred from the MiPCT Complex Care Manager to Anita, a moderate care manager for Diabetes self- management. LS was always friendly, but very indifferent when discussing changes to improve her health. She was repeatedly “too busy” and was not eating meals or taking her medications regularly. The patient eventually stopped responding to Anita’s calls and the case was closed to care management on 12/12/13.

On 5/20/14 LS was re-enrolled in care management by Anita with an A1c of 16.0 after a referral from her PCP. The patient was very friendly and willing to engage with Anita, but did not seem motivated to make healthy changes. LS did not understand the implications of elevated blood sugars, and shared she was “very busy”. She expressed she did not always like to come to the PCP office, because she felt her PCP “yelled at her”, even though her PCP was always very gentle in her discussions regarding the importance of better blood sugar control.

The patient’s medical record indicated that LS should be checking her blood sugar four times a day, taking insulin with meals and additional oral diabetic medications. LS freely admitted she was not following any of her PCP’s orders.

On 5/23/14 LS was admitted to the hospital for confusion, CVA, and uncontrolled DM. This hospitalization was the turning point for the patient. She finally realized her uncontrolled blood sugars had major implications on her health.

Once LS was discharged from the hospital her family became involved in her care. With coaching from Anita the patient’s daughter began helping her with meal planning and regularly scheduled meals. Her husband began to support LS also.

The care manager continued to provide diabetic education and LS soon realized she could control her blood sugars if she followed a diabetic diet and took her medications regularly. LS followed up with her Endocrinologist and medication adjustments were made.

Anita continued to provide LS with regular visits to answer questions, help coordinate care, and continue to provide education on Diabetes and A1c results. Anita provided educational materials which included, medication information, patient resources, information about hyper and hypoglycemia, meal planning, and managing sick days. Anita provided ongoing support and congratulated her on the improvements she was making.

Today the patient’s A1C is 6.1. She is administering her insulin as ordered. Due to her controlled blood sugar LS has decreased the amount of blood sugar checks from four times a day to twice a day.

LS continues to actively manage her health as evidenced by her Ophthalmologist visit, controlled BP, and maintenance of a log where she records her blood sugars and blood pressures which she brings to every PCP appointment. Since LS has been successful in controlling her blood sugar, she now feels empowered and motivated to reach another health goal of losing five pounds in the next month.

As the patient’s health status stabilized Anita provided a contact person in the office other than herself who could answer patient questions knowing the care manager was always available as a resource if needed. Anita focused on the things LS was doing and not on the things she was not doing. The care manager’s consistent interventions and supportive relationship made LS more willing to contact the office and accept PCP and practice team care management. As a result, the patient’s overall health has improved and she is now able to manage her health.

 NEXT ISSUE DATES:

• Next MiPCT P.O. FLASH Issue:

January 12, 2015

• Next MiPCT Practice FLASH Issue:

January 26, 2015

 

November 24, 2014

From the MI Department of Community Health – Your Public Health Partner:  Self-Management Support — Help your patients get on the right PATH

We all know the statistics. Chronic diseases are the leading cause of death and disability in the US and account for 75% of all health care spending. Half of all Americans have at least one chronic condition. Based on your day-to-day interactions with patients, you know that those are not just statistics. They are real people whose pain, social and work limitations, and poor mental health seriously compromise their quality of life.

As a provider, you want to help but you know that family and work demands, financial constraints, and limited knowledge of healthy lifestyle practices can make it difficult for patients to make healthy changes. NCQA Standard 4E (4A & 4B in 2011) directs you to help patients achieve improved health by offering self-management support in clinic and referring them to self-management programs and resources in the community. One Michigan program can help you do just that!

Personal Action Toward Health or PATH (Michigan’s name for the Stanford Chronic Disease Self-Management Program) is an evidence-based program designed to help people with chronic conditions be more engaged in their own health and healthcare. Workshops are designed to give participants tools to break the cycle of symptoms common to many chronic illnesses: pain, poor sleep, fatigue, physical limitations, depression and other difficult emotions. Over the course of a six-week PATH workshop, patients learn about:

  • Symptom management
  • Goal setting and decision-making
  • Appropriate use of medications
  • Healthy eating
  • Physical activity, and exercising safely
  • Good sleep habits
  • Communication with family, caregivers and healthcare providers, and more…

Every week each participant sets a weekly action plan, a goal they want to achieve, and report out at the next session. Together, they celebrate when they are successful, and work to problem-solve around obstacles that stood in their way when they are not.

PATH has been shown to help participants reduce pain, depression, fear, and frustration; improve mobility and exercise; increase energy; and boost confidence in their ability to manage their conditions. Your recommendation is key. Researchers at the CDC report that patients are 18 times more likely to participate in a self-management program if their provider recommends it! Write to info@mihealthyprograms.org for brochures, Rx-style referral pads and other materials to facilitate recommendation.

An up-to-date, searchable PATH workshop listing can be found at http://www.mihealthyprograms.org/path-workshop-search.aspx. Diabetes and Chronic Pain variants of the PATH program are available in some locations and can be found at the same link. New workshops are being scheduled every day. For more public health information and resources from the Michigan Department of Community Health, go to www.michigan.gov/primarycare.

1 http://www.cdc.gov/arthritis/docs/ASMP-executive-summary.pdf

PHYSICIANS’ CORNER: Choosing Wisely, by Kevin Taylor, MD

With the changing seasons many of our patients are presenting with upper respiratory infections. I have found the CDC guidelines that outline the evidence-based approach to prescribing antibiotics for upper respiratory infections to be a very helpful resource. Please see the link below.

Sinusitis is the most common reason provided for outpatient antibiotic prescriptions. The Choosing Wisely guidelines for management are outlined in our Allergy and Immunology section. Almost all upper respiratory infections or colds will be associated with discolored or purulent drainage during the five to seven-day course of the cold. Sinus radiographs or CT scans will be abnormal during a cold due to inflammation within the sinus as a result of the viral infection. Antibiotics are of only modest benefit in subjects with confirmed or strongly suspected bacterial sinusitis, as the condition will resolve spontaneously within seven to 10 days in the overwhelming majority of affected individuals.

In most cases, sinusitis accompanies viral cold infections where antibiotics are ineffective, but the few cases that have additional bacterial infections (one or two of every 100 patients with sinus symptoms) could benefit from antibiotics. Unfortunately, it is difficult to distinguish between those who have bacterial infections from those who do not, but it is important to avoid unnecessary use of antibiotics and thereby limit the potential for antibiotic resistance.

A Cochrane systematic review drew together data from 59 separate studies that used a variety of antibiotics for uncomplicated maxillary sinus infection (i.e., acute sinusitis in a person with a healthy immune system) in primary care settings. Six of the studies (747 participants) compared antibiotics to placebo and found that most of the participants improved within two weeks, regardless of whether they received the antibiotic or not. When antibiotics were given, they marginally accelerated recovery from sinusitis symptoms. In the remaining 53 studies comparing different antibiotics, none of the antibiotics were found to be superior to the others.

The small benefit gained by antibiotics may be overridden by the negative effects of the drugs. In addition to patient-related adverse effects (for example, skin rash and gastrointestinal problems, such as diarrhea, abdominal pain and vomiting), side effects include the risk of increased resistance to antibiotics among community-acquired pathogens.

Our colleagues from Drexel University have outlined communication strategies to help our patient understand the appropriate use of antibiotics.

Key Communication Concepts

Provide clear recommendations

The majority of patients want information about their health, illness and decision options.

  • “I would not use antibiotics as this is most likely a viral infection and antibiotics don’t help.”
  • “I want to be sure that we use antibiotics only when they are needed so we don’t develop any resistance issue and have problems using them later on when we need them.”
  • “It is important to identify and treat allergic rhinosinusitis before resorting to antibiotics for possible bacterial sinusitis. This is particularly true for individuals with a history of frequent exacerbations or chronic symptoms between episodes of suspected bacterial sinusitis.”

Elicit patient beliefs/questions

Understanding patients’ treatment goals and perspectives about their health during the visit will help improve patient satisfaction and can shorten visits.

Find out where the patient is coming from.

  • “You look uncomfortable today.”
  • “I am sure you think this is like other severe infections you may have had before, but most sinus infections do not require antibiotics and clear on their own.”

Provide empathy, partnership, legitimation

Patients are more satisfied and more likely to adhere to recommendations if they feel understood and supported, and have a sense of partnership with their physicians.

Make it clear that you are on the patient’s side (provide empathy and partnership).

  • “I certainly understand that you want to get better and I want you to feel better.”
  • “I want to reassure you that your symptoms are very different from those of last time. If you don’t feel better with this treatment I want you to call me back.”

Confirm agreement/overcome barriers

Finding common ground and understanding patient perspective and barriers will help reach agreement and provide patient satisfaction and hopefully improve patient health outcomes.

  • “There are things we can do to address your symptoms to help you feel better. Let’s try this treatment and I expect that in the next several days you will feel better. If you develop any new symptoms like fever, rash or worsening pain, you should call me. However, I expect like most people with this you will start to feel better with the treatment. If you don’t, you should call me.”

Short quotes of the compelling data supporting this recommendation:

  • “Allergic rhinitis affects up to 40 percent of the general population and the symptoms of allergy and upper respiratory infections are often very similar. Many times the increased symptoms following a cold are due to the allergic rhinitis worsening following the viral infection rather than sinusitis.”
  • “Antibiotics usually do not help sinus symptoms, which most of the time get better in a week or so without antibiotics.”
  • “Most sinus infections are caused by viruses and antibiotics don’t work against viruses.”
  • “Treatments other than antibiotics can help, such as nasal rinses and short-term use of oral or topical nasal decongestants.”
  • “About one in four people who take antibiotics have side effects.”

________________________________________

REFERENCES:

  1. Chow A, Benninger M, Brook I et al. IDSA Clinical Practice Guidelines for Acute Bacterial Rhinosinusitis in Children and Adults. Clinical Infectious Disease March 20, 2012; http://www.idsociety.org/Organ_System/#Lower/Upper Respiratory
  2. Ahovuo-Saloranta A, Borisenko OV, Kovanen N, et al. Antibiotics for acute maxillary sinusitis. CochraneDatabaseSyst;2(2):CD000243 http://summaries.cochrane.org/CD000243/antibiotics-for-acute-maxillary-sinusitis
  3. American College of Radiology. ACR Appropriateness Criteria for Sinonasal Disease, 2009.
  4. CDC: Adult Appropriate Antibiotic Use Summary: Physician Information Sheet (Adults)http://www.cdc.gov/getsmart/campaign-materials/info-sheets/adult-approp-summary.pdf

MiPCT Patient Experience Survey: Coming Soon!

As part of the evaluation of MiPCT, we will be conducting a patient experience survey from December 2014 through February 2015. The purpose of the survey is to determine whether patients of MiPCT practices report more favorable experiences in comparison to other practices. The adult and child versions of the CAHPS PCMH survey tool will be used to assess access, communication, coordination, comprehensiveness, self-management support, and care manager experience. Morpace, an NCQA-certified HEDIS CAHPS vendor has been selected to administer the survey. Over 27,000 surveys will be mailed to patients from MiPCT and non-MiPCT comparison practices. To encourage participation, reminder cards and phone follow-up will be conducted with non-responders. If you have any questions about the patient survey, please contact Jason Forney (jforney@mphi.org).

MiCMRC Care Manager Monthly Update: October/November, 2014

October, 2014

The MiPCT Annual Summit was held in Gaylord, October 1st, Ann Arbor, October 7th, and Grand Rapids October 9th. The Care Management session at the Summit was a two part session which included:

  • A presentation from the Care Management Best Practice Committee (see slides in attached file)
  • A presentation from palliative care subject matter experts Moni Franks who presented in Gaylord and Connie Dahlin who presented in Ann Arbor and Grand Rapids. The palliative care session included, communication, advanced care planning and conflict negotiation (see slides bin the attached MiCMRC Care Manager Monthly Update document.

There has been a request to repost the slides from Dr. David Weissman’s two webinars which were Giving Bad News/ DNR from August 27th and Leading Goals of Care from September 10th. The slides from both webinars are listed in the attached MiCMRC Care Manager Monthly Update document.

November, 2014

There were two webinars for care managers in November. The first was November 12, 2014, presented by Robin Schreur, RN, MiPCT Clinical Leads on Case Closure. The second, a pediatric webinar presented by Linda Fletcher, MS, CPNP on November 21, 2014, titled “Let’s Talk Transition – a Primary Care Approach”.

Below you will find the presentations for both webinars in November and additional documents for Case Closure which include a Case Closure worksheet and a Self-Care Prevention worksheet.

Both webinars have been recorded and will be available on www.micmrc.org

Statewide MiPCT Patient Advisory Council Member Nominations

The statewide MiPCT Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in MiPCT implementation and operations. We are recruiting additional nominations for this state-wide advisory group, which meets quarterly via conference call. Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at:

https://jodyooo.wufoo.com/forms/patient-advisorycouncil-nomination-form/

Following is a list of upcoming PAC Conference Calls:

  • December 12, 2014, 1-2 PM
  • March 27, 2015, 1-2 PM
  • June 26, 2015, 1-2 PM
  • September 25, 2015, 1-2 PM
  • December 18, 2015, 1-2 PM

MiPCT Complex Care Management Course

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1Live webinar – Introduction of MiPCT CCM course
  • Day 2Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4In-person training days

Register for the December 8-11, 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/december-811-2014-mipct-ccm-training/

Upcoming 2015 MiPCT CCM course dates:

January 5-8, 2015 – Introductory Webinar Jan. 5

  • January 5-6, 2015 – Total six hours of self-study modules and post-tests
  • January 7-8, 2015 – In-person training

February 9-12, 2015 – Introductory Webinar Feb. 9

  • February 9-10, 2015 – Total six hours of self-study modules and post-tests
  • February 11-12, 2015 – In-person training

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

Attached to this issue of the PO FLASH is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed below include information regarding course date/criteria to schedule.

For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self Management Support Training Programs” at https://mipct.org/care-management-resource-center/.

Stories of Your Care Management Success

  • Becki Strawderman, RN, HCM, Otsego Memorial Group, CIPA, and
  • Lori Lynn, RN, HCM, Cherry Street, CIPA

Becki, a MiPCT HCM, was contacted to assist in care coordination of a Medicare patient who lived in Lewiston and had been treated at Otsego Memorial Hospital (OMH) after sustaining several fractured ribs, pneumothorax, and leg injury from a fall off a ladder. The 65 y/o patient had spent 9 days in OMH when he was discharged and released to the care of his family (brother and sister-in-law) in Grand Rapids, four hours from his home in Lewiston. During his convalescence with his family in Grand Rapids, MI he developed complications, which included bilateral pulmonary embolisms, a pleural effusion, bilateral deep vein thrombus and urinary retention. After an eight day inpatient stay in a Grand Rapids hospital the patient was released again to his family living in Grand Rapids to convalesce. He suffered further complications, and again had to be readmitted for sepsis and bilateral pleural effusion. The patient had spent 29 days out of 37 days in the hospital.

It was evident that the patient’s health was too fragile for him to return to his home in Lewiston, MI. Therefore, a discharge plan inclusive of follow-up care in Grand Rapids would require additional care coordination as the patient’s primary care provider was located four hours away. The patient was discharged from the hospital and follow up care arranged at a MiPCT practice, Cherry Street, in Grand Rapids. Becki contacted Lori, the HCM at the Cherry Street practice and provided a care update to help facilitate a comprehensive post-hospital transition.

Lori and the practice team from Cherry Street collaborated with Becki from the Otsego Memorial Group while providing transition of care follow-up, and at the Cherry Street Practice in Grand Rapids, while the patient convalesced with his family.

Two months after his last discharge from the Grand Rapids hospital the patient was well enough to return to his home in Lewiston. The Cherry Street team provided the patient copies of his medical record in lieu of mailing it to his primary care physician. This was done in case the patient had to stop on his return to Lewiston for any needed care.

Becki was grateful for the coordination of care provided by the Cherry Street practice team. In turn, Lori and the practice team were proud of the patient’s favorable outcome and thankful for the patient’s uneventful trip home to Lewiston, MI.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: December 8, 2014
  • Next MiPCT Practice FLASH Issue: December 22, 2014

October 20, 2014

From the MI Department of Community Health – Your Public Health Partner

The Diabetes Prevention Program – Help At-Risk Patients Avoid Becoming Diabetic

Do you have patients who are at risk for developing diabetes?

Today 1 in 3 U.S. adults are at risk for developing type 2 diabetes and most do not know it. Almost 2.6 million Michiganders are estimated to have pre-diabetes and 10.4% of Michigan adults have diabetes .

Do you know there is a proven program to prevent or delay type 2 diabetes?

The Diabetes Prevention Program (DPP) is a structured, evidenced-based lifestyle change program for adults with pre-diabetes and those at risk for type 2 diabetes. This Program helps participants take charge of their health and well-being. A trained lifestyle coach leads each group of participants through the CDC approved curriculum over the course of 16 weekly sessions, and 6-8 monthly follow-up sessions. Participants learn ways to adopt healthy eating habits and be more physically active; receive tools to address problem solving, stress reduction, and coping skills; and have the ability to improve chronic disease risk factors. The Diabetes Prevention Program Study showed that modest lifestyle changes, including increasing physical activity to 150 minutes per week and losing 5-7% of their body weight, reduced the risk of developing type 2 diabetes by 58%. To read more about the original study please visit: http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/

How can you help your patients?

Priority Health is offering a demonstration pilot of the DPP program in partnership with the National Kidney Foundation of Michigan (NKFM). To learn more and to see if a class is offered in your area please contact NKFM at 800-482-1455. For patients who have other insurance plans, a self-pay option using flexible spending accounts and scholarships may be available.

To find a list of all Michigan organizations offering DPP please visit http://www.midiabetesprevention.org/dpp-programs-in-michigan.html. Learn more about the Diabetes Prevention Program and download the risk assessment (in English or Spanish) at http://www.cdc.gov/diabetes/prevention/index.htm.

PCPCC October Learning Event: Patient-Centered Best Practices October 23, Noon – 1PM

Join the PCPCC Center for Care Delivery and Integration on Thursday, October 23rd at Noon ET to learn how two very different primary care practices approached their transformation to a patient-centered medical home and employed new strategies to improve outcomes for their patients, especially those with diabetes.These practices are among the 52 practices in the Maryland Multi-payer PCMH Pilot (MMPP), which Discern administers for the Maryland Health Care Commission.

Register at: https://www1.gotomeeting.com/register/918495968

October 30th Deadline for Obtaining Practice Learning Credits for Summit Virtual Team Participation and Webinar Chat Q/A Follow-Up Document

Practice teams (a physician, care manager and one other team member) who used the Summit webinar viewing option (either real-time or by watching the recording), or who sent part of the team to a Summit in-person session with others participating virtually, the deadline for submitting minutes of team discussion is nearing.

To obtain the four (4) Practice Learning Credits for teams that participated (all or in part) virtually, if you have not done so yet, please submit minutes of meaningful team discussion regarding the Summit key take-away points that your practice can use by October 30, 2014 to mipctdemo@michigan.gov. The subject line should say: “Summit Practice Team Minutes” and include the practice’s name and PO affiliation. (The recorded webinar is available on the mipctdemo.org website at: https://mipct.org/resources/presentations/)

This applies to practice teams that:

  • Registered for and viewed the live webinar link, and watched the live webinar as a team; or
  • Viewed the recorded webinar as a team; or
  • Sent part of their team to an in-person Summit session, and had the others view by webinar.

On a related note, a Q/A sheet is attached for questions posed on the webinar chat questions that did not get addressed during the Summit. Please note that additional information on the resources that Elizabeth Hertel discussed is included.

MiCMRC Care Manager Monthly Update: August/September, 2014

The MiPCT webinars and resource weblinks s are included in the attached document: “MiCMRC CM Monthly Update Aug/Sept 2014.”

August 15, 2014, Jane Turner, M.D., presented, Gearing Up for the Upcoming Pediatric Conference scheduled for September 17, 2014 from 9a to 4p at the BCBSM Lyon Meadows Facility, South Lyon, MI. The slide deck from this meeting is included in this update as well as the conference flyer with the details of the location and objectives for the Pediatric Conference.

August 27, 2014, David Weissman, M.D., presented, Giving Bad News/Do Not Resuscitate. This is the first of two webinars presented by Dr. Weissman for the palliative care clinical focus in the MIPCT project. The second webinar in palliative care, was held September 10, 2014, from 12n to 1p, and was titled Leading Goals of Care.

October 2014 BCBSM Billing Road Show – Summary of Questions and Answers

BCBSM conducted in-person Billing Road Show meetings throughout the summer of 2014. As a result of questions raised during these sessions, BCBSM has gathered these questions along with answers and created a summary document.

Attached please find the 2014 Billing Road Show Document and the BCBSM Commercial PDCM Billing presentation. You can also access these documents via https://mipct.org/resources/mipct-documents-and-presentations/

Fast Facts on Palliative Care

Fast Facts and Concepts on Palliative Care provide concise, practical, peer-reviewed, and evidence-based summaries on key topics important to clinicians and trainees caring for patients facing life-limiting illnesses. Fast Facts are designed to be easily accessible and clinically relevant monographs on palliative care topics. They are intended to be quick teaching tools for self-study material for health care professional trainees and clinicians who work with patients with life-limiting illnesses.

Fast Facts are brief articles, numbering 250 currently, which address issues that arise in caring for persons with life-limiting conditions. Fast Facts and Concepts are available for easy access at http://www.eperc.mcw.edu/EPERC/FastFactsandConcepts Medical College of Wisconsin’s End of Life/Palliative Education Resource Center (no cost).

The following are a list of Fast Facts which are highlighted for your convenience:

There is a mobile version of Palliative Fast Facts for iPhone and iPad. The application can be located through iTunes. There is no charge for the iOS application.

We encourage physicians, care managers and practices to read these resources as MiPCT continues to focus on palliative care and its relevance to seriously ill patients.

For additional Palliative care resources: http://micmrc.org/palliative-care

Statewide MiPCT Patient Advisory Council Member Nominations

The statewide MiPCT Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in MiPCT implementation and operations. We are recruiting additional nominations for this state-wide advisory group, which meets quarterly via conference call. Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at:

https://jodyooo.wufoo.com/forms/patient-advisorycouncil-nomination-form/

The next PAC Conference Call will be held on Friday, 12/12/2014 at 1:00 PM.

MiPCT Complex Care Management Course

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1Live webinar – Introduction of MiPCT CCM course
  • Day 2Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4In-person training days

Register for the November 10-13, 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/november1013-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

  • November 10-13, 2014 – Introductory Webinar Nov. 10
    • November 10-11, 2014 – Total six hours of self-study modules and post-tests
    • November 12-13, 2014 – In person training
  • December 8-11, 2014 – Introductory Webinar Dec. 8
    • December 8-9, 2014 – Total six hours of self-study modules and post-tests
    • December 10-11, 2014 – In person training

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

Attached to this issue of the PO FLASH is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed below include information regarding course date/criteria to schedule.

For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/ .

Stories of Your Care Management Success

Karen McWilliams, RN, HCM, Lakeshore Medical Center-Shelby, Lakeshore Health Network

Karen McWilliams, RN, is a Hybrid Care Manager at Lakeshore Medical Center-Shelby within Lakeshore Health Network. Karen was working with a patient covered by BCBSM insurance. He is a 67 year old male with Benign Prostatic Hypertrophy (BPH), Hypertension (HTN), Gout, and Hypercholesterolemia. The patient’s Prostate-Specific Antigen (PSA) was being monitored and took a sudden jump in July of 2013. He consulted with an Urologist in Muskegon and had surgery for Prostate cancer in July of 2013. Following his discharge he received a call from Karen.

He accepted care manager services the first month after his surgery. Within a couple of weeks of surgery he developed some complications. These included elevated blood pressure, anxiety, depression, development of a fistula, and urinary catheter. The fistula resulted in further surgeries including a colostomy and subsequent reverse colostomy. He continued with care management during this time. He and his wife describe care management as their “lifeline”.

Karen was able to help coordinate services with the urologist in Muskegon, Gastroenterologist in Grand Rapids, Cardiologist in Lansing, home care nurses and ostomy nurse. She coordinated lab work and preoperative procedures, performed medication reconciliation after each procedure, confirmed discharge orders after each procedure, and encouraged healthy behaviors to promote optimal healing. Karen even assisted the patient in preparing to go hunting safely with his urinary catheter and colostomy. He was able to take numerous trips to the other side of the state to his cottage because as he stated, “I have my connection with my care manager [Karen] if I need anything”.

His surgical incisions healed without complications and his chronic conditions remained stable throughout his recovery. Blood Pressure stabilization and a healthy diet promoted optimal healing. His depression and anxiety improved with treatment. Ultimately, his colostomy was reversed and is now well healed. On February 13, 2014 Karen and the patient met face to face for the first time when his PCP gave him the good news that his labs showed his PSA was <0.01.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue:  November 10, 2014
  • Next MiPCT Practice FLASH Issue:  November 24, 2014

September 22, 2014

Practice Learning Credits Available for Summit Participation!

Four (4) Practice Learning Credits are available for Summit participation for practice teams (a physician, care manager and one other team member) who complete one of the following:

  • Attend in-person (each team member must register for the Ann Arbor or Grand Rapids 8:30 to noon in-person sessions, and initial the “sign in/sign out” sheet separately).
  • Register for the October 9th, 8:30 to noon live webinar link, watch the live webinar as a team, and submit minutes of SUBSEQUENT meaningful team discussion regarding the Summit (e.g., the “take-away” key points that your practice can use) to mipctdemo@michigan.gov by October 30th, 2014. The subject line should say: “Summit Practice Team Minutes” and include the practice’s name and PO affiliation.
  • View the recorded webinar (to be posted by October 15th on the www.mipct.com website under the “Summit” tab) as a team and submit minutes of SUBSEQUENT meaningful team discussion regarding the Summit (e.g., the “take-away” key points that your practice can use) to mipctdemo@michigan.gov by October 30th, 2014. The subject line should say: “Summit Practice Team Minutes” and include the practice’s name and PO affiliation.
  • Send part of the team to an in-person Summit session, and have the others view by webinar and submit minutes of A SUBSEQUENT meaningful team discussion regarding the Summit (e.g., the “take-away” key points that your practice can use) to mipctdemo@michigan.gov by October 30th, 2014. The subject line should say: “Summit Practice Team Minutes” and include the practice’s name and PO affiliation.

Registration is Open for the 2014 MiPCT Regional Annual Summits

We are excited to announce that registration is now open for the 2014 MiPCT Annual Summits. Please register for the Summit session of your choice using one of the registration links listed at the end of the article.

Morning Session – Open to All

The morning session is an all-stakeholder meeting that is open to all! This year, the theme for the morning is: “The Future of Primary Care: MiPCT in 2015 and Beyond” and will feature:

  • An update on MiPCT evaluation results to date, 2015 funding details, and continuity/sustainability
  • Celebrating MiPCT stakeholder partner achievements!
  • Best practice sharing
  • A segment on positioning your PO and Practice for MiPCT 2015 and beyond
  • A great chance to network and take the work even farther together

For details on how to earn Practice Learning Credits, see article on Page 1, entitied: “Practice Learning Credits Available for Summit Participation!

Afternoon Session – Care Manager Education

The Summit afternoon sessions are designed for MiPCT Care Managers. MiPCT stakeholders (physicians, POs, health plans, practice managers, multidisciplinary MiPCT practice teams, care managers, purchasers, members, etc.) are welcome to attend also.

Summit 2014 afternoon session topics include Palliative Care and MiPCT Care Management Best Practice Work Group Update. The session will provide opportunities for MiPCT Care Managers to enhance their Palliative Care skills and knowledge of effective communication regarding the seriously ill.

Palliative Care RN Expert Presenters:

  • Ann Arbor and Grand Rapids Summits – Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN, Palliative Care Service Nurse Practitioner at North Shore Medical Center, Salem, MA.
  • Gaylord Summit – Moni Franks BSN, CHPCA, CCM; Program Coordinator – Pain & Palliative Care, Mercy Health Saint Mary’s Hospital.

MiPCT Best Practice Work Group Update Presenters:

  • All 3 Summits – MiPCT Central Coordinator, Master Trainers and Clinical Leads

This continuing nursing education activity was approved by the Michigan Nurses Association, an approver, by the State of Michigan Board of Nursing. MIPCT 2014 Summit Care Management afternoon session attendees will receive 3.0 nursing continuing education credits.

Dates and Locations:

Morning Summit sessions – There are two in-person locations (one will have a webinar link allowing remote attendance as well):

  • Ann Arbor – University of Michigan North Campus Research Center (NCRC), October 7, 2014 – 8:00 AM to Noon
  • Grand Rapids – Frederik Meijer Gardens, October 9, 2014 – 8:00 AM to Noon (this location will also have a live webinar link allowing those who cannot travel to participate).

NOTE: After consultation with our northern participants, it was decided that the Gaylord in-person morning Summit session will not be held this year. Northern participants are invited to either attend the Ann Arbor or Grand Rapids in-person sessions, participate via webinar link from their location on October 9th, or listen to the recorded webinar of the October 9th session, which will be available on the mipct.org site by October 15, 2014.)

Afternoon Summit sessions – Care Manager Education:

  • Gaylord – Ostego Conference Center October 1, 2014 – 11:30am – 4:30 pm
  • Ann Arbor – University of Michigan North Campus Research Center (NCRC), October 7, 2014 – 1:00 pm — 4:30pm
  • Grand Rapids – Frederik Meijer Gardens, October 9, 2014 – 12:45 pm — 4:30pm

NOTE: The Gaylord afternoon Summit will begin at 11:30am with a special hour-long live briefing session with MiPCT Leadership on 2015 to present. An update on MiPCT evaluation to date and sustainability/continuity will also be provided.

Register at:

The attached flier contains additional details, and can be distributed to practices, etc.

MiCMRC Care Manager Monthly Update: August/September, 2014

The MiPCT webinars and resource weblinks s are included in the attached document: “MiCMRC CM Monthly Update Aug/Sept 2014.”

August 15, 2014, Jane Turner, M.D., presented, Gearing Up for the Upcoming Pediatric Conference scheduled for September 17, 2014 from 9a to 4p at the BCBSM Lyon Meadows Facility, South Lyon, MI. The slide deck from this meeting is included in this update as well as the conference flyer with the details of the location and objectives for the Pediatric Conference.

August 27, 2014, David Weissman, M.D., presented, Giving Bad News/Do Not Resuscitate. This is the first of two webinars presented by Dr. Weissman for the palliative care clinical focus in the MIPCT project. The second webinar in palliative care, was held September 10, 2014, from 12n to 1p, and was titled Leading Goals of Care.

Physicians’ Corner: Choosing Wisely by Kevin Taylor MD

The physician’s role with Choosing Wisely is to be responsible for the appropriate allocation of resources and to scrupulously avoid superfluous tests and procedures.

This past week I had the opportunity on to meet with one of my patients who is in his mid-70s and lives a very healthy lifestyle, exercising over 150 minutes per week with no chronic conditions or unhealthy behaviors.

He was most concerned about the possibility of having silent coronary artery disease. As a result, he electively chose to have an executive physical at an outside institution and proceeded to present me with the results of all of the tests that he had received during this assessment.

The evaluation included a full laboratory panel and Cardiac CT calcium assessment. He was astounded to find that he had evidence of plaque formation in his left anterior descending coronary artery. As a result of this finding, the facility recommended a stress test which he dutifully performed, exercising at 106% of his predicted max with an entirely normal stress test result.

Because of his LAD lesion he was advised to start a statin medication. At this point, he decided to meet with me, his primary care physician.

After reviewing the three-ring binder presentation that outlined the results of his executive physical and recommendations, I asked him what his goals for his health were. He stated that he was not seeking to live to 100 years old, but he did want to live a highly functional life.

After clarifying his goals for his health, I reviewed with him a strategy that he should consider using as he entertains further diagnostic testing or treatment options.

I recommended that he ask the 5 questions with his providers before agreeing to a test or treatment. These 5 questions are noted in the choosing wisely guidelines as follows:

  1. Do I really need this?
  2. What are the downsides?
  3. Are there simpler, safer options?
  4. What happens if I do nothing?
  5. How much does it cost?

I then informed him that more is not always better, and proceeded to use the new American Heart Association/American College of cardiology algorithm for determining his cardiac risk. http://tools.cardiosource.org/ASCVD-Risk-Estimator/

This algorithm noted that at 74 years old he had a 17.4% 10-year risk for a coronary artery disease event. The recommendation by the AHA/ACC is that he would benefit from a moderate dose statin medication. I noted to my patient that if he had come to see me we could have avoided extensive testing and radiation exposure, and arrived at the same conclusion.

We concluded our conversation by discussing his goal for a highly functional life. I recommended he develop his advanced care planning, and arranged a visit with our office nurse who is trained in reviewing advanced care planning with patients.

The ultimate goal of the Choosing Wisely campaign is to spark conversations between providers and patients to ensure the right care is delivered at the right time. One of the most challenging conversations to have with our patients is to help them understand that “more is not always better.” The “5 Questions to Ask Your Doctor” is a helpful guide in these necessary conversations.

Fast Facts on Palliative Care

Fast Facts and Concepts on Palliative Care provides concise, practical, peer-reviewed, and evidence-based summaries on key topics important to clinicians and trainees caring for patients facing life-limiting illnesses. Fast Facts are designed to be easily accessible and clinically relevant monographs on palliative care topics. They are intended to be quick teaching tools for self-study material for health care professional trainees and clinicians who work with patients with life-limiting illnesses.

Fast Facts are brief articles, numbering 250 currently, which address issues that arise in caring for persons with life-limiting conditions. Fast Facts and Concepts are available for easy access at http://www.eperc.mcw.edu/EPERC/FastFactsandConceptsMedical College of Wisconsin’s End of Life/Palliative Education Resource Center (no cost).

The following Fast Facts and Concepts on Palliative Care corresponds to the MiPCT webinars on August 27, 2014, presented on the topic Giving Bad News / DNR and September 10, 2014 on the topic Leading Goals of Care. Both webinars were presented by David Weissman, MD.

There is a mobile version of Palliative Fast Facts for iPhone and iPad. The application can be located through iTunes. There is no charge for the iOS application.

We encourage physicians, care managers and practice staff to read these resources as MiPCT continues to focus on palliative care and its relevance to seriously ill patients. For additional Palliative care resources: http://micmrc.org/palliative-care

Statewide MiPCT Patient Advisory Council Member Nominations

The statewide MiPCT Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in MiPCT implementation and operations. We are recruiting additional nominations for this state-wide advisory group, which meets quarterly via conference call. Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at:

https://jodyooo.wufoo.com/forms/patient-advisorycouncil-nomination-form/

The next PAC Conference Call will be held on Friday, 12/12/2014 at 1:00 PM.

All-Payer MiPCT Care Management Billing Collaborative: Your Opportunity to Sign Up Now!

To assist and support POs and practices in robust structures that support G- and CPT-code billing for embedded care management services across payers, an All-Payer MiPCT billing collaborative will begin in early fall and continue through early 2015. The collaborative will work in concert with our BCBSM and Priority Health Plan partners. The structure includes one half-day, in-person session (on the morning of October 30) that is supplemented with monthly webinars.

The approach supports a “train-the-trainer” spread of learning to other practices in the PO. Each interested PO is invited to select one or two practices (additional practices would be accommodated to the extent possible) to participate in the collaborative along with a PO representative. The charter for the collaborative is included as an attachment for your reference.

A team would generally consist of:

  • PO leaders (executives/those responsible for financial planning)
  • Practice Manager
  • Billers and Coders
  • Care Managers

A physician from each practice team would participate in one webinar focusing on the physician’s role in coding and billing. The focus is on a multi-payer perspective, and experts from each participating commercial plan have generously agreed to be involved. Some pre-work is required of all participating teams. Visit THIS LINK for the pre-work survey.

Three (3) Practice Learning Credits are available for teams that complete the September through December portion of the work. A webinar is available on the www.mipct.org website (https://mipct.org/resources/presentations/) that describes the all-payer collaborative for sharing with your interested partners. This webinar link is also available on the All Payer Billing Collaborative page). The charter for the collaborative is included as an attachment.

To sign up to participate in the All-Payer Billing Collaborative, please send an email to mipctdemo@michigan.gov by September 29th with the subject line: All-Payer Billing Collaborative. Please indicate the contact person within your PO, the PO name, and the practices you wish to involve.

Please visit the All Payer Billing Collaborative page, where you will find a copy of the charter, a link to the pre-work, an informative “All Payer Billing Collaborative” webinar link, and other important information!

BCBSM Wellness & Care Management Programs Webinar Rescheduled to October 21

The webinar about BCBSM Wellness and Care Management programs, previously scheduled for 9/18, has been rescheduled for Tuesday, October 21st, from 1 to 2 p.m. Please mark your calendars! At this webinar, BCBSM employees will discuss care management and case management resources that are available for practices to use in managing BCBSM patients who aren’t eligible for MiPCT.

To attend, simply follow these instructions at the time of the event:

To join the webinar:

  1. Go to https://bcbsm.webex.com/bcbsm/j.php?J=737844372&PW=67935ad6df5a585c0d
  2. If you are not logged in, log in to your account.

Meeting Number: 737 844 372

Meeting Password: 1234

To dial into the call:

  1. Please call: Toll-Free: 1-800-4625837
  2. Follow the instructions that you hear on the phone.Cisco Unified MeetingPlace meeting ID: 737 844 372

Updates to BCBSM Medicare Advantage PDCM Billing Guidelines

This is an overview of the billing codes which have been updated for BCBSM Medicare Advantage PDCM Billing as of August 2014. The updated guidelines are available at https://mipctdemo.files.wordpress.com/2012/04/medicare_advantage_pdcm_billing_guidelines-final_august_2014.pdf. Please note the following changes:

1. Added procedure code 98968 to first page:

  • As of Jan.1, 2014, added code S0257*.
  • These billing guidelines and payment policy are in regard to HCPCS codes G9001*, G9002*, G9007*, G9008*, and S0257* as well as CPT codes 98961*, 98962*, 98966*, 98967*, 98968*, 99487* and 99489*.

2. Under procedure code G9001, added “agree”:

  • Claims Reporting Requirements
    • For patients not entering into care management, the claim date of service reported should be the date of the face-to-face component.
    • For patients who are entering care management, the claim date of service reported should be the patient enrollment date. (Note: Prior to enrollment, patients must formally agree they understand and consent to the care plan and its goals, and agree to be actively engaged in the activities identified to meet goals.)

3. Expanded the nomenclature for procedure codes 98961 and 98962:

  • Group Education and Training
    • 98961* Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients.
    • 98962* Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients

4. Updated the billing chart for 99487 and 99489

All these changes align with the changes in the BCBSM Provider Delivered Care Management Commercial Payment Policy and Billing guidelines.

MiPCT Pediatric Conference Follow-Up

During the MiPCT Pediatric Conference held on September 17, 2014 many pediatric resources were shared throughout the day long conference. While there are numerous Pediatric resources available in our State, a request to develop a list of the top Pediatric resources was requested and agreed upon as a need by those in attendance. In keeping with this request a Pediatric Resource list has been developed and reviewed by various providers of pediatric services including but not limited to; Dr. Jane Tuner, pediatrician, Children Special Health Care Services, The Family Center and Parent to Parent. The list of Pediatric resources, the services they provide and contact information can be found in the attachment titled, Top Pediatric Provider Resources.

Recap of BCBSM PDCM Billing Road Show Webinars

Many questions were posed during the recent BSBCM PDCM Billing Road Shows held throughout the state. In an effort to consistently communicate the same information to all MiPCT participants, there will be two webinar sessions scheduled in near future. The purpose of these webinars will be to share all the questions and corresponding answers discussed and to provide the participants with an opportunity to ask additional questions. The two sessions will be held on September 30, 2014 and October 13, 2014. Each of the respective sessions has a separate call-in number, listed on the next page:

  • September 30, 2014 – 1:00 – 3:00 p.m.

Meeting Number: 738 662 728

Meeting Password: pdcm

To start this meeting:

1. Go to https://bcbsm.webex.com/bcbsm/j.php?J=738662728&PW=67935ad6df1b0e0c54

2. If you are not logged in, log in to your account.

Teleconference information:

1. Please call one of the following numbers:

Toll-Free: 1-800-4625837

Local: 1-313-2254000

2. Follow the instructions that you hear on the phone.

Cisco Unified MeetingPlace meeting ID: 738 662 728

  • October 13, 2014 – 9:00 – 11:00 a.m.

Meeting Number: 737 936 161

Meeting Password: pdcm

To start this meeting

1. Go to https://bcbsm.webex.com/bcbsm/j.php?J=737936161&PW=67935ad6df1b0e0c54

2. If you are not logged in, log in to your account.

Teleconference information

1. Please call one of the following numbers:

Toll-Free: 1-800-4625837

Local: 1-313-2254000

2. Follow the instructions that you hear on the phone. Cisco Unified MeetingPlace meeting ID: 737 936 161

MiPCT Complex Care Management Course

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1Live webinar – Introduction of MiPCT CCM course
  • Day 2Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4In-person training days

Register for the October 13-16, 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/october-1316-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

October 13-16, 2014 – Introductory Webinar October 13

  • October 13-14, 2014 – Total six hours of self-study modules and post-tests
  • October 15-16, 2014 – In person training

November 10-13, 2014 – Introductory Webinar Nov. 10

  • November 10-11, 2014 – Total six hours of self-study modules and post-tests
  • November 12-13, 2014 – In person training

December 8-11, 2014 – Introductory Webinar Dec. 8

  • December 8-9, 2014 – Total six hours of self-study modules and post-tests
  • December 10-11, 2014 – In person training

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

Attached to this issue of the PO FLASH is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed below include information regarding course date/criteria to schedule.

For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self Management Support Training Programs” at https://mipct.org/care-management-resource-center/ .

Stories of Your Care Management Success: Pam Szymanski, RN, CM, Domino Farms Family Medicine, Dexter Family Medicine, UMHS

Pam Szymanski, RN is a MiPCT Complex Care Navigator at Domino Farms Family Medicine and Dexter Family Medicine within the University of Michigan Health System. Pam was working with a patient covered by Medicare insurance. Mr. L was referred to Pam by the patient’s PCP for frequent hospitalizations. His diagnosis included CHF, COPD, OSA (on BiPAP-bi-level pressure airway device), CRI Obesity, and Pulmonary HTN. Mr. L. receives specialty services from Pulmonary and the Neurology sleep clinic. In a three month period Mr. L was hospitalized three times for CHF and/or COPD exacerbations.

Mr. L was obese and not using his BiPAP at bedtime. Pam discussed with him the importance of using the BiPAP at bedtime and assessed his understanding of this intervention and any barriers that may be preventing him from complying. His complaint was that he would fall asleep with the BiPAP on, but the forced air through the BiPAP woke him up at night. He also was waiting from the Medical Supply Company to deliver the ASV (automatic Servo ventilation) attachment for the BiPAP.

Pam contacted Mr. L’s pulmonologist and neurologist (who ordered the ASV) with a patient update. Both physicians were aware that Mr. L was not using the BiPAP as he should and he really needed the ASV attachment. Mr. L insisted that the 2-4 liters of oxygen via nasal cannula at bedtime was keeping his oxygen saturations in the 90’s while he slept. To confirm the patient’s sleeping oxygen saturation level Pam requested an order for an overnight saturation study to be done. The study revealed that Mr. L’s oxygen saturations dropped in the low 80’s several times during the night.

Mr. L and Pam began discussions related to the correlation of weight loss related to less strain on his heart and improved respiratory status. He agreed with a plan to lose weight and brought his wife with him to an appointment so she could support a change in diet and physical activity.

Pam educated Mr. L regarding the importance of calling her or the office with any change in symptoms so treatment could be initiated early and hospitalization avoided. Mr. L. voiced agreement as he too wanted to avoid further hospitalizations.

Mr. L lost weight and experienced less respiratory difficulty. His blood gases improved, walking distance improved and he is able to work at his hobby of woodworking in his garage. In following up with Mr. L. she learned he had not received the ASV attachment from the Medical Supply Company. Pam contacted the company again and learned Mr. L needed further testing to get the ASV attachment approved for the BiPAP machine. A blood gas with 2 liters of oxygen was ordered and the results of this test were within the range needed for the ASV approval.

Mr. L received the ASV attachment; however, he was not using the BiPAP machine consistently as ordered. Pam continued to educate and encourage Mr. L. to use the BiPAP machine every night. She made several contacts to the pulmonologist and neurologist who both discussed the importance of using the BiPAP with Mr. L at each of his scheduled appointments. Pam arranged two mask fitting appointments with the Medical Supply Company to address any issues Mr. L experienced with mask fit to improve his use of the BiPAP machine. Mr. L shared with Pam that he was able to do more and feeling much better. He continued to question if BiPAP was necessary for him.

During a subsequent follow up appointment with his PCP, pulmonologist, and neurologist, all three physicians agreed to have the BiPAP machine removed from the home. Although it was anticipated that Mr. L would be relieved, instead he said he would like to keep the BiPAP machine and try to get used to using it every night.

Since receiving MiPCT care management services Mr. L has lost weight, become more active and he has not been hospitalized. During phone visits with Pam he shares how frequently he is using the BiPAP machine and his blood gas results have improved.

Pam continues to support Mr. L as he continues to work on his goal of losing more weight by making healthy food choices and increasing his physical activity. She provides praise and encouragement for his healthy choices.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: October 6, 2014
  • Next MiPCT Practice FLASH Issue: October 20, 2014

August 25, 2014

MiPCT Pediatric Conference for Care Managers and Physicians

Date: September 17, 2014

Time: 9AM to 4PM

Location: BCBSM-Lyon Meadows Facility, 53200 Grand River Ave., New Hudson, MI (Conf. Room B)

Meals: A continental breakfast and lunch will be served.

Learning Objectives: The overall goals of the conference are to clarify the role of the care manager in pediatrics, to learn new strategies to work with systems (including the practice team and community agencies), to improve skills in partnering with families, and to improve strategies to identify high risk individuals who are likely to benefit most from care management services.

Format: We will have brief presentations from representa-tives of community agencies. Most of the day will be spent in small group discussion, facilitated by pediatric professionals and parent representatives. Principles of family-centered care coordination and partnering with families will be infused into all case discussions. Cases to be discussed include children and youth with autism spectrum disorder, the NICU grad with complex needs, asthma and depression.

In an effort to plan for small group discussion and facilitate networking, registration for conference attendance is required. Please register for the MiPCT Pediatric Conference for Physicians and Care Managers no later than Monday, September 8, 2014 by going to: https://jodyooo.wufoo.com/forms/mipct-pediatric-conference-registration/.

PHYSICIAN’S CORNER: Advance Directives

by Kevin Taylor MD

This past week we had the opportunity to care for one of our elderly patients who is suffering from the complications of coronary artery disease and cardiomyopathy. He has developed failure to thrive syndrome and we have recently engaged our local hospice program to provide care for him and his family.

Upon entering the hospice program, we realized that there were no advance directives (ADs) obtained at that time. Further conversations with the patient and his extended family revealed mixed feelings regarding ADs. As a result, we employed the resources of one of our behaviorists, who is trained in providing AD counseling for patients and families. With her assistance, we identified a family member as an advocate for the patient, and effectively articulated the patient’s wishes. The importance of obtaining ADs for patients entering hospice is highlighted by a recent study.

Patients who enter hospice with an AD already completed may have an enhanced hospice experience. Compared with patients who enroll without an AD, they have longer lengths of stay, are less likely to die in an inpatient setting, and are less likely to leave hospice voluntarily, according to a report published in the Journal of the American Geriatrics Society.1

“Most people prefer to die at home if possible, and these results suggest that advance directives may help to shape trajectories of care in ways that are more consistent with low-intensity care,” write the authors. “Individuals enrolled in hospice for longer periods are able to receive more services, and their families have more time to anticipate and plan for the individual’s death,” the authors point out.

“This additional time is important, because previous studies have shown that longer stays in hospice are associated with greater satisfaction.” Investigators analyzed data on patients (n = 49,370) admitted between 2008 and 2012 to one of three U.S. hospice programs participating in the CHOICE (Coalition of Hospices Organized to Investigate Comparative Effectiveness) network. Overall, 73% of subjects had an advance directive at the time of hospice enrollment, and 58.2% had both an advance directive and a do-not-resuscitate (DNR) order.

Subjects with Advance Directives were:

  • Older (81.0 vs 74.4 years of age)
  • More likely to be female (48.5% vs 42.4%)
  • More likely to have a DNR order before enrollment (79.9% vs 49.1%)
  • Less likely to have cancer as an admitting diagnosis (32.3% vs 40.6%) and more likely to be diagnosed with dementia (13.5% vs 8.2%)

In adjusted analysis, hospice enrollees with ADs:

  • Were enrolled in hospice longer than those with no AD (median, 29 days vs 15 days)
  • Were less likely to die within the first week after entering hospice (24.3% vs 33.2%; adjusted odds ratio [AOR], 0.83; 95% confidence interval [CI], 0.78 to 0.88; P = < .001)
  • Were less likely to leave hospice voluntarily (2.2% vs 3.4%; AOR, 0.82; 95% CI, 0.74 to 0.90; P = < .003)
  • Were less likely to die in a hospital or inpatient hospice unit rather than at home or in a nursing home (15.3% vs 25.8%; AOR, 0.82; 95% CI, 0.77 to 0.87)

“Participants with advance directives were enrolled in hospice for a longer period of time before death than those without, and were more likely to die in the setting of their choice,” write the authors. “More time might have allowed participants and families to prepare for the end of life by organizing caregiving resources, making death at home more likely.” The finding that patients with ADs are less likely to withdraw from hospice may reflect a desire to avoid life-sustaining treatments that prompts the completion of a directive, the authors suggest. An AD might also serve as “a reminder of individual preferences, as people near the end of life, reducing the likelihood of disagreements between family members, particularly when the individual is no longer able to participate in these decisions,” they add. Although the evidence increasingly shows an association of ADs with better outcomes and less aggressive treatment in the last months of life, little has been previously known about whether the presence of an AD might promote the effective use of hospice care, note the authors. More than 1.65 million people use hospice every year. Thus, “even small differences in care for individuals with advance directives could affect large numbers of individuals.”

Currently, only 18% to 36% of the general U.S. population has completed an AD, with seriously ill patients completing ADs at only a marginally higher rate. “Therefore, the effect of advance directives on hospice care is likely to remain modest until their use becomes more widespread,” the authors conclude. However, if ADs can shape the course of hospice care in favorable ways, then “further research should investigate whether completion of an advance directive after an individual has enrolled in hospice is also beneficial.” The researchers note one limitation of the study was their inability to examine the contents of the subjects’ directives. With the development of newer ways of documenting the preferences of seriously ill patients — such as the Physician Orders for Life-Sustaining Treatment (POLST) forms — they recommend further research to understand how ADs and physician orders might influence patterns of hospice care.

1 “Are Advance Directives Associated with Better Hospice Care?” Journal of the American Geriatrics Society; June 2014; 62(6):1091-1096. Ache K, Harrold J, Harris P, Dougherty.

MiPCT Complex Care Management Course

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1Live webinar – Introduction of MiPCT CCM course
  • Day 2Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4In-person training days

Register for the September 8-11, 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/september-811-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

  • September 8-11, 2014 – Introductory Webinar September 8

• September 8-9, 2014 – Total six hours of self-study modules and post-tests

• September 10-11, 2014 – In person training

  • October 13-16, 2014 – Introductory Webinar October 13

• October 13-14, 2014 – Total six hours of self-study modules and post-tests

• October 15-16, 2014 – In person training

  • November 10-13, 2014 – Introductory Webinar Nov. 10

• November 10-11, 2014 – Total six hours of self-study modules and post-tests

• November 12-13, 2014 – In person training

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu

All-Payer MiPCT Care Management Billing Collaborative Your Opportunity to Sign Up Now!

To assist and support POs and practices in robust structures that support G- and CPT-code billing for embedded care management services across payers, an All-Payer MiPCT billing collaborative will begin in early fall and continue through early 2015. The collaborative will work in concert with our BCBSM and Priority plan partners. The structure includes one half-day, in-person session that is supplemented with monthly webinars.

The approach supports a “train-the-trainer” spread of learning to other practices in the PO. Each interested PO is invited to select one or two practices (additional practices would be accommodated to the extent possible) to participate in the collaborative along with a PO representative. The charter for the collaborative is included as an attachment for your reference. A team would generally consist of:

  • PO leaders (executives/those responsible for financial planning)
  • Practice Manager
  • Billers and Coders
  • Care Managers

A physician from each practice team would be involved in one webinar focusing on the physician’s role in coding and billing. The focus is on a multipayer perspective, and experts from each participating commercial plan have generously agreed to be involved. Some prework is required of all participating teams. Three (3) Practice Learning Credits are available for teams that complete the September through December portion of the work. A webinar is available on the mipctdemo.org website (https://mipct.org/resources/presentations/) that describes the all-payer collaborative for sharing with your interested partners.

To sign up to participate in the All-Payer Billing Collaborative, please send an email to mipctdemo@michigan.gov by September 8th with the subject line: “All-Payer Billing Collaborative.”

Please indicate the contact person within your PO, the PO name, and the practices you wish to involve.

MiPCT Palliative Care Webinars for Primary Care Physicians and Care Managers

MiPCT is offering two Palliative Care Webinars in August 2014, primarily designed for a physician audience. MiPCT care managers are also welcome to attend. CME is available for the live webinars; see below for details.

MiPCT Palliative Care Webinars Qualify for MiPCT Practice Learning Activity Credits as Follows:

The following scenarios each qualify for MiPCT Practice Learning Activity credits.

  • MiPCT CM and a MiPCT PCP attend a Palliative Care webinar and have a follow-up discussion. Meeting minutes are documented and include next steps/implementation plan. (2 MiPCT Practice Credits), OR
  • MiPCT PCP attends Palliative Care webinar and has a subsequent team meeting, including the CM, to discuss next steps/implementation plan. (2 MiPCT Practice Credits).

Presenter:

DAVID E. WEISSMAN, M.D., FAAHPM is a nationally recognized palliative care expert who will present the Webinar topics: Giving Bad News and DNR. Dr. Weissman’s current appointments include:

  • Professor Emeritus; Medical College of Wisconsin
  • Co-Director, EPERC; Medical College of Wisconsin (http://www.eperc.mcw.edu)
  • Consultant; Center to Advance Palliative Care (2008-present)
  • Co-Director; Palliative Care-Outpatient Integration (IPAL-OP); CAPC, New York

Webinar 1 — Palliative Care: Giving Bad News/DNR: August 27, 2014, 12pm–1pm; Presented by David Weissman, MD, Medical College of Wisconsin.

Objectives:

  • List a six-step approach to giving bad news.
  • Describe two methods of starting a DNR discussion.
  • Identify three common patient misconceptions of the CPR procedure.

CME Information:

The Practice Transformation Institute is accredited by the Michigan State Medical Society to provide Continuing Medical Education for physicians. The Practice Transformation Institute designates this live activity for a maximum of one (1) AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

To receive Continuing Medical Education credit for this webinar you must complete the following:

  • Register for the webinar. Go to https://mphievents.webex.com/mphievents/onstage/g.php?t=a&d=662689954
  • On 8/27/14 join the live webinar, and login individually via your computer*. Attend the entire webinar presentation.
  • Complete and submit the evaluation form which is auto-generated at the end of the live webinar. The evaluation is only available electronically to attendees who join the live webinar via computer.

NOTE: MiPCT is not able to issue Continuing Medical Education credit for multiple attendees viewing the webinar on one computer. MiPCT is only able to issue Continuing Medical Education credit for participants who attend and login individually to the live webinar (i.e. viewing the recorded webinar will not provide Continuing Medical Education).

Attached please find a ‘SAVE the DATE Flyer” for this webinar. Help us get the word out to the MiPCT primary care physicians and care managers by distributing this flyer!

Please submit questions to: micmrc-requests@med.umich.edu

Webinar 2 — Palliative Care: Leading Goals of Care; September 10, 2014, 12pm–1pm; Presented by David Weissman, MD, Medical College of Wisconsin.

Objectives:

  • List a ten-step protocol for leading a family goal-setting meeting.
  • Identify three reasons for clinician-family conflict over end-of-life goals.
  • Describe two approaches to resolving conflicts over end-of-life goals.

CME Information:

The Practice Transformation Institute is accredited by the Michigan State Medical Society to provide Continuing Medical Education for physicians. The Practice Transformation Institute designates this live activity for a maximum of one (1) AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

To receive Continuing Medical Education credit for this webinar you must complete the following:

  • Register for the webinar. Go to https://mphievents.webex.com/mphievents/onstage/g.php?t=a&d=662099811
  • On 9/10/14 join the live webinar, and login individually via your computer*. Attend the entire webinar presentation.
  • Complete and submit the evaluation form which is auto generated at the end of the live webinar. The evaluation is only available electronically to attendees who join the live webinar via computer.

NOTE: MiPCT is not able to issue Continuing Medical Education credit for multiple attendees viewing the webinar on one computer. MiPCT is only able to issue Continuing Medical Education credit for participants who attend and login individually to the live webinar (i.e. viewing the recorded webinar will not provide Continuing Medical Education).

Attached please find a ‘SAVE the DATE Flyer” for this Webinar. Help us get the word out to the MiPCT primary care physicians and care Managers by distributing this flyer!

Please submit questions to: micmrc-requests@med.umich.edu.

From the MI Department of Community Health — Your Public Health Partner: Arthritis, Anxiety & Depression

Did you know that recent research1 conducted by the CDC suggests that approximately 1/3 of all people with doctor-diagnosed arthritis also have anxiety, depression or both? Due to the prevalence of anxiety and depression among people with arthritis, their impact on quality of life, and the range of effective treatment options available for both, study authors suggest that health care providers screen all adults with arthritis for anxiety and depression.

In a study involving nearly 1,800 adults, 45 years of age or older, with doctor-diagnosed arthritis, 31% were found to have anxiety and 18% had depression. Most respondents with depression also had anxiety. Only half of those found to have either condition had sought help in the past year. Among the most common correlates with anxiety and depression was “a lot” of difficulty with bathing and dressing, unemployment/inability to work/disability, and little or no confidence in ability to manage arthritis or joint symptoms. The authors noted that anxiety and depression prevalence in the sample were in line with other emerging research, indicating that anxiety may be under-recognized and under-reported. They also observed that at least one study has shown anxiety to be a better predictor of functional limitation than depression among people with arthritis.

What does this mean for your interactions with patients with arthritis? If you have recommended lifestyle or pharmacologic interventions for your patients with arthritis, they may have difficulty heeding those recommendations if they are experiencing significant levels of anxiety or depression. Treatment of one or both conditions may be necessary to get patients to a place where they can focus on better management of their arthritis. Without treatment of their mental health conditions, they may be subject to increased arthritis pain, functional limitations and disease progression.

Community-based self-management education programs have been shown to reduce anxiety and depression. Likewise, physical activity that is safe and appropriate for PWA can reduce mild to moderate depression. Both can complement your clinical treatment efforts. In Michigan, the evidence-based Stanford Chronic Disease Self-Management program is called Personal Action Toward Health (PATH). The six-week interactive workshops are available in many areas of the state, and most often are free to participants. The EnhanceFitness group exercise program is a low-cost, evidence-based option for older adults and those who have not been active for some time. Up-to-date listings for both programs can be found at http://www.mihealthyprograms.org. For more public health information and resources, and to find out more about effective management of arthritis go to http://www.michigan.gov/primarycare.

_____
1Murphy, L. B., Sacks, J. J., Brady, T. J., Hootman, J. M. and Chapman, D. P. (2012), Anxiety and depression among US adults with arthritis: Prevalence and correlates. Arthritis Care Res, 64: 968–976. doi: 10.1002/acr.21685

From the MI Department of Community Health — Your Public Health Partner: Free Cancer Screening for Insured and Uninsured Patients

Did you know that most Michigan residents with insurance are now covered for free cancer screening? As a result of the Affordable Care Act (ACA), most insured Michigan residents can now receive free cancer screenings for early detection of breast, cervical, and colorectal cancer. Getting the word out about these free screenings is important!

Expanded coverage through private insurance exchanges and Medicaid means many more people have access to free cancer screening, which is great. But, your practice may still see women who are uninsured, or who have insurance but little income to cover high deductibles. They may be able to receive free breast and cervical cancer screening through Michigan’s Breast and Cervical Cancer Control Program (BCCCP).

BCCCP Eligibility for Uninsured Women Women, ages 40-64, and having an income of 139% – <250% of the Federal Poverty Level, are eligible for the BCCCP (if not currently enrolled in Medicaid or the Healthy Michigan Plan or any other type of insurance). BCCCP eligibility means women can receive free screening mammograms and Pap smears, along with diagnostic services, to rule out cancer following an abnormal screening. They may also be eligible to receive treatment through the BCCCP Medicaid Treatment Act if diagnosed with breast or cervical cancer.

Diagnostic Services for Insured Women with High Deductibles Women, ages 40-64, and having an income of 139% – ≤250% of the Federal Poverty Level, and who have insurance, but have a high deductible and co-pays, may be eligible for diagnostic services provided through the BCCCP. If you do have women in your practice who are resisting breast or cervical follow-up of an abnormal screening due to high deductible costs, they should call the BCCCP at 1-800-922-MAMM (6266) to find the nearest BCCCP program.

Women above 250% of the Federal Poverty Level should be encouraged to obtain health insurance through the Health Insurance Marketplace for complete health care coverage. If they require assistance enrolling in an insurance plan, women can be referred to a patient navigator found on the Enroll Michigan website or to the Health Insurance Marketplace website.

For more information, call the BCCCP at 1-800-922-MAMM (6266). Please share this information with others. For more public health information and resources from the Michigan Department of Community Health, please visit our website for primary care www.michigan.gov/primarycare.

BCBSM Offering 2 PDCM Billing Roadshows in September 2014

BCBSM is offering two PDCM Billing Roadshows in September, 2014. Get all your questions answered and learn more about our PDCM program. If you have specific claim examples or questions, please bring them with you, or email them to providerpartnerships@bcbsm.com beforehand. We encourage all billers and any other care team members that are involved with PDCM and PDCM Oncology to attend.

Registration is required, so please email providerpartnerships@bcbsm.com to RSVP. See Billing Road Show Flyer for details.

  1. On September 4, from 2-4 pm, PDCM Billing Roadshow Videoconference for Marquette
  2. On September 24, from 1 – 4 PM, PDCM Billing Roadshow in the Aqua Training Room at the BCBSM Lyon Meadows facility at 53200 Grand River Avenue in South Lyon.

Care Management Resource Center Approved Self-Management Support Training Programs – Update

Attached to this issue of the PO FLASH is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed in the attached table include information regarding course date/criteria to schedule.

For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self Management Support Training Programs” at https://mipct.org/care-management-resource-center/.

New MiPCT Dashboard Open to Practice Users

MDC now has the ability to restrict Dashboard data down to the Practice level, which means that we can allow Practice users to access the Dashboard (if their account requests are approved by their PO Authorizers). The Dashboard contains various data tables, graphs, and reports that are customized to enhance analysis of multi-payer claims data, enable actionable care plans, and assist with quality measures. The three core areas of concentration are: membership/populations, quality of care, and utilization.

Practice-level users can request accounts using the same method as PO-level users (by accessing the MDC Website at www.MichiganDataCollaborative.org, navigating to the Accounts page, and clicking the Request Account button.)

If you have any questions, or if you would like to provide feedback or suggestions, please contact MDC at www.MichiganDataCollaborative.org.

Stories of Your Care Management Success:

Barbara Robbins, RN, BA, HCM, West Front Primary Care, UPHP

Barbara Robbins, RN, BA is a MiPCT Hybrid Care Manager working with West Front Primary Care in Traverse City, Michigan. This practice is affiliated with the Northern Physician Organization. Barbara initiated MiPCT Care Management services with a Priority Health patient Mrs. B in September of 2013. She was referred to care management by her PCP for improved control of hypertension, GERD, sleep apnea symptoms and weight loss.

At Mrs. B’s initial meeting with Barbara on October 11, 2013, knowledge of her health and potential barriers were assessed. The barriers identified included knowledge deficits relating to healthy eating habits and her motivation toward physical activity. A self-management action plan was developed to reflect goals of increased activity, better eating habits, and improved knowledge of healthy behaviors.

Mrs. B began meeting with Barbara every month for face to face visits which she believed were most beneficial. She valued the care manager visits as she gained knowledge about better eating habits, healthy behaviors, and gained the support she needed to keep herself motivated. Over the course of five months, Mrs. B had six face to face encounters with Barbara during which time she began to see a decline in weight. Mrs. B’s weight decreased from 253 to 224 pounds and her blood pressure improved from 142/76 to 118/76.

As a result of MiPCT Care Management services Mrs. B has gained the confidence to manage her weight independently. She understands how to overcome the barriers that prevented weight loss in the past. Currently, Mrs. B. is working towards her goal of discontinuing her blood pressure medications. She remains committed to the positive lifestyle changes she has made. Mrs. B continues to have face to face care management meetings with Barbara every three months. She is monitoring her blood pressure at home and is hopeful that as her weight continues to decrease she may no longer need the blood pressure medication.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: September 8 2014
  • Next MiPCT Practice FLASH Issue: September 22, 2014

July 28, 2014

IMPORTANT: The July 29 PO 1-2pm Meeting will Now Be a Webinar

As you have seen in the FLASH, we had planned an in-person July 29th meeting in Okemos from 1-3pm to discuss PO Leader perspectives and thoughts on the MiPCT 2015 and post-demonstration model design. We have learned from CMS that the decision on demonstration extension will not be available by that date. Hence, the in-person PO visioning session will be delayed until September. A date is being identified for the September in-person session and we will send a “save the date” soon.

We would like to use the 1pm time on July 29th for a one-hour webinar for an MiPCT Update and PO Open Forum Discussion. In addition to providing an MiPCT update, it will be an opportunity to discuss your questions and comments. The login information appears below:

Date: Tuesday, July 29

Time: 1:00 – 2:00 PM

Event Number: 660 543 376

Event Password: mipct01

To join the online meeting:

  1. Go to https://mphievents.webex.com/mphievents/onstage/g.php?t=a&d=660543376
  2. If requested, enter your name and email address.
  3. If a password is required, enter the meeting password: mipct01
  4. Click “Join”.

To join the audio conference only:

Call-in toll number (US/Canada): 1-650-479-3207

Access code: 660 543 376

Physicians’ Corner: Choosing Wisely

By Kevin Taylor MD

Are you looking for an opportunity to begin the Choosing Wisely journey in your organization? I would encourage you to provide a forum for a cross-specialty discussion related to pre-operative testing as our colleagues in New York have done recently.

I routinely have patients see me for preoperative evaluation. Often, my specialist colleagues have requested that our mutual patients receive preoperative testing including EKGs, laboratory testing and sometimes radiology studies.

This issue was addressed in a recent ABIM Foundation sponsored multispecialty panel discussion in New York and published by Deborah Korenstein1 in her May 28 blog on the Choosing Wisely website.

Dr. Korenstein notes that a number of specialty organizations have identified preoperative testing (i.e., lab tests, x-rays and cardiac testing) in healthy patients undergoing low-risk surgery as a frequently overused service and have included it on their Choosing Wisely® lists of tests and procedures that may be unnecessary. As preoperative testing may be ordered or requested by a multiple groups of physicians—surgeons, anesthesiologists, general internists or pediatricians or medical specialists—ensuring its appropriateness is complex. On April 30, the New York Academy of Medicine (NYAM) and the ABIM Foundation sponsored a multispecialty panel discussion to define appropriate preoperative testing and to discuss:

  • potential harms of overtesting;
  • reasons why overtesting is common; and,
  • strategies to optimize testing.

Panelists and attendees included internists, pediatricians, anesthesiologists and surgeons. Many attendees used the event as a springboard for revising policies around preoperative testing at their hospital or practice. In keeping with guidelines from the American Society of Anesthesiologists and the American College of Cardiology/American Heart Association, panelists from all specialties agreed that healthy patients undergoing low-risk surgery should undergo little or no testing. Beyond that important agreement, several notable points emerged from the discussion:

  1. Testing decisions must be individualized for patients with chronic medical conditions and for those undergoing higher-risk surgery. The group did note the lack of evidence or guidelines for how to do that.
  2. Several policies and strategies can facilitate appropriate testing, including centralized preoperative clinics. Such clinics can then work with multiple stakeholders to establish practice norms, and policies issued by the anesthesia departments can serve to disseminate information through the institution. Dr. Michael Janjigian from Bellevue Hospital discussed the process and impact of using a pre-op clinic to reduce unnecessary testing and Dr. Elizabeth A.M. Frost discussed anesthesia policies at Mount Sinai.
  3. Feedback on ordering appropriately, in a variety of contexts, must be given to providers.
  4. Good communication to optimize this process across departments, including communication among providers of patient care and between providers and the patient, is important in managing expectations and avoiding unnecessary testing.

The event highlights the importance of having a conversation around appropriate use of health care resources, a core purpose of Choosing Wisely campaign. Korenstein noted the program successfully facilitated constructive conversation among participants from diverse institutions, and specialties to work toward minimizing this important overuse of resources. It also emphasized the multifactorial drivers of inappropriate care, the complexity of reducing it and the need for consensus-building and strong interprofessional communication when working to optimize care.

1 Defining Appropriate Use System-Wide. Written by Deborah Korenstein, MD, FACP on May 28, 2014 http://blog.abimfoundation.org/defining-appropriate-use-system-wide/

Looking for 20 Practices!

Through a partnership with the Greater Detroit Health Council (GDAHC) and the Institute for Patient & Family-Centered Care (IPFCC), the leading national organization in incorporating the patient’s perspective in care decisions, twenty MiPCT practices have a special training opportunity.

The training is for practices interested in beginning or enhancing patient advisor programs. Up to four Practice Learning Credits will be awarded for the twenty practices selected from those who apply.

The attached flier describes the opportunity in greater detail, and can be distributed to practices. For more information, please contact dbechel@umich.edu.

From the MI Department of Community Health – Your Public Health Partner: Diabetes and Hypertension: Dangerous Co-Morbidities

You probably know high blood pressure is both a risk factor for developing type 2 diabetes and a well-known co-morbidity. Not only are many of your hypertensive patients at risk for diabetes, but diabetes is an independent risk factor for cardiovascular disease. It is crucial that people with high blood pressure be monitored for diabetes and people with diabetes have their blood pressure checked at every routine visit.

The 2014 American Diabetes Association’s Clinical Practice Recommendations suggest non-pregnant people with diabetes have their blood pressure treated to a goal of <140/80 mmHg. A lower systolic target of <130mmHg may be appropriate for some patients, such as younger individuals. But, for all people with Diabetes with a blood pressure >120/80mmHg, you should be recommending and supporting lifestyle changes such as increased physical activity, weight loss if appropriate, sodium reduction (e.g., a DASH style diet), and moderate alcohol intake. Pharmacological therapy is indicated in addition to lifestyle changes for any person with diabetes whose blood pressure is confirmed to be 140/80 mmHg or more.

Correct blood pressure measurement is important and should be performed by someone properly trained. Guidelines have been created for taking a blood pressure on someone without diabetes, and it is recommended the same guidelines be followed. They include:

  1. Use a cuff size that is correct for the person’s upper arm circumference,
  2. Have the person in a seated position with their feet on the floor,
  3. The arm should be at heart level and supported,
  4. Check the BP after 5 minutes of rest, and
  5. Repeat the blood pressure measurement on a separate day if the findings are elevated.

The importance of monitoring and taking care of hypertension to prevent cardiovascular complications is discussed in diabetes self-management education. There are 93 Diabetes Self-Management Education (DSME) Programs in Michigan certified by the Michigan Department of Community Health. You can refer patients to a DSME program to assist them in making lifestyle changes for blood pressure and blood glucose control. A list of DSME programs can be found at www.michigan.gov/diabetes. A multitude of hypertension resources, including a customizable treatment protocol, can be found at http://millionhearts.hhs.gov/. To order other materials related to chronic disease management and primary care, go to www.michigan.gov/primarycare.

Statewide MiPCT Patient Advisory Council Member Nominations

The statewide MiPCT Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in MiPCT implementation and operations. We are recruiting additional nominations for this state-wide advisory group, which meets quarterly via conference call.

Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at: https://jodyooo.wufoo.com/forms/patient-advisorycouncil-nomination-form/

The dates of the 2014 PAC Conference Calls are:

  • Friday, September 5, 2014 at 1:00 PM
  • Friday, December 12, 2014 at 1:00 PM

Fast Facts on Palliative Care

In a previous issue of the PO FLASH (June 16, 2014), the resource “Fast Facts and Concepts in Palliative Care” was introduced. These resources provide key topics important to clinicians caring for patients facing life-limiting illness. There are over 250 Fast Facts. The link is: http://www.eperc.mcw.edu/EPERC/FastFactsandConcepts

The following palliative care topics (which were presented in MiPCT webinars in July) and the corresponding Fast Facts that can enhance the clinicians understanding of these topics, are:

Download the free Palliative Care Fast Facts App from the iTunes Store! There is a mobile version of Palliative Fast Facts for iPhone and iPad. The application can be located through iTunes. There is no charge for the iOS application.

For additional Palliative care resources, visit:

MiPCT Care Manager Upcoming Webinars

In support of MiPCT’s 2014 clinical focus on Palliative Care you are invited to attend two webinars this summer.

August 27 , 2014, 12-1pm; Palliative Care – Giving Bad News/Do Not Resuscitate (DNR);

Presenter: David Weissman, MD, Project Director, Founder, Medical College of Wisconsin

Target Audience: Physicians and Care Managers.

September 10, 2014, 12-1pm; *Palliative Care – Learning Goals of Care;

Presenter: David Weissman, MD, Project Director, Founder, Medical College of Wisconsin

Target Audience: Physicians and Care Managers.

Anticoagulation Toolkits available from Michigan Anticoagulation Quality Improvement Initiative

The BCBSM hospital Collaborative Quality Initiative MAQI2 (Michigan Anticoagulation Quality Improvement Initiative) has created two very useful and comprehensive anticoagulation toolkits. One is for providers who administer anticoagulation medication and the other is for patients who receive anticoagulation medication.

These toolkits were created by MAQI2 consortium participants who are experts in anticoagulation care. Developed from best practices identified in data collected in patient registries as a part of the Initiative – the goal was to provide practitioners and patients with up-to-date, reliable, and easy to use source information on anticoagulation.

If your practice provides any level of anticoagulation management to patients these toolkits could be very useful to you and your patients.

The toolkits are free and available at www.anticoagulationtoolkit.com.

Save the Date! Pediatric Care Managers’ In-Person Meeting, September 17

An all day, in-person Pediatric Care Manager meeting is scheduled for September 17, 2014. The meeting will be held at the Blue Cross Blue Shield of Michigan Lyon Meadows Conference Center, 53200 Grand River Avenue, Wixom, MI.

We plan to offer a webinar at 10AM on Friday, August 15, to prepare for the face to face meeting. We will have some brief presentations to the whole group on Sept 17, but most of the day will be spent in small groups for discussion, problem solving and sharing resources. An email with more detailed information will be forthcoming in August.

MiPCT Complex Care Management Course

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1 – Live Webinar – Introduction of MiPCT CCM course
  • Day 2 – Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4 – In-person training days

Register for the August 18-20, 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/august-1821-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

August 18-21, 2014 – Introductory Webinar Aug. 18

  •  August 18-19, 2014 – Total six hours of self-study modules and post-tests
  •  August 20-21, 2014 – In person training

September 8-11, 2014 – Introductory Webinar Sept. 8

  • September 8-9, 2014 – Total six hours of self-study modules and post-tests
  • September 10-11, 2014 – In person training

October 13-16, 2014 – Introductory Webinar Oct. 13

  •  October 13-14, 2014 – Total six hours of self-study modules and post-tests
  •  October 15-16, 2014 – In person training

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu

MiPCT Primary Care Webinar August 2014 for Primary Care Physicians and Care Managers

MiPCT is offering a Palliative Care Webinar August 27, 2014 primarily designed for a Physician audience. MiPCT Care Managers are also welcome to attend.

Presenter: David E. Weissman, M.D., FAAHPM is a nationally recognized palliative care expert who will present the Webinar topics: Palliative Care: Giving Bad News and DNR.

Dr. Weissman’s current appointments include:

  • Professor Emeritus; Medical College of Wisconsin
  • Co-Director, EPERC; Medical College of Wisconsin (www.eperc.mcw.edu)
  • Consultant, Center to Advance Palliative Care (2008-present
  • Co-Director; Palliative Care-Outpatient Integration (IPAL-OP); CAPC, New York

Webinar: August 27, 2014, 12pm–1pm; Palliative Care: Giving Bad News/DNR; presented by David Weissman, MD, Medical College of Wisconsin.

Objectives:

  • List a six step approach to giving bad news.
  • Describe two methods of starting a DNR discussion
  • Identify three common patient misconceptions of the CPR procedure.

CME Information: The Practice Transformation Institute is accredited by the Michigan State Medical Society to provide Continuing Medical Education for physicians. The Practice Transformation Institute designates this live activity for a maximum of one (1) AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

To receive Continuing Medical Education credit for this webinar you must complete the following:

  • Register for the Webinar. Go to https://mphievents.webex.com/mphievents/onstage/g.php?t=a&d=662689954
  • On 8/27 Join the live webinar, login individually via your computer*. Attend the entire Webinar presentation.
  • Complete and submit the evaluation form which is auto generated at the end of the live webinar. The evaluation is only available electronically to attendees who join the live webinar via computer.

*NOTE: MiPCT is not able to issue Continuing Medical Education credit for multiple attendees viewing the webinar on one computer. MiPCT is only able to issue Continuing Medical Education credit for participants who attend and login individually to the live Webinar (i.e. viewing the recorded Webinar will not provide Continuing Medical Education).

Attached please find a ‘SAVE the DATE Flyer” for this Webinar. Help us get the word out to the MiPCT Primary Care Physicians and Care Managers by distributing this flyer!

Please submit questions to: micmrc-requests@med.umich.edu

MiCMRC Care Manager Monthly Update: July, 2014

Webinar resources and other important information are included in the attached “July 2014 MiCMRC CM Monthly Update” document.

 Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

Attached to this issue of the PO FLASH is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed in the attached table include information regarding course date/criteria to schedule.

 For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self Management Support Training Programs” at https://mipct.org/care-management-resource-center/

Stories of Your Care Management Success: Angela Weir RN, BSN, HCM, Marquette General Family Medicine, Upper Peninsula Health Plan

Angela Weir RN, BSN, is a hybrid care manager at Marquette General Family Medicine; an Upper Peninsula Health Plan provider. Angela began working with a 50 year old patient with BCBSM insurance with a history of obesity, HTN, and DM. The patient was frustrated because he had been trying to lose weight unsuccessfully. He was on medication to control his blood pressure and an oral DM medication. His A1C was 7.0 when he first started working with care manager but wanted to improve it. He was concerned if he didn’t start making changes this A1C would continue to climb. He had been trying to lower his A1C for over one year without success.

Angela spoke with the patient to identifying his goals. He wanted to stop taking some of his medication and reduce his A1C below 7 in three months. He planned to accomplish this by losing weight. Initially, he needed a lot support and Angela called him weekly to follow up on his progress and discuss his goals. Slowly he began to increase his physical activity and improve his diet.

After three months he had lost 19 pounds and his A1C deceased to 6.3. Due to his progress Angela decreased her phone visits with the patient from weekly to monthly. During each call Angela continued to assess the patient’s ability to maintain his new lifestyle and offered support and education when needed.

Six months after the patient began receiving care management services with Angela the patient was able to discontinue his blood pressure medication and decrease the dosage of the medication to control his blood sugar in half. His A1C remained below 7.0 and he lost an additional 16 pounds for a total weight loss of 35 pounds. His BMI decreased from 38.4 to 33.59.

 The patient was seen by the Primary Care Provider (PCP) in December of 2013. Since then he has maintained his weight loss, and his blood pressure and DM continue to be well controlled. As a result he is no longer actively followed by Angela.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: August 18, 2014
  • Next MiPCT Practice FLASH Issue: August 25, 2014

June 30, 2014

MiPCT/PDCM Billing Roadshow Schedule Attached

We are excited to bring the MiPCT/PDCM Billing Roadshows back to a town near you.  Please join us to learn the billing guidelines of Provider Delivered Care Management (PDCM).  The Billing Roadshow Schedule Flier is attached for your convenience.

BCBSM Symposium “Physician and Patient Experience”  

BCBSM’s  Corporate Marketing and Consumer Experience department held a “Physician and Patient Experience” themed Market Insight Symposium on Wednesday June 4, 2014 featuring  a presentation centering on physician/member/health plan interactions, and a panel discussion of PGIP PCMH  MiPCT Physicians and Care Managers.   The symposium is a quarterly meeting for BCBSM employees.

Panel topics included Care Management services and the associated positive impacts on their practices’ and patients’ experiences and outcomes.

The panel members included:

  • Kevin Taylor, MD, Integrated Health Associates, Co-Medical Director, MiPCT
  • Phil Rodgers, MD, Associate Professor, Family Medicine, University of Michigan Health System
  • Alexander Ruthven, MD, Huron Family Practice Center
  • Heidi Steinhebel, RN, BSN, CCM, CCP,  Lead Care Manager, Integrated Health Associates
  • Kelly Yero, RN, BSN, BA,  Ambulatory RN Case Manager, Henry Ford Health System, MiPCT Clinical Lead

The panelists shared their insights regarding care management delivery in their practice settings.  They highlighted stories of patient care, which included the care manager, physician and patient collaborating and developing a plan to address the patient’s health concerns.  This team approach results in improved patient outcomes and reduction of unnecessary utilization of Emergency room visits and or Hospital admissions.  The panel presenters each described how the practice team has evolved to actively include the patient as a vital member of the health care team.

From the MI Department of Community Health – Your Public Health Partner

Smoking & Diabetes
Did you know that in January, 2014, the Surgeon General released “The Health Consequences of Smoking: 50 Years of Progress,” which stated that smoking is a cause of diabetes and a risk factor for poorer control of blood glucose? Smokers are 30-40% more likely to develop type 2 diabetes than people who do not smoke. Moreover, the more cigarettes smoked, the higher the risk of diabetes. Regardless of the type of diabetes, smoking makes it more difficult to control blood glucose levels.

Many people are at risk for diabetes, particularly type 2, and don’t know it. Risk factors for type 2 diabetes include, among others, a family history of the disease, being overweight, physical inactivity, high blood pressure, age, and a history of gestational diabetes for women. Now smoking is a known cause for type 2 diabetes, as well.

Why is this important for your patients? Diabetes continues to be a leading a cause of heart disease, stroke, blindness in adults and amputation. In 2012, 1 out of 10 Michigan adults was diagnosed with diabetes and more than a third (35%) of Michigan adults were at high risk with prediabetes. But, there are things people can do to delay or prevent the disease, such as losing weight, getting more physical activity and quitting smoking.

Whether your patients are at risk for diabetes or already have the disease and smoke, you can support them in making a difference now! Refer them to a local Diabetes Self-Management Education (DSME) Program to learn more about managing their blood glucose.  A list of DSME programs can be found at http://www.michigan.gov/diabetes. And, make a referral to the Michigan Tobacco Quitline at 1-800-QUIT-NOW. To order additional materials related to chronic disease management and primary care, go to www.michigan.gov/primarycare.

From the MI Department of Community Health – Your Public Health Partner

Getting the Asthma ‘GIST’
Are your practice’s asthma patients getting consistent, guidelines-based care? In Michigan, nearly 30% of adults with asthma reported that their disease was poorly controlled, and 55% reported activity limitations due to asthma. The Asthma Guidelines Implementation Steps & Tools (GIST) program uses simple, focused tools to help clinicians make decisions based on the guidelines, and incorporate these tools into their everyday practice so that optimal asthma care is standard.

The materials condense the guidelines into five tools that include all age groups. Specifically, the tools and procedures can help you to:

•    Diagnose asthma accurately with an initial assessment of asthma severity and initiate treatment accordingly
•    Prescribe inhaled corticosteroids for patients who are diagnosed with persistent asthma, short-acting beta-agonist for all asthma patients
•    Provide a tailored asthma action plan and review/update it at each follow-up visit
•    Assess a patient’s asthma control and adherence to his/her treatment plan at each subsequent doctor’s visit, and address barriers to self-management

The GIST materials and more about the program are available free to any practice. For more information about asthma management, contact Tisa Vorce at vorcet@michigan.gov or (517) 335-9463.

For more information about public health approaches to chronic disease, health and wellness, and community-based programs and resources please visit www.michigan.gov/primarycare.

Juliann Testy- Recipient of the Clara Ford Nursing Excellence Award- Quality Pillar

Juliann Testy is the 2014 Recipient of the Clara Ford Nursing Excellence Award.

Juliann  is currently the manager for the Henry Ford Health System’s Ambulatory Nurse Case Managers and has been  managing the Michigan Primary Care Transformation (MIPCT) demonstration project that was implemented in January 2012.

Juli is seen by her colleagues as a role model, an inspiration, dedicated and a wonderful co-worker and leader. Excerpt from Juli’s nominations:

  • “Juli Testy has personally and professionally led our team of 10-22 Nurse Case Managers through the uncharted territory of the MiPCT Demonstration Project. She is an exemplary leader who has used her skills to keep our group on course to successfully effect change in the Primary Care Clinic setting. With her support, our group has successfully decreased avoidable Hospitalizations and Emergency Department visits in the System significantly. To validate the statistical content of the MiPCT program, she is instrumental in continuously developing quality data collection tools, specific billing codes and tirelessly collaborating with the HFHS IT department.
  • With the additional challenge of Henry Ford’s Epic EMR implementation coinciding with continuing development of the MiPCT program, she was able to successfully integrate the MiPCT coding and the case management documentation required within Epic. If there is one word that describes Juli, it would be dedication. Juli embodies the spirit of an innovator and is a true “team player”. She puts her all into everything she undertakes. Juli is always willing to assist as needed and makes herself available to her staff at all times. She consistently displays a great attitude and can find a way to infuse humor despite the stresses and challenges that being a change agent can bring.“

Excerpt from Juliann’s Nomination:

  • “While working as a case manager on K-15, Juliann was asked to be the clinical lead representing HFHS in the Michigan Primary Care Transformation (MiPCT) project. The project was new and Juliann jumped right into these uncharted waters. The position was quickly becoming much more of a responsibility than anyone anticipated. The title required a three-week intensive training period at Geisinger Health in Pennsylvania. Afterwards, she returned to complete the orientation of approximately 15 new case managers who were hired for the MiPCT project, while managing the handful of veteran case managers already embedded in a few outpatient internal medicine clinics. Juliann has taken all of the changes, frustrations, complaints and successes with grace and professionalism. With her guidance, the project has been a huge success. Our group was awarded Henry Ford Health System’s 2012 Focus on People Award. Congratulations Juliann!”

MiPCT would like to highlight individuals who have been recognized for professional achievements related to population health in future MiPCT FLASH Newsletters.  Please share your achievements by submitting a brief statement via mipctdemo@michigan.gov.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

Below is a table summarizing the Michigan Care Management Resource Center (MiCMRC)-approved self-management support training programs. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. The programs listed below include information regarding course date/criteria to schedule.
For additional detail about MiCMRC-approved self-management programs please see the document titled “Care Management Resource Center Approved Self Management Support Training Programs” at https://mipct.org/care-management-resource-center/.

Patient Advisory Council Member Nominations

The Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in the implementation and operations of the MiPCT. The council is comprised of patients serviced by the MiPCT. We are recruiting additional nominations for this state-wide PAC, which meets quarterly via conference call. Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at: https://jodyooo.wufoo.com/forms/patient-advisorycouncil-nomination-form/

The dates of the 2014 PAC Conference Calls are as follows:

  • Friday, June 6, 2014 at 1:00 PM
  • Friday, September 5, 2014 at 1:00 PM
  • Friday, December 12, 2014 at 1:00 PM

MiPCT Complex Care Management Course

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format.  The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).
Completion of the MiPCT CCM Course occurs over a 4 day period.  The course consists of:

  • Day 1 – Live Webinar  – Introduction of MiPCT CCM course
  • Day 2 – Self-study modules and post-tests, which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 and 4 – In-person training days

Register for the July 7-10, 2014 MiPCT CCM course at the following site:  https://jodyooo.wufoo.com/forms/july-710-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

July 7-10, 2014  – Introductory Webinar July 7

  • July 7-8, 2014 – Total six hours of self-study modules and post-tests
  • July 9-10, 2014 – In person training

August 18-21, 2014 – Introductory Webinar August 18

  • August 18-19, 2014 – Total six hours of self-study modules and post-tests
  • August 20-21, 2014 – In person training

September 8-11, 2014 – Introductory Webinar September 8

  • September 8-9, 2014 – Total six hours of self-study modules and post-tests
  • September 10-11, 2014 – In person training

Please submit questions regarding the MiPCT CCM course to:   micmrc-requests@med.umich.edu

Save the Date!  Pediatric Care Managers’ In-Person Meeting, September 17

An all day, in-person Pediatric Care Manager meeting is scheduled for September 17, 2014. The meeting will be held at the Lyon Meadows Conference Center for Blue Cross Blue Shield of Michigan, at 53200 Grand River Avenue, Wixom, MI. An email with more detailed information will be forthcoming.

MiPCT Care Manager Webinars for July

In support of MiPCT’s  2014 clinical focus for Palliative Care you are invited to attend two webinars in July 2014.

  • July 2, 2014, 2pm-3pm; Advance Care Planning; presented by Julie Seitz, MSBA, RN, St Joseph Mercy Health System, Advance Care Planning, Leader, Instructor and Facilitator.
  • July 9, 2014   2pm-3pm;   *Palliative Care –  Pain Assessment;   presented by Peg Nelson, RN-BC, MSN, NP, ACHPN, Director Palliative Care and Pain Services, St. Joseph Mercy Oakland.

*The July 9, 2014 Palliative Care Pain Assessment webinar has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.

To receive Nursing Continuing Education contact hour(s) for the Palliative Care –Pain Assessment webinar each attendee must:

  • Register for the webinar.  To join the live webinar, login individually via your computer*.
  • Attend the entire webinar presentation.
  • Complete and submit the evaluation form which is auto generated at the end of the live webinar.  The evaluation is only available electronically to attendees who join the live webinar via computer.

*NOTE:  MiPCT is not able to issue Nursing contact hour(s) for multiple attendees viewing the webinar on one computer.  MiPCT is only able to issue Nursing contact hour(s) for participants who attend and login individually to the live webinar.

Stories of Your Care Management Success:
Lynn Czech RN, BSN, MiPCT Hybrid Care Manager, Henry Ford – Sterling Heights Pediatrics

Lynn Czech, RN, BSN is a MiPCT Hybrid Care Manager at Henry Ford Sterling Heights Pediatrics within Henry Ford Health System. “Juan”, age 12, was a Medicaid insured patient identified on the daily emergency department discharge list by Lynn as someone who might benefit from MiPCT care management services. Lynn conducted a transition of care call. During their first conversation, Juan’s mother reported that Juan was playing in his first basketball game of the season when he jumped to take a shot. As he came down he twisted and “fell into a heap” on the court. Juan was unable to sit up and was in extreme pain. He was taken to the emergency department by his mother.  X-rays confirmed bilateral fractures to the growth plates of both tibias, and Juan was transferred to Children’s Hospital of Michigan for further management.  Fortunately, he did not require surgery.  He was placed in bilateral knee braces, given crutches and discharged home with no weight bearing for 6 weeks. Juan’s mother stated to Lynn, “I can’t believe this is happening”. She seemed overwhelmed by the situation and unsure of what to do.

Arrangements were made for DME equipment including a shower chair, elevated toilet seat, wheelchair, walker, and a temporary ramp for home entry.  Juan’s mother declined additional adaptive devices, stating “this is temporary.” Juan was unable to flex his knees with the immobilizers on; making it difficult for him to get in and out of a vehicle. As a result, additional arrangements were made for in-home physical and occupational therapy, as well as temporary home-schooling.

Lynn reviewed and discussed Juan’s neurologic / vascular assessment with his mother so she would be able to identify and report any problems if they occurred.  Lynn also advised Juan’s mother on appropriate nutritional intake to promote tissue healing and prevent constipation due to Juan’s decreased mobility and use of pain medication.

Juan’s teacher visited his home two to three times a week to review course materials and provide lessons and tests so he would not fall behind in school.  However, his mother expressed that Juan was sad and feeling down because his friends would call or text occasionally, but only one or two friends visited him during his first two weeks at home.  She said he missed playing basketball and seeing his friends.  Since she did not know all his friends on the basketball team and at school, Lynn suggested she talk to his teacher.  For the remainder of his recovery at home, they arranged for his friends to visit opposite the days his teacher came (so it would not interfere with his school lessons).  Juan looked forward to these visits.  His mother reported his spirits were lifted and he completed his homework quicker and worked harder in therapy.

Juan returned to the orthopedist six weeks after his injury. His leg braces were removed at that time.  He was advised to continue with PT and OT twice a week for four to six weeks and to follow up with his orthopedist in three months.  Gym restrictions are in place and Juan cannot participate in vigorous activity until cleared by PT.

Juan’s pain had been managed by a non-steroidal anti-inflammatory drug (NSAID) for the majority of his recovery, but his mother recently reported that he had some abdominal discomfort. A change to an over the counter analgesic and antipyretic was recommended, which has been successful in eliminating his abdominal pain.  Juan has returned to school without the use of assistive devices and is allowed extra time between classes due to his fatigue.  His mother expressed he continues to progress toward a full recovery and stated to Lynn, “Thank you so much for helping us during this time.  We would’ve done what we needed to do, but it was a relief knowing I had someone to call whenever we needed anything.  Having his friends schedule their visits was a great suggestion.  It was a big lift to his spirits and I believe helped him recover faster.  You are wonderful.”

Care Manager Monthly Update –  June 2014

Depression Management conference calls: There were four Depression Management conference calls in June.  June 4, 2014, included the Southeast region, June 11, 2014 included the North region, June 18, 2014 included the West region and June 25, 2014 included the MiPCT Social Workers.

Reference Materials:

  • ICSI Collaborative Care for Depression in the Primary Care setting
  • MQIC Depression in Primary Care Guideline
  • Veterans’ Affairs Primary care Diagnosis and Management
  • MiPCT Care Manager Conference Call Depression Part III

Pediatric conference call titled Childhood Obesity: Feeding Practices and Eating Behavior was held on June 20, 2014.

Please see the full MiCMRC Care manager Monthly Update for June 2014, attached.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue:     July 14, 2014
  • Next MiPCT Practice FLASH Issue:      July 28, 2014

May 19, 2014

MiPCT “v.2” Sustainability Update & Care Manager Sufficiency Ratio Interim Consideration

An update on MiPCT sustainability and continuity was included in the PO webinar held on 5/14/2014. The slides are attached and are included along with the webinar link on the mipctdemo.org website under “Presentations”. The 5/14/2014 update included messaging from the discussions with each payer to date. The findings are quite constructive and it is exciting to ensure that this important work will continue. A follow-up webinar is planned with more specific details for late June when we expect to have the refined CMS wording on their proposed chronic care management code.

Though the news about 2015 continuity and sustainability is positive, in the interim (from 5/24/2014 to 6/24/2014), in the event of a Care Manager resignation that puts the PO below the 80% sufficiency requirement at a 2 Care Manager per 5000 MiPCT member ratio, the PO or practice will not be responsible for replacing the position. When additional details are available regarding the specifics of funding continuity, the requirement will resume.

From Michigan Department of Community Health (MDCH): Your Public Health Partner – Assess Your Practice’s Accessibility

Are people with physical disabilities able to receive the best possible care from your practice?

Approximately 20% of Michigan residents have some kind of functional disability – and as our population ages, this number is likely to rise. People with disabilities develop chronic illnesses, like diabetes and heart disease, at about three times the rate of people without disabilities. And, their physical disabilities can create barriers to being diagnosed timely and accurately, receiving appropriate treatment, and engaging in self-management. You can help mitigate these barriers by providing care in the most accessible environment possible and ensuring that your patients with disabilities receive appropriate screenings and preventive care. Consider taking the US Department of Justice self-assessment on access, here . You’ll get specific ideas on how you can provide your patients with the most barrier-free environment possible, and make sure your facility remains in compliance with ADA Accessibility Guidelines.
If you are interested in additional disability resources, see www.midisabilityhealth.org, or contact Candice Lee at LeeC@Michigan.gov.

For more information about public health approaches to chronic disease, health and wellness, and community-based programs and resources please visit www.michigan.gov/primarycare.

From MDCH: Your Public Health Partner – Diabetes Self-Management Education

Are your patients with diabetes accessing all the services and benefits they can to manage their condition?

Diabetes is associated with numerous co-morbidities: depression, arthritis, heart attack and stroke to name a few. And, diabetes is the leading cause of preventable chronic kidney disease, adult onset blindness and non-traumatic amputation.

Even if you have a diabetes educator on-staff, there may be more that you can do to support and encourage good diabetes care and self-management among your patients [Standard 8, National Standards for Diabetes Self-Management Education and Support]. Consider referring your patients with diabetes to one of the 90+ hospital-based Diabetes Self-Management Education (DSME) programs in Michigan. DSME is an on-going, evidence-based approach for providing people with diabetes the information and support they need to make and sustain lifestyle changes that help manage their blood glucose levels. It is covered by most private insurance plans, Medicaid and Medicare. And, it works! People in Michigan who received formal DSME were more likely to follow through on recommended self-management and preventive recommendations, according to 2010 MI Behavioral Risk Factor Survey results.

For more information about MDCH-certified, hospital-based DSME programs in Michigan, see http://www.michigan.gov/diabetes, or contact Dawn Crane at craned@michigan.gov.

For more information about public health approaches to chronic disease, health and wellness, and community-based programs and resources please visit www.michigan.gov/primarycare.

Physicians’ Corner: Medical Professionalism

by Kevin Taylor MD

This past month we have been in dialogue with providers across Michigan regarding the Choosing Wisely guidelines. Specifically, we have discussed the AAFP guideline regarding use of office based electrocardiograms (ECGs). The guideline states:

  • Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.

This is a major issue in our state. In fact, BCBS of Michigan’s claims analysis in 2011 demonstrates that the highest volume of “low value care” in their analysis was ordering ECGs in ambulatory settings which were estimated at around 520,000 tests each year for a total of 15 million dollars!

In our conversations with providers, the concern was expressed that following this guideline would result in a decrease in their revenue. One provider asked, “How do we expect them to make up this lost revenue?”.

The challenge raised by this loss of revenue is a real issue, and cannot be ignored as we all manage the low margin business of primary care. It is the case however, that demonstrating effective stewardship of our resources will ultimately lead to healthier communities and a more vibrant health system that focus on up-stream population management to avoid downstream unnecessary costs. Refocusing our primary care resources to manage patients with chronic conditions and provide needed preventive care services when due, would be a much more appropriate use of our limited resources and energy.

This concept of avoiding overuse is central to medical professionalism. I believe that we all joined the medical profession wanting to do the right thing for our patients and our community. The Choosing Wisely campaign is an opportunity for us to “Do the right thing” and take back our profession.

With this in mind, I wanted to share a blog written by Deborah Korenstein about medical professionalism and found on the web site http://blog.abimfoundation.org/avoiding-overuse-is-key-to-medical-professionalism/

Avoiding Overuse is Key to Medical Professionalism

Written by Deborah Korenstein, MD
May 30, 2013

Deborah Korenstein, MD is one of the authors of the Professionalism Article Prize-winning article “Overuse of Health Care Services in the United States.” In her blog post, she details the impetus behind her research and how she discovered how closely the concept of “overuse” is tied to medical professionalism.

When my colleagues and I embarked on our review of overuse in the U.S. health care system, “professionalism” was not among the words we used to describe the project, despite the fact that notions of professionalism led us to focus on it. Rather, we thought a lot about:

  • systematic review methodology;
  • the research and policy implications of our work; and,
  • the rather daunting task of reviewing over 100,000 article titles for potential inclusion (which I can report was not fun).

Our receipt of this year’s ABIM Foundation “Professionalism Article Prize” for our article “Overuse of Health Care Services in the United States” may seem surprising to some who think of physician professional behavior largely in terms of appropriate comportment and interpersonal interactions. However, avoiding overuse is, in many ways, fundamental to physician professional behavior.

Overuse of health services is defined as the use of services which are more likely to harm than benefit the patient. While cost to either the individual patient or to society as a whole is a legitimate harm, the harm from overused services is more commonly real harm to patient health. This includes:

  • side effects or toxicity from medications;
  • complications of diagnostic or therapeutic procedures; and,
  • downstream harm from falsely positive tests in the form of complications from unneeded diagnostic testing and problems related to over-diagnosis of benign conditions.

Indeed, despite the fact that overuse is commonly discussed in the context of cost savings (and often conflated with the unmentionable — “rationing”), overuse is primarily a problem of quality of care and patient safety. If you examine the definition of professionalism, the avoidance of overuse is at the very core of what it means to be a doctor.

Medical Professionalism in the New Millennium: A Physician Charter describes three fundamental principles of professional behavior: the primacy of patient welfare, social justice in the health care system and patient autonomy. Avoiding overuse falls under all three of these principles.

First, avoiding interventions which are more likely to harm than help the patient is clearly central to the idea of patient welfare. Physicians must be mindful of the fact that all tests and treatments carry at least a small risk of patient harm. When those interventions are very unlikely to benefit the patient, the balance can easily tip toward net harm. Reasonable physicians can certainly disagree about the magnitude of potential benefit or harm from an intervention for an individual patient. Yet, all should agree to avoid interventions that are more likely to harm the patient than benefit them.

Similarly, the principle of social justice includes the fair distribution of resources. Health care spending with no potential benefit—even in the absence of substantial potential harm—is therefore unprofessional in its misuse of limited resources. Even the principle of patient autonomy, which physicians may use to argue for unhelpful interventions requested by patients, notes the primacy of patient decision-making as long as it does not “lead to demands for…inappropriate care.” Clearly, then, avoiding overuse is a major responsibility of all physicians.

But why bother talking about it? One of the major findings of our paper was that overuse has been understudied; for many services, we know nearly nothing about the frequency of overuse or the associated harms. There are many potential reasons why overuse has not been a subject of adequate investigation, including how difficult it is to study. Beyond the technical challenges though, overuse research has not been pursued or well-funded because talking about overuse makes doctors uncomfortable. We doctors want to feel like we can do things to help people and we want to offer tests and treatments to patients who ask for answers to their health problems; we don’t like not doing things.

Also, while potential benefits of tests and treatments are often tangible and easy for both patients and doctors to appreciate, potential harm from unnecessary tests can be abstract and difficult to quantify. There is an inherent tension when physicians consider overuse in terms of justice in the health care system and costs to society. Because physicians are always caring for an individual patient, notions of societal justice must be balanced with the principle of patient welfare (advocating for the individual), and in our system of seemingly unlimited resources, the harm to the system of unneeded care are difficult to weigh.

Because of the challenges of talking about overuse and in spite of the discomfort it can induce, conversations about overuse are important. Overuse of medical services threatens the health of our patients both individually and across our system of care. Working to minimize overuse is core to our professional identities as physicians. We are happy that our paper has contributed in a small way to this important ongoing dialogue and, just maybe, to professionalism itself.

Patient Advisory Council Member Nominations

The Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in the implementation and operations of the MiPCT. The council is comprised of patients serviced by the MiPCT. We are recruiting additional nominations for this state-wide PAC, which meets quarterly via conference call.
Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at: https://jodyooo.wufoo.com/forms/patient-advisorycouncil- nomination-form/

The dates of the 2014 PAC Conference Calls are as follows:

  • Friday, June 6, 2014 at 1:00 PM
  • Friday, September 5, 2014 at 1:00 PM
  • Friday, December 12, 2014 at 1:00 PM

MDC Launching a New MiPCT Dashboard Format May 21st

The Michigan Data Collaborative (MDC) is excited to launch a new and improved Dashboard to display the MiPCT data on May 21, 2014. This new Dashboard format is based on the Tableau platform, and will provide a more intuitive and flexible environment for our users. The new Dashboard will be released as Enhancement 8.01 and will contain the same data as the old Dashboard (currently, release 8.0 data). The old Dashboard will remain available until Release 9.0 is posted (June 2014).
On May 8th MDC hosted a webinar to introduce everyone to the new Dashboard format. To listen to the webinar, or review the slide deck and Q & A document, go to the Support Page and expand the Data Reference Material section. A link to the webinar, slides, and Q and A document are provided at the top of the section.

If you have any questions please contact MDC at MichiganDataCollaborative@med.umich.edu.

February and March 2014 G-Code Reports Update

MDC is waiting for one last data file, and then we will produce and post the February and March 2014 G-Code reports. When the reports are available, MDC will send out notice via email and the What’s New page on the MDC Website.

If you have any questions please contact MDC atMichiganDataCollaborative@med.umich.edu.

MDC’s April 2014 All Payer Patient Lists Reposted

Last week, MDC recreated and reposted the April 2014 All Payer Patient Lists (APPLs) to include patients from a large Washtenaw County employer group who were inadvertently left off the original April patient list that BCN submitted. All other Payers’ patients remain unchanged. However, every PO’s patient list was impacted—some greater than others, depending on their location in Michigan.

MDC sent out notice via email and the What’s New page on the MDC Website.

If you have any questions, please contact MDC at MichiganDataCollaborative@med.umich.edu.

MDC’s May 2014 MiPCT All Payer Patient Lists to be Released this Week

The Michigan Data Collaborative plans to post the May 2014 MiPCT All Payer Patient lists this week. An email announcing the release will be sent to Dashboard users. The MiPCT All-Payer Patient lists are located on the Download PO Reports tab of the MDC MiPCT dashboards. The patient list .zip file includes a list of all MiPCT patients for the PO, formatted lists for each Practice within your PO, and a dropped patient list.

Note: The BCBSM Medicare Advantage patient list is released as a separate file. The file is included in your PO’s patient list zip file and has the following name format: <POname>_All_Practice_BCBSM_MA_Patient_List_2014_05.

For information about the All-Payer Patient Lists, including a description of the fields, see the All-Payer Patient List Information document on the MDC Support page (https://www.michigandatacollaborative.org/MDC/#/support).
May 2014 MiCMRC Care Manager Monthly Update

The May, 2014 edition of the Michigan Care Management Resource Center (MiCMRC) Care Manager Monthly Update contains a review of MiPCT project events and developments that occurred in May and a resource list. The May resource list contains links to resources from the MiPCT CM webinars: Managing Obesity within the Practice Team and Depression Care – Depression Part I: Diagnosis, Screening, and Assessment
The MiCMRC Care Manager Monthly Update for May is provided as an attachment to this edition of the Practice FLASH.

Upcoming CM Webinars & Conference Calls

NEW: Calendar of CM Webinars and Conference Calls! A listing of all care manager webinars and conference calls has been compiled into a calendar on the mipctdemo.org website for your easy reference.

Visit the FEATURED LINKS sidebar on the right side of the home page. Click on the first item in the list: “To see a calendar of CM webinars and conference calls, CLICK HERE.”. The link will take you to the Care Manager Webinar/Conference Call Calendar tab. Go to the blue “CLICK HERE” text to open the calendar. The calendar is updated on the website monthly.

MiPCT Complex Care Management Course

The 2014 MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).
Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1 – Live Webinar – introduction of MiPCT CCM course
  • Day 2 – Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Days 3 & 4 – In person training

Register for the June 9-12, 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/june-912-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM Course Dates:

  • June 9-12,2014 Introductory Webinar June 9. Total six hour self-study modules and post- tests June 9-10. In person training June 11-12.
  • July 7-10, 2014 Introductory Webinar July 7. Total six hour self-study modules and post- tests, June 7-8, 2014. In person training July 9-10, 2014
  • August 18-21, 2014 Introductory Webinar August 18. Total six hour self-study modules and post- tests, August 18-19, 2014. In person training August 20-21, 2014.

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu

Stories of Your Care Management Success: Deanna Koscielny, RN, HCM, Marquette General Family Medicine – Lakewood, UPHP

Deanna Koscielny, RN, is a hybrid care manager at Marquette General Family Medicine Lakewood; an Upper Peninsula Health Plan provider. Deanna was working with a patient covered by BCBSM insurance. “Mary” is a 52 year old female referred to care management due to newly diagnosed Type 2 Diabetes Mellitus. At her initial visit with the care manager, Mary shared that she struggles with sugar cravings and a “chocolate addiction”. She also discussed her irregular eating schedule, often not eating until suppertime.

Deanna worked with Mary on simple goal setting, which involved establishing a more regular eating pattern, including more healthy foods in her diet, and weight loss. Deanna educated Mary on the long term complications of diabetes, how to take the medication to control her blood sugar, the importance of testing her blood sugar levels, and how to use her glucometer.

Deanna had regular phone contact with Mary in the first couple weeks after the initial visit. Mary went through various stages of denial and experienced medication side effects. Deanna was concerned during this period that Mary would give up and not be able to follow through with her goals. During this time Deanna provided Mary with support and encouragement. By the time she met with Mary for a two week follow up visit Mary seemed to be tolerating her medications, she was eating better, her blood sugar levels were within range, and she had begun to accept her diagnosis.

Mary recently had her three month follow visit with her Primary Care Provider (PCP) and her A1C improved and her BMI from 30 to 27. Her PCP was happy to report that she was doing so much better and has really turned her health around. This provider has seen the positive impact care management can have on patient outcomes and asks Deanna to help anytime one of her patients is struggling with diabetes management or other chronic health issues.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: June 16, 2014
  • Next MiPCT Practice FLASH Issue: June 30, 2014

April 28, 2014

Save the Date! Next PO Webinar Scheduled for May 14

On May 14 from 11:00 AM – 12:30 PM our next PO webinar takes place. We hope that you and your stakeholders can join us. The discussion is open to all MiPCT participants. Topics will include:

  • Palliative Care Curriculum Overview for MiPCT-Presenter: Dr. Phil Rodgers;
  • An Update on MiPCT Sustainability and Continuity by MiPCT leadership; and
  • An open question-and-answer session.

MiPCT Clinical Focus Areas for 2014

The MiPCT approach to population management encompasses patients at all stages of health. The goal of the Transformation Project is to improve overall population health through risk reduction for healthy individuals, self-management support for patients with moderate chronic disease, care coordination and support for patients with complex chronic diseases and appropriate, coordinated end-of-life care.

For 2014, MiPCT Leadership has identified specific Clinical Areas of Focus, (see MiPCT Clinical Focus article on page 6 – the last article in this edition of the Practice FLASH). By focusing on these areas and maintaining the current work of population management, MiPCT will be positioned to achieve success. The 2014 MiPCT Clinical Areas of Focus align with the program evaluation measures: to decrease utilization and positively impact quality improvement metrics. The Centers for Medicare & Medicaid is conducting the national evaluation. The CMS evaluation includes diabetes metrics and ER and hospitalization utilization. To access the “MiPCT State and National Evaluation Metrics,” visit: https://mipct.org/resources/presentations/. The 2014 MiPCT clinical focus areas can also be found at this link.

MiPCT Care Manager Conference Calls April 2014 – Recap and Resources (see attachment)

Care Managers, identified by their PO to be eligible to participate, attended the Transition of Care (Social Work and Adult Care Managers) and Depression Revisited (Pediatric Care Managers) conference calls in April. Five conference calls were held (4/2/14 CMs-South East region, 4/9/14 CMs-North region, 4/11/14 Pediatric CMs, 4/16/14 CMs-West region, and 4//18/14 Social Work CMs). The MiPCT Care Manager conference calls provide an opportunity for discussion of application of concepts presented in webinars as well as sharing of best practices and networking.

Resources reviewed during the Transition of Care (TOC) conference calls included the following: community resources document template, TOC roles template, LACE tool, post discharge tool, and TOC team process. These resources and the slide deck presented during the Transition of Care conference calls are provided as an attachment to this edition of the FLASH.

The Pediatric webinar presentation March 21, 2014 “Depression Screening and Referral” is also included in the attachment. The April 11,2014 Pediatric Conference Call focused on “Depression in Adolescents”.

MiPCT Complex Care Management Course

The 2014 MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiPCT CCM Course occurs over the four day period and includes:

  • Day One: A live, one-hour introductory webinar
  • Day Two: Total 6-hours of self-study modules and post-tests which are completed prior to the in-person training
  • Days Three and Four: Two in-person training days in Lansing, MI.

Register for the May 12-16 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/may-1215-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM Course Dates:

  • May 12-15, 2014 – Introductory Webinar May 12. Total six hour self-study modules and post-tests, May 12-13. In person training May 14-15.
  • June 9-12, 2014 – Introductory Webinar June 9. Total six hour self-study modules and post-tests, June 9-10. In person training, June 11-12.
  • July 7-10, 2014 – Introductory Webinar July 7. Total six hour self-study modules and post-tests, July 7-8. In person training, July 9-10

.
Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu

18-Month Incentive Payment Amounts to be Released

The 18-month incentive scores have received final approval, and the payment amounts for Medicare and Medicaid incentive funds will be released May 1, 2014. Medicare incentive payments are scheduled to be released in the first half of May. The 18-month incentives are based on the time period 7/1/2012 – 6/30/2013, with baseline period 7/1/2011 – 6/30/2012. Please contact mipctdemo@michigan.gov with any questions.

Stories of Your Care Management Success

Monica Brunetti, RN, HCM, Holt Family Practice, McLaren PHO

Monica Brunetti, RN, QMHP, CCM, CCP is a Hybrid Care Manager at Holt Family Practice, which is affiliated with McLaren PHO. Mr. Johnson is a 65 year old male with BCBSM insurance. He was referred to care management services in person by Dr. Wellemeyer following an office visit in June, 2013. The referral was made due to poorly controlled diabetes, hypertension and hyperlipidemia. Mr. Johnson’s A1C was 8.9.

Mr. Johnson had established self-management goals with his provider during his office visit. His short term self-management goal was to lose weight, one pound a week over two months by making changes to his diet through portion control and lowering his carbohydrate intake. In conjunction with diet changes he expressed a desire to establish a daily exercise routine by walking or doing yard work. His long term self- management goal is to lower his A1C to 7.0 or below within 4-6 months.

To support the patient with his self-management goals, Monica provided monthly follow up phone visits to assess his engagement in making his desired changes. She provided support when Mr. Johnson met his self- management goal(s) and discussed barriers with Mr. Johnson when his self- management plan was not followed. Monica used motivational interviewing techniques to engage Mr. Johnson to empower him to make changes that supported meeting his goal(s) and improving his overall health.

Over the course of several months Mr. Johnson acknowledged he loved the accountability related to Monica’s scheduled follow up phone visits and the personalized support and encouragement she provided. At his recent follow up visit in January, 2014 he had lost eleven pounds and lowered his A1C to 6.9. His triglycerides are down from 193 to 160. When meeting with Dr. Wellemeyer, Mr. Johnson shared his appreciation for the Care Manager in the practice and the support provided through the MiPCT program. Mr. Johnson has established new goals for himself and is eager to demonstrate his commitment to his own wellness at his follow up appointment in May.

Upcoming CM Webinars & Conference Calls

NEW: Calendar of CM Webinars and Conference Calls! A listing of all care manager webinars and conference calls has been compiled into a calendar on the mipctdemo.org website for your easy reference.

Visit the FEATURED LINKS sidebar on the right side of the home page. Click on the first item in the list: “To see a calendar of CM Webinars and Conference Calls, CLICK HERE. The link will take you to the Care Manager Webinar/Conference Call Calendar tab. Go to the blue “CLICK HERE” text to open the calendar. The calendar is updated on the website monthly.

Upcoming MiPCT CM Webinars:

Adult Webinars: Wednesdays, 2-3 PM
Pediatric Webinars: Fridays, 10-11 AM

  • May 14, 2014: TBD (All MiPCT Care Managers)
  • May 16, 2014: Managing Obesity Within the Practice Team (Pediatric Care Managers)
  • May 28, 2014: Depression Care – Medication Management; presented by Nicole M. Simpson, PharmD, Clinical Pharmacist (All MiPCT Care Managers)

MiPCT Clinical Focus Areas for 2014

MiPCT clinical areas of focus during 2014 have been identified. Note that the required strategies for the focus areas require ongoing attention be given to the maintenance of essential PCMH infrastructure supports such as clinical registries, team-based care and enhanced access to care.

1. Improve Clinical Indicators for Individuals with Diabetes
Rationale: Diabetes is a common, high-cost chronic illness. Improvement in control of A1C, BP, and LDL-c has been associated with lower healthcare costs. Diabetes is a focus of the CMS evaluations, which includes four diabetes clinical quality measures among the evaluation metrics.
Strategies:

  • Encourage practices and care managers to develop processes and protocols to identify and reach out to patients with diabetes who need office visits, lab work, or eye exams.
  • Target patients who do not meet clinical indicators of control for case management and/or self-management support services.

2. Target the Right (High-Risk) Patients
Rationale: Five percent of a patient population typically generates about fifty percent of the healthcare costs. While it is possible to retrospectively identify individuals who have been high utilizers, only a portion remain in the high utilization group year after year. Additional methods are needed to screen potential high-risk individuals and identify those whose clinical outcomes may be improved through team-based clinical care and/or enrollment in care management.
Strategies:

  • Target individuals with high-risk scores for case management.
  • Develop criteria to identify additional individuals who may benefit from case management and/or self-management support, e.g. complex children with special healthcare needs and individuals with poorly controlled chronic conditions such as congestive heart failure, chronic obstructive pulmonary disease, and asthma.

3. Behavioral Health and Depression
Rationale: Depression is a debilitating condition commonly experienced by individuals with chronic disease. Primary care practitioners are encouraged to screen adults and adolescents with chronic illness for depression and to treat/refer those who are diagnosed.
Strategies:

  • Identify and share best practices for implementing depression screening.
  • Many patients stop medications early on due to side effects. Promote referral of newly diagnosed patients to care management for assistance with medication management.

4. Palliative Care
Rationale: Palliative care has been shown to relieve pain and other symptoms of patients with serious illnesses, help patients complete their prescribed treatments, assist in making difficult decisions, and ultimately improve clinical outcomes.
Strategies:

  • Work with subject matter experts to develop and launch a year-long training curriculum for care managers and other professionals.
  • Provide best practices and other resources to assist MiPCT practices in developing processes for discussing advanced directives with patients.

 

The Focus for Pediatric Population:
1. Target the Right (High-Risk) Patients
Rationale: Similar to the adult population.
Strategies:

  • Ten Percent of children account for seventy-two percent of expenditures and one percent of children account for twenty-six percent of expenditures.
  • The task is similar to adults; develop criteria and methods to identify children and youth with complex medical conditions.
  • Target the NICU graduate. Assist practices with development of systems for smooth transition from NICU to home and primary care.

2. Behavioral Health and Depression
Rationale: The AAP Bright Futures just published new guidelines for preventive care and depression screening for all adolescents (beginning at age 11 years) and is now on the list as recommended (reference Bright Futures Periodicity Schedule). It is recommended that practices screen with the PHQ2. If positive, follow up with the PHQ9 and a more in depth interview.

Strategies:

  • Assist practices to incorporate screening into their practice flow, with positive screens (positive after the PHQ9) going to the care manager to link to community resources.
  • Provide active monitoring of those adolescents with identified mild to moderate depression
  • Although medications are used and useful in adolescents with depression, our first step is usually counseling. Focus for pediatrics differs from adults: “assistance with medication management” mentioned for adult depression is not the focus for pediatrics. Adolescent depression frequently has a major social component.

NEXT ISSUE DATES:

• Next MiPCT P.O. FLASH Issue: May 5, 2014

• Next MiPCT Practice FLASH Issue: May 19, 2014

March 24, 2014

Coming in May: Pediatric Obesity Care Management Conference

The following conference about pediatric obesity may be of interest to MiPCT care managers and others in practices that work with children and youth. The conference is sponsored by the Michigan Chapter of the American Academy of Pediatrics and the Michigan State Medical Society Foundation. It is a one day conference, May 15, in Dearborn. The target audience includes physicians, administrators, office managers and others, such as MiPCT care managers.

Please visit this link for more information: http://origin.library.constantcontact.com/download/get/file/1102494410259-206/Childhood+Obesity+Brochure.5.2014.pdf

PHYSICIANS’ CORNER: Choosing Wisely

by Kevin Taylor MD

Since the beginning of the new year we have found many patients are more price-sensitive in their decisions regarding use of healthcare resources. This has been the case in regards to laboratory testing. Patients are beginning to ask how much a lab test will cost in their discussions with primary care physicians.

For years, pathologists and physicians have spoken out about the overuse of medical laboratory tests and other diagnostic procedures. Now, through Choosing Wisely, we have a list of recommendations for tests that are not recommended.

Attached to today’s issue of the Practice FLASH is a DOCUMENT listing the recommendations made by the different medical specialty associations that identify a clinical laboratory test that should NOT be done in specific situations. Here are some of the recommendations, summarized:

Allergy and Immunologic

  • Don’t routinely do diagnostic testing in patients with chronic urticaria. -American Academy of Allergy, Asthma and Immunology

Endocrinologic

  • Don’t order a total or free triiodothyronine (T3) level when assessing levothyroxine (T4) dose in hypothyroid patients. -The Endocrine Society, American Association of Clinical Endocrinologists

Hematologic

  • Don’t perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability. -Society of Hospital Medicine (Adult)
  • Don’t do workup for clotting disorder (order hyper-coagulable testing) for patients who develop first episode of DVT in the setting of a known cause. -Society for Vascular Medicine
  • Don’t test for thrombophilia in adult patients with VTE occurring in the setting of major transient risk factors (surgery, trauma, or prolonged immobility). -American Society of Hematology
  • Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions. -Critical Care Societies Collaborative–Critical Care [Societies: American Association of Critical-Care Nurses, -American College of Chest Physicians, -American Thoracic Society, and -Society of Critical Care Medicine]

Infectious Disease Urologic

  • Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract. -American Medical Directors Association

Preventive Medicine

  • Don’t routinely measure 1,25-dihydroxyvitamin D unless the patient has hypercalcemia or decreased kidney function. – The Endocrine Society, American Association of Clinical Endocrinologists

Preventive Medicine – Endocrinologic

  • Don’t perform population-based screening for 25-OH-vitamin D deficiency. -American Society for Clinical Pathology

Preventive Medicine – Geriatric

  • Don’t recommend cancer screening in adults with life expectancy of less than 10 years. -Society of General Internal Medicine

Preventive Medicine – Gynecologic Oncologic

  • Don’t perform routine annual cervical cytology screening (Pap tests) in women 30 to 65 years of age. -American College of Obstetricians and Gynecologists
  • Don’t screen women younger than 30 years for cervical cancer with HPV testing, alone or in combination with cytology. -American Academy of Family Physicians
  • Don’t screen women older than 65 years for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer. -American Academy of Family Physicians
  • Don’t perform Pap tests in patients younger than 21 years or in women after hysterectomy for benign disease. -American Academy of Family Physicians
  • Don’t screen for ovarian cancer in asymptomatic women at average risk. -American College of Obstetricians and Gynecologists

Preventive Medicine – Nephrologic Oncologic

  • Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms. -American Society of Nephrology

Preventive Medicine – Urologic Oncologic

  • Don’t routinely screen for prostate cancer using a PSA test or digital rectal exam.

Rheumatologic

  • Don’t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings. -American College of Rheumatology
  • Don’t test ANA subserologies without a positive ANA and clinical suspicion of immune-mediated disease. -American College of Rheumatology
  • Don’t order autoantibody panels unless positive ANA and evidence of rheumatic disease. -American College of Rheumatology—Pediatric Rheumatology

Rheumatologic Infectious Disease

  • Don’t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings. -American College of Rheumatology—Pediatric Rheumatology

Surgical

  • Don’t perform routine preoperative testing before low-risk surgical procedures. -Society of General Internal Medicine
  • Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery–specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal. -American Society of Anesthesiologists

Urologic

  • Don’t order creatinine or upper-tract imaging for patients with benign prostatic hyperplasia. -American Urological Association

Upcoming MiPCT Complex Care Management (CM) Webinars & Conference Calls

NEW: CALENDAR of MiPCT Care Management (CM) Webinars and Conference Calls! A listing of all care manager webinars and conference calls has been compiled into a calendar on the mipctdemo.org website for your easy reference.

Visit the “FEATURED LINKS” sidebar on the right side of the mipctdemo.org home page. Click on the first item in the list: “To see a calendar of CM Webinars and Conference Calls Click Here”. The link will take you to the “Care Manager Webinar/Conference Call Calendar” tab. Go to the blue “CLICK HERE” text to open the calendar. The calendar is updated on the website monthly.

Upcoming MiPCT CM Webinars:
Adult Webinars: Wednesdays, 2-3 PM
Pediatric Webinars: Fridays, 10-11 AM

  • March 26, 2014: Palliative Care Part II (All MiPCT Care Managers)
  • April 11, 2014: Depression, Revisited (Pediatric Care Managers)
  • April 23, 2014: TBD (All MiPCT Care Managers)
  • May 16, 2014: Managing Obesity Within the Practice Team (Pediatric Care Managers)

Stories of Your Care Management Success

Denise Schesky, RN, HCM,
Henry Ford Internal Medicine-Fairlane
Henry Ford Health System

Denise Schesky, RN is a Hybrid Care Manager at Henry Ford Internal Medicine Fairlane, which is part of the Henry Ford Health System. Denise works with a patient Ms. B who has insurance coverage by both Medicare and Medicaid, with Medicare as the primary coverage. Ms. B is a 62 year old female with a history of morbid obesity, hypertension, type 2 diabetes, hyperlipidemia, GERD, bilateral knee osteoarthritis, chronic knee pain, gout and stage III CKD secondary to hypertensive nephropathy with nephrotic syndrome.

Ms. B’s primary care physician, Dr. Alis Vidinas, requested care management because of gaps in care, difficulty taking medication, diabetic management and chronic pain. Ms. B wanted to reduce her weight, it seems her entire life. She had attempted many times to diet and experienced significant rebound. She realized she had to overcome many obstacles to achieve her goal of gastric bypass surgery, but was so overwhelmed she did not have the strength or motivation to manage her chronic diseases.

During the initial patient meeting Denise completed a depression screening. Ms. B scored moderate to high depression, and she reported suicidal thoughts without a plan. She was very tearful. Denise huddled with the PCP and it was recommended Ms. B should follow up with Behavioral Health the same day, according to protocol, due to suicidal ideation. Denise made the arrangements for a same day Behavioral Health visit and facilitated a taxi ride to the appointment with a voucher since the patient lacked adequate transportation resources.

Within ten days Ms. B had been seen twice by Behavioral Health. After her sessions the patient started to find internal strength and motivation.

Because Denise conducted a depression screening in the Primary care office Ms. B’s depression was targeted and treated. Ms. B reports she has had significant relief from symptoms of depression since working with Behavioral Health. She states she was told by her therapist, Jean El-Fakhoury, MSW, that she was “tucking things away” and not coping with them when they presented themselves. The patient shared this behavior, “led her to a deep depression and sadness.”

Ms. B received care management services before and after her bariatric surgery. She faced many challenges including pancreatitis pre op and a DVT post op. Ms. B demonstrated she was serious about losing weight. This was evident by weight loss prior to bariatric surgery, working towards self-management of her medical conditions and following up with her specialists Dr. Jessica Shill (Endocrinology) and Dr. Arthur Carlin (GI Surgeon).

Ms. B was sufficiently motivated and emotionally stable to go forward with surgery. She states that if it were not for her therapist she would not have been able to proceed with the bariatric surgery and continues with her therapy to this day.
Ms. B has achieved many successes. She improved her A1C from 6.6 to 5.9, no longer has to monitor her daily blood glucose and has lost 66 pounds. Her weight loss has resulted in reduced back pain and increased energy for Ms. B She exercises several times a week at a local fitness center, continues her consistent follow up with her specialists and PCP and arranges her own transportation. Best of all, Ms. B reports a positive attitude and is empowered to continue to manage her health conditions effectively.

Dr. Vidinas expressed satisfaction with Ms. B’s progress stating, “The patient is doing very well.” Ms. B expressed that having the depression screening done was “…the best thing that has ever been done for me, and I am very surprised and happy that a primary care doctor really cared about my state of mind. I am thankful that someone cared enough to help me.”

MiPCT Complex Care Management Course

The 2014 MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).
Completion of the MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Day 1 – Live Webinar – introduction of MiPCT CCM course (1 hour)
  • Day 2 – Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • Day 3 and Day 4 – In person training days

Register for the April 7-10 2014 MiPCT CCM course at the following site: (https://jodyooo.wufoo.com/forms/april-710-2014-mipct-ccm-training/)

Upcoming 2014 MiPCT CCM course dates:

  • April 7-10 2014 Introductory Webinar April 7. Total six hour self-study modules and post- tests April 7-8. In person training April 9 & 10
  • May 12-15 2014 Introductory Webinar May 12. Total six hour self-study modules and post- tests, May 12-13. In person training May 14-15.
  • June 9-12 2014 Introductory Webinar June 9. Total six hour self-study modules and post- tests, June 9-10. In person training June 11-12.

Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu
Michigan Care Management Resource Center Care Manager Monthly Update – February, 2014

The February, 2014 edition of the Michigan Care Management Resource Center (MiCMRC) Care Manager Monthly Update contains a review of MiPCT project events and developments that occurred in February and a resource list. The February resource list contains links to resources provided during the Palliative Care Introduction Part I webinar, Pediatric Care Manager conference call and the AHRQ Improving Health Care Decision-making: Comparative Effectiveness Research webinar.

The MiCMRC Care Manager Monthly Update for February is provided as an attachment to this edition of the Practice FLASH.

Your Help Needed: Patient Advisory Council  Member Nominations

The Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in the implementation and operations of the MiPCT. The council is comprised of patients serviced by the MiPCT. We are recruiting additional nominations for this state-wide PAC, which meets quarterly via conference call.

Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted at:
https://jodyooo.wufoo.com/forms/patient-advisory-council-nomination-form/

The dates of the 2014 PAC Conference Calls are as follows:

  • Friday, June 6, 2014 at 1:00 PM
  • Friday, September 5, 2014 at 1:00 PM
  • Friday, December 12, 2014 at 1:00 PM

Seeking Input & Your Experience: PO or Practice Patient Advisory Councils

In preparation of a document that is a user support tool for the new Learning Activity option of Practice or PO Patient Advisory Councils, we are interested in talking to any PO or practice that has an active patient advisory council or patient advisor program. If you have such a program, please contact Diane Marriott at dbechel@umich.eduto arrange for a short phone discussion.

Practice Representative for MiPCT Steering Committee: Nominating Period Ends April 30

The MiPCT is soliciting nominations for one slot for a physician practice representative to sit on the MiPCT Steering Committee. The purpose of the Steering Committee is to provide strategic direction to MiPCT Leadership and monitor progress toward the goals and objectives of MiPCT. The Steering Committee meets bimonthly in Okemos. The nominee must be a participating physician at an MiPCT practice. The goal of adding a practice representative is to represent an “on-the-ground” clinical perspective and insight in shaping program development and operations. Nominees may self-nominate or be nominated by their PO.

Please submit nominations to https://jodyooo.wufoo.com/forms/steering-committee-nominations/ by April 30, 2014.

NEXT ISSUE DATES:
• Next MiPCT Practice FLASH Issue: April 28, 2014
• Next MiPCT P.O. FLASH Issue: April 14, 2014

February 24, 2014

New PDCM Billing Code: Advance Care Planning and End of Life Counseling

A new billing code has been defined by BCBSM, the S0257 code for Advance Care Planning and End of Life Counseling. Beginning January 1, 2014, BCBSM will be accepting and paying claims for advance care planning and end of life counseling. This code should be used to bill for individual face-to-face or telephonic conversations regarding end-of-life care issues and treatment options conducted by qualified allied health personnel on the care management team with patients enrolled in care management. It may also be used for conversations with the patient’s caregiver/family about developing or revising a documented advance care plan.

Each encounter should be billed on its own claim line, and all active diagnoses should be reported in each claim. The S0257 code should be listed separately, in addition to the code for appropriate evaluation and management service as applicable.

 Documentation associated with S0257 that must be recorded and maintained in the patient’s record should include:

  •  Enumeration of each encounter including:
    • Date of service
    • Duration of contact
    • Name and credentials of the allied professional delivering the service
    • Other individuals in attendance (if any) and their relationship with the patient
  • Pertinent details of the discussion (and resulting advance care plan decisions), which, at a minimum, must include the following:
    • A person designated to make decisions for the patient if the patient cannot speak for him or herself
    • The types of medical care preferred
    • The comfort level that is preferred
  • Advanced care planning discussions/decisions may also include:
    • How the patient prefers to be treated by others
    • What the patient wishes others to know
  • Indication of whether or not an advance directive or Physician Orders for Life-Sustaining Treatment (POLST) document has been completed

Complete details, including documentation requirements, can be found in the most recent BCBSM Medicare Advantage PDCM Billing Guidelines 01.2014, and

BCBSM Commercial PDCM Payment Policies 02.2014, which are provided as attachments to this edition of the FLASH, and posted at https://mipct.org/resources/mipct-documents-and-presentations/ .

Please Note: BCN does not pay for the S0257 code.

Seeking Input & Your Experience: PO or Practice Patient Advisory Councils

In preparation of a document that is a user support tool for the new Learning Activity option of Practice or PO Patient Advisory Councils, we are interested in talking to any PO or practice that has an active patient advisory council or patient advisor program. If you have such a program, please contact Diane Marriott at dbechel@umich.edu  by March 14, 2014 to arrange for a short phone discussion.

Your Help Needed: Patient Advisory Council Member Nominations

The Patient Advisory Council (PAC) is an advising resource to the Steering Committee, subcommittees and other MiPCT groups (PO Advisory Council, etc.). Our goal is to ensure that the patient voice is incorporated in the implementation and operations of the MiPCT. The council is comprised of patients serviced by the MiPCT. We are recruiting additional nominations for this state-wide PAC, which meets quarterly via conference call.

Members should be:

  1. MiPCT patients (especially patients who have experience with care managers)
  2. Able to use their own experience constructively
  3. Able to see beyond their own experience
  4. Able to listen to and hear differing opinions

Member nominations are now being accepted through March 14, 2014 at:

https://jodyooo.wufoo.com/forms/patient-advisory-council-nomination-form/

The dates of the 2014 PAC Conference Calls are as follows:

  • Friday, March 7, 2014 at 1:00 PM
  • Friday, June 6, 2014 at 1:00 PM
  • Friday, September 5, 2014 at 1:00 PM
  • Friday, December 12, 2014 at 1:00 PM

Practice Representative for MiPCT Steering Committee: Nominating Period Ends March 10

The MiPCT is soliciting nominations for one slot for a physician practice representative to sit on the MiPCT Steering Committee. The purpose of the Steering Committee is to provide strategic direction to MiPCT Leadership and monitor progress toward the goals and objectives of MiPCT. The Steering Committee meets bimonthly in Okemos. The nominee must be a participating physician at an MiPCT practice. The goal of adding a practice representative is to represent an “on-the-ground” clinical perspective and insight in shaping program development and operations. Nominees may self-nominate or be nominated by their PO.

Please submit nominations to https://jodyooo.wufoo.com/forms/steering-committee-nominations/  by March 10, 2014.

MiPCT Complex Care Management Course – NEW 2014 Format

 The 2014 MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT hybrid care managers (HCMs) and complex care managers (CCMs).

MiPCT Complex Care Management Course NEW 2014 Format:

Completion of the MiPCT CCM Course includes a live, one-hour introductory webinar, 6 hours of self-study modules, post-tests, and 2 in-person training days in Lansing, MI. This entire course is completed during a four day period. The kickoff of the training begins with the Live MiPCT CCM Course Introduction Webinar on day 1.

Register for the March 10-13 2014 MiPCT CCM course at the following site: https://jodyooo.wufoo.com/forms/march-1013-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

  • March 10-13 2014
  • April 7-10 2014
  • May 12-15 2014
  • June 9-12 2014

Please submit questions regarding the MiPCT CCM Training course to: micmrc-requests@med.umich.edu  

NEW PO/Practice Webinars to be Offered Every Other Month Beginning March 2014

A webinar on the impact of health reform on MiPCT practices and POs has been confirmed for March 12, 12:30 to 1:30 PM. Presenters from Medicaid, BCBSM, BCN and Priority Health will recap important aspects from each payer’s perspective.

INSTRUCTIONS FOR WEBINAR REGISTRATION:

Please follow these instructions to register for the webinar:

The following webinar requires all individuals to register for participation. Please follow the link below, and select one of the “register” options to complete the registration in full.

Once you have registered, a confirmation email with instructions for joining the meeting will be sent to you by messenger@webex.com . The email subject line will state: “Registration Approved for Web Seminar: PO Webinar – The Effect of Health Reform on MiPCT”.

Please be sure to save the confirmation email to access the webinar.

  • Topic: PO Webinar – The Effect of Health Reform on MiPCT
  • Date: Wednesday, March 12, 2014
  • Time: 12:30 PM, Eastern Standard Time (New York, GMT-05:00)

To register for this meeting, go to: https://mphievents.webex.com/mphievents/onstage/g.php?t=a&d=661322762, and register for the meeting. (Click here for an example):

Other webinars will be held every other month in May, July, September and November of 2014. The dates, topics and login information will be published in the FLASH closer to their dates.

NOTE: For the MiPCT Care Management Webinar Series, please refer to this issue of the Practice FLASH article below, entitled: “Placement of Upcoming Webinars”.

BCBSM Available for your Claims Questions Related to PDCM at PGIP

At the March 14th PGIP Quarterly Meeting, BCBSM staff will be available to answer any claims questions related to PDCM. Please bring your questions and examples (voucher or contract number, date of service, and member). BCBSM staff will be available after the General Morning Session for the remainder of the day. The location will be announced at the meeting.

MDC’s February 2014 MiPCT All-Payer Patient Lists to be Released this Week

The Michigan Data Collaborative plans to post the February 2014 MiPCT All-Payer Patient Lists the week of February 24, 2014. An email announcing the release will be sent to Dashboard users. The MiPCT All-Payer Patient Lists are located on the Download PO Reports tab of the MDC MiPCT dashboards. The patient list .zip file includes a list of all MiPCT patients for the PO, formatted lists for each Practice within your PO, and a dropped patient list.

Note: The BCBSM Medicare Advantage patient list is released as a separate file. The file is included in your PO’s patient list .zip file and has the following name format: <POname>_All_Practice_BCBSM_MA_Patient_List_2014_02.

For information about the All-Payer Patient Lists, including a description of the fields, see the All-Payer Patient List Information document on the MDC Support page (https://www.michigandatacollaborative.org/MDC/#/support ).

Placement of Upcoming Webinars: 

MiPCT Webinars: Upcoming webinars can be found on the www.mipctdemo.org  website. On the right side of the homepage you will see a box containing the date, topic, intended audience, and presenter if known of future webinars. This list is updated monthly.

Upcoming MiPCT CM Webinars: | Adult Webinars: Wednesdays, 2-3 PM | Pediatric Webinars: Fridays, 10-11 AM |

  • February 26, 2014: Palliative Care Introduction (All MiPCT Care Managers)
  • March 21, 2014: Depression in Adolescents: Identification, Screening, Community Resources and Follow-Up (Pediatric Care Managers)
  • March 26, 2014: Palliative Care Part II (All MiPCT Care Managers)
  • April 11, 2014: Depression, Revisited (Pediatric Care Managers)
  •  April 23, 2014: TBD (All MiPCT Care Managers)
  •  May 16, 2014: Managing Obesity Within the Practice Team (Pediatric Care Managers)

Care Team Connect (CTC) Spotlight Training Webinar Recording

 A CTC/ Spotlight recorded training webinar is now available on the mipctdemo.org website at https://mipct.org/resources/presentations/ . This webinar includes an overview of CTC/Spotlight functionality, Admission, Discharge and Transfer (ADT) alerts and corresponding Care Manager work- flows.

 Michigan Care Management Resource Center Care Manager Monthly Update: January 2014

The January, 2014 edition of the Michigan Care Management Resource Center (MiCMRC) Care Manager Monthly Update contains a review of MiPCT project events and developments that occurred in January and a resource list. The January resource list contains links to resources provided during the CM Best Practice Daily Workflow and DM Care Management and Autism webinars.

The MiCMRC Care Manager Monthly Update for January is provided as an attachment to this edition of the Practice FLASH.

2014 MiPCT Due Dates & Action Steps Document Attached

Attached to today’s issue of the Practice FLASH is a new 2-sided document which summarizes important program deadlines, and lists large group meetings, webinars and MiPCT/MDC incentive timing.

A few examples of items included in this document are:

  • Deadlines for quarterly report submissions
  • Annual Summit dates
  • Bi-monthly MiPCT webinars.

We hope you find this information helpful.

Stories of Your Care Management Success:

Bernice Morrison, RN, CCM, Care Manager Henry Ford Taylor Medical Center

Bernice Morrison, RN, CCM, is a care manager at Henry Ford Taylor Medical Center within Henry Ford Health System. Bernice was working with a Medicare patient with a new diagnosis of HF and a history of poorly controlled diabetes. The patient’s A1c was 10.3 and she could not afford her co-pay for insulin. The patient was receptive to working with Bernice, and because of her uncontrolled diabetes, new diagnosis of HF, and assessed barriers to care, she was a good candidate for care management services.

Bernice assisted the patient by discussing HF management, including diet, daily weights and when to contact the Primary Care Physician office. The patient has not had any hospital admissions for exacerbation since enrollment into care management services. Bernice, in collaboration with Dr. Shu (PCP), was able to guide the patient to lower cost medications, including low cost insulin. The change in medication regimen made it possible for the patient to obtain the insulin needed to get her diabetes under control. As a result, her A1c has decreased to 7.7. She has also made many lifestyle changes including better eating habits and increased physical activity.

Dr. Shu expressed that Bernice’s communication and teaching interventions were directly related to the patient’s success with diabetes and HF self-management. The patient stated, “There is not high enough praise that I could give Bernice for all the help and kindness she has shown not only me, but my family. Bernice was always there for me and helped me with any question without ever making me feel silly. Her only thought throughout my time with her was for my comfort and care. Throughout my experience with other health professionals I have met there was not one that could hold a candle to the EXCELLENCE Bernice has shown me.”

NEXT ISSUE DATES:

  • Next MiPCT Practice FLASH Issue: March 24, 2014
  • Next MiPCT P.O. FLASH Issue: March 10, 2014

January 27, 2014

AHRQ Diabetic Planned Visit Notebook

The Agency for Healthcare Research and Quality website has a Diabetic Planned Visit Notebook section. Diabetes planned visits facilitate patient engagement in their own care by encouraging them to set self-manage goals to better manage their chronic conditions and improve their health. It is important to control blood glucose, blood pressure and lipid levels. Success in managing diabetes requires the patient to become competent in the daily management of their chronic condition.

Helpful information on how to conduct a planned visit in primary care for a diabetic patient including a pre-visit questionnaire and algorithm are provided.  Tools and resources such as glucose and blood pressure decision guides are also available within the notebook. Practice teams may choose to use this resource to develop their own or improve on current processes. The Diabetic Planned Visit Notebook can be found at http://www.ahrq.gov/professionals/education/curriculum-tools/diabnotebk/index.html

Practice Representative for MiPCT Steering Committee: Nominating Period Ends February 28

The MiPCT is soliciting nominations for one slot for a physician practice representative to sit on the MiPCT Steering Committee. The purpose of the Steering Committee is to provide strategic direction to MiPCT Leadership and monitor progress toward the goals and objectives of MiPCT.   The Steering Committee meets bimonthly in Okemos.  The nominee must be a participating physician at an MiPCT practice.  The goal of adding a practice representative is to represent an “on-the-ground” clinical perspective and insight in shaping program development and operations.   Nominees may self-nominate or be nominated by their PO.

Please submit nominations to https://jodyooo.wufoo.com/forms/steering-committee-nominations/ by February 28, 2014.

Seeking Input & Your Experience:  PO or Practice Patient Advisory Councils

In preparation of a document that is a user support tool for the new Learning Activity option of Practice or PO Patient Advisory Councils, we are interested in talking to any PO or practice that has an active patient advisory council or patient advisor program.   If you have such a program, please contact Diane Marriott at dbechel@umich.edu by February 14, 2014 to arrange for a short phone discussion.

Physicians’ Corner: Choosing Wisely
by Kevin Taylor MD

The Polar Vortex greeted us all this New Year, and along with it came a host of upper respiratory infections. We all have stories we could share; patients showing up with masks over their mouths and noses, febrile, sneezing, coughing and feeling awful. Many of them complain of sinus drainage and facial pain. Classic symptoms of acute rhinosinusitis. They are also likely interested in getting an antibiotic. Perhaps they found this worked for them in the past.
How we manage this patient problem is one way for us to demonstrate our ethical and professional obligations as health care providers to be good stewards of our resources.
The American Board of Family Medicine addressed this specific issue with the Choosing Wisely Guideline on Treating Sinusitis that states:
Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.
Here is a brief review of the evidence on the cost-effective management of sinusitis.
Sinusitis symptoms must include discolored nasal secretions and facial or dental tenderness when touched. Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80 percent of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs.
Sinusitis is one of the most common diagnoses in primary care. Annually, it accounts for 15 to 20 percent of adult antibiotic prescriptions, and costs more than $20 million in patient visits. Current recommendations strongly support not prescribing antibiotics within the first week of illness for mild to moderate sinusitis1. A meta-analysis published in 2012 in the Archives of Internal Medicine states that some randomized controlled trials showed that patients assigned to antibiotics had a 7 to 14 percent higher rate of improvement in symptoms2. However, these researchers concluded that the potential harms from use of antibiotics to manage sinusitis, including adverse effects (e.g., diarrhea), increased risk of antibiotic resistance and cost, clearly outweigh the potential minor benefits.
A Cochrane review compiled data from 59 studies that involved the use of a variety of antibiotics to manage simple maxillary sinus infection in primary care settings3,4. Studies that compared antibiotics with placebo showed that, in most cases, symptoms improved within two weeks, regardless of whether the participant received an antibiotic or not. The review found that, in addition to patient-related adverse effects (e.g., skin rash, abdominal pain, vomiting), antibiotic use poses the risk of increased resistance to antibiotics among community-acquired pathogens.
Among recommended resources on preventing sinusitis and antibiotic resistance, the Centers for Disease Control and Prevention website has information from the Choosing Wisely campaign about avoiding antibiotic use for mild to moderate sinusitis.

Key Communication Concepts

Provide clear recommendations.  The majority of patients want information about their health, illness and decision options.

  • “The good news is that you will get better and we can treat the symptoms while your body fights the infection.”
  • “I would not use antibiotics, as this is most likely a viral infection and antibiotics don’t help.”
  • “I want to be sure that later, when we use antibiotics and they are needed, we don’t have any resistance issue.”

Elicit patient beliefs/questions. Understanding patients’ treatment goals and perspectives about their health during the visit will help improve patient satisfaction and can shorten visits.

Find out where the patient is coming from.

  • “You look uncomfortable today.”
  • “I am sure you think this is like the other severe infection you had last time, but most sinus infections do not require antibiotics and clear on their own.”

Offer short quotes of the compelling data supporting this recommendation:

  • “In most cases, sinus problems will improve without antibiotics in about one week.”
  • “Most sinus infections are caused by viruses, and antibiotics don’t work against viruses.”
  • “Treatments other than antibiotics, such as nasal rinses and some over-the-counter medications, can be very helpful.”

REFERENCES:

  1. Here is a detailed evidence-based discussion on treating sinusitis.  http://modules.choosingwisley.org/
  2. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical Infectious Diseases; 2012:e1-e41. http://www.idsociety.org/Organ_System/#Rhinosinusitis
  3. Smith SR, Montgomery LG, Williams JW Jr. Treatment of mild to moderate sinusitis. Arch Intern Med. 2012;172:510-513.
  4. Ahovuo-Saloranta A, Rautakorpi U-M, Borisenko OV, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008;(2):CD000243. Available at http://summaries.cochrane.org/CD000243/antibiotics-for-acute-maxillary-sinusitis. Accessed November 21, 2012.

Join a Webinar on Using Evidence to Improve Clinical Care on February 25, 2014

Hosted by the Michigan State Medical Society, Michigan Primary care Transformation Project and the Agency for Healthcare Research and Quality

Interested in learning more about evidence-based resources to improve your patients’ health?  Join the Michigan State Medical Society, Michigan Primary Care Transformation Project and the Federal Agency for Healthcare Research and Quality (AHRQ) for a free Web conference from noon – 1 pm ET Tuesday, February 25, 2014.  Physicians can receive 1 AMA PRA Category 1 CreditTM upon completion of the program.

The webinar, titled “Improving Health Care Decisionmaking:  Comparative Effectiveness
Research,” will:

  • Describe what is comparative effectiveness research
  • Summarize how comparative effectiveness research can be used to help improve clinical practice
  • Identify free comparative effectiveness research resources through the Agency for Healthcare Research and Quality (AHRQ) for physicians and other clinicians

AHRQ conducts comparative effectiveness research (CER) to improve the quality of treatment decisions among clinicians and their patients.  CER highlights the effectiveness, benefits, and risks of different treatment options for common health conditions, such as diabetes, heart disease, cancer and mental health.  When integrated into clinical practice, these free, unbiased resources help improve health outcomes and clinical quality, while engaging patients.

In addition to the Michigan State Medical Society and the Michigan Primary Care Transformation Project, other organizations throughout Michigan already partner with AHRQ on this initiative, including the Michigan Academy of Family Physicians, Michigan Association of Osteopathic Family Physicians, Blue Cross Blue Shield of Michigan, Michigan Primary Care Association, Michigan Council of Nurse Practitioners and American Nurses Association – Michigan, among others.

SPEAKERS
Stephanie Chang, MD, MPH, is a board-certified general internist and pediatrician.  She has worked at the Agency for Healthcare Research and Quality on the Effective Health Care Program and with the Evidence-based Practice Center Program since 2006. She was appointed director of the Evidence-based Practice Center Program in 2010. Dr. Chang completed undergraduate and medical school at the University of Michigan and continued postgraduate residency training in internal medicine and pediatrics at the University of Minnesota.  She completed a master’s degree in public health at the Johns Hopkins Bloomberg School of Public Health and a general internal medicine fellowship at Johns Hopkins University in 2006.

Pamela Montagno, MA, is the lead of the Chicago Regional Partnership Development Office of AHRQ, which is part of the U.S. Department of Health and Human Services.  As an AHRQ contractor, Ms. Montagno  has served in various health care roles for most of her career.  She worked at Cincinnati Children’s Hospital Medical Center and Loyola University Medical Center in Maywood,  Ill., and consulted at the University of Chicago Medical Center, Joint Commission International and the University HealthSystem Consortium, among others.  She earned a bachelor’s and master’s degree at Loyola University Chicago.

REGISTRATION
To register for the webinar, please go to https://improving-healthcare-decisionmaking.eventbrite.com/ and select “Attend Event,” no later than FEBRUARY 24, 2014.   Although the Web conference is free, participants must register ahead of time.  Details on accessing the Web conference will be communicated via email to registered participants.

STATEMENT OF ACCREDITATION
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Michigan State Medical Society and Agency for Healthcare Research and Quality (AHRQ).  The Michigan State Medical Society is accredited by the ACCME to provide continuing medical education for physicians.

AMA CREDIT DESIGNATION STATEMENT
The Michigan State Medical Society designates this live activity for a maximum of 1 AMA PRA Category 1 CreditTM.  Physicians should claim only credit commensurate with the extent of their participation in the activity.

DISCLOSURE
The planners and presenters for this activity have no relevant financial relationships.  This activity has
received no commercial support or sponsorship.

For more information and questions about the Web conference, please contact Karen Costa at
karen.costa@ahrq.hhs.gov.

Announcement of Upcoming MiPCT Webinars

MiPCT Webinars: Upcoming webinars can be found on the home page of micpctdemo.org website.  On the right side of the web page you will see a box containing the date, topic, intended audience, and presenter if known of future webinars.  This list is updated monthly.

Upcoming MiPCT CM Webinars:

MiPCT CM Webinars: Wednesdays, 2:00 – 3:00 PM
Pediatric CM Webinars:  Fridays, 10:00 – 11:00 AM

  • February 26, 2014: Palliative Care, (All MiPCT Care Managers)
  • March 21, 2014: TBD (Pediatric Care Managers)
  • March 26, 2014:  TBD (All MiPCT Care Managers

Michigan Care Management Resource Center Care Manager Monthly Update: December 2013

The December, 2013 edition of the Michigan Care Management Resource Center (MiCMRC) Care Manager Monthly Update contains a review of MiPCT project events and developments that occurred in December, and a resource list. The December resource list contains links to resources provided during the MiPCT Learning Collaborative Cohort Two and Care Manager Essentials, core skills, MiPCT and MDC update and 2014 Project Metrics webinars.

The MiCMRC Care Manager Monthly Update for December is provided as an attachment to this edition of the Practice FLASH.

Stories of Your Care Management Success:

Elizabeth Eaton, RN, MPH
MiPCT Clinical Lead, and Care Manager,
Sparrow Medical Group-North

Elizabeth Eaton, RN, MPH is a care manager at Sparrow Medical Group-North and a MiPCT Clinical Lead. Elizabeth received a referral from Dr. Cynthia Buchweitz, MD to work with a patient, ‘Wanda’. ‘Wanda’ is a 68 year old, married female with multiple chronic conditions. These include DM, HTN, CKD, CAD, Hyperlipdemia, Glaucoma and hypothyroidism. At the time of the referral ‘Wanda’s’ diabetes was uncontrolled (HgA1c of 13.5 and blood sugar readings in the 300-400’s). She did not have insulin because she could not afford her copays. She was not taking many of her medications because of high copays.

Elizabeth met with ‘Wanda’ and identified potential barriers to effective management of her chronic conditions. These included financial issues, problems navigating the medical insurance and prescription coverage environment, skipping medications and not refilling prescriptions due to copays costs, very low vision, no longer driving and relying on her husband (who is in poor health and was recently hospitalized) to draw up and administer her insulin, not following up with the Diabetes Center and Endocrinologist as requested by her PCP and it had been seven months since her last office visit.

Elizabeth helped ‘Wanda’ reconnect with the Diabetes Center and Endocrinologist. She obtained sample insulin through the drug reps at the Diabetes Center. Elizabeth provided education and assisted ‘Wanda’ and her husband with pharmacy benefits and use of the pharmacy mail order program. Based on Elizabeth’s patient assessment, referrals were requested and made to home care nurse and physical therapy as well as meals on wheels.

Elizabeth included ‘Wanda’s’ daughter in her care as well. Initially, Elizabeth made calls to ‘Wanda’ daily for the first three weeks of intervention. As ‘Wanda’ demonstrated better self-management and control of her diabetes, Elizabeth was able to decrease the frequency of calls to weekly and then monthly.

Over the course of five months, ‘Wanda’s’ overall condition has improved. Her HgA1c initially decreased to 8.8 in three months and is currently 8.3. She has gained physical strength and no longer requires the use of a walker or cane for ambulation. ‘Wanda’ is very engaged in her care. She is keeping her appointments with both her PCP and Endocrinologist, testing her blood sugars regularly and reordering her medications before they run out.

Elizabeth continues to assist ‘Wanda’ with medication adherence due to financial limitations, specifically the cost of insulin. ‘Wanda’ remains dependent on her husband to draw up and administer her insulin as well as provide transportation to her appointments because of her poor vision. Continued care management support will be needed because of these persistent potential barriers as well as the fact that ‘Wanda’s’ daughter moving out of the area, creating a decrease in social support and available resources. Despite significant barriers to care, ‘Wanda’ has been able to impact the management of her diabetes because of care management interventions.

2014 MiPCT Care Manager Educational Opportunities

The Michigan Care Management Resource Center (MiCMRC) has developed a new format for MiPCT Care Manager 2014 educational offerings. Monthly educational webinars will continue to be provided for MiPCT Care Managers. In addition, regional/specialty Care Manager conference calls will be offered.  Participation is dependent on the  PO/PHO/Medical Groups decision to have their designated Care Managers attend these regional/specialty conference calls.  If you have Conference Call participation questions, please inquire with your leadership regarding the decision of your PO/PHO/Medical Group.   Information and details regarding each type of MiPCT CM educational offering will be sent to CMs via e-mai within the next three weeks.

  • Beginning February 2014, registration is required for each educational activity.  Please note Care Managers who register for the Conference calls will need to add this meeting to their calendar.
  • The Care Management Webinars and Conference Calls are approved for Care Manager MiPCT Learning Activity.
  • Please submit questions to micmrc-requests@med.umich.edu

MiPCT Care Manager Educational Webinar 2014 Dates

MiPCT CM Webinars will be held  2:00pm-3:00pm on the following dates:

  • February 26, 2014
  • March 26, 2014
  • April 23, 2014
  • May 28, 2014
  • June 25, 2014
  • July 23, 2014
  • August 27, 2014
  • September 24, 2014
  • October 22, 2014
  • November 19, 2014

MiPCT Pediatric CM Webinars will be held  10am-11am on the following dates:

  • February 21, 2014
  • March 21, 2014
  • April 11, 2014
  • May 16, 2014
  • June 20 2014
  • July 18, 2014
  • August 15, 2014
  • September 19, 2014
  • October 17, 2014
  • November 21, 2014
  • December 19, 2014

MiPCT Care Manager Conference Calls
(Requires registration via Web-ex)

The MiPCT Care Manager conference calls are organized into three groups; LMSW, pediatrics and all other Care Managers.  The LMSW, pediatric and all other Care Manager’s conference call will be offered every other month. All conference calls will be facilitated by the MiPCT Central Clinical Coordinator, Master Trainers and Regional Clinical Leads.

The purpose of the conference calls is to provide an opportunity for smaller groups of Care Managers to have discussions with their colleagues to address skill-building, share tools and resources, explore challenges/solutions, and Best Practices. Resources will be reviewed and discussed during the conference calls and posted on the MiCMRC website. Theme topics will be addressed via the Care Manager webinar, conference calls, and articles in the Practice FLASH newsletter.  The Care Management Conference Calls are approved for the  Care Manager MiPCT Learning Activity.

The new educational format is being trialed in the coming months. Continuation of this offering is dependent on Care Manager participation and program evaluation. The MiCMRC will evaluate the effectiveness of this offering through post-call evaluations.  MiPCT Care Managers attending the conference calls are encouraged to provide specific feedback when completing post-call evaluations.

MiPCT Care Managers who have been identified by their PO Leader to attend the conference calls, will receive information and details via e-mail regarding dates, times and registration instructions.  Please submit questions to micmrc-requests@med.umich.edu

MiPCT Complex Care Management Course – NEW 2014 Format

The 2014 MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format.  The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

MiPCT Complex Care Management Course NEW 2014 Format:  Completion of the MiPCT CCM Course includes a Live one hour Introductory Webinar, 6 hours of self-study modules, post tests and 2 in person training days In Lansing, MI.  This entire course is completed during a four day period. The kickoff of the training begins with the Live MiPCT CCM Course Introduction Webinar on day 1.

Register for the February 10-13, 2014 MiPCT CCM course at the following site:   https://jodyooo.wufoo.com/forms/february1013-2014-mipct-ccm-training/

Upcoming 2014 MiPCT CCM course dates:

  • Feb 10-13 2014
  • March 10-13 2014
  • April 7-10  2014
  • May 12-15 2014
  • June 9-12 2014

Please submit questions regarding the MiPCT CCM course to:   micmrc-requests@med.umich.edu

Seeking Pediatric MiPCT Clinical Lead

The MiPCT Care Manager train the trainer program is seeking candidates for year three intervention and has the following open position:  Pediatric Clinical Lead.

This position maintains a patient caseload and/or has a leadership role as a manager of MiPCT Care Managers.   The MiPCT team would like the position filled by a candidate employed by either the participating MiPCT Physician Organization or the physician practice.  A $20,000 subsidy is provided to the organization, prorated as applicable.  The Clinical Lead position has preceptor and support responsibility for MiPCT Care Managers 8 hours per week.

For details of the role and qualifications, please refer to the “2014 MiPCT Clinical Lead Role and Responsibilities” document (attached).    If you would like to offer a candidate for a Clinical Lead position, please submit the candidate’s resume and this completed Letter of Interest form (attached) to micmrc-requests@med.umich.edu by 2-3-14.

NEXT ISSUE DATES:
•    Next MiPCT Practice FLASH Issue:  February 24, 2014
•    Next MiPCT P.O. FLASH Issue:  February 10, 2014

 

 

UPCOMING PRACTICE FLASH ISSUES:

  • Volume 4, Issue 1, (January 26, 2015)
  • Volume 4, Issue 2, (February 23, 2015)
  • Volume 4, Issue 3,  (March 23, 2015)
  • Volume 4, Issue 4, (April 27, 2015)
  • Volume 4, Issue 5, (May 18, 2015)
  • Volume 4, Issue 6, (June 22, 2015)
  • Volume 4, Issue 7,  (July 27, 2015)
  • Volume 4, Issue 8,  (August 31, 2015)
  • Volume 4, Issue 9, (September 28, 2015)
  • Volume 4, Issue 10, (October 26, 2015)
  • Volume 4, Issue 11, (November 16, 2015)
  • Volume 4, Issue 12, (December 21, 2015)