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  • May 15, 2021   Major Depressive Disorder   Major depressive disorder (MDD) is the second leading cause of disability worldwide, affecting an estimated 120 million people. 1 Screening is to be done once per year in the year that the patient is seen for an encounter. HEDIS measures the percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care    A positive screen MUST have a...

  • May 1, 2021 New Treatment Option for CHF   More than 9 million people in the Unites States have congestive heart failure reduced ejection fraction (HFrEF).  It is the most common diagnosis in hospitalized patients over the age of 65.  One of nine deaths have heart failure as a contributing cause and inflicts considerably quality of life.  It’s an illness that consumes healthcare resources.   Established therapies for chronic HFrEF include angiotensin receptor-neprilysn inhi...

  • Chronic Kidney Disease Approximately 11% of U.S. adults have CKD, many of whom are elderly. The condition is usually asymptomatic until its advanced stages. Most cases of CKD are associated with diabetes or hypertension. eGFR is considered the best screening tool for Chronic Kidney Disease (CKD) eGFR Calculator Treatment of early stages of CKD is generally targeted to comorbid medical conditions, such as diabetes, hypertension, and cardiovascular disease, to reduce the risk for complications and progres...

  • Appropriate Treatment of the Adult Upper Respiratory Infection Adult upper respiratory infection (URI) represents one of the most common acute illness seen in the outpatient setting. Adults ages 19 – 39 are diagnosed with 2.2 URI per year and adults 40 and beyond are diagnosed with 1.6 URI per year.(1) In the United States, the annual costs associated with the inappropriate  utilization of antibiotics for treatment of URI in adults and children is $3 Billion dollars. 2 Inappropriate antibiotic pres...

  • DEXA for Osteoporosis The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors 1 .   Limited evidence from good-quality studies found no benefit in predicting fractures from repeating bone measurement testing 4 to 8 years after initial screening 2 .   RISK FACTORS RECOMMENDATIONS Fracture from minor trauma Adequate calcium and vitamin...

  • Medication Adherence Best Practices Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions. Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs. Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particul...

  • Best Practices: High Emergency Department Utilization   Provide 24/7 access to a clinical decision-maker. Avoid verbiage stating, “if this is an emergency, please hang up and call 911 or go to the nearest emergency room”. Encourage the patient to speak with the clinical decision-maker before seeking care. Provide outreach to patients who have had an urgent care visit or emergency department visit and schedule follow-up appointment as appropriate. Communicate appropriate use of after-hours care. Uti...

  • Best Practices: Transition of Care (TOC) Visits   Utilize MPP Transition of Care documentation or notifications from your local hospitalist group to initiate need for TOC appointment. Establish open access scheduling with appointments for TOC visits each week. Review and sign the Care Manager’s notes (from the required initial patient contact within 48 hours of discharge) enabling you to bill the Transitional Care Management (TCM) codes and generate higher revenue.  99495- TOC visit within 14 ...

  • Doctor performing surgery with a team

    Is it an Emergency?

    Please use the form below for sharing with patients to assist with determining what type of care a patient should seek based on symptoms. Is it an Emergency?

  • The presence of albuminuria is a POWERFUL predictor of Renal and Cardiovascular Risk in patients with Type 2 Diabetes. Download PDF . All patients with Diabetes should have a microalbumin screen at least once a year. If you have significant gaps in this metric, you will receive a separate mailing with a list of patients for gap closure. If you are interested in obtaining a list of gaps, or have any other questions, please feel free to contact your Regional Medical Director or Quality Performance Special...