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  • January 15, 2022 Quality Performance Challenges In 2022, as we move into downside risk for multiple lines of business (commercial, Medicare) the reality is that the performance of the individual provider remains important, but group performance is paramount. Our downside risk will be measured at the group level. The COVID 19 pandemic continues to put the brakes on the return to “normal”. With the arrival of a new and more infectious variant, medical staffing, supplies, and stamina will be stretched to t...

  • January 1, 2022 Kidney Disease EVALUATION for Patients with Diabetes (KED)   HEDIS MEASURE: The percentage of adults ages 18 to 85 years of age with diabetes, as of December 31 of measurement year, who received a kidney health evaluation. BACKGROUND: Facts a Approximately 90% of those with early kidney disease don't know they have it. Approximately 1 in 3 adults with diabetes may have kidney disease or are at risk. Kidney disease  affects an estimated 37 million people in the U.S. (15% of the ...

  • December 15, 2021 HCC (Hierarchical Condition Category) Coding The goals of value-based care programs are lowering health care costs and improving patient outcomes. Identifying patients at high risk of serious health events such as emergency department visits or inpatient admissions and preventing them is one way to reach the above goals. The McLaren High Performance Network ACO and the MPP Medicare Advantage gainsharing contracts are examples of value-based contracts. Regulatory agencies and payers use...

  • December 1, 2021 MEDICARE WELLNESS EXAMS Improve Quality and Maximize Revenue   The main benefit of the Annual Wellness Visit (AWV) to patients is the creation of a personalized prevention plan, which is a written plan that can help guide their preventive care decisions.   AWVs can boost revenue and provide a template for physicians to help close gaps in many pay-for-performance quality measures. Listed below are important codes that may be billable in addition to the appropriate AWV code (G04...

  • November 15, 2021 Chronic Care Management (CCM) Chronic care management is care coordination services done outside of the regular office visit for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These services are typically non-face-to-face and allow eligible practitioners to bill for at least 20 minutes or more ...

  • November 1, 2021 Palliative Care The World Health Organization (WHO) defines palliative care as an “approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems- physical, psychosocial, and spiritual.”   McLaren’s Palliative Care Program is administered by the McLaren Health Manage...

  • October 15, 2021 Medication Reconciliation   Why does medication reconciliation need to occur after every discharge? Medication errors are a leading cause of increased ED utilization and admissions/readmissions. Performing medication reconciliation after every discharge ensures that patients understand any new medications they may have been prescribed, as well as any previously prescribed medications that may have been discontinued or changed.   Who can conduct medication reconciliation post-d...

  • October 1, 2021 CHLAMYDIA SCREENING Chlamydia is the most commonly reported bacterial sexually transmitted disease in adolescents in the United States. It occurs most often among adolescent and young adult females. 1 HEDIS measures the percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. Patients who were dispensed prescription contraception for reasons other than contraception (acne, PCOS) during the measu...

  • September 15, 2021 Renin Angiotensin Aldosterone System Inhibitors (ACE-I and ARB) BACKGROUND: ACE cleaves C-terminal peptides on angiotensin I, converting it to angiotensin II, and thus increases blood pressure in two ways: vasoconstriction and stimulation of the release of aldosterone, which increases the retention of water and sodium. ACE-I, ARB’s and DRI’s block this process. ACE Inhibitors Angiotensin II Receptor Blockers (ARBs) benazepril (Lotensin) candesartan (Atacand) captopril (Capoten) eprosa...

  • September 1, 2021 "Are your patients struggling with the cost of medications?”   No medication can be the best treatment for a patient if it costs so much that the patient cannot fill the prescription. CAHPS (Consumer Assessment of Healthcare Providers and Systems) is a program of some 26 years designed to understand the patient experience with healthcare. CAHPS surveys asks patients to report on their experiences with a range of health care services and experiences with providers (practice sites a...