Case Management Program Update
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Pat Noonan, Director of Transitional & Ambulatory Case Management recently presented a Case Management Program Update to NEPHO providers at their monthly meetings. Some key points noted from the recent presentation included:
- Patients in the ACO and commercial risk products are stratified into high risk and complex care classifications so resources can be targeted for this population.
- Prioritization for many of the common high risk diagnosis such as CHF, COPD, DM, Dementia, Behavioral Health, etc. occurs for both transitional and ambulatory resources.
- Data was shared data on patient enrollment increases since 2013 in the transitional and ambulatory programs and favorable readmission rate compared to MA rate for Q3, 2015.
- Future considerations such as Transitional Case Management and Chronic Care Management services were touched on as well as upcoming initiatives such as CHF/COPD pilot, palliative care and behavioral health initiatives.
- Recommendations from the committee included imbedding care managers, standardizing in house processes for tracking ED utilizers, and regular feedback.
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What's Next ?
April and July 2016 Requirements
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Acute Hospital Monthly Reporting of Infants/Children Exposed to Opioids
A technical fix, scheduled for April 1, 2016 implementation, is evolving to revise the current law requiring acute care hospitals monthly reporting process for any infant / child (defined as those under the age of 11) exposed to a Schedule I through VI drug. See the attached Mass Hospital Association Summary on Reporting of Infants. for details and request for response. ED Requirements for Substance Abuse Evaluation
As of July 1, 2016 any patient who arrives in an ED
experiencing an overdose or was administered Naloxone before arriving, must undergo a substance abuse evaluation within 24 hours of receiving ER services. Evaluation can be performed by an ESP or a licensed mental health professional. Patient may refuse the evaluation or the clinician may release the patient if the evaluation does not occur within the 24 hours. Patient may consent to further treatment after the evaluation at the ED or at another facility, provided the medical determination for treatment shall be determined by the treating clinician. For any child who is a minor (under the age of 18), facility must inform the parent/guardian of the overdose and that an evaluation will occur during which the parent/guardian may be present during the findings.
Upon discharge, patient must receive information on local and statewide treatment programs; facility must record the overdose in the EMR; facility must also notify the patient's PCP (if known) of the overdose and treatment recommendations.
Coverage for these services must be provided without preauthorization by GIC, MassHealth (PCC and MMCOs), and Managed Care plans (with the exception of ERISA plans)
2016 MA Opioid Bill
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Management of a First Seizure
by
Ilya Bogorad M.D.
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He notes, less than 50% of patients who have a first unprovoked seizure have a second seizure; thus, the evaluation should focus on determining the patient's risk of seizure recurrence. Provoked or acute symptomatic seizures do not confer increased risk for subsequent unprovoked seizure recurrence. Multiple seizures in a given 24-hour period do not increase the risk of seizure recurrence. Remote symptomatic seizures, an epileptiform EEG, a significant brain imaging abnormality, and nocturnal seizures are risk factors for seizure recurrence. Antiepileptic drug therapy (AED) delays the time to second seizure but may not influence long-term remission.
Ilya Bogorad M.D.
North Shore Neurology & EMG
83 Herrick Street, Suite 1001
Beverly, MA 01915
978 922 2226
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HPHC Vitamin D Screening & Testing Guidelines
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- Vitamin D screening is considered medically necessary for members under age 18.
- Screening for Vitamin D deficiency (i.e., testing to determine if someone without signs or symptoms is Vitamin D deficient) is not medically necessary in healthy adults as there is limited clinical evidence to support routine screening in this population.
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NEPHO Clinical Newsletter
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Produced by Northeast Physician Hospital Organization
For more information contact:
Carol Freedman, RPh, MAS, CGP
Clinical Pharmacist NEPHO
Louis Di Lillo M.D., Northeast PHO Medical Director
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cfreed@nhs-healthlink.org | http://www.nepho.org 500 Cummings Center Suite 6500 Beverly, MA 01915
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