Educating Practices in Community Integrated Care for Children with Special Health Care Needs...

Educating Practices in Community Integrated Care for Children with Special Health Care Needs

Pennsylvania Chapter, AAPA Medical Home Initiative

of the MCHB

EPIC-Integrated Care

Community Integrated Care for Children with SHCN

Federal MCHB Medical Home Initiative

EPIC-IC Education/QI Program Demonstration Projects Advocacy

Pennsylvania DOH Program Support EPIC-IC Care Coordination Demonstration

Projects Child Care Education about children

with SHCN


Other EPIC Programs

Immunization Education Stop Child Abuse Now (SCAN) Smoking Cessation


Case Presentation


Why should you care about children with SHCN?

Increasing numbers of children with SHCN--time, cost

Opportunity for improvement Health care system built around acute

care, not chronic care Families want more involvement in care

process More care provided in the home and

community Primary care practice staff want to provide

the best care possible


Take Home Message

Primary care practices can

Develop patient/family centered care Identify and monitor children with SHCN Improve coordination of care and communication Improve documentation to enhance coding and

reimbursement. Improve how the primary care practice team

provides chronic care through systems change Facilitate patient access to services in practice and

community


Community Integrated Care for Children with SHCN

Who are “Children with SHCN”?

What is a “Medical Home”?

Where should we focus?

How does this relate to our

practice?

How can we improve our practice?


Who are children with special health care needs?

“Children with Special Health Care Needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” (Maternal and Child Health Bureau ’95)


Children with Special Health Care Needs

Chronic Conditions, 30%, 21,540,000

Special Health Care Needs, 18%, 12,608,000

Limitation of Activity, 7%, 4,711,000

Limitation Activities of Daily Living, 0.2%,

149,000Long Term Care, 0.1%, 92,000

0

5

10

15

20

25

30

35600

360

140

4

2


Epidemiological Statistics of Children with Special Health Care Needs (1994)

18% of Children or 12.6 million (0-18 years of age)*

Avg. Annual School Absences 7.4 2.8 3.6 % with Health Insurance 88.8 86.4 86.8 % with Usual Source of Care 94.4 93.2 93.4 % not Satisfied with Care 17.9 13.6 14.7 % with Unmet health Needs 12.9 6.4 7.6 Avg. Annual Physician Contacts 6.4 2.6 3.3 Avg. Annual Hosp.Days/1000 691 122 225

*Newacheck et al. Pediatrics, Vol 102, No. 1, July. 1998, pp 117-121

CwSHCN Typical Avg.


Annual Cost of Medical Care for Children with SHCN

Specialists14%

DME5%

Primary Care5%

Other15%

Hospitalization61%

HealthPartners/Institute for Health and Disability 2/97"Other" includes therapies, pharmaceuticals, outpatient lab, ED, disposables


A Medical Home Is an approach and process to

providing care Is not a building Is a partnership with the child, family

and practice care staff Emphasizes the primary care

practice as the “home” where the family and child Feel recognized and supported Find a centralized base for medical care Find connection to other medical and

non-medical community resources


Components of Care in a Medical Home Family-Centered Accessible Comprehensive Continuous Coordinated Compassionate Community-Based Culturally-Competent Provided in an Environment of Trust

and Mutual Responsibility


Identifying Challenges to Medical Home Care

TIME, TIME, TIME (and reimbursement) Organized systems of care Adequate parent-professional

partnerships Knowledge Communication Coordination Medical staff turnover Awareness of community resources

and programs


Physicians’ and Parents’ Ranking of Services

RankingService Physicians Parents

Respite care 1 9

Day care 2 21

Parent support groups 3 3

Help with behavior problems 4 10

Financial information or help 5 2

After-school child care 6 20

Assistance with physical

household changes 7 15

Vocational counseling 8 6

Psychological services 9 5

Homemaker services 10 22

Recreational opportunities 13 4

Information about

community resources 14 1

Dental treatment 16 8

Summer camp 19 7


Benefits to the Practice

Increased professional satisfaction

Improved coordination of care Efficient use of limited

resources Streamlined office procedures Compensation for the

additional care provided


Benefits to Patient/Family

Increased quality of care Increased patient and family

satisfaction Improved communication with

physician and staff


Benefits to the Community

Improved coordination of care Increased integration of

CSHCN into schools and extracurricular activities


Community Services for Children with SHCN and Their Families

Role of Primary Care Practice in Community Services Child Welfare Social Services Early Childhood Services Education Mental Health Community Based Therapies Public Health Family Support Spiritual Support


Changing a primary care practice is like trying to change the tire on a bicycle while you are riding it


Getting Started

Identify the team within the practice

Evaluate practice Identify the CSHCN in the

practice Select a parent advisor Share concepts and goals with

practice staff


Identifying the Team

A practice team includes Primary care clinician Nurse manager/care

coordinator Office manager Parent advisor


Evaluating the Practice

Medical Home Index Medical Home Family Index


Identifying CSHCN Utilize severity scoring tools available Define chronic conditions within the

practice Use ICD-9 codes and Flu shot list to

identify Review utilization reports to determine

those children seeing > 1 specialist on a regular basis

Determine how to identify the chart i.e., using color coded charts, stickers, and binders


Select a Parent Partner

Identify potential parent advisors who will provide effective input

Communicate role and responsibilities of parent advisor

Be open to constructive feedback regarding practice policies and procedures


Share Concepts/Goals With Practice Staff

Present the broad, general topics of the medical home and role of parent advisors to all members of your practice

Meet with your practice team to choose and plan your first improvement project

Implement practice wide Review with your practice team

What worked What did not

Celebrate your success


Key Factors for Success

Unifying leadership Common goal Thorough planning Staff buy-in Communication plan Small steps first Learn from your mistakes


Practical Applications

Scheduling Use a telephone script for all

schedulers to easily identify those children requiring extra time

Parent Advisors Develop Tips sheet for parents Act as a resource for other families of

CSHCN Provide community resource

information for the practice



Coordination of Care Complete care plans or summaries

for each child with SHCN. One copy for chart, one for family.

Fax back forms being used to facilitate communication with subspecialists

Develop flow sheets for specific diseases that providers and staff will use for care



Reimbursement Conduct coding sessions for

staff to understand correct coding for CSHCN

Update encounter forms to include CPT and ICD9 codes that reflect the population seen

Develop progress note templates to ensure accurate documentation


Compensation

Coding

Documentation

Data Collection

Managed Care Negotiation


Coding for Children with Complex Medical Needs

No specific code exists for additional time and effort required

Use appropriate E & M code following documentation guidelines

Remember if it’s not documented it didn’t happen



Preventative medicine service codes (99381-99397) [with the use of E/M codes (99201-99215) and the –25 modifier]

Counseling and/or risk factor reduction codes (99401-99412)

Team conferences (99361-99362) Telephone calls (99371-99373)



Care plan oversight services (99375-99376)

Prolonged physician service (99354-99359)

Office or other outpatient service codes (99201-99215)

Consultations (99241-99245) Modifier –21/09921


Summary

This is introductory material; a starting point to create an ongoing process to: Develop a

patient/family--physician/practice relationship of care

Improve how the primary care practice team provides chronic care

Integrate comprehensive care of the child with the community


Other EPIC IC Trainings Available

Family Centered Care Care Coordination Practice Management/Care Design Transition


Where Do We Go From Here?

Develop the infrastructure, develop the process

Start with a few small steps Recognize that change needs to be

gradual Implement medical home strategies one

at a time After strategies have been implemented

for a few months, evaluate progress


Contact Information

EPIC IC Program: (800) 414-7391 Email at [email protected]

Helpful Websites


Home is the place whereWhen you go thereThey have to take you in

R. Frost

Date post:	17-Dec-2015
Category:	Documents
Upload:	suzan-wade
View:	214 times
Download:	0 times

Educating Practices in Community Integrated Care for Children with Special Health Care Needs...

Documents