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Joanne Roberts, PHN Perinatal Services Coordinator Los Angeles County November 8, 2012 Integrating Interconception Health into CPSP
Joanne Roberts, PHNPerinatal Services Coordinator
Los Angeles CountyNovember 8, 2012
Integrating Interconception Health into CPSP
Recommendations for The Postpartum Visit
ACOG: – Recommend four to six weeks
postpartum
– General assessment of physical and mental well-being
– Special emphasis on depression screening, breastfeeding, and contraception
Recommendations for the Post Partum Visit
World Health Organization: Recommend contact with the health care system:
“six hours, six days, six weeks and six months”
post-delivery
Improved postpartum care will not only improve the health and well being of the postpartum woman but will also improve outcomes of subsequent pregnancies
The Facts: Postpartum Visit & CPSP
• Common belief: one pp visit at 4-6 weeks
• Providers have minimum 3 ½ hours postpartum
– Health education– Nutrition– Psychosocial services
• Additional time (4 hours)
Perinatal Education (Z6410) if not all used prenatally
The Postpartum Visit & CPSP
• Perfect opportunity to discuss interconception care
• Begin with review of prenatal medical records: OB and CPSP
The Postpartum Visit & CPSP Challenges: Delivery Record
– Often missing from charts
– Key to identifying potential risks for future pregnancies
Postpartum Visit Compliance
• Patient
• Provider
• Systems
Addressing Compliance
• Stress the importance of the postpartum visit:
– Client Orientation
– Initial Assessment
– 2nd and 3rd Trimester Reassessments
– Post-delivery contact
• All team members – every opportunity
Los Angeles County Projects to Incorporate Interconception Care
• Messages added to CPSP Training
• ABCDE’S
– Train the Trainer
– ABCDE’S for CPSP Providers
• CPSP Postpartum Project
ABCDE’S
CPSP Training
CPSP Training
CPSP Training
Training at provider office (1 hour):
• Described PCC and ICC; ABCDE’S
• Overlap of PCC/ICC with CPSP
• Used sample Care Plan to identify the risks that have not resolved during pregnancy
• Discussed CPSP billing codes that can be used for interconception care during postpartum
LA County CPSP Postpartum Project
LA County CPSP Postpartum Project
• Trained 12 sites:103 CPHWs
• Reviewed 10 CPSP charts per site and documented postpartum services and billing on data collection tool
• Follow-up 1-2 months post-training to review new postpartum charts
• Compare pre- and post-training services and billing
CPSP Postpartum Project
Procedure Code
Description When to UseMax Units of Service
Reimbursement Max
Reimbursement
Z6208
Postpartum Nutrition Assessment, Treatment, and/or Intervention, including update of Care Plan, Individual.
1) Postpartum nutrition assessment;2) Postpartum nutrition intervention
4 $8.41 $33.64
Z6308
Postpartum Psy Assess. Treatment, and/or Intervention, including update of Care Plan
1) Postpartum psy assessment;2) Postpartum psy intervention
6 $8.41 $50.46
Z6414
Postpartum Health Education Assessment, Treatment, and/or Intervention, including update of Care Plan
1) Postpartum health education assessment;2) Postpartum health education intervention.
4 $8.41 $33.64
Z6410Perinatal Education, Individual, each 15 min
Individual education provided prenatally or postpartum
16 $8.41 $134.56
Z6412
Perinatal Education, Group, per patient, each 15 minutes (Maximum 4 hours/day,18 hours/pregnancy)
Group education
Can be used during Perinatal and during Post Partum period
72 $2.81 $202.32
18% Improvement
Project Challenges
• Difficult to schedule follow-up visits• Many providers don’t do CPSP postpartum• Difficult to measure results
– How can we measure increase in ICC services?– Comparing number of postpartum services billed was
not effective
http://www.everywomancalifornia.org
RESOURCES
RESOURCES
www.cdph.ca.gov/programs/preconception
RESOURCES
Visit ph.lacounty.gov/mch/ Select “Preconception Health”
