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July 2014

 

 

INTEGRIS Health Partners

INTEGRIS Health Partners

 

 


July 2014 Update

Inside this issue:

Letter from IHP President

Inpatient coding: Did you know?

Choosing Wisely

Colorectal Cancer Screening

New IHP Doctors

 

Dear Colleagues,

Many of you have inquired about what INTEGRIS Health Partners has been working on recently. Here is an update on several important recent activities.

First, we have been finalizing results of 2013 health plan activities. I know it seems crazy that we are still working on our 2013 data. When you operate a calendar year health plan with a July 1 to June 30 fiscal year, in an environment where it takes three to four months for claims to get through the system, it takes a while to get it right. We are almost there; however, it is safe to say we were very successful in providing efficient, high quality health care to covered INTEGRIS employees and their dependents.

The covered lives INTEGRIS Health Partners managed had a 14 percent reduction in health care costs. I will report the specific and final numbers next month and the amount INTEGRIS Health Partners will get in the shared savings pool. We are proud of what we accomplished.

Second, INTEGRIS Health Partners has been involved in multiple discussions with major insurance organizations in Oklahoma to pursue development of products involving the network. We have made significant progress. We set out to learn how to operate a clinically integrated network utilizing our experiences with the INTEGRIS Health plan. We have succeeded, and others have taken notice that this program works. It is time to take it to the market. I feel we will soon be responsible for many more covered lives as a result of these discussions. More to come.

Third, INTEGRIS Health Partners and its members are deeply involved in EPIC implementation across the INTEGRIS Health system. This will truly be a game changer. It will be the centerpiece of the clinical and system integration that is ongoing. When asked to participate in the EPIC project, please do. Physician involvement is the key to making this work.

Fourth, the INTEGRIS Health Partners Inpatient Collaborative has been exploring an innovative gainsharing and quality initiative developed by a company called Applied Medical Software. AMS provides a Centers for Medicare and Medicaid Services-approved framework to incentivize providers to carefully look at practice patterns, costs of care, protocols and outcomes at a very granular level.

The collaborative feels strongly we should pursue this program as it has great potential to improve our efficiency in the hospital. It allows us to receive a shared savings incentive in the inpatient area based on believable data and attribution models. We are doing our final analysis and legal review currently. It will unlock the power of clinical integration to the hospital based physician and surgical specialists. Stay tuned.

This is a short list of the things INTEGRIS Health Partners is pursuing. As mentioned above, next month we will announce the 2013 results. You will be proud of what the network has done. As always, we need more of you to become more involved. This is the future of health care. The above initiatives and a willingness to work together will make us successful.

Sincerely,

Carl Raczkowski, M.D.
President, INTEGRIS Health Partners


Inpatient coding: Did you know?

In the Inpatient setting, coders are not allowed to assign codes based upon findings in diagnostic reports alone, such as pathology or radiology. Although signed by a physician (i.e., pathologist or radiologist), the interpreting physician is not responsible for any decision-making regarding the care or treatment of the patient. The diagnosis must be specifically documented in the medical record (i.e., progress notes, DC summary) by the physician responsible for care and treatment in order to be coded and reported.

 

Example: Pt has an elective colon resection for colon cancer and the path report shows mets to lymph nodes. Coders are not allowed to pick up a code for the lymph node mets until confirmed in the medical record by the treating physician. In addition, if a physician documents “breast mass” and the pathology confirms it is breast cancer, coders cannot code “breast cancer” until the physician confirms this in the body of the record.

 

If you have questions, please contact Kati Beisel, system director, INTEGRIS health information services, at kati.beisel@integrisok.com or 405-949-3387.


Choosing Wisely

Choosing Wisely is a website created by the American Board of Internal Medicine intended to prompt discussions between patients and providers. Lists of specialty-specific guidance provide evidence-based education to aid in making appropriate decisions for individual patients. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in the creation of the lists. These lists were developed by United States health care provider organizations. http://www.choosingwisely.org/doctor-patient-lists/


Colorectal Cancer Screening

An important INTEGRIS Health Partners metric for 2014 is colorectal cancer screening. Currently, 50.9 percent of eligible INTEGRIS Health Partners’ patients have been screened for colorectal cancer. The goal for 2014 is 63.2 percent. The metric is “all patients age 50 to 75 should be screened for colorectal cancer by colonoscopy at least once every 10 years or by fecal occult blood test annually.” Care coordination recently sent letters from you to patients non-compliant for the screening. The letters advise patients to contact their primary care physicians to begin the scheduling process. Please encourage your patients to have this preventative exam. If you have questions about your current score for this metric, then feel free to get in touch with care coordination at 405-951-2504 or 855-582-3003.


New IHP Doctors

Please see the IHP website for contact information and practice locations.

Physician

Specialty

Andrew Crabbe, M.D. - metro

Anesthesiology

Mark Fine, M.D. - metro

Anesthesiology

Darrell Heck, M.D. - metro

Anesthesiology

Michael McLaughlin, D.O. - metro

Pain Management

Deborah Nilson, D.O. - metro

Pain Management

Charles Shields, M.D. - Enid

Pain Management/PMR

 

IntegrisHealthPartners@integrisok.com 

integrisok.com/ihp

405-713-4476



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Oklahoma's largest hospital network
3300 N.W. Expressway
Oklahoma City, OK 73112 Phone: (405) 951-2277
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