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August 2013

       
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August 2013 Update

 
 

Inside this Issue:

  • Letter from IHP President
    The
  • TWO-MIDNIGHT Rule
  • IHP Physician Online Profiles
  • Pharmacy Committee
  • INTEGRIS Diagnostic Imaging Services Price Reduction
  • New IHP Physicians

 

 

 

 

 

 

 

 

 

 Dear Colleagues,

As we enter into the second half of the calendar year, IHP is beginning to collect meaningful, reliable data about how we are doing.

BIG DATA is the buzz word in the healthcare industry recently. There have been recent articles in the Wall Street Journal, Forbes and many other publications about how data is transforming healthcare delivery. This data isn’t lab results and x-ray reports. Quality data, performance data, outcome data, prescribing data, cost data and population health data are driving reimbursement and planning. It is no longer good enough to proclaim yourself a center of excellence or a high performance network without being able to back it up. You have to prove it. Those who pay the bills now demand transparency and proof of quality if you want to do business with them. This will be a very important issue for IHP as we go forward.

Our ability to collect and analyze this type of data is growing daily. We are getting a clearer picture of the health issues in the patients we are responsible for. This information will allow us to understand what we do well and what we need to work on. The early results of the IHP scorecard are starting to be looked at as well. This will allow us to see who is doing well and who needs to improve. It should be interesting and very helpful. The key to improvement is having a real understanding of where you are.

We are also starting to get very useful pharmacy data. Many of you may have received pharmacy utilization reports already. There is huge potential savings in this arena. Our pharmacy committee is doing the heavy lifting of utilizing evidence-based information to be certain we don’t compromise care in the name of savings. In IHP, the physicians make this call, not an insurance provider. Spend some time with these reports if you get one. They are designed to help guide your practice in an efficient manner. They are not criticism. It is very powerful data. When you see that you are the most expensive prescriber of a popular PPI, you change your behavior. Someone else will be #1 next time. I promise. The dollar amounts are unbelievable.

Without data, we can’t get better. If we don’t get better and more efficient, our future is much more difficult. The IHP Board is committed to providing useful and accurate data to our members. It is a big challenge. We will do it and do it well. Our success and our patient’s health depend on it.

Sincerely,

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

MEDICARE ALERT
New Medicare Definitions
for
Inpatient Admission
and
Observation
The Two-Midnight Rule

Inpatient Admission Guidelines
Medicare now defines an inpatient admission by midnights. The encounter must meet the following guidelines to be classified as an inpatient admission:

  1. The physician must anticipate that the patient will be in the hospital for two midnights and
  2. The patient must meet medical necessity for an inpatient stay.

Documentation Guidelines

  1. The physician order must state Inpatient Admission. (Other wording is not allowed) The order must be written at or before the time of the admission
  2. The physician must certify the inpatient admission. The certification must include:
    1. Order for Inpatient Admission,
    2. Reason for hospitalization for inpatient medical treatment,
    3. Diagnosis,
    4. Estimated time patient needs to be in the hospital (must be 2 midnights or greater),
    5. Plans for post-hospital care, and
    6. Signature and date by physician

Observation Guidelines
Observation is now defined as

  1. Any stay less than two midnights and
  2. Patient meets at a minimum medical necessity for an observation stay.
  3. Includes an ICU stay of less than two midnights.
  4. Exceptions that qualify for Inpatient Admission even if less than a 2-midnight stay:
    1. Inpatient only procedures as defined by Medicare
    2. The physician anticipates a 2 midnight stay and the patient
      1. Dies
      2. Transfers
      3. Leaves AMA
  5. To qualify for a skilled nursing (SNF) admission, the patient must be inpatient for three midnights. Observation midnights do not count toward the three midnight total.

A special edition of the Physician Update, the INTEGRIS physician newsletter, will be forthcoming with more detailed information. If you have questions, please contact Sandi Slover, 405-949-3420, Dr. Shirley Dearborn, 405-951-8522 or Lisa Anderson, 405-951-2529.

________________________________________

Update Your Online Profile

We would like to make sure all IHP physicians are listed in the Find a Doctor module on the INTEGRIS website. We have created an IHP group on the site and included the physicians already in the directory (these are physicians with active, provisional active or courtesy privileges). The listing includes 560 physicians. There are ways to search it by specialty as well in the advanced search.

We have an online form for physicians to fill out in order to be included in the online directory: http://integrisok.com/profile. Please complete the profile to ensure you are included in the online directory.
________________________________________

IHP Pharmacy Committee Update

  • Letters have gone out to patients and providers regarding possible medicine exchanges. We will continue this process as we go through the formulary.
  • It is recommended that fluticasone nasal be used instead of nasonex and other nasal sprays.
  • If a patient is on nexium, switching them to omeprazole 20mg twice daily is recommended. It is also recommended that they take the omeprazole on an empty stomach then eat approximately 30 minutes later.
  • The formulary will be updated for calendar year 2014. For the first time, the P&T committee will be working with HR to develop the formulary. Previously, the HR department has purchased the formulary from the insurer. We are hoping this will result in a better formulary with savings for patients and IHP.
  • We hope to have a P&T committee CME during the next calendar year.
  • We have discussed making some medications a step edit or requiring prior authorization.
  • We’ve discussed making some exchanges “automatic” unless the physician writes “DAW” on the prescription.
  • Please keep in mind that using rebate cards may help the patient obtain a drug more cheaply, but if it is a nonformulary medication or a higher tier co-pay drug, the cost to IHP is most likely significant. Please try to keep patients on formulary drugs, generics, if possible.

________________________________________

Reduction in Pricing for INTEGRIS Diagnostic Imaging

We have been listening to our physician community who have told us that many of their patients choose to go elsewhere for diagnostic imaging services due to the current pricing of outpatient services at the INTEGRIS Health facilities. INTEGRIS is committed to providing high-quality health care services offered in the best possible facilities and coordinated by the most accomplished physicians, clinical professionals and other employees. In an effort to better serve our patients, INTEGRIS Diagnostic Imaging Services has reviewed its current pricing structure for diagnostic outpatient imaging and is pleased to announce a significant reduction in charges. The new rates are effective immediately in order to meet the needs of our customers.

The radiology departments at INTEGRIS Health provide a full range of radiology services including CT, MRI, open MRI, ultrasound, nuclear medicine/ PET, diagnostic X-rays, digital mammography and bone mineral density testing among others. Imaging services including the following are provided 24 hours a day, seven days a week.

  • CT SCAN
  • MRI
  • ULTRASOUND
  • NUCLEAR MEDICINE/PET
  • GENERAL DIAGNOSTIC X-RAYS
  • DIGITAL MAMMOGRAPHY

The INTEGRIS Health radiology departments offer a number of benefits to your patients:

  • Board certified radiologists
  • Physicians on staff 24 hours a day
  • Weekend and after-hours imaging
  • Fully licensed and ACR accredited staff
  • Free valet parking at many locations
  • Easy accessible parking
  • Kiosk registration

Services are provided at:

INTEGRIS Diagnostic Imaging Services Locations
INTEGRIS Baptist Medical Center
Oklahoma City, OK 73112

INTEGRIS Canadian Valley Hospital
Yukon, OK 73099

INTEGRIS Cancer Institute - Proton Campus
A campus of INTEGRIS Baptist Medical Center
Oklahoma City, OK 73142

INTEGRIS Comprehensive Breast Center of Oklahoma
3525 NW 56 Street
Oklahoma City, OK 73112

INTEGRIS Health Edmond
Edmond, OK, 73034

INTEGRIS Southwest Medical Center
Oklahoma City, OK 73109

For more information regarding the new pricing for specific diagnostic imaging, please call the INTEGRIS Priceline at 405-713-4500 or toll free at 877-313-4500.
________________________________________

New IHP Physicians

Please see IHP website for practice locations.

Serena Anderson MD

Family Medicine

Erik Angles MD

Emergency Medicine

Alan Betensley MD

Critical Care

Jon Blaschke MD

Cardiology

Jason Breed MD

Family Medicine

D. Randolph Brown, Jr. MD

Pediatric Ophthalmology

Andrew Chang MD

Radiation Oncology

Lauren Chastain MD

Hospitalist

Michael Confer MD

Radiation Oncology

Rachel Crain MD

Otolaryngology

Samar Farghaly MD

Hospitalist

Manuel Fortes MD

Radiology

John Fuller MD

Pain Management

Charles Groves MD

Radiology

Tracy Langford DO

Psychiatry, Child/Adolescent

Melanie Marshall MD

Family Medicine

Margaret Mehle MD

Family Medicine

Andrea Miller DO

Obstetrics & Gynecology

Jeffrey Miller MD

Anesthesiology

Joseph Mitro MD

Obstetrics & Gynecology

Joseph Nguyen MD

Family Medicine

Bilal Piracha MD

Hospitalist

Catherine Porter MD

Neurology

Elizabeth Prater MD

Dermatology

Michael Roberts MD

Anesthesiology

Jason Sigmon MD

Otolaryngology

Jesse Sullivan MD

Family Medicine



 
 
 
 
 


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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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