Children’s Hospital to use Evidence-Based Bronchiolitis Guideline
2010-12-30 - by Elizabeth Pierce, M.D.
CPF, CPIPA, and Children’s Hospital are teaming up to introduce an evidence-based order set for inpatients with bronchiolitis and asking the community physicians to help achieve a high level of compliance.
This order set does not include therapies of questionable value: antibiotics, cool mist, CPPD, steroids, or scheduled inhaled medications. A trial of inhaled albuterol, epinepherine, or hypertonic saline can be ordered (in your office, the ED, or inpatient), but the medication is only continued if there is documented improvement. This guideline will apply only to patients 8 weeks of age and older with no other diagnosis. Here is the order set and you can follow these links to evidence-based documentation from Cincinnati Children's Bronchiolitis Guideline, and review articles about Epinephrine and Nebulized Hypertonic Saline for bronchiolitis.
Contact Paul Hain (615-936-4040, paul.hain@vanderbilt.edu) or Liz Pierce (615-838-0087, drp@rgpeds.com) for questions or concerns.
IPA's Clinical Integration Underway
2010-07-22 - by Devona Matthews
Our goal at Cumberland Pediatric IPA is to provide all participating members meaningful use criteria.
“Meaningful Use” is designed to improve efficiency in patient care and increase eligibility in pay-for-performance initiatives.
The IPA will aggregate data from independent practices, and Monroe Carell Children’s Hospital at Vanderbilt, creating a database to permit analysis of healthcare operations, application of clinical guidelines, and consulting and treating patients with similar illnesses. This aggregation of data will allow CPIPA to provide all participating members useful performance measures, statistical data and meaningful use criteria. The data set will also allow monitoring of patient outcomes and adherence to guidelines through interdependence and cooperation of primary care and specialist physicians.
Phase I of this project will include retrieving data from six to ten clinics (pilot clinics) from both practice management systems and electronic medical record systems. The IPA will then generate reports back to the pilot clinics, presenting both practice-level data and an IPA-level data to all IPA members.
Phase II will include all additional 26 clinics with electronic medical records systems and/or practice management systems and Children's Hospital at Vanderbilt. Reports will be generated back to individual clinics as well as combined reports to all IPA members and Vanderbilt. Statistical data will be used to coordinate P4P contracts with Managed Care Organizations. Individual practice or patient data will not be shared with other clinics and will not be shared outside of the IPA membership.
We are currently working with practices to get connected. If you have any questions please call or email devona@cpipa.org.
AmeriGroup PQIP in Full Swing
2010-07-02 - by Devona Matthews
The new Provider Quality Incentive Program (PQIP) is in full swing.
First quarter preliminary 2009 "base-year" and first quarter 2010 reports have been sent to all IPA practices. Final 2009 and updated first quarter 2010 will be send out in late August.
These reports are a tool to use for examining expenses incurred by patient for each practice and the IPA as a whole, as well as how much premium Amerigroup receives for each member assigned to each practice.
These preliminary reports show the IPA as a whole has decreased expenses for first quarter 2010 from last year. We expect to receive a small first quarter bonus in August or September. The new PQIP program is based on improving Medical Loss Ratio (MLR) from the prior year. Medical Loss Ratio is the gross profit of Amerigroup, specific to the IPA assigned members, which is Amerigroup revenue per member less the direct medical expense per member; it does not include any administrative expenses.
It is very likely we can improve the MLR 2% to 3% in 2010. For every 1% we improve the MLR, our bonus would be estimated at $400,000. The bonus estimate for a 2% improvement in MLR is equivalent to decreasing ER visits by 22% or down to 475 per 1,000 members (which was the criteria for previous P4P bonus plan). We still want to monitor and manage the number of ER visits and believe this can be done by fostering the Medical Home philosophy. Distribution of the bonus will be based on number of members and the decrease from prior year MLR, as well as establishing certain operational procedures such as extended hours in flu season, ER visit follow up procedure, or utilizing a nurse triage service.