In This Issue:
Welcome New Members!
From Our Email Inbox…
New Dates: University of St. Thomas Chiropractic Leadership Institute
June is National Safety Month
Triple Aim and Health Care Transformation
Minnesota Bans Anti-Bacterial Chemical from Soaps
- May 31, 2014: Active Care Program 4
- August 1, 2014: Deadline to apply for the Chiropractic Leadership Institute at the University of St. Thomas
Arik Axness, DC
Brian Benjamin, DC
Carissa Barnes, DC
Steven Cass, DC
Jason Fredericks, DC
Kaley Jacobsson, DC
Tiffany Kirkpatrick, DC
Danielle Klick, DC
Sarah Mack, DC
Matthew Mayo, DC
Jerrald Miller, DC
Alex Onsomu, DC
Jennifer Skelton, DC
Kathleen Clare, DC
Bridget Owens, DC
Brent Paulson, DC
Meggan Tank, DC
Q. We received a remit today from ChiroCare and a patient’s seventh visit was denied with the following code: “B5 – coverage/program guidelines were not met or were exceeded.” Prior to her visit, we verified coverage on the ChiroCare website and it listed the limit at 24 visits/year. Can you explain?
A. Under Medicaid in Minnesota, the law allows 24 chiropractic visits per year. Traditionally, Minnesota’s Medicaid agency has permitted health plans to confirm medical necessity through authorization requirements. While the majority of doctors in the ChiroCare network may treat patients without prior authorization, some ChiroCare providers currently have a preauthorization requirement after a certain number of visits. Six, in your case, have been paid but additional care requires authorization in order to be eligible for payment. The prior authorization process is actually designed to help protect doctors by confirming the medical necessity of care up front, significantly reducing the risk of refund requests following a retrospective review that covers many dates of service.
While the Department of Human Services (DHS) recently communicated a need for managed care organizations to follow the state’s chiropractic authorization criteria, and not require authorization before 24 visits has been paid, global discussions between DHS and managed care organizations related to that new requirement continue. Once the outcome of those discussions is known, ChiroCare will send a formal communication to its network of providers and implement any necessary program revisions.
The second cohort of CLI, originally scheduled to begin this month, will begin in September 2014. The health care industry offers numerous advancement opportunities for those who are ready, willing and able to take on new challenges. The University of St. Thomas can prepare you for your next role. To learn more about how you can gain fresh knowledge, insight and skills for a changing health care environment, click here.
National health observances provide a perfect opportunity to address certain topics with patients because your communications and conversations will be supplemented by information in the media. We can all use this month to raise awareness about important safety issues.
Injuries are a leading cause of disability for people of all ages — and they are the leading cause of death for Americans ages 1 to 44. The good news is everyone can get involved to help prevent injuries.
We encourage you advise your patients about important safety issues like prescription drug abuse, distracted driving, and slips, trips, and falls.
- Prescription drug abuse: Prescription painkiller overdoses are a growing problem in the United States, especially among women and teens. About 18 women die every day from a prescription painkiller overdose — more than four times as many as back in 1999. Teens abuse prescription painkillers to such an extent that they are considered the second most abused drugs by this group. The gateway for heroin addiction often begins today in our own medicine cabinets: About four out of every five new heroin addicts got addicted to prescription drugs before they turned to heroin. Here is a helpful fact sheet you can share with parents and/or teen-age patients.
- Slips, trips, and falls: One in three older adults falls each year. Many falls lead to broken bones and other health problems. ChiroCare’s Chief Clinical Officer, Dr. Vivi-Ann Fischer, devotes a blog to how pain medications can lead to falls, especially among the elderly.
- Distracted driving: Doing other activities while driving — like texting or eating — increases your chance of crashing. Almost one in five crashes (18%) that injured someone involved distracted driving. The National Safety council provides this fact sheet for use with patients. Patients with teenagers may appreciate your guidance in directing them to the National Safety Council’s “Pledge to Drive Cell Free.”
You can make a difference by reminding patients about these safety issues and encouraging them to make healthy and safe decisions.
For more information, visit the official site for National Safety Month.
Care delivery organizations are undergoing phenomenal change in their pursuit of the Triple Aim, described as:
- Improving the health of the population
- Improving the patient experience, including quality
- Improving the affordability of care by decreasing per capita costs
“I attended ICSI’s conference on May 5 and found it to be very valuable,” says Dr. Vivi-Ann Fischer, Chief Clinical Officer for ChiroCare. “The overall theme was the impact IT is having in health care today and using it to make health care systems sustainable. I look forward to applying some of the recommendations to our own Triple Aim initiatives.”
Here are some highlights from the 17th Annual ICSI Colloquium on Health Care Transformation:
- Top Questions: Will the emerging system rein in unsustainable health care cost increases and still ensure patients get appropriate care and value? How are health care systems reducing costs and remaining viable? What payment systems are working? Can we succeed without community and patient engagement? What new leadership skills will be required?
- Transforming Care Through Connectivity and Collaboration: “Unless you’re focused on both health and health care, and engaging with your system and the community, you won’t succeed at the rapid transformation needed in today’s environment.” Presenter Craig Brammer focused on providing better care for individuals, better health for populations, and lower per capita costs.
- Living with Chronic Disease: Kerri Sparling, creator and author of Six Until Me, one of the most widely read diabetes patient blogs, shared her experience living with type 1 diabetes…and how the health system can address the coming tsunami of patients with chronic diseases.
ICSI’s annual conference brought together more than 500 leaders working to advance and accelerate transformation in the health care system and in our communities. Workshops and presentations addressed leadership, accountable care, patient engagement, quality and safety, and the integration of behavioral health into primary care.
Gov. Mark Dayton on Friday signed a bill to make Minnesota the first state to prohibit the use of triclosan in most retail consumer hygiene products. The Minnesota House and Senate passed it earlier last week because of health and environmental concerns about the chemical. Even with the concerns, triclosan is used in an estimated 75 percent of anti-bacterial liquid soaps and body washes sold across the United States, according to the Food and Drug Administration. Click here to learn more.