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August 2018 News Flash

August 31, 2018

In this issue

  1. SAVE THE DATE! MN & WI Symposiums
  2. PROMs - Patient Reported Outcome Measures
  3. Utilization Management Improvements Coming in Late 2018
  4. HIPAA Compliance Monitoring
  5. Moving or Retiring? Let us Know!

SAVE THE DATE! MN & WI Symposiums

Fulcrum Health - Save the Date - Join us for one of our symposiums, 10.04.18 and 10.25.18

Please join us for one or both of our symposiums!

  • Continuing education credits
  • Engaging speakers - DC's, MD's, and more
  • Audience interactive panel discussion
  • Lunch & refreshments provided
  • MN Symposium 8:00 a.m. - 4:00 p.m.
  • WI Symposium 10:00 a.m. - 5:00 p.m.

Detailed agendas, invitations, and registration to follow.

Education

PROMs - Patient Reported Outcome Measures

Figure of a person next to a question markMeasurable goals and patient progress are an expectation in healthcare today. 

What is the best method to accomplish this task?

Patient reported outcomes allow for the proper management of a patient's care plan by either demonstration of treatment success or identifying a need to adjust the treatment approach. The initial outcome assessment score establishes a baseline from which to measure progress (or lack of) through periodic re-assessment to determine if the anticipated goals are attained.

Standardized outcome assessment tools provide a common language with which to evaluate the success of chiropractic care and allows for comparisons of effectiveness to other practitioners. Improved clinical practices can be determined through different intervention approaches and tracking outcomes.

Using outcomes shows:

  • Meaningful, measurable goals can be established with patients using this simple tool
  • Demonstrate the value of your care
  • Compare the quality of your care with your peers
  • Benchmark yourself against national recognized performance measures
  • Improve clinical practices approaches by tracking successes with chiropractic care
  • Driving quality payment initiatives

Where do I start? 

Find several outcome tools on ChiroCare Connect under the Clinical Resources/Provider Tools/ Outcome Assessments Toolbox Begin with the Neck Index and Primary Care Low Back Disability Questionnaire (PCLBDQ).

ADMINISTRATIVE

Utilization Management Improvements Coming in Late 2018

As mentioned in previous Newsflashes, Fulcrum Health’s strategic direction is to deliver high-quality, patient-centered, evidence-based care that also strengthens ChiroCare’s network providers' practice through outcomes data, treatment decision support tools, and education. With these improvements, we will advance our efforts in paying for value-based care
To achieve this, we are bringing our Utilization Management Program in-house. This new program incorporates concepts used in the CMS value-based model and use of outcome assessment tools, while providing additional tools and education to support better patient outcomes. The intent is to further the Triple-Aim - cost, quality, and patient experience.

Fulcrum is implementing this change to create a platform that adds quality measures to performance in addition to building a compensation system that pays for quality performance.

Enhance UM Program

  • Moving from volume service to patient-centered
  • Adding quality measures
  • Real-time treatment decision support tools with recommendations for care
  • Best practice guidelines
  • Proactive coding tips

Introduce Quality

  • Collect patient functional outcomes data
  • Improve measures that result in positive outcomes for patients
  • Improve understanding of medical risk factors
  • Enhance treatment decision support algorithms by incorporating risk factors and functional outcomes
  • Additional information to come in future Newsflash’s!

COMPLIANCE

HIPAA Compliance Monitoring

HIPAA text with magnifying glassThis article will provide guidance on ways to monitor your clinic’s compliance with the Health Information Privacy and Accountability Act (HIPAA).

HIPAA requires organizations that handle protected health information (PHI) to regularly review the administrative, physical and technical safeguards that are in place to protect the privacy and security of the patient information. It is critical that your clinic has policies and procedures in place that address the expectations and requirements of working with PHI. A simple way to find out if your policies are effective and to gauge how well your staff are following your organization’s policies is to observe staff during their day-to-day activities. This can be achieved by conducting routine walk throughs of your organization’s facilities. A walkthrough can help you uncover potential weaknesses in your policies, procedures or day-to-day operations. Here are some tips to consider before conducting a walkthrough:

  • Consider using a checklist – Remember, not every checklist will work for every clinic. Be sure to find one relevant to your staff and clinic.
  • Be “anonymous” – do not announce to staff that you are going to be monitoring their activities. This gives you a more accurate view of how your office is being run on a day-to-day basis.
  • Observe whether staff actions are in line with the policies and procedures already in existence.
  • Do not limit your walkthrough to just office hours. Check for privacy violations after staff have left for the day (i.e. computers locked, patient records properly put away, etc.).
  • Conduct walkthroughs regularly to stay in touch with how operations are being conducted. As staffing and policies change, you will want to conduct walkthroughs to ensure that staff were trained appropriately and/or that policies changes are being implemented correctly.
  • If you notice any violations or variations from expectations, you will need to speak with your staff and ensure that the identified issues are addressed going forward. This may mean that your policies and procedures need to be updated to address the issues that were found.

As always, if you know or suspect FWA is occurring in your place of business please report it immediately to Fulcrum’s compliance hotline at 1-866-714-0526. Tips can be left on this voicemail 24/7 by anyone (provider, office support staff, patients, etc.).

If you have any non-PHI related questions, please direct them to Compliance@FulcrumHealthInc.org.

Illustrated Man with Magnifying Glass

Moving or Retiring? Let us Know!

Address Book IconIt is vital that you report any practice changes to ensure that we have your current address, phone, fax, and email address. Any changes or corrections to your TIN/name combination should be communicated immediately. TheProvider Update tool within ChiroCare Connect offers a quick and electronic means to report changes. Simply select the “Billing Information Update” option within the Provider Update tool.

Please contact our Provider Services team at (888) 638-7719 with any questions about submission of updates.

We appreciate your continued partnership!