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Educating Practices in Community Integrated Care for Children with Special Health Care Needs

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Educating Practices in Community Integrated Care for Children with Special Health Care Needs Pennsylvania Chapter, AAP A Medical Home Initiative – PowerPoint PPT presentation

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Title: Educating Practices in Community Integrated Care for Children with Special Health Care Needs


1
Educating Practices in Community Integrated Care
for Children with Special Health Care Needs
  • Pennsylvania Chapter, AAP
  • A Medical Home Initiative
  • of the MCHB

2
Community Integrated Care for Children with SHCN
  • Federal MCHB
  • Medical Home Initiative
  • EPIC-IC Education/QI Program
  • Demonstration Projects
  • Advocacy
  • Pennsylvania DOH Program
  • Support EPIC-IC
  • Care Coordination Demonstration Projects
  • Child Care Education about children with SHCN

3
Other EPIC Programs
  • Immunization Education
  • Stop Child Abuse Now (SCAN)
  • Smoking Cessation

4
Case Presentation
5
Why should you care about children with SHCN?
  • Increasing numbers of children with SHCN--time,
    cost
  • Opportunity for improvement
  • Health care system built around acute care, not
    chronic care
  • Families want more involvement in care process
  • More care provided in the home and community
  • Primary care practice staff want to provide the
    best care possible

6
Take
Home Message
  • Primary care practices can
  • Develop patient/family centered care
  • Identify and monitor children with SHCN
  • Improve coordination of care and communication
  • Improve documentation to enhance coding and
    reimbursement.
  • Improve how the primary care practice team
    provides chronic care through systems change
  • Facilitate patient access to services in
    practice and community

7
Community Integrated Care for Children with
SHCN
  • Who are Children with SHCN?
  • What is a Medical Home?
  • Where should we focus?
  • How does this relate to our practice?
  • How can we improve our practice?

8
Who are children with special health care needs?
  • Children with Special Health Care Needs are
    those who have or are at increased risk for a
    chronic physical, developmental, behavioral, or
    emotional condition and who also require health
    and related services of a type or amount beyond
    that required by children generally. (Maternal
    and Child Health Bureau 95)

9
Children with Special Health Care Needs
600
360
140
4
2
10
Epidemiological Statistics of Children with
Special Health Care Needs (1994) 18 of
Children or 12.6 million (0-18 years of age)
CwSHCN Typical Avg.
  • Avg. Annual School Absences 7.4 2.8
    3.6
  • with Health Insurance 88.8 86.4
    86.8
  • with Usual Source of Care 94.4 93.2
    93.4
  • not Satisfied with Care 17.9 13.6
    14.7
  • with Unmet health Needs 12.9 6.4
    7.6
  • Avg. Annual Physician Contacts 6.4 2.6
    3.3
  • Avg. Annual Hosp.Days/1000 691 122
    225

Newacheck et al. Pediatrics, Vol 102, No. 1,
July. 1998, pp 117-121
11
Annual Cost of Medical Care for Children with SHCN
12
A Medical Home
  • Is an approach and process to providing care
  • Is not a building
  • Is a partnership with the child, family and
    practice care staff
  • Emphasizes the primary care practice as the
    home where the family and child
  • Feel recognized and supported
  • Find a centralized base for medical care
  • Find connection to other medical and non-medical
    community resources

13
Components of Care in a Medical Home
  • Family-Centered
  • Accessible
  • Comprehensive
  • Continuous
  • Coordinated
  • Compassionate
  • Community-Based
  • Culturally-Competent
  • Provided in an Environment of Trust and Mutual
    Responsibility

14
Identifying Challenges to Medical Home Care
  • TIME, TIME, TIME
  • (and reimbursement)
  • Organized systems of care
  • Adequate parent-professional partnerships
  • Knowledge
  • Communication
  • Coordination
  • Medical staff turnover
  • Awareness of community resources and programs

15
Physicians and Parents Ranking of Services
  • Ranking
  • Service
    Physicians Parents
  • Respite care
    1 9
  • Day care
    2
    21
  • Parent support groups
    3 3
  • Help with behavior problems 4
    10
  • Financial information or help 5
    2
  • After-school child care
    6 20
  • Assistance with physical
  • household changes
    7 15
  • Vocational counseling
    8 6
  • Psychological services
    9 5
  • Homemaker services
    10 22
  • Recreational opportunities 13
    4
  • Information about
  • community resources
    14 1
  • Dental treatment
    16 8
  • Summer camp
    19 7

16
Benefits to the Practice
  • Increased professional satisfaction
  • Improved coordination of care
  • Efficient use of limited resources
  • Streamlined office procedures
  • Compensation for the additional care provided

17
Benefits to Patient/Family
  • Increased quality of care
  • Increased patient and family satisfaction
  • Improved communication with physician and staff

18
Benefits to the Community
  • Improved coordination of care
  • Increased integration of CSHCN into schools and
    extracurricular activities

19
Community Services for Children with SHCN and
Their Families
  • Role of Primary Care Practice in Community
    Services
  • Child Welfare
  • Social Services
  • Early Childhood Services
  • Education
  • Mental Health
  • Community Based Therapies
  • Public Health
  • Family Support
  • Spiritual Support

20
Changing a primary care practice is like trying
to change the tire on a bicycle while you are
riding it
21
Getting Started
  • Identify the team within the practice
  • Evaluate practice
  • Identify the CSHCN in the practice
  • Select a parent advisor
  • Share concepts and goals with practice staff

22
Identifying the Team
  • A practice team includes
  • Primary care clinician
  • Nurse manager/care coordinator
  • Office manager
  • Parent advisor

23
Evaluating the Practice
  • Medical Home Index
  • Medical Home Family Index

24
Identifying CSHCN
  • Utilize severity scoring tools available
  • Define chronic conditions within the practice
  • Use ICD-9 codes and Flu shot list to identify
  • Review utilization reports to determine those
    children seeing gt 1 specialist on a regular basis
  • Determine how to identify the chart i.e., using
    color coded charts, stickers, and binders

25
Select a Parent Partner
  • Identify potential parent advisors who will
    provide effective input
  • Communicate role and responsibilities of parent
    advisor
  • Be open to constructive feedback regarding
    practice policies and procedures

26
Share Concepts/Goals With Practice Staff
  • Present the broad, general topics of the medical
    home and role of parent advisors to all members
    of your practice
  • Meet with your practice team to choose and plan
    your first improvement project
  • Implement practice wide
  • Review with your practice team
  • What worked
  • What did not
  • Celebrate your success

27
Key Factors for Success
  • Unifying leadership
  • Common goal
  • Thorough planning
  • Staff buy-in
  • Communication plan
  • Small steps first
  • Learn from your mistakes

28
Practical Applications
  • Scheduling
  • Use a telephone script for all schedulers to
    easily identify those children requiring extra
    time
  • Parent Advisors
  • Develop Tips sheet for parents
  • Act as a resource for other families of CSHCN
  • Provide community resource information for the
    practice

29
Practical Applications
  • Coordination of Care
  • Complete care plans or summaries for each child
    with SHCN. One copy for chart, one for family.
  • Fax back forms being used to facilitate
    communication with subspecialists
  • Develop flow sheets for specific diseases that
    providers and staff will use for care

30
Practical Applications
  • Reimbursement
  • Conduct coding sessions for staff to understand
    correct coding for CSHCN
  • Update encounter forms to include CPT and ICD9
    codes that reflect the population seen
  • Develop progress note templates to ensure
    accurate documentation

31
Compensation
  • Coding
  • Documentation
  • Data Collection
  • Managed Care Negotiation

32
Coding for Children with Complex Medical Needs
  • No specific code exists for additional time and
    effort required
  • Use appropriate E M code following
    documentation guidelines
  • Remember if its not documented it didnt happen

33
Coding for Children with Complex Medical Needs
  • Preventative medicine service codes (99381-99397)
    with the use of E/M codes (99201-99215) and the
    25 modifier
  • Counseling and/or risk factor reduction codes
    (99401-99412)
  • Team conferences (99361-99362)
  • Telephone calls (99371-99373)

34
Coding for Children with Complex Medical Needs
  • Care plan oversight services (99375-99376)
  • Prolonged physician service (99354-99359)
  • Office or other outpatient service codes
    (99201-99215)
  • Consultations (99241-99245)
  • Modifier 21/09921

35
Summary
  • This is introductory material a starting point
    to create an ongoing process to
  • Develop a patient/family--physician/practice
    relationship of care
  • Improve how the primary care practice team
    provides chronic care
  • Integrate comprehensive care of the child with
    the community

36
Other EPIC IC Trainings Available
  • Family Centered Care
  • Care Coordination
  • Practice Management/Care Design
  • Transition

37
Where Do We Go From Here?
  • Develop the infrastructure, develop the process
  • Start with a few small steps
  • Recognize that change needs to be gradual
  • Implement medical home strategies one at a time
  • After strategies have been implemented for a few
    months, evaluate progress

38
Contact Information
  • EPIC IC Program
  • (800) 414-7391
  • Email at paaap_at_voicenet.com
  • Helpful Websites

39
Home is the place where When you go there They
have to take you in R. Frost
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