Clinical Integration News

A Publication by Atlantic Coast Health Network

Clinical Integration News WINTER 2021

Inside This Issue Meet The Co-Medical Directors Value-Based Care: The Tools Drive the Work COVID-19 Impact on Healthcare Coding Corner

From The Executive Director Dear Friends and Supporters, Atlantic Coast Health Network (ACHN) is pleased to launch The CI Digest, a quarterly newsletter dedicated to supporting our physician partners in achieving value-based care success. As a regional clinically integrated network, our triple aim continues to guide our efforts towards improved patient outcomes, lower costs and a healthier population.

In this inaugural issue, we introduce the leadership team and all members of the Board and Committees, whose vision and dedication enable ACHN to implement evidence-based strategies across the care continuum. We also present the ongoing impact of the pandemic, and how our healthcare systems have risen to every challenge to care for our communities. Lastly, we offer insight on how to utilize and optimize the value-based tools we have at our disposal, including new coding guidelines.

ACHN is immensely grateful to our network’s providers and hospitals for helping us create sustainable pathways to care. As we continue to expand our digital publication, we welcome feedback. Which topics deserve more attention? Which resources would be most useful? Our hope is to be a valuable partner on this shared journey—together, shaping the future of healthcare.

With gratitude,

Luisa Hurtado Executive Director Atlantic Coast Health Network

Daniel S. Edelman, DO

Kenneth Homer, MD

Meet The Co-Medical Directors Daniel S. Edelman, DO Dr. Dan Edelman joined Memorial Healthcare System as the CMO for all value-based care programs, and Atlantic Coast Health Network as Co-Medical Director.

Dr. Edelman is an Internal Medicine physician who has spent the last decade supporting medical informatics and population health. Since 2013, he has predominantly focused on value-based care design, working with leaders in the industry, influencing caregivers, driving operations, and implementing new workflows. At ACHN, his goal is to drive success by optimizing resources, bringing greater value to the patient population.

Dr. Edelman holds a medical degree from Kansas City University and completed his clinical training at Mount Sinai Medical Center/Miami Heart Institute in Miami.

Kenneth Homer, MD Dr. Kenneth Homer serves as a Senior Leader and Chief Population Health Officer at Holy Cross Hospital. He also previously served as and is now consultant to the Medical Director of Holy Cross Physician Partners Clinically Integrated Network. In his leadership role as Co-Medical Director of Atlantic Coast Health Network, Dr. Homer aims to improve health outcomes, enhance patient satisfaction, and lower the total cost of care. Dr. Homer completed his undergraduate degree at Cornell University, Doctor of Medicine at the University of Miami and his Internal Medicine Residency at Northwestern University.

COVID-19 Impact on Healthcare As the COVID-19 pandemic continues to upend healthcare delivery across the nation, ACHN considers the impact on our own community. Throughout the crisis, Holy Cross Health and Memorial Healthcare System have responded in meaningful ways. We implemented testing and safety protocols early on, expanded telemedicine, provided educational resources, and participated in multiple research studies. We spearheaded mitigation actions including vaccine mandates for associates, and continue to emphasize the importance of vaccinations to anybody who hasn’t been vaccinated. As hospitals and providers, we stepped up to serve our community.

Even so, long-term implications were inevitable. Preventive medicine, a cornerstone of value-based care, faced several challenges over the past 18 months. Patients fell behind on their routine checkups and critical screenings. Elective surgeries were postponed. Physician offices were empty for several months, which trickled down to metrics.

Dr. Kenneth Homer, Co-Medical Director of ACHN, looks to value-based care to find the right balance.

“We had to move some of our resources to address the crisis. Our population health nurses and care management teams, in particular, had to switch gears and shift their focus to COVID-19 patients. On the other hand, they are now touching patients that may not have appeared to be high-risk before. In that respect, we are reaching a different patient population.”

According to Dr. Homer, 40,000 patients in our population still have conditions that need to be managed, irrespective to COVID-19. Prior to the pandemic, our teams were already going into homes to ensure that our patients had everything they needed to heal and stay healthy. We have continued to support our community in that way, making sure our patients receive adequate follow-up when they leave the emergency room or the hospital.

The demand for telehealth has also surged due to the pandemic, optimizing the way we deliver care. According to Dr. Homer, these digital solutions can be utilized to close care gaps and promote preventative health measures. “Blood pressure follow-ups, for example, are things you can do from home. By combining all of our resources, including telehealth and care management, we can continue to give patients the highest quality care.”

Despite all challenges, ACHN has maintained its focus on reaching targets. We continue to help physicians by reaching out to their patients directly, addressing any concerns and communicating safety measures. Our goal at ACHN has always been to improve patient outcomes. By doing that more efficiently, we keep patient populations healthier and lower the total cost of care.

Value-Based Care: The Tools Drive the Work Shortly after his first encounter with EMR, Dr. Daniel Edelman realized a powerful truth that has since defined his leadership role. The tools drive the work.

In a clinically integrated health system, these tools can drive a successful patient experience, and ultimately, a positive outcome. As the Co-Medical Director of ACHN explains, “population health is really about creating the tools that create better pathways for patients. With the right tools, there’s a whole litany of opportunity to outperform.”

One such opportunity in value-based care is the ability to customize cohorts of patients. Being able to identify diabetic patients with food insecurity, for example, allows providers to deliver the most appropriate care possible. We can further maximize these opportunities by leaning on the assets in our community who are not physicians but can support the experience. Instead of having one physician educate one patient on diabetes, a care manager can host a nutrition series for an entire group of newly diagnosed diabetic patients.

When resources are optimized in this manner, a greater portion of our patient population benefits.

Understanding quality outcomes and optimizing our physician partners toward a defined target for success becomes just as critical. At ACHN, we always consider how we deploy our resources and for whom that makes the most sense. The question becomes: Is this happening for the right patient, at the right time, and for the right reason?

“The value of our network is that we have a multitude of asset points to look at, correlate and understand, and then we utilize those tools to optimize experiences for our patients,” explains Dr. Edelman. “There’s always an opportunity to build better reports, educate, and hold people accountable. No one person can do this alone. It has to be a team of teams approach.”

Coding Corner ICD-10-CM Updates Every year, the International Classification of Diseases 10th Revision with Clinical Modifications (ICD-10-CM) is updated to accommodate changes that will apply to medical services performed on October 1st and on. During this year’s update, 20 revisions were made along with 32 deletions and the addition of 159 new codes (CDC, 2021). The following are highlighted changes that may impact your medical practice: Thrombocytosis has a new code Unspecified thrombocytosis is now code D75.839. The old code, D47.3, now classifies essential, idiopathic, and primary thrombocytosis.

Code both insulin and hypoglycemic drugs If the patient is treated with both oral hypoglycemic drugs and insulin for long-term glucose control, both codes Z79.4 and Z79.84 are assigned. Previous to this guideline, only the insulin code Z79.4 was used for patients on both therapies.

Depression has a new code Unspecified depression is now code F32.A. Previously, unspecified depression was classified as a single episode of a major depressive disorder (F32.9) HbA1c control in patients with diabetes The documentation in the medical record must include a note indicating the date when the HbA1c test was performed and the result. The most recent A1C level must be <8.0% for non-Medicare patients and <9.0% for Medicare (MA) patients to meet the measure.

Cough and low back pain got revamped The cough classification was expanded to include the severity of the symptom. In consequence, an unspecified cough is now classified using code R05.9. In addition, see the following new codes for other cough severities: • R05.1, Acute cough • R05.2, Subacute cough • R05.3, Chronic cough • R05.4, Cough syncope • R05.8, Other specified cough The classification of low back pain (LBP) was expanded to accommodate “vertebrogenic LBP,” code M54.51. Consequently, the new code for unspecified LBP is M54.50. In addition, another code for other types of LBP was created, M54.59.

Utilization guidelines for imaging studies for LBP Non-Medicare patients between ages 18-50 should not have an imaging study for an uncomplicated LBP less than 28 days of its onset (the first time the LBP code was billed on the claim). Other management options should be put in place before ordering an X-ray, MRI or CT scan.

A new specific code for COVID-19 residuals The new code to capture COVID-19 residuals is U09.9. This code substitutes a generic code, B94.8, which was used to identify several infectious sequelae, not just COVID-19. However, take into consideration the following guidelines when assigning the new U09.9 code.

• Code first the COVID-19-related residual, such as: – Chronic respiratory failure, J96.10 – Loss of smell or taste, R43.8 – Pulmonary fibrosis, J84.10 – Other • If the patient does not have any residual, use the history COVID-19 code Z86.16 instead.

• Active COVID-19 reinfections are coded using the U07.1, do not use U09.9. However, an exception is made in cases of re-infection with COVID-19, occurring with a condition related to prior COVID-19.

More codes for Social Determinants of Health (SDOH) Some SDOH categories were expanded to include more social factors. These are some of the new codes: • Z55.5, Less than a high school diploma • Z58.6, Inadequate drinking-water supply • Z59.01, Sheltered homelessness • Z59.02, Unsheltered homelessness • Z59.41, Food insecurity • Z59.811, Housing instability, housed, with risk of homelessness • Z59.812, Housing instability, housed, homelessness in past 12 months Documentation and reporting requirements SDOHs should be coded and reported when the information is documented. They do not need to be established by a physician since SDOHs represent social information rather than medical diagnoses: • They can be documented by social workers, community health workers, case managers, or nurses . and reported if their documentation is included in the official medical record.

• Patient self-reported documentation may be used to assign codes for SDOHs, as long as the patient self-reported information is signed off and incorporated into the medical record by either a clinician or provider.

If you have any questions, please contact Gabriel Aponte, MSHIA, RN, RHIA, Director of Clinical Documentation and Coding, at gabriel.aponte@achnfl.com.

References:

CDC, 2021. ICD-10-CM FY 2022 Changes: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2022/ LeBlanc, C. 2021. AHIMA Diving into the FY 2022 ICD-10-CM Diagnosis Code and Guideline Updates. https://journal.ahima.org/diving-into-the-fy-2022-icd-10-cm-diagnosis-code-and-guideline-updates/

Physicians in Leadership 2021 ACHN Board & Committee Membership BOARD OF MANAGERS

QUALITY & IT COMMITTEE

Physicians

Physicians

William Pena, MD - Chair Richard Perryman, MD - Vice-Chair Charles Russo, MD Alexander Llanos, MD Kenneth Homer, MD Mark Doyle

Matt Muhart Nina Beauchesne

Kenneth Homer, MD - Chair Shonte Fraser-Damas, MD Kenneth Budowsky, MD Brett Cohen, MD Eduardo Locatelli, MD Stacey Oddman, MD Je-Anne Beaufort, MD Michelle Fiorillo, DO Jennifer Goldman, DO Jennifer Capezzuti, MD

Non-Voting Members

Administrators

Luisa Hurtado (Ex-officio) Daniel Edelman, MD

Jeff Sturman Mike Paseltiner

Administrators

Non-Voting Members FINANCE & CONTRACT COMMITTEE Physicians Ben Freedman,MD Alex Llanos, MD Nigel Spier, MD Lav K. Goyal, MD Fausto De La Cruz, MD

Administrators Jeff Bross Matt Muhart* - Interim Chair Ron Brandenburg Sandy Seefeld Bill Pepe

Non-Voting Members Luisa Hurtado (Ex-officio) Daniel Edelman, MD Kenneth Homer, MD Richard Ashenoff Carol Toro

Luisa Hurtado (Ex-officio) Daniel Edelman, MD Monica Puga Maria Castanos Gabriel Aponte

Partnering For Your Health

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