PROVIDER FOCUS
AUGUST 2014
Cancer Staging Documentation Changes
Central Iowa Oncology Co-Management, LLC has recently taken on the task of streamlining the cancer staging documentation process. Many of you receive green staging forms to complete staging for patients with a cancer diagnosis. Beginning August 1, 2014, the John Stoddard cancer registry will no longer be sending you paper forms to complete staging; instead, you will be receiving a pended note in your inbasket in Epic that you must complete and sign. We are in the process of better identifying these notes in your inbasket, but temporarily they will come through as a progress note that requires co-signature from one of our registrars (Julie Meuler, Michelle Stewart or Julie Schmidt). To help you identify these notes, weekly we will also be sending a list via fax of the cases you need to stage and therefore should look for the co-sign required notes in your Epic inbasket. Just like other deficiencies, you must complete the staging documentation and sign these notes within 30 days to avoid creating a delinquency due to incomplete medical records. Please use the following reference as necessary to complete the staging:
Staging is an important step when determining cancer treatment and proper and timely documentation is required to demonstrate compliance with national treatment guidelines. Please still take the time to complete any green staging forms you still have from before August 1. This is important information for our cancer registry to have.
Please contact a member of the Quality Committee if you have any questions or suggestions about how this process can be further improved.
Quality Committee Members
Dr. Olaf Kaufman, Committee Chair
Dr. Matt Hill
Dr. Kathleen Hansen
Dr. Robert Isaak
Dr. Kyle Rogers
Dr. Andy Nish
Dr. Mark Purtle
Dr. Qasim Chaudhry
Carma Herring
CMS Policy Change Re: Physician Payments
Change in Medicare Policy That Affects Your Hospital Practice!
As of September 8, 2014, CMS will now allow recoupment of any payments made to physicians for services provided at the hospital if the hospitalization is denied or Level of Care otherwise changed.
- Prior to this policy change, CMS did not allow the audit contractors to act on the physician claim or other claims related to that hospital claim without a separate and distinct review of those claims.
- This policy change:
Now allows the contractors to act upon these related claims based on the results of the hospital claim review, without any additional and separate review of those related claims.
Means that physicians may now face a financial risk associated with inadequate chart documentation to support the medical necessity of a hospitalization or procedure.
Underscores the importance of the physician documentation in the hospital record.
The CMS Policy:
“The purpose of this CR# is to allow the MAC*and ZPIC* to have the discretion to deny other “related” claims submitted before or after the claim in question. If documentation associated with one claim can be used to validate another claim, those claims may be considered “related."
“The MAC and ZPIC shall await CMS approval prior to initiating requested “related” claim(s) review.
Approved examples of “related” claims that may be denied as “related” are in the following situations:
• The MAC performs post-payment review/recoupment of the admitting physician's and /or surgeon's Part B services. For services related to inpatient admissions that are denied because they are not appropriate for Part A payment (i.e., services could have been provided as outpatient or observation), the MAC reviews the hospital record and if the physician service was reasonable and necessary the service will be recoded to the appropriate outpatient evaluation and management service. For services where the patient’s history and physical (H&P), physician progress notes or other hospital record documentation does not support the medical necessity for performing the procedure, post-payment recoupment will occur for the performing physician’s Part B service.”
#CR=Change Request
*MAC and ZPIC are acronyms for several of the entities through which CMS contracts for post-payment claims audits/reviews/denials/recoupments
New Surgeon at Weight Loss
UnityPoint Clinic-Surgery and UnityPoint Clinic-Weight Loss welcome Steven Cahalan, MD, FACS to our experienced and dedicated team of specialty providers.
Steve completed his undergraduate education and medical education at the University of Iowa. He did his general surgery residency at Iowa Methodist Medical Center and has been practicing in the Des Moines area for over 20 years. He is certified by the American Board of Surgery. Steve’s clinical interests include general surgery, bariatrics and laparoscopy.
Infection Prevention News
We have heard a lot about Ebola in the past few weeks.
So what would you do if:
A 53-year-old female presents to your ED or clinic with a fever of 102.4F, chills and headache that began this morning. She is a missionary who returned 3 days ago from working in a Liberian hospital. She reports no unprotected contact with body fluids.
Q: With this history, what disease should be considered?
A: 1- Malaria, 2. Influenza. 3. Ebola 4. Typhoid Fever/Others
WHY:
1. Malaria:About 1,500 cases of malaria are diagnosed in the United States annually, mostly in returned travelers. Malaria diagnostics should be a part ofinitial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries
2. Influenza: Influenza should always be considered for patients with sudden onset fever headache and myalgia. This infection occurs worldwide and can be acquired in route.
3. Ebola: Since she had been in area of Ebola transmission within the known incubation period (typically 8–10 days, range 2 to 21 days) and has abrupt onset of fever, think of Ebola! Contact Infectious Disease Physicians and the Iowa Department of Public Health for testing and further guidance.
Q: Should this patient be isolated?
A: YES….. Use enhanced Standard, Contact, and Droplet precautions as required for Ebola. This will also prevent transmission of Influenza, (Droplet) Malaria (Standard) and other viral illnesses. See table for Enhanced Precautions. It includes face shield or goggles with mask and an impervious gown and other considerations.
For more information about Ebola, Malaria and Influenza visit CDC.gov
LifeFlight 35 Years
Des Moines’ mission to provide rapid, quality air transport of critically ill and injured patients was born on July 12, 1979, when the Iowa Methodist Medical Center launched the first medical transport service in the state. It was one of just 15 hospital-based programs in the nation at the time and the only air ambulance service in Central Iowa. Fast-forward 35 years and LifeFlight continues to fly hundreds of vital missions per year. Nearly 18,000 patient transports and more than 1 million miles later, LifeFlight remains dedicated to providing non-stop, life-saving transport to residents around 300 nautical miles of our destination facilities.
Today, LifeFlight is recognized as a leader in air ambulatory services throughout the Midwest. It is the only air program in Iowa to have three distinct teams to respond to scene flight requests for adult, pediatric and neonatal transport patients, as well as the ability to carry blood products onboard to transport patients requiring Nitric Ventilation.
Since its founding, LifeFlight has clocked more than 19,000 hours of flight time in air transportations from emergency scenes and between hospitals for patients in need of specialized medical care or surgical treatment. Their expertise spans a whole spectrum of emergency conditions, from trauma and extreme prematurity of a newborn to chest pain and stroke.
Quality in Action
Please click here to view the August edition of Quality in Action
Other Medical Notes
Medication changing to a controlled substance
Tramadol will become scheduled C-IV on August 18th. All DEA registrants will be required to inventory forms of tramadol on the effective date. With this change, discharge prescriptions in Epic will no longer be able to be e-prescribed and will need a wet signature (same as other controlled substance prescriptions). Automated dispensing machines (Pyxis) within UnityPoint will also be set to “blind count” for tramadol, consistent with controlled substance settings within automation. Please contact Brian D. Benson, RPh, Pharm.D, Executive Director of Pharmacy, for any additional information.
Achieving Safe Use of ER/LA Opioids While Improving Patient Care Webinar. This educational activity is supported by an independent educational grant from ER/LA Opioid Analgesic REMS Program Companies (RPC) to the Association for Hospital Medical Education (AHME). This activity is intended to be fully compliant with the ER/LA Opioid Analgesic REMS education requirements issued by the US Food & Drug Administration (FDA). Please note that this program also satisfies the Iowa physician licensure requirement for two hours of chronic pain management education (IA Administrative Code Chapter 11.4).
To register for this webinar please go to the following link This link can also be found on the UnityPoint Health – Des Moines intranet, Physicians tab,Continuing Medical Education.
Sticky Note Use by Ancillary Areas:
The Clinical Quality Improvement Committee (CQIC) for Unity Point Health Des Moines discussed the lack of a standard communication area for patient care recommendations at their July meeting. The committee decided that communication of recommendations by ancillary services should be standardized using the Epic Sticky Notes. Since the sticky note is not a part of the permanent medical record it is up to the provider to address the rationale to accept or reject these recommendations in the provider’s progress note. This has been implemented as of August 1st.
Recent trauma research that was presented and published:
Smith H, Tonui P, Spilman S, Schirmer L. In-hospital use of antidepressant medications in critically ill trauma patients. 47th Annual Society for Epidemiological Research (SER) Meeting, Seattle, WA, June 24-27, 2014.
Landeen C, Smith HL, Examination of pneumonia risk and risk levels in trauma patients with pulmonary contusion. J Trauma Nurs. 2014;21(2):41-49
In Stitches