agenda - dfa. · pdf filekeathley reported information was collected from uams, afmc,...
TRANSCRIPT
AGENDA
State and Public School Life and Health Insurance Board Quality of Care Sub-Committee
Meeting
March 8, 2016
1:00 p.m.
EBD Board Room – 501 Building, Suite 500
I. Call to Order ..................................................................Margo Bushmiaer, Chairman
II. Approval of January 12, 2016 Minutes .........................Margo Bushmiaer, Chairman
III. Continued Review of Anesthesia for Colonoscopies…….. ....... Dr. Creshelle Nash,
.............................................................................................. Medical Director BCBS
IV. Wellness Programs Presentation . Janna Keathley, EBD Quality Assurance Officer
............................................................................................ & Cecilia Walker, EBD RN
V. Update of Primary Care Referral Recommendation .......................... Janis Harrison,
..................................................................................................... EBD Interim Director
VI. New Business/Topics ...................................................Margo Bushmiaer, Chairman
Upcoming Meetings
April 12, 2016
May 10, 2016
June 14, 2016
July 12, 2016
NOTE: All material for this meeting will be available by electronic means only
[email protected]. Notice: Silence your cell phones. Keep your personal
conversations to a minimum. Observe restrictions designating areas as “Members and
Staff only”.
1
State and Public School Life and Health Insurance
Board Quality of Care Sub-Committee
Minutes
March 8, 2016 The State and Public School Life and Health Insurance Board, Quality of Care Committee met on March 8, 2016 at 1:00 p.m. in the EBD Board Room, 501 Woodlane, Little Rock, Arkansas.
Members Present Members Absent Margo Bushmiaer Marjorie Greenberg `
Zinnia Clanton Dr. Tony Thurman Michelle Murtha Dr. Eric Crumbaugh Pam Brown
Don Hollingsworth Dr. Joseph Thompson Robert Boyd Dr. Namvar Zohoori
Frazier Edwards David Bell (Proxy for Marjorie Greenberg)
Janis Harrison, EBD Interim Director, Employee Benefits Division
Others Present Dwight Davis, David Keisner, Geri Bemberg, Arlene Chan-Monton, Jill Johnson, R. Smith, Rachael McCaleb, UAMS; Ethel Whittaker, Janna Keathley, Stella Greene, Gretchen Baggett, Andrew Carle, Cecilia Walker, EBD; Pam Lawrence, AHH; Dr. Creshelle Nash, ABCBS; Marc Watts, ASEA; Steve Althoff, MTI; Kristi Jackson, ComPsych; Takisha Sanders, Jessica Akins, M. Carls, Health Advantage; Karyn Langley, Qual Choice; Ronda Walthall, Wayne Whitley, AHTD, Sean Seago, Merck; Andy Davis, Arkansas Democrat Gazette; Sean Sbago, Merck; Leah Ramirez, ACHI; Robyn Keene, AAEA; Martha Hill, Mike Motley
CALL TO ORDER The meeting was called to order by Margo Bushmiaer, Chair
APPROVAL OF MINUTES: By: Margo Bushmiaer, Chair
Bushmiaer requested approval of the January 12, 2016 minutes. Edwards motioned for approval of the minutes. Brown seconded. All were in favor.
Minutes Approved.
2
CONTINUED REVIEW OF ANESTHESIA FOR COLONOSCOPIES: By: Dr. Creshelle Nash, Medical Director, Blue Cross and Blue Shield Today’s discussion is a continuation from previous meetings. Standard of care is considered conscious sedation for colonoscopies. In today’s industry a vast number of clinics automatically administer propofol for anesthesia and the cost is passed on to the member. The plan will cover propofol only if it’s medically necessary, which must be verified by clinical documentation. The goal is to balance standard of care with the cost not allocated to the members. Currently, all screening colonoscopy claims with general anesthesia are denied until reviewed by Health Advantage for medical necessity. Dr. Nash reported BCBS can receive related claims depending on services rendered; (1) Facility Charge, (2) Anesthesia Charge, and (3) Physician Charge. Dr. Nash reported updated information regarding the physician numbers by city and their respective amount and percentage of general anesthesia use for screening colonoscopies. Murtha has concerns if the propofol is administered by a qualified CRNA or Anesthesiologist separate from the attending physician. Dr. Nash reported yes there is a CRNA or Anesthesiologist attending the patient.
Discussion was held and it was expressed that physicians are able to see more patients when using propofol; thereby, allowing quicker access to be seen by a physician. Hollingsworth expressed concern that a member might have to wait up to six (6) weeks for a colonoscopy if they were experiencing concerning symptoms. It was explained that the six (6) week time period only applies to screening colonoscopies and that patients have symptoms, they should be seen more quickly. A representative from BCBS reported most new GI physicians are only trained to use propofol. They receive no training on conscious sedation. After detailed discussion the committee requested literature from UAMS regarding their training program. In addition, the committee requested data regarding conscious sedation versus propofol. The data is to be presented at the next meeting.
WELLNESS REQUIREMENTS 2016: By: Janna Keathley, EBD Quality Assurance Officer, Cecilia Walker, Nurse Supervisor
Keathley reported information was collected from UAMS, AFMC, Nabholtz, Children’s Hospital, and Windstream. There are differences and similarities with the programs. Some similarities are they all require a health assessment and a
3
Biometric screening. There are multiple locations available for the screenings. Several have incorporated activities within their wellness programs. The Biometric screening includes: checking blood pressure, lipids, cholesterol, Body Mass Index (BMI) with weight circumference, and glucose. On-site and physician screening is also available. Penalties and incentives are incorporated in the programs. One organization reported they have found gift cards to be the most successful incentive. The following outlines the goals for the EBD wellness program:
- Establish a wellness program in the true sense of the word; - Establish a standard that is entrenched in our membership so they
have an expectation of completing wellness requirements annually; - Move toward increased membership engagement in the wellness
activities in years to come;
- Move toward measurable outcomes in the years to come.
Due to the current legislation in process regarding wellness programs, Dr.
Thompson recommended a representative from Medicaid provide data as well.
UPDATE OF PRIMARY CARE PHYSICIAN ASSIGNMENT: By: Janis
Harrison, EBD Interim Director
Harrison reported the Board met February 16th and adopted the Primary Care
Physician Program, previously recommended by the Quality of Care Committee.
Health Advantage has begun the process by providing letters to EBD for review
regarding the members and spouses. Upon approval by EBD, the appropriate
letters will be mailed to the members by Health Advantage.
NEW BUSINESS TOPICS: By: Margo Bushmiaer, Chair
There were no new business topics for discussion
ARKANSAS BLUE CROSS and BLUE SHIELD An Independent Licensee of the Blue Cross and Blue Shield Association
ASE/PSE Report
March 8th, 2016
Anesthesia for Lower Endoscopic Procedures
Creshelle R. Nash, MD, MPH Medical Director, Arkansas Blue Cross and Blue Shield
ARKANSAS BLUE CROSS and BLUE SHIELD
• The American Society for Gastrointestinal Endoscopy states that:
“The routine assistance of an anesthesiologist for
average risk patients undergoing standard upper
and lower endoscopic procedures is not warranted”
However general anesthesia is recommended in:
• Patients with more extensive GI endoscopy procedures (e.g.,
ERCP);
• Patients with complicated co-morbid medical conditions;
• Patients who cannot tolerate conscious sedation; and
• Patients with an increased risk for airway obstruction due to an anatomic variant.
The Issue of General Anesthesia
ARKANSAS BLUE CROSS and BLUE SHIELD
• Who are the physicians using general anesthesia for screening
colonoscopy?
• What are their rates of use by location?
The Questions from the Quality Subcommittee
ARKANSAS BLUE CROSS and BLUE SHIELD
• Claims data from 1-1-2015 to 12-31-15
• ABCBS can receive related claims depending on services rendered
• Facility Charge
• Anesthesia Charge
• Physician Charge
• We queried for all claims for screening colonoscopy in any claim field and associated services without exclusion
• Overall, we estimate that the anesthesia rate for screening colonoscopy by providers is 45%
• The Quality subcommittee has received detailed information on anesthesia rates
The Analysis
ARKANSAS BLUE CROSS and BLUE SHIELD
• Pending Claims
• Prior Authorization for general anesthesia for
screening colonoscopy
• Educational Efforts- at multiple levels
Member
Provider
Facility
Options for Intervention
Thank You
Providers total colonoscopy with and without anesthesia
Diagnosis (any field, primary, 2nd, 3rd, etc was routine)
DOS 01/01/2015 - 12/31/2015
Provider Total
billings of
Screening
Colonoscopy
Provider Total
Billings of
Colonoscopy
WITH
Anesthesia
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 1 Arkadelphia AR 24 0%
provider 2 Arkadelphia AR 29 0%provider 3 Batesville AR 8 3 38%
provider 4 Batesville AR 14 5 36%provider 5 Batesville AR 32 10 31%provider 6 Batesville AR 24 6 25%
provider 7 Batesville AR 10 0%provider 8 Batesville AR 2 0%
provider 9 Benton AR 1 1 100%provider 10 Benton AR 20 19 95%
provider 11 Benton AR 13 10 77%
provider 12 Benton AR 63 20 32%provider 13 Benton AR 42 0%
provider 14 Bentonville AR 4 4 100%
provider 15 Bentonville AR 3 0%
provider 16 Berryville AR 5 5 100%provider 17 Berryville AR 5 5 100%provider 18 Berryville AR 4 4 100%provider 19 Blytheville AR 8 8 100%
provider 20 Blytheville AR 1 1 100%
provider 21 Blytheville AR 1 1 100%
provider 22 Booneville AR 3 3 100%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 23 Booneville AR 4 4 100%
provider 24 Calico Rock AR 13 0%
provider 25 Camden AR 12 12 100%provider 26 Camden AR 1 1 100%
provider 27 Camden AR 1 1 100%provider 28 Camden AR 21 18 86%provider 29 Camden AR 3 2 67%
provider 30 Clarksville AR 16 0%
provider 31 Clarksville AR 5 0%provider 32 Clarksville AR 5 0%
provider 33 Clarksville AR 4 0%provider 34 Clarksville AR 4 0%
provider 35 Clarksville AR 4 0%
provider 36 Clarksville AR 3 0%provider 37 Clarksville AR 1 0%
provider 38 Clinton AR 4 0%provider 39 Clinton AR 3 0%
provider 40 Clinton AR 1 0%
provider 41 Conway AR 64 55 86%provider 42 Conway AR 54 46 85%provider 43 Conway AR 39 1 3%
provider 44 Conway AR 66 1 2%
provider 45 Conway AR 87 0%
provider 46 Conway AR 43 0%provider 47 Conway AR 9 0%
provider 48 Conway AR 3 0%
provider 49 Conway AR 2 0%provider 50 Crossett AR 11 11 100%provider 51 Crossett AR 9 8 89%provider 52 Danville AR 4 0%
provider 53 Danville AR 3 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 54 Danville AR 2 0%
provider 55 Dumas AR 1 1 100%
provider 56 Dumas AR 1 1 100%provider 57 El Dorado AR 3 3 100%
provider 58 El Dorado AR 3 3 100%provider 59 El Dorado AR 2 2 100%provider 60 El Dorado AR 1 1 100%
provider 61 El Dorado AR 22 21 95%
provider 62 El Dorado AR 48 45 94%provider 63 El Dorado AR 13 12 92%
provider 64 El Dorado AR 1 0%provider 65 Eureka Springs AR 2 0%
provider 66 Eureka Springs AR 1 0%
provider 67 Fayetteville AR 4 1 25%provider 68 Fayetteville AR 19 1 5%
provider 69 Fayetteville AR 189 0%provider 70 Fayetteville AR 46 0%
provider 71 Fayetteville AR 45 0%
provider 72 Fayetteville AR 31 0%provider 73 Fayetteville AR 27 0%provider 74 Fayetteville AR 22 0%
provider 75 Fayetteville AR 16 0%
provider 76 Fayetteville AR 12 0%
provider 77 Fayetteville AR 4 0%provider 78 Fayetteville AR 4 0%
provider 79 Fayetteville AR 4 0%
provider 80 Fayetteville AR 3 0%provider 81 Fayetteville AR 3 0%provider 82 Fayetteville AR 2 0%provider 83 Fayetteville AR 2 0%
provider 84 Fayetteville AR 1 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 85 Fayetteville AR 1 0%
provider 86 Fordyce AR 1 0%
provider 87 Forrest City AR 1 1 100%provider 88 Forrest City AR 11 5 45%
provider 89 Forrest City AR 19 8 42%provider 90 Fort Smith AR 16 16 100%provider 91 Fort Smith AR 5 5 100%
provider 92 Fort Smith AR 4 4 100%
provider 93 Fort Smith AR 2 2 100%provider 94 Fort Smith AR 1 1 100%
provider 95 Fort Smith AR 45 40 89%provider 96 Fort Smith AR 35 31 89%
provider 97 Fort Smith AR 148 126 85%
provider 98 Fort Smith AR 38 31 82%provider 99 Fort Smith AR 26 21 81%
provider 100 Fort Smith AR 46 37 80%provider 101 Fort Smith AR 49 32 65%
provider 102 Fort Smith AR 49 28 57%
provider 103 Fort Smith AR 14 7 50%provider 104 Fort Smith AR 1 0%provider 105 Fort Smith AR 1 0%
provider 106 Gentry AR 14 12 86%
provider 107 Germantown TN 5 5 100%
provider 108 Germantown TN 2 2 100%provider 109 Germantown TN 1 1 100%
provider 110 Germantown TN 1 1 100%
provider 111 Germantown TN 1 1 100%provider 112 Gravette AR 3 0%provider 113 Gravette AR 2 0%provider 114 Gravette AR 1 0%
provider 115 Greenville MS 2 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 116 Harrison AR 30 0%
provider 117 Harrison AR 23 0%
provider 118 Harrison AR 8 0%provider 119 Hazen AR 4 0%
provider 120 Heber Springs AR 13 1 8%provider 121 Heber Springs AR 12 0%provider 122 Helena AR 6 6 100%
provider 123 Helena AR 3 3 100%
provider 124 Hot Springs AR 12 12 100%provider 125 Hot Springs AR 4 4 100%
provider 126 Hot Springs AR 2 2 100%provider 127 Hot Springs AR 1 1 100%
provider 128 Hot Springs AR 29 28 97%
provider 129 Hot Springs AR 52 50 96%provider 130 Hot Springs AR 135 127 94%
provider 131 Hot Springs AR 67 63 94%provider 132 Hot Springs AR 47 43 91%
provider 133 Hot Springs AR 25 22 88%
provider 134 Hot Springs AR 7 6 86%provider 135 Hot Springs AR 6 5 83%provider 136 Hot Springs AR 10 6 60%
provider 137 Hot Springs AR 1 0%
provider 138 Jonesboro AR 26 7 27%
provider 139 Jonesboro AR 63 0%provider 140 Jonesboro AR 50 0%
provider 141 Jonesboro AR 54 0%
provider 142 Jonesboro AR 29 0%provider 143 Jonesboro AR 17 0%provider 144 Jonesboro AR 15 0%provider 145 Jonesboro AR 15 0%
provider 146 Jonesboro AR 12 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 147 Jonesboro AR 12 0%
provider 148 Jonesboro AR 3 0%
provider 149 Lake Village AR 5 5 100%provider 150 Lake Village AR 1 1 100%
provider 151 Lake Village AR 1 1 100%provider 152 Little Rock AR 38 38 100%provider 153 Little Rock AR 22 22 100%
provider 154 Little Rock AR 22 22 100%
provider 155 Little Rock AR 20 20 100%provider 156 Little Rock AR 4 4 100%
provider 157 Little Rock AR 3 3 100%provider 158 Little Rock AR 1 1 100%
provider 159 Little Rock AR 1 1 100%
provider 160 Little Rock AR 162 158 98%provider 161 Little Rock AR 27 26 96%
provider 162 Little Rock AR 65 62 95%provider 163 Little Rock AR 19 18 95%
provider 164 Little Rock AR 23 21 91%
provider 165 Little Rock AR 30 27 90%provider 166 Little Rock AR 17 15 88%provider 167 Little Rock AR 87 75 86%
provider 168 Little Rock AR 28 24 86%
provider 169 Little Rock AR 123 103 84%
provider 170 Little Rock AR 100 83 83%provider 171 Little Rock AR 51 42 82%
provider 172 Little Rock AR 33 27 82%
provider 173 Little Rock AR 33 27 82%provider 174 Little Rock AR 169 137 81%provider 175 Little Rock AR 40 32 80%provider 176 Little Rock AR 28 22 79%
provider 177 Little Rock AR 74 58 78%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 178 Little Rock AR 134 100 75%
provider 179 Little Rock AR 23 16 70%
provider 180 Little Rock AR 16 11 69%provider 181 Little Rock AR 386 259 67%
provider 182 Little Rock AR 3 2 67%provider 183 Little Rock AR 36 23 64%provider 184 Little Rock AR 2 1 50%
provider 185 Little Rock AR 9 3 33%
provider 186 Little Rock AR 43 11 26%provider 187 Little Rock AR 4 1 25%
provider 188 Little Rock AR 7 1 14%provider 189 Little Rock AR 66 0%
provider 190 Little Rock AR 49 0%
provider 191 Little Rock AR 39 0%provider 192 Little Rock AR 28 0%
provider 193 Little Rock AR 24 0%provider 194 Little Rock AR 23 0%
provider 195 Little Rock AR 15 0%
provider 196 Little Rock AR 12 0%provider 197 Little Rock AR 11 0%provider 198 Little Rock AR 10 0%
provider 199 Little Rock AR 9 0%
provider 200 Little Rock AR 8 0%
provider 201 Little Rock AR 5 0%provider 202 Little Rock AR 3 0%
provider 203 Little Rock AR 3 0%
provider 204 Little Rock AR 3 0%provider 205 Little Rock AR 3 0%provider 206 Little Rock AR 2 0%provider 207 Little Rock AR 2 0%
provider 208 Little Rock AR 2 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 209 Little Rock AR 2 0%
provider 210 Little Rock AR 2 0%
provider 211 Little Rock AR 1 0%provider 212 Little Rock AR 1 0%
provider 213 Little Rock AR 1 0%provider 214 Little Rock AR 1 0%provider 215 Little Rock AR 1 0%
provider 216 Little Rock AR 1 0%
provider 217 Little Rock AR 1 0%provider 218 Little Rock AR 1 0%
provider 219 Little Rock AR 1 0%provider 220 Lowell AR 34 29 85%
provider 221 Lowell AR 33 25 76%
provider 222 Lowell AR 27 16 59%provider 223 Magnolia AR 2 2 100%
provider 224 Magnolia AR 2 2 100%provider 225 Malvern AR 7 1 14%
provider 226 Malvern AR 1 0%
provider 227 Memphis TN 2 2 100%provider 228 Memphis TN 2 2 100%provider 229 Memphis TN 1 1 100%
provider 230 Memphis TN 1 0%
provider 231 Memphis TN 1 0%
provider 232 Mena AR 13 13 100%provider 233 Mena AR 11 11 100%
provider 234 Mena AR 3 3 100%
provider 235 Monticello AR 6 6 100%provider 236 Monticello AR 3 3 100%provider 237 Monticello AR 14 13 93%provider 238 Monticello AR 5 4 80%
provider 239 Morrilton AR 3 3 100%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 240 Morrilton AR 14 13 93%
provider 241 Morrilton AR 13 11 85%
provider 242 Mountain Home AR 42 0%provider 243 Mountain Home AR 16 0%
provider 244 Mountain Home AR 14 0%provider 245 Mountain Home AR 12 0%provider 246 Mountain Home AR 11 0%
provider 247 Mountain Home AR 9 0%
provider 248 Mountain Home AR 1 0%provider 249 Nashville AR 11 11 100%
provider 250 Nashville AR 7 7 100%provider 251 Nashville AR 3 3 100%
provider 252 Newport AR 3 2 67%
provider 253 Newport AR 2 1 50%provider 254 North Little Rock AR 19 2 11%
provider 255 North Little Rock AR 24 1 4%provider 256 North Little Rock AR 34 1 3%
provider 257 North Little Rock AR 153 2 1%
provider 258 North Little Rock AR 48 0%provider 259 North Little Rock AR 38 0%provider 260 North Little Rock AR 30 0%
provider 261 North Little Rock AR 32 0%
provider 262 North Little Rock AR 25 0%
provider 263 North Little Rock AR 1 0%provider 264 Ozark AR 13 2 15%
provider 265 Ozark AR 7 1 14%
provider 266 Paragould AR 13 0%provider 267 Paragould AR 7 0%provider 268 Paragould AR 4 0%provider 269 Paris AR 6 1 17%
provider 270 Piggott AR 2 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 271 Pine Bluff AR 1 1 100%
provider 272 Pine Bluff AR 30 29 97%
provider 273 Pine Bluff AR 27 26 96%provider 274 Pine Bluff AR 46 38 83%
provider 275 Pine Bluff AR 46 37 80%provider 276 Pine Bluff AR 13 8 62%provider 277 Pine Bluff AR 2 1 50%
provider 278 Pine Bluff AR 48 4 8%
provider 279 Pine Bluff AR 47 0%provider 280 Pine Bluff AR 4 0%
provider 281 Pine Bluff AR 3 0%provider 282 Pocahontas AR 6 0%
provider 283 Pocahontas AR 4 0%
provider 284 Rockport AR 2 2 100%provider 285 Rogers AR 30 24 80%
provider 286 Rogers AR 158 124 78%provider 287 Rogers AR 30 23 77%
provider 288 Rogers AR 25 14 56%
provider 289 Russellville AR 12 1 8%provider 290 Russellville AR 40 0%provider 291 Russellville AR 42 0%
provider 292 Russellville AR 18 0%
provider 293 Russellville AR 4 0%
provider 294 Salem AR 1 0%provider 295 Searcy AR 33 0%
provider 296 Searcy AR 21 0%
provider 297 Searcy AR 10 0%provider 298 Searcy AR 7 0%provider 299 Searcy AR 5 0%provider 300 Sherwood AR 5 5 100%
provider 301 Sherwood AR 38 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 302 Siloam Springs AR 17 10 59%
provider 303 Springdale AR 13 13 100%
provider 304 Springdale AR 5 5 100%provider 305 Springdale AR 1 1 100%
provider 306 Springdale AR 53 49 92%provider 307 Springdale AR 2 1 50%provider 308 Springdale AR 9 0%
provider 309 Stuttgart AR 7 0%
provider 310 Stuttgart AR 4 0%provider 311 Texarkana TX 18 18 100%
provider 312 Texarkana TX 14 14 100%provider 313 Texarkana TX 12 12 100%
provider 314 Texarkana TX 83 82 99%
provider 315 Texarkana TX 28 26 93%provider 316 Texarkana TX 10 9 90%
provider 317 Texarkana TX 16 11 69%provider 318 Texarkana TX 25 12 48%
provider 319 Texarkana TX 9 2 22%
provider 320 Texarkana TX 7 0%provider 321 Texarkana TX 3 0%provider 322 Van Buren AR 3 3 100%
provider 323 Van Buren AR 4 3 75%
provider 324 Waldron AR 3 3 100%
provider 325 Waldron AR 2 2 100%provider 326 Walnut Ridge AR 5 0%
provider 327 Warren AR 5 5 100%
provider 328 Warren AR 2 2 100%provider 329 Warren AR 27 26 96%provider 330 Warren AR 15 14 93%provider 331 West Memphis AR 11 7 64%
provider 332 Wynne AR 11 0%
Provider City State All_ServBill WithAnes_S
ervBill
Percentage Billed
with Anesthesia
provider 333 1 1 100%
provider 334 Out-of-State 183 105 57%
6874 3523 51%