Survey: What Does Success Look Like in an Integrative Oncology Program?

keywords and phrases: acupuncturists in oncology programs, hospital-based acupuncturists, integrative oncology, community surveys, metrics

www.thehospitalhandbook.com

Community Survey this Month: 

What Does Success Look Like in Integrative Oncology?

For those of you working in oncology/cancer care or a large % of your patient care is oncology/cancer care, this community survey is for you!

Please share the survey link with colleagues who can add their wisdom.

Survey Link

Suspense Date: respond by Oct. 1st, 2019

Goal: Learn about the current standards and metrics for integrative oncology programs focus on the work of licensed acupuncturists

How will this info be used?

1. Continue the discussion in the community about the following topics: using metrics in clinical care, finding relevant metrics for your work, how integrative oncology programs are being set up, maintained, and grown
2. When enough information gathered, will create a summary document(s) available to the discussion community and a public blog post summary via the blog 
3. Follow up interview potential about specific programs for those interested in participating, part of the "issues in hospital practice" community webinar/interview series. For more about this special Project series, go here.  

The survey link 

Why this survey

• Integrative oncology programs have been growing quickly in the last 5 years. I usually field questions to those practitioners in the community who are working in oncology, but the rate of queries coming in have increased in rate and complexity. To the point, I feel it would help us and the people-with-questions if I wrote up a summary of the community wisdom to share both in the discussion groups and in a blog post. 
• I still feel it is necessary to connect people entering these programs or, especially, those creating/standing up these programs to connect to potential mentors in the community. This does not substitute the person-connection/mentor-relationship building. It will, I hope, provide a softer landing spot for those who are in the “waiting place” to connect with their very busy mentors. Softer landing spot = basic background on the subject, resources to read and review, etc.

So, without further ado! Would you fill out this survey to share your wisdom before October 1st?

Thank you. 🏥🦋🙂☕️

If you are a student or practitioner in the field and are interested in connecting to mentors or programs,

1. First, check out our Hospital-based Practice Learning Opportunities Directory.
2. Then, if the options in the directory don't fit your needs, you can contact me via the website with your query. 

Related Blogposts

• Research Thursdays: Oncology
• Paths to Practice Interview with Dr. Annie Budhathoki of Huntsman Cancer Institute and Wellness Programs

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
for "research and metrics Thursdays" on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

Metrics in Pediatrics and Medical Herstory: Dr. Virginia Apgar

keywords: metrics, pediatrics, medical history, Dr. Virginia Apgar

Metrics in Pediatrics and Medical History: Dr. Virginia Apgar

• Hospital-based practice her-story tidbit with Dr. Virginia Apgar and the APGAR metric for infants:

While working at “Sloane Hospital for Women with laboring and new mothers [Dr. Apgar noticed] that medical personnel had no standardized way to assess the health of newborn babies. Although mortality for children under a year old had been going down in the U.S. between the 1930s and 1950s, the rate of death among newborns had remained constant, in part because doctors weren't identifying babies who were at risk. In a 1953 paper, Apgar proposed a test to assess infant health on five criteria: heart rate, respiration, color, muscle tone, and reflex irritability. Within a few years, the test was becoming broadly adopted and had become known as the Apgar Score, a mnemonic learning aid based on its inventor's last name which stands for Appearance, Pulse, Grimace, Activity, Respiration. Due to its effectiveness and simplicity, the Apgar Score was widely used by hospitals throughout the United States by the 1960s and is now used by doctors throughout the world.” [emphasis added]

References

• Herstory note is from A Mighty Girl blog.
• More about the Apgar score is and how it is used in practice (Medline article)

Related Information

• Are you an acupuncturist and want to learn more about working in labor and delivery (L&D)? Then check out the highly rated post-graduate studies on this subject with Claudia Citkovitz, PhD, LAc.
• For more about metrics and clinical outcome measures used in clinical practice, following the blogpost tag "metrics".
• For more about pediatrics in hospital practice for acupuncturists, use the search feature on this blog and type in "pediatrics". 

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

Summer Health Policy News Roundup

keywords: health policy

The Summer 2019 Health Policy News Roundup

• Medicare acupuncture coverage update, the July 2019 decision was in the “receiving comments” period until 8.15.2019.  
• Joint Commission blog post update on home health program measures and hospice measures
• How a recent U.S. Health Policy Addresses Social Determinants of Health
• The following July 2019 study, "Perspectives of Medicare Advantage Plan Representatives on Addressing Social Determinants of Health in Response to the CHRONIC Care Act" looked at how these insurance companies were responding to the Medicare incentive from innovative ideas to limits, including coverage of integrative health services.
• Why This Policy Change and Its Implementation is Important
• More than 1/3 of Medicare beneficiaries are enrolled in Medicare Advantage plans. These plans, under the 2018 CHRONIC Care Act must address these members’ social determinants of health through supplemental benefits (such as acupuncture and other integrative health modalities with an evidence base).
• Challenges these companies have when they are innovating new patient care coverage plans that address social determinants of health:
• finding strong evidence base for types of clinical care or procedures that show improved patient outcomes 
• finding evidence-base for cost-effectiveness 
• finding partners who can provide these evidence-based services
• getting clear guidance from CMS about what is permitted
• Read more at the blog...
• Public Health Policy
• Interested in learning about the health indicators for Healthy People 2030 and the process for identifying them?
• I recommend checking out the National Academy of Medicine’s recorded webcast of some sessions and looking up “Well-being in the Nation (WIN)” as part of the Healthy People 2030 process. 
• Public health and integrative health paradigms are inextricably linked 🙂🦋👩🏻‍🌾
• Perspectives on Pain Research, an update from NCCIH Director Dr. Helene Langevin (May 2019)
• The National Cancer Institute NIH Report
• Remember that NIH conference in February 2019? Here's the report from that conference, "The National Cancer Institute NIH Report". Thank you to Jennifer Stone for sharing this!

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

The Hospital Practice Handbook Project Resource: For Students, Prospective Practitioners, the New Hospital Employee, and the Current Hospital-based Acupuncturist

keywords: resource landing page (a work-in-progress), students, acupuncturists

www.thehospitalhandbook.com

Resources for Students and Prospective Hospital-based Practice Practitioners

• We finished the “prospective practitioner or student-interested- in-Hospital-practice” resource set in spring 2019 and you can order your copy of these resources at the website:
• Get Your Foot in the Door of Hospital-Based Practice: First Steps for the Acupuncturist or Integrative Health Student
• Workbook Companion, a resource with exercises to guide you through the “First Steps” outlined in the booklet.

Resources for the New Hospital Employee

• I have been beta-testing the reorganized resource for new employees (new hires to hospital practice) since spring. Here is the link for more info. 
• In the meantime, if you are new hire into hospital-based practice and don’t have several hospital-based practice mentors, please contact me via the website and I will endeavor to get you connected to some resources.
• Interview Series: Basics of Being an Employee in a Healthcare System: Focus on Performance Management
• I finished recording this interview series with Sondra Abanto, MBA, this spring. The next step is to work with a video editor.
• We are open to sponsors to help cover the costs of editing video and creating print and electronic resources for this series. If you know someone or a business or organization that may be interested in sponsoring or co-sponsoring an episode or the series, please share this post with them. Thank you!

Current Hospital-Based Acupuncturists and Their Hospital Sponsors

• The resources for current hospital practitioners include information on:
• the website
• the blog, and the closed discussion groups. 
• Resources on the blog include:
• The Hospital Practice Learning Opportunities Directory
• The Lunchtime Listen recommendations page. This is a growing list of audio or audiovisual resources recommended for integrative health practitioners in a hospital-based practice. 
• The blog has many more resources that are read-only
• If you are a current hospital-based acupuncturist and have not connected to these resources yet, contact me with your request, where you work, why you want to connect, and who your sponsor/mentor connection to the group is. If you don’t have a sponsor/mentor, let me know and I can work on connecting you to one.
• Tags in the blog that might interest you include
• leadership and workplace
• research literacy
• From the Gift Ideas page, you may find these categories interesting:
• Integrative Medicine: The Philanthropic Movement into Mainstream Medicine
• Reflecting on Leadership
• The Hospital Sponsor/Hospital Administrator
• The Researcher
• Gift ideas for the hospital-based practitioner

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

The Medicare Denial Letter

Topics: Medicare (CMS) denial letter, reimbursement issues in a hospital-based practice

Do you need a pdf copy of this article?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

The Medicare Denial Letter:

useful for this period of history when Medicare does not cover acupuncture services

Contributors: 

Bobbee Vang, LAc, Timothy Suh, DAOM, LAc, and Megan Kingsley Gale, MSAOM, LAc

 

example of a Medicare Denial Letter

CMS = U.S. Center for Medicaid and Medicare Services

FQHC= federally qualified health centers, more info at the FQHC website

BLUF = bottom line up front. Acronym communication tool

SBAR = situation, background, assessment, recommendation. A team communication tool.

Question(s) for practitioners working in CMS facilities (this includes FQHC) 

When a patient is eligible for Medicare, but Medicare does not cover acupuncture nor acupuncturists as providers, what is the process in billing for care? 

How do you process coverage for a Medicare-qualifying patient in a CMS facility?

Background: The rule in a CMS facility is that Medicare must be billed as primary and then denied in order to bill secondary/co-insurance or supplemental insurance. All other payors we bill under our credentials (as licensed acupuncturists).

Situation (Example): Since Medicare does not cover acupuncture services nor acupuncturists as providers, how does one deal with coverage for a Medicare-qualifying patient in a CMS facility?

In this case, my colleague is dealing with the supplemental insurance which is denying all reimbursement because they are “awaiting CMS denial”. My colleague’s GY modifiers are now getting denied, too. Prior to Jan. 1^st, 2018, they were getting covered/accepted.

Assessment: Yes, you cannot bill. If you bill Medicare, it won’t be considered. So, then it will not be “officially denied”. Treatment must be officially denied by Medicare before you can bill any other insurance or reimbursement program.

Recommendation:

BLUF: Ask the patient to submit a “request for medical reimbursement”. Since the patient is enrolled in Medicare, the payor must respond to the payment. The response [from CMS/Medicare] is the denial. That response lasts a lifetime and does not need to be renewed. Make a copy of that denial for future billing.

What form is the “request for medical reimbursement”?  

screenshot of form CMS 1490S

8.2019: Form number has changed. The correct form is now CMS 1490S, “request for medical reimbursement”.

Note from the CMS website:

• “Effective April 1, 2019, only the revised 01-18 version will be accepted for the Form CMS-1490S. the provided link below includes the form and all the applicable instructions. Please read all the instructions prior to submitting a claim to Medicare. (1) The Form CMS-1490S is fillable, can be completed online, printed then mailed. (2) Mail the completed form and itemized bills to the correct Medicare Administrative Contractor as indicated on pages 7 through 18 of the instructions.”
• Landing page
• Form: English version; Spanish version
• If you read this and the form is again outdated or you want to make another correction, please note it in the comments below or contact me on the website. Thank you.

“We have kept a denial letter from our early insurance years stating the denial. We keep this letter and send it to the secondary insurance. Most supplement insurance will not cover what Medicare does not deny. The one supplement insurance I have noticed covering acupuncture in my region this year is a Medicare Advantage plan, ‘UnitedHealthcare AARP Medicare Advantage Supplement’. However, a true secondary insurance may have coverage. “–Timothy Suh

Since the CHRONIC Care Act of 2018, some supplement insurance, namely Medicare Advantage plans, do cover acupuncture services. This coverage is highly variable, though. To learn more about this special case coverage in Medicare Advantage and what the CHRONIC Care Act is, go to the related blog post on this health policy. 

“Personally, I believe Medicare is a fight worth fighting for. [In a few years it is likely] we will have coverage. All the signs point toward it. The only issue is to create the data that backs our medicine in a biopsychosocial model that is accepted by the current system.” -Bobbee Vang

Review

To clarify:

1. The fill-able form, “request for medical reimbursement” is on the CMS website.
2. The screenshot at the top of this post is an example of what a Medicare Denial Letter looks like.
3. Once you have a Medicare Denial Letter for a specific patient, keep it.
4. This letter is good “forever” or until the law changes.
• It takes an Act of Congress for a profession to be added as a covered benefit in Medicare law/Social Security Act. For more info see section 1861 of the Social Security Act. 

• “Medicare is a defined benefit program. For an item or service to be covered by the Medicare program, it must fall within one of the statutorily defined benefit categories outlined in the Social Security Act.”—cms.gov

Related Blogposts

• What is CMS?
• The CHRONIC Care Act: A Health Policy focused on Addressing the Social Determinants of Health
• For more on team communication techniques like BLUF and SBAR, see the HH Project’s
• “Basics of Being an Employee in a Healthcare Setting: Focus on Performance Metrics” series
• or the “New Hospital Employee” resource  

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

Lunchtime Listen Recommendation: The VA Whole Health Program

keywords: Veterans' Health Administration (VHA), U.S. Department of Veterans' Affairs (VA), acupuncturists, the new "whole health" program

The VA Staffing Position for Acupuncturists
Acupuncturists are being hired as a unique staffing position into the U.S. VHA system as part of their whole health programs.  See the "VA Staffing Code" blogpost for more information.

What is the Whole Health program at the VA?
I recommend watching this presentation of Dr. Tracy Gaudet's work with this field-forwarding initiative to learn more. Dr. Gaudet's lecture here is the NIH's Stephen E. Strauss Distinguished Lecture, given November 29th, 2018, "Transforming Veteran's Health Care: The Whole Health System". 

The Academic Collaborative of Integrative Health hosted a webinar series that included a presentation (6.13.2019) on the VA's Whole Health model, "VA's Whole Health System: What can be learned and applied to your practice?" by Kavitha Reddy, MD, and Lauri Phillips, RDN, LD. More information, including how to download slides can be found at the ACIH landing page for this presentation.

For more about the Lunchtime Listen Recommendations series, learn more at this webpage and check out the related YouTube playlist.

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

The CHRONIC Care Act: A Health Policy Focused on Addressing Social Determinants of Health

keywords: Centers for Medicaid and Medicare Services (CMS), Medicaid, Medicare, federally qualified health centers (FQHC), Medicare Advantage plans, health policy in the United States, social determinants of health (SDOH), patient-centered medical home (PCMH), accountable care organizations (ACA), community health, population health

themes: evidence-based health care, addressing social determinants of health (SDOH) to decrease societal health care costs, addressing SDOH to improve individual health outcomes, public health, health policy

Do you want a pdf copy of this article? 
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. 

Community News on U.S. Health Policy, Research, and Measuring Patient-Centered Outcomes (Metrics): Medicare the CHRONIC Care Act

You know how hit or miss, depending on your region, the Medicare Advantage plans are on covering acupuncture the past couple years? Ever wonder why the Advantage plans have more variability than standard Medicare? This article from JAMA that touches a bit on Medicare Advantage plan flexibility and the 2018 CHRONIC Care Act helped me better understand this and how it has impacted coverage of acupuncture services.

Medicare Advantage programs (not to be confused with regular Medicare) are allowed to be innovative.  In fact, you may have noticed several programs are leading the way on innovation and coverage of integrative health services and other wellness-promoting and function-promoting services.

Some of this innovation is in response to recent federal health policy initiatives to address social determinants of health (SDOH) in patients and patient populations with chronic health conditions.

The following July 2019 study, "Perspectives of Medicare Advantage Plan Representatives on Addressing Social Determinants of Health in Response to the CHRONIC Care Act" looked at how these insurance companies were responding to the Medicare incentive from innovative ideas to limits.

acronym of "CHRONIC" stands for: "Creating High-quality Results and Outcomes Necessary to Improve Chronic care" aka the "CHRONIC Care Act of 2018"

Connection to Integrative Health (IH)

The IH paradigm looks at a person as a garden, as part of a larger system that includes their environment and community. Some Medicare/Medicaid advantage programs have begun covering IH care, including services provided by acupuncturists as related to its large evidence base demonstrating improved health outcomes. Medicare Advantage program patients can receive care at private practice clinics or hospital-based outpatient clinics.

Why This Policy Change and Its Implementation is Important

According to the paper, “The passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act in 2018 allows Medicare Advantage (MA) plans, which enroll more than one-third of Medicare beneficiaries, greater flexibility to address membersʼ social determinants of health (SDOH) through supplemental benefits.”

“To provide more benefits to address SDOH, MA plans may learn from the experience of other payment models in expanding their service offerings. While, to our knowledge, there is no evidence to date of how MA plans can better address SDOH, flexibility has existed to address SDOH and other patient needs in patient-centered medical homes, 36 accountable care organizations (ACOs),10,37-41 and Medicaid Managed Care. 42-44" [emphasis added]

Challenges these companies have when they are innovating new patient care coverage plans that address social determinants of health

1. finding strong evidence base for types of clinical care or procedures that show improved patient outcomes 
2. finding evidence base for cost-effectiveness 
3. finding partners who can provide these evidence-based services
4. getting clear guidance from CMS about what is permitted

"In particular, ACOs may face many of the same challenges as MA plans as they begin to take on more capitated risk, i.e., the need for a strong evidence base that addressing SDOH may improve patient outcomes and reduce costs, the ability to find partners who can provide these services, and clear guidance from CMS about what is permitted.39"
"In a 2014 qualitative study (38) of ACO perspectives on SDOH, ACOs, similar to MA plans, were interested in expanding these types of benefits but did not always know how." [emphasis added]

"The Hennepin model, (41) in which a Medicaid Managed Care agency partners with a hospital, a community health center, and the county department of health to better coordinate services, is often seen as a successful example of how organizations can address SDOH through community partnerships."
"The past successes of Medicaid Managed Care in addressing SDOH may be an even more relevant example to MA plans on how an insurer can best address these concerns.(10)” [emphasis added]

source:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2737895

Citation: JAMA Netw Open.2019;2(7): e196923. doi:10.1001/jamanetworkopen.2019.6923 


More information about Medicare Advantage Programs (updates added 9.30.2019)

• How New Medicare Advantage Programs are Lowering Healthcare Costs, an article by AthenaInsight published 6.11.2019 
• CMS Announcement published 4.2019
• Community Aging in Place--Advancing Better Living for Elders (CAPABLE), a related John Hopkins program

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee.
All proceeds go toward basic operating costs to keep the HH Project going. Thank you.

Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com