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Clinically Integrated Network Newsletter
May 18, 2023
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Coming Soon for Adult and Pediatric PCPs! Your 2022 Clinical Integration Index Score Report
Your 2022 Clinical Integration (CI) Index Score Report will be available in mid-June and summarizes your performance in the 2022 CI Program. Watch for a communication from us that will share details on where to find your report in your practice’s OneDrive account. For adult PCPs, we’ll include details on the discrepancy review process and timeline for submitting documentation.
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Fulfill Your Practice Communication Requirement by June 30, 2023
It's time to complete the mandatory Practice Communication requirement of the 2023 Clinical Integration Program by updating your practice's demographic information on the MSHP Practice Profile. Information to review includes providers’ names, NPI, email address, provider type, specialty, EMR system name, EMR direct address, and practice location. Starting this year, we are also requesting information regarding telehealth services and online scheduling.
You can submit your attestation using the MSHP Practice Profile web tool. To learn more, review this communication or download these training guides for instructions on how to submit your attestation.
Note: Office managers can complete this on behalf of all physicians in your practice.
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Meet Your Quality Metrics: Kidney Health Evaluation for Patients With Diabetes (KED)*
Fulfilling quality metrics is crucial to our performance as a Clinically Integrated Network and impacts your incentive payments. Refresh yourself on the KED measure for patients with diabetes and ensure your eligible patients are screened appropriately.
Definition
The percentage of members 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year (or rolling 12 month period for our CI reporting).
How to fulfill this metric
Ensure your patients with diabetes receive the following during the measurement year:
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At least one eGFR (Estimated Glomerular Filtration Rate Lab Test)
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At least one uACR (Urine Albumin Creatinine Ratio Lab Test)
These tests may be performed on the same or different dates of service. The eGFR can be done through a BMP or CMP.
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*This measure was developed by NCQA with input from the National Kidney Foundation | |
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Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications
The DEA announced earlier this month that they are temporarily extending telemedicine flexibilities for the prescription of controlled medicines including Adderall, opioids such as oxycodone, and buprenorphine.
Review our April issue and this CMS Fact Sheet for more policy and procedural changes following the end of the PHE.
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MSHP Board of Managers Spotlight
Meet Mount Sinai Health Partners’ Board Member, David Brody, MD. Dr. Brody is a psychiatrist at David Brody, MD, PLLC. We recently caught up with Dr. Brody to learn more about him as a MSHP Board member!
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How long have you served on the Board:
Several years. (I actually don’t recall the year I joined the Board. Time flies when you’re having fun? Or just old. Maybe both).
What do you like most about serving on MSHP’s Board of Managers?
I enjoy the opportunity to interact with colleagues around integrating behavioral healthcare into primary care practice. I also enjoy the presentations at the Board about population health metrics, payer contracting and clinical outcomes. None of this existed when I attended medical school (in the twentieth century!) and I am consistently filled with admiration for the MSHP physician leaders who focus their clinical, administrative and academic work on population health.
What do you hope to accomplish while serving on MSHP's Board of Managers?
I want to be a voice that speaks to the importance of identifying opportunities in primary care to identify and treat psychiatric disorders. We know that most psychiatric medication is prescribed by PCPs, not by psychiatrists or non-MD psychiatric prescribers (e.g., psychiatric NPs). MSHP has improved access to behavioral health care for our patients and I want to help my clinical colleagues build on this success.
What are your interests/hobbies outside of work?
Fencing and reading
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We look forward to Dr. Brody continuing to
serve on MSHP’s Board of Managers!
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Dr. Brody recently sat down with our Director of Behavioral Health Population Management, Anitha Iyer, PhD to discuss behavioral health care access and integration, as well as his work on the Board of Managers and as a Medical Advisor for the Mood Disorders Support Group. | |
Interested in becoming part of MSHP's governance? Join a committee today! Reach out to Lauren Hertan to learn more about how you can participate. | | |
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Chronic Condition Management | |
Co-existing Medical and Mental Health Conditions | |
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In observance of Mental Health Awareness Month we'd like to take a minute to remind you of the importance of screening for depression and anxiety and share some resources for your practice.
Physical and mental health are closely intertwined and depression and anxiety can be chronic and debilitating disorders that severely impact patients’ functioning and quality of life. Numerous epidemiological studies have shown that patients with chronic medical diseases such as diabetes, heart failure and COPD have increased risk for depression. At the same time, there is strong evidence that people with depression are at higher risk of developing other chronic illness.
The relationship between depression, anxiety, and chronic medical disease can be complex; overlapping symptoms can influence severity, treatment adherence, and outcomes. Perceived shame, fear of discrimination, and lack of awareness around mental health needs, prevalence, and impact may prevent a patient from providing a full and accurate account of their symptoms.
Primary care providers are often the first line intervention for patients struggling with depression, and most antidepressants are prescribed by PCPs. The literature estimates that while 10-14% of patients in primary care have major depressive disorder, as many as 50% of these patients are not diagnosed. Very few adults without a depression diagnosis are screened in primary care practices, and men, adults 75+, minorities, and uninsured patients are even less likely to be screened. This gap in screening means many of our patients are not receiving necessary treatment and support.
We urge you to use the below materials to improve screening rates in your practice and ensure your patients are receiving treatment as needed:
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Ensure Your Billing NPI is Entered Correctly on Claims Submissions
Empire is enforcing the billing guidelines of CMS that hold providers accountable for billing claims data correctly. Effective December 9, 2023, claims submitted with missing or incorrect billing NPI will be rejected and returned. Submitting claims with complete and correct data is critical to ensure Empire is able to process your claims efficiently and accurately. All data fields on claims are used when building your claim records.
Learn more
To stay up to date with the latest news, guidance, and policy changes from Empire, sign up for their newsletter.
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United Healthcare Medical and Reimbursement Policy Updates
United Healthcare shared medical and reimbursement policy updates, effective May 1. They have also included reference documents pertaining to pharmacy and drug prior authorization, notification and medical necessity coverage criteria for medications with utilization management programs.
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Cigna Q2 2023 Network News
Cigna shared their Q2 2023 Network News. Highlights include:
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Policy reimbursement updates related to E&M codes—providers are required to submit office notes for certain modifiers on the same date of service
- Updates to the precertification/authorization list
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Updates to the Cigna for Health Care Professionals website that allows providers to easily see if care will be in-network or out-of-network for patients with Cigna-administered coverage
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EmblemHealth Updates
EmblemHealth shared their May 2023 provider newsletter. Highlights include:
- Process changes concomitant to the end of the COVID-19 Public Health Emergency
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Medical authorization requests for ConnectiCare Medicare Advantage members must be sent to ConnectiCare via the provider portal effective June 1, 2023
- Members will receive a new member ID card.
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Pharmacy authorization requests must be sent to the applicable pharmacy contacts
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Review Your Customized Reports for PCPs
On April 5th, adult PCPs and pediatricians in our network received customized reports in their One Drive account. Please be sure to view these reports — including the patient opportunity report that shows you patient-level information on care gaps and patients that need to be seen for appointments.
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2023 Reimbursement Rates for Contracted Health Plans
Reimbursement rates for top E&M codes for Manhattan localities are available on our website (login required). We have also added the fee schedules for our three opt in contracts: GHI Commercial, Emblem Health Enhanced Care Medicaid, and Empire Medicaid.
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Welcome to MSHP!
We'd like to extend a warm welcome to the newest members of our Clinically Integrated Network:
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Specialty Care
Daniel Adler, MD
Gastroenterology
New York Gastroenterology Associates LLP
New York, NY
Justin Balavram, PT
Physical Therapist
Gramercy Medical Pain Management, PA
Pearl River, NY
Sameer Berry, MD
Gastroenterology
New York Gastroenterology Associates LLP
New York, NY
Sun Chung, MD
Anatomic Pathology
New York Gastroenterology Associates LLP
New York, NY
Agnes Colanta, MD
Anatomic Pathology
New York Gastroenterology Associates LLP
New York, NY
Sheli Erspamer, AUD
Audiology
ENT and Allergy Associates
Brooklyn, NY
Yesika Garcia-Lopez, MD
Endocrinology
Bodhi Medical Care, LLC
New York, NY
David Kriegel, MD
Dermatology
West 57th Street Dermatology PLLC
Scarsdale, NY
Jennifer Leong, MD
Transplant Hepatology
New York Gastroenterology Associates LLP
New York, NY
Qinghu Ren, MD
Anatomic & Clinical Pathology
New York Gastroenterology Associates LLP
New York, NY
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Oliver Szeto, MD
Anatomic & Clinical Pathology
New York Gastroenterology Associates LLP
New York, NY
Jennifer Toh, MD
Allergy & Immunology
ENT and Allergy Associates
New York, NY
Carol Tong, DPM
Podiatry
TD Podiatry P.C
New York, NY
Ronaldo Zamuco, MD
Anatomic Pathology
New York Gastroenterology Associates LLP
New York, NY
Behavioral Health
Margaret Addiego, LMHC
Bethany Medical Clinic of New York, PLLC
New York, NY
Advanced Care Practitioners
Nia Gil, NP
Gynecology & Integrative Women's Care, PC
New York, NY
Artem Pinkhasov, PA
Bruce E. Katz, MD DBA JUVA Skin & Laser Center
Brooklyn, NY
Caroline Ready, PA
Bethany Medical Clinic of New York, PLLC
New York, NY
Michael Rubio, PA
Forest Hills Dermatology Group, PLLC
Forest Hills, NY
Marianne Woody, NP
Bruce E. Katz, MD DBA JUVA Skin & Laser Center
New York, NY
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If you have any questions about any of our announcements, please contact your Population Health Manager, email Mount Sinai Health Partners at mshp@mountsinai.org or call us at 877-234-6667.
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P: 877-234-6667
F: 646-537-1481
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