[Ohioaap-practicemanagers] CPC kids question (Michael Chamberlin)

Fri Dec 3 15:34:49 EST 2021

 I find it interesting that with CPC, the visit is included in the denominator for the 2 and under, maybe that has something to do with it? If the child is coming in as a walk in and doesn't have a visit within the last year, this would not be counted.  If Caresource is not including the denominator for the visits maybe that's the difference in the scoring?  We have reached out to Caresource to see if they use that same criteria.

Kathi Ely, RMM, REMS
Medical Practice Manager
Child & Adolescent Specialty Care
2760 S. County Road 25-A
Troy, Ohio 45373
937-667-7711 x 5

CARING FOR YOUR CHILD IS OUR SPECIALTY
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From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of Price, Jonathan via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
Sent: Friday, December 3, 2021 3:10 PM
To: twells <twells at hometownpediatric.com>; ohioaap-practicemanagers at lists.deltaforce.net <ohioaap-practicemanagers at lists.deltaforce.net>
Subject: Re: [Ohioaap-practicemanagers] CPC kids question (Michael Chamberlin)

Thank you for this.
We all start off wrongly thinking the flaw in the data is from our patients getting their immunizations elsewhere ( a previous practice maybe or the health department) and so their vaccines aren’t captured in our billing data.
 You point out the other explanation, which for you and probably for all of us might be a much bigger deal, which is attribution. Managed care plans assign patients to a provider but that doesn’t mean that they come to you at all and so your denominator in any quality calculation contains people you’re not at all responsible for.
    We just a conversation about this issue today at the Pediatric Care Council meeting where reps from CareSource and Paramount participated but we didn’t cover attribution. This is a great time to pass along this wrinkle to them and to contacts at ODH, on whom the Medicaid managed care plans depend for data!!
    Jon Price MD
     Co-chair Ohio AAP Pediatric Care Council

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From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of Toni Wells via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
Sent: Friday, December 3, 2021 2:12:30 PM
To: ohioaap-practicemanagers at lists.deltaforce.net <ohioaap-practicemanagers at lists.deltaforce.net>
Subject: Re: [Ohioaap-practicemanagers] CPC kids question (Michael Chamberlin)

[WARNING: External Email - Use Caution]

Dr.  Chamberlain,

We participate in Partner's For Kids for our Medicaid Managed Care kids.  We currently accept Caresource, Molina, United Healthcare Community Plan and Buckeye Health.

I have notice that our numbers have always appeared low on our HEDIS measures.  After much discussion and many review of records,  I have discovered that our the difference is between the number of patients that Medicaid has attributed to us vs the actual number of kids that are really our patients.   I  recently reviewed data from 2021 Q2, and found that approximately 75% of the kids attributed to us had never been seen in our practice.

It is frustrating!  We are a very small practice (1 physician) and I keep a close eye on all our numbers, so I KNOW we are doing the right thing.  When the reports come out, it is discouraging to see the numbers so low.

This could be similar to what you are experiencing.

Hope this may shine some light on the problem.

Have a great weekend!

Toni Wells
Practice Manager
Certified Child Passenger Safety Tech

Hometown Pediatric Care, LLC
p:740.286.5455
f:740.286.6782
a:504 McCarty Lane, Ste 1
   Jackson, OH 45640
w: hometownpediatric.com
e: twells at hometownpediatric.com

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Today's Topics:

   1. CPC kids question (Michael Chamberlin)

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Message: 1
Date: Fri, 3 Dec 2021 09:36:19 -0500
From: Michael Chamberlin <mikechamberlinsoapm at gmail.com>
To: "Ohioaap-practicemanagers at lists.deltaforce.net"
        <ohioaap-practicemanagers at lists.deltaforce.net>
Subject: [Ohioaap-practicemanagers] CPC kids question
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We have concerns that CPC kids is not accurately measuring our patients who are up to date on vaccines.  For example, CPC kids is saying that 11% of our 2 year olds are meeting the HEDIS measure for appropriate vaccination.
  The only managed Medicaid we participate with is Caresource. When we asked them, their reports are saying that over 70% of our 2 year old patients are meeting this metric.  This is quite a large difference.

Has anyone else seen discrepancies in their CPC kids metrics?  Does anyone know of a contact at CPC kids that we could discuss this with?

Thanks for your help,

Mike

Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)
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