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Thank you for this. </div>
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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. </div>
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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.</div>
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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!!</div>
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Jon Price MD</div>
<div style="color: rgb(0, 0, 0); background-color: rgb(255, 255, 255);" dir="ltr">
Co-chair Ohio AAP Pediatric Care Council</div>
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<div id="divRplyFwdMsg" dir="ltr"><font face="Calibri, sans-serif" style="font-size:11pt" color="#000000"><b>From:</b> Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces@lists.deltaforce.net> on behalf of Toni Wells via Ohioaap-practicemanagers <ohioaap-practicemanagers@lists.deltaforce.net><br>
<b>Sent:</b> Friday, December 3, 2021 2:12:30 PM<br>
<b>To:</b> ohioaap-practicemanagers@lists.deltaforce.net <ohioaap-practicemanagers@lists.deltaforce.net><br>
<b>Subject:</b> Re: [Ohioaap-practicemanagers] CPC kids question (Michael Chamberlin)</font>
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<div class="PlainText">[WARNING: External Email - Use Caution]<br>
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Dr. Chamberlain, <br>
<br>
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.
<br>
<br>
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.
<br>
<br>
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.
<br>
<br>
This could be similar to what you are experiencing. <br>
<br>
Hope this may shine some light on the problem. <br>
<br>
Have a great weekend!<br>
<br>
<br>
Toni Wells<br>
Practice Manager<br>
Certified Child Passenger Safety Tech<br>
<br>
Hometown Pediatric Care, LLC<br>
p:740.286.5455<br>
f:740.286.6782<br>
a:504 McCarty Lane, Ste 1<br>
Jackson, OH 45640<br>
w: hometownpediatric.com <br>
e: twells@hometownpediatric.com<br>
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-----Original Message-----<br>
From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces@lists.deltaforce.net> On Behalf Of ohioaap-practicemanagers-request@lists.deltaforce.net<br>
Sent: Friday, December 3, 2021 12:00 PM<br>
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Subject: Ohioaap-practicemanagers Digest, Vol 47, Issue 1<br>
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1. CPC kids question (Michael Chamberlin)<br>
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----------------------------------------------------------------------<br>
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Message: 1<br>
Date: Fri, 3 Dec 2021 09:36:19 -0500<br>
From: Michael Chamberlin <mikechamberlinsoapm@gmail.com><br>
To: "Ohioaap-practicemanagers@lists.deltaforce.net"<br>
<ohioaap-practicemanagers@lists.deltaforce.net><br>
Subject: [Ohioaap-practicemanagers] CPC kids question<br>
Message-ID:<br>
<CACoKQ8nts_gViePpXSYZx6WzdfX3T-oU6V02YTsNW7NeE-0heA@mail.gmail.com><br>
Content-Type: text/plain; charset="utf-8"<br>
<br>
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.<br>
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.<br>
<br>
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?<br>
<br>
Thanks for your help,<br>
<br>
Mike<br>
<br>
Michael Chamberlin, M.D., FAAP<br>
Pediatric Assoc. of Mt Carmel<br>
4371 Ferguson Dr<br>
Cincinnati, OH 45230<br>
513-752-3650<br>
513-752-3387 (fax)<br>
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