The Oregon chapter of the American Academy of Pediatrics is committed to supporting the pediatricians in Oregon. This page is intended to provide introduction and links to practice management resources for primary care and specialty pediatric medical practices.
Practice Management Online (AAP membership required to access) is an excellent online resource maintained by the AAP Section on Administration and Practice Management (SOAPM). This is a very large section with excellent ongoing discussion on practice management issues. We recommend both of these resources for latest and most comprehensive information on practice management.
Primary care transformation for the 21st century is evolving towards the primary care medical home model. This model was originally developed by pediatricians and has been adopted to provide a framework for all primary care offices. The model as defined by the AAP is to deliver medical care in a way that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective. The shift is to more pro-active population management that is family centered and truly improves the health of a population.
Payment incentives are now available. For each patient with a qualifying diagnosis who received a "core service" at least quarterly you can receive additional per-member-per-month payments. This is available for those covered by an MCO or fee-for-service open card patients. To learn more visit Oregon Medical Home resources payment incentive page. In addtion you can download an excellent power point that reviews the rules.
- AAP National Center for Medical Home Implementation
- NCQA Primary Care Medical Home certification program
- Oregon state Standards and Measures for Patient Centered Primary Care Homes, with information on state certification in Oregon. These criteria may support enhanced reimbursment in the future from medicaid and state funded health insurances.
Oregon Coordinated Care Organizations (CCO)
Approved by the legislature in 2011 session was formation of CCO's to reform the delivery of medicaid in Oregon. Loosely modeled on federal ACO's (for Medicare) the intent is to better blend medical, mental health and dental delivery in a community. Structure will likely vary by community. To learn more visit Oregon.gov CCO resources. Many are up an running beginning 8/1/2012 with many more to start Fall of 2012. Most counties in Oregon will be covered with these first two waves. If you aren't talking with CCO leaders in your area, now is the time!
The Oregon Pediatric Improvement Partneship (OPIP) has drafted an excellent white paper on child health considerations for CCO's along with OPS and other partners. This is an excellent list of talking points when informing CCO of child health needs. Download
Accountable Care Organizations (ACO)
Accountable Care Organizations are new model for payment for health services in the country. The goal is to provide increase care coordination across medical services in a community to improve quality of care and reduce costs. Physician members of an ACO are financially rewarded for providing more cost effective care and take risk if utilization and costs increase. In many ways these are an extension of Primary Care Medical Home model with improved connections with community medical partners with goal for improved population management of health.
Meaningful Use (Health Information Technology)
In July of 2010 the final rules on meaningful use criteria were released. This is an incentive program as part of American Recovery and Reinvestment act of 2009 (“stimulus bill”). The incentives were designed to offset costs for medical offices to adopt, upgrade and implement medical records in a way that drives the delivery of quality health care. The meaningful use criteria are designed to transition use of health IT to improved data collection, reporting and sharing.
Most pediatricians will adopt under medicaid program which will be managed by the state, rather than directly with federal government. At this time 2011 practices will be able to qualify under Adopt/Implement/Upgrade criteria. Under this criteria practices only have to document they have put in place a certified EHR. Stage 1 meaningful use criteria will not have to be met until 2012. Registration for eligible providers became available in Oregon in Fall of 2011. Registration in 2012 is now available whether you are applying for your first or second year.
- Oregon State Medicaid Health IT Program for latest information regarding state implementation of meaningful use incentive program
- Office of National Coordinator (ONC) is federal program implementing federal health IT incentive program.
- AAP Child Health Informatics site is latest web site from AAP Council on Clinical Information Technology
- O-HITEC is regional extension center for Oregon to support medical practices in implementing and meeting meaningful use requirements. Many free webinars available reviewing relevant topics.
January 1st, 2010 the 5010 HIPAA claim form becomes the new standard. This is an upgrade from current 4010 standard. This is format of electronic claims transmission.
In October 2014 ICD-10 will be the new standard for diagnosis coding. This is a much larger code set than current ICD-9 diagnosis code set. This has been delayed several times with current date for implementation set to 2014.
There isn’t too much practices need to do now as most of the hard work will come from your billing software vendor. If considering purchase of new billing software in next year confirm vendor is ready for the transition for these two big changes coming. If you are already on an electronic billing system talk with your vendor to assure their readiness. As the ICD-10 transition comes closer practices will need to be sure to update superbills and EHR’s.
Healthcare Insurance Portability and Accountability Act was signed into law in 1996. Most offices are familiar and already have their policies and procedures in place. Since the original federal legislation there have been more recent updates as part of health care reform as well as changes in legislation here in Oregon. Each medical practice must meet the more stringent requirements when federal and state laws conflict.