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Live From Dallas + Some Correlations
Jan
15
I am, again, in the back of the room at our Coding and Practice management event and listening to Dr. Tuck. I have to steal a line or two from him, he’s got some good ones. Dr. Lander is next.
I’ve noticed some real changes in the audiences I speak to over the last few years. Today, when I ask, “Who uses RVUs to set prices?” most of the hands go up. Even 2-3 years ago, almost none went up. I like that.
Oh, I did get to make the first official announcement of our Disney C&PM event! Woohoo!
While Dr. Lander now explains how to collect money, let me share a few things we learned recently. Igor and I have been working on our “clinical benchmark” for PCC clients. Essentially, we’ve defined a series of pediatric specific measurements that even non-PCC clients can generate to get some sense of their clinical effectiveness. To do this, we started by making some assumptions and then ran the data. Then, we reviewed the results to confirm or deny our suspicions. We turned up some interesting results:
- There is a strong negative correlation between the percentage of Medicaid patients in a practice and how many of their asthmatics are caught up with their flu shots. [Note, this is, in part, due to those patients getting their shots elsewhere.]
- There is also a strong negative correlation between Medicaid presence and patients being up to date for their physicals.
- There is no correlation, however, between Medicaid and the Sick:Well visit ratio among our clients. I found that fascinating. It flies in the face of the “Medicaid clinic” stereotype, and it also shows that our clients are preventive care focused across the board.
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Flu shot *supply* a major factor in up-to-dateness
The first point is intriguing: the more Medicaid patients you have, the fewer asthmatics have had annual flu shots. I'd be interested in knowing how this ties to availability of VFC flu vaccine, which is an unstable variable at best.
That is, let's say I have 1000 Medicaid patients and anticipate getting 700 of them vaccinated; so I'll order 700 doses (well, more than that, since babies or other first-seasoners will get 2 doses -- but let's do round numbers.) And maybe I'll get 500 doses from the VFC program. If I'm lucky, in February or March, the state will "release" the remaining 200 doses to me.
Colleague A down the road has 50 Medicaid patients and anticipates vaccinating all of them. He orders 50 vaccines, and gets all of them, since our state's VFC program does not set caps on such a small order.
That is, he doesn't have to prove he's going to use all his vaccines, but I do, even though my Medicaid panel is 20 times the size of his.
I think a good correlative metric would be: given an X-dose shipment of VFC vaccine, at what rate (doses used per week, or whatever) does a practice deplete it? And how does this compare to a Y-dose shipment of non-VFC flu vaccine?
Example: Let's say I have 1000 Medicaid patients and get 200 doses of flu vaccine, which I blow through in a week. I have 1000 commercial patients and vaccinate 800 of them in a 4 week period. In both cases, I vaccinate 200 kids from each panel in a week. But at the end of the month, I've vaccinated 20% of my Medicaid kids but 80% of my commercial kids, even though I've offered both patient populations all the available vaccine I had at the time, and used it at the same rate. However, it makes my Medicaid immunization rates look crappy.
Flu shot *supply* a major factor in up-to-dateness
Yes, it would be interesting to more closely analyze how the Medicaid/asthmatic/flu shot/VFC relationship works, but gathering VFC availability in a meaningful manner is tough, to say the least :-) Still, the point is made: the more Medicaid kids you have, the fewer of their asthmatics have come to your office for their flu shots. I suspect we'd also see that the rate for the non-asthmatics is lower, too.
The only way to track the above - which would be very fascinating, I agree - is to consider the use of CPT II codes or similar. That is, at each visit would have an additional code for each vaccine indicating whether or not you gave the vaccine, etc. Are you familiar with that process?
Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog
Flu shot supply
OK... you can use the regular 90655-90660 codes to document patients who DID receive a flu vaccine (although with VFC stock, it would be a $0.01 charge.)
CPT II codes would be for tracking the encounters where a flu vaccine was NOT given. The possibilities would be:
* Flu vaccine not given, because it's not due (i.e. already had, either here or some other place of service; or 2nd dose isn't due yet)
* Flu vaccine not given, because it's contraindicated (severe egg allergy)
* Flu vaccine not given, because we offered but it was declined
* Flu vaccine not given, because we didn't have it available
In the first case, the metric to determine "due-ness" should fix this; also, we need to capture when flu vaccines are given outside the medical home (health dept, Walgreens, etc)
In the second case, you should be able to identify these kids by historical V codes.
The real challenge is going to be distinguishing the third case from the fourth case. If you have an electronic vaccine inventory, on the day when your VFC stock goes to 0 until the day it goes to a nonzero number, it's safe to assume that all are the fourth case...