Family First Health Care

February 2016 News

Brianna Poole, PA-C joins the Family First Health Care Team!

Brianna graduated from Shenandoah University's PA Program. Brianna says, "Family Practice is a great fit for me because I will be given the opportunity to form lasting relationships with patients and help them in their journey in health throughout their lifetime. "I will get the chance to watch their story unfold", she says. She is originally from Jackson Michigan. In her free time she enjoys running and cooking. She loves sports and looks forward to coaching volleyball or softball in the near future. We are excited to have "Bri" join our team and look forward to working with her for many years to come.

FFHC Delivering Quality Care - How we measure up 2015 Final stats

Blue Care Network (Commercial)

  • Insurance Plan goal is to close 80% of patients gaps in care.
  • Offices within our Physician Hospital Organization (PHO) closed 63% of patient gaps.
  • State of Michigan closed 68% of patient gaps.
  • Region closed 68% of patient gaps.
  • Family First Health Care closed 81% of patient gaps.

Blue Care Network (Medicare Advantage)

  • Insurance Plan goal is to close 80% of patients gaps in care.
  • Offices within our Physician Hospital Organization (PHO) closed 80% of patient gaps.
  • State of Michigan closed 83% of patient gaps
  • Region closed 82% of patient gaps.
  • Family First Health Care closed 91% of patient gaps.

* More updates when they become available (March)

Eventful News

  • Happy Birthday! Angie Eagen Feb 14th, Jan McIntyre Feb 15th
  • PCMH Staff Training Coming (mandatory for our certification)
  • Upcoming - Voicemail tree for script requests, cancelled appointments
  • Upcoming - Time study will be done (per PCMH) to view when patient checks in, roomed then discharged. Please be conscious of this time study daily!
  • New for 2016 - Performance Evaluations
  • Monday, June 27 @ 4:00 p.m. - 401K Meeting

February Awareness

National Cancer Prevention Month

World Cancer Day (February 4th)

American Heart Month

What's New for 2016

  • Tobacco Cessation (18 years and older) is now a HEDIS Measure - There are three components of this measure. 1) Advise smokers and tobacco users to quit 2) Discuss cessation medications 3) Discuss cessation strategies.
  • Retired Measure - Follow-up Visits Post Hospital Discharge - moving to report only.
  • Revised Measures for Incentive Program 1) Depression Screening - Patients 12 years and older with PHQ2, PHQ4, or PHQ9 conducted during a PCP (E&M) visit. 2) Optimal Diabetes Care - added Diabetes Controlled Blood Pressure into the measure 3) Senior Care Education - implement routine discussions/counseling during annual wellness visits or a physical exam to cover the following topics with Medicare members (bladder control, fall prevention, mental health, physical health). 4) Patient Experience Survey - Must conduct a minimum of 150 surveys from May 1, 2016-January 31, 2016. 5) Care Management Incentive - Practices must meet/provide billed claims for care management services.


We have exciting news! The expansion project has been approved and will begin this spring. This will include four new exam rooms and a utility room. The existing exam room hall way will be extended out the front of the building to accommodate these rooms. Other changes include turning the current autoclave room into the providers dictation room housing three new stations

Billing News - A Step Ahead

Telephone E-Visits: CPT Codes 99441-99443

Some insurances are now covering Evaluation & Management services performed via the telephone for the treatment of “acute” conditions.

For example: If an established patient calls the office complaining of symptoms related to a UTI, they have had UTI’s in the past and just need a prescription. The doctor may be able to address the issues over a 5-10 min. phone conversation. He evaluates the patient and calls in a script, without the patient having to come into the office. He documents the phone call, and we can then charge for the service.

BCBS, BCN, HAP (plan specific), Priority Health, Health Plus, UHC and others are accepting the codes as billable codes and will process claims based on each individual’s policy. Most plans are covering it.

This is something that we will be starting to do in the very near future. We are working on getting all the processes in place right now.

**Reminder** HEALTHY MI PLAN is the Medicaid plan for patients aged 19-64 (this plan replaced the Adult Benefit Waiver program). HRA (Health Risk Assessment) FORMS – for adults only, must be completed within 150 days of their initial enrollment/effective date to qualify for the incentive:

  • Meridian Incentive $25

  • McLaren Medicaid $50

Medical Assistants - What's New

  • Medical Assistant assigned to specific provider daily (rotating schedule)
  • Preventative Care Reminder Postcards presented during visit and updated in Health Maintenance table the date the card was given
  • Must put in all orders including verbal orders from providers unless already done. The service has been done but without the order entered it has been missed on the superbill at times.
  • Receiving transferred calls from front desk - due to Hippa the front desk will no longer relay information prior to transferring calls.
  • Blood Pressure Control - If last one charted is uncontrolled and patient comes in for injection, flu shot, etc., take blood pressure to see if we can report a controlled BP for last one of year.

Front Desk - What's New

  • Patient Check In - Front desk must keep patient flow throughout day. Communication is key when unable to put patient up themselves in a timely manner.
  • Preventative Care Reminder Postcards to schedule appointments upon checkout
  • Front Desk to triage calls unless beyond clinical knowledge
  • Call backs - Front Desk to make call backs and only transfer to MA's if questions arise that are beyond their clinical knowledge.

Across the Miles

Jan and Mike are doing well. Jan says the weather was in the 90's when they arrived but has varied tremendously. She shared that most recently it goes down to freezing at night then holds steady at 70 degrees during the day. Mike is enjoying car things while Jan engages in pool aerobics daily. They are having a wonderful time with family and friends. She says she hopes we are all doing well and will see us in the spring!

Providers - Missed Diagnosis Closure Incentives

Diagnosis closure is a coordinated effort to ensure that patients with chronic conditions are seen every year and that their conditions are appropriately managed, evaluated, assessed or treated (M.E.A.T), along with newly identified conditions. There is an incentive payment of $100 per member issued for your role in addressing/closing 100% of each member's diagnosis gaps. A Gap is considered a historical or suspected diagnosis that hasn't been addressed and coded in the current year. A gap can also be a diagnosis that hasn't been confirmed as not applicable to the member.

Note: Diagnosis Gap Lists are derived from claims, lab results, pharmacy claims. These open DX Gaps will be noted at the top of the chart prior to the patient's visit. Keep in mind that that may be the last opportunity to close the DX gap if the patient does not return prior to the end of the year. If you deem addressing the condition at that visit is not appropriate, have the patient schedule a future appointment to address and close.

The gap should only be closed if you have conducted an office visit, addressed the condition and confirmed the patient still has the condition or determined that the patient no longer has the condition or the suspected condition does not exist.

*Note: Please address DX in chart note when refilling medications and add to superbill.

What Kite are you flying?

One windy March day the Mayor of the town decided to take a stroll across the park. He ran into a small boy who was flying the biggest and most beautiful kite he had ever seen.

It soared high and gently across the sky that the mayor was sure it could be seen in the next city. This little town didn’t have very many things that were spectacular, so the Mayor decided to award a “key to the city” to the one responsible for such a beautiful thing. “Who is responsible for flying this kite?” the Mayor asked. “I am,” said the little boy holding with all his might to the beautiful big kite. He said, “I made this huge kite myself, with my own hands. I painted all of the colorful pictures on it, and I fly it!”

“I am,” said the wind. “It is my breeze that keeps it in the air flying so big and beautiful. Unless I blow on it, it will not fly at all. I fly it!”

“Not so,” claimed the kite’s tail. “I make it sail and give it stability against the wind’s blowing gusts. Without me the kite would spin out of control and not even the boy could save it from crashing to the earth. I fly the kite!”

So, who flies the kite? They all do, don’t they?

In the day-to-day hustle and bustle of work it easy to forget that everyone flies the kite. Without the team, the leader would never be successful. Without a good leader the team would fail. Both need each other. And each person on the team need one another as well. They all fly it!

What kite are you flying?

Upcoming March Newsletter

This newsletter is put together in an effort to keep our staff informed on a continuous basis. If you have anything you would like to add or share in the March newsletter, please feel free to let Donna know prior to distribution.