Internal Gaps
Name the Internal Gaps (3)
HbA1c, Kidney Health Exam, and Blood Pressure
Name the External Gaps (4)
Breast Cancer Screening, Colorectal Screening, Osteoporosis Management, Diabetic Eye Exam
When does a patient fall into the MedAd measure?
Upon the 2nd fill using an MA benefit
When should you 'Create a Hospital Visit' in a blob?
When they have been discharged to home/long-term care
Where is Main Street headquartered?
Nashville, TN
Wy do we wait till the end of the year to chase BP and HbA1c?
The last reading is the only one that counts.
What information do you need to close a BCS Task?
Documentation Requirements:
Most recent mammogram with date of service (minimum month and year)
Mastectomy status and date of service (minimum year performed)
Patient reported mammograms are acceptable
Document date in the history or preventive service section of the medical record
Required Exclusions:
Hospice, Palliative Care, Long Term Care, or Enrolled in an Institutional Special Needs Plan (I-SNP) – only for patients who are 66+
Frailty and Advanced Illness – only for patients who are 66+
Bilateral mastectomy
History of bilateral mastectomy
Unilateral mastectomy on both the left and right side on the same or different dates of service
Two unilateral mastectomies, which do not specify left and right, must be performed 14 days or more apart (a single unilateral mastectomy does not count as a full exclusion)
Members who had gender-affirming chest surgery with a diagnosis of gender dysphoria
What is the best way to make sure your patient stays adherent to their medications? (2 answers)
Make sure the patient is on a 90-day Rx and are set up for home delivery
When should you 'Snooze' a blob?
If the patient has been discharged to a skilled nursing facility (SNF)
Who is the CEO of Main Street?
Brad Smith
The nurse takes the patient's blood pressure two times and gets the readings: 120/100 and 180/80. What should the nurse enter as the patient's blood pressure?
120/80
Name two test a patient can do, and how often, to close the Colorectal Screening gap
Annual fecal occult blood test, flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, computed tomography colonography every 5 years, stool DNA test every 3 years.
When does the patient fail the MedAd measure?
Patients “fail” the measure if, after picking up their medications twice that year, they do not have the medications on hand for at least 80% of days.
How long do we have to obtain a discharge summary?
2 Days
Who was the first Market President of TX?
Tim Bailey
The patient comes in for their KED and the provider tells you they are going to wait till the next appointment to complete the task. How should you disposition this?
Not Applicable>Provider will address at later visit> Provide next visit date
A woman 67-85 who suffered a fracture must complete a DEXA within 6 months or be prescribed an osteoporosis medication within 6 months UNLESS...
The patient had a BMD/DEXA test during the 24 months prior to the fracture
The patient had osteoporosis therapy during the 12 months prior to the fracture
The patient was dispensed a medication or had an active prescription for medication to treat osteoporosis during the 12 months prior to the fracture
How can we earn days back on a patients MedAd?
If they were in the hospital
Who can speak with the patient to close the Patient Engagement After Inpatient Discharge task?
ANYONE
Which Main Street Employee was once a school principal?
Jake Ramsey
You're stuck on how to move forward with a task and think you need to snooze it. What should you do first?
Call a TL or ANDREA :)
How do you close the DEE measure?
Documentation of retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) during the current measurement year
OR
Documentation of a negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement year
****BONUS 200pts: If the patient went in for an eye exam and the documentation does not mention retinopathy, can you still use this to close the measure?
****BONUS 200pts: Besides Frailty Codes and Hospice/LTC - What is the only other way to exclude the patient from the measure?
True/False: You can have the provider enter a frailty code to remove the patient from the MedAd Measure?
FALSE:
MAC Exclusions:
MAD Exclusions:
MAH Exclusions:
Who can speak with the patient to close the Medication Reconciliation task?
The Provider or the RN
*****Bonus 200 pts:
What do we need to close this measure?
Who is your favorite Market Manager?
Andrea Martos