pediatric wcc cpm...pedi wcc cpm | 3 population • the recommendations included in this cpm are...

Pediatric WCC CPM

Mission Health SystemPat Brown, MDJune 2017

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Why focus on child well care?

• Well Child Care (WCC) is one of the primary means of ensuring that primary care clinicians can provide appropriate screening, immunizations and anticipatory guidance to our pediatric patients (newborns through adolescents 17 years of age) in the ambulatory setting.

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Population

• The recommendations included in this CPM are intended for average-risk patients and does not apply to patients who may need catch-up vaccines or who are otherwise deemed "high risk".

• The screening recommendations included in the WCC CPM are informed by – The American Academy of Pediatrics (AAP) Bright Futures

Guidelines for Universal Screening– The Center for Disease Control (CDC) Recommended

Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2017.

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WCC CPM Goals

• The goal of this CPM is to align the delivery of WCC and improve clinical workflows through a combination of:– 1) Updated PowerPlans– 2) New documentation templates– 3) Revised office protocols– 4) Guidance for appropriate charge capture

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Updated PowerPlans

• 14 PowerPlans for well child care were reviewed and updated to maximize:– Screening for prevention/early treatment

• Laboratory testing• Developmental & Social screening

– Treating for preventable conditions• Oral health• Immunization

– Enhanced charge capture

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Newborn & Infant - Laboratory

• Newborn Metabolic Screening – Confirm that newborn screening was performed or perform in the

office setting. • Bilirubin

– Infants should be examined at a delivering hospital with further testing as needed.

– Options for laboratory testing or point of care (POC). • Hg/Hct

– Screen at 12-months• Lead

– Screen at 12- and 24-months

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Newborn & Infant – Dev & Social Screening

• Maternal Depression Screening– Postpartum depression screening should be performed from

newborn through the 6-month visit. – Available tools include the PHQ-2/PHQ-9 depression screening

forms or the Edinburgh Postnatal Depression Scale (EPDS). • Charge code 96161 (Health Risk Assessment Caregiver)

• Developmental Screening – Developmental, behavioral, and psychosocial assessments are

recommended for every visit.– Specific validated screening tools (e.g. Ages & Stages) should

be used at the 9- and 12-month visits.• Charge code 96110 (Developmental Screening w/Interp+Reprt Std Form)

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Newborn & Infant – PowerPlan Screenshots

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Early Childhood (15-36 months)

• Laboratory Testing– None required

• Developmental Screening – Specific validated screening tools (e.g. Ages & Stages) at

- 18-months - 30-months- 24-months - 36-months• Charge code 96110 (Developmental Screening w/Interp+Reprt Std Form)

• Autism Screening (MCHAT)– Screen at 18- and 24-months

• Charge code 96110 (Developmental Screening w/Interp+Reprt Std Form)

• Visual Acuity– Screen at 3-years

• Charge code 99173 (Snellen Chart), 99174 or 99177 (Instrument ocular)

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Developmental & Social Screening

• Developmental Screening: ASQ– NC Health Check

Recommends Screenings at 6, 12, and 18 or 24 months

• Paper form with score charted

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Developmental & Social Screening

• Autism Screening: MCHAT– 18 months– 24 months

• Paper form with score charted

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Oral Health

• Oral Health Assessment– 6-months to 5-years

• Documented in PCA AdHoc form

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Early to Middle Childhood (4-6 Years)

• Laboratory Testing– None required

• Visual Acuity Screening– 4-years to 6-years


• Hearing Screening– 4-years to 6-years

• Charge code 92551 (Screening), 92552 (Threshold), 92567 (Impedance)

• Oral Health Assessment – Document in Oral Health Form

• Charge code D0145 (Comp Oral Evaluation)

• Dental Varnishing for at-risk patients– Through 5-years

• Charge code D1206 (Dental Varnishing)

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Early/Middle Childhood (4-6 Yrs) – PowerPlan Screenshots

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Middle Childhood (7-10 Years)

• Laboratory Testing– Cholesterol– Lipid Panel beginning at 9-years

• Visual Acuity Screening– 8-years and 10-years


• Hearing Screening– 8-years and 10-years


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Adolescence (11-12 Years)

• Visual Acuity Screening– At 12-years,11-years if risk factors exist


• Hearing Screening– Once between 11 and 14-years


• Depression Screening– 12-years

• Charge code G0444 (PHQ-A)

• Health Risk Assessment– 13 through 17-years

• Charge code 96160 for up to 15 minutes(CRAFFT assessment)

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Adolescence (13-17 Years)• Laboratory Testing

– HIV: Check once between 15- and 18-year visits– Chlamydia/Gonorrhea*: Once between 15- and 18-year visits – Lipid Panel: Between the ages of 17-21 years.

• Visual Acuity– Once at 15-years and other years if risk factors exist


• Depression Screening– 13 through 17-years

• Charge code G0444 (PHQ-A)

• Health Risk Assessment– 13 through 17-years

• Charge code 96160 for up to 15 minutes (CRAFFT assessment)* GC/Chlamydia is a selective screening option in the AAP Bright Futures Guideline

Reference the STD CPM (in development) for further guidance.

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Health Risk Assessment

• Health Risk Assessment: CRAFFT– 11-17 years

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Depression Screening

• Depression Screen: PHQ-A– 11-17 years

• Located in Ambulatory Pediatric Intake Form

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Vaccine Orders

• The PowerPlans have been amended to match the CDC recommendations for each age group.

• Because some Plans cover a range of ages, providers should review the patient’s vaccine status to determine the appropriateness of each vaccine order (e.g. Tdap & HPV are not required annually)

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Vaccine Refusal

• Handling Vaccine Refusals: It is important to listen to concerns, discuss benefits of vaccines and stress the number of lives saved by vaccines. Documenting vaccine refusal and the discussion about the benefits of vaccines is recommended for the visit notes.

• Suggested Autotext: – Parent refused vaccines at this visit. I reviewed the risks and

benefits of vaccinations as well as the risks of not vaccinating their child or delaying the vaccine schedule. Educational information about vaccines was provided to the family.

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WCC CPM Metrics

• Immunization compliance can be viewed on the NC Immunization Registry

Measure Definition ACO Goal

NCIR Immunizations @ 24months

% of Patients aged 24-35mo, who received DTaP (4), HepB(3), Hib(3), MMR(1), Polio(3),

Pneumo(4), Varicella(1) by time they were 24 months.

76%

NCIR Tdap (1) @13yo

% of Patients aged 13yo, who received Tdap(1) by the time they were 13yo. 88%

NCIR Meningococcal

(1) @ 13yo

% of Patients aged 13yo, who received Meningococcal(1) by the time they were 13yo. 87%

NCIR HPV(2) @13yo

% of Patients aged 13yo, who received HPV(2) by the time they were 13yo. 21%

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How to Run NCIR Data for your Clinic

All: Select Site (i.e. McDowell Peds). Go to Benchmark Reports

NCIR < 36 months. Choose all clients, Select Age range, youngest age 2, oldest age 3, assess clients with sufficient refusal history as covered. Select today's date. Select 431331 @ 36 months. Select Generate. Wait. Click on Benchmark report.

TDAP @13 . Choose birth date range 5/24/2003-5/23/2004. Assess Clients with sufficient Refusal as covered. Select Today's date. Select Adolescent Complete TD. Click Generate!

Meningococcal @13 . Choose birth date range 5/24/2003-5/23/2004. Assess Clients with sufficient Refusal as covered. Select Today's date. Select Adolescent Complete TD. Click Generate!

HPV @13 . Choose birth date range 5/24/2003-5/23/2004. Assess Clients with sufficient Refusal as covered. Select Today's date. Select Adolescent Complete HPV. Click Generate!

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WCC CPM Metrics

• Other metrics identified in the WCC CPM are also measured as part of the organization’s Pediatric ACO Quality Measures

Measure Definition GoalACO 14 Flu (Tier 2 only) 6 months and older seen for a visit between October 1 and March 31 who received or reported flu shot. 45%

ACO 17 Tobacco Use (Tier 2 only)

Percentage of patients aged 18 years and older who were screened for tobacco use AND who received cessation counseling if using 82%

ACO 18 Clinical depression + F/up (Tier 3) Percentage of patients aged 12 years and older screened for clinical depression AND follow-up plan 41%

ACO 61 Ped BMI (Tier 3) Percentage of patients 3-17 years of age w/ - Body mass index (BMI) percentile documentation* PLUS - Counseling for nutrition PLUS - Counseling for physical activity 76%

ACO 60 Asthma Meds (Tier 3) The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year 90%

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Documentation Templates

• Precompleted Note Templates are available for PowerNotes.

• By default the notes document a healthy child visit.

• The templates serve as a guide and must be updated for each individual patient visit.

• Developmental milestone questions are based on the Ages & Stages questionnaire.

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• Providers who use Dynamic Documentation can highlight the content of the Precompleted Notes and save this as an Autotext.

• The Autotext can be used to populate a Freetext Dynamic Doc template.

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• Select the text from the PowerNote and right-click to “Save As Auto Text”

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• Add a name in the abbreviation field (description is optional)

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• Open up Dynamic Doc and select “Free Text Note”

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• Begin typing the abbreviation you want to use

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• The content of the WCC note is now available for you to edit.

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Practice Resources

• Tools and Resources have been uploaded to the Mission Children’s Toolbox.

• The best way to find the Toolbox is to use your favorite search engine and search for “Children’s Service Line Toolbox”

http://www.mission-health.org/documents_links.php

http://www.mission-health.org/documents_links.php

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Appendix – PowerPlan Screenshots

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Early Childhood (15-36 months) – PowerPlan Screenshots

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Early Childhood (15-36 months) – PowerPlan Screenshots

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Early/Middle Childhood (4-6 Yrs) – PowerPlan Screenshots

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Middle Childhood (7-10 Yrs) – PowerPlan Screenshots

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Adolescence (11-17 Yrs) – PowerPlan Screenshots

pediatric wcc cpm...pedi wcc cpm | 3 population • the recommendations included in this cpm are...

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