Module 3, Slide 1

1
AAPHP Preventive Services Toolkit

• Planning
• -- selecting problems to address
• -- selecting interventions

2
Teaching Objectives

• Address preventive services from a policy
  perspective
• Understand how best to select problems to address
  and select packages of interventions
• Understand coding and reimbursement for clinical
  preventive services
• List and locate software and other tools for
  planning and evaluation
• Understand how statistical approaches to planning
  and evaluation differ from research

3
Policy and Management Issues from a Healthcare
Perspective - 1

• Many preventive services are considered social or
  educational not medical services
• Counseling services are often seen as soft and
  ineffective
• Some preventive services not reimbursed as
  clinical services
• Most are unrelated to current chief complaints

4
Policy and Management Issues from a Healthcare
Perspective -2

• Some are best provided on a community, rather
  than clinical, basis
• Benefits may be indirect and therefore difficult
  to quantify
• Benefits may only accrue to a percentage of
  recipients, and therefore be difficult for staff
  to recognize
• Return on investment (both health-related and
  fiscal) are often delayed

5
Benefits of Preventive Services

• Improve health outcomes
• Improve compliance with regulatory and
  accreditation guidelines
• Reduce healthcare costs
• Reduce absenteeism
• Improve job performance (of patients)
• Increase satisfaction by all stakeholders
• Improve the communitys perception of the local
  healthcare system

6
Initiating a Preventive Services Plan

• Acceptance of bright ideas, innovations, local
  preference or opportunity  
• Analysis of  practice diagnosis-specific
  treatment data
• Regulatory and accreditation guidelines 
• Community Diagnosis per outcome of COPC process

7
Implementing Preventive Services

• Select the problem and/or the intervention
• Select population(s) to be served
• Consider the Evidence
• Define the
• Package of interventions
• Baselines and benchmarks
• Secure authorization and resources
• Advocate, Implement, Evaluate

8
Accreditation

• Immunization child, adolescent, adult
• Cancer screening breast and colon
• Chlamydia screening
• Smoking cessation
• Prenatal and postnatal care

9
Evidence Based Interventions

• High Priority Health Conditions
• Diabetes
• Obesity
• Heart Disease and Stroke
• Asthma
• Cancer
• Physical Inactivity and Poor Nutrition
• Tobacco Use\Youth Risk Taking

10
Planning Datasets

• Demographics and other data from state and local
  health departments
• Billing data
• Medical records data
• Opinion/perception data
• Focus-group-like sessions with patients and staff
• COPC process
• Newly gathered statistical data interviews and
  survey techniques

11
Establish Baselines, Benchmarks and Objectives By
Sub-Population

• Define sub-populations
• Determine baselines from local data
• Identify benchmarks from reference documents
• Determine health outcome goals and objectives

12
Coding and Reimbursement - 1

• Some clinical preventive services are
  reimbursable, others are not
• Which ones are reimbursable varies with health
  plan
• Many physicians and administrators not aware
  available codes to secure Medicare and other
  reimbursement

13
Coding and Reimbursement 2CPT Codes for
Preventive Individual Counseling

• CPT Code Approximate Duration
• 99401 15 minutes
• 99402 30 minutes
• 99403 45 minutes
• 99404 60 minutes

14
Coding and Reimbursement 3CPT Codes for
Comprehensive Preventive Evaluations

• CPT Codes Age Range
• Initial Evaluation Periodic Reevaluation
• 99381 99391 Under 1 year
• 99382 99392 1-4
• 99383 99393 5-11
• 99384 99394 12-17
• 99385 99395 18-39
• 99386 99396 40-64
• 99387 99397 65 and over

15
Tracking Evaluation and Data Systems - 1

• Quarterly and annual tracking
• Software
• Agency data warehouse 
• Excel
• Access
• Epi Info
• GIS for health and hospital systems

16
Tracking Evaluation and Data Systems - 2

• Guides for community health agencies
• NACCHO guidance documents
• Model Practices Program.
• APEXPH program 
• Strategic decisions about Partnerships.
• MAPP
• National Public Health Performance Standards
  Toolkit
• Map-It
• BMJ -- Socio-Economic Determinants of Health

17
Statistical Data

• Baselines and trends
• plt0.2 is statistically meaningful for planning
  and evaluation
• (statistical significance at plt0.05 impossible to
  achieve and maintain for most state, local and
  healthcare facility preventive services)

18

Final Comments

• Instructors Manual with supplemental materials
• http//www.aaphp.org
• Under Preventive Services ToolKit
• Q A