CDHPs, FSAs, HSAs, HRAs…A Brief Introduction to the “New” ABCs of Health Care. What does it mean for Complementary and Alternative Medicine?

By Pamella J. Marchand, Complementary Healthcare Plans CEO

As the health care landscape continues to evolve, an alphabet soup is emerging which describes a range of new configurations of health care benefits. Consumer Directed Health Plans (CDHPs), Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs) are some of the newer kids on the block in the health care market. Some observers say this is the most important development in health insurance since the widespread introduction of HMOs in the 1980s.

Proponents of CDHPs look to this development with great anticipation. They argue that CDHPs will lead to better informed and more discerning consumers. As a consequence, the plans will reduce unnecessary utilization, increase healthy behaviors, and ultimately reduce the growing burden health care costs place on the U.S. economy.

But what are these new schemes? Where did they come from? How are they supposed to help contain escalating health care costs? Employers are looking for ways to contain health care costs. This alphabet soup of solutions does increase the consumer’s financial responsibility for their health care choices. Will this help health care or just health care financing?

More financial responsibility for patients is backed by greater access to information about the cost and quality of health care services and providers. The theory being that, to date, patients have largely been shielded from the true cost of care by fixed co-pays and insured benefits. At the same time that consumers have been insulated from the actual cost of the care and service they receive, they have also been kept from information about the quality of that care and service.

Health care, unlike just about any other consumer transaction in which the purchaser determines value by weighing the cost of the good or service against its quality, has largely escaped the typical market forces that operate in almost every other sector of the economy.

For example, a patient willingly goes to the nearest hospital for treatment because (1) it is close and (2) her doctor sends her there. Why should she worry about the cost, when the insurance company picks up most of the bill anyway? But suppose the patient now has to pay a significant chunk of the cost for the stay and can also access reliable data about the costs and outcomes that compare hospital “A” with hospital “B?” The decision will likely favor the maximization of value.

Skeptics, of course, contend these changes are not feasible and the impact of CDHPs will not be equitable. They claim many consumers will be unable to change their health care consumption, will be forced to do so in ways that will compromise their health, or will exceed their maximum deductibles too quickly to provide any real incentive for behavioral changes. The impact of CDHPs will therefore be limited and the adjustment burden will fall unfairly on the poor and chronically ill.

What does this mean for providers of complementary care? As long as CAM services are considered as “qualified medical expenses” (see IRS Pub 502, available at www.irs.gov), a patient’s health care decision will be based on the same value-driven decision as between hospital “A” and “B.” At that point, CAM providers will be on the “level playing field” that has been so elusive in the health care market.

If you’re interested in learning more about CDHPs, the following sites may be of interest:

http://www.healthdecisions.org/HSA/

http://www.altbenefits.com/

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Complementary Healthcare Plans Access Report

by Juanita Neibert, CHP Director of Provider Services and Quality

Access to Care: Assuring patients access to care is an important measure of quality.  Having a diverse community of providers enhances cultural competency and improves access for a wider base of patients.   CHP routinely captures and evaluates access data to ensure the broadest possible access for the patients we serve.

An analysis of the data was performed, providing CHP with the following access report:

Gender Distribution

• The total number of active practitioners on the Oregon/Southwest Washington panel for 2005 is 620.
• Male practitioners comprise 42% (263 practitioners)
• Female practitioners comprise 58%  (357 practitioners).

Appointment Availability

• CHP practitioner’s ability to schedule an urgent new patient appointment within 24 hours-96%.
• CHP practitioner’s ability to schedule a routine new patient appointment within 1 week- 99%.
• CHP practitioner’s ability to schedule an urgent established patient within 2 days – 96%.

ADA (Handicap) Access

CHP practitioner’s ability to:

• Provide an office that is wheelchair accessible- 88%.
• Provide wheelchair accessibility and maneuverability within the office-94%.

Cultural Competence

Languages spoken:

Foreign languages spoken by CHP practitioners:

• 18 foreign languages, plus
• sign language.

Languages include: Chinese, Dutch, French, German, Greek, Hawaiian, Italian, Japanese, Korean, Latin, Mandarin, Norwegian, Persian, Portuguese, Russian, Sign language, Spanish, Taiwanese and Vietnamese.

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Best Practices in Clinical Record Keeping

by Charles A. Simpson, DC, CHP Medical Director

Note: This is the first part of a continuing series on clinical documentation. CHP believes that high quality clinical records reflect high quality patient care. We devote considerable time and effort to enhance record keeping competency. In keeping with a “best practices” model, CHP relies on clinical and state-of–the-art professional resources to develop models and tools to assist our practitioners.

Medical Record Documentation Performance Standards:

CHP’s Standards for Medical Record Documentation establish expectations for record keeping that will facilitate communication, coordination and continuity of care and promote safe, effective and high quality patient care.

In compliance with the National Committee on Quality Assurance, CHP requires a contemporaneous, written clinical record is established and maintained for each Member who receives services from a CHP Practitioner. Clinical records must be maintained in accordance with all applicable professional standards and the CHP standards as outlined in that section of the CHP Practitioner Operations Manual.

These best practices will assure clinical documentation that is current, detailed and organized in order to deliver effective and confidential patient care, permit quality review and document medical necessity.

Definitions:

Medical Records. Every time a patient receives healthcare, a record is maintained of the observations, interventions, and treatment outcomes. The term "medical record" means a record created by or on behalf of a health care provider of health care provided to a patient. This record includes information that the patient may provide concerning his personal identification, demographics, the clinical symptoms and medical history.

Information entered into the medical record by the provider includes the history reported by the patient, the results of examinations, reports of x rays, laboratory tests, and consultations, diagnoses or clinical assessments, and treatment plans and treatments rendered including instructions, advice and recommended follow-up.

Patient-Specific Health Information (PHI). PHI is health care information, in any form whatsoever, that may be identified as pertaining to a particular person and that relates to the person’s past, present or future physical or mental health, health care treatment or payment for health care services, including information that relates to the diagnosis, treatment and/or prognosis of drug or alcohol abuse, sexually transmitted diseases, HIV or AIDS, mental health or genetic testing.

Confidentiality of Medical Records:

Patient-specific health information is legally protected and must be handled in a confidential manner. Unless otherwise required by law, including those laws that apply to minors, disclosure of patient-specific health information can be only to:

• The individual to whom the information relates.
• A health plan that contracts with CHP to perform health care delivery, payment, administration and/or management functions on their behalf.
• A third party only if specific authorization is obtained from the individual to whom the information relates.
• Except as otherwise provided by law, CHP providers will make its subscriber’s (and the subscriber’s minor children’s eligible dependents) patient-specific health information available to the subscriber for inspection and copying.

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FAQs from patients and parents on antibiotics

(This article is courtesy of The Oregon Alliance Working for Antibiotic Resistance Education (AWARE). Complementary Healthcare Plans is a supporting member of Oregon AWARE and joins a coalition of more than 40 partners that promotes the safe use of antibiotics. Feel free to share this article with your patients. For more information and helpful tools to assist your and your patients use antibiotics more wisely, visit the Oregon AWARE web site at http://www.healthoregon.org/antibiotics.cfm)

As providers of complementary health care we are often in a position to counsel our patients about therapeutic options for common illness such as colds and flu. CAM providers are perhaps uniquely qualified to offer appropriate advice about antibiotics. Many patients (and their medical providers) still labor under incorrect assumptions concerning antibiotics. There is a community coalition in Oregon that is actively working to promote appropriate use of antibiotics and prevent the growing problem of antibiotic-resistant bugs.

Oregon Alliance Working for Antibiotic Resistance Education (AWARE) and its more than 40 community partners recognize that safe, appropriate antibiotic use depends on a wide variety of people. Health care providers, parents, patients, childcare providers and health care systems all have a part to play. The Oregon AWARE coalition provides information about the dangers of using antibiotics inappropriately and emphasize the importance of using antibiotics wisely. Our common goal is to preserve the effectiveness of antibiotic medications for future generations.

This message resonates with CHP’s commitment to high quality health care and we support the mission of Oregon AWARE. The following is taken from an Oregon AWARE brochure and may be helpful for use with patients who are seeking information about antibiotics. The entire brochure is available free for downloading at http://egov.oregon.gov/DHS/ph/antibiotics/pdfs/chbroch.pdf.

My child has had a cough on and off for a long time. Shouldn’t my child get antibiotics to get rid of this?

Children can have up to 7-8 viral cough illnesses each year, and the cough and runny nose commonly last 1-2 weeks each time. So just the fact that a child has been sick on and off for a long time doesn’t mean that he or she has a bacterial infection needing antibiotics.

If mucus from the nose changes from clear to yellow or green, does this mean that my child needs antibiotics?

Yellow or green mucus does not mean that your child has a bacterial infection. It is normal for the mucus to get thick and change color during a viral cold.

Does this mean I should never give my child antibiotics?

Antibiotics are very important medicines for treating infections caused by bacteria. If an antibiotic is prescribed, make sure you give your child the entire course and never save antibiotics for later use.

How do I know if my child’s illness is caused by bacteria or a virus?

Ask your doctor or other health care provider. If you think that your child might need treatment, you should contact your provider. But remember, colds are caused by viruses, and should not be treated with antibiotics.

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CONTINUING EDUCATION OPPORTUNITIES:

CAM Grand Rounds at OHSU:

“Doctors who train together practice together.”

Since 2003, Oregon Health and Science University has sponsored a CAM Grand Rounds program that is held every third Wednesday of the month from noon to 1:00pm in the Basic Science Building, Lecture Room #4340. The CAM Grand Rounds is attended by OHSU faculty, residents, staff, students and members of the community. CME accreditation is also available for all D.C.s, N.D.s M.D.s and DOs.

Each lecture includes an expert panel discussion with experts from the allopathic field, spirituality, MindBody Medicine, naturopathic medicine, chiropractic and traditional Chinese medicine. The panelists discuss one case and see if consensus can be reached as to the best treatment for the specific patient. Patients are selected from the Integrative Medicine Clinic at OHSU.

For course information and videos of past Grand Rounds, visit the CAM Course website at www.ohsu.edu/cam/for_docs/grand_rounds.html.

CHP Distance Learning:

TALKING WITH PATIENTS: Best practices in clinical communication.

Talking with patients is a fundamental skill that all clinicians depend on daily. We talk to patients about their condition, our clinical findings, treatment options, expected outcomes, our clinical approaches, and we answer their questions. This program is an excellent (and free) opportunity to hone these vital skills. 4 hours of CE credit has been approved for DCs, LAcs and NDs.

This CHP-sponsored program HAS received an enthusiastic response. The entire 4-hour program is available in a distance-learning format that includes all printed material from the original presentation and 4 high-quality audio CDs.

The Program and the Presenters:

Exploring Clinician-Patient Communication: The heart of the visit
Ward R. Mann, FNP

Informed Consent: An evidence-based guideline
Steven L. Sebers, DC, DABCO

CONTINUING EDUCATION CREDIT: This distance learning activity is free to all CHP practitioners.

• LISTEN to the 4-hour live seminar program,
• READ the accompanying reference material and
• COMPLETE the 20-question self test.
• SEND the completed answer form (don’t forget your name and contact information) and
• RECEIVE 4 CEUs approved for credit by the OBNE (Oregon NDs), NCCAOM (all LAcs) and Oregon and Washington Chiropractors.

For registration and learning materials or questions, please contact Clifton Cobbin @ 503-203-8333 ext 129 or ccobbin@chpplans.us

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