Keller family physician Gregory M. Fuller, MD, says TMA’s new prevention calculators can improve care and help physicians negotiate contracts with insurers.
(USPSTF) services without patients shar- ing costs. The services are in four catego- ries: evidence-based screenings, counsel- ing, routine immunizations, and preven- tive services for women and children. Some physicians may already per- form those services for their patients but miss out on additional payment; others may not realize the range of preventive services that would benefit patients. Still others may be unsure of the fis- cal sustainability of providing the ser- vices. To help physi- cians make those assessments, the Texas Medical As-
Jason Terk, MD 40 TEXAS MEDICINE June 2013
sociation Council on Health Care Qual- ity developed 36 interactive “prevention calculators” encompassing all of the bill- ing codes associated with each USPSTF guideline. They help doctors compare payments from various payers for those services, Dr. Terk says, but quality im- provement is at the heart of the effort. Dr. Terk, chair of the TMA Council on Science and Public Health, was a con- sultant to the Council on Health Care Quality subcommittee that developed the calculators. “Ultimately, these tools are about elim- inating the money concern as a barrier to providing preventive care services. In the end, these tools are about better pa- tient outcomes because more preventive care is executed according to the USP- STF guidelines.”
A simple calculator The Council on Health Care Quality de- veloped 35 calculators covering each of the preventive services under PPACA. A “general prevention” calculator drawing on common codes across various condi- tions also is available. A grant from the TMF Health Quality Institute (the Cen- ters for Medicare & Medicaid Services’ quality improvement organization for Texas) funded the project. There is a calculator for everything
from obesity, cancer, and diabetes screenings for adults to depression and hearing loss interventions for children. TMA is working on similar tools to help doctors evaluate their participation in the Medicare Physician Quality Report- ing System and the commercial Bridges to Excellence quality programs.
MATT RAINWATERS
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