Communication regarding a patient’s clinical status is an important element in the assurance of the continuity of care, as well as the quality of care, for Independent Health members. Independent Health requires the timely exchange of pertinent patient information among all of the member’s practitioners. Please refer to Independent Health policy “
Exchange and Evaluation of Clinical Information Among Providers” (log in is required to view the policy).
Whether or not a referral is required, and regardless of the method of referral, the exchange of patient information among practitioners should occur:
- Following an initial consultation/evaluation,
- When the member has had significant changes in clinical presentation or treatment, and/or
- When the member has been seen on an ongoing basis for twelve (12) months or longer.
Acceptable forms of communication among practitioners include, but are not limited to:
- Office notes or summaries, inclusive of diagnostic reports
- Treatment plans
- Facility discharge summaries
Communication sent to other practitioners, as well as communication received from other practitioners, needs to be documented in the patient’s medical record. The documentation should include the date that the communication (report) was sent and received, as well as evidence that incoming communications from other providers has been reviewed by the practitioner. Physicians should develop a method for monitoring the status of referrals requested, in order to determine whether the consultation has been completed and whether the associated report has been received following the consult.
Adherence to the practice of communication among practitioners is monitored through annual
audits of medical records as specified in the Exchange and Evaluation of Clinical Information Among Providers policy noted above.
An annual audit is performed by Independent Health to evaluate compliance of communication between the acute care facility and the member’s PCP when a member has an acute inpatient stay greater than two days and when a discharge to home is identified. The compliance threshold set by Independent Health is 90 percent.
- In 2014 (using 2013 data), the overall compliance score was 70 percent. Six of 20 hospitals did not meet the compliance threshold.
- In 2015 (using 2014 data), the overall compliance score was 80 percent. Four of 20 hospitals did not meet the compliance threshold.
- Facilities scoring less than 90 percent for compliance on the audit were required to submit plans for improving communication with the PCP.
An audit is performed by Independent Health to evaluate compliance of communication between specialists and the member’s PCP. The compliance threshold set by Independent Health is 90 percent.
- A random sample was obtained from active Independent Health members who attended a dermatology visit in 2014.
- The overall compliance rate was 67 percent, with three of nine dermatologists not meeting the compliance threshold.
- Dermatologists scoring less than 90 percent compliance on the audit were required to submit plans for improving communication with the PCP.
Communication between Behavioral Health (BH) practitioners and primary care physicians (PCP)
As referenced in the Evaluating Continuity and Coordination of Care policy, BH practitioners (including psychiatrists, psychiatric nurse practitioners, psychologists, neuropsychologists, social workers, mental health clinics and chemical dependency clinics) are expected to communicate pertinent clinical information to the member’s the PCP.
Timeframes for ensuring the timely exchange of pertinent patient information include:
- Following completion of the third BH visit
- Following medication changes
- With modification of the treatment plan
The BH practitioner must be in receipt of a valid, patient-signed HIPAA-compliant consent form in order to release clinical information to another practitioner, including the PCP. Member refusal to sign a consent form for release of BH clinical information must be documented in the medical record.
Acceptable forms of communication between BH practitioners and the PCP include:
- Confidential written communication
- Confidential verbal communication
- Documentation of the communication and the date that it occurred in the patient’s medical record
An annual audit is performed by Independent Health to evaluate compliance of communication between BH practitioners and the member’s PCP. The compliance threshold set by Independent Health is 90 percent.
- A random sample of 151 active Independent Health members, all lines of business, who had attended at least three visits to the same BH practitionerin 2014, was obtained. These members were also already linked to a PCP.
- BH practitioners completed an attestation document indicating whether or not there was communication between the practitioner and the member’s PCP. The BH practitioner was also asked to submit a sample of the communication format that was utilized.
- The overall compliance rate was 93 percent, with nine of the 55 participating BH practitioners not meeting the compliance threshold.
- BH practitioners scoring less than 90 percent compliance on the audit were required to submit plans for improving communication with the PCP.
Education regarding the necessity of timely communication between BH practitioners and the PCP was included in survey-related letters forwarded to the BH practitioners.
A tip sheet on the “Continuity of Care between Facilities, Specialists and Primary Care Physicians” is available by clicking
here (log in is required).
If you have any questions regarding Independent Health’s Continuity and Coordination of Care
initiative, please contact Durann Vitali RN, MS, CCM, Clinical Quality Reviewer at (716) 635-3660 or
Durann.Dracup-Vitali@independenthealth.com or Jay Swarthout, Manager, Behavioral Health at (716) 635-7803 or Jay.Swarthout@independenthealth.com.