Gulf Care Draft Document: A HHS Information Technology Demonstration Project Supporting Distributed Quality Health Care in the Katrina and Other Hurricane Disaster Areas

Goal. To quickly provide greater public access to quality health care in the states of Louisiana and Mississippi using qualified non-physician licensed health care providers to increase the capacity of the healthcare system in each state.

Current Gulf State Situation. The conventional, physician health care network in the gulf coast states affected by hurricanes Katrina and Rita has deteriorated to the point that there is inadequate capacity to meet the needs of the community. Studies funded by many organizations are underway to determine the exact impact, but approximately two-thirds of medical doctors on the coast lost or sustained significant damage to their practices (Dr. Edward Hill, AMA). Similar declines are evident in all other non-physician health care provider categories as well. Approximately 4,400 physicians left the area (Dr. Karen DeSalvo, Tulane). With more health care professionals leaving the region than returning to it, the time line for recovery is long.

Most, if not all, recovery plans focus on physician care. However, with the proper information technology infrastructure and a proper benefit plan design that includes coding, billing, and Internet connectivity tools, a host of state-licensed health care providers, such as advanced practice nurses, chiropractors, physiologists, psychologists, midwives, et al., who have not relocated from the region, can dramatically and quickly increase the capacity of the health care system.

Background. ABC Coding Solutions (formerly Alternative Link) empowers the healthcare industry to provide greater public access to cost-effective and quality healthcare.

ABC codes and related solutions support care from 17 licensed practitioner types that represent approximately five times the number of physicians in each state. The healthcare services offered by these practitioners are not adequately described in other national code sets. Without adequate codes, these practitioners are challenged to submit claims and reimbursement organizations, such as Medicaid, are challenged to process payments. By using ABC codes and related solutions, these practitioners can quickly increase the capacity of the states to respond to critical healthcare needs.

ABC codes are used in combination with CPT® and HCPCS II codes (the standard medical code sets) and fit into existing standard paper claim forms, practice management, payment and other information systems used to process electronic and paper healthcare claims. ABC codes allow states to use well established business processes, including processing electronic healthcare claims mandated under HIPAA.

Together with CPT® and HCPCS II codes, ABC codes help measure the economic and health outcomes of all approaches to care while defining who is allowed to perform each healthcare service.in the state where care is provided. For example, this code set identifies each practitioner in the state who is licensed to give shots or treat wounds.


Test Cases Proving the Concept.

• Alaska Medicaid used ABC Codes to process claims for behavioral health care services provided by paraprofessionals to clients in remote areas of the state. The state estimated para-professional care was provided at half the cost of professional services. Further, the state said there were no professionals to provide care in these areas.
• Military Spirit is a $1.8 million dollar activity funded in the 2005 Congressional Budget to codify the use of spiritual guidance and counseling provided by members of the Navy Chaplain Corps to sailors. Ultimately, the chaplain corps will use ABC codes to quantify the impact of spiritual counseling on force readiness, retention, rehabilitation and reintegration.
• Lovelace/Sandia Medicare Advantage plan in New Mexico used ABC codes to increased care options by providing alternative medicine services to a senior population. Access grew from 500 seniors in 1999 to 21,000 seniors in 2005 while costs in this population declined.

Proposal. This is a one-year proposal, with the possibility of two additional years being added as proof of concept and savings are demonstrated. ABC Coding Solutions requests $5 million dollars in the 2007 budget. Per year cost of years two and three will be similar and the program will expand coverage access to Florida, Alabama, and Texas. Activities to be undertaken include:

• Identify critical health care requirements (Louisiana and Mississippi State, local, and tribal).
• Identify practitioners in these states who are licensed to provide required healthcare services, especially nursing, chiropractic, behavioral heath, and midwifery care.
• Design plan benefits in the Medicaid program of each state to fully access qualified non-physician practitioners based on each practitioner type’s full legal scope of practice.
• Negotiate managed care contracts, based on ABC codes and relative value units, to determine payments in each state for each healthcare intervention supplied by non-physician practitioners.
• Incorporate these codes into the existing health care payment systems within each state.
• Supply non-physician practitioners with an electronic means of filing coded claims to Medicaid (directly, through clearinghouses and/or contracted insurers acting as MCOs).
• Connect IT pipelines to send claims electronically to the appropriate entity.
• Partner with state professional associations (such as the American Nursing Association and the American Public Health Association) and universities to educate/train state personnel and qualified non-physician licensed health care providers in the use of the system.
• Integrate and test the system in each affected state.
• ransition the system to operational use in each state.
• Set up methodologies to track the impact on each state.
• Report and share lessons learned with the rest of the nation.

ABC Coding Solutions provides enabling technology to assure timely success. The funds would be used to set up central project offices in Louisiana and Mississippi, hold workshops to assess requirements, survey existing capability and capacity, design and build prototype systems, and educate the practitioners and public. The team that will execute this project consists of government, academia, practitioners and industry. ABC Coding Solutions suggests that a state consortium take the lead on coordinating activity with the states and the federal government.

Other Related Congressional Activities

Katrina Health Access Recovery and Empowerment Act of 2006 (Jefferson, D-LA); presently does not include methodology to provide direct access to non-physician providers.