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Below are the best practices for the Ortho & Neuro Surgeon Quality pilot.
| Best Practices for the Ortho & Neuro Surgeon Quality Pilot | ||||
|---|---|---|---|---|
| Indicator | Expectation | Threshold | Data source | Required? |
| Activity Prescription Form (APF) | Complete 1st APF for each state fund patient (on initial visit if possible).
Complete a 2nd APF following surgery. |
Meet expectation for at least 85% of your state fund injured workers. | L&I administrative data | Yes |
| Rehabilitation plan | Report worker's progress and current rehab plan on the APF. | 85% of APF's reviewed have rehab plan complete. | L&I administrative data - random review of APF forms. | Yes |
| Dispense as Written (DAW) | Prescribe preferred drugs or allow substitution when medically appropriate. | Less than 10% of prescriptions are Dispense as Written. | L&I administrative data | Yes |
| Timely access to service | Worker seen within 9 calendar days of referral. | 70% of new state fund workers seen within 9 calendar days of referral. | Provider report | No |
| Timely surgery | Worker has surgery within 21 calendar days of claim manager authorization. | 80% of workers have surgery within 21 days. | L&I administrative data | No |
| Occupational health continuing education | Receive at least 3 hours of training annually. | 100% completion of 3 hours. | L&I administrative data or Provider report (if training not done by/with L&I). | No |
Activity prescription form
This form was developed for the Ortho & Neuro Surgeon Quality pilot and the COHE pilot and can be used by pilot providers without a request from a Claim Manager.
Activity Prescription Form (F245−067−000) (78 KB PDF).- Spanish version of the Activity Prescription Form (F245−067−909) (79 KB PDF).
Get Help Downloading Files (files open in a new window).
Reason
Documentation is essential to prevent delayed recovery.
- Clear rehabilitation planning,
- Release for work and
- Estimated abilities will enable:
- Employers,
- Claim managers and
- Vocational counselors to better coordinate care and return to work planning.
Providing information at initial and subsequent visits (when the worker's status changes) will reduce the need to complete at least 3 other forms (Time loss notification, Estimate of physical capacities and Supplemental medical report.)
Expectation
Bill for at least 1 Activity Prescription Form (APF) for each injured worker. If the injured worker has surgery, at least 1 additional form must be completed following surgery.
Threshold
APFs are completed and billed for 85% of the injured workers seen.
Note: To accurately evaluate the APF, you must bill using procedure code 1069M each time the form is completed. Submit bills within 1 month of the date of service. This ensures that the data is available for analysis.
Method of measurement
L&I will analyze all claims seen during the 6 month time frame for the report* using our administrative data. L&I will round all findings to the nearest whole percent.
*Exception: Initial report will include first 3 months of participation.
Rehabilitation plan
Reason
Early development and ongoing review of physician-directed rehabilitation reduces disability, recurrent injury and the need for future health care use.
Expectation
Describe the rehab plan using the "Plans" section at the bottom of the APF. The following 2 fields must be addressed:
- Worker progress, note whether the worker is:
- Progressing better than expected,
- Progressing as expected, or
- Not progressing.
- Current rehab, briefly describe the rehab activity (e.g. PT, OT, rest, home exercise, etc.)
Threshold
Note the worker's progress and describe the current rehab plan in the "Plans" section of 85% of the APFs reviewed.
Note: To accurately evaluate the APF, you must bill using procedure code 1069M each time the form is completed. Submit bills within 1 month of the date of service. This ensures that the data is available for analysis.
Method of measurement
For each provider, L&I will review APFs submitted during the 6 month time frame for the report*. Depending on the number of forms submitted L&I will review either all forms or a random sampling.
*Exception: Initial report will include first 3 months of participation.
Dispense as Written (DAW)
Reason
Endorsing the WA state preferred drug list (PDL) reduces authorization requirements for providers. Minimizing dispense as written prescriptions enhances the use of cost-effective drugs within specific drug classes (therapeutic interchange program).
Expectation
As a pilot provider, you must endorse the WA state PDL and are expected to prescribe preferred drugs or allow appropriate substitution within the therapeutic interchange program (TIP).
Threshold
Less than 10% of the prescriptions written for PDL drug classes in the TIP are for non-preferred drugs.
Method of measurement
L&I will analyze all prescriptions subject to TIP written during the 6 month time frame for the report* using our administrative data. L&I will round all findings to the nearest hundredth.
*Exception: Initial report will include first 3 months of participation.
Timely access to service
Reason
Reducing delays in accessing care can enhance recovery, return-to-work and minimize or prevent disability.
Expectation
Visit occurs within 7 business days of the referral.
Threshold
70% or more first visits occur within 7 business days. Visits by PA-C and ARNP will count as long as an APF is completed and billed by the ortho-neuro pilot surgeon.
Method of measurement
You must provide the following information to L&I on a semi-annual basis:
- Claimant name,
- Claim number,
- Date office received first referral for an appointment,
- Date visit occurred,
- Appointment rescheduled by worker? Y/N
- Appointment rescheduled by provider? Y/N
- Worker declined access within 7 business days? Y/N
Timely surgery
Reason
Reducing delays in accessing care can enhance recovery and return-to-work as well as minimize or prevent disability.
Expectation
Surgery is performed within 3 weeks (21 calendar days) of claim manager authorization.
Threshold
Surgery is performed within 3 weeks on 80% of the injured workers who have surgery.
Method of measurement
L&I will analyze all injured workers who have had surgery during the 6 month time frame for the report*. They will use their utilization review administrative data. L&I will also round all findings to the nearest whole percent.
*Exception: Initial report will include first 3 months of participation.
Occupational health continuing education
Reason
Helps physicians understand and recognize the specific medical and management needs that are associated with treating worker's compensation injuries. This knowledge can enhance recovery and reduce long-term disability.
Expectation
Receive annual occupational health training. Annual requirements are met with any 1 of the following:
- Participate in pilot provider training (1.5 hours); or
- Complete at least 1 of the following CMEs in L&I publications:
- Participate in L&I or Centers of Occupational Health and Education-sponsored course(s); or
- Provide verification of 3 or more hours of continuing education in occupational health topics including, but not limited to:
- Disability prevention.
- Assessment tools for occupational health (e.g. pain diagrams, depression inventories, estimating physical capacities).
- Return-to-work planning.
- Job modification.
- Chronic pain management.
Threshold
Annual requirements are met.
Method of measurement
Provide verification of attendance to L&I as follows:
- Pilot provider training: L&I will maintain records of attendance.
- L&I CME publications: L&I will confirm participation using CME self-assessments submitted to L&I's Office of the Medical Director.
- L&I sponsored courses: L&I will confirm participation.
- Other occupational health training: Provider submits a provider education verification form, that includes:
- Copy of attendance certificate with numbers of hours attended and
- Course objectives.
