Provider Education: Bridging the Gap (09/25/2024)

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A. When the care provided to a patient is inconsistent with the recommended best practices in healthcare

B. A high-risk patient for breast cancer does not receive a regular screening mammogram

C. Unable to arrange transportation to medical appointments

D. Diagnoses, medications, or test results that are not shared between primary care physicians and specialists

E. Unable to find the care they need within their network or area

A, B and D

All of the above

The work required does not get done

The work done is not coded right

The work done is not sent to the payer

The exclusion criteria for a patient are not applied correctly

Data

Diagnosis

Status

System

Performance

Plan

The screening age for colon cancer and breast cancer has recently been lowered

Not tolerating the medication for osteoporosis is a valid exclusion criterion

Not tolerating the statin medication is a valid exclusion for statin therapy

Closing gaps in BP management, medication adherence, all-cause 30-day readmission to the hospital and glycemic control are all double weighted

A “Diabetic Eye” exam by an Ophthalmologist is all the documentation needed to close the gap for retinopathy in diabetics

Fecal occult blood/Guaiac Stool test – Annually

Fit-DNA (Cologuard) – Annually

CT Colonography – every 5 years

Flexible Sigmoidoscopy – every 5 years

Colonoscopy – every 10 years