Compliance with Practice Guidelines Still Falls Below Mark
To monitor member progress across time and truly see the “big picture” when it comes to quality of care, practitioners must remain diligent in documenting member treatment. As part of Magellan’s treatment record review process, our Southwest and Michigan Care Management Centers audit treatment records of high-volume practitioners to determine how well they follow the recommendations in Magellan’s adopted clinical practice guidelines.
In 2009, Magellan reviewed practitioner treatment records for compliance with our clinical guidelines for Major Depressive Disorders (MDD) and Assessment and Management of the Suicidal Patient. The overall results indicated 72 percent of the elements reviewed were consistent with these guidelines. Representing only a one percentage point increase over last year’s result, the score remains below the established 90 percent goal.
Scoring
Results are based on the presence of particular elements in the treatment record, as detailed in our Major Depressive Disorders - Suicide Management Audit Tool. This tool emphasizes three scoring domains that correspond with crucial aspects of assessment and treatment for members who may be depressed and/or suicidal. These domains include diagnostic assessment, suicide risk assessment and management, and major depressive disorder therapeutic interventions.
Increased Compliance Areas
We are excited about the practitioner improvement noted during the review process in the following areas:
- Assessment for severity of MDD: Mild, moderate or severe
- If evidence of co-morbid substance abuse exists, provider developed a plan to maintain sobriety.
How Providers Can Improve
However, we have identified some opportunities for improvement as follows:
- In addition to the assessment for current suicidal ideation and plans, assess for a history of suicidal ideation and attempts
- Document the type of psychotherapy to be used and measurable treatment goals
- Deliver education about MDD and its treatment to the member, and, if appropriate, to the family.
Providers who fail to meet the clinical practice guidelines standards receive individualized feedback regarding deficient areas. When the deficiencies are great enough, a corrective action plan is implemented and further records are requested to demonstrate compliance.
Magellan appreciates your commitment to providing quality care to our members and, as always, welcomes your input on our Clinical Practice Guidelines.