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Chronic Disease Management Programme

1. C Hypertension YYYY C DM Retinopathy YYYY O Lipid Disorder YYYY C DM Nephropathy YYYY O Cerebrovascular Accident CVA YYYY C DM Foot Complications YYYY C Coronary Heart Disease CHD YYYY Asthma YYYY M COPD YYYY Major Depression 2007 YYYY Schizophrenia 2007 YYYY C Bipolar Disorder YYYY C Dementia YYYY C Oral Medications YYYY O Insulin YYYY C Oral Medications YYYY C Oral Medications YYYY C Preventer YYYY Atypical Antipsychotics Prescribed 2008 YYYY C Atypical Antipsychotics Prescribed C Atypical Antipsychotics Prescribed 49 Date of Visit DDMMYYYY Blood Pressure Systolic Diastolic y DM Eye Assessment o LDL C mg dl v DM Nephropathy Assessment o HbA1c DM Foot Assessment o Weight kg Stroke Thromboembolism Risk Assessment J use 999 if not measurable Smoking Assessment Oo Inhaler Technique Assessment Asthma amp o COPD only Cigarettes smoked per day average ACT Score Asthma only Influenza Vaccination Assessment COPD Oo only The following care components are only for CDMP Mental Health Programme Patients CGI Severity of Illness v Fasting Lipids Blood Test Oo CGI Global Improvement K Fasting Glucose Blood Test F Consultation for CDMP Mental Health E Assessment of Memory oO Indicate the patient attendance For patients on cogni
2. tumour markers such as CEA CA 125 Medications for the management Traditional and complementary of approved chronic conditions medicine e g herbal medicine and or their complications Ayurveda Dietary supplements except for cases with established deficiencies Life style modifying medications e g hair loss or weight loss medications Non evidence based or non HSA registered medications Off label use of medications Allied Health services such as Complementary non evidence based nursing occupational therapy therapies e g massage therapy physiotherapy speech therapy chiropractic homeopathy dietician and podiatry services as acupuncture referred by physicians Medical devices such as blood pressure monitoring machines and ambulatory devices More disease specific examples of claimable and non claimable items services can be found in Chapter Two The Clinical Guidelines 3 5 Eligible patients can use their personal Medisave account and immediate family members Medisave accounts for payment of their chronic disease treatments Immediate family members refer to the spouse parent or child of the patient Patients who are Singapore Citizens or Permanent Residents will also be able to use their grandchildren s Medisave accounts to pay for their treatments Scenario 1 Mr Lim is a retiree with 2 working children He is suffering from COPD and has Medisave from his earlier years of working Mr Lim can make use of a maximum of 1
3. 1 2 An outline of the registration and accreditation process is provided in Table 2 Table 2 Registration and Accreditation Process Medisave for CDMP Steps Clinics submit E Application form to MOH v Interested clinics submit documents to CPF Board and NCS v Clinic representative s attends training session process IT and Medisave guidelines v MOH approves the participation of the clinics v NCS confi th SA Pa i CPF Board prepares Deed MOH issues letters of system setup amp issues i rete ee of Indemnity with clinics approval to clinics token cards v Doctors submit accreditation forms to MOH v Effective date of participation in the CDMP by clinics 2 2 Registration of Clinic Medical Institution with MOH 2 2 1 To join the CDMP clinics medical institutions will need to fulfil the following criteria 25 a Be able to make Medisave claims for patients through the online MediClaim system b Sign a Deed of Indemnity with CPF Board and c Be able to submit clinical data to MOH 2 2 2 To make claims for patients through the online MediClaim system clinics medical institutions need to have a A MediClaim User account b A Security Token Card Incurs a non refundable cost of 191 20 inclusive of 7 GST and delivery fee The subsequent token is priced at 171 20 c A Personal Computer Laptop with the following
4. Foreigners Current Medisave rules apply As long as Permanent Residents or Foreigners have Medisave accounts or their immediate family members have Medisave accounts they are eligible for the scheme How will the scheme apply to those who have employer medical benefits or an existing comprehensive insurance plan Claims can be made under employer plans This also applies to pensioners Employer medical benefits or an existing comprehensive insurance plan can be used to cover the cost of the deductible and co payment Any amount in excess of the employer medical benefits or the insurance plan can be paid using Medisave Clinics will have to liaise directly with their partnering employers for payment under employer plans as per their current arrangements What is the process of making Medisave claims like Will it involve a huge change in my clinic operations The process is as follows 61 Q19 a The clinic doctor should explain the following to patients suffering from any of the approved chronic conditions and their immediate family member s whose Medisave account s is are being used if any e the treatment components e the cost of treatment e estimated amount that can be claimed from Medisave e the out of pocket cash payment that the patient will need to make b When the patient and or his her immediate family member s have decided to use Medisave for the bill each Medisave account holder who wishes to make use of his
5. Not applicable to acute All acute conditions Except Acute conditions for non ISP screening tests aesthetic and lifestyle treatments Applicable only to Blue Health Assist cardholders Chronic 15 identified chronic conditions claimable under either or both schemes Claims Data Mediclaim eCHAS Submission Portal When claims are made for both Medisave for CDMP and CHAS clinical indicators only need to be submitted once through either Mediclaim or eCHAS 1 1 The Chronic Disease Management Programme CDMP forms the clinical core of the management of patients with chronic conditions in the community It includes a evidence based structured Disease Management Programmes DMPs where applicable and b option for patients to either tap on subsidy e g CHAS or draw on their Medisave to help reduce out of pocket payments for outpatient treatment Components of disease management include a population identification process b evidence based practice guidelines c Collaborative practice models to include physician and support service providers d Patient self management education e Process and outcome measurement evaluation and management f Routine reporting feedback loop both at the primary care and specialist settings required in the management of their chronic conditions It supports the Ministry s vision of encouraging One Family Physician for Every Singaporean Patients who h
6. Submission of clinical data is an essential component of the CDMP 3 2 We encourage clinics to submit clinical data as soon as possible during or immediately after the patient s clinic visit Doing this would reduce the backlogs in submitting clinical data 3 3 Clinics are allowed to accumulate patient records for submission in batches However for batch submissions regular e g weekly or monthly submissions are encouraged 3 4 When using the electronic Clinic Management System to capture data during the consultation the system may allow submission of data automatically at the end of each patient consultation 3 5 The deadline for the clinical data submission will be fourteen days after the end of each quarter As an example for the quarter from Jan to Mar 2013 the deadline for data submission will be 14 Apr 2013 34 Annex B Data Fields Required for Clinical Data Submission Patient Name ee C DOB dd mm vyw DoS Gender Male Female Chinese Malay Indian Others O Current Smoker Yes No Year Started Smoking yyyy Hypertension Hyperlipidemia Coronary Heart Disease CHD Diabetes DM DM Retinopathy DM Nephropathy DM Foot Complications Chronic Obstructive Pulmonary Disease COPD Nephritis Nephrosis Oral Medications Insulin Oral Medications Oral Medications Requires Controller A Diabetes Hypertension and Lipid Disorders DMP For D
7. a maximum of 10 Medisave accounts 4 Process of Making a Medisave Claim 4 1 A typical process of making a Medisave claim for a patient is described below 4 2 What to convey to patient or immediate family members who wish to use Medisave a The treatment components b The cost of treatment c Estimated amount that can be claimed from Medisave and d Out of pocket cash payment that the patient needs to make 4 3 Administrative Procedure a Each Medisave account holder will need to sign a Medisave Authorisation Form MAF to authorise the CPF Board to deduct his her Medisave funds for the treatment of the patient The 29 authorisation can be made on a per treatment basis or over a period of time The authorisation will stand until revoked in writing b Clinic medical institution staff should witness the identity and the signature by the account holder Clinic medical institution staff should also verify relationships stated in the MAF where possible c Clinics medical institutions are to submit the Medisave claims electronically to CPF Board for processing via the MediClaim System 4 4 If the patient is deemed to be mentally incapacitated see definition of mentally incapacitated person below his immediate family members would need to authorise the use of the patient s own Medisave for his treatment using the MAF for Mentally Incapacitation Unconscious patients on the patient s behalf The doctor in charge would need
8. a responsibility to safe guard patients Medisave accounts to avoid premature depletion and to achieve cost effective care for the patient A general list of claimable and non claimable items services can be found in Table 3 in Chapter Three Registration and Medisave Use 4 3 The maximum amount that can be withdrawn for chronic disease treatments attendances taking place in the year 2012 and thereafter is 400 per Medisave account per calendar year 4 4 Withdrawals may be made from more than one Medisave account in any given year For example the patient may use his her own Medisave account as well as the Medisave accounts of any of his her immediate family members to pay for his her chronic disease treatments Immediate family members refer to parents spouses and children Patients who are Singapore Citizens or Permanent Residents will also be able to use their grandchildren s Medisave to pay for their treatments Please see Chapter Three Registration and Medisave Use for more information 4 5 Please refer to the following summary for the use of Medisave Patient has one or more of the 15 chronic diseases See Chapter 1 Visits a clinic doctor who is registered with Medisave for CDMP See Chapter 3 Patient is counselled on how he she can draw on his her or his her family members Medisave max of 400 per account per year to help pay for management of these chronic disease s See Chapter 3 Patient consents and signs
9. an acute condition at the same time can the entire bill be claimed Medisave can only be used for treatment related to the 15 chronic conditions listed subject to a cap of 400 per Medisave account per year up to 10 accounts If patient attendance is purely for an acute or unrelated condition Medisave deduction is not allowed even though the patient may have an existing chronic condition Checks will be made during audits to ensure that claims made are only in relation to the approved chronic conditions and or their complication s How does the annual cycle of the 400 limit apply Is it calculated based on the time that the patient first seeks treatment under the scheme 59 Q7 Q8 Q9 Q10 Q11 Q12 The 400 annual limit is reset at the start of each calendar year i e 400 for the period from 1 Jan to 31 Dec Will Medisave use be allowed for purchasing equipment e g blood pressure monitoring equipment glucometer or strips etc No In line with existing Medisave guidelines Medisave use does not cover equipment purchase whether for chronic disease treatment or other uses How will know if the patient has sufficient balance left for claims An enquiry function to check the withdrawal limit and overall account balance is available via the MediClaim e service Clinics may use this function to check the remaining balance of the Medisave account holder with his her consent Alternatively you can request fo
10. claim Q18 Am allowed to divulge patients medical information to the CDMP Audit Q19 Team for audit Yes clinics are subject to audits by CDMP Auditors appointed by MOH as stated in the Agreement In addition the patient will need to sign the Medisave Authorisation Form MAF How do I submit my bills for audit All items claimed need to be itemized 65
11. configuration i CPU Pentium IIl and above ii Memory RAM Minimum of 256MB iii Operating System Windows XP iv Browser Internet Explorer 6 0 and v Internet connection d GIRO arrangement with CPF Board for Medisave payments to be credited into the clinic medical institution s bank account and e Attended training to process Medisave claims 2 2 3 Clinics medical institutions interested in joining the CDMP will need to submit the following forms to MOH a E Application for Clinics to Participate in the Medisave for CDMP by MOH and b Direct Authorisation Credit Form by CPF Board The E Application website can be accessed via http www moh gov sg mmae overview aspx 2 2 4 Clinic medical institution staff who will be making Medisave claims are required to attend a free half day training session on Medisave claims process Medisave use guidelines and use of the MediClaim system Clinics medical institutions are also required to sign the Deed of Indemnity with CPF Board 2 2 5 Clinics medical institutions participating in the CDMP will be subjected to a Clinical quality checks conducted by MOH on patients who make Medisave claims through the clinics medical institutions b Professional medical audits conducted by MOH on Medisave claims and or c Operational audits conducted by CPF Board on Medisave claims Clinics which are not ready to make claims through Medisave e service could opt to submit cla
12. dialysis complications is also claimable Transplant related investigations and or procedures are not claimable 15 CHAPTER TWO The Clinical Guidelines Non reportable Conditions Routine online submission of clinical data for the following conditions is not required However clinicians are expected to provide for essential components of care as listed below 1 Stroke Defined to include Stroke and Transient Ischemic Attack TIA Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Thromboembolism Risk As clinically indicated Evaluate for atrial fibrillation cardiac Assessment murmurs and need for anti thrombotic therapy Rehabilitation Need Assessment As clinically indicated Blood Pressure Measurement Twice a year General BP target of lt 140 90 mmHg Lipid Profile Annually All patients should be risk stratified as recommended in the Lipids CPG Targets of treatment should be personalised by levels of risk Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist New suspected onset of TIA or Stroke e e New onset of atrial fibrillation or cardiac murmurs requiring further evaluation Part III Claimable Non Claimable Items Specific Examples of Claimable Non Claimable Purchase of medical equipment such as walking aids wheelchairs and other home nursing equipment are not claimable Investigations d
13. for each item severity improvement 3 2 1 3 2 2 3 2 3 One assessment of memory One assessment of mood and behaviour One assessment of rehabilitation Needs Dementia Two consultations for CDMP Mental Health instruments One assessment of functional and social difficulties if any For patients on cognitive enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated Screen 3 New Submission Select the Identification Type and enter the Patient NRIC FIN Select the chronic condition applicable to this patient You can select one or more conditions as applicable Click on Next to proceed to the Clinical Indicator Form 40 Patient Name Tan Ah Kun Patient NRIC FIN 81234567D Date of Birth Male C Female 14041971 Sex DDMMYYYY 4041971 E pra Chinese Z a eee 1 62 use 9 99 if not measurable Current Smoker C Yes No Year Started Smoking YYYY g Diabetes 2007 YYYY C Hypertension YYYY C DM Retinopathy YYYY O Lipid Disorder YYYY C DM Nephropathy YYYY C Cerebrovascular Accident CVA YYYY C DM Foot Complications YYYY C Coronary Heart Disease CHD YYYY Asthma YYYY M corp YYYY Major Depression 2007 YYYY Schizophrenia 2007 YYYY O Bipolar Disorder YYYY C Dementia YYYY O Oral Medications YYYY O Insulin YYYY O Oral Medications l C Oral Medications I O Preventer Atypical Antipsy
14. not measurable Current Smoker Yes No 1990 Year Started Smoking YYYY denotes a mandatory field Screen 5 Patient Details 5 Known Medical History 5 1 This section details the patient s medical history If it is your first submission for the patient please enter all the details For subsequent submissions you can omit the details if there are no changes 5 2 If you are unsure whether you have submitted the information it is recommended you fill in the details 43 Hypertension ase o YYYY Lipid Disorder Cerebrovascular Accithagt CVA V Diabetes 2007 __ YYYY Oo Oo Oo O Co 5 ocol Textbox is disabled unless M s corresponding checkbox is Oo Dementia YYYY Oral Medications YYYY O Insulin YYYY Oral Medications YYYY Oral Medications YYYY v Atypical Antipsychotics Prescribed 2008 YYYY Atypical Antipsychotics Prescribed YYYY Atypical Antipsychotics Prescribed YYYY Screen 6 Known Medical History and Treatment Sections 5 3 Enter the relevant medical conditions for the patient If a particular condition is selected then the year of diagnosis is mandatory You only need to fill in medical conditions that apply to the patient 6 Clinical Indicators and Assessment 6 1 This section enables you to enter the indicator measurement and ass
15. of the patient for the visits which were claimed For claims on the complications of the approved chronic diseases doctors have to document the causal relationship For packages please indicate dates of visits which are claimed f Investigation Test reports where available e g HbA1c results lipid results g Prescription records and h Evidence supporting diagnosis e g documentation in case records or laboratory reports 5 3 Medisave claims for all CDMP conditions will be audited but routine clinical data submission will only be required for Diabetes Mellitus Hypertension Lipid Disorders COPD Asthma and Nephritis Nephrosis Please note that in case the Medisave claim includes treatment for complication s due to the chronic disease the doctor would need to document clearly the causal relationship between the approved chronic condition and the complication s which arose from it 5 4 Clinics medical institutions or doctors found guilty of wrong claims will be required to refund the amount to the affected Medisave accounts Each time the doctor is found making wrong claims for his her patients he she will be issued a warning letter Repeated infringements by a doctor can lead to suspension of the Medisave accreditation of the doctor 31 CHAPTER FOUR Capture and Submission of Clinical Data 1 Commencement of Clinical Data Collection 1 1 Data collection will commence at the patient s first visit to the doctor for sel
16. only if a the patient has been diagnosed to have COPD AND b It is clinically deemed to be beneficial for the patient Can make claims for ambulatory aids e g walking sticks for my patient with Stroke or for oxygen concentrators for my patient with COPD requiring long term oxygen therapy Currently medical devices are not claimable items under Medisave for CDMP However for a patient with COPD he may claim up to 75 per month for rental of oxygen concentrators The Seniors Mobility and Enabling Fund SMF may be used to subsidize purchases of mobility devices for means tested patients above the age of 60 years old Can I make claims for Glucosamine Chondroitin supplements for my patient who has Osteoarthritis You may prescribe Glucosamine Chondroitin supplements for suitable patients but they are currently not claimable items under Medisave for CDMP Although Glucosamine and Chondroitin supplements are commonly prescribed for patients with Osteoarthritis their benefits have not been supported by sufficient clinical evidence Patients Medisave funds should only be claimed for evidence based medications and treatment modalities such as physiotherapy Q8 Can I claim for Hep B and Pneumococcal Vaccines amp Mammograms Medisave claims for Hep B and Pneumococcal Vaccines amp Mammograms are allowed but not under the CDMP framework From 1 Nov 2009 Medisave can also be used for Pneumococcal vaccinations for child
17. r 50 Amend Close Screen 13 Editable Page of Patient Record 10 CIDC Clinic Reports 10 1 This function provides standard report s for use by clinics One report is currently available and additional reports may be added in future releases 10 2 To access this function click on the CIDC Clinic Reports under the Reports menu button A page displaying all the available reports and their description will be loaded MEDIClaim NCSO NCSO001 v Chronic Diseases Claim CIDE Clinic Summary Reports 0 7 Clinical indicators F01 List of Patient NRIC No s Requiring Clinical Indicators Report Submission as Provides the list of NRIC for patients who have successful claims but no clinical indicators have been Reports j submitted by the clinic within the fixed 12 months period from the claim submission date Billing Details CIDC Clinics Rports Click on Reports menu and select Chronic Balance Enquiry CIDC Clinics Reports Chronic Payment Listing Screen 14 CIDC Clinic Reports 10 3 List of NRICs for patients for whom Clinical Indicators have not been submitted a This report enables the clinics to have a listing of all the patients NRICs for whom the clinics had made claims in the specified year but no clinical indicator reports were submitted within a fixed period of 12 months from the claim submission date of each patient This report is built in to assist doctors and clinics to keep track of the outstanding clini
18. s behalf 58 C MEDISAVE CLAIMS REIMBURSEMENT BILLING For Doctors and Clinics that wish to be registered into the CDMP Q1 Q2 Q3 Q4 Q5 Q6 In total how much can patients claim from Medisave for chronic disease treatments Patients can claim up to 400 per Medisave account per year for outpatient treatment of the approved chronic conditions regardless of the number of conditions they might have Whose Medisave account s can a patient make use of apart from his her own Patients can use their own Medisave account s and the account s of their immediate family members i e parents children and spouse In addition patients who are Singapore Citizens or PRs can also use the Medisave accounts of their grandchildren Claims can be made once the family member has signed the relevant Medisave Authorisation Form What will be the exact level of deductible and co payment Are the levels different for packages and individual visits There is a 30 deductible and 15 co payment of the bill balance for each claim that the patient has to pay in cash regardless if the claim is for an individual visit or packaged treatment Who should submit Medisave claims Any of the permanent staff of a Medisave accredited clinic medical institution who has attended the training sessions e g doctors nurses counter staff clinic managers can submit Medisave claims If the patient sees me for both a chronic condition and
19. the iris Urgent referrals o Sudden loss of vision o Retinal detachment o Neovascular glaucoma e Foot care team podiatry orthopaedics surgery vascular surgery if any of the following o Ulceration gangrene severe foot infection o Suspected acute Charcot s foot o Vascular claudication Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable Items Where appropriate drugs related to complications e g Ischaemic Heart Disease Chronic Renal Failure Neuropathic pains e g Amitriptyline and Carbamazepine and Peripheral Vascular Diseases e g Pentoxifylline are claimable Weight management and lifestyle management programmes are not claimable Slimming pills and drugs for erectile dysfunction are not claimable Supplements such as Vitamin B B12 are non claimable unless actual deficiency is documented 10 2 Hypertension Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Blood Pressure Measurement Twice a year General BP target of lt 140 90 mmHg but target of treatment should be personalised Weight and BMI Assessment Twice a year Keep BMI lt 25kg m For Asian population keep BMI lt 23 kg m Smoking Assessment Annually Ai sticks day zero for non or ex smoker Lipid Profile At or soon after diagnosis All patients should be risk stratified as d linically indicated recommended in the Lipid
20. windows In order to access the full system functionality you need to enable pop up windows for the MediClaim website To enable this feature follow the steps below a Select Tools gt Pop up Blocker gt Pop up Blocker Settings 52 40 Microsoft Internet Explorer tes Tools Help Mail and News z v Pop up Blocker 4 Turn Off Pop up Blocker wis LJ X 3 LAJ a a Q 2 Manage Add ons Pop up Blocker Settings Synchronize Windows Update Yahoo Services gt Windows Messenger ICQ Lite Edit with Altova XMLSpy manne MEDIC Hiss Screen 17 Internet Explorer Menu b Enter medinet gov sg and moh gov sg then click on Add MediClaim 20051212 1640 Microsoft Internet Explorer Pop up Blocker Settings Exceptions Pop ups are currently blocked You can allow pop ups from specific Web sites by adding the site to the list below Address of Web site to allow Allowed sites medinet gov sq Remove moh gov sq anos Remove All SE sword Authentication UserID __ Notifications and Filter Level isation ID sd Play a sound when a pop up is blocked Password sd IV Show Information Bar when a pop up is blocked Filter Level Medium Block most automatic pop ups iiid mended screen resolution 1024 X 76 Screen 18 Configuring Pop up Blocker 12 Fallback Procedures 12 1 Inthe event that the submission canno
21. 07 Stroke Thromboembolism Risk Assessment Y Delete Indicators Click to delete selected clinical indicators Delete after selecting the checkboxes All entries saved in the table will be of the unwanted Clinical Indicators submitted to the CIDC system Screen 8 Clinical and Assessment Indicators 6 5 After saving the data you can use the delete button to remove any mistakes 6 6 By default the data displayed is sorted by date of visit and indicators You can also click on the Indicators and Date headers to sort the data according to your preference 7 Attending Physician Information 7 1 This section details the physician attending to the patient It is required for each submission 7 2 If there is more than one physician attending to the patient the main physician information should be entered here a Registration C77 Doctor Name imbes E 3 Healthcare Mm Specialty Training Please select if applicable Establishment Role Date of 06 Jan 2008 Attending Doctor is th ient lar pri hysici ending Doctor is the patient s regular primary physician arden The Clinic is the patient s regular primary provider None of the Above denotes a mandatory field Submit Save Draft Close Screen 9 Physician Information 46 8 Report Submission 8 1 Once you have completed the data entry you can submit the report to MOH by clicking on the Submit button 8 2 If you are not yet ready to sub
22. 10 Anxiety 14 Parkinson s Disease 5 Chronic Obstructive 15 Benign Prostatic Pulmonary Disease COPD Hyperplasia BPH 6 Nephritis Nephrosis 2 Clinical Guidelines and Clinical Data Submission 2 1 Participating clinics medical institutions are expected to provide care to patients in line with the latest Clinical Practice Guidelines CPG and or best available evidence based practice as well as to track clinical data at patient and clinic medical institution level to monitor patient outcome While participating clinics medical institutions will still be required to submit relevant clinical indicators MOH has revised the requirement for clinical data submission to only 6 of the 15 conditions under CDMP For the other 9 conditions essential care components are expected to be documented and may be subjected to periodic audits 2 2 Please refer to Chapter Two The Clinical Guidelines for further details on the essential care components indications for referral and specific examples of claimable non claimable items These are recommended by Subject Matter Experts based on best available medical evidence The list of clinical indicators to be submitted is detailed in Chapter Four Capture and Submission of Clinical Data 2 3 Patients often have one or more of the 3 common metabolic and cardiovascular diseases namely Diabetes Mellitus Hypertension and Lipid Disorders For these patients they should be enrolled into the respective Disea
23. 200 of Medisave from his and his children s Medisave accounts total of 3 accounts every year to pay for his outpatient treatment for COPD 28 Scenario 2 The grandmother and parents of Ms Tan are suffering from Diabetes Mellitus However they have no Medisave Ms Tan can make use of a total of 400 annual withdrawal limit of her own Medisave every year to pay for the outpatient treatments of all 3 of her elders Scenario 3 Mdm Haslina is a working adult and has no children She has Hypertension and Asthma and can use up to 400 annual withdrawal limit from each of her s and her spouse s Medisave accounts to pay for treatment related to Hypertension and Asthma 3 6 Patients may have employer benefits and outpatient insurance that can be used for pay for outpatient treatments Bills should be paid using employers benefits and any relevant insurance that the patient may have first before claiming from Medisave for the balance 3 7 In cases where only part of the chronic disease outpatient treatment bill is payable by employer companies and the patient chooses to use Medisave for the balance of the bill clinics would a Follow the current arrangements it has with the employer to seek payment and b Help patients submit the Medisave claim 3 8 The maximum amount that can be withdrawn for chronic disease treatments attendances taking place in the year 2012 and thereafter 400 per Medisave account per calendar year up to
24. Bipolar Disorder Two consultations for CDMP Mental Health One Clinical Global Impression CGI Scale for each item severity improvement Osteoarthritis One Joint function assessment One bodyweight measurement One exercise and or weight loss plan One International Prostate Symptom Score I PSS BPH e One Abdominal examination Digital rectal examination e One Urine dipstick test e One Clinical Global Impression CGI Scale for each item Anxiety severity improvement Parkinson s Disease One Unified Parkinson s Disease Rating Scale for falls One Schawb and England Activities of Daily Living Scale per year refers to 12 months from the first visit of the patient for the chronic condition s i Only for patients with Schizophrenia on atypical antipsychotic medications 33 2 Collection and Submission of Clinical Data 2 1 The collection of clinical data can be carried out by a Manually recording the clinical data on a hardcopy template Annex B page 35 36 Please note that for submission purposes the data will subsequently have to be keyed in via the online CIDC e Service see Chapter Five User Manual for e Service Clinical Data Submission b Recording the clinical data directly onto electronic records through the Clinic Management System installed for electronic submission of clinical data for Medisave enrolled patients 3 Deadlines for Submission of Clinical Data to MOH 3 1
25. Chronic Disease Management Programme gt Diabetes Mellitus COPD e Osteoarthritis Hypertension Schizophrenia BPH Lipid Disorders Major Depression Anxiety Stroke Dementia Parkinson s Disease Asthma Bipolar Disorder Nephritis Nephrosis Handbook for Healthcare Professionals 2014 Includes the use of Medisave for CDMP and clinical components of Community Health Assist Scheme CHAS CONTENTS CHAPTER ONE The Chronic Disease Management Programme CDMP scccccssssssssesseeeeesees e Overview Update e Clinical Guidelines and Clinical Data Submission e Shared Care Programme for CDMP Mental Illnesses CDMP MI e Medisave use under CDMP CHAPTER TWO The Clinical Guidelines e Reportable Conditions e Non Reportable Conditions CHAPTER THREE Registration and Medisave USC cccssssscccssssseccessssscessssscceenssssceacsssseeeees e Policy on Medisave Use e Registration Process for Medisave for CDMP e Guidelines on Medisave Use for CDMP e Process of Making a Medisave Claim e Audit CHAPTER FOUR Capture and Submission of Clinical Data ccccssssscccssssssceessseceeessseeeeees e Commencement of Clinical Data Collection e Collection and Submission of Clinical Data e Deadlines for Submission of Clinical Data to MOH CHAPTER FIVE User Manual for Clinical Data Submission via CIDC Service ccessssseceeees e Introduction e Getting Started e Clinical I
26. Date before doing a DDMMYYYY search To Date i J DDMMYYYY lt Sort By Patient Name v Ascending x Search Screen 11 Search Criteria 9 6 All submissions made by your clinic which matches the criteria will be displayed as shown on Screen 12 Patient Name Patient NRIC FIN F From Date opmmyyyy 12122006 To Date DDMMYYYY o Sor By Patient Name Ascending M Click to retrieve all records that match the specified criteria Search 3 records retrieved Check only one record for 12 Dec 2006 amendment or many 12 Dec 2006 records for deletion 42 Dec 2006 Click on the hyperlink to retrieve a read only page of the record Amend Delete selected selected record records Screen 12 Search Results 9 7 If the number of search results is too large you can either specify more restrictive search criteria or use the page number to navigate through the results 48 9 8 9 9 Click on the Patient Name hyperlink to view the report submitted When the Amend button is clicked the selected record will be displayed in editable mode as shown on Screen 13 Patient Name ffanAhKun Patient NRIC FIN 1234567D Date of Birth aan f Male C Female DDMMYYYY 14041971 mes Sex Chinese F Height Metres 1 62 use 9 99 if not measurable Current Smoker C Yes No Year Started Smoking YYYY denotes a mandatory field Diabetes 2007 YYYY
27. Q18 cash co payment collected previously 30 deductible and 15 co payment on the bill balance the clinic can refund the amount to the patient in cash If patients have signed up for the Programme can they opt out of it at a later date Do I need to refund the amount that he had paid up for a package Patients can opt out at a later date by informing the clinic from which he she is receiving care In terms of refund it is a private arrangement between the provider and the patient Patients should find out the provider s policy on refunds before signing up for packages However funds withdrawn from Medisave must be reimbursed to the Medisave accounts first Is Medisave withdrawal dependent on the patient having only one specific primary care provider No Patients are encouraged to have continuity of care with one family physician but they are free to choose and switch providers Hence they can make Medisave claims at any Medisave accredited clinic How will claims be made if a patient is referred to an unaccredited provider Medisave claims will not be allowed at an unaccredited clinic However the referring party can make arrangements to bill on behalf of his unaccredited partners The referring party is expected to bear full responsibility for any such arrangements made In addition the referring party is also responsible for the submission of clinical data for the patient How will the scheme apply to Permanent Residents and
28. aim e Service 1 2 System Requirements 1 2 1 In order to use the CIDC e Service an Internet enabled computer with the following is required a Hardware Requirements The minimum recommended hardware configuration is e Pentium III MHz Processor with 256MB RAM e Atleast 200 MB free hard disk space b System Software Requirements e Windows XP e Internet Explorer 6 0 and above e Broadband Internet Connection c Other Requirements e RSA token card e MediClaim user account 2 Getting Started 2 1 User Account 2 1 1 You will be using your MediClaim system user account to access the CIDC e Service The MediClaim account is the same one used for the submission of claims 2 1 2 If you do not have an account for the claims submission you will need to approach MOH for the creation of a new account 2 2 Accessing the CIDC e Service 2 2 1 The web URL to access the MediClaim system is https access medinet gov sg Refer to the MediClaim user manual for details on login procedures Welcome to MEUL Password Authentication userIo Organisation mw Password iind Best Viewed with IE 6 0 or higher Recommended screen resolution 1024 X 768 pixels 16 bit true colour Screen 1 MediClaim Login Screen 2 2 2 Upon successful login to the MediClaim system you will be able to see the CIDC e Service in the left hand menu as shown on Screen 2 below All users with access to the Chronic Disease Claim Form e Servi
29. alist Complicated or Atypical Young onset lt 55 years old Parkinson s Disease Parkinsonism Atypical Parkinsonism Patients who do not respond to levodopa or dopamine agonists Patients with cognitive impairment or neuropsychiatric dysfunction Parkinson s disease complicated by dyskinesia dystonia myoclonus or gaze palsies Family history of Parkinson s Disease Part IIl Claimable Non Claimable Items Specific Examples of Claimable Non Claimable e Dietary supplements or traditional medications therapies e g CoEnzyme Q10 are not claimable 18 4 Osteoarthritis Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Joint Pain and Function Annually Prescription and Review of Exercise Annually In the form of a directed or supervised Plan muscle strengthening or aerobic exercise programme Can be undertaken by physiotherapist Weight and BMI Assessment Annually Weight reduction should be oavoraren for patients with BMI of 223 kg m Obese patients with BMI 230 kg m should be referred to a medically supervised weight reduction programme Activities of Daily Living ADL Annually Referral to physiotherapy occupational A t therapy assessment for assisted devices ssessmen made should ADL be impaired Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Lack of Response to e Unsatisfactory improvement of pa
30. also be able to track its own performance trends Q15 What will the clinical quality improvement process be like The clinical data that is monitored is useful for clinical quality improvement in the care of chronic conditions When meaningfully used it will empower 64 patients to take charge of managing their chronic condition as guided and supervised by their family physician This can improve compliance with the recommended care of the chronic condition s with better longer term outcomes Q16 What will the clinical audit process be like Periodic audits will be carried out to ensure accuracy of clinical data submission and to ensure that minimum standards of performance are met Due consideration will be given so that such audits do not disrupt clinic operations and patient care processes Q17 What documents must submit if my clinic is selected for audit Photocopies of the following documents should be submitted by post a Doctor s clinical notes for the visit visits submitted for specified claim b Laboratory results relevant to the medical condition s for which claim was made e g HbA1c Lipid Panel Spirometry test etc c Prescription or clinical notes with documentation of details of the drugs prescribed i e name of drug frequency dose duration and d Invoices receipts showing the itemized breakdown medication s investigation if any consultation amp total claim amount of the bill s submitted for
31. alth GP Partnership Programme b Doctors with MMed FM GDFM or on the Register of Family Physicians need not attend CDMP Mental Health training if the mental health training modules of these programmes include all the conditions in CDMP Mental Illnesses gt Dementia will not be considered a mental illness under the CDMP as of 1 Jan 2014 and therefore physicians who wish to manage Dementia under CDMP are not required to participate in the Shared Care Programme gt The Shared Care Programme was meant to provide specialised support e g from psychiatrists and mental health trained nurses as well as supply of drugs for mental illness to primary care doctors and ensure that they have sufficient training and confidence in treating patients with mental health conditions 24 c Doctors with Family Medicine FM training who had 3 months posting at psychiatric departments at the various Restructured Hospitals from May 2007 d Doctors Family Physicians Family Doctors Medical Officers who had 6 months posting at psychiatric departments at the various Restructured Hospitals OR e Holders of the Graduate Diploma in Mental Health 2 Registration Process for Medisave for CDMP 2 1 Clinics That Wish to Participate in the CDMP 2 1 1 To be in the CDMP both the clinic medical institution and its doctor s have to register with and be accredited by MOH Upon accreditation the doctors can then make Medisave claims for their patients 2
32. ardless of type Pregnant women or those planning pregnancy who require pre conception intensive glycaemic control Patients with morbid obesity who are open to the option of intensive weight management including bariatric surgery High Risk Individuals Individuals with or at risk for recurrent severe hypoglycaemia diabetic ketoacidosis DKA or hyperglycaemic hyperosmolar state HHS regardless of HbAic High risk patients who may benefit from intensive control of blood glucose and or other risk factors e g to retard progression of retinopathy or nephropathy Severe hypoglycaemia refers to hypoglycaemia where assistance from another person is required DM Complications Requiring e Nephrology referral if any of the following Active Sub Specialist o Unexpected or rapid decline in renal function Management o Difficult management issues blood pressure hyperkalaemia control o Atypical features e g haematuria presence of casts in the urine sediment presence of renal bruit nephritic range proteinuria gt 3g day absence of retinopathy e Ophthalmology referral if any of the following o Hard exudates retinal thickening within one disc diameter of the fovea diabetic macular oedema o Severe non proliferative diabetic retinopathy o Unexplained drop in visual acuity eye findings Early referrals o Neovascularisation from proliferative diabetic retinopathy o Pre retinal and or vitreous haemorrhage o Rubeosis iridis new vessels on
33. ave been seeing their family doctor can continue to see their preferred doctor as they age and develop chronic conditions 1 2 When the CDMP was first introduced in 2006 it started with Diabetes Mellitus Since then more common chronic conditions with internationally established treatment protocols and clear measurable clinical outcomes such as Hypertension and Lipid Disorders were progressively included Subsequently CDMP was also extended to include outpatient psychiatric treatment for patients with Schizophrenia Major Depression Dementia and Bipolar Disorder 1 3 From January 2014 Medisave use and CHAS subsidies for chronic conditions was further extended beyond conditions that traditionally benefited from DMPs e g Diabetes Mellitus to include chronic conditions with relatively high disease burdens e g Osteoarthritis This helps these patients reduce out of pocket payments Table 1 below lists the conditions under CDMP CHAS as of January 2014 with the newly introduced conditions in bold Table 1 Chronic Conditions under CDMP CHAS Chronic Conditions with Established DMPs Requiring the reporting of indicators CDMP Mental Illnesses Requiring participation of clinic doctor in a Shared Care Programme Other Chronic Conditions 1 Diabetes Mellitus 2 Hypertension 3 Lipid Disorders 7 Schizophrenia 8 Major Depression 9 Bipolar Disorder 11 Stroke 12 Dementia 13 Osteoarthritis 4 Asthma
34. cal indicator reports they would require to submit with each claim b Click on the report title from the list of available reports as shown on Screen 15 A report page with a textbox would appear for the user to key in the year of the requested report as shown below 51 MEDIClaim NCS0 NCS0001 v Chronic Diseases Claim CIDE Clinic Summary Reports 00 ra minn F01 List of Patient NRIC No s Requiring Clinical Indicators Report Submission Reports Provides the list ofWRIC for patients who have successful claims but no clinical indicators have been submitted by the clink within the fixed 12 months period from the claim submission date Billing Details CIDC Clinics Reports Chronic Balance Enquiry Click on a Report title from the list of available reports Chronic Payment Listing Screen 15 Selecting a Report c Upon entering a valid year a list of patient NRIC numbers will be generated The report generated below shows the record of a patient who had a claim submitted but with no submission of any clinical indicator MEDIClaim NCSO NCS0001 v Chronic Diseases Claim Clinical Indicators Year YYYY 2006 E __View Report Download as csv File Reports CIDC Clinics Reports 94480330E Chronic Balance Enquiry Chronic Payment Listing Screen 16 Viewing a Report 11 Troubleshooting 11 1 Enabling of Pop Ups Certain screens within the application will be displayed as pop up
35. cant involuntary weight loss gt 10 during the last 6 months or gt 5 in the past month Self Management Education At diagnosis and as Educate on what to do during acute ay oss pe exacerbations clinically indicated Inhaler technique assessment Spirometry At or soon after diagnosis and subsequently as clinically indicated Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Severe or Complex Cases Moderate to severe COPD i e FEV1 lt 50 predicted Frequent exacerbations e g two or more a year despite compliance to treatment Rapidly progressive course of disease Development of new symptoms e g haemoptysis or new physical signs e g cyanosis peripheral oedema Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable Medications not indicated for COPD including mast cell stabilisers e g Ketotifen are not claimable Investigations done prior to diagnosis e g spirometry or unrelated to the follow up of COPD are not claimable Non evidence based investigations such as hand held spirometry are not claimable 14 6 Nephritis Nephrosis Conditions include a Chronic Glomerulonephritis presenting as nephritic or nephrotic syndromes b Nephropathies e g secondary to underlying diabetes or other conditions and c Chronic Kidney Diseases with or without known underlying aetiology Part I Clinical Indicators Essential Components Reco
36. ce will have access to the CIDC e Service 2 2 3 Click on the menu to display the functions available Clinical Indicators Submission Search Claim Advice Error Message Screen 2 Menu a Submission is used to submit a new report b Search is used to retrieve submitted reports 38 3 Clinical Indicators Report Submission 3 1 This function is used to submit clinical data on patients who have used their Medisave under the CDMP A new submission can be made each time there is additional indicator information for the patient either on a per visit basis or consolidated over a few visits All submissions are distinct and will be used for analysis by MOH on a cumulative basis 3 2 To submit a new set of clinical data for a patient to MOH click on the Submission sub menu The following screen will appear Compulsory fields Patient ID Type SINGAPORE PINK BLUE NRIC Patient NRIC FIN as entered in Medisave claim form O Diabetes C Hypertension O Stroke C Asthma Diseases C Major Depression E Schizophrenia C Dementia Click to go to Clinical Indicator Form in Screen 4 Condition are Components Per Year Two blood pressure measurements Two bodyweight measurements Two haemoglobin A1c HbA1c tests One serum cholesterol level LDL C test One smoking assessment One eye assessment One foot assessment One nephropathy screening test Diabetes m
37. ch visit The items in the medical history data will only need to be captured once but should be updated as and when there are changes 62 Q3 Q4 Q5 Q6 Q7 Q8 Q9 How do record the actual year of diagnosis of patients with long standing chronic diseases The estimated year of diagnosis for the patient s chronic condition can be recorded if the exact year is not known Will data on all clinical parameters be required at every visit No Only data on assessments or tests performed during the visit need to be captured Would need to repeat HbA1c or LDL cholesterol if my patient is able to produce the results of a test done elsewhere You can submit the relevant details of your patient s test results that have been performed elsewhere instead of repeating the test If you do so please keep a copy of the record of the test results What if the patient is lost to follow up Please note it down in your clinical documentation Alternatively if you are using the web based CIDC e Service for data submission you may also document the information using the textbox available under the Patient Participation Module present on the navigation bar If you are using CMS for data submission please contact your CMS provider for more details on capturing of this type of information electronically What if the patient refuses certain tests Tests are performed when indicated as part of the proper management of th
38. chotics Prescribed 2008 YYYY C Atypical Antipsychotics Prescribed YYYY C Atypical Antipsychotics Prescribed YYYY 41 Date of Visit DDMMYYYY Blood Pressure Systolic Diastolic I DM Eye Assessment o LDL C mg dL DM Nephropathy Assessment o HbA1c DM Foot Assessment Fi Weight kg Stroke Thromboembolism Risk Assessment use 999 if not measurable Smoking Assessment oO Inhaler Technique Assessment Asthma amp oO COPD only Cigarettes smoked per day average ACT Score Asthma only Influenza Vaccination Assessment COPD Oo only The following care components are only for CDMP Mental Health Programme Patients CGI Severity of Illness v Fasting Lipids Blood Test Oo CGI Global Improvement v Fasting Glucose Blood Test Oo Consultation for CDMP Mental Health oO Assessment of Memory Oo Indicate the patient attendance For patients on cognitive enhancers oO Assessment of Mood and Behaviour o documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Assessment of Functional and Social Difficulties if any C Assessment of Rehabilitation Needs o denotes a mandatory field For current smokers smoking cessation advice should be given For non or ex smoker please reinforce the benefits of not smoking cigarettes Applicab
39. d general physical health Part Il Suggested Indications for Referrals a Schizophrenia Referral from Primary Care to Specialist Special Patient Population Pregnant paediatric or geriatric patients Forensic or medico legal issues involved High Risk Individuals Risk of violence to self or others Unstable uncontrolled symptoms e g recent hospitalisation within last 6 months Complex Cases Doubt with regard to initial assessment diagnosis and initiation of treatment Unexpected changes in symptomatology Drug related complications Treatment resistance Switching to Clozapine third line antipsychotic with risk of agranulocytosis requiring regular monitoring 21 b and c Major Depression or Bipolar Disorder Referral from Primary Care to Specialist Special Patient Population Pregnant or paediatric patients Forensic or medico legal issues involved High Risk Individuals Risk of violence to self or others especially patients with suicidal risk Unstable uncontrolled symptoms e g recent hospitalisation within last 6 months Complex Cases Doubt with regard to initial assessment diagnosis and initiation of treatment Presence of psychotic symptoms having hallucinations or odd beliefs Presence of stuporous behaviour refusing to talk eat or drink Complicated by medical psychiatric and or psychosocial co morbidities including addiction disorders and substance abuse Failure of one or two trials of medication Need fo
40. dicators into the table below after filling in the form d Bipolar Disorder Atypical Antipsychotics Medication To check the box if test is done DM Eye Assessment o mgidL DM Nephropathy Assessment oO DM Foot Assessment oOo Stroke Thromboembolism Risk Assessment not measurable Inhaler Technique Assessment Asthma amp oO COPD only Influenza Vaccination Assessment COPD Oo only egramme Patients Fasting Lipids Blood Test o Fasting Glucose Blood Test oO Assessment of Memory o Assessment of Mood and Behaviour o O C 11 May 2007 Systolic BP mmHg C 11 May 2007 Diastolic BP mmHg 100 C 11 May 2007 LDL mg dL 40 C 11 May 2007 HbA1c 30 C 11 May 2007 Weight kg 90 C 11 May 2007 Cigarettes smoked per day Avg 10 C 11 May 2007 DM Eye Assessment Y C 11 May 2007 DM Nephropathy Assessment Y C 11 May 2007 DM Foot Assessment Y C 11 May 2007 Stroke Thromboembolism Risk Assessment Y Delete Indicators Click to delete selected clinical indicators Screen 7 Filling in the Clinical Indicators 45 Click to sort the records e H Date C 11 May 2007 Systolic BP mmHg 150 C 11 May 2007 Diastolic BP mmHag 100 C 11 May 2007 LDL mg dL 40 C 11 May 2007 HbA1c 30 C 11 May 2007 Weight kg 90 C 11 May 2007 Cigarettes smoked per day Avg 10 C 11 May 2007 DM Eye Assessment Li C 11 May 2007 DM Nephropathy Assessment Y C 11 May 2007 DM Foot Assessment Y C 11 May 20
41. e chronic disease As such the physician should inform the patient as to the rationale and provide other key information regarding these tests If the patient refuses the tests please note this response in the patient s clinic notes If missed the previous deadline for submission of clinical data do still need to submit the data for that period Yes you should still submit the relevant data for that period as well as the current data Which healthcare provider should submit clinical data if the patient makes Medisave claims at three different healthcare providers during one year It would be appropriate for each provider to collect relevant data for the care that has been provided and to submit the data If they are not able to make the submission they should forward the data to the primary physician who is 63 Q10 Q11 Q12 Q13 coordinating the care of the patient s chronic condition so that he she may be updated and make the submission If a patient starts making Medisave claims from June onwards must submit clinical information captured before June You can capture the relevant clinical data of the patient However for the purpose of assessing the care process and outcome of the chronic condition the period of one year taken from the date when the patient first enrolled into the CDMP for the chronic condition will be used My patient claimed Medisave for treatment of a chronic condition when he fi
42. ected chronic CDMP conditions These conditions are Diabetes Mellitus Hypertension Lipid Disorders COPD Asthma and Nephritis Nephrosis 1 2 The quality of patient care for these six chronic conditions will be evaluated according to whether the relevant process and care components have been met as listed below Table 4 List of Clinical Indicators for CDMP For Submission Chronic Condition Care Components Per Year e Two blood pressure measurements e Two bodyweight measurements e Two haemoglobin A1c HbA1c tests e One serum cholesterol level LDL C test e One smoking habit assessment e One eye assessment e One foot assessment e One nephropathy assessment Additional indicators for patients with nephropathy will follow that of Diabetes Mellitus Nephritis Nephrosis e Two blood pressure measurements Hypertension e One bodyweight measurement e One smoking habit assessment e One serum cholesterol level LDL C test Lipid Disorders e One smoking habit assessment e Two Asthma Control Test ACT scores Asthma i e One smoking habit assessment e One smoking habit assessment COPD e One bodyweight measurement e One COPD Assessment Test CAT score e One influenza vaccination e Two blood pressure measurements Nephritis Nephrosis e One renal function creatinine and or eGFR e One urine protein urine protein creatinine ratio per year refers to 12 months from the fir
43. ellitus marked with asterisk C Lipid Disorder OcoPD C Bipolar Disorder Select patient ID Type Enter patient NRIC FIN Select the medical conditions applicable to the patient more than one medical condition may be chosen Two blood pressure measurements e One bodyweight measurement Hypertension e One smoking assessment e One serum cholesterol level LDL C test One smoking assessment Lipid Disorder Two blood pressure measurements One serum cholesterol level LDL C test Stroke One smoking assessment One clinical thromboembolism risk assessment One inhaler technique assessment e One smoking assessment Asthma Two Asthma Control Test ACT scores One inhaler technique assessment One smoking assessment One bodyweight measurement One influenza vaccination COPD The following care components are only for CDMP Mental Health Programme Patients Major Depression Two consultations for CDMP Mental Health e One Clinical Global Impression CGI Scale for each item severity improvement Two consultations for CDMP Mental Health One blood test for fasting lipids One blood test for fasting glucose Schizophrenia Two consultations for CDMP Mental Health One blood test for fasting lipids One blood test for fasting glucose Bipolar Disorder One Clinical Global Impression CGI Scale for each item severity improvement One Clinical Global Impression CGI Scale
44. en urinary tract infection Bladder stones Hard and or irregular prostate Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable e Dietary supplements or traditional medications therapies e g Saw palmetto extract are not claimable e PSA and Testosterone tests are not claimable 20 6 Mental Illnesses a Schizophrenia b Major Depression c Bipolar Disorder _and_d Anxiety In order to provide greater support e g professionally as well as drugs for family physicians managing patients with mental illness family physicians are required to participate in Shared Care or GP Partnership Programmes with Restructured Hospitals before Medisave claims can be made Anxiety disorders claimable under CDMP are General Anxiety Disorder Panic Disorder Phobic Anxiety Disorders Obsessive Compulsive Disorder and Post traumatic Stress Disorder Part I Clinical Indicators Applicable to all Mental Illnesses Essential Components Recommended Frequency Remarks more frequent if clinically indicated Clinical Global Impression CGI Annually CGI assessment for Scale Severity Scores 1 7 Clinical improvement Scores 1 7 1 indicates normal no mental illness or very much improved Consultations for CDMP Mental Twice a year Consultation includes assessment for symptoms response and adherence to Health medications psychosocial interventions risk of harm to self or others an
45. essment done on the patient over any period Only measurements and assessments not reported previously need to be entered in this section 6 2 Initially there will be no clinical indicators added to the report 6 3 Fill in all the clinical indicators and use the Add Indicators button to save them as shown in Screen 7 6 4 There must not be any unsaved data left in the Clinical Indicators Section before submitting the form 44 Date of Visit DDMMYYYY Blood Pressure Systolic Diastolic LDL C HbAtc Weight kg Smoking Assessment Cigarettes smoked per day average ACT Score Asthma only The following care components are only for CDMP Mental Health P CGI Severity of Illness CGI Global Improvement Consultation for CDMP Mental Health Indicate the patient attendance For patients on cognitive enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Assessment of Functional and Social Difficulties if any denotes a mandatory field use 999 if o For current smokers smoking cessation advice should be given For non or ex smoker please reinforce the benefits of not smoking cigarettes Applicable to current smokers only Only for patients on Schizoghose S ick to add clinical indicators only those performed Add all Clinical lous In
46. her Medisave account need to sign a Medisave Authorisation Form MAF to authorise the CPF Board to deduct his her Medisave savings for the treatment of the patient The authorisation can be made on a per treatment basis or over a period of months It then stands until revoked in writing Clinic medical institution staff should witness the signing and verify the relationship s to the patient as stated in the MAF c Clinics medical institutions can then submit the Medisave claims electronically to the CPF Board for processing via the MediClaim System d Payment will be made daily to Medisave accredited medical institutions via InterBank Giro IBG on the 3 working day after the approval date of the Medisave claims Can GPs who are contracted by nursing homes to provide outpatient care for their residents help the ones suffering from one of the approved chronic conditions make Medisave claims Yes if the GP and his her clinic are accredited for Medisave use for CDMP He She can help the nursing home patients to make a Medisave claim for their outpatient chronic disease treatment s through his her clinic D DATA SUBMISSION CLINICAL IMPROVEMENT AND AUDITS Q1 Q2 Why is the patient s medical and treatment history required The data collected will provide a better profile of patients on CDMP This information will be useful for fine tuning for programme planning and management purposes Must the medical history be captured at ea
47. iabetes Hypertension and Lipid Disorders Date of Visit LDL C Systolic BP Diastolic BP Weight Avg no dd mm yy mg dL mmol L __ mmHg mmHg kg cigs day For Diabetes only Date of Visit Glucose HbA1c Eye v Foot V Nephropathy v dd mm vy For DM Nephropathy only Date of Visit Serum Creatinine eGFR Urine ACR dd mm yy umol L ml min 1 73m mg mmol B Asthma and Chronic Obstructive Pulmonary Disease COPD DMP For Asthma For Asthma For COPD only COPD only Date of Visit Avg no Asthma Weight kg COPD Influenza dd mm yy cigs day Control Test Assessment Vaccination ACT Score Test CAT v Score C Nephritis Nephrosis DMP For Nephritis Nephrosis Date of Visit Systolic BP Diastolic BP Serum eGFR Urine ACR or dd mm yy mmHg mmHg Creatinine ml min 1 73m Urine PCR umol L mg mmol 36 CHAPTER FIVE User Manual for e Service Clinical Data Submission 1 Introduction 1 1 Purpose 1 1 1 The manual serves as a guide on how to use the Clinical Indicators Data Collection CIDC e Service for the submission of data to MOH as part of CDMP 1 1 2 The manual is intended for the hospital clinic staff who are doing clinical data and indicators submission The staff should already be familiar with web browsing and the MediCl
48. ific DMP or for the treatment of the condition and its complications The doctor in charge must clearly document this causal relationship or link between the condition and its treatment c In this regard Medisave claims will generally not be allowed for sleeping pills slimming pills or erectile dysfunction drugs used for lifestyle purposes d Under certain equivocal circumstances the auditors will seek further clarification with the prescribing doctor and decide on acceptance of claim on a case by case basis e Essential care components are to be documented in the doctor s clinical notes Audits may call for essential care components to be submitted at random 3 4 Certain items including non evidence based treatments are not Medisave claimable This is to ensure judicious usage of patients Medisave dollars so that 27 they cover essential care components and medications A general list of claimable and non claimable items is included in Table 3 below for reference Table 3 General List of Medisave Claimable and Non Claimable Items Services Claimable Not claimable Relevant investigations Investigations prior to diagnosis in a laboratory and radiological for previously well patient e g OGTT in a the evaluation of approved previously well patient chronic conditions and or their Investigations unrelated to the complications management of the condition or its complications Screening tests e g STD screening Hepatitis screening
49. ims via other Clinic Management Systems such as ClinicAssist 26 2 3 Registration of Doctor with MOH 2 3 1 Doctors practising at accredited clinics medical institutions need to register with MOH to participate in the CDMP before they can make Medisave claims for their patients 2 3 2 Interested doctors can submit an E Application to participate in the CDMP The website is http www moh gov sg mmae DoctorApplication aspx Registration of doctors in the CDMP needs to be renewed every 2 years 2 3 3 Registered doctors will be audited by MOH and CPF Board on the clinical outcomes and Medisave claims of their patients 3 Guidelines on Medisave Use for CDMP 3 1 Participating clinics medical institutions and doctors have to comply with these guidelines on Medisave use for CDMP 3 2 Medisave use is only allowed for outpatient treatments of the approved chronic conditions in Table 1 and or its associated complications Doctors must certify by indicating the diagnosis diagnoses within Part 3 3 of the Medisave Authorisation Form that patients they make Medisave claims for are suffering from one or more of the approved chronic conditions and that treatment administered are related to that chronic condition 3 3 Medisave claims will be accepted only if a The patient is diagnosed to have one of the approved chronic conditions listed in Table 1 b The claim must be related to the essential care components in the management of that spec
50. in stability or function despite Conservative Treatment adequate conservative non pharmacological and pharmacological treatment Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable Off label non HSA approved non evidence based medications or therapies e g Glucosamine Calcium and Intra articular viscosupplementation Acupuncture and Chiropractic are not claimable Investigations e g X ray knees related to the management of Osteoarthritis are claimable 19 5 Benign Prostatic Hyperplasia BPH Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Review of Lower Urinary Tract Annually Recommended tool for assessment of LUTS is Symptoms the International Prostate Symptom Quality of Life Score Clinical Examination Abdominal Initial assessment Abdominal examination includes assessment zas for a palpable bladder Rectal examination to and Digital Rectal Exam assess size consistency and regularity of prostate Co Morbidity Assessment includes Initial assessment medication review Urine Labstick or Microscopy Initial assessment Screen for haematuria pyuria and glycosuria Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Retention of urine palpable bladder and or high residual urine Urinary incontinence and or other persistent bothersome symptoms Haematuria Prov
51. le Non Claimable Off label non HSA approved non evidence based medications or therapies e g NSAIDs COX2 inhibitors and Prednisolone for prevention of cognitive decline are not claimable Dietary supplements e g Vitamin E Ginkgo or traditional medications therapies e g aromatherapy or massage therapy are not claimable 17 3 Parkinson s Disease Defined to include Parkinson s Disease and Parkinsonism excluding Drug induced Parkinsonism Part I Clinical Indicators Essential Components Recommended Remarks Frequency more frequent if clinically indicated Review of Diagnosis Annually The diagnosis would be reviewed regularly and reassessed if there are atypical features e g falls at presentation and early in the disease course poor response to levodopa symmetry at onset rapid progression to Hoehn amp Yahr stage 3 in 3 years lack of tremor or dysautonomia Review of Treatment Annually Review and discussion with regard to medical and surgical treatment options as well as need for rehabilitative therapies physiotherapy occupational therapy and speech therapy Review of Complications Annually Assessment for cognitive impairment psychiatric disorders e g depression psychosis autonomic dysfunction e g constipation incontinence orthostatic hypotension falls sleep disorders and medication related side effects Part Il Suggested Indications for Referrals Referral from Primary Care to Speci
52. le to current smokers only Only for patients on Schizophrenia and Bipolar Disorder Atypical Antipsychotics Medication To check the box if test is done _Add Indicators Click to add clinical indicators only those performed Registration M Doctor Name pape Rcd a Healthcare Specialty Training Please select if applicable gt Establishment Role Gl AE is tac naksont ae ini Date of 06 Jan 2008 ending Doctor is the patient s regular primary physician Paras an The Clinic is the patient s regular primary provider None of the Above denotes a mandatory field Submit Save Draft Close Screen 4 Clinical Indicator Form The Clinical Indicator Form consists of 4 sections a Patient Details b Known Medical History c Clinical and Assessment Indicators and d Attending Physician Information 42 4 Patient Details 4 1 This section details the patient s basic bio data If it is your first submission for the patient only Patient NRIC Name Date of Birth Sex Race and Current Smoker is required For subsequent submissions only the Patient NRIC and Name are mandatory 4 2 In the event of differences between two submissions the data from the latest submission will be considered as the up to date information Patient Name Lee Yong Kun Patient NRIC FIN 51234567D Date Bith Coman e Male C Female ODMMYYYY 02121970 pe Sex Race Chinese X Height Metres 17 use 9 99 if
53. lled with remaining treatments clinics medical institutions should refund the unused Medisave amount to the appropriate payer Authorisation can be for a period of 3 6 or 12 months or for an open ended length of time subject to revocation in writing 30 4 8 For clinics which are unable to make claims electronically via the MediClaim system they could also opt to submit Medisave claims via other Clinic Management Systems CMSs such as ClinicAssist 5 Audit 5 1 All Medisave claims for CDMP conditions may be subjected to audit The CPF Board may carry out regular audits of the participating clinic s medical institution s records for Medisave claims There are 2 types of audits for the Medisave claims a Operational audit This audit looks at the operational aspect of making Medisave claims such as completion of Medisave Authorisation Forms b Professional audit This audit looks at treatments and investigations administered for each Medisave claim to determine if it is related to the proclaimed diagnosis 5 2 Prior notice will be given to identify the cases to be audited The following documents may be required for the audit a Hard copies of Claim Forms submitted electronically b Medisave Authorisation Forms c Itemised bills Payment records detailing consultation charges individual drug charges DRP nursing charges other services d Photocopies of identification papers where necessary e Case records
54. ltiple psychosocial problems Concurrent active GERD which may mimic asthma Cases Requiring Further Uncertain diagnosis with need for additional investigations Investigation e g unilateral wheeze unable to differentiate COPD from asthma Probable Occupational Asthma High Risk Individuals History of near fatal asthma requiring intubation and ventilation Failed to achieve asthma control despite optimal treatment e g patients requiring daily oral steroids for control Severe asthma requiring step 4 care and yet experiencing exacerbation despite compliance Poorly controlled asthmatics with 22 hospitalisations and or requires gt 2 courses of burst therapy with oral steroids in the past year Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable e Investigations done prior to diagnosis e g spirometry or unrelated to the follow up of Asthma are not claimable e Non evidence based investigations such as hand held spirometry are not claimable 13 5 Chronic Obstructive Pulmonary Disease COPD Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated COPD Assessment Test CAT Score Annually Smoking Assessment Annually aoe sticks day zero for non or ex smoker Influenza Vaccination Annually Weight and BMI Assessment Nutritional intervention should be considered in all COPD patients with BMI Annually lt 18 5kg m or signifi
55. ment help patients avoid subsequent costly hospitalisations To bring about better health outcomes MOH has allowed Medisave to cover selected chronic conditions in the outpatient setting 1 2 Nonetheless to ensure judicious and prudent use of Medisave funds three safeguards have been put in place under the Medisave for CDMP a Deductible A deductible of 30 will apply for each outpatient bill i e bills below 30 will not be eligible for Medisave claims b Co payment A co payment of 15 will apply on each outpatient bill in excess of the deductible and c Annual withdrawal limit An annual withdrawal limit of 400 per Medisave account applies This will be reset on 1 January of each year Example For a bill of 130 the patient pays the first 30 of the bill and 15 of the remaining 100 15 in this case Thus a patient will need to pay 45 out of pocket The remaining 85 can be claimed from Medisave 1 3 Only doctors and clinics medical institutions which are accredited for Medisave use and participating in the CDMP can make Medisave claims for patients To make claims for Mental Illnesses i e Schizophrenia Major Depression Bipolar Disorder and Anxiety doctors also need to attend training updates for CDMP MI and participate in a Shared Care or GP Partnership Programme with a public hospital Doctors with the qualifications below are exempted from having to attend any training update a GPs on the existing Mental He
56. mit you can click on the Save Draft button and retrieve the report later from the search function for submission submit Csave vrar close The Table below describes the function for each button Button Function Description Submit Submits the form after completion Deletes any existing drafts saved previously Save Draft Saves the inputs in the unfinished form as a draft for completion in the future Close Closes the current form and returns to the main menu 9 Search Clinical Indicator Reports 9 1 After you have submitted a report or created a draft you can retrieve the reports at a later stage using the search function This function allows you to specify search criteria and retrieve all reports matching the criteria 9 2 After retrieving the report you can also proceed to Amend it if there was any mistake in the previous submission or delete it altogether 9 3 To access this function click on the Search sub menu under the Clinical Indicators main menu as shown on Screen 10 Clinical Indicators Submission Claim Advice Screen 10 Search Menu 9 4 The Search page will be shown Enter your search criteria and click on the Search button The search is case insensitive 47 9 5 At least one of the search criteria must be entered before you can proceed with the search Patient Name Patient NRIC FIN Fill in at least one search criteria From
57. mme with a Restructured Hospital before your clinic is registered as a CDMP Mental Illness CDMP MI clinic and Medisave claims for patients with mental illnesses can be made This is part of an assurance framework to ensure quality of care for patients How do register for a Shared Care or Partnership Programme with a Restructured Hospital You may register via MOH s MMAE website http www moh gov sg mmae overview aspx by selecting the Chronic Disease Management Programme CDMP Shared Care Programmes What will be the cost of registration and start up Apart from computer hardware and Internet access subscription which may already be in place there is a one time non refundable cost of 191 20 inclusive of 7 GST and delivery fee for the security token to access the Medisave claims system The subsequent token is priced at 171 20 This security token is required only when using the MediClaim e service You or your staff will need to attend a half day training session on Medisave claims process guidelines on Medisave use and the use of the MediClaim system This training session is free of charge How do patients sign up for the CDMP To qualify patients need to be certified by a doctor to be treated for at least one of the approved chronic conditions The certification is made by the doctor when the patient fills out the Medisave Authorisation Form which allows the doctor to make Medisave claims on the patient
58. mmended Frequency Remarks more frequent if clinically indicated Blood Pressure Measurement Twice a year ACE I and ARBs should be used for BP control when proteinuria is present Renal Function eGFR or Serum Annually If eGFR is submitted it should be using the MDRD formula Serum Creatinine to be submitted for calculation for calculation if lab does not generate MDRD eGFR Creatinine Urinary Protein Urine Protein Annually Creatinine Ratio uPCR or Albumin Creatinine Ratio uACR Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Significant Proteinuria e Urine protein gt 1 g day or its equivalent i e uPCR gt 100mg mmol or ACR gt 70mg mmol Persistent Haematuria Declining Renal Function e eGFR lt 45 ml min 1 73 m or rapid decline gt 5 ml min 1 73 m per year Difficult BP Control e BP gt 150 90mmHg despite 3 anti hypertensive medications at maximal doses Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable Supplements such as Iron Calcium Vitamin D are not claimable unless deficiency is proven Unrelated or pre diagnostic investigations e g myeloma panels are not claimable Investigations that are related to Glomerulonephritis are claimable e g autoimmune serological markers Pre and post dialysis investigations are also claimable The treatment of complications such as Renal Osteodystrophy is claimable Treatment for
59. ndicators Report Submission e Patient Details e Known Medical History e Clinical Indicators and Assessment e Attending Physician Information e Report Submission e Search Clinical Indicator Reports e CIDC Clinic Reports e Troubleshooting e Fallback Procedures e Contact Information for Queries Related to Clinical Data Collection and Submission CHAPTER SIX Frequently Asked Questions snsessesssessosssssoossssooseseosssssossessossessoosessosssssossese e Clinical Matters e Registration Matters e Medisave Claims Reimbursement Billing e Data Submission Clinical Improvement and Audits CHAPTER ONE The Chronic Disease Management Programme CDMP INTRODUCTION This handbook provides an update on one of the key programmes from the Ministry of Health MOH to better manage chronic conditions in the community the Chronic Disease Management Programme CDMP The handbook is organized into three sections a Section 1 Chapter One provides an updated overview summarizing the key past and recent changes relevant to the CDMP b Section 2 Chapter Two provides a disease by disease guide on the respective clinical indicators indications for referral and disease specific claimable and non claimable items c Section 3 Chapters Three to Six provides a one stop reference for administrative matters related to the CDMP 1 Overview Update Medisave for CDMP CHAS ME ise Medisave Subsidy for eligible persons Disease Coverage
60. of the primary condition or its complication s Hence it is suggested that his bill be itemised so that the patient can use cash to pay for the thyroid function test and Medisave to co pay the rest of the bill which is related to DM care components Please refer to Chapter 3 Q3 Who decides on the stipulated clinical care components Q4 The clinical care components were drawn from the Clinical Practice Guidelines with inputs from professional bodies which include leading specialists in the respective fields and respected primary care physicians They were also endorsed by the Primary Care Professional Advisory Committee What if the patient has symptoms suggestive of both Asthma and COPD Which DMP should I enrol him into For patients whose signs and symptoms are not so distinct between the two conditions spirometry and or bronchodilator reversibility testing may be performed to help classify the patient into one of the two diagnoses or to differentiate these conditions from other diseases that may mimic its presentation It is important to try to classify the patient into the correct DMP as this will help to determine the management of the patient and also prevent any issues with respect to the Medisave claims Please refer to the Clinical Practice Guidelines for more information on diagnosis and management of Asthma and COPD 55 Q5 Can the patient use Medisave to pay for pulmonary rehabilitation Q6 Q7 Yes
61. ol L despite treatment Referral to Gastroenterologist Pre treatment transaminases are 1 5 to 3 times above normal range Persistently high transaminases at least 3 times above normal range during statin therapy or when statin has been stopped Part Ill Claimable Non Claimable Items Specific Examples of Claimable Non Claimable e Red yeast supplements Hypocol and Co enzyme Q10 are not claimable However Omega 3 which is HSA registered is claimable 12 4 Asthma Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Asthma Control Test ACT score Twice a year Recommended for assessment of control at every visit Applicable for patients 4 years and above For those below 4 years old proper documentation e g daytime or night time symptoms whether symptoms affect the patient s sleep feeding activities from patient s carer is required Self Management Education with At diagnosis and as Provide and review patient s Written Asthma 5 so s os Action Plan Written Asthma Action Plan clinically indicated educate oa E E E eens exacerbations Inhaler technique assessment Smoking Assessment Annually eae sticks day zero for non or ex smoker Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Presence of Co Morbidity Concurrent heart failure that may complicate management Psychiatric disease or mu
62. one prior to diagnosis of Stroke Transient Ischemic Attacks e g CT or MRI brain are not claimable Supplements such as Vitamin B B12 are non claimable unless actual deficiency is documented Treatment of depression in stroke is claimable Non HSA approved medications and nootropics e g piracetam are not claimable Dietary supplements e g Glucerna Ensure are not claimable 16 2 Dementia Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Assessment of Memory Annually For patients on cognitive enhancers objective documentation of memory assessment with a bedside cognitive screening instrument e g Mini Mental State Examination must be performed Assessment of Mood and Annually Behaviour Assessment of Social Difficulties Annually Assessment and referral to appropriate 7 community services may be required and Caregiver stress if any Assessment of Functional and Annually To assess home safety driving safety falls ois functional decline and swallowing difficulties Rehabilitation Needs d Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist e Young onset Dementia YOD i e onset before the age of 65 e Patients in whom diagnosis of Dementia is uncertain e Uncontrolled neuropsychiatric symptoms despite trial of medications Part Ill Claimable Non Claimable Items Specific Examples of Claimab
63. r augmentation or combination i e with psychotherapy therapy Need for specialised treatment e g Electroconvulsive treatment d Anxiety Referral from Primary Care to Specialist Special Patient Population e Paediatric patients High Risk Individuals e Risk of violence to self or others especially patients with suicidal risk Unstable uncontrolled symptoms e g recent hospitalisation within last 6 months Complex Cases Doubt with regard to initial assessment diagnosis and initiation of treatment Marked functional impairment disruptive personality disorders Complicated by medical psychiatric and or psychosocial co morbidities including addiction disorders and substance abuse Failure of one or two trials of medication Need for hypnotics e g Benzodiazepines Zolpidem Zolpiclone Clozapine Lithium Valproate and or formal psychotherapy 22 Part Ill Claimable Non Claimable items Specific Examples of Claimable Non Claimable Treatments such as Psychological Therapy Electro Convulsive Therapy ECT Occupational Therapy Physiotherapy and Speech Therapy are claimable Medications including sedatives hypnotics such as Benzodiazepines Zolpidem and Zolpiclone are not claimable 23 CHAPTER THREE Registration and Medisave Use 1 Policy on Medisave Use 1 1 The primary purpose of Medisave is to help Singaporeans afford costly hospitalisation bills For chronic conditions early detection and good manage
64. r the Medisave holders to show you a print out or electronic statement of their current Medisave balance They can obtain their current Medisave balance from the CPF Board s website www cpf gov sg under My CPF Online Services My Statement by logging in with their SingPass You may wish to ask your patients to bring along a copy of the Medisave balance of the Medisave payers if you do not have a computer terminal at your clinic If the Medisave balance is insufficient to cover the costs can the patient top up the difference in cash Yes Can the bill be split among two or more accounts according to a given percentage Yes a claim can be shared by a maximum of 10 Medisave accounts Will patients have to pay the full amount upfront and then be reimbursed or can they make partial payment based on estimated Medisave payout This decision will lie upon the individual clinics However clinics should explain to their patients on the mode of payment clearly so as to avoid any confusion or unhappiness How will refunds for Medisave withdrawals be handled e g if a patient opts out of a package The clinic will have to amend the approved Medisave claim through the MediClaim system to return the money back to the relevant Medisave accounts CPF Board will liaise with the clinics to debit and credit the amounts accordingly Medisave will have first claim on any refunds As for the amount of 60 Q13 Q14 Q15 Q16 Q17
65. ren under the age of 5 years and Hepatitis B vaccinations subject to a withdrawal limit of 400 per Medisave account per year To help patients and their family members keep track of the amount of Medisave used under this Programme CPF Board has created a separate account summary for the CDMP Participating clinics can check the Medisave balances under the CDMP on behalf of their patients upon request 56 For more information please refer to http www moh gov sg content moh web home policies and issues elderly healthcare html B REGISTRATION MATTERS For Doctors and Clinics which wish to be registered into the CDMP Q1 What are the requirements to be on the CDMP Clinics that wish to participate in the CDMP must agree to a Participate in a shared care or GP partnership programme with a Restructured Hospital b Provide treatment to chronic disease patients through evidence based DMPs These DMPs will include MOH recommended key treatment components c Treat patient medical information with confidentiality d Submit to MOH with the informed consent of patient data on patient care delivery on an annual basis or as specified by MOH for the purpose of medical audits Relevant aggregated performance data will be published to assist patients in making informed choices e Be accredited for the use of Medisave for CDMP and f Be periodically reviewed and audited both clinically and administratively Any clinic medical ins
66. rst consulted me on 5 Jan 2013 but paid cash for three subsequent visits in Mar Jul Oct 2013 for the same chronic condition Would still need to submit clinical data for the latter three visits Yes you should continue to submit the patient s clinical data on this chronic condition for one year from 5 Jan 2013 Can the clinical data submitted be shared by different healthcare providers within the same clinic institution cluster This will depend on the electronic Clinic Management System if any that is used by the healthcare institution If have already fulfilled the number of care components for the chronic condition do still need to submit clinical data subsequently The care components are the essential aspects of medical care that are recommended for management of the chronic conditions The data submission system allows you to submit more than the recommended number of care components Q14 Will clinical data submitted be shared with the providers The clinical data received will be used to monitor the success of the CDMP and also to give feedback routinely to the registered clinics for quality improvement Clinical data submitted have been routinely fed back to the clinic as the online CDMP outcome reports via the Mediclaim system from the first quarter 2008 onwards In these reports a clinic will be able to compare its performance against the aggregated local and national performance Over time each clinic will
67. s CPG anq as clinically indicate Targets of treatment should be personalised by levels of risk Cardiac Assessment At diagnosis before _ Includes baseline ECG initiating medications and as Clinically indicated Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Complex Cases Young patients who are less than 30 years old Patients suspected to have secondary causes of hypertension Patients with labile hypertension or hypertension refractory to a combination of 3 or more drugs Patients presenting with hypertensive emergencies or urgencies Part Ill Claimable Non claimable Items Specific Examples of Claimable Non claimable e Purchase of blood pressure monitoring machines is not claimable e For patients with Ischaemic Heart Disease investigations like 2D Echocardiogram MIBI scans are claimable 11 3 Lipid Disorders Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Lipid Profile Annually All patients should be risk stratified as recommended in the Lipids CPG Targets of treatment should be personalised by levels of risk Smoking Assessment Annually a sticks day zero for non or ex smoker Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Referral to Endocrinologist Target parameters not achieved despite maximised drug therapy Triglyceride level more than 4 5mm
68. se Management Programme DMP according to Annex A page 7 3 Shared Care Programme for CDMP Mental Illnesses CDMP MI 3 1 Mental health conditions i e Schizophrenia Major Depression Bipolar Disorder and Anxiety are included in the CDMP MI Doctors interested in making Medisave claims for the above mentioned conditions are required to attend training updates for CDMP MI and participate in a Shared Care Programme with a public hospital to ensure that they have sufficient training and confidence in treating patients with mental health conditions Please refer to point 1 3 in Chapter Three Registration and Medisave Use for more details 3 2 Dementia will not be considered as a CDMP MI condition as of 1 Jan 2014 and therefore physicians who wish to manage Dementia under CDMP are not required to participate in the Shared Care Programme 4 Medisave use under CDMP 4 1 Only doctors and clinics medical institutions which are accredited for Medisave use and participating in the CDMP can make Medisave claims 4 2 Medisave can be used to pay for the essential care components in the management of that specific DMP or for the treatment of the approved conditions in Table 1 and its complications Some items such as sleeping pills slimming pills and erectile dysfunction drugs are not Medisave claimable This is to ensure judicious usage of patients Medisave dollars so that they cover essential care components and medications Physicians too have
69. st visit of the patient for the chronic condition s This is only applicable for patients aged 4 and above For patients aged 4 to lt 12 years please use the Childhood ACT and for those aged 12 years and above the ACT 1 3 Although data submission is not required for the remaining nine conditions clinicians are advised to manage according to best clinical practises and document essential care components as listed below Table 5 List of Clinical Indicators for CDMP Routine Data Submission not required Chronic Condition Recommended Clinical Indicators Per Year Stroke Two blood pressure measurements One serum cholesterol level LDL C test One smoking habit assessment One clinical thromboembolism risk assessment Schizophrenia Two consultations for CDMP Mental Health One Clinical Global Impression CGI Scale for each item severity improvement Blood test for fasting glucose and fasting lipids Major Depression Two consultations for CDMP Mental Health One Clinical Global Impression CGI Scale for each item severity improvement Dementia Documentation of i Assessment of memory mood and behaviour ii Assessment of functional and social difficulties if any iii Assessment of rehabilitation needs Two consultations for CDMP Dementia For patients on cognitive enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments
70. t be done online immediately you can keep a record of the information and submit it at a later date 53 13 Contact Information for Queries Related to Clinical Data Collection and Submission 13 1 For online e service related technical queries please e mail to mediclaim ncs com sg or contact NCS at 6776 9330 Mon Fri excluding public holidays 8 30 am to 6 00 pm 13 2 For clinical data collection and submission issues related feedback please email to moh_cds moh gov sg preferred method or contact at 6325 1757 Mon Fri excluding public holidays 8 30 am to 6 00 pm 54 CHAPTER SIX Frequently Asked Questions A CLINICAL MATTERS For Doctors who have already registered into the CDMP Q1 have a patient with Diabetes Mellitus Hyperlipidaemia and Asthma Which Q2 DMPs should I enrol him her into Your patient should be enrolled into both Diabetes AND Asthma DMPs He She will then be able to use Medisave to co pay for the total bill for the treatment administered for all 3 conditions However you will also need to submit clinical outcome data based on the essential care components of Diabetes Lipid Disorders and Asthma Please refer to Annex A on page 7 for details My patient has DM however he also has symptoms and signs of Hypothyroidism Can I use his Medisave to co pay the thyroid function test In this instance thyroid function test was done to screen for a possible condition and not for monitoring
71. the Medisave Authorisation Form Patient is enrolled into the relevant Programmes See Chapter 2 Submit Clinical Data of Submit Medisave Claim for Patient Patient See Chapters 2 4 amp 5 See Chapter 3 i Data submitted reflects i Allows patient to draw essential clinical care from his her own or his her components in management family member s Medisave of the chronic disease s account s for outpatient ii Feedback on aggregated treatment data to clinic allows ii Leads to reduction in out comparison amp self of pocket payment upfront assessment of clinic s performance and identify areas in need of quality improvement Annex A Enrolling patients with Diabetes Mellitus Hypertension Lipid Disorders and or Stroke o Diabetes Mellitus DMP_ Mellitus DMP OSs Hypertension DMP gt Lipid Disorders DMP Lipid Disorders DMP Disorders DMP CHAPTER TWO The Clinical Guidelines Reportable Conditions Regular data submission is required for these 6 conditions based on their Clinical Indicators 1 Diabetes Mellitus Part I Clinical Indicators Essential Components Recommended Frequency Remarks more frequent if clinically indicated Glycated Haemoglobin HbA1c Twice a year General HbAic target of lt 7 0 but target of treatment should be personalised e g for elderly Blood Pressure Measurement Twice a year General BP target of lt 140 90 mmHg but target of treatment sho
72. titution that fails to satisfy the minimum standards of clinical performance set by MOH will be asked to withdraw from the Programme See Chapter Two The Clinical Guidelines Q2 How do register for the CDMP Clinics medical institutions who are already in the CDMP need not re register for the Programme For clinics who are not in the CDMP they must submit the following forms for registration a E Application for Clinics to Participate in the Medisave for Chronic Disease Management Programme by MOH b Direct Authorisation Credit Form by CPF Board c GIRO Form MediClaim charges by NCS and d GIRO Form Medisave charges by CPF Board The E Application website can be accessed via http www moh gov sg mmae overview aspx 57 Q3 Q4 Q5 Q6 Clinics participating in the CDMP will also have to sign a Deed of Indemnity with the CPF Board Doctors need to be individually registered under the Programme in order to process Medisave claims for their patients Doctors can do so by submitting the Application Form for Medical Professionals which can be found in the link http www moh gov sg mmae DoctorApplication aspx My clinic is already participating in CDMP Can make Medisave claims for my patient who is suffering from Schizophrenia Major Depression Bipolar Disorder or Anxiety In addition to participating in CDMP your clinic will also need to be participating in a Shared Care or GP Partnership Progra
73. tive enhancers o Assessment of Mood and Behaviour al documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Assessment of Functional and Social Difficulties if any J Assessment of Rehabilitation Needs Oo denotes a mandatory field For current smokers smoking cessation advice should be given For non or ex smoker please reinforce the benefits of not smoking cigarettes Applicable to current smokers only Only for patients on Schizophrenia and Bipolar Disorder Atypical Antipsychotics Medication To check the box if test is done _Add Indicators Click to add clinical indicators only those performed C 11 May 2007 Systolic BP mmHg C 11 May 2007 Diastolic BP mmHg 100 C 11 May 2007 LDL mag dL 40 C 11 May 2007 HbA1c 30 C 11 May 2007 Weight kg 90 C 11 May 2007 Cigarettes smoked per day Avg 10 C 11 May 2007 DM Eye Assessment Y C 11 May 2007 DM Nephropathy Assessment Y C 11 May 2007 DM Foot Assessment Y C 11 May 2007 Stroke Thromboembolism Risk Assessment Y Delete Indicators Click to delete selected clinical indicators Doct A COSS Registration CT Number P nes z Healthcare Tr wl Specialty Training Please select if applicable Establishment Role Attending Doctor is the patient s regular primary physician orci 06 Jan 2008 The Clinic is the patient s regular primary provider None of the Above denotes a mandatory field lt
74. to certify on Part V of the MAF that the patient is mentally incapacitated at the point Definition A mentally capacitated person either a has a medical report from a psychiatrist declaring that the patient is permanently mentally incapacitated or b is determined by a doctor at the material time to be unable to make a decision for himself An inability to make a decision is when a patient is unable to i Understand the information relevant to the decision ii Retain that information relevant to the decision iii Use or weigh that information as part of the decision making process and iv Communicate his decision by any means 4 5 Payment will be made daily to Medisave accredited clinics medical institutions via InterBank Giro IBG on the 3 working day after the approval date of the Medisave claims 4 6 Where a clinic medical institution has made an over claim or unauthorised deduction from Medisave it will have to refund the amount deducted to the Medisave account The clinic medical institution will have to pay the interest lost by individuals if it is the clinic s medical institution s error The interest will be computed at the prevailing CPF interest at the time of the adjustment 4 7 For clinics medical institutions that offer treatment packages for chronic diseases such packages should only be valid for one year from the date of the first treatment received under the package Where such package lapses or is cance
75. uld be personalised e g for patients with Nephropathy Weight and BMI Assessment Twice a year Keep lt 25kg m For Asian population keep BMI lt 23 kg m Lipid Profile Annually All patients should be risk stratified as recommended in the Lipids CPG Targets of treatment should be personalised by levels of risk Nephropathy Assessment Annually Good glycaemic control and good BP control with Angiotensin Converting Enzyme ACE Serum Cr and eGFR and inhibitor or Angiotensin Receptor Blocker Urine Albumin Creatinine uACR ARB preferred to slow progression of Diabetic Nephropathy Submission of readings of Cr eGFR uACR required only for patients with Nephropathy Eye Assessment Annually Includes retinal photography and visual acuity Patients with T1 DM First assessment within 3 5 years after diagnosis of diabetes once patient is aged ten years or older Patients with T2 DM First assessment at diagnosis Foot Assessment Annually Screen for peripheral neuropathy peripheral vascular disease or bone joint skin and nail abnormalities Smoking Assessment Annually et sticks day zero for non or ex smoker Cardiac Assessment At diagnosis before Includes baseline ECG initiating medications and as Clinically indicated Part Il Suggested Indications for Referrals Referral from Primary Care to Specialist Special Patient Population Adults with suspected Type 1 DM Children and adolescents with suspected DM reg

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