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Handbook for Healthcare Professionals 2011

1. for pahenta Schizophrinia Bipolar Diwamers Atypical Anipsrenoncs Medication To check the If test is amo Click to add m cators only those performed gt Registration Doctor Specialty Training Please select 4 applicable Fw pel dn 1 Role amp Attending Doctor is the patient s regular primary physician pa dini 06 Jan 2008 The Clinic is the patient s regular primary provider C None of the Above ganolog d mandatory faid Screen 4 Clinical Indicator Form 3 3 Clinical Indicator Form consists of 4 sections 3 3 1 Patient Details 3 3 2 Known Medical History 3 3 3 Clinical and Assessment Indicators 3 3 4 Attending Physician Information 48 Chronic Disease Management Programme 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 4 2 For subsequent submissions only the Patient NRIC and Name are mandatory 4 3 In the event of differences between two submissions the data from the latest submission will be considered as the up to date information Patient Details Patient Name fle Yong Kun Patient NRIC FIN 512345670 Pa of Binh paza a Sex amp Female Race Chinese Metres 7 use 9 99 if not measurable Curr
2. anda lipatnya setengah dan letak di lantai Correct Incorrect 25 Takes paper in right hand 26 Folds paper in half L 27 Puts paper on floor 36 Chronic Disease Management Programme Correct Incorrect L L 28 Present piece of paper which reads Close your eyes and say Read this and do what it says App Lil it Je Mc Baca ini dan patuhi lakukan apa yang tertulis Scora correct only if the subject actually clases his her ayes L 29 Say Say a complete sentence The sentence must have noun a verb and be meaninaful If needed prompt the subject For example say something about the weather Write down the sentence provided illit semet n tpe de TT XT Sebutkan sebuah ayat lengkap Misalnya bina sebuah ayat berkenaan cuaca down sentence Construction Pemban 30 Presant the subject with the Construction Stimulus Say Copy this design sum Cuba lukis gambar ini Do allow erasure The subject may request a second attempt Clearly label the lirst and second attempts 21 Correct O Incorrect Languages Dialects used Remarks The subject is having following problem s at the time of iiteryiew 0 Mute 1 Cannot 2 Paralysed 3 literale 4 Tired 5 Cannot hear Total Score Assessor Handbook for Healthcare Professionals 37 Close your eyes Vi CARER 8 FF E
3. Handbook for Healthcare Professionals 73 Q9 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 coordinating the care of the patient s chronic condition so that he she may be updated and make the submission 010 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 O11 My patient claimed Medisave for treatment of a chronic condition when he first consulted me on 5 Jan 2009 but paid cash for three subsequent visits in Mar Jul Oct 2009 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 09 O12 Can the clinical data submitted be shared by different healthcare providers within the same clinic institutio
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5. see Chapter Two Clinical Programme b I 2 66 Chronic Disease Management Programme O2 How register for the CDMP Programme Clinics who are already in the CDMP Programme need not re register for the Programme For clinics who are not in the Programme 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 GIRO Form MediClaim charges by NCS d GIRO Form Medisave charges by CPF Board The E Application website can be accessed via http www moh gov sg mmae overview aspx Clinics participating in the Programme 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 Q3 My clinic is already participating in CDMP Can make Medisave claims for my patient who is suffering from schizophrenia major depression dementia or bipolar disorder In addition to participating in CDMP your clinic will also need to be participating in a shared care or GP partnership programme with a restructured hospital before Medisave claims for patients with psychiatric illnesses can be made This is part of an additional quality assurance framework in place to
6. Amisulpride Lithium Amitriptyline Maprotiline Aripiprazole Memantine Benzhexol Mirtazepine Benztropine Moclobemide Bupropion Nortriptyline Carbamazepine Olanzepine Chlorpromazine Paliperidone w nm Clomipramine Paroxetine Clozapine Donepezil Perphenazine Ouetiapine Dothiepin Risperidone Doxepin Rivastigmine Duloxetine Sertraline Escitalopram Sodium Valproate Fluoxetine Sulpiride Flupenthixol Fluphenazine Tianeptine Trazodone 2 13 14 15 16 17 18 19 Fluvoxamine Trifluoperazine Galantamine Trimipramine Haloperidol Venlafaxine Imipramine Ziprasidone Lamotrigine Zuclopenthixol Mood stabilizers 3t Drugs which are specific for the treatment of dementia Table 3 3 List of Allowable Therapies for Treatment of Psychiatric Conditions Psychological therapy in specific cases Electro convulsive therapy ECT Occupational Therapy Physiotherapy Speech therapy Qi BQN c 22 Chronic Disease Management Programme 4 8 Anything that is not listed in the above Tables is not claimable by Medisave under this Programme Some examples are list is not exhaustive a Conditions not related to the approved chronic diseases e g cancer b Tests prior to diagnosis of disease e g OGTT CT brain drug screen or u
7. These clinics will be able to help patients who are suffering from dementia and bipolar disorder to claim Medisave for their outpatient treatments with effect from 1 Nov 2011 2 2 Medisave withdrawal limits for patients under the Programme remains as 300 per Medisave account per calendar year for treatments received before 1 Jan 2012 and 400 per Medisave account per calendar year for treatments received on or after 1 Jan 2012 regardless of the number of chronic disease that they are currently being treated for The annual withdrawal limit is reset on 1 Jan each year 16 Chronic Disease Management Programme 2 3 The transaction cost for each Medisave claim has been brought down to 2 915 exclude GST with 2 44 charged by CPF Board for every Medisave account processed and the remaining 0 47 charged by NCS for MediClaim System usage 2 4 The guidelines on the use of Medisave for the new conditions are updated in Section 4 of this Chapter 2 5 The claim submission process detailed in Section 5 of this Chapter remains unchanged 2 6 Similar to the earlier approved conditions Medisave claims for dementia and bipolar disorder will be audited 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 3 Registration Process for Medi
8. 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 O9 Ifthe Medisave balance is insufficient to cover the costs can the patient top up the difference in cash Yes O10 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 Handbook for Healthcare Professionals 69 O11 What is the cost of making Medisave claims The current cost is 2 91 exclude GST per transaction and has to be paid in cash The cost is levied on the clinics and not the patients However some clinics may decide to pass on this cost to their patients Q12 Why is there a transaction cost of 2 91 The transaction cost consists of a 2 44 charge from CPF Board for processing each Medisave account and a 0 47 charge from NCS for use of the MediClaim System O13 Can transfer the cost per transaction 3 11 with GST to the patient You may choose to do so However medical institutions deciding to charge out the operational transaction cost should list this item in the bill as Medisave processing fee This fee has to be paid in cash Should medical institutions decide to charge out additional administrative fees on top of what MOH CPFB charged out to them they are r
9. 0G 91 Kep 3W 921 OL ud JeXO1ag 8 00 8 00 09 09 97 aUL 4 8 08 3w 09 02 INO 3w 02 01 0220 eunexon J 8 02 Ava Yad ISOa WWoodu Xv 8 02 01 Ava uad JONVY 3504 1vnsn fep 3u 01 9 2508 ONILYVLS NAY 1vnsn Suisoq 9 Z s 0Jdexe S3INVN S3 Id 1 053 JINVN 58719 Chronic Disease Management Programme 14 Abbreviations SSRI Selective Serotonin Reuptake Inhibitor SNRI Serotonin and Noradrenaline Reuptake Inhibitor NASSA Noradrenaline and Specific Serotonin Antidepressant RIMA Reversible Inhibitor of Monoamine Oxidase Important Notes For details please consult the manufacturers most current product literature or other standard references Lowest effective doses should be used Elderly patients should be carefully initiated at lower doses of a suitable antidepressant Individualized dosing for any antidepressant should be based on an in depth evaluation of the individual patient s therapy requirement with considerations to issues such as contraindications warnings precautions adverse reactions and interactions with other drugs There are many adverse drug interactions with antidepressant drug use please refer to drug literature for deta
10. 1 The primary purpose of Medisave is to help Singaporeans afford costly hospitalisations For chronic diseases early detection and good management help patients avoid subsequent costly hospitalisation To bring about better health outcomes MOH has decided to allow Medisave to cover selected chronic diseases 1 2 Nonetheless to prevent over consumption and over servicing three safeguards have been put in place under the Medisave for Chronic Disease Management Programme a Deductible A deductible of 30 will be set on each outpatient bill i e bills below 30 will not be eligible for Medisave claims b Co payment A co payment of 15 percent on each outpatient bill will be set in excess of the deductible and c Annual withdrawal limit An annual outpatient withdrawal limit of 300 per Medisave account for all treatments received before 1 Jan 2012 and an annual withdrawal limit of 400 per Medisave account for all treatments received on or after 1 Jan 2012 Example For a bill of 130 a patient will need to pay 45 out of pocket This is because the patient pays the first 30 of the bill and 15 percent of the remainder 100 in this case The remaining 85 can be claimed from Medisave 2 Clinics Currently Participating in the Programme 2 1 Forclinics already registered on the Programme and participating in a shared care or GP partnership programme with a Restructured Hospital there is no need to register for the new conditions
11. 96 E DM Foot Assessment El Weight Stroke Thromboembolism Risk Assessment 7 use 999 if not measurable Smoking Assessment E Inhaler Technique Assessment Asthma amp E COPD only Cigarettes smoked per day average ACT Score Asthma only Influenza Vaccination Assessment COPD Oo SS only The following care components are only for CDMP Mental Health Programme Patients CGI Severity of Illness v Fasting Lipids Blood Test e EH CGI Global Improvement Fasting Glucose Blood Test o Consultation for CDMP Mental Health Assessment of Memory Indicate the patient attendance For patients on cognitive enhancers E 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 7 Assessment of Rehabilitation Needs o denoles a mandatary field For current amokers smoking cessation advice should be For non or ex smoker please reinforce the benefits of cigarettes Applicable to current smokers only Only for patients on Schizophrenia and Bipolar Disorder Atypical Antipsychotics Meticali n check the box if test is done veu x add In 5 Click to add clinical indicators only those erformed Add all Clinical Indicators into the table below after filling in the form 52 Chronic Disease Management Programme
12. Asthma and Chronic Obstructive Pulmonary Disease COPD were added in Apr 2008 Since 2009 CDMP has also been extended to cover common psychiatric conditions like Schizophrenia and Major Depression from 1 Oct 2009 1 4 Starting with just over 7000 patients in Oct 2006 the CDMP has grown and as of Dec 2010 there are about 112 000 patients in this Programme with an annual Medisave withdrawal of about S 27 million in 2010 1 5 Submission of clinical data is an essential component of the Programme Participating clinics are required to monitor the quality of care that patients receive and submit clinical data to the Ministry of Health MOH 1 6 To facilitate quality improvement the clinical data submitted had been routinely fed back to the clinic via the online CDMP outcome reports through the Mediclaim system since 2008 2 Chronic Disease Management Programme 2 Inclusion of Dementia and Bipolar Disorder into the CDMP 2 1 From 1 Nov 2011 Dementia and Bipolar Disorder will be included into the CDMP This is expected to bring about better health outcomes for patients who will have better control of their conditions with close supervision from their doctors 2 2 It is recognised that the treatment of chronic diseases is costly when administered collectively over a long period However this Programme will help reduce out of pocket payments and also reduce the barriers for patients to seek medical treatment 2 3 With the implementation
13. E Schizophrenia 12007 0 Bipolar Disorder YYYY Dementia Handbook for Healthcare Professionals 47 Clinical Indicators 0 T Date of Visit DDMMYYYY a Blood Pressure Systolic Diastolic i DM Eye Assessment LDLC d DM Nephropathy Assessment HbAte DM Foot Assessment Weight Stroke Thromboembolism Risk Assessment 7 use 999 if not measurable Smoking Assessment Inhaler Technique Assessment Asthma amp only Cigarettes smoked day average LI ACT Score Asthma only Influenza Vaccination Assessment COPD o EN only The following care components are only for COMP Mental Health Programme Patients CGI Severity of Hines Fasting Lipids Blood Test gt o CGI Global Improvement Fasting Glucose Blood Tast ev o Consultation for CDMP Mental Health Assessment of Memory a Indicate the patient attendance For patients on cognitive enhancers Assessment of Mood and Behaviour documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Assessment of Functional and Social Difficulties if any 7 Assessment of Rehabilitation Needs denoles mandstory field For current smokes amoking cessation advice smould he gwen Forman cr please aeinfoma tha benefits af naf smoking egamsites 9 to current amoke ony
14. Hypertension Hyperlipidemia Cerebrovascular Accident CVA Coronary Heart Disease CHD Diabetes DM DM Retinopathy DM Nephropthy DM Foot Complications Asthma Chronic Obstructive Pulmonary Disease COPD Major Depression Schizophrenia Bipolar Disorder Dementia Diabetes Treatment Year of Diagnosis yyyy Oral Medications Insulin Hypertension Treatment Year of Diagnosis yyyy Oral Medications Hyperlipidemia Treatment Year of Diagnosis yyyy Oral Medications Asthma Treatment Year of Diagnosis yyyy Requires Controller Schizophrenia Treatment Year of Diagnosis yyyy Atypical Anti psychotic Prescribed Bipolar Disorder Treatment Atypical Anti psychotic Prescribed Dementia Treatment Atypical Anti psychotic Prescribed Handbook for Healthcare Professionals 41 A Diabetes Hypertension Lipids and Stroke DMP For Diabetes Hypertension Lipids Stroke Date of Visit dd mm yy LDL C mg dL Systolic BP mmol L mmHg Diastolic BP Weight kg Avg no cigs mmHg day Date of Visit dd mm yy For Diabetes Only Glucose 1c For Stroke Only Nephropathy Thromboembolism B Asthma and Chronic Obstructive Pulmonary Disease Date of Visit dd mm yy For Asthma COPD Inhaler Smoking Tech
15. Hypertension Available Available Available Available Available Lipid Disorders Available Asthma COPD Available Available Major Depression X Schizophrenia Bipolar Disorder Dementia None of the above Medical Condition Depression Treatment Schizophrenia Treatment Bipolar Disorder Treatment Dementia Treatment Diabetes X Hypertension X Lipid Disorders X Asthma COPD Major Depression Schizophrenia Available Available X Bipolar Disorder Available Dementia None of the above Available Handbook for Healthcare Professionals 51 6 Clinical Indicators and Assessment 6 1 This section enables you to enter the indicator measurement and assessment done on the patient over any period 6 2 Only measurements and assessments not reported previously need to be entered in this section 6 3 Initially there will be no clinical indicators added to the report 6 4 Fill in all the clinical indicators and use the Add Indicators button to save them as shown in Screen 7 6 5 There must not be any unsaved data left in the Clinical Indicators Section before submitting the form Date of Visit DDMMYYYY Blood Pressure Systolic Diastolic I DM Eye Assessment m LDL C mgldL 4 DM Nephropathy Assessment 1 HbA1c
16. Monitoring 3 1 As part of the national effort under this Programme the Health Promotion Board has prepared Patient Education Booklets for dementia and bipolar disorder 3 2 These materials will be distributed to all CDMP clinics for the doctors to use in patient education Specialist Outpatient Clinics SOCs and Polyclinics will also use the same materials to facilitate integration of care across the various care settings 8 Chronic Disease Management Programme 3 3 It will be useful to explain the contents of the patient education booklet to the caregiver and patient if appropriate as this will help enhance the doctor patient relationship 4 Guidelines for Continuing Care 4 1 To facilitate integration of care across the various levels so that patients are able to continue and receive the appropriate management of their conditions MOH has developed the following guidelines a Referral from Specialist to Primary Care i Suitable patients must be assessed by specialist to be stable and suitable for community follow up ii They should have a clear diagnosis of dementia or bipolar disorder iii For dementia their caregivers should have been counselled on their condition natural history and progression of illness For bipolar disorder their caregivers should have been counselled on their condition and the need for continual treatment iv For dementia they should not have significant behavioural issues or significant caregive
17. RR RS Tutup Mata 38 Chronic Disease Management Programme Handbook Healthcare Professionals 39 4 CMMSE scoring sheet Attention forward digit span 4719 582036 1 Intact 2 Impaired ITEMS 61 CMMSE What day of the week is it What is the date today What is the month What is the year Where are we now What floor are we now In which estate are we In which country are we Repeat the following words Lemon Key Balloon Subtract 7 from 100 and make 5 subtractions Can you recall the three words What is this show a pencil What is this show a watch Repeat the following a No ifs ands or buts English b Forty four stone lions Chinese Follow a 3 stage command Take this piece of paper fold it in half and put it on the floor Say a sentence of your choice Read amp obey what is written on this piece of paper Raise your hands Copy this drawing on a piece of paper TOTAL SCORE 40 Chronic Disease Management Programme ANNEX 4 B Data Fields required for Clinical Data Submission Patient Details Patient Name NRIC FIN Gender Female Race Malay Indian Others Height m Current Smoker No Year Started Smoking yyyy Medical History Year of Diagnosis yyyy
18. YYYY coPD YYYY V Major Depression 2007 Schizophrenia 2007 YYYY 0 Bipolar Disorder YYYY 0 Dementia YYYY Diabetes Treatment Treatment Year Started Treatment Year Started 0 Oral Medications E Insulin Hypertension Treatment Treatment Year Started Oral Medications tz Lipid Disorder Treatment Treatment Year Started Oral Medications P _ Schizophrenia Treatment Only for Mental Health Programme patients Treatment Year Started Atypical Antipsychotics Prescribed 2008 YYYY Bipolar Disorder Treatment Only for COMP Mental Health Programme patients Treatment Year Started 0 Atypical Antipsychotics Prescribed m YYYY Dementia Treatment Only for COMP Mental Health Programme patients Treatment Year Started 0 Atypical Antipsychotics Prescribed YYYY Screen 6 Known Medical History and Treatment Sections 5 5 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 5 6 Depending on the medical condition indicated different treatment sections will be available for input see following page 50 Disease Management Programme Medical Condition Diabetes Treatment Hypertension Treatment Lipid Disorder Treatment Asthma Treatment COPD Treatment Diabetes
19. cost of the deductible and co payment Any amount in excess of the employer medical benefits orthe 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 Handbook for Healthcare Professionals 71 022 What is the process of making Medisave claims like Will it involve a huge change in my clinic operations The process is as follows 1 The clinic doctor should explain the following to patients suffering from any of the approved chronic diseases and their immediate family member s whose Medisave account s is are being used if any the treatment components the cost of treatment estimated amount that can be claimed from Medisave the out of pocket cash payment that the patient will need to make the charging of transaction fees IS 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 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 Cl
20. done during the reporting period you need not enter anything If the exact date of assessment is not known please key in the date as 0101 for e g for an assessment done in 2006 you can key in 01012006 If the known date is March 2006 you can enter as 01032006 Click to sort the records DJ 14 May 2007 Systolic BPlmmHg 150 11 May 2007 Diastolic BPimmHg 100 3 11 May 2007 40 11 May 2007 Hb 1ci 30 3 11 May 2007 Weight kg 90 3 11 May 2007 Cigarettes smoked per day amp vg 10 11 May 2007 DM Eye Assessment y 7 11 42 2007 OM Nephropathy Assessment Y 0 11 May 2007 DM Foot Assessment Y 0 11 May 2007 Stroke Thromboembolism Risk Assessment 2 Glick to delete selected clinica indicators Delete after selecting the checkboxes of the All entries saved in the table will be unwanted Clinical Indicators submitted to the CIDC system Screen 8 Clinical and Assessment Indicators 6 7 After saving the data you can use the delete button to remove any mistakes 6 8 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 Handbook for Healthcare Professionals 55 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 t
21. ensure quality of care for patients O4 How do register for a shared care or partnership programme with 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 05 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 171 20 for the security token to access the Medisave claims system This security token is required only when using the MediClaim e service Handbook for Healthcare Professionals 67 You or your staff will need to attend 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 O6 How do patients sign up for the Programme To qualify patients need to be certified by a doctor to suffer from at least one of the approved chronic diseases The certification is made by the doctor when the patient fills out the Medisave Authorisation Form that allows the doctor to make Medisave claims on the patient s behalf C MEDISAVE CLAIMS REIMBURSEMENT BILLING For Doctors amp Clinics that wish to be registered into the Programme O1 total how much can patients claim from Medisave for chronic disease treatments Patients can claim up to 300 per Me
22. of Pop Ups 62 Chronic Disease Management Programme 11 1 1 Certain screens within the application will be displayed as pop up 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 i Select Tools gt Pop up Blocker Pop up Blocker Settings 40 Microsoft Internet Explorer tes Tools Help Mail and News PET ws por ee d e 3 Jiclair 5 Ad Pop up Blocker Settings Edit with altova xmuspy 0 EWC Screen 17 Internet Explorer Menu ii Enter medinet gov sg and moh gov sg then click on Add E 20051212 1640 microsoft internet Pop up Blocker Settings Exceptions Pop ups are currently blocked You can allow pop ups fram specific g Web sites by adding the site to the list below Address of Web site to allow moh gov sd medinet gov sg Hemoye moh gov sg Remove All sword Authentication User ID isaon ip si Password 1 p Notifications and Filter Level Play a sound when a pop up is blocked IV Show Information Bar when a pop up is blocked Filter Level Block most automatic pop ups Pop up Blocker FAG Screen 18 Configuring Pop up Blocker mended screen resolution 1024 X 76 Handbook for Healthcare Professi
23. of the CDMP GPs will be able to take on a greater role in the management of chronic diseases of their patients 2 4 With effect from 1 Nov 2011 the use of Medisave for CDMP will apply to the ten conditions listed below a Diabetes Mellitus DM f COPD b Hypertension HPT g Schizophrenia c Lipid Disorders h Major Depression d Stroke i Dementia e Asthma j Bipolar Disorder 2 5 This Handbook presents the essential components of the use of Medisave for CDMP for dementia and bipolar disorder It covers the following details Chapter Two The clinical aspects of the Programme including how to enrol patients into the appropriate DMP The essential components of the DMPs Clinical guidelines for referrals between primary and tertiary care Chapter Three The registration process for clinics and doctors who have yet to participate and are interested in the Programme Guidelines for use of Medisave for chronic disease outpatient treatment Chapter Four The data submission requirements for participation in the Programme The plan for clinical quality improvement Chapter Five User Manual for e Service Clinical Data Submission Guide on how to use the Clinical Indicators Data Collection CIDC e Service for the submission of data to MOH Chapter Six Frequently asked questions for healthcare professionals Handbook for Healthcare Professionals 3 CHAPTER TWO THE CLINICAL PROGRAMME 1 Enrolling Patie
24. 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 06 the patient use Medisave to pay for pulmonary rehabilitation Yes if and only if the patient has been diagnosed to have COPD AND b It is clinically deemed to be beneficial for the patient B REGISTRATION MATTERS For Doctors amp Clinics which wish to be registered into the Programme O1 What are the requirements to be on the Programme Clinics that wish to participate in the Programme must agree to a Participate in a shared care or GP partnership programme with a Restructured Hospital Provide treatment to chronic disease patients through evidence based DMPs These DMPs will include MOH recommended key treatment components Treat patient medical information with confidentiality 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 Be accredited under the Medisave for CDMP f Be periodically reviewed and audited both clinically and administratively Any clinic hospital that fails to satisfy the minimum standards of clinical performance set by MOH will be asked to withdraw from the Programme
25. we 11 May 2007 112 2007 11 May 2007 11 May 2007 7 11 May 2007 3 11 May 2007 17 11 May 2007 3 11 43 2007 0 11 Mav 2007 11 May 2007 Stroke Thromboembolism Risk Assessment cick to delete selected clinical indicators Screen 7 Filling in the Clinical Indicators TL LIE mM Systolic BPlmmHg 150 Diastolic BP mmHg 100 40 1 30 Weight kg 90 Cigarettes smoked per day Avg 40 DM Eye Assessment Y DM Nephropatny Assessment Y DM Foot Assessment Y Y Handbook for Healthcare Professionals 53 54 6 6 The list of Clinical Indicators and Assessments applicable Clinical Indicators Remarks Glucose HbA 1c Value must be between 0 1 and 40 0 inclusive Blood Pressure Diastolic BP Value in mmHg must be between 20 and 200 inclusive and must be smaller than Systolic BP reading Blood Pressure Systolic BP Value in mmHg must be between 30 to 300 inclusive Lipids LDL C Value in mg dL must be between 1 and 999 inclusive Value in mmol L must be between 0 1 and 30 0 inclusive f measurement is attempted but not measurable due to high Triglyceride TG value a reading of 999 mg dL should be entered Lifestyle Weight kg Value in kg must be between 1 0 and 300 0 inclusive or 999 if not measurable Smoking Cigarettes smoked per day average Value must be between 0 to
26. 1000 Asthma ACT Score Value must be between 5 and 25 inclusive for patients who are aged 12 years and above Value must be between 0 and 27 inclusive for patients who are aged between 4 to below 12 years old Value must not be entered for patients who are aged below 4 years old CGI Severity of Illness Only for CDMP Mental Health Programme patients Value must be between 1 and 7 inclusive CGI Global Improvement Only for CDMP Mental Health Programme patients Value must be between 0 and 7 inclusive Assessments Screening Remarks DM Eye Screening DM Foot Screening DM Nephropathy Screening Stroke Thromboembolism Risk Assessment Inhaler Technique Assessment Asthma amp COPD only Influenza Vaccination Assessment COPD only Fasting Lipids Blood Test Fasting Glucose Blood Test Only for CDMP Mental Health Programme Schizophrenia Patients on Atypical Antipsychotics Consultation for CDMP Mental Health Only for CDMP Mental Health Programme Patients Assessment of memory Assessment of mood and behaviour Assessment of functional and social difficulties Assessment of rehabilitation needs For patients on cognitive enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Chronic Disease Management Programme Select and enter date of assessment if done If assessment is not
27. Dementia Bipolar Disorder Chronic Disease Management Programme E Handbook for 201 Healthcare Professionals Includes instruction edisave for CDMP CONTENTS 29 44 65 CHAPTER ONE The Chronic Disease Management Programme CDMP e Overview Update on use of Medisave for CDMP e Inclusion of dementia and bipolar disorder into the CDMP CHAPTER TWO The Clinical Programme CHAPTER THREE Registration and Medisave Use CHAPTER FOUR Clinical Data Capture and Submission CHAPTER FIVE User Manual for Clinical Data Submission via e Service CHAPTER SIX Frequently Asked Ouestions THE CHRONIC DISEASE MANAGEMENT PROGRAMME CDMP 1 Overview Update Disease management is system of coordinated health care interventions and communications for populations with conditions in which patient self care efforts are significant Definition from Disease Management Association of America 1 2 The Medisave for Chronic Disease Management Programme was introduced at the end of 2006 and involves a evidence based structured Disease Management Programmes DMPs and b option for patients to draw on their Medisave to help reduce out of pocket payments for outpatient treatment required in the management of their chronic diseases 1 3 On 1 Oct 2006 CDMP was implemented for Diabetes This was extended to three additional diseases in Jan 2007 namely Hypertension Lipid Disorders and Stroke
28. Where a clinic institution has made an overclaim or unauthorised deduction from Medisave it will have to refund the amount deducted to the Medisave account The clinic institution will have to pay the interest lost by individuals if it is the clinic s institution s error The interest will be computed at the prevailing CPF interest at the time of the adjustment 5 1 7 For clinics which are unable to make claims electronically via the MediClaim system they could in the interim approach Service Bureaus to help them with their paper submissions Contact details of these Service Bureaus are available on the MOH website www moh gov sg 10 The transaction cost of 2 91 assumes 1 Medisave account is used Figures exclude 7 6 GST charges With GST the transaction cost is 3 11 11 National Computer Systems NCS is the company appointed by to maintain the MediClaim system The MediClaim system is an online e service for clinics medical institutions to submit Medisave claims to CPF Board for processing 26 Chronic Disease Management Programme 5 2 Audit 5 2 1 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 etc b Professional audit This audit looks at treatments a
29. after completion Deletes any existing drafts saved previously Save Draft Saves the unfinished form inputs 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 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 9 5 At least of the search criteria must be entered before you can proceed with the search Search Patient Nama Patient NRIC FIN From Date Im DOMMYYYY To Date i DOMMYYYY L j Sort By Patient Name Ascending Fill in at least one search criteria before doing a search Search Screen 11 Search Criteria Handbook for Healthcare Professionals 57 Criteria Remarks Patient Name All reports where the patient n
30. ame matches are retrieved A partial name is allowed e g if Mark is entered reports for all patients with Mark in their names are retrieved Patient NRIC FIN All reports where the patient NRIC matches are retrieved From Date All reports submitted from this date inclusive are retrieved To Date All reports submitted up to this date inclusive are retrieved Sort By Specifies the sorting sequence for the results 9 6 All submissions made by your clinic which matches the criteria will be displayed as shown on Screen 12 Search Patient Name Patient NRIC FIN F From Date DoMMvvyy 122206 Ei To Date 1 DOMMYYYY Son Patient Name Ascending e Click to retrieve all records that match the specified criteria ma i 3 records retrieved Check only one record for amendment or many records for deletion Patient Name Patient NRICFIN Submission Date Jean Pang F0145580W 12 Dec 2006 Jimmy Fong F2324653P 12 Dec 2006 31238886F 12 7 y Click on the hyperlink to retrieve a read 2 only page of the record Delete lt Delete selected 1 Delete records Amend selected record Screen 12 Search Results 9 7 Ifthe 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 9 8 Click on the Patient Name hyperlink to view the report submitted 9 9 When the Amend button
31. assessment One eye assessment One foot assessment One nephropathy screening test Hypertension Two blood pressure measurements One bodyweight measurement One smoking habit assessment Lipid Disorders One serum cholesterol level LDL C test One smoking habit assessment Stroke Two blood pressure measurements One serum cholesterol level LDL C test One smoking habit assessment One clinical thromboembolism risk assessment Asthma One inhaler technique assessment One smoking habit assessment Two Asthma Control Test ACT scores One inhaler technique assessment One smoking habit assessment One bodyweight measurement One influenza vaccination Schizophrenia 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 Major Depression One Clinical Global Impression CGI Scale for each item severity improvement Two consultations for CDMP Mental Health Bipolar disorder One Clinical Global Impression CGI Scale for each item severity improvement Two consultations for CDMP Mental Health Dementia Documentation of i assessment of memory ii assessment of mood and behaviour iii assessment of functional and social difficulties if any iv assessment of rehabilitation needs Two consultations for CDMP Dementia For patients on
32. at patients receive The following are for management of dementia patients after establishing diagnosis a Documentation in follow up of dementia patients Documentation of assessment of memory Documentation of assessment of mood and behaviour Documentation of assessment of functional and social difficulties if any Documentation of assessment of rehabilitation needs b Consultation for CDMP Dementia For patients on cognitive enhancers objective documentation of memory assessment must be performed by way of a bedside cognitive screening instrument such as the Mini Mental State Examination MMSE or Chinese Mini Mental State Examination CMMSE d Blood test for sodium and liver function tests only for patients on SSRIs or mood stabilisers e Full blood count for patients on mood stabilisers or considered anti platelet therapy f Clinical parameters HR BP especially for patients on cholinesterase inhibitors and antidepressants or antipsychotic medication Physical examination of extrapyramidal side effects for patients on antipsychotics h Electrocardiogram especially for patients being considered for or on cholinesterase inhibitor Also for patients on antipsychotics For those patients with stroke and dementia a Documentation of thromboembolism risk assessment Clinical evaluation including atrial fibrillation cardiac mumurs and need for anti thrombotic therapy b Documentation of rehabilitation ne
33. at 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 Any unused Medisave monies for unused treatments have to be refunded to patient s Medisave accounts upon request by patient O18 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 Q19 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 O20 How will the scheme apply to Permanent Residents and Foreigners Current Medisave rules apply Patients can be Permanent Residents or Foreigners As long as they have Medisave accounts or their immediate family members with Medisave accounts they are eligible for the scheme O21 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
34. cognitive enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Handbook for Healthcare Professionals 31 2 Collection and Submission of Clinical Data 2 1 The collection of clinical data can be carried out by 2 1 1 Manually recording the clinical data on a hardcopy template Annex 4 B page 41 Please note that for submission purposes the data will subsequently have to be keyed in via the online e Service which was introduced by MOH in Jan 2007 2 1 2 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 Submission of clinical data is an essential component of the Programme 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 As per current practice MOH would continue to provide each clinic via the e Service daily online updates on the list of patients for whom data submission remains outstanding see Section 10 Page 61 MOH would also send reminder letters on a quarterly basis to clinics which have outstanding list of patients with no clinical data submission for their data submission compliance 3 4 Clinics are allowed to accumulate patient reco
35. cs to keep track of the outstanding clinical indicator reports they would require to submit with each claim 10 3 2 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 MEDIClaim 50 50001 Clinical Indicators ERN ON Billing Details CIDC Clinics Reports Chronic Balance Enquiry J Chrome Payment Listing i ini Provides fhe list of NRIC for patients who have successful claims but no clinical indicators have been the clinic within the fixed 12 months period from the daim submission date Click on a Report title from the list of available reports Screen 15 Selecting a Report 10 3 3 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 NCSO001 gt F01 List of Patient NRIC No s Requiring Clinical Indicators Report Submission Clinical Indicators 2006 sack to Report List _Wiew Report Download As csv Fite Billing Details List of NRICs of patients who had claims submitted but not clinical indicators CIDC Clinics Reports 34480330 Chronic Balance Enquiry Chronic Payment Listing Screen 16 Viewing a Report 11 Troubleshooting 11 1 Enabling
36. d subject to a cap of 300 for all treatments received before 1 Jan 2012 and an annual withdrawal limit of 400 per Medisave account for all treatments received on or after 1 Jan 2012 If patient attendance is purely for an acute or unrelated condition Medisave deduction is not allowed even though the patient may have a chronic condition Checks will be made during audits to ensure that claims are related to approved chronic conditions Q6 How does the annual cycle of the limit apply Is it calculated based on the time that the patient first seeks treatment under the scheme The annual limit is reset at the start of each calendar year i e 1 Jan to 31 Dec Q7 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 O8 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 for 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
37. der they should in addition be enrolled into the dementia or bipolar disorder DMP For enrolment of patients with multiple chronic diseases please refer to Annex 2 A page 10 1 6 Patients who are assessed to be suitable for community follow up will be able to use Medisave to pay for management of all these chronic diseases existing rules and regulations for Medisave claims apply Clinical outcomes will be tracked for all the DMPs that the patient has been enrolled into 4 Chronic Disease Management Programme 2 Disease Management Programmes DMPs 2 1 The care components in each DMP are recommended by the Clinical Advisory Committee appointed by MOH These care components are recommended based on current available medical evidence 2 2 Some clinics have found it administratively easier to package their services for their patients Packages should contain the care components detailed in the DMPs Additional components if any can only be offered as add ons 2 3 Figure 2 1 and 2 2 show the treatment algorithm for dementia and bipolar disorder respectively Details regarding each of the essential care components can also be found in the MOH Clinical Practice Guidelines available at http www moh gov sg mohcorp publications aspx id 16266 Table 2 1 Essential care components for Dementia follow up management in Dementia Disease Management Programme Essential Component Assessment of memory if on cognitive enhancers to doc
38. disave account per year for outpatient treatments received before 1 Jan 2012 and 400 per Medisave account per calendar year for treatments received on or after 1 Jan 2012 of the approved chronic diseases regardless of the number of diseases they might have O2 Whose Medisave account s can a patient make use of other than his own Patients can use their own Medisave account s and the account s of their immediate family members i e parents children 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 O3 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 O4 Who should submit Medisave claims Any of the permanent staff of a Medisave accredited clinic who has attended the training sessions i e doctors nurses counter staff clinic managers etc can submit the Medisave claims 68 Chronic Disease Management Programme 05 Ifthe patient sees me for both a chronic disease and an acute illness at the same time can the entire bill be claimed Medisave can only be used for treatment related to the chronic diseases liste
39. dministered for each claimed treatment to determine if it is related to the proclaimed diagnosis 5 2 2 Prior notice will be given to identify the cases to be audited The following documents are required for the audit a Hard copies of Claim Forms submitted electronically b Medisave Authorisation Forms 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 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 HbA results lipid results g Prescription records 5 2 3 Evidence supporting diagnosis e g documentation in case records or laboratory reports 5 2 4 Clinics medical institutions or doctors found guilty of wrong claims may be required to refund the amount to the affected Medisave accounts Each time the doctor is found making wrong claims for his patients he she will be issued warning letters His Her Medisave privilege may be suspended upon repeated infringements Handbook for Healthcare Professionals 27 Table 3 4 Registration and Accreditation Process Medisave for Chronic Disease Management Programme Steps Clinics submit E Applica
40. e Clinical Indicators Data Collection CIDC e Service for the submission of data to MOH as part of CDMP b 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 MediClaim e Service 1 2 System Requirements In order to use the e Service an Internet enabled computer with the followings is required a Hardware Requirements The minimum recommended hardware configuration is e Pentium IIl MHz Processor with 256MB RAM Atleast 200 MB free hard disk space b System Software Requirements Windows XP Internet Explorer 6 0 and above 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 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 44 Chronic Disease Management Programme 2 2 Accessing the 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 Password Authentication _______ Organisation 10__ ____ Password um Best Viewed with IE 6 0 or hig
41. ed assessment 1 2 The Clinical Practice Guidelines details the good clinical practices required in dementia evaluation and management The documentation of the important care component process in dementia evaluation and dementia management is captured in the first two clinical parameters to indicate good clinical dementia care Handbook for Healthcare Professionals 11 10 1 3 following up patients to detect complications early and prevent the morbidity and mortality associated with complications is an important aspect of care for dementia patients the Consultation for CDMP Dementia at least twice per year is a key care compliance indicator for the Programme 1 4 For dementia patients who are prescribed antidepressants or antipsychotic medications biochemical tests should be performed at least once yearly 1 5 For dementia patients who are prescribed cholinesterase inhibitors and antipsychotic agents they should have clinical parameters taken during consultation visits and if there are concerns electrocardiogram should be done Recent evidence has shown association of cardiac rhythm abnormalities with cholinesterase inhibitor use Note Indicators 1 1 c to 1 1 h are applicable only if patients are on these drugs Table 2 4 summarises the clinical indicators for patients with Dementia required for submission via electronic channels to MOH Clinical Indicator Frequency Documentation of i assessment of memory
42. eferral to appropriate community services Documentation of discussion with patient and or caregivers before starting on cognitive enhancers after careful consideration of expected magnitude of benefit side effects co morbidities and costs of treatment Handbook for Healthcare Professionals 7 Figure 2 2 Treatment Algorithm for Bipolar Disorder Assessment of mood state and previous mood episodes Assessment of co morbidities Diagnosis and acute phase Treatment of bipolar disorder Psychoeducation to caregivers and patient Maintenance phase treatment and monitoring Referral to appropriate community services Clear documentation on current symptoms of depressive manic or hypomanic episodes Exclusion of organic causes Clear documentation of appropriate history as well as investigations assessing for organic pathology and or co morbidities Diagnosis of bipolar disorder following either the DSM IV TR or ICD 10 criteria Appropriate intervention in accordance to the bipolar CPG Documentation of newly diagnosed bipolar disorder patients as well as their caregivers having received appropriate counselling and education Documentation of patients being stabilised with the appropriate treatments and monitored with the relevant serum levels Documentation of stable patients with bipolar disorder being considered for referral to appropriate community services 3 Patient Education and
43. ent Smoker Yes C No 1990 Year Started Sm king Y YYY denotes a mandala herd Screen 5 Patient Details Data Item Remarks Patient Name Patient s name as in NRIC Patient NRIC FIN Will be copied from previous screen Date of Birth Patient s date of birth enter in DDMMYYYY format Sex Gender of patient Race Ethnic group of patient Height m Patient s height in metres e g 1 75 and must be between 0 10 and 2 50 inclusive or 9 99 if not measurable Current Smoker Whether patient is a current smoker Year Started Smoking Year that patient started smoking enter in YYYY format 5 Known Medical History 5 1 This section details the patient s medical history 5 2 If itis your first submission for the patient please enter all the details 5 3 For subsequent submissions you can omit the details if there are no changes Handbook for Healthcare Professionals 49 5 4 If you are unsure whether you have submitted the information it is recommended you fill in the details Known Medical History Medical Condition Diagnosis Year Medical Condition Diagnosis Year Diabetes 2007 YYvv 0 Hypertension 0 DM Retinopathy 0 Lipid Disorder Nephropathy YYYY 0 Cerebrovascular Accident CVA YYYY DM Foot Complications 0 Coronary Heart Disease YYYY Asthma
44. equired to separately attribute it to their own business administrative charges instead of lumping it as Medisave processing fee O14 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 Q15 Can accumulate several bills to be submitted in a single claim for the whole year so as to decrease the cost per transaction Yes The deductible and co payment is based on a per claim basis You will need to enter the visit date and bill details for each visit within the single claim Q16 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 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 70 Chronic Disease Management Programme Q17 If patients have signed up for the Programme can they opt out of it at a later date Do need to refund the amount th
45. fasting lipids One blood tast for fasting glucose One Clmica Global Impression CGI Scale for each jseventy improvement consuitalians for Mental Health Bipolar Disorder a One blond test far fasting lipids One blood test far fasting glucose One assessment of memory assessment af mood and behaviour assessment of functional and social dificulties if any One assessment of rehabilitation Needs Two consultations for COMP Mental Health For patients cognitne enhancers documentation of objective assessment nf memory MMSE or CMMSE testing or other validated instruments Dementia Screen 3 New Submission 46 Chronic Disease Management Programme 3 2 1 Select the Identification Type and enter the Patient NRIC FIN 3 2 2 Select the chronic disease applicable to this patient You can select one or more diseases as applicable 3 2 3 Click on Next to proceed to the Clinical Indicator Form Patient Name Tan Ah Kun Patient NRICIFIN 512345670 Date of Gath amp Female 44041971 DDMMYYYY ponm m Sex Race Height Mets a 0 DM Retinopathy Lipid Disorder Ei DM Nephropathy vvv Cerebrovascular Accident CVA OM Foot Complications vvv 0 Coronary Heart Disease E Asthma vvv corp Major Depression 2007 yvvv
46. he main physician information should be entered here Attending Physician Information Registration Doctor Name Specialty Tranmg Please select 4 applicable Porat ent Role Attending Doctor is the patient s regular primary physician Date ot 06 2008 Submission C The Clinic is the patient s regular primary provider C None of th Above ganolog mandatory Submit SaveOra Close Screen 9 Physical Information Data Item Remarks Doctor Name Full Name of Doctor Registration Number The Doctor s MCR Number Speciality Training Select the appropriate value from the drop down list if applicable Healthcare Establishment The Healthcare Establishment which is making the submission It is tied to the user ID of the person making the submission and is defaulted based on the user s ID establishment Role Indicate the role applicable Name of Primary Only applicable when None of the Above is selected Physician 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 submit you can click on the Save Draft button and retrieve the report later from the search function for submission 56 Chronic Disease Management Programme The Table below describes the function for each button Button Function Description Submit Submits the form
47. he severity and improvement of the mental condition It is chosen as it can be applied to reflect severity and improvement in other mental conditions 2 4 As patient compliance to follow up is an important aspect of care for patients suffering from mental illness the Consultation for CDMP Mental Health at least twice per year is a key care compliance indicator for the Programme 2 5 For patients with bipolar disorder who are prescribed atypical antipsychotic medications a blood test for fasting lipid and fasting glucose should be performed at least once yearly to alert doctors to possible development of metabolic syndrome a known complication of treatment with atypical antipsychotics Table 2 5 summarises the clinical indicators required for patients with Bipolar Disorder required for submission via electronic channels to MOH Clinical Indicator Frequency Clinical Global Impression CGI Scale At least once yearly or as clinically indicated Consultation for CDMP Bipolar Disorder Twice yearly or as clinically indicated Handbook for Healthcare Professionals 13 uoissaidap pue eiueJudoziuos 03 si 3w 002 09 BW 872 GZ 3w 002 091 sesop ul 091 92 sesop Z ul 3 09 GZ 4 y uo 8 061 0 WO 8 051
48. her Recommended screen resolution 1024 X 768 pixels 16 bittrue colour Screen 1 MediClaim login screen 2 2 2 Upon successful login to the MediClaim system you will be able to see the Clinical Indicators data collection e Service in the left hand menu as shown on Screen 2 below All users with access to the Chronic Disease Claim Form e Service will have access to the Clinical Indicators Data Collection e Service 2 2 3 Click on the menu to display the functions available Screen 2 Menu a Submission is used to submit a new report b Search is used to retrieve submitted reports Handbook for Healthcare Professionals 45 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 Select patient ID Type Enter patient NRIC FIN marked with asterisk New Submission Patient ID Type SINGAPORE BLUE HRIC E Patient HRIC FIN Lae Be EN s qs io lt Select the medical T Ela Depression Flchsopireme Cleipalr Oar
49. iClaim User account b Security Token Card non refundable cost of 171 20 inclusive of 7 GST c A Personal Computer Laptop with the following configuration i CPU Pentium Ill and above ii Memory RAM Minimum of 256MB iii Operating System Windows iv Browser Internet Explorer 6 0 v Internet connection d GIRO arrangement with CPF Board for Medisave payments to be credited into the clinic medical institution s bank account e GIRO arrangement with CPF Board for the payment of Medisave claims handling charges f GIRO arrangement with NCS for the payment of MediClaim usage charges g Training to process Medisave claims 3 2 3 Forms to Complete a Clinics Medical institutions interested in joining the Programme will need to submit the following forms to MOH i E Application for Clinics to Participate in the Medisave for Chronic Disease Management Programme by MOH ii Direct Authorisation Credit Form by CPF Board iii GIRO Form MediClaim charges by NCS iv GIRO Form Medisave charges by CPF Board The E Application website can be accessed via http www moh gov sg mmae overview aspx 3 2 4 Clinic 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 Institutions are also required to sign the Deed of Indemnity with CPF Board 3 2 5 Clinics Medical institutions participa
50. ii assessment of mood and behaviour iii assessment of functional and social difficulties if any iv assessment of rehabilitation needs At least once yearly or as clinically indicated Consultation for CDMP Dementia Twice yearly For patients on cognitive enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Chronic Disease Management Programme At least once yearly or as clinically indicated 2 82 2 Clinical Indicators for Bipolar Disorder 2 1 Participating medical institutions must monitor the quality of care that patients receive The following are for management of bipolar disorder patients after establishing diagnosis a Clinical Global Impression CGI Scale b Consultation for CDMP Mental Health c Blood test for fasting lipid only for patients on atypical antipsychotic medication d Blood test for fasting glucose only for patients on atypical antipsychotic medication 2 2 The Clinical Practice Guidelines details the good clinical practices required in bipolar disorder evaluation and management The documentation of the important care component process in bipolar disorder evaluation and management is captured in the first two clinical parameters to indicate good clinical bipolar disorder care 2 3 The Clinical Global Impression CGI Scale is a simple easy to administer 2 item scale each item has 7 points scale to indicate t
51. ils Some examples of potential clinically significant interactions with general medicines when initiating increasing an antidepressant dose can be Triptans e g Sumatriptan St John s Wort Risks of serotonin syndrome with SSRIs and related antidepressants Insulins oral hypoglycaemic agents Risks of hypoglycaemia with some antidepressants e g Fluoxetine Theophylline Clozapine Risks of toxicity with Fluvoxamine Digoxin Risks of toxicity with Fluoxetine Anticonvulsants Levels affected by many antidepressants Seizure threshold reduced by TCAs bupropion Warfarin Risks of bleeding with many antidepressants e g Fluvoxamine Precautions when switching antidepressants Other antidepressants should not be started until at least 2 weeks after Moclobemide has been stopped Moclobemide should not be started until at least 1 week after a TCA or SSRI or related antidepressant has been stopped 2 weeks in the case of Sertraline and at least 5 weeks in the case of Fluoxetine Combinations of SSRIs and related antidepressants may cause serotonin syndrome hypotension and drowsiness References British National Formulary Vol 57 Mar 2009 amp Geriatric Dosage Handbook 11 Ed MICROMEDEX DRUGDEX Healthcare Series Vol 140 2009 American Hospital Formulary System 2009 Edition Manufacturers Product Information Handbook for Healthcare Professionals 15 CHAPTER THREE REGISTRATION AND MEDISAVE USE 1 Policy on Medisave Use 1
52. inics Medical institutions can then submit the Medisave claims electronically to the CPF Board for processing via the MediClaim System Payment will be made daily to Medisave accredited medical institutions via InterBank Giro IBG on the 3rd working day after the approval date of the Medisave claims gt Q23 Can GPs who are contracted by nursing homes to provide outpatient care for their residents help the ones suffering from one of the six listed chronic diseases make Medisave claims Yes if the GP and his her clinic are on the Programme 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 O1 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 72 Disease Management Programme 02 Mustthe medical history be captured at each 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 O3 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 O4 Will data on all clinical parameter
53. is clicked the selected record will be displayed in editable mode as shown on Screen 13 58 Chronic Disease Management Programme Patient Name Tan Ah Kun Patient NRICIFIN 512345670 98 un m5 Sex Male Female Race GG Hagh enes use 9 99 if not measurable Current Smoker C Yes 6 Year Started Smeking Y YYY t denotes mandatory frail E Hypertension Retinopathy E Lipid Disorder Ei DM Nephropathy 0 Cerebrovascular Accident CVA vvv E Foot Complications 0 Coronary Heart Disease E Asthma f corp vvv Major Depression E Schizophrenia 2007 Bipolar Disorder 0 Dementia Handbook for Healthcare Professionals 89 Clinical indicators 000 Date of Visit a Blood Pressure Systolic Diastolic j DM Eye Assessment o LDLC DM Nephropathy Assessment HbAte 95 DM Foot Assessment o Weight kg Stroke Thromboembolism Risk Assessment 7 use 999 if not measurable Smoking Assessment Inhaler Technique Assessment Asthma amp only Cigarettes smoked per day average amp ACT Score Asthma only Influenza Vaccination Assessment COPD o 10 only The following care components are only for Health Programme Patients CGI Severity of 5 Fasting Lipids Blood Test awa Global Improvement Fasting Gl
54. ition 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 O16 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 Handbook for Healthcare Professionals 75 Summary of Use of Medisave for CDMP Patient has one or more of the chronic diseases with DMPs Chapter 1 Patient is counselled on i Benefits of being on a DMP Chapter 1 Visits a clinic doctor who is registered with Medisave for CDMP Chapter 3 ii How he she can draw on his her Medisave to help pay for management of these chronic disease s Chapter 3 Patient consents and signs the Medisave Authorisation Form Patient is enrolled into the relevant DMPs or Shared Care Programme SCP GP Partnership Programme GPP Chapter 2 DM DMP HPT DMP Lipid Disorders DMP Stroke DMP Asthma DMP Submit Clinical Data of Patient See Chapters 4 amp 5 Y i Data submitted reflects essential clinical care components in management of the chronic disease s ii Feedback on aggregated data to clinic allows comparison amp self assessment of clinic s performance and identify a
55. ive 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 savings for the treatment of the patient The 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 Institution staff should also verify relationships stated in the MAF where possible Clinics Medical institutions are to submit the Medisave claims electronically to CPF Board for processing via the MediClaim System 5 1 3 The MAF is a legal document As such CPF Board is unable to accept the authorisation from a person of unsound mind Such a 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 9 Authorisation can be for a period of 3 6 or 12 months for an open ended length of time subject to revocation in writing Handb
56. lipids only for patients At least once yearly on atypical antipsychotics Chronic Disease Management Programme Provider administered Notes Medisave can also be used for doctor follow up nurse follow up evaluation physiotherapy occupational therapy speech therapy home visit evaluation as clinically indicated and ordered by the attending doctor but not for home meal delivery transport or other non medical aspects of care Figure 2 1 Treatment Algorithm for Dementia Assessment of cognition Assessment of complications behavioural functional social Diagnosis of dementia and aetiogy Counselling and education including Advanced Care Planning to caregivers and patient where appropriate Referral to appropriate community services Management of complications of dementia Discussion and initiation of cognitive enhancers where appropriate Clear documentation on evaluation of cognition mood and behaviour using subjective and objective approach Documentation of advice on non pharmacological intervention prior to institution of pharmacologic agents Clear documentation in those started on pharmaco logical agents after careful consideration of benefits adverse effects and co morbidities Documentation of newly diagnosed dementia patients having received appropriate counselling and education Documentation of newly diagnosed dementia patients with care needs being considered for r
57. ma Please refer to Chapter 3 for details Q3 My patient has DM however he also has symptoms and signs of Hypothyroidism Can use his Medisave to co pay the thyroid function test No In this instance thyroid function test was done to screen for an associated disease and not for monitoring of the primary condition or its complication 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 Q4 Who decides on the stipulated clinical care component 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 Clinical Advisory Committee Handbook for Healthcare Professionals 65 05 the patient has symptoms suggestive of both COPD and Asthma Which DMP should enrol him into For patients whose signs and symptoms are not so distinct between the two conditions spirometry or and 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
58. make Medisave claims for patients For dementia and bipolar disorder doctors also need to be participating in a Shared Care or GP Partnership Programme with a Restructured Hospital to make Medisave claims for patients receiving outpatient treatment 4 5 Doctors must certify on the Medisave Authorisation Form that patients they make Medisave claims for are suffering from one or more of the approved chronic diseases and treatment is related to that chronic condition 4 6 The table below provides a guideline on what can be used for Medisave claims The doctor is expected to exercise clinical judgment and discretion when making claims MEDISAVE MAY BE USED FOR Management of the patient based on the care components in the respective Disease Management Programme DMP Medical consultations primarily for the approved chronic conditions under the Programme Relevant investigations including laboratory and radiological for the evaluation of the disease or its complications Prescribed drugs and nursing care for the management of the approved conditions or their complications Physiotherapy occupational and speech therapy for the rehabilitation of the patient 20 Chronic Disease Management Programme 4 7 Tables 3 1 to 3 3 lists the investigations drugs and therapies for the evaluation and management of dementia and bipolar disorder for which Medisave use can be allowed Table 3 1 Recommended investigations for
59. n cluster This will depend on the electronic Clinic Management System if any that is used by the healthcare institution Q13 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 diseases The data submission system allows you to submit more than the recommended number of care components O14 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 The release of data back to the clinics had been effected in phases Clinical data submitted have been routinely fed back to the clinic as the online CDMP outcome reports via the Mediclaim system from the first 74 Chronic Disease Management Programme quarter 2008 onwards In these reports clinic will be able to compare its performance against the aggregated local and national performance Over time each clinic will also be able to track its own performance trends O15 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 patients to take charge of managing their chronic cond
60. n annual withdrawal limit of 400 per Medisave account for all treatments received on or after 1 Jan 2012 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 900 of Medisave from his and his children s Medisave accounts total of 3 accounts every year before 1 Jan 2012 and a maximum of 1 200 per year on or after 1 Jan 2012 to pay for his outpatient treatments Handbook for Healthcare Professionals 23 Scenario 2 The grandmother and parents of Ms Tan Hao Sun are suffering from Diabetes Mellitus However they have no Medisave Ms Tan can make use of a total of 300 annual withdrawal limit of her own Medisave every year before 1 Jan 2012 and a maximum of 400 per year on or after 1 Jan 2012 to pay 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 300 annual withdrawal limit before 1 Jan 2012 and a maximum of 400 per year on or after 1 Jan 2012 to pay from her Medisave 4 11 Patients may have employer benefits and outpatient insurance Employer benefits and outpatient insurance can be used for pay for outpatient treatments under the Scheme Medisave can come in to help pay the balance after employer benefits and or outpatient insurance 4 12 n cases where only part of the chronic disease ou
61. n for needs CDMP Dementia For patients on cognitive As above enhancers documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Handbook for Healthcare Professionals 29 B Bipolar disorder NRIC FIN DOB DD MM YYYY Gender Male Female Clinical Global Impression Scale a Severity Numerical value from 1 7 Consultation for CDMP Mental Health b Improvement Numerical value from 0 7 1 3 The clinical data fields required for all the chronic conditions in CDMP are summarised in the template please see Annex 4 B Page 41 1 4 The quality of patient care for all the chronic conditions will be evaluated according to whether the relevant process and care components have been met as listed on the following page 12 per year refers to 12 months from the first visit of the patient for the chronic condition s 13 This is only applicable for patients aged 4 years and above For patients aged 4 to 12 years please use the Childhood ACT and for those aged 12 years and above the ACT 14 Only for patients with schizophrenia on atypical antipsychotic medications Chronic Disease Management Programme Chronic Condition s Care Components Per Year Diabetes Mellitus Two blood pressure measurements Two bodyweight measurements Two hemoglobin A1c HbA1c tests One serum cholesterol level LDL C test One smoking habit
62. nique Assessment Assessment V V Avg no cigs day For Asthma Only For COPD Only Asthma Control Influenza Test ACT Score Vaccination C Major Depression and Schizophrenia DMP For Schizophrenia Major Depression Date of Visit dd mm yy Consultation for Mental Health Clinical Global Impression CGI Scale Severity Improvement For Schizophrenia on atypical antipsychotics Only Date of Visit dd mm yy Blood Test for Fasting Lipids Blood Test for Fasting Glucose 15 For the annual recommended frequency of the clinical indicators please refer to the table on pg 31 42 Chronic Disease Management Programme D Bipolar Disorder and Dementia For Bipolar Disorder Dementia For Bipolar Disorder Only Date of Visit dd mm yy Consultation for Mental Health Scale Clinical Global Impression CGI Severity Improvement For Dementia Only Assessment of Memory Assessment of mood and behaviour Assessment of functional and social difficulties if any Assessment of rehabilitation needs Objective assessment of memory MMSE or CMMSE testing or other validated instruments Handbook for Healthcare Professionals 43 CHAPTER FIVE USER MANUAL FOR E SERVICE CLINICAL DATA SUBMISSION 1 Introduction 1 1 Purpose a The manual serves as a guide on how to use th
63. nrelated to the conditions e g Pap smear fertility treatments Purchase or rental of nebulisers wheelchair prosthesis or other home nursing equipment Employment of caregiver or nursing aides Co morbid conditions such as treatment for drug and alcohol abuse f Alternative medicine e g acupuncture Novel treatments e g rTMS Drugs and therapies not explicitly listed as Medisave approved for treatment of dementia or combination of stroke and dementia and bipolar disorder including sleeping pills erectile dysfunction pills and other drugs for lifestyle purposes o s 09 4 9 Eligible patients can use their own and immediate family members Medisave for payment of their outpatient treatments Immediate family members refer to the spouse parent or child of the patient Grandparents who are Singapore citizens or PRs can also use their grandchildren s Medisave Siblings are not considered immediate family members 4 10 The amount of Medisave that can be used is subject to the 3 conditions mentioned in paragraph 1 2 of this Chapter a Deductible A deductible of 30 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 percent on each outpatient bill also apply in excess of the deductible and c Annual withdrawal limit An annual outpatient withdrawal limit of 300 per Medisave account for all treatments received before 1 Jan 2012 and a
64. nts in the Programme Clinics enrolled under the Medisave for CDMP are required to provide all the essential care components detailed in the DMP The basis for diagnosis and management of dementia and bipolar disorder should conform to the prevailing MOH Clinical Practice Guidelines Shared Care Programmes or GP partnership programme with an RH must provide the essential care components for the continuing evaluation and management of dementia and bipolar disorder as set out in the Tables 2 1 2 2 and 2 3 1 2 Existing patients with dementia and bipolar disorder in the RHs or IMH are recommended to be assessed by geriatricians psychiatrists their primary care physician to be suitable forfollow up in the community by GP clinics or polyclinics which are participating in Shared Care or GP Partnership Programmes 1 3 Fornew diagnosis of dementia or suspected cognitive impairment when in doubt it is advisable to consult or refer to a geriatrician psychiatrist neurologist for confirmation as these diagnoses carry long term medical and legal implication 1 4 For new diagnosis of bipolar disorder it is advisable to refer to a psychiatrist as this diagnosis carry long term medical social and legal implications 1 5 Patients who are already enrolled under the existing DMPs i e Diabetes Mellitus Hypertension Lipid Disorders Stroke Asthma or COPD Schizophrenia and or Major Depression but who also suffer from dementia or bipolar disor
65. onals 63 12 Fallback Procedures 12 1 In the event that the submission cannot be done online immediately you can keep a record of the information and submit it at a later date 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 64 Chronic Disease Management Programme CHAPTER SIX FREQUENTLY ASKED QUESTIONS A CLINICAL MATTERS For Doctors who have already registered into the Programme O1 Which chronic diseases are currently included under this Programme Diabetes Mellitus Hypertension Lipid disorders Stroke Asthma COPD Schizophrenia Major Depression dementia and bipolar disorder are currently included under this Programme O2 have a patient with Diabetes Hyperlipidaemia and Asthma which DMPs should enrol him into Enrol him into both Diabetes AND Asthma DMPs He will then be able to use Medisave to co pay for the total bill for the treatment prescribed for all 3 conditions However the doctor will also need to submit outcome data based on the essential care components of diabetes and asth
66. ook for Healthcare Professionals 25 5 1 4 If the patient is deemed to be mentally incapacitated his immediate family members or his appointed donee deputy under the Mental Capacity Act may 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 to certify on Part V of the MAF that the patient is mentally incapacitated at the point 5 1 5 Claim Process a 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 b Currently the transaction cost for each Medisave claim is 2 91 exclude GST 2 44 is charged by CPF Board for every Medisave account processed and the remaining 0 47 is charged by NCS for MediClaim System usage The transaction charges will be collected on a monthly basis via InterBank Giro IBG Patient s Medisave cannot be used to cover the processing fees Should medical institutions decide to pass on this cost to the patient the description of this item in a patient s bill should be Medisave processing fee Should medical institutions decide to charge out additional administrative fees on top of what MOH CPFB charged out to them they are required to separately attribute it to their own business administrative charges instead of lumping it as Medisave processing fee 5 1 6
67. or Central LETT EA N ZR V RP Di manakah kedudukan tempat ini di Singapura Utara selatan timur barat atau pertengahan Chronic Disease Management Programme Immediate Recall 8151 7 Pengingatan Kembali Segera I m going to name three objects When I am through want you to repeat them HRCA SOEMREPEM Saya akan sebutkan tiga benda Selepas ini saya ingin anda ulanginya lagi The first repetition determines his her score 0 3 but keep saying them until he she can repeat all three up to six trials Correct Incorrect 11 Ball Bola HF 12 Flag Bendera BUR 13 Tree Pokok AFR 13a Number of trials Range 1 6 Please remember them as will ask you to repeat them again later on AREI 0 Cuba mengingatinya kerana saya akan menyuruh anda sebutkan benda benda sebentar lagi Attention amp 7j Perhatian Subtract 7 from 100 and keep on subtracting 7 from each answer until tell you to stop Tell me your answer for each subtraction MURS TAS A BENERE Ro HEB BEN IE Sila tolak 7 dari 100 dan terus menolak 7 dari setiap yang didapati sampai saya berhenti Berikan jawapan setelah setiap tolakan Each answer must be independently compared to the prior answer to ensure that a single mistake is not unduly penalised Correct Inc
68. or Hokkien and Cantonese However examiners are recommended not to deviate overly from the provided instructions to avoid giving too much or too little information to the participants and potentially biasing their performance For each of the 30 items check the appropriate box correct or incorrect and record the subject s verbatim response in the spaces provided Correct Incorrect E LI EI EH ET B 10 Orientation Orientasi What is the year FRESE E Sekarang tahun apa What is the month OK to accept Chinese calendar equivalents but ask if subject knows Western calendar equivalent Sekarang bulan What is the date today ARIUS Apakah tarikh hari ini What day is today Hari ini hari apa Without looking at your watch what time is it Jangan melihat jam sekarang pukul berapa Subject s response Current time What area are we in FRA TCE AEK Kita berada di kawasan mana What building are we in now If necessary ask for name or block number of building FEA ECE If necessary IAEA 41 51652 Sekarang kita berada di bangunan apa If necessary tanyakan nama bangunan atau nombor blok What floor are we on TA RACE E JURE Sekarang kita berada di tingkat berapa What country are we in AH CE CEM 39 Kita berada di negara apa Which part of Singapore is this place North South East West
69. orrect Lo il 14 93 15 86 LJ 16 79 175 72 18 65 Handbook for Healthcare Professionals 35 Delayed Recall 22 1817 Peringatan Kembali Perlambatan Can you tell me the three objects that asked you to remember earlier SER ARR WARM PENSAR ETA Cuba namakan tiga benda yang saya suruh ingatkan tadi Correct Incorrect 19 Ball Bola 20 21 Tree Pokok AFR Language Bahasa Correct Incorrect 22 Show the subject a wrist watch and ask What is this If subject gives a function say Yes but what is this called or What is its name S MA HN BEENA FRITA Apakah ini Ya tetapi ia dipanggil apa or Apakah nama nya 23 Repeat for pencil 16 pensil 24 Say will say this once only please listen carefully and repeat after me An apple a day keeps the doctor away 2 RARE Saya akan menyatakan sekali sahaja sila dengar baik baik dan ikut apa yang saya cakap marah merah murah Hold a piece of paper in front of subject do not allow him her to take it until all three commands are given and say Listen carefully take the paper in your right hand fold it into half and put it on the floor URE E Dengar baik baik ambil kertas dengan tangan
70. patients receiving selected pharmacotherapy S N Investigation Indication BIPOLAR DISORDER Full Blood Count Patients on most mood stabilisers at baseline and yearly for carbamazepine Renal Panel U E Cr Patients on all antidepressants carbamazepine and lithium Liver Function Test Patients on antidepressants atypical antipsychotics mood stabilisers Patients on lithium Patients on atypical antipsychotics and those at risk of metabolic syndrome 4 Thyroid function TFTs 5 Fasting lipids and glucose 6 Serum levels DEMENTIA Full Blood Count Patients on Lithium Carbamazepine and Sodium Valproate Patients on mood stabilisers Patients for consideration or on antiplatelet agent Renal Panel U E Cr Patients on antidepressants or mood stabilisers Patients on antidepressants atypical antipsychotics mood stabilisers 1 3 Liver Function Test 4 Electrocardiogram Patients for consideration or on cholinesterase inhibitors and antipsychotics both typical and atypical and in whom there is concern with regards to cardiac rhythm abnormalities Handbook for Healthcare Professionals 21 Table 3 2 List of Medisave Claimable Drugs for Treatment of Psychiatric Conditions This list includes any new medications excluding benzodiazepines approved by the Health Sciences Authority HSA for the treatment of psychiatric conditions which are included in the CDMP programme Drug Drug
71. r 250 01 E10 E11 E13 E14 Hypertension 401 9 110 to 113 Lipid Disorders Stroke 272 4 436 E780 to E785 160 to 164 Asthma 493 J45 to J46 COPD 491 492 or 496 J41 to J44 J47 Schizophrenia 295 or 297 F20 to F22 Major Depression 296 1 292 2 or 292 3 F322 F323 F332 F333 F34 F38 9 Dementia 290 291 2 294 1 331 0 or 331 1 200 to 2051 F107 G310 G311 Bipolar Disorder 296 0 296 4 to 296 8 F310 to F319 Handbook for Healthcare Professionals 19 4 3 Medisave claims will be accepted only if a The patient is diagnosed to have one or more of the chronic diseases listed above b The patient has been enrolled into their respective DMP see chapter 2 for details c The claim must be related to the essential care components in the management of that specific DMP or for the treatment of the disease and its complications The doctor in charge must clearly document this causal relationship or link between the disease and its treatment d In this regard Medisave claims will generally not be allowed for sleeping pills slimming pills or erectile dysfunction drugs used for lifestyle purposes e Under certain equivocal circumstances the auditors will seek further clarification with the prescribing doctor 4 4 Only doctors and clinics medical institutions which are Medisave accredited and participating in Programme can
72. r stress If they have behavioural issues these should be stable before transfer to their primary care physician For bipolar disorder their last mood episode should have been more than three months ago v For dementia if prescribed antidepressant and or antipsychotic agents they should be on stable doses of these medications for at least 3 months Similarly for bipolar disorder they should be on stable doses of medications b Referral from Primary Care to Specialist i GPs should refer for specialist s review patients in whom diagnosis of dementia is uncertain GPs should also refer for specialist s review complicated cases of bipolar disorder such as co morbidities pregnancy patients 18 years or younger or other complications which in the family physician s opinion would require specialist opinion ii Patients who under special circumstances require specialist opinion for medication titration for their condition i e side effects or complications from conventional medication iii For bipolar disorder patients who are relapsing Handbook for Healthcare Professionals 9 2 Enrolling patients with multiple chronic diseases Patient with multiple chronic diseases may be enrolled into 1 and or 2 and or 3 and or 4 Stroke DMP Chronic Disease Management Programme Annex 2 B1 1 Clinical Indicators for Dementia 1 1 Participating medical institutions must monitor the quality of care th
73. rds for submission in batches However for batch submissions regular e g weekly or monthly submissions should be carried out to avoid backlogs in clinical data submission 3 5 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 32 Chronic Disease Management Programme Annex 4 A1 CLINICAL GLOBAL IMPRESSION CGI SCALE Considering your total clinical experience with this particular population how would you rate this patient s mental condition at this time 1 Severity of Illness 1 Normal not at all mentally ill 2 Borderline mentally ill 3 Mildly mentally ill 4 Moderately mentally ill 5 Markedly mentally ill 6 Severely mentally ill 7 Extremely mentally ill 2 Global Improvement 0 Not assessed 1 Very much improved 2 Much improved 3 Minimally improved 4 No change 5 Minimally worse 6 Much worse 7 Very much worse Handbook for Healthcare Professionals 33 34 4 2 SLAS 2 Date SUBJECT NO Name MINI MENTAL STATE EXAM BARA R PEPERIKSAAN KEADAAN ROHANI MINI Instructions Read the instructions for each item to the participant word for word as provided Due to colloquial differences between the Chinese dialects some minor deviations from verbatim instructions is acceptable only f
74. reas in need of quality improvement 76 Chronic Disease Management Programme AND OR COPD DMP Schizophrenia SCP GPP MD SCP GPP Dementia SCP GPP Bipolar Disorder SCP GPP Submit Medisave Claim for Patient See Chapter 3 i Allows patient to draw from his her own or his her family member s Medisave account s for outpatient treatment ii Leads to reduction in out of pocket payment upfront
75. s be required at every visit No Only data on assessments or tests performed during the visit need to be captured 05 Would I need to repeat HbA1c 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 Q6 What the patient is lost to follow up Please note it down in your clinical documentation Alternatively if you are using the web based 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 Q7 What the patient refuses certain tests Tests are performed when indicated as part of the proper management of the 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 08 Ifl 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
76. s conditions applicable to Cements the patient more than one E lt Click to go to Clinical medical condition may Indicator Form in Screen 4 be chosen Condition Care Components Per Year Two blood pressure measurements Two bodyweight measurements Two haemoglobin Arc HbATc tests One sarum cholesterol level LDL C test Diabetes mellitus One smoking assessment One eye assessment One foot assessment One nephropathy screening test Two blood pressura measurements One bodyweight measurement Hypertension One smoking assessment One serum cholesterol level LDL C test Lipid Disorder One smoking assessment Tun blood pressure measurements One serum cholesterol level LDL C test Stroke smoking assessment clinical thr mboembolism n k assessment One inhaler technique assessment One smoking assessment fama Two Asthma Control Test scores One inhale techmque assessment One smoking assessment COPD One bodyweight measurement One influenza vaccination The following care components are only for COMP Mental Health Programme Patients One Clmica Global Impression CGI Scale for each item severity improvement Major Depression Two consultations for COMP Mental Health One Clinica Global Impression CG Scale for each severity improvement Two consultations for Mental Health Schizophrenia One blood test for
77. s or antipsychotics which might affect cardiac rhythm Only for patients on SSRIs Full Blood count At least once yearly or as clinically indicated For patients on mood stabilisers or antiplatelet Physical examination for extra pyramidal side effects At least once yearly or as clinically indicated Only for patients on antipsychotics Electrocardiogram Table 2 2 Additional care componen Essential Component As indicated Minimum Recommended Frequency per year Especially patients who are being considered for cholinesterase inhibitor and or on cholinesterase inhibitor but concerns regarding heart rhythm and patients on antipsychotics ts for patient with Dementia and Stroke Remarks Thomboembolism Risk Assessment Annually Clinical evaluation including atrial Fibrillation cardiac Mumurs and need for anti thombotic therapy Rehabilitation need As clinically indicated assessment Table 2 3 Essential care components for bipolar disorder follow up management in Bipolar Disorder Disease Management Programme Essential Component Minimum Recommended Frequency per year Remarks Clinical Global Impression CGI a Severity b Improvement At least once yearly or as Clinically indicated Provider administered Patient attendance At least twice a year or as Clinically indicated Provider administered Blood test for fasting glucose and
78. save for Chronic Disease Management Programme 3 1 Clinics That Wish to Participate on the Programme 3 1 1 To be on the Programme both the clinic medical institution and its doctors have to register with and be accredited by MOH Upon accreditation the doctors can then make Medisave claims for their patients 3 1 2 An outline of the registration and accreditation process is provided in Table 3 4 page 28 3 2 Registration of Clinic Medical Institution with MOH 3 2 1 To join the Programme you will need to fulfil the following criteria a Be able to make Medisave claims for patients through the online MediClaim system b Sign a Deed of Indemnity with CPF Board c Be able to submit Clinical Quality data to MOH The transaction cost of 2 91 assumes 1 Medisave account is used Figures exclude 7 GST charges With GST the transaction cost is 3 11 6 National Computer Systems NCS is the company appointed by MOH to maintain the MediClaim system The MediClaim system is an online e service for clinics medical institutions to submit Medisave claims to CPF Board for processing 7 Clinics which are not ready to make claims online can approach Service Bureaus to help them with their paper claims in the interim The details of these Service Bureaus can be found on the MOH website Handbook for Healthcare Professionals 17 3 2 2 To make claims for patients through the online MediClaim system clinics medical institutions need a Med
79. t s reguli primary provider C Hone of the Above decies 4 mandatory Screen 13 Editable Page of Patient Record Amend Re submits all the data in the report Close Closes the form 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 Clinics Reports under the Reports menu button A page displaying all the available reports and their description will be loaded MEDIClaim Chronic Diseases Claim CIDC Clinic Summary Reports Reguirina Cini Provides the list of NRIC for patients who have successful claims but no clinical indicators have been mum submitted by the clinic within the fixed 12 months period trom the claim submission date Billing Details Chronic Balance Enquiry lt Click on Reports menu and select CIDC Clinics Reports Screen 14 CIDC Clinics Reports 10 3 List of NRICs for patients for whom Clinical Indicators have not been submitted Handbook for Healthcare Professionals 61 10 3 1 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 clini
80. ting in the Programme will be subjected to a Clinical quality checks conducted by MOH on patients who make Medisave claims through the clinics institutions b Professional medical audits conducted by MOH on Medisave claims Operational audits conducted by Board on Medisave claims 18 Chronic Disease Management Programme 3 3 3 3 1 3 3 2 3 3 3 4 1 4 2 Registration of Doctor with MOH Doctors practising at accredited clinics medical institutions need to register with MOH to participate in the Medisave for CDMP before they can make Medisave claims for their patients Interested doctors can submit an E Application to participate in the Medisave for Chronic Disease Management Programme The website is http www moh gov sg mmae DoctorApplication aspx Registration of doctors in the Programme needs to be renewed every 2 years Registered doctors will be audited by MOH and CPF Board on the clinical outcomes and Medisave claims of their patients Guidelines on Medisave Use for Chronic Disease Outpatient Treatments Participating clinics medical institutions and doctors have to comply with these guidelines on Medisave use for chronic disease outpatient treatments Medisave use is allowed only for the outpatient treatments of the following chronic diseases and or its associated complications ICD9 Diagnosis Codes bef 1 Jan 2012 ICD 10AM Diagnosis codes on or after 1 Jan 2012 Diabetes 250 00 o
81. tion form to MOH Interested clinics submit documents to Board and NCS Joint training session process IT and Medisave guidelines for clinics approves the participation of the clinics NCS configures the CPF Board prepares MOH issues letters of system setup amp issues Deed of Indemnity BO Gruul tienes token cards with clinics PP Doctors submit accreditation forms to MOH Effective date of participation in the Programme by clinics 28 Chronic Disease Management Programme CHAPTER FOUR CAPTURE AND SUBMISSION OF CLINICAL DATA 1 Commencement of Clinical Data Collection 1 1 For patients who have been enrolled in the Dementia or Bipolar Disorder Chronic Disease Management Programme CDMP data collection will commence at the patient s first visit to the doctor for the chronic condition 1 2 The clinical data fields required for the new chronic disease condition A Dementia and B Bipolar Disorder are shown below A Dementia DATA TO BE ENTERED ONCE ONLY EXCLUDING UPDATES NRIC FIN DOB DD MM YYYY Gender Male Female DATA TO BE ENTERED ONCE DATA TO BE ENTERED AT LEAST ONCE YEARLY EVERY 6 MONTHS Documentation of Yes if assessment done i assessment of memory OR ii assessment of mood and if assessment not done behaviour iii assessment of functional and social difficulties if any iv assessment of rehabilitation Consultatio
82. tpatient 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 4 13 Bills should be paid using employers benefits and any relevant insurance that the patient may have first before claiming from Medisave 4 14 A patient who wishes to use multiple Medisave accounts to pay for his her outpatient treatment expenses in 1 claim may use up to a maximum of 10 Medisave accounts However the costs for the processing of such claims are higher No of Payers Transaction Cost No of Payers Transaction Cost exclude GST 1 payer 6 payers 2 payers 7 payers 3 payers 8 payers 4 payers 9 payers 5 payers 10 payers 8 Transaction cost is computed based on the following formula 0 47 2 44 No of Medisave payers These figures exclude 7 GST 24 Chronic Disease Management Programme 5 Process of Making a Medisave Claim 5 1 A typical process of making a Medisave claim for a patient is described below 5 1 1 What to convey to patient or immediate family members who wish to use Medisave a The treatment components b The cost of treatment Estimated amount that can be claimed from Medisave d Out of pocket cash payment that the patient needs to make e Clinic s policy on transaction costs 5 1 2 Administrat
83. ucose Blood Tast ew o Consultation for CDMP Mental Assessment of Memory o Indicate the patient attendance For patients on cognitive enhancers Assessment of Mood and documentation of objective assessment of memory MMSE or CMMSE testing or other validated instruments Assessment of Functional and Social Difficulties if any 7 Assessment of Rehabilitation Needs o denoles mandstory field Far amokes amoking cessation advice Scald he gwon For cr please nioa tha benefis af not smoking cigarettes 9 Apoiceo e to current amoke only Qnis fov patients od Sehizephmnia Bipolar Diwamers Atypical Antiosychotics Medication To check tha naw if test is dono Click to add clea m icators only those performed omo amo tC 1 Map2007 BP I mmHg m 7 1 Diastolic BPimenigi 00 O 2007 itara 7 gn Map 2097 Cigartmes sm ked par 7 DM Epe amp amp pasamani Y Assessment Y May 2007 DM Faet Assessment Y Sanka Tommsembstsm Fas Assessment ee selected cinical imdicatang Chronic Disease Management Programme Pease salect i appicacie Mem E Attending Doctor is the patient s reguiar panary physician of Of Jan2008 C The Clinic is the patien
84. ument MMSE CMMSE scores Minimum Recommended Frequency per year At least once yearly or as clinically indicated Remarks Enquiring about memory and or performing cognitive screening test Assessment of mood and behaviour At least once yearly or as clinically indicated Enquiring about mood and behaviour and initiating appropriate non pharmacological and or pharmacological treatment where appropriate Assessment of social difficulties and caregiver stress At least once yearly or as clinically indicated Assessment and referral to care co ordinator or medical social worker or appropriate community services Functional needs assessment As indicated The diagnosis of dementia needs to be already established To initiate if there are concerns with regards home safety driving safety reports of recurrent falls functional decline swallowing difficulties Handbook for Healthcare Professionals 5 In addition components A5 to A9 are recommended for patients who are on particular drugs due to higher risk of adverse drug effects in these frail elderly patients Essential Component Minimum Recommended Frequency per year Remarks Clinical parameters HR BP Blood test for sodium and liver function tests At least once yearly or as clinically indicated At least once yearly or as clinically indicated Especially patients on cholinesterase inhibitors and antidepressant

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