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Chronic Disease Management Programme

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1. CHRONIC DISEASE MANAGEMENT PROGRAMME Diabetes Hypertension Lipid Disorders Stroke o MINISTRY OF HEALTH EA E Handbook for Healthcare Professionals 2008 N SINGAPORE March 2008 Includes instructions on use of Medisave for CDMP CHAPTER ONE encrier N iiis 1 The Chronic Disease Management Programme CDMP e Overview Update on use of Medisave for CDMP e Inclusion of Asthma and COPD into the CDMP CHAPTER TWO ssssccceecseccessssstvaccatenciccetecedeasssapndssaaauansonnaaag a naa 4 The Clinical Programme CHAPTER TAREE sisscesesccessseneasaece gazaseesrsauenenvasseandeaaasdavanetasasasessanesansy 35 Registration and Medisave Use CHAPTER FOUR craneae E arie 47 Capture and Submission of Clinical Data CHAPTER PIVE enr eron rorirori a EEA AN 53 User Manual for e Service Clinical Data Submission CHAPIER SIK oriei A AT AAN 75 Frequently Asked Questions N carter one O The Chronic Disease Management Programme CDMP The Chronic Disease Management Programme CDMP 1 Overview Update on the use of Medisave for CDMP Disease Management is a 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 Dise
2. Screen 16 Viewing a Report 11 Troubleshooting 11 1 Enabling of Pop Ups a 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 gt Pop up Blocker Settings 40 Microsoft Internet Explorer Pop up Blacker Pop up Blocker Settings Screen 17 Internet Explorer Menu 72 MG corer rive ee User Manual for e Service Clinical Data Submission ii Enter medinet gov sg and moh gov sg then click on Add rodna gov g Fieah gwaz Screen 18 Configuring Pop up Blocker 12 12 1 13 13 1 13 2 Fallback Procedures 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 Contact Information for Queries Related to Clinical Data Collection and Submission 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 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 74 MG cures iii Freq
3. Click to go to Clinical 4 Indicators Form in Screen 4 55 a b c Condition Care Components Per Year Two bleed pressure measuremants lt Two becyws ght measurements Two hzemoglooa Arc f IbAtc tests One serum cholesterol 2vel LD_ C test Liabetes m tus e One smoking habit asses3mer a One eye assessment e One fea assessment a One raphrooathy screen ng tast e Two blecd pressure messurements n a One bodyweight meesurement Hyprateredon o One smoking hahi asses3mer o Onr sanm cholesiel kad AM C ked Lipit Disorder One vnokmg habil assevsenen gt wo blecd pressure measurements One esrum cholesterol evel LD_ C tast Siros One smoking habit assessmer t lt One co cal thombcambe in riex assessment One irnaler tachniqus assessment jin One smoking habit asseesmert ma lt Two Asthma Cortol Test ACT scores One irnaler tachniqus assessment One smoking habit assessmer COPS One bodyweight mezsurerent One in u2qza vace ration Screen 3 New Submission Select the Identification Type and enter the Patient NRIC FIN Select the chronic disease applicable to this patient You can select one or more diseases as applicable Click on Next to proceed to the Clinical Indicators Form charter rive ee User Manual for e Service Clinical Data Submission Patient Name Patient NRIN 5123456 L Date of Birth Mal C Temale DONMYYYY panan m Sax s nace
4. The MediClaim system is an online e service for clinics medical institutions fo submit Medisave claims to CPF Board for processing 36 MS coerce tHree Registration and Medisave Use 3 2 An outline of the registration and accreditation process is provided in Table 3 1 page 46 Registration of Clinic Medical Institution with MOH 3 3 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 systems b Sign a Deed of Indemnity with CPF Board c Be able to submit Clinical Quality data to MOH 3 4 To make claims for patients through the online MediClaim system clinics medical institutions need a MediClaim User account b Security Token Card non refundable cost of 203 30 inclusive of 7 GST c A Personal Computer Laptop with the following configuration i CPU Pentium IIl and above ii Memory RAM Minimum of 256MB iii Operating System Windows XP iv Browser Internet Explorer 6 0 v Internet connection d GIRO Arrangement i GIRO arrangement with CPF Board for Medisave payments to be credited into the clinic medical institution s bank account ii GIRO arrangement with CPF Board for the payment of Medisave claims handling charges 3 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 ca
5. chronic conditions 8 This is only applicable for patients aged 4 years and above For patients aged 4 to lt 12 years please use the Childhood ACT and for those aged 12 years and above the ACT b Recording the clinical data directly onto electronic records through the Clinic Management System installed for electronic submission of clinical data for Medisave enrolled patients 3 Deadlines for Submission of Clinical Data to MOH 3 1 Submission of clinical data is an essential component of the Programme 3 2 To avoid backlogs in submitting clinical data it is encouraged that the clinical data is submitted as soon as possible during or immediately after the patient s clinic visit 3 3 Clinics are allowed to accumulate patient records for submission in batches However for batch submissions regular e g weekly or monthly submissions are encouraged 3 4 When using the electronic Clinic Management System to capture data during the consultation the system may allow submission of data automatically at the end of each patient consultation 3 5 The deadline for the clinical data submission will be fourteen days after the end of each quarter As an example for the quarter from Jan to Mar 2008 the deadline for data submission will be 14 Apr 2008 To facilitate this MOH has provided each GP clinic via the e Service daily online updates on the list of patients for whom data submission remains outstanding In addition a reminder lett
6. 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 HbAj results lipid results g Prescription records h Evidence supporting diagnosis e g documentation in case records or laboratory reports o 6 3 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 doctoris found making wrong claims for his patients he she will be issued warning letters His Her Medisave privilege may be suspended upon repeated infringements Table 3 1 Registration and Accreditation Process Medisave for Chronic Disease Management Programme Steps Clinics submit application form to MOH Interested clinics submit documents to CPF Board and NCS Joint training session process IT and Medisave guidelines for clinics MOH approves the participation of the clinics Doctors submit accreditation forms to MOH Effective date of participation in the Programme by clinics _ 46 ME cuvrrer our Capture and Submission of Clinical Data Capture and Submission of Clinical Data 1 Commencement of Clinical Data Collection 1 1 For patients who have been enrolled in the Chronic Disease Management Programme CDMP data collection will commence at the
7. clinics to have a listing of all the patients NRICs for whom the clinics had made claims in the specified year but no clinical indicator reports were submitted within a fixed period of 12 months from the claim submission date of each patient This report is built in to assist doctors and clinics to keep track of the outstanding clinical indicator reports they would require to submit with each claim b Click on the report title from the list of available reports as shown on Screen 15 A report page with a textbox would appear for the user to key in the year of the requested report as shown below 70 charter ive ee User Manual for e Service Clinical Data Submission FOl I isl of Paieul NRIS Nu s Requit to Clin cal lificelos Repon Sutenissign Provides the list of NAC cr patients wno have suczessful clams but no din cal indicators have been submited by the clinic grin te nyed 12 MITAS perce trom the daim submission cate Chronic alanen Hagun Click on a Report title from hacia aa the list of available reports Screen 15 Selecting a Report c Upon entering a valid year a list of patient NRIC numbers will be generated The report generated below shows the record of a patient who had a claim submitted but with no submission of any clinical indicator DIClaim fnesoncsooe ta M Chive Diseeses Clari F01 List of Patient NRIC No s Requiring Clinical Indicators Roport Submission Clinizal ndizatars a 2006
8. for outpatient treatment of the approved chronic diseases regardless of the number of diseases they might have Q2 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 Q3 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 Q4 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 Q5 Q6 Q7 Qs If the 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 six chronic diseases listed subject to a cap of 300 If patient attendance is purely for an acute or unrelated condition Medisave deduction is not allowed even though the pati
9. institutions need to register with MOH to participate in the Medisave for Chronic Disease Management Programme before they can make Medisave claims for their patients 3 9 Interested doctors should complete and submit the Application Form for Medical Practitioners to Participate in the Medisave for Chronic Disease Management Programme Registration of doctors in the Programme needs to be renewed every 2 years 3 10 Registered doctors will be audited by MOH and CPF Board on the clinical outcomes and Medisave claims of their patients 4 Guidelines on Medisave Use for Chronic Disease Outpatient Treatments 4 1 Participating clinics medical institutions and doctors have to comply with these guidelines on Medisave use for chronic disease outpatient treatments 4 2 Medisave use is allowed only for the outpatient treatments of the following chronic diseases and or its associated complications a Diabetes Mellitus b Hypertension c Lipid Disorders d Stroke e Asthma f COPD 4 3 Medisave claims will be accepted only if a The patient is diagnosed to have one of the 6 chronic diseases listed above 39 b c a e The patient has been enrolled into their respective DMP see chapter 2 for details 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 relatio
10. oatiert s requir prmsry physician es C6 Jen 2098 3 m Tre Clinic is the patient s regular primary pravicer Mone of the Abeve denotes a mandatory field Screen 9 Physician Information ME corer rive User Manual for e Service Clinical Data Submission Data Item Remarks ile Doctor Name Full Name of Doctor 2 Registration Number The Doctor s MCR Number 3 Speciality Training Select the appropriate value from the drop down list if applicable 4 Healthcare The Healthcare Establishment which is Establishment making the submission It is tied to the user ID of the person making the submission and is defaulted based on the user ID establishment 5 Role Indicate the role applicable 6 Name of Primary Only applicable when None of the Above Physician is selected 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 The Table below describes the function for each button Button Function Description Submit Submits the form after completion Deletes any existing drafts saved previously Save Draft Saves the unfinished form inputs as a draft for completion in the future Close Closes the current form and returns to the main menu 65 9 Search Clinical Indicator Reports 9
11. 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 Q1 Why is the patient s medical and treatment history required The data collected will provide a better profile of patients on the CDMP This information will be useful for fine tuning for programme planning and management purposes Q2 Must the 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 Q3 Howdolrecord 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 Q4 Will data on all clinical parameters be required at every visit No Only data on assessments or tests performed during the visit need to be captured 85 Q5 Q6 Qs Q9 Would I need to repeat a HbA or LDL cholesterol if my patient is able to produce the results of a test done elsewhere You can submit the relevant details of your patient s test results that have been performed elsewhere instead of repeating the test If you do so please keep a copy of the record of the test results
12. physician who is coordinating the care of the patient s chronic condition so that he she may be updated and make the submission Q11 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 Q12 My patient claimed Medisave for treatment of a chronic condition when he first consulted me on 5 Jan 2007 but paid cash for three subsequent visits in Mar Jul Oct 2007 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 2007 Q13 Can the clinical data submitted be shared by different healthcare providers within the same clinic institution cluster This will depend on the electronic Clinic Management System if any that is used by the healthcare institution 87 Q14 Q15 Q16 Q17 If I have already fulfilled the number of care components for the chronic condition do I still need to submit clinical data subsequently The care components are the essential aspects of medical care that are recommended for management o
13. 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 charter rive ee User Manual for e Service Clinical Data Submission Patient Details Patient Name ee Yong Xun Patient NRIC HIN Rave enres Height Metres MF saan use 9 99 if not measurabie Currant Smoker Yes No foso oar Started Smoking YYYY denotes a mandatory field Screen 5 Patient Details Data Item Remarks 1 Patient Name Patient s name as in NRIC 1 Patient NRIC FIN Will be copied from previous screen 2 Date of Birth Patient s birthday enter in DDMMYYYY format 3 Sex Gender of patient 4 Race Ethnic group of patient 5 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 6 Current Smoker Whether patient is a current smoker 8 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 it is your first submission for the patient please enter all the details 5 3 For subsequent submissions you can omit the details if th
14. 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 54 charter rive User Manual for e Service Clinical Data Submission c Click on the menu to display the functions available Claim Advice Error Message Screen 2 Menu i Submission is used to submit a new report ii Search is used to retrieve submitted reports 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 j ji marked with asterisk Select patient ID Type Enter patient NRIC FIN Patient ID Type 3INGAFORE PINX 3LUE NRIC Select the medical condition s applicable Petien NRIC FIN foun E s entered Ir Nedsave claim orm aah ae a ee EA O Diabetes O Hyportersion E Lipid Disorder condition may be E Streke E Asthma E copo chosen if indicated according to patient s chronic condition
15. 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 amends 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 a Cc Submission laim 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 with the search Patient Name Patient NRIC FIN From Date DDMMYYYY To Date DDMMYYYY Sort By 9 5 Atleast one of the search criteria must be entered before you can proceed Fillin at least one search criteria before doing a search Patient Name Ascending m Screen 11 Search Criteria 66 MM cheer rive User Manual for e Service Clinical Data Submission Criteria Remarks i Patient Name All reports where the patient name 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 2 Patient NRIC FIN All reports where the patient NRIC matches are retrieved S From Date All reports s
16. Cigarettes smoked per day average Asthma ACT Score Value must be between 0 1 and 40 0 inclusive Value in mmHg must be between 20 and 200 inclusive and must be smaller than Systolic BP reading Value in mmHg must be between 30 to 300 inclusive Value in mg dL must be between 1 and 999 inclusive Value in mmol L must be between 0 1 and 30 0 inclusive If measurement is attempted but not measurable due to high Triglyceride TG value a reading of 999 mg dL should be entered Value in kg must be between 1 0 and 300 0 inclusive or 999 if not measurable Value must be between 0 to 1000 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 MR charter ive ee User Manual for e Service Clinical Data Submission Assessments Screening Remarks DM Eye Screening Select and enter date of assessment if done DM Foot Screening If assessment is not done during the reporting period you need not enter Stroke Thromboembolism anything Risk Assessment DM Nephropathy Screening If the exact date of assessment is not Inhaler TechniqueAssessment Known please key in the date as 0101 Asthma amp COPD only for DDMM Influenza Vaccination e g for an assessment done in 2006
17. Have uncontrolled blood pressure persistently gt 160 90 6 Have new medical condition which if left untreated will impact on Heart Failure prognosis iii Clinical guideline for referral from Specialist to Primary Care for patients with Ischemic Heart Disease This guideline suggests some parameters that could help identity patients who may be suitable to be cared for by his her family physician in the community Patients with all the following criteria 1 to 4 a OR with criterion A b could be considered for direct discharge to or shared care with a family physician Yes No 1 Stable IHD patients a Are post MI patients after follow up for 1 yr b Are post PClI patients after follow up for 1 yr c Are post CABG patients after follow up for 2 yrs d Are patients where no revascularisation and no further adjustment of medicine are needed after 2 3 visits Stable risk factors a Blood pressure Have blood pressure lt 140 90 mmHg or improving trend over the last 6 months b Lipid profile Have LDL lt 2 6 mmol L or improving trend over the last 6 months c Diabetes Have reached targets as per DM guidelines see above IHD complications a Have no deterioration in symptom effort tolerance for two visits b Have no hospitalisation for angina arrhythmia or Heart Failure in last the 6 months Patient factors a Have been counselled on their condition and the im
18. Hom etsy E7 use 9 99 if not measurabie Current Srroxer Ves No 1990 Year Stared Smoking YYYY denotes a mandatory fiela Ciabetes l A D Fyperension D EN Retnapachy C em I Lipid Disoreer I EM Neph ooathy M levveyy e i I OM Foot Complications er aoe Caan D Asthma yyy D corp YY M Oral Medications M Insulir YN M Oral Medications D Oral Medications Date of Visit DMMYYYY C Ja Bluwd Pressure Sys vie Diaswic 7 DM Eye Assesment O 1 LC myl E DM Naparapatay Assessment O HbA Ic ee DM Foot Assessment Oo Weeght kg Stroke Tarambozmbalism Rist o fuse 999 E rot neasurabls ASSeSSMENE Cigarelles sriused pet day averayel Inbale Technique Assessrrent B C iAsthme amp COFD only ACT Score Asthma orly Influerza Veccinacion Assessrert J pare denotes e mandetory field Auu micao Chek to add clinical indicators only those pestarmed voorname O fein SpecialtyTraining Please sclect if appl cavie H ahea Rola Atending Dozor is the patient s reguia primary pryscier ate Ea 06 Jan 2098 The Ciinic is the patient s regular orimary provider None of the Above denotes a mandatory field Screen 4 Clinical indicators Form 3 3 The Clinical Indicators Form consists of 4 sections a Patient Details b Known Medical History c Clinical and Assessment Indicators d Attending Physician Information 4 Patient Details 4 1 This
19. L C lt 3 4 mmol l AND require minimal adjustment of lipid lowering drugs to achieve optimal lipid control or improving trend 3 Diabetic complications a Do not have diabetic complications on screening in the last 12 months OR b Have stable diabetic complications with risk factors not requiring active and or intensive management by specialists and or specialised services 4 Stable co morbidities In the last 6 12 months Have NOT required active and or intensive management by specialists and or specialised services e g Stroke Heart failure refers to hypoglycaemia where assistance from another person is required cN i 13 N I However patients deemed not to benefit from further specialist care in the optimisation of their condition could be considered for direct discharge to or shared care with a family physician ii Clinical guideline for referral from Primary to Specialist Care for patients with Diabetes Mellitus This guideline suggests some parameters that could help family physicians identify patients who may benefit from specialist review Patients with ANY of the following criteria could be considered for referral to the appropriate specialist for shared or follow up care Yes No 1 Are adults with Type 1 Diabetes Mellitus unless achieving treatment targets or referred by specialists 2 Are children and adolescents with Diabetes Mellitus regardless of type of Diabe
20. PD This guideline suggests some parameters that can help family physicians identify patients who may benefit from specialist review Patients with ANY of the following criteria could be considered for referral to the specialist for shared or follow up care Have FEV1 lt 50 predicted Have frequent exacerbations despite compliance to treatment e g two or more a year Have rapidly progressive course of disease Have developed new symptoms e g haemoptysis or new physical signs e g cyanosis peripheral oedema C Diabetes Mellitus i Clinical guideline for referral from Specialist to Primary Care for patients with Diabetes Mellitus This guideline suggests some parameters that could help identify Type Il diabetic patients who may be suitable to be cared for by his her family physician in the community 2 orro oO The Clinical Programme 1 Glycemic control Have reasonable glycemic control as defined by HbA lt 8 on two occasions AND require minimal adjustment of oral medications and or insulin treatment to achieve optimal target Patient should also not have been admitted for hypoglycemia DKA or HHNK in the last 6 months 2 Risk factors a Blood pressure Have BP lt 140mmHg systolic and or lt 90 mmHg diastolic in the last 6 months AND require minimal adjustment of antihypertensive drugs to achieve optimal BP target lt 130 80 mmHg b Lipid profile Have LD
21. Service for the submission of data to MOH The Clinical Programme The Clinical Programme 1 Enrolling Patients in the Programme 1 1 Clinics registered under the Medisave for CDMP are required to provide all the essential care components detailed in each DMP The basis for diagnosis of the target chronic diseases should conform to the prevailing MOH Clinical Practice Guidelines 1 2 Patients with Asthma or COPD will be enrolled into the respective DMPs 1 3 For patients who are already enrolled under the existing DMPs i e Diabetes Mellitus Hypertension Lipid Disorders or Stroke but who also suffer from Asthma or COPD they should in addition be enrolled into the Asthma or COPD DMP For enrolment of patients with multiple chronic diseases please refer to Annex 2 A page 22 For details of the existing four CDMPs and their essential care components please refer to Annexes 2 B 2 C 2 D and 2 E pages 23 to 31 1 4 Patients will be able to use Medisave to pay for management of all these six chronic diseases existing rules and regulations for Medisave claims apply Clinical outcomes will be tracked for all the DMPs that the patient had been enrolled into 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 eas
22. What if the patient is lost to follow up Please note it down in your clinical documentation Alternatively if you are using the web based e Service for data submission you may also use the textbox to document this information a textbox function is being developed for free text entry in the updated version of the e Service If you are using CMS for data submission please contact your CMS provider for more details on capturing of this type of information electronically What if the patient refuses certain tests Tests are performed when indicated as part of the proper management of 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 If missed the previous deadline for submission of clinical data do still need to submit the data for that period Yes you should still submit the relevant data for that period as well as the current data MG curcesx iii Frequently Asked Questions Q10 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
23. aler technique C4 Smoking Annual Assessment on smoking Assessment habits and provide counselling for current smokers to quit C5 Spirometry At or soon after diagnosis and subsequently as clinically indicated copy of Spirometry test result e g done at hospital is acceptable Notes e Medisave cannot be used for purchase of oxygen tanks nebulisers or other home nursing equipment e For COPD patients who rent devices for Long Term Oxygen Therapy they would be subject to a separate scheme with a withdrawal limit of 75 per month These claims would have to be submitted separately by the clinic not with the claims for the chronic outpatient treatment ME curcewo ie The Clinical Programme e Medisave can be used for physiotherapy occupational therapy and speech therapy or day rehabilitation as clinically indicated and ordered by the doctor but not for home meal delivery transport or other non medical aspects of care e Please see Chapter Three page 35 for more details on what Medisave can cover In the event that a patient has Asthma or COPD and other diseases like Diabetes Mellitus Hypertension or Lipid disorders please refer to the Annexes 2 B to 2 E at the end of the chapter for the essential care components of the corresponding DMP 3 Patient Education and Monitoring 3 1 As part of the national effort under this Programme the Health Promotion Board has prepared the following materials a Patient Educatio
24. ase 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 1 4 Starting with just over 7 000 patients in Oct 2006 the CDMP has grown and as of Dec 2007 there are about 91 000 patients in this Programme with an annual Medisave withdrawal of about 15 million in 2007 1 5 One of the key requirements of the CDMP scheme is the submission of clinical data for outcome measures This is inportant to the Ministry of Health MOH as it allows for the evaluation of clinical outcomes with the goal of improving overall health of the population It is also equally important to the individual GP as it provides a clinical quality improvement tool to allow for self evaluation From the first quarter 2008 onwards registered clinics will receive feedback on the outcome reports regularly 1 6 As of 27 Nov 2007 94 4 of claims made Jan to Jun 2007 had clinical data submitted This is encouraging as the preliminary results on clinical outcomes of diabetic patients managed under CDMP have shown to be 2 22 2 3 2 4 comparable to international benchmarks MOH is pleased with the progress of the scheme Inclusion of Asthma and COPD int
25. ave 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 iv 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 6 Audit 6 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 administered for each claimed treatment to determine if it is related to the proclaimed diagnosis 6 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 c lItemised bills Payment records detailing consultation charges individual drug charges DRP nursing charges other services 45 d Photocopies of identification papers where necessary Case records of the patient for the visits which were
26. betes Have reached targets as per DM guidelines see above 4 Heart Failure complications a Do not have admission for recurrent Heart Failure in past 6 months b Do not have significant symptomatic arrhythmia 5 Co morbidities a Have stable renal function and electrolytes for past 6 months b Do not have active co morbidity that can significantly impact prognosis of Heart Failure e g unresolved anaemia thyroid disease 6 Patient factors a Have been counselled on their condition and the importance of compliance with management care OR b Are deemed not to benefit from further specialist care in the optimisation of their condition ii Clinical guideline for referral from Primary to Specialist Care for patients with Heart Failure This guideline suggests some parameters that could help family physicians identify patients who may benefit from specialist review Patients with ANY of the following criteria could be considered for referral to the appropriate specialist for shared or follow up care MG circ wo ii The Clinical Programme 1 Have persistent increase in weight despite up titration of diuretic over 3 5 days gt 1 kg d or gt 4 kg wk 2 Have increase in serum creatinine of more than 30 compared to baseline 3 Have significant decline in functional class new class IV or jump more than 1 class I to IIL Il to IV 4 Have new onset or worsening angina 5
27. e i Clinical guideline for referral from Specialist to Primary Care for patients with Heart Failure This guideline suggests some parameters that could help identity patients who may be suitable to be cared for by his her family physician in the community Patients with all the following criteria 1 to 6 a OR with criterion 6 b could be considered for direct discharge to or shared care with a family physician a MG curcewo ii The Clinical Programme 1 Stable clinical status a Are in NYHA class or Il with no change or improvement in functional class in last 6 months b Are euvolemic on physical examination stable weight no peripheral oedema no crepitations in lung fields c Have no further plan for revascularisation or device therapy d Are not in heart transplant program 2 Stable medications a Have the following medications up titrated to maximum therapeutic dose as tolerated by patient i ACE Inhibitors Angiotensin Receptor Blockers ii Beta blocker b Have no change in dosages for 2 visits c Have no adverse drug reaction d Have been assessed and offered Warfarin therapy appropriately and dose have been stable for last 3 months for patients with Atrial Fibrillation 3 Stable risk factors a Blood pressure Have BP lt 140 90mmHg or improving trend over last 6 months b Lipid Profile Have LDL lt 2 6 mmol L or improving trend over last 6 months c Dia
28. eline assessment for all components Notes e Medisave cannot be used for purchase of blood pressure monitoring equipment wheelchair or other home nursing equipment e Medisave can be used for physiotherapy occupational therapy speech therapy or day rehabilitation as clinically indicated and ordered by the doctor but not for home meal delivery transport or other non medical aspects of care for Stroke patients In the event that a patient has Stroke and other diseases like Diabetes Mellitus Hypertension or Lipid Disorders please refer to the corresponding DMP MG curcewo ii The Clinical Programme Asthma Control Test for Patients 12 years old and above Asthma Control Test ACT 1 In the past 4 weeks how much of the time did your asthma keep you from getting as much done at work school or at home 3 During the past 4 weeks how often did your asthma symptomes wheezing coughing shortness of breath chest tightness or pain wake you up at night or earlier than usual in the morning 4 During the past 4 weeks how often have you used your rescue inhaler or nebulizer medication such as albuterol patient total score Childhood Asthma Control Test for children 4 11 years old Please follow the steps below to answer the Asthma Control Test Please lez your chi respond Lu the fivst Faur questions 1 7 4 Uf your child needs help read g ve understanding uations you may hep but p c
29. emain as 300 per Medisave account per calendar year regardless of the number of chronic diseases that they are currently being treated for 2 3 The transaction cost for each Medisave claim has been brought down to 3 36 with 2 61 charged by CPF Board for every Medisave account processed and the remaining 0 75 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 Asthma and COPD will be audited as well Please note that in case the Medisave claim includes complications due to the approved chronic disease the doctor would need to document clearly the causal relationship between the approved chronic condition and the complication which arose from it 3 Registration Process for Medisave for Chronic Disease Management Programme Clinics That Wish to Participate on the Programme 3 1 To be on the Programme both the clinic medical institution and its doctors have to register with and be accredited by MOH Upon registration the doctors can then make Medisave claims for their patients l The transaction cost of 3 36 assumes 1 Medisave account is used Figures include 7 GST charges 2 National Computer Systems NCS is the company appointed by MOH to maintain the MediClaim system
30. ent and discretion when making claims 4 7 Anything that is not listed in the above Table 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 or unrelated to the conditions e g Pap smear c Purchase or rental of nebulisers wheelchair prosthesis or other home nursing equipment d Employment of caregiver or nursing aids e Alternative medicine e g acupuncture 4 8 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 9 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 Al 4 10 Patients may have employer benefits and outpatient insurance Employer benefits and outpatient insurance can be used to offset the deductible 4 c Annual withdrawal limit An annual out
31. ent care processes MG cons ii Frequently Asked Questions Summary of Use of Medisave for CDMP Patient has one or more of the 6 chronic diseases with DMPs Chapter 1 Visits a clinic doctor who is registered with Medisave for CDMP Chapter 3 Patient is counselled on i Benefits of being on a DMP Chapter 1 ii How he she can draw on his her Medisave max of 300 per account per year 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 Chapter 2 DM DMP Asthma DMP ee AND OR Lipid Disorders DMP COPD DMP Stroke DMP i Submit Clinical Data of Patient Submit Medisave claim for Patient See Chapters 4 amp 5 See Chapter 3 i Data submitted reflects i Allows patient to draw from essential clinical care his her own or his her family components in member s Medisave management of the account s for outpatient chronic disease s treatment ii Feedback on aggregated ii Leads to reduction in out data to clinic allows of pocket payment upfront comparison amp self assessment of clinic s performance and identify areas in need of quality improvement
32. ent may have the disease Checks will be made during audits to ensure that claims are related to approved chronic conditions How does the annual cycle of the 300 limit apply Is it calculated based on the time that the patient first seeks treatment under the scheme The 300 annual limit is reset from the start of each calendar year i e 1 Jan to 31 Dec Will Medisave use be allowed for purchasing equipment e g blood pressure monitoring equipment glucometer or strips etc No In line with existing Medisave guidelines Medisave use does not cover equipment purchase whether for chronic disease treatment or other uses How will know if the patient has sufficient balance left for claims An enquiry function to check the withdrawal limit and overall account balance is available via the MediClaim e service Clinics may use this function to check the remaining balance of the Medisave account holder with his her consent Alternatively you can request 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 www cpf gov sg under My CPF Online Services My Statement _ 80 CHAPTER SIX i Q9 Q10 Q11 Q12 Q13 Frequently Asked Questions by logging in with their SingPass Ask your patients to bring along a copy of the Medisave balance of the Medisave payers if you do not have a co
33. er will be issued at the last month of each quarter to alert the clinic on the data submission deadline ME ciarrer our O D Capture and Submission of Clinical Data Data Fields Required for Clinical Data Submission eraran es e Patient Details Medical Histo Ki Patient Name Hypertension NRICFIN oo Hyperlipidemia DOB dd mmiyy en Cerebrovascular Accident CVA Gender Male Female Coronary heart disease CHD Race Chinese Malay e Others Drapetes OM a a a Year started smoking yyyy Se DM Foot Complications Astma Chronic Obstructive Pulmonary Disease COPD LDL mg dL i iastoli i Average mmol L no cigs day Diabetes Treatment Date started yj Oral medications Yes Hypertension Treatment Date started yy Oral medications Co Treatment Date started al Orai medications medications Asthma Treatment Date started y Requires controller Annual Assessment Inhaler g gt Smoking Influenza a i a eas ae tar Kopien Assessment Vaccination Ai i v charter rive ee User Manual for e Service Clinical Data Submission User Manual for e Service Clinical Data Submission 1 Introduction 1 1 Purpose a The manual serves as a guide on how to use the Clinical Indicators Data Collection CIDC e Service for the submission of data to MOH as part of CDMP b The manual is intended for the hospital clinic staff who are doing clin
34. ere are no changes 5 4 If you are unsure whether you have submitted the information it is recommended you fill in the details BoM D Asthma ore C COFD mrw IZ Oral Medizatiors avy C insulin M Oral Medicatiors D Oral Medicatiors 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 below Medical Diabetes Hypertension Lipid Asthma ove Jp Condition Treatment Treatment Disorder Treatment Treatment Treatment Diabetes Available Available Available X X Hypertension X Available Available X X Lipid Disorders X Available X X Asthma X X X Available X CORD X X X X Available None of the X X X X X above ME chsrrer rive O User Manual for e Service Clinical Data Submission 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 Fillin all the clinical indicators and use the Add Indicators b
35. eriencing exacerbation despite compliance to treatment d Are poorly controlled asthmatics who have had 2 2 hospitalisations for Asthma and or requires gt 2 courses of burst therapy with oral steroids in the past year MG curce wo ii The Clinical Programme B COPD i Clinical guideline for referral from Specialist to Primary Care for patients with COPD This guideline suggests some parameters that could help identify patients who may be suitable to be cared for by his her family physician in the community Patients with all the following criteria 1 to 4 a OR with criterion 2 4 b could be considered for direct discharge to or shared care with a family physician in the first year with the aim of long term follow up if suitable 1 Mild to moderate COPD Have FEV1 gt 50 predicted 2 Well controlled condition Generally not more than two exacerbations a year and compliant to medication 3 Stable course disease The course of the disease is not rapidly progressive no change in dyspnoea scale or weight loss lt 10 in last 6 months or lt 5 in last 1 month 4 Patient factors a Have been counselled on their condition and the importance of compliance with management care OR b Are deemed not to benefit from further specialist care in the optimisation of their condition ii Clinical guideline for referral from Primary to Specialist Care for patients with CO
36. es which include leading specialists in the respective fields and respected primary care physicians They were also endorsed by the Clinical Advisory Committee 7S Q5 What if 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 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 Q Can the patient use Medisave to pay for pulmonary rehabilitation Q1 Yes if and only if a The patient has been diagnosed to have COPD AND b Itis clinically deemed to be beneficial for the patient Registration Matters For Doctors amp Clinics who wish to be registered into the Programme What are the requirements to be on the Programme Clinics that wish to participate in the Programme must agree to a Provide treatment to chronic disease patients through evidence based DMPs These Programmes will include MOH recommended key treat
37. ese clinical guidelines are for referral of patients with the above chronic diseases between SOCs and primary care clinics These guidelines aim to facilitate integration of care across the various levels so that patients are able to continue and receive the appropriate management of their conditions A Asthma i Clinical guideline for referral from Specialist to Primary Care for patients with Asthma This guideline suggests some parameters that could help identify patients who may be suitable to be cared for by his her family physician in the community Patients with all of the following criteria A orro oO The Clinical Programme 1 to 5 a OR with criterion 5 b could be considered for direct discharge to or shared care with a family physician 1 Non high risk Do not have a history of near fatal Asthma 2 Well controlled Have ACT scores consistently 2 20 in the last 3 6 months by MOH CPG definition while on long term controller medication 3 Stable medication Are on the lowest dose of controller for at least 3 months 4 For children lt 16 years old a Have achieved Asthma control GINA 2006 MOH CPG b Are on low to moderate dose of medications with no recent exacerbations ICS dose lt 400 mcg per day c Are conversant with medication administration d Are educated on action plan and trigger avoidance e Have concomitant allergies that are evaluated and contr
38. f the chronic diseases The data submission system allows you to submit more than the recommended number of care components 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 willtake place in phases Each clinic willreceive a periodic report of its own performance in each of the key areas for which data has been submitted For example a 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 What will the clinical quality improvement process be like The clinical data that is monitored is useful for clinical quality improvement inthe care of chronic conditions When meaningfully used it will empower patients to take charge of managing their chronic condition as guided and supervised by their family physician This can improve compliance with the recommended care of the chronic condition s with better longer term outcomes What will the clinical audit process be like Periodic on site 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 pati
39. gle 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 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 If patients have signed up for the Programme can they opt out of it at a later date Do need to refund the amount that he had paid up for a package Patients can opt out at a later date by informing the clinic from which he she is receiving care In terms of refund it is a private arrangement between the provider and the patient Patients should find out the provider s policy on refunds before signing up for packages However funds withdrawn from Medisave must be reimbursed to the Medisave accounts first MG curcnresx iii Frequently Asked Questions Q18 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 choo
40. have early nephropathy may require other forms of assessment e g 24 hour urinary protein as detailed in Diabetes Mellitus CPG In the event that a patient has Diabetes and Stroke include the following assessments S1 and 2 Table A2 B 2 Additional Care Components for Patient with Diabetes and Stroke Essential Recommended Remarks Components Frequency S Thromboembolism Annually Clinical evaluation risk assessment including Atrial Fibrillation cardiac murmurs and need for anti thrombotic therapy S2 Rehabilitation As clinically need assessment indicated include a baseline assessment for all components Notes e Medisave can be used for physiotherapy occupational therapy speech therapy or day rehabilitation as clinically indicated and ordered by the doctor but not for home meal delivery transport or other non medical aspects of care for Stroke patients MG curce wo ii The Clinical Programme Table A2 C 1 Essential Components of Hypertension Disease Management Programme II Hypertension Disease Management Programme Key Components Recommended Remarks Frequency H1 Blood Pressure Every 3 6 monthly Measurement or as clinically indicated H2 BMI and Annually or as Weight Assessment clinically indicated H3 Fasting Lipid Profile At or soon after Fasting Blood diagnosis and as Glucose Serum clinically indicated Electrolyte Urea and Creatinine Urinalysis and ECG 4a ECS At or soon after diagn
41. hiki select he resparsit aplete ths remarring three gi jons 5 7 or your own aod without lettre your lt h d s responsa influence yonr answers Piensas tele nola shat there av no right ar weoty answers Write Lhe mumbar of eech answne in the score box provided Add up each the sears box for tre Lola Being vuur Jest along zo discuss wits your doctor bcul your child s total senres children 4tolly Know the s tor determire if your child s doe This test will provide a sore that may Oe Corking or if it might be time for a change Score 2 a gt E Geed aS Very Good How much of a eroblem is your asthma when you run exercise or play sperts ri 3 4 It s not Ir s a hig penha Ts a probem a l tle probiere a prociem trant ce what werittoda sed dont ike t bet Its okay Do you cough because of your astama o aos Do you wake up curing the ngnt because of yow asthe aX Yes Yes mest of the ime seme of tre time 7 how many Gays per month did your cid wy dayome asthma symptoms 1 a imo D2adsswe Everyday During the last 4 weeks cn 2veraz2 how many cays per month did your child wheeze during the day keceuse ct asthma iat o Everyday During the Last 4 weeks on average aw mary days per month did your child wake i during the night because of asthma x dadea 19 24 dyphro Everyday ia Total Score MS coerrer tHe Registration and Medisave Use Registration and Medisave Use 1 Pol
42. ical 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 following is required i Hardware Requirements The minimum recommended hardware configuration is e Pentium III MHz Processor with 256MB RAM e Atleast 200 MB free hard disk space ii System Software Requirements e Windows XP e Internet Explorer 6 0 and above e Broadband Internet Connection iii Other Requirements e RSA token card e MediClaim user account 53 2 Getting Started 2 1 User Account a 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 b If you do not have an account for the claims submission you will need to approach MOH for the creation of a new account 2 2 Accessing the e Service a ThewebURLto access the MediClaimsystemis https access medinet gov sg Refer to the MediClaim user manual for details on login procedures Ke WED CEI l Password Authentication User L Orgz nisat on L I sswors tee Best Vicwed vith JE 0 or igrcr Recomsronded zerean esoluicn 1224 4762 piele 16 gt it true colour Screen 1 MediClaim login screen b 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
43. icipating 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 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 203 30 for the security token to access the Medisave claims system This security token is required only when using the MediClaim e service You or your staff will need to attend a half day training session on Medisave claims process guidelines on Medisave use and the use of the MediClaim system This training session is free of charge How do patients sign up for the 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 MG cures ii Frequently Asked Questions C Medisave Claims Reimbursement Billing For Doctors amp Clinics who wish to be registered into the Programme Q1 In total how much can patients claim from Medisave for chronic disease treatments Patients can claim up to 300 per Medisave account per year
44. icy on Medisave Use 1 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 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 al For clinics already registered on the Programme there is no need to register for the new conditions These clinics will be able to help patients who are suffering from Asthma and COPD to claim Medisave for their outpatient treatments 35 2 2 The Medisave withdrawal limits for patients under the Programme r
45. ier 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 MG orro oO The Clinical Programme 2 3 Tables 2 1 to 2 2 show the essential care components for Asthma and COPD DMPs Details regarding each of the essential care components can also be found in the MOH Clinical Practice Guidelines available at http www hpp moh gov sg HPP DOCTORS_Home html A Asthma Disease Management Programme Table 2 1 Essential Components of Asthma Disease Management Programme Essential Minimum Remarks Components Ee aaae Ee Frequency per year Al ACT Score 3 4 monthly see Annexes 2 F and 2 G A2 Self Management 3 4 monthly Provide review patient s Education Written Asthma Action Plan Written Asthma and educate patient on Action Plan what to do when Asthma symptoms develop A3 Inhaler Technique 6 monthly Assessment and review on correct inhaler technique A4 Smoking 6 monthly Assessment on smoking Assessment habits and provide counselling for current smokers to quit B COPD Disease Management Programme Table 2 2 Essential Components of COPD Disease Management Programme Essential Minimum Remarks Components Recommended Frequency per year e Weight or BMI Annual Annually or as clinically indicated CX Influenza Annual Vaccination C3 Inhaler Technique Annual Assessment and review on correct inh
46. ii The Clinical Programme III Lipid Disorders Disease Management Programme Table A2 D 1 Essential Components of Lipid Disorders Disease Management Programme Essential Recommended Remarks Components Frequency LI Lipids Check For those on drug Fasting lipids therapy Every 6 12 monthly or as indicated For those not on drug therapy and who have achieved the LDL goals lipids check can be done every 1 to 3 years L2 Self At diagnosis and All patients must be risk management regular intervals stratified as recommended Education according to risk level in Lipids CPG Provide patient with a patient monitoring booklet and explain its use Self management education should include nutrition counselling weight management exercise smoking cessation and medication compliance L3 Medical As clinically indicated Consultation and Follow up of Abnormalities Detected include a baseline assessment for all components Notes e Medisave cannot be used for purchase of wheelchair or other home nursing equipment In the event that a patient has Lipid disorders and Stroke include the following assessments S1 and 52 Table A2 D 2 Additional Care Components for Patient with Lipid Disorders and Stroke Essential Recommended Remarks Components Frequency S Thromboembolism Annually Clinical evaluation Risk Assessment including Atrial Fibrillation cardiac murmurs and need for anti thrombo
47. ment components ae MG c nsx iii Frequently Asked Questions b Treat patient medical information with confidentiality c 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 e 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 Please refer to Chapter Two Clinical Programme Q2 How do register for the Programme Clinics who are already in the Programme need not re register for the Programme For clinics who are not in the Programme they must submit the following forms for registration i Application Form 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 These forms can be downloaded from the MOH website at http www moh gov sg mohcorp forms aspx id 94 Please complete the forms and return to MOH MOH will despatch your forms and documents on your behalf to CPF Board and NCS Q3 Q4 Clinics part
48. mputer terminal at your clinic If the Medisave balance is insufficient to cover the costs can the patient top up the difference in cash Yes Can the bill be split among two or more accounts according to a given percentage Yes a claim can be shared by a maximum of 10 Medisave accounts What is the cost of making Medisave claims The current cost is 3 36 per transaction and has to be paid in cash The cost is levied on the clinics and not from the patients However some clinics may decide to pass on this cost to their patients Why is there a transaction cost of 3 36 The transaction cost consists of a 2 61 charge from CPF Board for processing each Medisave account and a 0 75 charge from NCS for use of the MediClaim system Can transfer the cost per transaction 3 36 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 an administrative cost or apply a similar generic description This fee has to be paid in cash Q14 Will patients have to pay the full amount upfront and then be reimbursed or can they make partial payment based on estimated Medisave payout Q15 Q16 Q17 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 Can I accumulate several bills to be submitted as a sin
49. n Booklets Asthma and COPD b Patient Record Book 3 2 These materials will be distributed to all 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 3 3 The Patient Record Book enables the patient to keep track of his her condition so as to achieve the agreed treatment target set together with his her doctor It is also an important record if the patient needs to see other doctors for related conditions 3 4 It will be Useful to explain the contents of the patient education booklet to the patient or parents and caregiver and help those who need assistance in filling up the record book This will helo enhance doctor patient relationship 4 Clinical Guidelines for Continuing Care 4 1 Toencourage appropriate siting of care for patients with chronic diseases MOH has worked with relevant specialists to propose uniform continuing care guidelines a To identify suitable patients who are stable and can be managed in the community by their family physician rather than in a tertiary setting or b To identify patients who are at risk and may benefit from specialist s opinion 4 2 There are a total of four sets of guidelines for the following chronic diseases a Asthma b COPD c Diabetes Mellitus d Cardiac diseases Heart Failure and Ischemic Heart Disease 4 3 Th
50. n be found on the MOH website 37 iii GIRO arrangement with NCS for the payment of MediClaim usage charges e Training to process Medisave claims Forms to Complete 3 5 Clinics Medical institutions interested in joining the Programme will need to submit the following forms to MOH a Application Form for Clinics to Participate in the Medisave for Chronic Disease Management Programme by MOH b Direct Authorisation Credit Form by CPF Board c GIRO Form MediClaim charges by NCS d GIRO Form Medisave charges by CPF Board These can be downloaded from the MOH website at http www moh gov sg mohcorp userprofile aspx id healthprofessionalserviceprovider 3 6 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 N Clinics Medical institutions participating 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 c Operational audits conducted by CPFB on Medisave claims 38 MS coerce tHeee Registration and Medisave Use Registration of Doctor with MOH 3 8 Doctors practising at accredited clinics medical
51. nship or link between the disease and its treatment In this regard Medisave claims will generally not be allowed for sleeping pills slimming pills or erectile dysfunction drugs used for lifestyle purposes Under certain equivocal circumstances the auditors will seek further clarification with the prescribing doctor and decide on acceptance of claim on a case by case basis 4 4 Only doctors and clinics medical institutions which are Medisave accredited and participating in the Programme can make Medisave claims for patients 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 Management of the patient based on the care components in the respective Disease Management Programme 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 40 MS charter tore Registration and Medisave Use 4 6 The Table below provides a guideline on what can be used for Medisave claims The doctor is expected to exercise clinical judgm
52. o the CDMP From Apr 2008 Asthma and Chronic Obstructive Pulmonary Disease COPD will be included into the CDMP An estimated 188 000 more Singaporeans will benefit from using their Medisave to manage Asthma and COPD 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 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 With the implementation of the CDMP GPs will be able to take on a greater role in the management of chronic diseases of their patients With effect from Apr 2008 the use of Medisave for CDMP will apply to the six medical conditions listed below a Diabetes Mellitus DM b Hypertension HPT c Lipid Disorders d Stroke e Asthma f COPD carter one O The Chronic Disease Management Programme CDMP 2 5 This Handbook presents the essential components of the use of Medisave for CDMP for Asthma and COPD It covers the following details Chapter Three The data submission requirements for participation in the Programme e The plan for clinical quality improvement Chapter Five User Manual for e Service Clinical Data Submission e Guide on how to use the Clinical Indicators Data Collection CIDC e
53. olled 5 Patient factors a Have been counselled on their condition including the use of Written Asthma Action Plan and the importance of compliance with management care OR b Are deemed not to benefit from further specialist care in the optimisation of their condition ii Clinical guideline for referral from Primary to Specialist Care for patients with Asthma This guideline suggests some parameters that could help family physicians identify the patients who may benefit from specialist review Patients with ANY of the following criteria could be considered for referral to the appropriate specialist for shared or follow up care Ie Co morbidity a Have concurrent heart failure which may complicate Asthma management b Have psychiatric disease or multiple psychosocial problems c Have concurrent active Gastro Esophageal Reflux Disease GERD which may mimic Asthma 2 Well controlled condition a Have probable Occupational Asthma requiring further diagnostic work up b Have atypical signs and symptoms such as unilateral wheeze to exclude other tracheobronchial pathology 3 Poor control amp high risk a Have history of near fatal Asthma requiring intubation and ventilation b Have failed to achieve Asthma control despite optimal treatment patients who are currently on or have recently stopped using daily oral steroids c Have severe Asthma requiring step 4 care and yet exp
54. oms Sudden and or unexplained blurring or loss of vision Sudden onset of multiple floaters with or without loss of vision Red painful eyes with or without loss of vision Sudden visual field defects NB Referrals should not be based on the level of vision alone as serious diabetic retinopathy and good visual acuity can co exist li Based on Retinal Photography Findings Unreadable photographs where the retinal features are obscured by the presence of cataracts poorly dilating pupils Enlarged and or unequal optic disc cupping where the presence and diagnosis of glaucoma cannot be excluded from photographs alone For accurate staging of diabetic retinopathy by a full dilated pupil retinal examination when features of diabetic retinopathy are seen When features of potentially sight threatening diabetic retinopathy severe non proliferative proliferative preretinal vitreous haemorrhage and maculopathy macular oedema are detected Other retinal features or photographic findings requiring further evaluation and as advised by experienced retinal photograph readers 8 Have co morbid medical conditions requiring active management by specialists or specialised services refers to hypoglycaemia where assistance from another person is required Diabetic Ketoacidosis Hyoerglycemic Hyperosmolar Nonketotic Coma D Cardiac Diseases Heart Failure and Ischemic Heart Diseas
55. osis and subsequently as clinically indicated H5 Self management At diagnosis and Provide patient with a Education regular intervals patient monitoring booklet and explain its use Self management education should include nutrition counselling weight management exercise smoking cessation and medication compliance H Medical As clinically Consultation indicated and Follow up of Abnormalities Detected include a baseline assessment for all components copy of ECG e g done at hospital on discharge is acceptable Nofes e Medisave cannot be used for purchase of blood pressure monitoring equipment wheelchair or other home nursing equipment In the event that a patient has Hypertension and Stroke include the following assessments S1 and 2 Table A2 C 2 Additional Care Components for Patient with Hypertension and Stroke Essential Recommended Remarks Components frequency Sl Thromboembolism Annually Clinical evaluation Risk Assessment including Atrial Fibrillation cardiac murmurs and need for anti thrombotic therapy 52 Rehabilitation As clinically Need Assessment indicated include a baseline assessment for all components Notes e Medisave can be used for physiotherapy occupational therapy soeech therapy or day rehabilitation as clinically indicated and ordered by the doctor but not for home meal delivery transport or other non medical aspects of care for Stroke patients ME curcewo
56. patient s first visit to the doctor for the chronic condition 1 2 The clinical data fields required for the two new chronic disease conditions Asthma and Chronic Obstructive Pulmonary Disease COPD are shown below A Asthma DATA TO BE ENTERED ONCE ONLY EXCLUDING UPDATES Asthma Treatment Patient Details Patient Name Requires controller such as inhaled steroids Y N NRIC FIN DOB DD MM YYYY Gender Male Female Current smoker Yes No Year started smoking YYYY DATA TO BE ENTERED ONCE EVERY 6 MONTHS DATA TO BE ENTERED ONCE A YEAR Inhaler Technique Assessment Smoking Assessment B COPD Patient Details Patient Name DATA TO BE ENTERED ONCE ONLY EXCLUDING UPDATES Current smoker Yes No NRIC FIN Year started smoking YYYY DOB DD MM YYYY Height Gender Male Female _ DATA TO BE ENTERED ONCE A YEAR Inhaler Technique Y N Assessment Smoking Assessment Y N Influenza Vaccination Y N Weight measurement 1 3 The clinical data fields required for all the six chronic conditions in CDMP are summarised in the template please see Annex 4 A Page 51 52 1 4 The quality of patient care for the six chronic conditions will be evaluated according to whether the relevant process and care components have been met as listed below Chronic Conditions Diabetes Melli
57. patient withdrawal limit of 300 per Medisave account 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 to pay for his outpatient treatments 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 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 from her Medisave account to pay for treatment related to Hypertension and Asthma and co payment cash requirements In cases where only part of the chronic disease outpatient treatment bill is payable by employer companies and the patient chooses to use Medisave for the balance of the bill clinics would a Follow the current arrangements it has with the employer to seek payment and 42 MS coerce tHeee Registration and Medisave Use b Help patients submit the Medisave claim 4 12 Bills should be paid using employers benefits and any relevant insurance that the patient may have first before claiming from Medisave 4 13 A patient who wi
58. plain the following to patients suffering from 2 4 any of the approved chronic diseases and their immediate family member s whose Medisave account s is are being used if any e the treatment components e the cost of treatment e estimated amount that can be claimed from Medisave e the out of pocket cash payment that the patient will need to make e the charging of transaction fees 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 Clinics 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 MG curnsx ii Frequently Asked Questions Q23 Can GPs who are contracted by nursing homes to provide outpatient care for their residents help the ones suffering from one
59. portance of compliance with management care OR b Are deemed not to benefit from further specialist care in the optimisation of their condition MG orro oO The Clinical Programme iv Clinical guideline for referral from Primary to Specialist Care for patients with Ischemic Heart Disease This guideline suggests some parameters that could help family physicians identify patients who may benefit from specialist review Patients with ANY of the following criteria could be considered for referral to the appropriate specialist for shared or follow up care 1 Have new symptom signs of heart failure worsening of Heart Failure 2 Have recurrent angina increase in frequency or severity of angina ok Have new onset Atrial Fibrillation 4 Have Hypertension that are difficult to manage labile BP refractory to multiple medications develop side effects to multiple medications 5 Have deteriorating renal function Enrolling patients with multiple chronic diseases Perient with multiple cheor c HO Diabe es Mellitus DM es Mellitus DM gt diseases may be enrclled into ne 11 and or 2 E IIypetersen DMP 4 Lipid Disorders DMP Streke DM Asthme DMP or COPD DMF Notes Patients with i Diabetes only or Diabetes with one or more of these Hypertension Lipid Disorders Stroke gt Diabetes DMP ii Hypertension only or Hypertension with one or both of these Lipid Diso
60. rders Stroke gt Hypertension DMP iii Lipid Disorders only or Lipid Disorders with Stroke gt Lipid Disorders DMP iv Stroke only gt Stroke DMP MG orro oO The Clinical Programme I Diabetes Disease Management Programme Table A2 B 1 Essential Components of Diabetes Disease Management Programme Essential Recommended Remarks Components Frequency D1 Glycated At risk 6 monthly Haemoglobin High risk 3 4 monthly HbA lt D2 Blood Pressure At risk 3 4 monthly Measurement High risk as clinically indicated D3 BMland At risk 3 4 monthly Weight High risk as clinically Assessment indicated D4 Lipid Profile At risk annual High risk as clinically indicated D5 Eye Assessment At risk annual Assess for visual acuity High risk as clinically AND indicated Assess for retinopathy D Nephropathy At risk annual Assess for urine albumin Assessment High risk as clinically creatinine ratio indicated AND Serum creatinine D7 Foot Assessment At risk annual Assess for peripheral High risk as clinically neuropathy peripheral indicated arterial disease bone joint skin and nail abnormalities Essential Recommended Remarks Components Frequency D8 Cardiac At risk as clinically Evaluate risk factors Assessment indicated and management High risk as clinically indicated ECG for adults at baseline and subsequently when clinically indicated D9 Self management At risk annual Provide patient
61. se 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 clinics 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 Q20 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 Q21 How will the scheme apply to those who have an employer medical benefits or an existing comprehensive insurance plan Claims canbe made under employer plans This also applies to pensioners Employer medical benefits or an existing Comprehensive insurance plan can be used to cover the cost of the deductible and co payment Any amount in excess of the employer medical benefits or the insurance plan can be paid using Medisave Clinics will have to liaise directly with their partnering employers for payment under employer plans as per their current arrangements Q22 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 ex
62. sed Taite SSS dares Specially Training Pleese select if applicable fee ES E Role e j i iri Data of 95 an 2008 Atcerding Doctor s the petiert s regular prmary prysiciar AFE C The Cinc is the patent s regular prmary provicer C Nere v the Above Screen 13 Editable Page of Patient Record Button Action Amend Re submits all the data in the report denofas a mandatory fied Close Closes the form 10 10 1 10 2 10 3 CIDC Clinic Reports This function provides standard report s for use by clinics One report is currently available and additional reports may be added in future releases 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 MED IClaim Chini Rssaasecse Cein IDC Clinic Summary Reports as ena Hd EN I ist of Fatient NRIC Sla s Racu rirg Clin cal Indicators Rapor Suamissian Provides ha list of NRIC or patients wno have successful aims cut no clinical indicetors have been suten Led by the clin 2 wiihin the Teed 12 imon hs period from the cairn susmiss vitae Dilling Details Click on Reports menu and select CIDC Clinics Reports Chronic Balance Enquiry Chronic Payrrect Lising Screen 14 CIDC Clinic Reports List of NRICs for patients for whom Clinical Indicators have not been submitted a This report enables the
63. shes 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 1 payer 3 36 6 payers 16 41 2 payers 527 7 payers 19 02 3 payers 8 58 8 payers 21 64 4 payers 11 19 9 payers 24 25 5 payers 13 80 10 payers 26 86 5 Process of Making a Medisave Claim Di A typical process of making a Medisave claim for a patient is described below A What to convey to patient or immediate family members who wish to use Medisave i The treatment components ii The cost of treatment iii Estimated amount that can be claimed from Medisave iv Out of pocket cash payment that the patient need to make v Clinic s policy on transaction costs 4 Transaction cost is computed based on the following formula 0 75 2 61 No of Medisave payers Figures are inclusive of 7 GST 43 B Administrative Procedure iii 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 months The authorisation will stand until revoked in writing Clinic Medical institution staff should witness the identity and the signature by the account holder Clinic Institution staff should also
64. tes Mellitus unless treatment targets achieved or referred by specialists 3 Are pregnant women or those planning pregnancy who require preconception intensive glycemic control 4 Are individuals with or at risk for recurrent severe hypoglycemia DKA or HHNK regardless of HbA level 5 Have failed to reach individualised targets set e g over a 6 month period for blood glucose blood pressure and or lipid levels despite best efforts at optimising treatment and where referral to tertiary care will benefit patient 6 Are high risk patients who may benefit from intensive control of blood glucose blood pressure lipids and or other risk factors e g to retard progression of diabetic retinopathy or nephropathy A orro oO The Clinical Programme 7 Have diabetic complications requiring active management by specialists or specialised services For example a Patients should be referred to nephrologist if any of the following condition is present i Deteriorating serum creatinine or creatinine clearance despite optimal blood pressure control over a period of 3 6 months li There is unexplained hematuria iii Persistent increasing proteinuria despite optimal ACE ARB therapy over 3 6 months iv Difficulty achieving physician patient determined blood pressure targets b Patients should be referred to ophthalmologist if any of the following condition is present i Based on Visual Sympt
65. tic therapy 52 Rehabilitation As clinically Need Assessment indicated include a baseline assessment for all components Notes e Medisave can be used for physiotherapy occupational therapy soeech therapy or day rehabilitation as clinically indicated and ordered by the doctor but not for home meal delivery transport or other non medical aspects of care for Stroke patients 2 orro oO The Clinical Programme IV Stroke Disease Management Programme Table A2 E 1 Essential Components of Stroke Disease Management Programme This Programme is for patients who are not concurrently on other Disease Management Programmes Essential Recommended Remarks Components Frequency S1 Clinical Annually Clinical evaluation Thromboembolism including atrial fibrillation Risk Assessment cardiac murmurs fasting glucose and need for antithrombotic therapy 2 Rehabilitation Baseline Need Assessment and as clinically indicated S3 Blood Pressure Baseline Measurement and 6 monthly S4 Lipid Profile Baseline Fasting lipids At least 6 12 monthly 5 Self management Annually or Provide patient with a Education as clinically patient monitoring booklet indicated and explain its use Self management education should include nutrition counselling weight management exercise smoking cessation and medication compliance S6 Medical As clinically Consultation indicated and Follow up of Abnormalities Detected include a bas
66. tions 02 3 3 M Oral Medications D Oral Medicatiors Patient NRIC FIN 51234557D Sex Male Fonae Haight Metras 17 use 9 99 if not measuratte iasa Woar Started Smoking YY I Hypertensior erry I Lipid Dsarcer YYYY I Cerebrovascular Accident Pan evn I Coronary Heart Lisease CHD levy corp erm E insulin charter rive ee User Manual for e Service Clinical Data Submission Date of Visit DDMMYYYY 5 Rlond Prassure Systalic Niastolicy r DM Fye Assessment o LDL C DM Nephropacky Assessman mi IIbA1c 1 DM ect Assessment m Weigh kg Stroke Thromba2mbclism Risk m fuse 559 f rot measurable FARR MENT Cigarettes smokec per day average Inhaler Technique As3essrent O Asthma amp COPD ony ACT Scure Asthina valy Inlaenca Vaccination Assessinent M a Pores denotes a mandotory field Add tndicaturs Click fo add chnica indicators only those parformea jai 44 May 2097 Systolic I mml lq 150 l 11 May 2037 Diastolic BP mmTHg 100 E 11 May 2097 LEL mg dL 40 F 14 May 2097 HbA1ci 30 EJ 14 May 2037 Weight ka 90 E 11 May 2097 Ciuarelles smoked per day Ara 10 l 14 May 2097 DN Eye Assessment Y E 11 May 2097 DN Nepnropathy Assessmert Y E 17 May 2037 DN FootAssessment Y m 1 may Stoke Invambaemralism RISk Assessment Y Click to dziete selected clinicel indicators oo Doctor Mamot i O Number jalyTaining Plane
67. tus Care Components Per Year Two blood pressure measurements Two bodyweight measurements Two hemoglobin Aj HbA lt tests One serum cholesterol level LDL C test One smoking habit assessment One eye assessment One foot assessment One nephropathy screening test ME ciarrer our O Capture and Submission of Clinical Data Chronic Conditions Care Components per Year Hypertension e Two blood pressure measurements e One bodyweight measurement e One smoking habit assessment Lipid Disorders e One serum cholesterol level LDL C test e One smoking habit assessment Stroke e Two blood pressure measurements One serum cholesterol level LDL C test e One smoking habit assessment e One clinical thromboembolism risk assessment e One inhaler technique assessment e One smoking habit assessment e Two Asthma Control Test ACT scores Asthma e One inhaler technique assessment e One smoking habit assessment COPD e One bodyweight measurement e One influenza vaccination 2 Collection and Submission of Clinical Data 2 1 The collection of clinical data can be carried out by a Manually recording the clinical data on a hardcopy template Annex 4 A page 51 52 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 7 oer year refers to 12 months from the first visit of the patient for the
68. ubmitted from this date inclusive are retrieved 4 To Date All reports submitted up to this date inclusive are retrieved S Sort By Specifies the sorting sequence for the results 9 6 All submissions made by your clinic which match the criteria will be displayed as shown on Screen 12 patenam OOOO O O Patient NRIC FIN F From Date DNMMYYYY To Date DDMMYYYY Sort By Click to retrieve all records _ scart that match the specified criteria 3 records relieved O JeanPang Check only one record 12 Dec 2706 o iry Fong for amendment or many 12 Dec 2906 E lanamu Kon records for deletion 12 Dec 2906 Click on the hyperlink to retrieve a read only page of the record _ Amend selected record Delete selected records Screen 12 Search Results 67 W 9 7 If the number of search results is too large you can either specify more restrictive search criteria or use the page number to navigate through the results 9 8 Click on the Patient Name hyperlink to view the report submitted 9 9 When the Amend button is clicked the selected record will be displayed in editable mode as shown on Screen 13 Patlent Name Lee Yong Kun Date of Dirth DDMNYYY a e Currant Smoker yes No denotes a mandatary field F Diaheres Caa ai I UN Retinopathy LC lom TOM Neohrooathy jen I OM Hoot Compicetons eyr 1 Asthma C imm 4 Oral Medica
69. uently Asked Questions Frequently Asked Questions A Clinical Matters New For Doctors who have already registered into the Programme Q1 Which chronic diseases are currently included under this Programme Diabetes Mellitus Hypertension Lipid disorders Stroke Asthma and COPD are currently included under this Programme Q2 Ihave a patient with Diabetes Hyperlipidaemia and Asthma which DMPs should I 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 all3 conditions However the doctorwillalsoneed to submit outcome data based on the essential care components of Diabetes and Asthma Please refer to Chapter 3 for details Q3 My patient has DM however he also has symptoms and signs of Hypothyroidism Can 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 bodi
70. utton 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 Clinieal Indicators Hate of Visit UUMMYYY I Bi Blcod Pressure Systolic Diastolic I i DM Eya Assessment o LOL I mg id EJ DM heshrapethy Assessmert o Hbfie DM Font Assessment m We ght kg I Stroke Trrombaerbalism Risx m P Asaesament use 999 if not measurable Cicareties smoxec per day averaga Inhaler Technique Assessment o REEE Asthma amp COPD an yy ACT Score Asthma only I A Add all Clinical Indicators into the Table below after Tdermoles a nandelory Mell filling in the form above Dae ctor E 17 May 2007 Systolic Ir mmI iq 150 P 1 taay 2007 Clastolic BF mmH 120 E 14 May 2007 INI rg d s E 1 May 2007 HbA1 2 30 DO 1 May 2007 Weighiky 90 D 1 ay 2007 Ciyaralles sinakes ser day Avg 10 E 14 May 2007 Ci Cyz Assessment T D 17 mar 2007 LM Neprropathy Assessment T M 17 May 2007 CW FootAssesemont t DO 1 May 2007 Shoke Throitnemboi m Risk Asse smnent Y Delete Indicators Glick h delete selected clinical marcetos m Screen 7 Filling in the Clinical Indicators 61 6 6 The list of Clinical Indicators and Assessments applicable are Clinical Indicators Remarks Glucose Blood Pressure Diastolic BP Blood Pressure Systolic BP Lipids LDL C Lifestyle Weight kg Smoking
71. 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 C Claim Process Payment wil be made daily to Medisave accredited medical institutions via InterBank Giro IBG on the 3 4 working day after the approval date of the Medisave claims Currently the transaction cost for each Medisave claim is 3 365 2 61 is charged by CPF Board for every Medisave account processed and the remaining 0 75 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 generically termed e g administrative costs 5 The transaction cost of 3 61 assumes 1 Medisave account is used Figures include 7 GST charges 6 National Computer Systems NCS is the company appointed by MOH to maintain the MediClaim system The MediClaim system is an online eservice for clinics medical institutions to submit Medisave claims to CPF Board for processing 44 MS coerce tHree Registration and Medisave Use iii Where a clinic institution has made an overclaim or unauthorised deduction from Medisave it will have to refund the amount deducted to the Medis
72. with Education High risk a patient monitoring as clinically booklet and explain indicated its use Self management education should include nutrition counselling weight management exercise smoking cessation medication compliance foot care self blood glucose monitoring for insulin treated and high risk non insulin treated patients D10 Medical As clinically Consultation indicated and Follow up of Abnormalities Detected include a baseline assessment for all components MS curcewo ie The Clinical Programme Notes e An at risk individual may be defined as one who is stable and meeting targets of control as defined in MOH CPG e A high risk individual may be defined as 1 One whose control has been unstable and failing to meet targets in the past 12 months 2 One already with established diabetic complications 3 One with psychosocial problems including alcohol or substance abuse that complicate management e Medisave cannot be used for purchase of glucometer glucometer strips blood pressure monitoring equipment wheelchair prosthesis or other home nursing equipment e For D5 to D8 patients who are already suffering from respective organ complications may be assessed differently For example patients with retinopathy on regular eye follow up would be assessed by the ophthalmologist Primary physician need only to ensure that patients are compliant to eye follow up Patients who already
73. you Assessment COPD only can key in 01012006 If the known date is March 2006 you can enter as 01032006 Click to sort the records E 11 May 2007 Systolic BP mmHa 150 E 14 May 2007 Diastolic BP mmHg 100 E 11 May 2007 LDL mag dL 40 E 11 May 2007 HbA1c 30 41 May 2007 Weight kg 90 EO 11 May 2007 Cigarettes smoked per day Avg 10 E 14 May 2007 DM Eye Assessment Y E 11 May 2007 DM Nephropathy Assessment Y E 11 May 2007 DM Foot Assessment Y 11 May 2007 Stroke Thromboembolism Risk Assessment Y Click to delete selected clinical indicators All entries saved in the table will Delete after selecting the checkboxes be submitted to the CIDC system of the unwanted Clinical Indicators Screen 8 Clinical and Assessment Indicators 63 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 7 Attending Physician Information 7 1 This section details the physician attending to the patient It is required for each submission 7 2 If there is more than one physician attending to the patient the main physician information should be entered here Doctor Name eee Specialty Training Please select if anplicanle z eee o Role Attendirg Doctor is the

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