Connection supplemental articles and policies - September 2006

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Connection - September 2006 (pdf, 229 KB)

supplemental articles

• formulary updates
• recognizing postpartum depression
• domestic violence: you can make a difference
• fchp’s network of hospitals and medical centers

policies and forms

• Assistant surgeon payment policy (pdf, 41 KB)
• CRNA payment policy (pdf, 44 KB)
• Eye examinations and refraction payment policy (pdf, 49 KB)
• Global surgical payment policy (pdf, 58 KB)
• Inpatient medical review and payment policy (pdf, 51 KB)
• Medical supplies and surgical dressings payment policy (pdf, 670 KB)
• Nurse midwife payment policy (pdf, 37 KB)
• Nurse practitioner/physician assistant payment policy (pdf, 50 KB)
• Obstetric anesthesia payment policy (pdf, 54 KB)
• Well baby/well child care visits policy (pdf, 49 KB)

script alert

formulary updates
Fallon Community Health Plan has made several changes to its formularies, including changing prior authorization requirements and adding new medications. Please see the list of changes to our commercial plan and our Medicare Part D formularies below.

* FCHP’s Moratorium Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for noncovered pharmaceuticals.

let’s connect

recognizing postpartum depression
by Barbara Earing, L.I.C.S.W., Beacon Health Strategies

Postpartum depression is the most common complication of childbearing. Despite recent media attention, it remains under-diagnosed and under-treated.

Postpartum depression is a type of major depression that occurs in approximately 10% to 20% of new mothers, depending on how the time frame of onset is defined (10% to 15% if onset is defined as 6 to 9 weeks after delivery; 20% if defined as within six months after delivery). Prevalence increases to 25% in adolescent mothers and in mothers who have experienced a prior depression, and increases to 50% in mothers who have had a prior postpartum depression.

more than the not your typical “baby blues”
Postpartum depression is more serious than—and needs to be distinguished from—the “baby blues,” which involve milder symptoms and occur in 50% to 85% of all new mothers. Baby blues typically develop three to four days after delivery and usually disappear within a couple of weeks. Tearfulness, mood swings, irritability and anxiety are symptoms of the blues.

The symptoms are normal reactions to the hormonal changes and stress that having a newborn bring. While unsettling, baby blues usually do not require treatment and generally respond to reassurance, support, validation and education. Some evidence suggests, however, that women who have experienced the blues are at increased risk for postpartum depression later in the postpartum period.

If the emotional state of anxiety, self doubt and agitation continues beyond a month, the mother may be diagnosed with the clinically depressed condition known as postpartum depression.

postpartum psychosis
Postpartum depression also needs to be differentiated from a more serious disorder called postpartum psychosis, a mental illness that requires immediate medical attention. Postpartum psychosis is rare, affecting only one in 1,000 new mothers. The potential effects can be devastating: child abuse, suicide and infanticide. The presentation of women suffering from this disorder includes delusions and hallucinations, confusion, sleeplessness, disorientation and agitation.

postpartum depression: symptoms
Symptoms of postpartum depression include:

• Loss of pleasure or interest in things that used to be fun or interesting
• Strong feelings of sadness, anxiety or irritability
• Emotional stress that interferes with self-care
• Tearfulness
• Lack of motivation
• Diminished interest in food (or overeating)
• Disturbed sleep
• Difficulty with concentration
• Intense worries about the baby
• Lack of interest in the baby
• Fear of harming the baby
• Thoughts of self-harm or suicide

Risk factors for postpartum depression include depression during pregnancy, prior postpartum depression, history of depression or bipolar disorder, diminished social support, sensitivity to hormonal fluctuations, family history of psychiatric disorders, and current or past stressful life events (such as trauma, poverty, unwanted pregnancy, marital discord, illness, and loss).

postpartum depression: screening and treatment
The Edinburgh Postnatal Depression Scale was developed to assist primary care health professionals in detecting mothers experiencing postpartum depression. The EPDS, developed in health centers in Livingston and Edinburgh, Scotland, is a well-validated scale used to assess a new mother’s depressive mood in the past seven days. The scale is a 10-item self-report questionnaire that usually can be completed without difficulty in less than five minutes. The instrument can be quickly scored, and a woman who meets a threshold score can be referred for further assessment and treatment. One Australian study showed that a threshold score of 12.5 can detect postpartum depression with a sensitivity of 100% and a specificity of 95.5%.

The type of treatment selected to treat postpartum depression is based on the severity of symptoms present. It may include short-term cognitive-behavioral therapy or interpersonal therapy, as well as pharmacological interventions. Women with more severe postpartum depression may choose to receive treatment with psychotropic medications in addition to therapy. Postpartum depression can be successfully treated, and women treated with antidepressant medicines and therapy usually show marked improvement.

widespread benefits
The importance of identifying and treating postpartum depression goes far beyond concern for the well-being of the mother. Postpartum depression has been shown to have an adverse impact on mother-infant attachment and late infant development, as well as adolescent development. Depressed mothers tend to be less involved with their children. In infancy, the children of depressed mothers may not perform as well on developmental tasks as children of non-depressed mothers.

for more information
If you have patients who are FCHP members whom you would like to refer for behavioral health services, please contact FCHP’s behavioral health partner, Beacon Health Strategies, at 888-421-8861.

other resources

• Postpartum Support International
  800-944-4PPD (4773)
  www.postpartum.net

sources
Boyce P, Stubbs J, Todd A. The Edinburgh Postnatal Depression Scale: validation for an Australian sample. Aust N Z J Psychiatry 1993;27:472-6.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987 Jun;150:782-6.

Epperson CN. Postpartum major depression: detection and treatment. Am Fam Physician 1999 Apr 15;59(8):2247-54, 2259-60

Massachusetts General Hospital Center for Women’s Mental Health, www.womensmentalhealth.org

domestic violence: you can make a difference
by Donna Watson, L.I.C.S.W., Beacon Health Strategies

A 2002 national study of domestic violence found that 29% of women and 22% of men had experienced physical, sexual or psychological abuse by an intimate partner during their lifetime. Domestic violence occurs in every community, across social class and in all ethnic and religious groups, including immigrant and refugee populations.

All health care professionals who are providing care are treating patients affected by domestic violence and are in a position to identify and intervene on behalf of victims. 

Looking beyond physical harm, domestic violence is connected to risk factors for chronic health problems. Physical and psychological injuries related to abuse are linked to adverse medical health effects, including arthritis, chronic neck or back pain, migraine, sexually transmitted infections, ulcers and irritable bowel syndrome.

The psychological impact of abuse may affect a victim’s ability to manage chronic illnesses such as asthma, seizures, diabetes, gastrointestinal disorders and hypertension. Victims of abuse are more likely to participate in injurious health behaviors, including smoking, substance use and high-risk sexual activity. Abuse significantly increases the risk for serious mental health consequences, including depression, post-traumatic stress disorder, anxiety and suicidal ideation. 

you can make a difference
Providers play a vital role in preventing domestic violence by routinely screening their patients for signs of it. Victims of domestic violence say that one of the most important parts of their interactions with their physicians was being listened to about the abuse. Talking about domestic violence provides an opportunity for primary prevention. Educating your patients on how abuse impacts their health will encourage and promote self-care. Early identification of domestic violence can help victims escape before the violence escalates. The American Academy of Family Physicians, the American College of Physicians, the American Medical Association and the American College of Obstetricians and Gynecologists all recommend screening for domestic violence.  

resources
Health care professionals should educate themselves and their staff on screening, identification and documentation of cases of abuse. Providers should be knowledgeable about interventions and community resources that will assist them in providing care for their patients.

The Family Violence Prevention Fund works with health care providers across the country, providing education on how to identify and help victims of abuse. They have developed the National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings, available at www.endabuse.org/programs/healthcare/files/Consensus.pdf.

The American Medical Association also has prepared the Diagnostic and Treatment Guidelines on Domestic Violence, a guide for physicians about implementing domestic violence protocols in their practice. See www.ama-assn.org/ama1/pub/upload/mm/386/domesticviolence.pdf.

what you can do
The following are suggestions that can be implemented into your clinical practice.

• Routinely conduct a screening at the first visit and annually thereafter for all patients over the age of 14. Do so in private and confidentially. Ask questions in a direct, nonjudgmental and culturally competent manner.
• Establish protocols and conduct trainings for staff that include guiding principles, routine assessment, intervention and documentation strategies, including reporting policies and confidentiality rules.
• Create a supportive environment with multicultural and multilingual posters and brochures that include information about victims, perpetrators and resources. Place brochures in exam rooms and other private areas such as bathrooms. The Family Violence Prevention Fund provides resources and materials that can assist you in preparing your practice to identify and respond to victims of domestic violence. Visit www.endabuse.org/programs/healthcare.

Routine screening can alert patients that domestic violence is an important health care issue, and you can help them understand the impact that abuse is having on their health. Talk to your patients about domestic violence—it could save a life.

help is available
Contact the National Domestic Violence Hotline (www.ndvh.org) at 800-799-SAFE (7233) or call a domestic violence advocate at the Massachusetts Domestic Violence Programs, SafeLink at 877-785-2020 (TTY: 877-521-2601), where the trained staff is available to provide counseling services, support groups and advocacy services 24 hours a day. SafeLink also has the capacity to provide multilingual translation in more than 140 languages.

fchp network

fchp select care

• Addison Gilbert Hospital
• Anna Jaques Hospital
• Athol Memorial Hospital
• Beth Israel Deaconess Medical Center*
• Beverly Hospital
• Boston Medical Center*
• Brigham and Women’s Hospital*
• Brockton Hospital
• Caritas Good Samaritan Medical Center
• Caritas Norwood Hospital
• Caritas Saint Elizabeth’s Medical Center*
• Children’s Hospital
• Clinton Hospital
• Dana-Farber Cancer Institute*
• Emerson Hospital
• Harrington Memorial Hospital
• HealthAlliance Hospitals
• Heywood Hospital
• Holy Family Hospital and Medical Center
• Hubbard Regional Hospital
• Lahey Clinic
• Lawrence General Hospital
• Lawrence Memorial Hospital
• Lowell General Hospital
• Malden Medical Center
• Marlborough Hospital
• Massachusetts General Hospital*
• Melrose-Wakefield Hospital
• Merrimack Valley Hospital
• MetroWest Medical Center
• Milford Regional Medical Center
• Mount Auburn Hospital
• Nashoba Valley Medical Center
• New England Baptist Hospital*
• New England Medical Center*
• Newton-Wellesley Hospital
• North Shore Medical Center—Salem Hospital
• North Shore Medical Center—Union Hospital
• Saint Vincent Hospital
• Saints Memorial Medical Center
• South Shore Hospital
• Sturdy Memorial Hospital
• UMass Memorial Medical Center—Memorial Campus
• UMass Memorial Medical Center—University Campus
• Whidden Memorial Hospital
• Winchester Hospital
• Wing Memorial Hospital

fchp direct care

• Beth Israel Deaconess Medical Center*
• Boston Medical Center*
• Brigham and Women’s Hospital*
• Caritas Saint Elizabeth’s Medical Center*
• Children’s Hospital*
• Dana-Farber Cancer Institute*
• Emerson Hospital
• Harrington Memorial Hospital
• HealthAlliance Hospitals
• Hubbard Regional Hospital
• Lahey Clinic*
• Massachusetts General Hospital*
• MetroWest Medical Center
• Milford Regional Medical Center
• Mount Auburn Hospital*
• New England Baptist Hospital*
• New England Medical Center*
• Saint Vincent Hospital
• UMass Memorial Medical Center—Memorial Campus*
• UMass Memorial Medical Center—University Campus*

infertility services only

• Boston IVF*
• Fertility Center of New England*
• Reproductive Science Center of Boston*

* These facilities may only be available for certain services or for specialty care through FCHP-authorized tertiary care or our Peace of Mind Program^™. The information on these lists is current as of July 1, 2006. We encourage you to check for the most updated provider information by contacting our Customer Service Department at 800-868-5200 (TDD/TTY: 877-608-7677).