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The Importance of Clinical Call Center Nurses in the RPM Care Journey

The emergence of Remote Physiological Monitoring (RPM) has greatly contributed to the rapid adoption of virtual health services. This practice would not be possible without the work of clinical call center nurses, who observe the condition of patients and accordingly make relevant health decisions.

How does RPM work?

RPM uses technology to track a patient’s vital parameters such as heart rate, blood pressure, weight, etc. This data is recorded by the device and sent to health professionals involved with the patient’s care. The care provider can then make informed decisions on the patient’s health. RPM devices notify the care provider if any abnormal vitals are detected. They also allow patients to receive quality health care from a virtual setting. Effective RPM systems result in higher patient satisfaction while increasing the revenue of care providers.

The role of Call Centers in RPM

Clinical Call Centers play a crucial role in the RPM care journey. RPM devices track a large number of complex metrics relating to the patient’s health. Any data recorded by an RPM device is useless until a qualified health professional is able to analyze it. This is where call center nurses factor into the Care Journey. The RPM device emits data through the provider’s RPM software to the clinical center. Here the data can be received and analyzed by the nurses in charge of the virtual patient care. They can record a patient’s progress and better understand how a patient responds to treatment. If there are any slight deviations from the care plan, nurses can video conference with the patient to identify and address the source of the irregularity. If there are any concerning metrics, the nurses can immediately connect the patient with the necessary professional.

How RPM help Call Center Nurses

Call Center Nurses may be in charge of monitoring hundreds of patients in a virtual manner. Without a Remote Monitoring option, nurses need to manually contact individual patients. RPM devices can connect with these patients on a daily basis, without constant human interaction. These devices can collect the data of hundreds of patients and send these results to the call center in just a few minutes. RPM also allows patients to track their health from the comfort of their homes-meaning providers are able to turn their attention to their most at-need patients.

RPM and the COVID-19 Pandemic

The COVID-19 pandemic has heightened the importance of virtual care services like RPM. The pandemic has greatly decreased the healthcare industry’s focus on combating non-COVID related ailments. However, providers with existing RPM mechanisms are benefiting from the ability to monitor health through a virtual platform. In addition, patients who suffer from chronic conditions are still able to receive daily updates on their health.

Characteristics of a functional RPM platform

The following characteristics can be found among all effective RPM systems:

Reduce Emergency Situations: RPM devices can track any abnormal patterns and immediately report them to a health center. Emergency situations are of increased danger to the health of chronic care patients. RPM devices can provide a timely intervention and allow the patient to receive care before an emergency situation unfolds.
Reduce Readmissions: An efficient RPM platform can prevent patients from being readmitted for their existing conditions. By tracking the trajectory of the patient’s health, nurses can notify patients when they deviate from their care plan. This helps patients stay on top of their treatment while decreasing the probability that they are readmitted.
Increased Patient Involvement: The interactive nature of RPM gives patients the opportunity to be more involved in their care. This means patients are more informed on their condition and the treatment plan referred to them. Ultimately a more involved patient increases the likelihood of recovery.

The increased importance of virtual care has allowed RPM to emerge as a powerful tool in care delivery. The proper use of these technologies greatly enhances the convenience and effectiveness of health care.

Schedule a demo and learn how HealthViewX is transforming the Care Journey for both patients and providers!

How to Enhance Referral Process in Healthcare Organizations

Many large hospitals and health systems are losing revenue in millions due to patient referral leakage. Every single patient who looks for care somewhere else is lost revenue now and in the future.

Common challenges in referral system

Majority of health systems experience some sort of challenges with their referral process, which potentially create a negative impact on patient satisfaction, clinical care, and outcomes. More than two-thirds (68 percent) of specialists receive no information from primary care physicians (PCPs) prior to referral visits, according to the Journal of General Internal Medicine. And incredibly, 40 percent of PCPs do not receive consult reports back from specialists following referrals, according to the Archives of Internal Medicine.

A lot of other challenges like the below lead to patient dissatisfaction, poor patient health outcomes which in-turn results in patient leakage and revenue loss.

Not being able to identify in-network specialists/providers
Providing unclear and incomplete information while referring patients to specialists or other in-network providers
Lack of mechanism to measure referral team’s performance or revenue outcomes
Inefficient process and ineffective prioritization
Challenges in the insurance authorization process, issues related to denials and write-offs
Manual processes and dependencies on paper-based communication
Inability to track patient leakage due to unclear referral process and lack of referral analytics

Analyzing Your Health System’s Improvement Opportunity

It is vital to identify gaps in the current process, understand challenges and make significant improvements in the referral process. Standardizing the process will help to make it efficient, and adopting technological solutions will not only streamline the process but also will save time and seal leakage. Providers need an end-to-end referral solution to meaningfully improve the handling of both incoming and outgoing referrals.

Here’s how healthcare providers can improve their referral process

Standardize your referral process

It is key for organizations to develop a consistent workflow and streamline the referral process that clearly delineates responsibilities depending on the role and the action to be taken. To achieve this excellence both clinical and operational leadership should collaborate and identify a suitable solution to help develop a strong referral system.

Choosing the technological solution that works

In spite of having a proactive and organized approach to tracking and handling referrals, some technology systems are still unable to facilitate workflows of best practice or provide the performance data required to manage the end-to-end process effectively. So choosing the right solution, and defining roles and responsibilities to support better referral management is crucial.

Defining vision and goals

Once the right technology solution is adopted and implemented, it is vital for the health system to understand the level of performance and opportunity. Analyzing the understanding the below is required

From disparate referral process to a clear and standard process
From a decentralized to a centralized process
From paper-based or manual processes to an automated single system that manages end-to-end processes.

Measure success that matters

Organizations need to track their journey towards excellence and ensure they are in par with the industry standards to provide enhanced care for their patients through quality care and better patient satisfaction.

What organizations need to understand?

Organizations should invest time and effort into their referral management. The entire team including clinical teams, operations teams, IT, referral teams, etc. should involve in choosing the right referral solution for a streamlined end-to-end automated referral solution. They also need to understand the potential of the referral software, and the potential revenue a technology-enabled workflow can bring into the system.

Schedule a demo. Talk to our experts to understand how HealthViewX Referral Management streamlines the referral workflow and automates the process seamlessly.

Technology’s Role in the Shift Towards Value-Based Care

Value-Based Care is an increasingly popular healthcare model in which providers receive reimbursement that reflects the outcome of the patient. This concept emphasizes the importance of improved patient health and accordingly benefits providers who are able to deliver to their patients. The traditional “Fee-For-Service” model which involves flat rate payments irrespective of patient outcomes or care quality has grown out of favor.

The move away from a purely profit-focused model and towards a patient-centric model highlights the trend of developments in the US healthcare industry. This seismic shift towards Value-Based Care is not possible without some of the modern health tech innovations which are at the forefront of the movement.

The move towards Value-Based Care

For quite some time, the healthcare industry was known as a purely profit-based industry. In order to shift the care focus towards the patient outcome, the Centers for Medicare & Medicaid Services (CMS) has laid the groundwork for various Federal Acts that incentivize providers who adopt a value-based model. The most notable of these was the 2010 Affordable Care Act (ACA). This aligns with the “Triple Aim” framework promoted by the CMS:

The increase in concrete support from the Federal Government influenced many providers in shifting to a Value-Based model.

Why Value-Based Care?

The attractiveness of the Value-Based structure can be attributed to its numerous benefits for both patients and providers. This model is highly popular amongst patients as it highlights provider accountability for the outcome of their care. Patients can achieve peace of mind knowing that the improvement of their health is the primary goal.

For providers, this model offers a larger patient outreach while handing out incentives for better performance. The increased use of technology has helped practices use reliable data to make informed business decisions. While this structure is inherently appealing for all parties involved, the advancement of technology has fueled its widespread acceptance.

Achieving Value-Based Care through Enhanced Care Journey Mapping

Enhanced Care Journey Mapping involves the tracking of patient activities throughout their care process. It is used to conceptualize the process and eliminate any tedious or redundant tasks. Journey Mapping is a prime example of Value-Based care as it seeks to improve patient outcomes. Providers can identify areas where patients face inconvenience and take measures to address them. By analyzing the overall care journey, providers can optimize the patient experience.

What technology solutions are involved?

The large-scale move to a Value-Based Care model has been made possible by the following solutions:

- Telehealth: Telehealth involves the exchange of virtual health services (such as video conferencing) using an electronic platform. The emergence of telehealth software has given patients high accessibility to quality care. Providers can open a new revenue stream while staying up-to-date with their patients, even when a physical meeting is not possible.
- Remote Patient Monitoring: Remote Patient Monitoring (RPM) is a healthcare practice that uses technology to monitor patients in a virtual manner. RPM allows patients to monitor their health daily and encourages them to be more involved with their care. The adoption of RPM services can be directly attributed to a decrease in readmission rates. RPM gives providers valuable insights into the patient’s current condition.
- Chronic Care Management: Chronic Care Management (CCM) involves the facilitation of patients suffering from two or more chronic conditions. Virtual health software services have greatly improved the quality of CCM. Providers save time and money by using these services to connect with their chronic care patients. Patients with chronic conditions can eliminate unnecessary clinic visits and receive timely health feedback from the convenience of their homes.
- Referral Management: Providers have increasingly adopted software systems that streamline their patient referrals. Patients can expect increased efficiency while not having to worry about documentation and processing issues. This has greatly decreased referral leakage which can cost individual practices millions of dollars each year.

Challenges in shifting to a Value-Based Model

While providers across the nation have welcomed the value-based model, some significant obstacles remain before it becomes the industry standard.

Technological Disparities: Many practices do not have the necessary tech infrastructure to operate a value-based model. Many practices lack programs like RPM and EHR Integration, which are integral to the operability of the model.
Government Support: While the CMS has supported many value-based initiatives, it remains to be seen how the Federal Government will include all patients and providers under the triple aim
Financial Risk: This shift, like any large financial investment, comes with a moderate level of risk. Many smaller practices cannot afford to gamble on a move that may not pan out.

Nonetheless, the Value-Based model has shown great promise in bringing change to provider-patient relationships. The response to these issues will determine the success of the model in the long run.

Talk to us to understand more about Value-Based Care and we will guide you to achieve our common goal “Quality Care for All” seamlessly.

Chronic Care Remote Physiological Monitoring (RPM) and its Medicare Reimbursement Codes

Chronic Care Remote Physiological Monitoring (RPM) or Remote Patient Monitoring is a healthcare practice that involves the use of technology to monitor patients in a virtual manner. This practice has gained popularity in recent years and is being utilized with great success in the treatment of chronic care patients.

Specifics of RPM

RPM is a form of real-time telehealth that employs the use of technology in the live collection of vital parameters such as heart rate, blood pressure, weight, or any other relevant measure. This information is then sent to health professionals, who can analyze the data and make informed decisions on the patient’s health. Another beneficial factor is RPM devices often notify both patients and care providers if any abnormal vitals are detected.

How do patients benefit from RPM?

An extensive RPM system gives patients increased access to healthcare. New innovations in the health-based tech industry have afforded patients with high-quality devices to track their health progress. Patients with chronic care conditions that require extensive care are able to monitor any changes to their health on a daily basis. The interactive nature of RPM allows patients to be more involved in their care. RPM is also proven to decrease both readmission and emergency situations. The combination of these factors ultimately results in higher patient satisfaction.

How do providers benefit from RPM?

RPM has given providers an opportunity to stay updated with their patients, even when they cannot physically meet with them. The rapid growth of RPM technologies has also presented care providers with additional streams of revenue. The CMS has recognized this and introduced new codes that provide reimbursement for virtual care related to RPM. RPM also increases the number of patients a clinic can serve as well as the efficiency of care.

RPM and COVID-19

The ongoing Covid-19 pandemic has brought an increased level of attention to RPM practices. Patients and providers with existing RPM infrastructure are greatly benefiting from the ability to monitor health through a virtual platform. Observing a successful model of RPM use during the pandemic will convince many providers to adopt such practices moving forward.

Different Medicare CPT Codes within RPM

Care Providers can use the following CPT codes to generate revenue from the establishment and monitoring of RPM practices.

CPT 99453

CPT 99453 is an RPM code that is used when establishing RPM technologies and educating the patient about safe practices. In 2020, the average revenue received when issuing this code is $19. It must be noted that this code can only be issued one time when installing the necessary technology. Any additional support related to technology or patient education cannot be issued using this code.

CPT 99454

CPT 99454 is an RPM code that can be used to cover the transmission of biometric recordings and program alerts. ThIn 2020, the average revenue received when issuing this code is $64. The reimbursement cost also covers the cost of the device(s) involved in the care. This code is to be issued every 30 months. In order to issue this code, all RPM devices used in the care process must be FDA approved.

CPT 99457

CPT 99457 is an RPM code that can be issued for any care that is at least 20 minutes per month and is monitored by a qualified health professional. In 2020, the average revenue received when issuing this code is $52. This code covers any non-face-to-face interactions between providers and patients that involve the patient’s RPM progress. Providers must not issue CPT 99457 or any other code for any care that is less than 20 minutes per month.

CPT 99458

CPT 99458 is a new RPM code that addresses care provided by a qualified health professional for every additional 20-minute interval after the first 20 minutes of RPM services, which is currently billed under CPT 99457. This code came into effect on January 1, 2020, and has an estimated reimbursement rate of $42. This code must be used as an add-on to the existing RPM’s CPT 99457 for billing.

Challenges with RPM

Despite the previously mentioned benefits of an RPM scheme, there are still a few challenges that have prevented such programs from being widely accepted.

Despite these challenges, RPM technology remains a promising force in the healthcare industry. Its revolutionary nature is reshaping the patient-provider relationship for the better. This care model will help move from reactive care to proactive care. Providing immediate attention will help reduce readmission rates, reduce hospital admissions, etc. thereby helps reduce the overall cost.

Schedule a demo and talk to our RPM solution experts and get your RPM started in a jiffy!