Author Archives: Vignesh Eswaramoorthy

Human-Centric Design In Healthcare

Human-Centric Design in Healthcare – A total game changer to strengthen your referral network, increase your revenue and boost patient engagement

Referrals are key for any Healthcare Specialities or Imaging Centres to generate a steady, strong and sustainable referral pipeline. Health systems need to understand that today’s referral is tomorrow’s repeat patient. Thus, adopting industry’s best practices or solutions will help them to improve patient experience and patient referral rates. Traditionally referrals come through multiple sources like fax, phone, direct messaging, virtual print, etc. and regardless of how they are referred, responding to patients’ health needs and keeping them within the network is vital for all businesses. A good referral relationship requires a systematic, streamlined and scheduled amount of time and attention.

Health Systems and Hospitals should know the financial impact of losing patient referrals and ascertain those lost revenue opportunities.

If, on average, 55 – 65% of revenue is lost from leakage, that means a hospital could lose between $821K to $971K per doctor per year. For a hospital that employs 100 affiliated providers, those numbers skyrocket to between $78M to $97M per year.

The technology in healthcare is exponentially advancing and rapidly changing the industry for the better. Both, small and large health systems, and imaging centers have more options to select a suitable solution than ever before. But, before choosing it is important to evaluate, analyze the options and adopt the right solutions to achieve their business goals or needs.

In the referral process, it is important for the referring physicians to know if their patients actually see the recommended specialist. Research has demonstrated that 25% – 50% of referring providers do not know if their patients completed the referral, both the referring and receiving provider may not communicate, and studies show that around 50% of providers do not have contact with one another. And, 61% of patients would switch providers if it were more convenient to schedule an appointment.

Today’s patient referral system is a paradigm shift from fee-for-service to value-based-care. This shift towards increased collaboration, improved overall access to care, lower cost, better outcomes, etc., demands a technology that is human-centric. Such design will improve communication and collaboration, transparency, efficiency for coordinated care to align with the business objective to improve efficiency and deliver better patient care. In order to achieve this, healthcare systems need to change their longstanding approach to keep the referrals within their network and learn to be agile. The new solution should enable workflow optimization and improve financial performance when combined with operational best practices to provide timely care, improved appointment conversion, and completion rates.

So how to get a steady, strong and sustainable growth for your business?
1. Invest in the right technology
2. Diversify – build a strong referral network, keep your referring physician informed, collaborate better for an improved outcome and have a steady patient inflow
3. Grow and sustain your revenue stream

Then, sustain and grow to the next level
1. Learn to be agile – agile provides compelling competitive advantages
2. Follow industry best practices – Engage| Interact| Build Trust
3. One of the most important responsibility is to make your patients feel safe and truly valued
4. Keep your referring physicians informed about the referral, build trust and get more patients referred to you

Most PCP’s and other healthcare providers remain the most important source of new patient acquisition. Driving new patient acquisitions and retaining them within the network is an ongoing requirement for successful practices. To succeed in business, providers need to

– Effectively manage referrals from multiple sources, utilize a standard deep-rooted process
– Communicate instantly with referral sources to fill in the missing information
– Respond to referrals quickly to reduce referral leakage
– Customizable dashboards to give instant information for informed decisions
– Ensure to have a key metrics to track, study and measure real-time metrics for referral volume and patient leakage
– Improve overall quality of care across the care continuum
– Have a well-orchestrated customizable workflow

Once a referral comes in it is important to analyze – who needs to be involved, what has to happen, and when – the timelines. This has to be documented and technology can be of great help to have all the parties involved. With the help of industry experts, human-centric designs often involve out-of-box thinking and lead to creative and highly innovative solutions when compared to that of traditional designs. To create a successful human-centric design it is important to share and discuss what you’ve made with the people you’re designing for and further refine it according to their requirement and current business challenges. By understanding the customer needs, technology providers will be primed to innovate successfully.

Our powerful solutions are tightly focused to give your business the winning edge, improve your patient experience and achieve operational excellence. Understanding the customer needs and developing solutions is our hallmark. Sustainable development means adopting solutions that best suit your business needs. The sustainable growth of any business is the result of forces working together. Let’s get started!

Referral Network & Its’ Complexity Decoded

Why generate referrals?

When a patient suffers from any illness he seeks the advice of his Primary Care Provider(PCP). If the illness lies within the PCP’s specialty he can initiate and complete the treatment – a need for the referral arises when additional tests, diagnosis, and therapy are beyond the scope of the PCP. There is also an additional need where a specialist intervention may be required for more advanced specialized treatments.

A care provider prefers to refer his patient to the practice because it increases the chances of the patient being referred back to him after additional treatment. It also helps the PCP generate more revenue by retaining the patient in his reach, thereby minimizing patient leakage. This way the PCP, imaging centers and specialists generate referrals for each other and the patient is retained in their ecosystem. There are two categorizations of medical referrals between physicians and PCPs. In-network, when a patient is referred to the practice and Out-of-network when he is referred out of the practice.

Sources of Referral

A hospital or imaging center can get referrals through multiple channels such as direct messaging, email, fax, virtual print, phone, patient walk-in etc. In a day an imaging center or hospital can have numerous referrals in hard copy or faxed option sent through emails and/or EMR.

What complicates a referral network?

There are many factors that can cause the failure of a referral. Let us take the following instances to understand why tracking a referral becomes tedious:

Dr. Anderson a Cardiologist attends to many patients in a day. He is treating a patient with cardiac arrest who fell down and suffered a fracture, he would need the assistance of an orthopedic to treat the fracture. Dr.Anderson would need to refer the patient to an orthopedic based on both their availability. The patient’s progress will have to be tracked after the referral has been made. If the patient fails to update Dr. Anderson, how would he know the status of the diagnosis?

Dr. Matthews gets a referral for asthma. He does not get the case history or the previous reports of the patient. He tries to contact the referring provider but to no avail. So he makes the patient repeat the tests to diagnose his condition and to continue with the treatment. This is a waste of time for both the patient and the provider.

Mr. Andrews is referred to a specialist from a famous hospital. As the hospital does not accept diagnostic reports from other clinics, Mr.Andrews is forced to spend money on the same tests again. He is made to wait for a long time which forces him to look for another specialist. This leads to an unclosed referral loop and patient referral leakage.

To summarize the key points,

  • Tracking a referral manually is tedious for both the referrer and receiver.
  • It is difficult for the patient to coordinate between the PCP and the specialist or imaging center

Why does referral leakage happen?

Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors leading to patient leakage.

  1. A reputation of the Provider – Sometimes, a provider will refer their patients out-of-network in order to have them see another provider who is more reputable in a certain field, specialty, or procedure.
  2. Lack of Knowledge or Insight – Sometimes the providers are not aware of the specialists in their practice and tend to refer out of their network.
  3. Patient’s Choice – If the patient decides to move out of the practice due to unavoidable reasons then referral leakage becomes inevitable.

Why should it be curbed?

  • It is important to process and close a referral as soon as possible because the patients may be in need of immediate attention.
  • Patient referral leakage ultimately leads to unclosed referral loops.

How can HealthViewX Referral Management solution help?

The patient referral is contributing factor for patient volume in the case of imaging centers and hospitals. The current process of referral is very time consuming and tedious with no tracking and periodic updates to the referrer, patient, and the receiver. An updated system that will help make the process streamlined and seamless would enhance the overall experience of the PCP and patients and also curb the referral leakage and patient no-show rate.

How great would it be if referrals from all possible channels and forms can be brought into a single queue? That is how exactly HealthViewX works.

HealthViewX Referral management helps to implement a multi-channel referral consolidation system. Let us take an imaging center that receives referral requests. The referrals usually have an attachment in pdf form which will be non-editable. Any imaging center will have a form that has to be filled out with the details given in the referral. HealthViewX referral Management comes to play here. Using Optical Character Recognition(OCR) the information from the referral will be read and the form is prefilled with the required details. Now the referral coordinator can just validate the details and create a referral and assign it to the person concerned. The referral information can also be channelized based on the request of the user for eg: Two referrals forms can be filled in if it concerns people in different locations. The solution can be integrated with EMR/EHR/RIS and can write the updated information back the system used by the imaging center.

Impacts

  • Multi-channel referral consolidation –  Fax, Phone, Email, Online form referrals are captured, managed and monitored in a single interface
  • No change in current process – PCP’s continues to send the referrals without any change in the current process(Fax/Phone/Email/Online form)
  • OCR – Optical Character Recognition (Helps avoid manual errors and reduces the referral processing time for referrals through eFax)
  • Patient Appointment Scheduling and notification – Increase the conversion of referral to patient appointment by automated reminders and notifications for pre-requisites (through SMS and/or email)
  • Referral Analytics – Helps in making informed decisions with regards to the future investments, GTM strategy, and workforce increase
  • PCP, Patient, and Imaging Centre Communication – Streamlined and secure communication

Are you looking for a solution to solve your referral complexity? A 30-minute demo with our HealthViewX team will help. Our experts will walk you through the HIPPA compliant solution that makes the referral workflow simple but significant. Schedule a demo with us to know more about HealthViewX – Referral Management Solution

Improve Your Referral Management System – Where To Start?

Here’s what HealthViewX did at one of our key clients, a leading imaging center in the US – where we implemented an efficient, patient-centric system for managing referrals.

Imaging centers are under growing pressure as gaps in the referral processes and the resultant loss of referrals is adversely impacting revenues. The main gaps in the process are improper referral data exchange, lack of visibility on referral status aside and delayed delivery of reports.

An answer to solving this challenge cannot be merely expanding staff or teams. To justify the productivity of a large team will be an additional challenge.

Before embarking on a solution that would fit the need, we presented a few questions to the client team:

  • Which point in the process are we losing patients?
  • What constitutes an “appropriate” referral?
  • Are we providing the right response, at the right time, at the right frequency, for the right duration?

The answers to these questions pointed us to certain parts of referral routine that needed intervention. The flow of patient information, the capture of historic data & detailed patient information and tracking of follow-up information stood out as major improvement areas. A much-needed interoperability strategy backed by our referral management system to streamline workflows, enhance referral networks and increase referrals was put in place. In the new system, there is provision to establish a communication channel between all stakeholders involved, trigger notifications on status changes, track status until referral closure and be on top of the referrals at any point.

In addition to these mandatory features that create direct impact on the problem statements, there are also options to create customized templates based on the specialty they serve like for a cardiology scan centre, orthopaedic centre; ability to create orders in external systems and pull data/reports from external devices/applications and share it with referring provider/ practices thereby reducing the processing time for each order and resulting in quick turnaround time. To enable true interoperability, the platform safely and securely exchanges this patient data with physicians. Automated delivery to distribute images and reports directly to a referring physician was made possible.

To summarize some of the key benefits:

By adopting a platform that offers advanced interoperability, apart from important benefits of streamlined workflows, the growth of referral networks and improvements to the bottom line, clients also see a reduction in unnecessary imaging. By streamlining the workflows and eliminating time-consuming calls/ to and fro communication for authorization we were able to dramatically reduce the cost of unnecessary and inappropriate imaging.

But before embarking on a technology journey to improve the referral scenario at your practice or center we need to start by asking the right questions and most often, all answers point to enabling interoperability. ‘Care’ to start here? Schedule a demo

Chronic Care Management – Decoded (FAQ)

Chronic diseases are a long-term illness that needs special care and periodic evaluation. Conditions such as diabetes, cancer, heart diseases, high blood pressure and so require continuous care and help.

Both diagnosis and treatment cost of any chronic disease is very expensive. And, if a person has multiple chronic conditions, the costs will skyrocket. That’s where Medicare comes to play, like other health insurance it pays half of the treatment and care cost.

What is Medicare?
Medicare is a health insurance program administered by the U.S. Federal government for people aged 65 or above, and for people with certain disabilities and end-stage renal disease of any age.

What is Medicare Chronic Care Management service?
Under Medicare payment, a Chronic Care Management service will be provided to patients with multiple (two or more) chronic conditions by a physician or skilled professional per calendar month.

Examples of the chronic condition include, but not limited to, the below list

- Alzheimer’s Disease and Related Dementia		 - Heart Failure
- Arthritis (Osteoarthritis and Rheumatoid)		 - Hepatitis (Chronic Viral B & C)
- Asthma						 - HIV/AIDS
- Atrial Fibrillation					 - Hyperlipidemia (High cholesterol)
- Autism Spectrum Disorders				 - Hypertension (High blood pressure)
- Cancer (Breast, Colorectal, Lung, and Prostate)	 - Ischemic Heart Disease
- Chronic Kidney Disease				 - Osteoporosis
- Chronic Obstructive Pulmonary Disease		         - Diabetes
- Depression						 - Stroke
- Schizophrenia and Other Psychotic Disorders

What is CPT 99490?
Chronic Care Management Services, takes at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
● Comprehensive care plan established, implemented, revised, or monitored

What are the new complex CCM codes?
CPT 99487 – Complex Chronic Care Management Services, with the following, required elements:
● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
● Establishment or substantial revision of a comprehensive care plan
● Moderate or high complexity medical decision making
● 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

How do physicians get paid for CCM services?
Mostly primary care physicians can bill for CCM service and in some cases, specialists involved in care can also bill. But only 1 practitioner can be billed per patient per calendar month for either complex or non-complex code.

What is the best way to keep track of chronic care minutes?
Care providers generally keep track of the service time. A tracking software can be used to track every minute spent on care and documentation is done for reimbursement purpose. Based on the service offerings, time will be tracked for every interaction made with the patient on a monthly basis.

How to start Chronic Care Management to patients?
Patient with multiple chronic conditions first needs to enroll for CCM care service. Then physician or care professionals will provide care according to needs of the patient. This service will be then documented for billing.

Is there any chronic disease Self- Management Program?
Yes!. A low-cost Chronic Disease Self-Management Program (CDSMP) helps chronic patients to learn how to manage and improve their own health. An interactive session will be conducted for patients with the common disease by doctors that cover pain management, nutrition, exercise, and medication use.

Home Health Care for Chronic Disease Management

Home health model is established with an objective to deliver high-quality care at each level of healthcare delivery chain. As we all know this is offered at the patient’s residence by either licensed health care providers or caregivers.

Home Health Agencies are certified centers that provide skilled care for older Americans, people with disabilities or for people who suffer from acute and chronic conditions.

There are about 83.7 Million people in the US who are benefiting through home health agencies.
As a result of this parallel growth of both aged population and chronic diseases, the need for optimum care delivery continues to grow.

For elder care help, CMS offers to pay home health agencies for providing 60 days of care under HHA PPS.

So, how does home health agencies get patients?

On the basis of illness or injury, doctors send people who need care services to home health. Mostly Medicare patients, people with 2 or more chronic conditions who need care after discharge will be shifted to home health immediately following hospitalization.

Patient-centric care is provided to see quick progress in their health considering the needs of the patient and doctor recommendations.

How does a care coordination model work?

Once a patient is referred, a care plan is set with goals to regain patient health status. Some home health agencies have started embracing technology platforms through which automated care plans can be generated using Care Management Software.

Care plans are set with goals and rolled out to patients. Health status will be continuously monitored by skilled professionals at regular intervals and if required changes will be made looking at real-time health data.

Both patient and the providers are equally involved in the care cycle and are expected to work together and achieve health goals to ensure patient recovery.

Multiple specialists will be connected in this care loop to better collaborate, communicate and coordinate care whenever there is a necessity or emergency.

Coaching will be given with the help of patient education tablets to connect and follow the care goals for quicker recovery. Home health also organizes a community meeting where people facing the same kind of illness will share their experiences to encourage and motivate to fight against chronic illness.

Telehealth Home Service

Many US seniors enjoy living independently at their own place and need a little help from providers when they get ill. Telehealth is a gift for those to improve their health thus promoting independent living.

Telehealth program is technology integrated with clinical care to change the healthcare delivery, model. Some healthcare providers have already implemented this telemonitoring service that will guide patients through a daily check-up, and also record vital signs and symptoms.

These details will be then sent to a central monitoring system, from where home health agencies will be receiving an alert in case of emergency.

Challenges faced by Home Health

Technology Changes
From Health Monitoring Systems to medication tracking devices, technology is expanding at ever-increasing speed and home health struggles to keep up that pace.

New technology is presenting new methods for providers, and of course, home health agencies to connect with their patients but this can also be problematic. From the cost involved in procuring such technologies to patients perception. Changing legal and regulatory climate around the use of technology in the field of healthcare adds to the problem.

Lack of care continuum
Among long-term care patients, 90 percent of them live in their own homes to avoid hospital environment. Increasing demands due to rising older population makes the delivery model challenging to provide affordable, continuous care and to meet the expected quality parameters.

Adapting to changes in government regulations and practices also influences the style of functioning of the system. Value-based physician reimbursement for improving quality and lack of skilled professionals are some of the areas that need immediate attention.

Employing technology can help in improving care delivery, and admittedly choosing the right solution that meets the needs of the practice is the key to success in the ever-changing healthcare environment.

HealthViewX Care Management Solution allows to create and send customized care plan for individual or group of patients to help manage the health of the whole population. Integrated telehealth feature enables provider to connect with patients quickly and track patient’s health condition remotely.

Complex CCM Codes To Expand Care Opportunities

On November 15, 2016 – the Centers for Medicare and Medicaid (CMS) announced the new changes to Chronic Care Management payment options by adding new codes and key improvements to the existing CCM billing methods and services.

Feedback from providers is the key reason for new codes. These changes are now set to implement on practices starting 2017 with an objective to enhance patient care and ensure hassle-free documentation for billing. Services offered by physicians will be based on the complexity of the patient’s need and will be billed under different CPT codes based on the service provided. Here is a summary of CCM and complex CCM codes.

CCM payment option till 2016

A physician will be paid $42 for 20 minutes of clinical staff time provided to patients with multiple (two or more) chronic conditions per calendar month under CPT 99490. Reimbursement for the provider will be the same if the clinical service time exceeds 20 minutes.

Changes in CCM codes effective from 2017

CMS recognized some patients may have complex chronic conditions and they might need additional care time. So, CMS addressed the need by introducing new codes 99487 and 99489 which will benefit those who need extra care and will also compensate providers with increased reimbursement options through new codes.

  • CCM Code 99490
    Payment has increased from $42 to $43 for 20 minutes of clinical staff time.
  • Complex CCM Code 99487
    60 minutes of CCM service for $94 that includes moderate to high complex medical decision-making.
  • Add-On Complex CCM Code 99489
    This code is to use with 99487. Additional 30 minutes of service will be provided for bill amount $47.

In addition to the CCM codes, there are changes made in the service elements for enhanced care and administrative simplifications on billing.

CCM Service Changes for 2017

Initiating Visit

From 2017, initial visit is required for new patients or patients who have not enrolled their name for CCM services within past twelve months. Payment of $44-$209 to be billed by the billing practitioner for initiating visits.

For initial visit, CMS has introduced a new add-on code G0506 that includes extensive assessment and care planning performed by the billing practitioner beyond the usual efforts. A payment of $64 will be billed for this extensive initiation work- only once per patient per provider.

EHR and Technology requirements

CMS continues to stress on using certified EHR with a standard format (demographics, problems, medications, medication allergies, etc.) to record core clinical information.
It also states that the use of certified technology is no longer required for CCM documentation or care plan for sharing within or outside the network. Frequent access to care document is not required, given that providers have timely information on hand or for individuals providing CCM service after hours.
At the same time, CMS recommends physician to use certified technology as per the conditions of Medicare Physician Fee Schedule (PFS) payment to get points for the Quality Payment Program (QPP)
Beginning 2017, care plans can also be shared through fax as it has created more fuss last year among some providers when shared electronically.

Care Management

From now, the clinical summary is renamed as “continuity of care document(s)” and a care management plan copy given to patient requires no format. Usage of certified technology has been completely removed in this revision.
Beneficiary and caregivers are given the opportunity to communicate with the practitioner, not only through telephone, but also by means of secure messaging, Internet, or through any non-face-to-face communication methods.

24 hours access to care

Patients and caregivers are provided access to any of the physicians or other qualified professionals or clinical staff to make quick contact to address urgent care needs, not just for chronic care needs.
Continuous relationship with a designated member of the care team is improved to schedule quick and routine appointments.

Consent Change

Consent can be either verbal or written, but it must be documented in the patient record and the same should be explained for transparency.