Tag Archives: care management

How Is CMS Changing The Face Of Remote Patient Monitoring And Patient Access?

CMS has finally issued its 2019 Physician Fee Schedule Proposed Rule. It has highly anticipated new reimbursement policies for telehealth, remote monitoring, with a stronger focus on patient access to health information.

The new codes for Patient Remote Monitoring

The 2019 Proposed Rule offers three codes through which providers can get reimbursements for integrating remote monitoring data into their practice.

The first two are practice expense codes, which include resources providers spend such as office rent, supplies, and medical equipment. The third code tracks the amount of time a care provider spends managing patient care using the remote monitoring data.

990X0 – Remote monitoring of physiologic parameter(s). Covers the time providers spend on setting up the technology and explaining to patients how it works.
990X1 – Remote monitoring of physiologic parameter(s). Covers device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
994X9 – Remote physiologic monitoring treatment management services. Covers 20 minutes or more of clinical staff, physician, or other qualified healthcare professional time in a calendar month. The code requires interactive communication with the patient and/or the patient’s caregiver during the month.

There are some challenges in the proposed codes. These codes only cover the exchange and interpretation of “physiologic” data; yet many providers today would agree that there is a wealth of patient data that is helpful at the point of care, including patient-reported outcomes or behavioral data, that would fall outside the definition of physiologic.

Further guidance may be helpful to determine exactly which providers on a care team can spend time working with remote monitoring data. While the code definition states “clinical staff, physician, or other qualified healthcare professional,” elsewhere in the PFS proposed rule refers to the term “practitioner,” which “is used to describe both physicians and non-physician practitioners (NPPs) who are permitted to bill Medicare under the PFS for the services they furnish to Medicare beneficiaries.”

New Reimbursement for “Communication Technology-Based Services”

CMS acknowledges the evolution of physician services furnished through communication technology. So Medicare enacted the telehealth services statutory provision for patients with chronic conditions. Recognizing the many statutory restrictions on telehealth in Section 1834 (m) of the Social Security Act, CMS has taken the interpretation that there are physician services that involve interaction with a patient via remote communication technology that are not considered telehealth services and therefore are not covered by these restrictions.

CMS proposed several new HCPCS codes that are not considered “telehealth” services and as such, not subject to the conditions of Section 1834 (m):

HCPCS code GVCI1 – Brief Communication Technology-Based Service, e.g. Virtual Check-in. This would include the kinds of brief non-face-to-face check-in services furnished by a physician or other qualified healthcare professional, using communication technology, to evaluate whether or not an office visit or other service is warranted.
HCPCS code GRAS1 – Remote Evaluation of Pre-Recorded Patient Information. This covers physician time spent reviewing patient-submitted video or images to determine if a follow up visit is needed.

CMS acknowledges modern communication technology that allows for “the kinds of brief check-in services furnished using communication technology that are used to evaluate whether or not an office visit or other service is warranted.”

Beginning January 1, 2019, CMS is proposing to pay providers for utilizing these types of preventative technology services, even in cases where the activity means that a follow-up office visit is not scheduled. Where the check-in services precede an office visit or follow a visit within the previous 7 days, they would be bundled into the payment for the visit, but where the service does not lead to an office visit, there could be a separate payment.

CMS is seeking comments on the implications of this approach, as well as more information from industry about the types of technologies in use today to achieve these goals. Additionally, CMS seeks insight from industry as to if,

These services are appropriate for new patients
They are only for existing patients
Patient consent is required

Health Information Technology to simplify the process

Information Technology can greatly simplify the process by making remote patient monitoring easy for the hospitals. HealthViewX is a healthcare product that provides solution for remote patient monitoring, chronic care management and referral management. Our product has many unique features that simplify the workflow and improves patient satisfaction. To know more about our solution, schedule a demo with us.

References

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

Physicians Complete Guide to Chronic Care Management

Senior citizens with one or more chronic conditions have a hard time managing their health. CMS was spending a lot of money on patient’s insurance who were suffering from chronic conditions. In order to cut down the expenses on hospital admissions, the CMS introduced the Chronic Care Management program. Patients usually visit their physicians for chronic care once or twice a year. With a Chronic Care Management program, a patient’s health improves due to increased attention and care. They can also spend less time on health issues and more on what they like to do.

What is Chronic Care Management?

Medicare defines Chronic Care Management program as non-face-to-face service provided to its beneficiaries with multiple (two or more) significant chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include

Communication with the patient
Health professionals being available both electronically and by phone for care coordination, medication management, and being accessible to patients.

Time-consuming process

Despite the increased Medicare reimbursement rates, patients do not get CCM services due to the physician’s time constraints. Chronic Care Management program requires a lot of time and effort from the physician. Unfortunately, providers must meet a number of requirements to qualify for a CCM Medicare reimbursement. These include:

Twenty minutes of non-face-to-face conversation per month with the patient
Use of a certified EHR
Create a patient care plan based on the assessments and available resources
Provide the patient with a copy of the monthly updated care plan and document the same in the EHR
Ensure that the care plan is available electronically to anyone within the practice providing CCM services
Share the care plan electronically outside the practice as appropriate
Ensure 24/7 access to care management services
Ensure continuity of care with a designated practitioner or member of the care team who will take care of successive routine appointments

The list goes on at considerable length defining the care practice must give. The fact sheet offered by the CMS goes up to eleven pages with multiple requirements to bill for CPT code 99490. This can become quite cumbersome for any practice, considering that the Medicare reimbursements are only $42.60/patient/month.

Steps to improve the Chronic Care Management program

1.Building a strong team

If a practice chooses to offer CCM services, it will be an investment. The demands include

Additional staffing with additional salaries,
Benefits and increased workload for management.
Additional office space depending on your current facility
It is important for the practice to set up a plan of action to calculate the required additional staff members required and the exact cost of this service. The practice must,
Start by assessing how many patients in the practice will be eligible to receive CCM services.
Identify how many people are needed to give quality CCM services to their patients and also additional salaries and benefits, added office space, etc.
It is important to analyze the merits and demerits from a financial perspective. Even if a practice is not profiting from CCM in the first stages, it is always possible to derive profit later.

2.Outsourcing Chronic Care Management services

Many private practices and hospitals who want to offer CCM services but cannot the implementation process can opt for outsourcing their CCM. There are vendors who provide this service and understand the new requirements better for reimbursement eligibility. In essence, they become an extension of the practice and require minimal financial investment from the provider. By this, the practice can manage the risk factors, patient experience, and profit better. A study on outsourcing chronic care management for diabetes patients found that those who participated in the outsourced care,

Rated the experience more positively
Demonstrated better clinical outcomes than those who received clinic-based care

3.Using a Chronic Care Management software

Chronic Care Management software can reduce the time and the manual effort spent in giving the CCM services. HealthViewX Chronic Care Management solution has the following features that make the process simpler,

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

A healthcare practice following the above steps will find significant improvement in their Chronic Care Management program. HealthViewX Chronic Care Management software has features that suit practices as well as CCM vendors. To know more about our Chronic Care Management solution, schedule a demo with us.

References

Wolf, M. S., Seligman, H., Davis, T. C., Fleming, D. A., Curtis, L. M., Pandit, A. U., … & DeWalt, D. A. (2014). Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention. Journal of general internal medicine, 29(1), 59-67.

Remote Care And How Chronic Care Management Simplifies It

Healthcare industry of the US has introduced many technologies to give the best care to all irrespective of their place, accessibility, etc. Remote Care to patients is the latest healthcare technology. It enables monitoring of patients’ health outside conventional clinical settings. This may increase access to care and cut down the healthcare delivery costs. Hospitals offer Telehealth services as a part of Remote Care. This includes,

Virtual Consultation – It is a virtual visit that takes place between the patient and the physician. It takes place through audio or video calls. It is effective for common problems like flu, acne, fever, etc. It reduces the patient’s traveling cost and provides better access to quality care.
Remote Health Monitoring – Patient Health Monitoring is the latest technology in the healthcare industry. Patient physiological data like blood pressure, blood sugar, heart rate, etc can be measured by external devices. It can be a Fitbit, apple watch, etc that can communicate with the system in the hospital. It will help the physician to always keep an eye on their patients’ vitals and prescribe telemedicine and preventive care plans.
Chronic Care Management – Chronic Care Management is non-face-to-face care provided to patients with multiple chronic conditions. Medicare reimburses a certain amount for the Chronic Care Management services given by the hospital. Chronic Care Management is most administered through audio calls.

As Chronic Care Management services have reimbursements, physicians must consider administering CCM to the eligible patients. Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions

Expected to last at least 12 months or until the death of the patient.
Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.

CCM Service Summary

The following are steps through which a Chronic Care Management service is furnished,

Initiating Visit – Initiation during an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE) or face-to-face E/M visit for new patients or patients not seen within one year prior to the commencement of Chronic Care Management services.
Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of demographics, problems, medications, and medication allergies using certified EHR technology.
24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified healthcare professionals or clinical staff and continuity of care with a designated member of the care team.
Comprehensive Care Plan – Creation, revision, and/or monitoring of an electronic person-centered care plan.
Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.

Eligibility Criteria for Physicians

Physicians and the following non-physician practitioners may bill CCM services:

Certified Nurse Midwives
Clinical Nurse Specialists
Nurse Practitioners
Physician Assistants

HealthViewX Chronic Care Management solution features

HealthViewX Chronic Care Management solution has the following features that make the process simpler,

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture from the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. All patient-related documents are managed securely.

HealthViewX Chronic Care Management solution is on par with the current requirements. Remote care is the easiest and the cheapest way to treat your patients. Medicare provides reimbursements for Chronic Care Management which makes it the best way to give care to patients from the remote. To know more about our Chronic Care Management solution, schedule a demo with us.

How Can Physicians Manage Patients’ Annual Wellness Visit better?

What is AWV?

In the year 2011, the Center for Medicare and Medicaid Services (CMS) introduced the Annual Wellness Visit (AWV). An AWV is a yearly appointment of the patient with the physician funded by the American Affordable Care Act. It is very different from an Annual Physical Exam and is more of an educational visit than a diagnostic one. During this visit, the physician formulates a preventive plan for the patient for the coming year. This plan can help in preventing illness based on current health and risk factors.

Eligibility Criteria

Medicare provides Personalized Prevention Plan Services (PPPS) under the wellness plan for beneficiaries who:

Are no longer within 12 months after the effective date of their first Medicare Part B coverage period
Have not received an Initial Preventive Physical Examination (IPPE) or Medicare yearly wellness visit within the past 12 months

The following medical practitioners are eligible for providing Medicare yearly wellness visit services to patients:

Physician (a doctor of medicine or osteopathy)
Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioners), or a team of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)

Medicare Wellness checklist

Initial Annual Wellness Visit – This is applicable the first time a beneficiary receives an Annual Wellness Visit. It includes the following components:

Acquire Beneficiary Information: The physician assesses the health risk factors of the patient. It includes analyzing patient self-reported information, demographic data, daily activities, etc. He/She collects data from the list of physicians who regularly treat the patient. The physician reviews the beneficiary’s medical and social history, completely studies the patient’s potential risk factors, mood disorders, functional ability and level of safety.

Begin Assessment: The physician begins the assessment by measuring the patient’s vitals. He/She identifies the patient’s illness through direct observation, medical history, concerns raised by family members, friends, caretakers, etc.

Counsel Beneficiary Action: The physician establishes a written screening schedule for the beneficiary, such as an appropriate checklist for the next 5 to 10 years, etc. He/She furnishes personalized health advice to the beneficiary and generates appropriate referrals to specialist clinics or imaging centers. The physician gives advance care planning at the discretion of the beneficiary.

The subsequent Medicare yearly wellness visits include the above components and will be updated on the later patient visits.

Billing Codes for Medicare Yearly Wellness Visit

G0438	$117	Annual wellness visit which includes a personalized prevention plan of service (PPS) and the first visit
G0439	$173	Annual wellness visit which includes a personalized prevention plan of service (PPS) and the subsequent visits

Tips for physicians to benefit from Annual Wellness Visit

Managing patients – All Medicare Part B patients are eligible for Wellness Plan services. It is necessary for the practice to find the right patients who would benefit from this service. The physicians must give the patients a clear idea of how Medicare Wellness Program process works, what they can expect from the service, etc. The practice must make the patients aware of the reimbursements and the additional charges they may incur depending on their insurance coverage.
Developing protocols for schedules – A Medicare Wellness Program takes a great deal of both staff and physician resources to give the service. It is better for a practice to take some time to decide how these appointments best fit into their existing schedule. Creating a scheduling protocol will save more time and frustration. For example, how many days in a week, the practice can schedule these appointments, what tool for tracking the Medicare Wellness Program services, patient records, reimbursement rates, etc.
Pre-visit planning – The practice must verify not only the patient’s Medicare Part B effective date but also whether the patient has received a Wellness Plan from any physician in the last 11 months. Otherwise, Medicare may deny the service, leaving the patient with an unexpected bill. The practice must do the same verification for other preventive services that patients receive along with the Medicare Yearly Wellness Visit. It is ideal to have the staff note the last date of these preventive services on a Medicare Yearly Wellness Visit documentation form in advance of the visit. This will help in determining which preventive services are needed and whether the patient is eligible to have these paid for by Medicare. A pre-visit history can also find whether the patient needs any laboratory tests such as the cardiovascular scans, diabetes screening blood tests, etc. These should be completed prior to the Medicare Yearly Wellness Visit to allow discussion of its results at the visit.
Planning for effective follow-up care – The physician should analyze the patient’s risk factors and problems accurately during the Medicare Wellness Program. The physician must generate a care plan for the patient considering these factors. It is necessary to develop a preventive service plan and a general checklist for the next ten years. The physicians should follow-up the same on the patient’s subsequent Medicare Yearly Wellness Visits.
Getting complete reimbursements – The last step in providing the Medicare Yearly Wellness Program is to get paid the service rendered. AWV attracts the physicians’ attention because of the reimbursements offered by Medicare. The practice must keep up a clear documentation to make the process hassle-free.

These practices simplify the Medicare Wellness Program process thereby improving the efficiency of the practice. The HealthViewX solution eases the AWV workflow for the practice. With HealthViewX solution, there is no chance of losing the reimbursements. To know more about HealthViewX solution, schedule a demo with us.

Why Should A Physician Share A Good Relationship With The Patient?

A physician attends to many patients in a day. But for a patient, the major concerns are about the severity of the illness, the quality of the treatment, etc. Patients expect the physician to diagnose the problem accurately and wants the best care possible. The ultimate goal is to get relieved of the illness as soon as possible. The physician must be interactive with the patient and it is important for the patient to cooperate with the physician to recover soon. So the relationship a physician shares with his patients is very important.

Factors affecting the physician-patient interaction

A patient wants to be taken care of and be able to frequently communicate with the physician. The physician also likes to engage with his patient and make the treatment easier but it is not easy always. So what are the factors that affect the interaction between the patient and the physician?

Physicians get busy – Physicians are always busy. Remembering the diagnosis of every single patient is close to impossible. He might forget what the patient is suffering from and will ask the same questions to the patient which can annoy the patient. The physicians being busy may not always follow-up with the patient. Instead, the physician will have a nurse to do that for him.
No effective modes to communicate – The system of care is still stuck with paperwork and following up or interacting with the patient is more of a documentation work than inquiring his well-being. There are no effective means to communicate with the patient. Following up manually is always prone to errors and leads to patient dissatisfaction.
Unable to reach physicians – Patients may always have to come to the hospital for even small problems as the physician is unavailable over phone calls or messages. It makes it difficult for the patient to get in touch with the physician every now and then.

These factors lead to care fragmentation and affect the health of the patients and also damage the reputation of the provider. Care fragmentation will ultimately lead to frustration between the patient and the provider.

Tips to strengthen physician-patient relationships

Following are five tips to strengthen physician-patient relationships,

Follow-up appointments
Get Feedback
Being available at all times
Staying in touch
Embracing Technology

Follow-up appointments – Scheduling follow-up appointments with a patient after discharge is very essential for continued conversation between doctor and patient. It can help in having a check over patient’s health and also improve physician-patient relationships. Follow-up appointments need not be a face-to-face visit always. The physicians’ can follow-up with their patients through audio or video calls eliminating the effects of poor communication in healthcare. A software to manage appointments and patient demographics can be a very useful physician communication strategy.
Get feedback – A lesser known tip for strengthening physician-patient relationships is by getting feedback from the patients. Feedbacks can be taken through a patient survey on the quality of care and treatment, phone calls, personal conversation with the patients, etc. Feedbacks can be useful in improving patient-physician relationship, knowing how good the service is and the areas for improvement.
Being available at all times – The physician must be available over calls or messages. This will make it easy for the patients to reach out to the physicians at the time of need. A nurse can also assist and bring it to the doctor’s attention if required.
Staying in touch – Though there are no appointments scheduled with the patient, it is always good to have a team of nurses following up with such patients occasionally. This will make the patient feel good about the physician and thus the patient-physician relationship will improve.
Embracing Technology – Technology is simplifying healthcare. With the help of a software, scheduling follow-up appointments, improving network connections, getting feedback from the patients, marketing a hospital, etc are made easy.

What HealthViewX solution offers?

HealthViewX Care Management Solution can help the physicians to check on their patients’ health even after hospital discharge. It results in effective communication within the practice and also between the provider and the patient thus improving the physician-patient relationship. The following are the key aspects of HealthViewX Care Management Solution.

Care plans to enable remote care – A provider can create a care plan for a patient depending on the vitals, treatments, measurements, etc that need to be tracked. The patient-centric application helps in logging data for the vitals specified in the care plan. If needed the care plan can also be printed.
Customizable dashboards to suit the need – Dashboards comprising of graphs and tables show a comprehensive data of the number of patients in different care plans depending on the patient diagnosis.
Scheduler to keep track of the appointments – An inbuilt scheduler keeps track of the appointments and sends timely reminders to both the patient and the provider. The chances of missing out an appointment are very less.
Audio and video calling features – HealthViewX Care Management solution support inbuilt audio and video calling features which help in connecting with the patients for follow-ups.
Patient-reported data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the providers in monitoring the patient vitals. The patient records can be anytime printed in pdf or excel report form.
Health device integration – HealthViewX Care Management solution can integrate with any wearable device like Fitbit, apple watch, etc. Hence the patients need not waste time in logging data in the application if they are already using wearables.

HealthViewX Care Management Solution provides real-time communication between the patients and the providers thus enhancing the relationship between them. Schedule a demo with us to know HealthViewX HIPAA compliant Care Management solution better.