Tag Archives: chronic care

What is Complex Chronic Care Management – All you need to know

Chronic Care Management

The Centers for Medicare & Medicaid Services (CMS) considers Chronic Care Management (CCM) as a crucial part of primary care. Chronic Care Management is non-face-to-face care provided to Medicare patients with two or more chronic conditions. It contributes to better health services to people. In 2015, Medicare started to reimburse a certain amount for the Chronic Care Management services under the Medicare Physician Fee Schedule (PFS).

Service 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, 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 care provider, per calendar month
CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified care provider, per calendar month (List separately in addition to code for primary procedure)

Difference Between CCM and Complex CCM

CCM (“non-complex” CCM) and complex CCM services have similar health service elements. They differ in the following aspects,

Amount of clinical staff service time provided
Involvement and work of the billing practitioner
The extent of care planning performed

According to Medicare, “Complex Chronic Care Management services of less than 60 minutes in duration, in a calendar month, are not reported separately. Practitioners must report CPT 99489 in conjunction with CPT 99487. They must not report CPT 99489 for care management services of less than 30 minutes along with the first 60 minutes of Complex Chronic Care Management services during a calendar month.”

Eligibility Criteria for Care Providers

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

Certified Nurse Midwives
Clinical Nurse Specialists
Nurse Practitioners
Physician Assistants

Patient Eligibility

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

As Chronic Care Management services have reimbursements, physicians must consider administering CCM to the eligible Medicare patients. The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex Chronic Care Management services during a given service period, not both.

Supervision

The Complex CCM codes (CPT 99487, 99489) come under the general supervision according to Medicare PFS. A billing practitioner need not give the health service personally. Any qualified care provider can give the service under the billing practitioner’s overall direction and control. The billing practitioner’s physical presence is not required.

CCM Service Summary

Care providers give a non-complex or complex Chronic Care Management service through the following steps,

Initiating Visit – Medicare requires initiation of CCM services for new patients or patients not seen within one year of commencement of CCM. It is a face-to-face visit with the billing practitioner. It includes an Annual Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or other face-to-face visits. This initiating visit is not part of the CCM service and is separately billed.
Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of patient’s demographics, problems, medications, and medication allergies using certified Electronic Health Record (EHR) technology.
Comprehensive Care Plan – A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment. The care provider must,

Provide the patient and/or caregiver with a copy of the care plan
Ensure the electronic care plan is available and shared timely within and outside the billing practice to people involved in the patient’s care

24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified care providers or clinical staff and continuity of care with a designated member of the care team.
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.

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 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 reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution has features that satisfy non-complex and complex CCM services. Medicare reimbursements for Chronic Care Management services increase the profits for community health centers. It also benefits patients with multiple chronic health conditions. To know more about our Chronic Care Management solution, schedule a demo with us.

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.

Top 7 Measures That Can Help In Boosting A Hospital’s Revenue

Hospitals in the USA play a vital role in the healthcare industry. But in today’s economy hospitals in USA are facing a serious financial crisis despite the various revenue sources. This is due to the increase in the number of uninsured people seeking medical services, lower reimbursement rates from the Center for Medicare and Medicaid Services (CMS), staff shortage, etc. Many hospitals are facing bankruptcy and some are eventually shutting down.

Why are hospitals in the USA facing economic recession?

The following are the few reasons why hospitals are facing financial difficulties

Lower reimbursement rates – Financial burden on the hospitals have increased due to the falling reimbursement rates from the CMS. According to the study done by the American Health Association, there is a steady decrease in the reimbursement rates for Medicare and Medicaid services. When the cost incurred on the service is more than the reimbursement received, the hospital suffers a huge loss. Hospitals in the USA received only 87 cents for every dollar spent on Medicare patients in 2016. Hospitals in the USA received only 88 cents for every dollar spent on Medicaid patients in 2016. In 2016, 66% of hospitals received less Medicare payments, while 61% of hospitals received less Medicaid payments. With the increase in the aging population, Medicare and Medicaid services will become a financial burden for the hospitals.
Increasing the number of uninsured and older people – The increasing number of uninsured and older people implies that many hospital services will go unpaid affecting their medical billing cycle. This increases the hospitals’ debt, as the state and federal laws insist on providing care for all regardless of their financial ability affecting the overall healthcare revenue cycle. In addition to the increasing number of the uninsured population, people are living longer. Therefore, they need more care and longer hospital stays.
Rising cost of hospital equipment – Hospitals must have updated equipment to retain their patients. When hospitals change to new technology they incur significant cost on the equipment and on training their staff in operating the new device. There is no more long hospital stay because of the technological advancements. This affects the medical billing revenue cycle. Also, there is an increase in labor costs due to the acute shortage of registered nurses.

Top seven approaches to maximize profitability

Industry experts say that the key to maximizing a hospital’s profit is to cut down the costs and increase the reimbursements. Following are the top seven practices that a hospital can take up amid the poor economic conditions.

Cut down staffing costs by data-driven decisions
Cut down costs by managing vendors
Involve physicians in cost-cutting efforts
Partnering with other organizations
Partnering with local physicians
Attracting new physicians
Changing the quality of service

Let us look into each of them in detail.

Cut down staffing costs by data-driven decisions – Labor is the biggest cost for hospitals. It is important for the hospitals to have the right headcount in their facilities. Hospitals can employ staff on a part-time or hourly basis. This is called “flexible staffing”. The hospitals can adjust the staff strength based on the patient census data. The hospital management must also monitor the efficiency of the staff. They can review the average hours spent on a case and compare it with the benchmark value. The hospital must communicate about the efficient staffing benchmark throughout the organization. The hospital management must collaborate with the physicians, nurse practitioners, etc to meet the expectations. Hospitals must not have a blanket approach to layoffs. The hospital management must take a close look at their business before laying off employees.
Cut down costs by managing vendors – Hospitals can cut down supply costs by working with vendors. This will improve contracts and encourage physicians to take fiscally responsible supply decisions. The hospital management should not shy away from approaching vendors for discounts. Hospitals must have only the required number of vendors. The hospitals can also ask the vendors to submit purchase orders for equipment or implants that were not included in the written agreement with the facility.
Involve physicians in cost-cutting efforts – Hospitals should encourage physicians to keep a watch over the supply costs and other activities, such as unnecessary tests and inefficient treatments that may drive up the hospital costs. The hospital must support the use of products from vendors that are cost-effective but still of high quality, especially in areas such as orthopedic implants, which can be considerably costly for hospitals. In addition, experts say the use of protocol-based care can cut down costs associated with unnecessary tests or treatments.
Partnering with other organizations – During tough economic times, some hospitals can outsource or partner with other organizations for certain services, such as food and laundry services, clinical services, etc. By outsourcing certain services to more efficient providers, hospitals can share the savings with the service provider. However, hospitals must be sure to select truly efficient providers. Often, hospitals outsource services such as laundry, food and nutrition, information technology or human resources as they do not have the capital to invest in these. Some hospitals have also begun to outsource clinical services such as emergency room staffing, anesthesiology, etc to become more efficient.
Partnering with local physicians – Hospitals can join hands with local physicians and surgery center management companies to offer outpatient services. This reduces competition and also improves the hospital’s revenue cycle management.
Attracting new physicians – Identifying and attracting new physicians to bring cases to the hospital is another way to increase profits. Physician-owned hospitals can bring in more physicians as partners, while other types of facilities can recruit new physicians who are willing to visit patients at their hospitals.
Changing the quality of service – Hospitals can change or increase the quality of services they offer to be able to compete in the market. For instance, a hospital can invest money to develop their cardiac or cancer treatment centers which will attract more patients from different areas. New programs and treatment centers will also influence more doctors and nurses to join their hospitals. This may cost a lot but it has the potential to bring in higher profits because specialized care cost more money and attracts more patients who otherwise cannot receive this care in other hospitals.

Hospitals that focus on enacting these best practices are likely to see improvements in their profitability. Hospitals can also benefit from using today’s economic conditions as an opportunity to improve their overarching approach to business, creating a more sustainable organization in the future. Schedule a demo with us to know more!

Community Clinics Missing Out On The Progress Of A Referral – Know More!

What are Community Health Centers and what they do?

Community Health Center (CHC) in the United States is a non-profit entity comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in CHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. CHC is a dominant model for providing integrated primary care and public health services to low-income and underserved population. There are two types of CHCs, one receives federal funding under Section 330 of Public Health Service Act and the other meets all requirements applicable to federally funded health centers and is supported through state and local grants. To receive federal funding, CHCs must meet the following requirements.

Be located in a federally designated medically underserved area (MUA) or serve medically underserved populations (MUP)
Provide comprehensive primary care
Adjust charges for health services on a sliding fee schedule according to patient income
Be governed by a community board of which a majority of members are patients at the CHC

Patient Referral Program in a Community Health Center

Community Health Centers constitute Primary Care Providers (PCP) who serve the underserved population. CHCs are high outbound referral setups i.e they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the severity, the physician might refer the patient to an imaging center for further diagnosis or to a specialist practice for advanced treatments.

Any Community Health Center will have a dedicated referral coordination team to send out referrals and take care of the community care coordination program. With the help of the patient demographics and diagnosis details available, the referral coordinator will go about doing the insurance preauthorization and finding the right imaging center or specialty practice for the patient. After that, the coordinator will create a referral that includes the details of patient demographics and the required diagnosis. Then the referral is sent to the relevant imaging center or specialty practice.

Challenges faced

The referral creation involves tedious manual work due to the following reasons.

Finding the right specialist/imaging center – The number of imaging centers and specialist practices is increasing day-by-day. It takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one.
Time Spent – As the referrals are handled manually, a referring coordinator spends about half-an-hour to one-hour for a creating referral on an average and even more time in following up the same.
No Updates – After a referral is sent, both the referring and the receiving providers get busy. It is not possible for both of them to be updated on the referral progress. So the specialist/imaging center and the patient fail to update the clinic on the progress of the referral. This results in open referral loops.

Why are referral updates important to a clinic?

The patient’s well being – Any physician would always want to check on his/her patients’ health. So it is essential for a provider to want to know if the receiving provider accepted the referral, scheduled an appointment with the patient, the patient recovery status, or how severe is the illness, etc.
Referral loop closure– Open referrals are a result of the referring provider not getting to know the referral’s progress. The ultimate aim of a referral process is to give the patient better treatment. Closing a referral loop is very important because it indirectly proves that the patient was taken care of.
Data Analytics – PCPs require concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
Referring to the right person – Depending on the progress of the referral and the patient’s feedback, the physician can get to know how good or bad the referral process has been. This will help the physician in knowing to whom he can refer and to whom he should not.
Schedule follow-up appointments – After the referral is done, the physician has to schedule an appointment for the patient. For eg: If the physician is referring his patient to an imaging for X-ray, the physician must be notified once the test is done so that he can schedule an appointment and give treatment to his patient depending on the results. Structured appointments scheduled in a well-managed referral system is a constant source of new patient revenue.

Be updated about referrals with the HealthViewX solution

The major problem with a Community Clinic not getting updates is that everything is manual. A software solution can solve this problem quite easily. HealthViewX Patient Referral Management solution enables creating a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. The system can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view, history of the referral can be seen for eg: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can always keep you updated on the progress of the referral thus simplifying the referral process and helps in closing the referral loop.

HealthViewX Patient Referral Management solution helps the referring provider to track the referral progress. Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant solution.

All That You Need To Know About Patient Readmission Rates

What is Patient Readmission?

Patient readmission happens when a discharged patient is again admitted to the hospital within a specified period. CMS used different time frames for research purposes, the most common being 30-days, 90-days and 1-year readmission. They define patient readmission as “An admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital”. It uses an “all-cause” definition, meaning that the cause of the readmission need not be related to the cause of the initial hospitalization. The CMS set the time frame to 30 days because readmission during this time is a result of the care given at the hospital and how well they coordinated the discharges.

Why does Patient Readmission happen?

Before knowing why readmission happens, there are two terminologies that we must know to understand it better.

Index Hospitalization – The original hospital stay i.e when a patient gets admitted for a treatment in a hospital is “index admission”.

Hospital Readmission Rates – The rate at which a hospital readmitted its patients is a “hospital readmission rate”. In other terms, it is an outcome or a quality measure of care given by health systems.

Here are the top four reasons for patient readmissions,

Importance of paying heed to the physician – Mr. Hayden got admitted to a hospital for a knee surgery. The physician advised him to take complete rest. He did not listen to the physician and strained himself resulting in severe leg pain. Now Mr.Hayden is then re-admitted to the hospital. In this case, the patient should have paid attention to his physician’s advice.
Recovery Instructions – Dr. Adams is a cardiologist. He performed an open heart surgery on one of his patients. Since Dr. Adams was busy with many other surgeries on the same day he couldn’t give the patient instructions regarding post-surgery clinical exercises. He entrusts a nurse with the job. The nurse forgets to instruct the patient about the prescribed exercises. The patient then gets readmitted to the hospital complaining of chest pain. It is the responsibility of the specialist to give the required instructions to his patient and help them recover quicker.
Communication between the patient and the specialist – Mr. Mark gets admitted to the hospital for ulcer treatment. The patient fails to give his complete health problems to the specialist. The specialist does not probe much and gives the usual treatment. Mark is fine for a week after discharge but is then re-admitted for the same problem. It is important for the patient to share all his problems with the specialist and it is the duty of the specialist to understand the complete health history of the patient.
Continuous care to the patient after discharge – Dr. George is an Orthopedic specialist. His patient is suffering from arthritis. The patient needs continuous monitoring and care. The specialist is mostly not reachable over the phone for doubts. Here arises the need for technology, a software that can help both the patient and the specialist in continuous assessment.

Patient readmission risks

Readmission rates decide the quality of care given by the physicians. The CMS introduced the Patient Protection and Affordable Care Act in 2010 penalizing the health systems having higher than expected readmission rates through the Hospital Readmission Reduction Program. They specifically designed the program for incentivizing hospitals that had higher readmission rates of 20% in 2010. CMS reduced the reimbursements of the hospitals depending on the rate of the breach which was effective in reducing the readmission rates by 2% in 2013.

Ways to Reduce Patient Readmission Rates

A study presented by the Harvard Business Review found that on average, a hospital can reduce its readmission rates by 5% if it simply prioritized communication with patients while also complying with evidence-based standards of care. The following steps are a great initiative in cutting down the readmission rates.

Scheduling follow-up appointments – After a patient gets discharged it is essential to get in touch with him to inquire about his well-being. The appointments need not be face-to-face always. The physicians can conduct appointments through audio or video calls or sometimes even through messaging or e-mails. It will help the physician in knowing how well the patient is after the treatment or surgery.
Long-term relationships with patients – Patient engagement is the key to reduce patient readmission rates. Rehabilitation programs, good nursing team, home care, wellness programs etc can improve patient engagement and thus reduce readmissions.
Technology to play a vital role – A software to monitor the patients continuously can really help in solving the readmission rates problem in a cost-effective way. It also provides many other advantages and reduces manual work.

How can technology help in curbing readmission risks?

Information Technology is everywhere, so why not in healthcare? HealthViewX Care Management Solution helps the providers in monitoring and providing care to patients anywhere. It allows the provider to create a care plan for the patient. The care plan comprises many vitals, activities, treatments etc. The provider can select the appropriate ones and create a care plan. The patient who has a mobile application gets notified about the care plan. He can go about recording data for the vitals or measurements given. Both the patient and the provider can view the data in form of graphs or tables which will help the provider to keep an eye on the patient’s vitals. The following features help the hospitals in monitoring the patients easily and thus reducing the readmission risks.

Electronic Care Plans – Care plans to monitor patient’s vitals, measurements, etc. If required, it can also be printed and handed over to the patient.
Patient Reported Data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the provider in monitoring the patient’s vitals. The physicians can print reports at any time in pdf or excel 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.
Follow-up Appointments – The solution enables to schedule follow-up appointments and sends reminders to both the patient and the provider. It also has inbuilt audio and video calling features to support such meetings.

HealthViewX Care Management Solution offers a range of advantages and lessens the chances of a patient getting readmitted. To know more about our solution, schedule a demo with our expert team who will guide you through the process. Schedule a demo with us to learn more.