Tag Archives: chronic care

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?

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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,

  1. 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.
  2. 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.
  3. 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.
  4. 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit (AWV) is becoming increasingly significant in preventive healthcare services and there are many questions surrounding AWV and its actual benefits. Here is our answer to some of the trending questions:

Is Annual Wellness Visit the same as an Annual Physical Exam?

The immediate answer is a No, AWV is not the same as an annual physical exam. Medicare will cover an Annual Wellness visit but not an annual physical exam.  Under the Affordable Care Act (ACA), Medicare covers AWV completely, with no co-payment and no patient deductible. This is only valid  if the services provided during the visit meet specific criteria for information-gathering, assessment, and counseling.

What’s the difference between AWV and Annual Physical Exam in terms of patient assessment?

The premise of an Annual Physical Exam is to study the body and determine if there is any physical problem with the patient. On the other hand, the Annual Wellness Visit is to identify risks and then mitigate those risks by referring the patient to an appropriate resource.

Medicare Wellness is a holistic assessment routine

Annual Physical Exam is a measurement routine
  • The Doctor will measure height, weight, blood pressure and other routine measurements
  • The Doctor will assess your risk factors and treatment options
  • Review Health Risk Assessment questionnaire
  • Updating list of providers and prescriptions
  • Looking for signs of cognitive impairment
  • The Doctor will set up a screening schedule for appropriate preventive services
  • The Doctor will review your medical and family history
  • The Doctor will measure height and weight; blood pressure; BMI
  • The Doctor will assess your risk factors for preventable diseases
  • The Doctor will perform head and neck; lung; abdominal and neurological exams
  • The Doctor will check vital signs and test your reflexes
  • The Doctor may conduct any blood work or lab tests
  • The Doctor will review your medical and family history

The purpose of Annual Wellness Visit under Medicare is to record the current state of health and to create a starting point for the future. Medicare also covers a number of other preventive services such as preventive cancer screenings, bone density measurement, and flu shots free of cost.

The most important question would be – How is the delivery of an AWV— a preventive care service related to HealthCare Technology?

As a service, AWV is good for both patients and for HealthCare System’s Strategic Objectives. The manual processes involved in delivering AWV can be guided by an automated workflow tool. This tool can enable providers to create an assessment, create personalized care plans, set automated reminders, streamline documentation and educate the eligible population.

AWV intervention points for a tool/software platform like HealthViewX –

Patient eligibility verification Assessment/Scheduling of patient visit Patient visit/ Conducting the routine AWV reports Billing of Medicare CCM Suggestion
Done by HealthViewX Done by HealthViewX Done by Provider Done by HealthViewX, reviewed by Provider, shared with patients Done by Provider Suggest providers to enroll eligible patients for CCM

Empower your practice with HealthViewX’s smart and streamlined AWV and make the most out of Medicare’s profitable wellness program both for your practice and your patients.

Rising popularity of CCM – Common Chronic Diseases In The USA

Chronic illness rates are increasing year by year and are taking a toll on the nation’s population. Serious chronic diseases like stroke, diabetes, cancer, heart disease, etc. are one of the leading cause of increased death rate in the country. More than 75% of healthcare spending is on people with chronic conditions. Beyond any statistics, medication non-adherence is a poor clinical outcome and overcoming this is another great challenge. Thus, doing more to take care of the population health is crucial.

Even today, we witness patients suffering from poor access to healthcare and it is continuing to increase. So improving quality of life for people with chronic disease is vital and is an epidemic in the USA. Simultaneously, the burden of multiple chronic illnesses is also increasing rapidly. In one of the recent release, it is noted that two-thirds of Medicare patients have two or more chronic conditions; another one-third have four or more.  The growing impact of this condition is placing a huge economic demand on the nation. Utmost care has to be taken to address this growing condition, and addressing it will not only reduce cost but also increase the quality of life.  Taking steps towards better health and using care more effectively is a need today.

Chronic Care Management is a boon to both the providers and the patients. The Center for Medicare and Medicaid Services (CMS) has taken a lot of new initiatives to raise awareness of the benefits of Chronic Care Management. This initiative offers family physicians and other healthcare specialists the support they need to implement Chronic Care Management in their practice. It is all about providing care to patients with chronic illness through a framework for embracing healthy life, improving patient health and increasing revenue.

The prime goal of CCM is to improve care quality through remote monitoring and managing patient health conditions better by creating care individual care plans for each of the patients for achieving better health outcomes.

Chronic Care Management promises the below

  • Continuity of care by the provider.
  • Individual care plan for patients.
  • 24/7 access to healthcare.
  • Assessment of patient health records, patient-generated health data.
  • Access patient health information at regular intervals.
  • A secure electronic platform to share patient information and care plans
  • Managing care transitions

Apart from this Chronic Care Management includes non-face-to-face care management and care coordination. The transition from fee-for-service to value-based payment has a huge impact in the healthcare industry. And the CCM billing model makes it possible by getting paid for the time and effort the care team invests in their patients. It is evident that this is benefitting both the patient and the provider. CCM has gained in traction through the value the physicians bring in by delivering continuous and connected healthcare. For the past many years, physicians have helped patients over the phone but never got paid for it. But now with the introduction of Chronic Care Management (CCM) by Center for Medicare and Medicaid Services (CMS) this has been resolved. Patients can elect one physician to take care of their CCM program. The elected CCM physician or provider must establish, implement, revise, or monitor and manage an electronic care plan that addresses the physical, mental, psychosocial, functional, and environmental needs of the patient as well as maintain an inventory of resources and supports that the patient needs. Thus, the practice must use a certified EHR to bill CCM codes. The CPT CPT codes 99490 and 99487, and the add-on CPT code 99489 is a new source of revenue for the physicians’ and other care providers.

And it is no surprise that CCM is gaining popularity among all the care providers, physicians, and patients. Schedule a demo with us to know more about HealthViewX – Chronic Care Management Solution

Redesigning the Healthcare Delivery Model To Suit The Future

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The WHO predicts that in the decades to come to the population of people above 65 will surpass that of children under 5 years of age. Analyzing the current trends, it can be concluded that many of these senior citizens are prone to have one or more chronic conditions.

Chronic conditions could mean more expenses for the payers and more pressure to the system. This is a volatile situation, where the social and demographic changes resulting will have a negative impact on efficiency and per capita cost factor.

To cope with this rise in senior population with chronic conditions, healthcare systems will have to manage the following:

1. Adding human resources:
Perhaps the most obvious but the most important step to adapt is to invest in human resources. It has been observed that human interactions cannot be substituted, healthcare delivery centers who focus on having optimum qualified resources in their care delivery system have more often proved to deliver the better patient experience.

2. Precision Medicine:
Precision medicine is understanding and acknowledging that different patients react to medication and treatment differently due to genetic disposition. Treatment and medication must be engineered to get the best result as possible.

Connected devices and health monitoring equipment that aids in gathering patient information near to real-time helps best possible health outcomes achievable even in the most complex scenarios.

3. Overcoming impending shortage of healthcare professionals:

The proportion of healthcare providers to that of the population is already less than ideal. This trend is said to continue even as the number and necessity of patients multiply. Healthcare providers must find a way to bridge the gap between demand and supply in healthcare. One way to do it is to create new models of care delivery using technology to stretch help across geographic distances. Telemedicine is a viable option available for healthcare professionals to augment their services in order to do more with less time and resources.

4. Holistic Medicine:

Decades of focus on specialization has made healthcare professionals see a disease or its symptom as an isolated case, and the patients are considered cured by only removing the disease. In practice, a person might be suffering from multiple health issues and a simplified isolated view might do more harm than good to a patient.

5. Leading cause and concentrated efforts

In the coming years and even now, termination of a patient’s life is more likely to occur due to traceable lifestyle choices or practices than from any infection or diseases. For example the relation between obesity and disease has for long been proven beyond any doubt, furthermore, obesity and related illness will increase the cost of treating a patient. Therefore a concentrated effort to reduce obesity can bring about a positive result in reducing the possibility of heart disease and stroke.

Like obesity, scientific observation can identify key causes of a disease and healthcare providers can make a concentrated effort in reducing the causes in a population.

These are the most important steps a healthcare provider will have to consider in improving healthcare outcomes.

The transition to a more technology involved healthcare delivery management can tremendously help providers be agiler and more effective with necessary amendments.
Healthcare strategies must be relooked to have a more holistic & flexible approach not only to accommodate CMS led changes but also to benefit the entire population.

Era of A Personalized Care

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Humans differ in terms of DNA & Genome Composition. This factor may not necessarily surface as a disorder or a disability but will create variations in the manner each person responds to drugs and treatment for a disease or a condition. In any given population, there is a chance that a group exists who do not respond to any given medication in the desired manner.

Personalized medicine is the practice of designing and conducting medicine tailored to suit an individual patient’s needs with procedures, drugs and treatment approaches. Personalized medicine has been the war cry for many healthcare reformists for decades, but now there is more likelihood of the general healthcare practice widely adopting the idea because of the following reasons.

Change in regulation
Change in attitude
Healthcare technology
The current model is ineffective

Change in regulations:

The US healthcare regulations are changing giving way to implement the new methodology of care delivery and management. The provider reimbursement is being made flexible allowing healthcare professionals the space to adopt their practice for the benefit of each individual. Change in regulations also will lead way to alterations in the structure of organizations; the organizations will be revamped to be more collaborative and serve a population that is demanding quality and services that match any other industry’s methodology.

Change in attitude:

Providers of today have many tools at their disposal and partially due to this reason providers are more willing to embrace change and improve the lives of those whom they serve. The complexity that the modern medicine requires and the practice of handling a large amount of data is almost impossible to manage and generate result without healthcare IT.

Healthcare Technology:

Healthcare Technology is improving and evolving tremendously, allowing both providers and the patients not only to keep track but actively engage in Care Management. The data that is collected by connected devices and the quality of information that is gathered by hospital systems allows for an in-depth analysis of healthcare conditions and concerns.
For those not residing in cities, Healthcare IT means fast care with the focus on those suffering from chronic conditions. In personalized medicine, Healthcare IT can be used to gather personal information and monitor the effects of treatment and medication, and also play as a channel to direct personalized care.

The current model is inefficient:

The current model is inefficient and rigid to incorporate the necessary changes that need to be made to accommodate all the variations required in care delivery. The results are varying and the outcome cannot be accurately predicted. The healthcare sector now works under the assumption that reaction to a medication or procedure is the same for every individual. This is a risky assumption and one which is costing the public their health and money.

Personalized medicine is the future of healthcare, it is the next big idea that is going to shape healthcare delivery for the times to come incorporating technology. We at HealthViewX understand this, and we are determined to create healthcare delivery tools that collect useful patient information to help providers make choose the right path always.