Tag Archives: chronic care

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.

Patient Engagement – A Key To Reduce Readmission

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Many buzzwords are battling around healthcare practices and patient engagement is not new. Healthcare is reforming constantly by implementing new technologies and methods. The reforms in technology make hospitals function better while the changes made in quality measures bring better care quality. The bottom line of any provider is to provide quality care to improve the health outcome through cost-effective methodologies.

Though hospitals have been trying to bring out transitions in patient care with emerging technology they are constantly facing same issues over a period of time called readmission. Hospitals that are registered under Medicare bears the pain of being penalized if their patients get readmitted. In Chronic Care Management, patients get 20 minute of care after their discharge and CMS pays for it. The reason behind this payment is to reduce preventable readmission, and emergency room visits.

Each individual’s health outcome depends on the consistent effort taken by primary care physicians, registered nurses, care coordinators, community health workers, family members and the patients themselves. If there is a readmission then it means there is either a gap in care flow or in communication flow. The only solution to this problem is to engage patients in their own care through simple user-friendly technologies.

Smartphones to engage patients

The smartphone is a good companion for every single individual. People spend most of their time interacting with their smartphones. After smartphones hit the market it has opened a door for many portable health devices which now act as an effective tool in engaging patients in their own health.

It is found that 1 out of every 6 people who are aged above 65 have access to tech devices. Growing population adapt technology faster which means many of them in the next Medicare age group will have smartphones. If the providers pay attention to this stat then it is easy to reduce the readmission. The answer to the question “How smartphones can reduce readmission?” is engaging patients through smartphones.

Mobile technology allows the patient to know about the details of their disease, medication plan, sends appointment reminders to both patient and doctor if any wrong occurs, it helps physicians to create care plans and communicate any time with their patients. At the same time, monitoring devices help to continuously observe the health conditions and send messages to the hospital providers to get instant care.

Educating Patients

Some mobile applications have an inbuilt library which has all the details of medical diseases with their causes, symptoms, medications, treatment procedures, risk factors, and preventive measures. This acts as a reference resource for the patients and they have access to all information in one small handy device. Some tracking and monitoring apps take one step further to engage patients more effectively.

Proper Communication

Some hospitals have also seen a positive outcome in simple and secure text messaging. The message will be sent to the patient and physician as an appointment reminder. Patients who reply back are considered as active patients and they have the low possibility of getting readmitted. These responses will also help providers to check the patient availability to fix up the meeting, also it saves time.
Mobile technology also facilitates timely follow up with patients. Chronic Care Patients who have early follow-up within 7 days have lowered the readmission rate.

CCM Readmission Preventive Measures

1. Send the detailed patient medical summary to outpatient care team immediately after discharge
2. Knowing the patient’s immediate point of contact
3. Follow-up with a week after discharge
4. Educating patient about their health condition before discharging
5. Maintain EHR in such a way to reduce medical errors

Better outcomes come from a better system. Collecting proper patient data and involving patients in engagement activities will help in reducing readmissions.

Profiting From Chronic Care Management

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Chronic patients care requirements are different when compared to regular patients. In case of chronic patients, the provider should create, and maintain continuous yet flexible care delivery model to accommodate various healthcare requirements. Until the recent past, the provider’s reimbursement plans for Medicare was not flexible enough to hold all the post and pre ER visit care that is necessary for health and well-being of people with chronic diseases.

Chronic Care Management CMS has given providers the needed elasticity and space to work best with their chronic patients. Under the scheme, providers can charge CMS for 20 minutes of non-hospital, non-face-to-face care that they give to patients over a month. This is a great leap in the right direction but given the strict parameters of the program, many providers are concerned that being a part of it will do more harm than good financially. But here are a few steps that can ensure the greater chance of financial success.

Start with the program
Design a standard approach
Employ resources
Review

Start with the program

Yes, this is the less obvious but important step, less obvious because no provider would want to get into a program with outcome unknown. Chronic Care Management has a few unique features such as only one provider shall charge for CCM services. This means by the time a provider makes his mind and assigns resources their patients would have already gone to a different provider.

It is also true that the program and the approach with which it is designed is rather new in the industry today and it will do good for providers to understand and be used to the change.

Design a standard approach

Like all programs CCM would benefit from a standard approach, it will make it easier for providers to alter and adapt it later. A standard approach will also make billing easier & less troublesome. The main idea here is to spot what works best for a practice and if it doesn’t then how it can be changed to arrive at the result that the provider hopes to achieve.

Employ Resources

Provider/ Practice must designate and assign a resource for CCM program. Resources which include human can achieve the objectives better if the program is taken seriously and not like a side assignment without any defined parameters. In most cases, resources are already available and assigned to chronic patients care but adjustments need to be made so that such systems will meet the program parameters.

Review

This step is evident and for the right reasons. The review can help in understanding the causes of malfunction if any. And what is required to make it right and more importantly to know the aim of the exercise – that is improved care quality, is achieved. The introduction of this program CMS has laid the groundwork for healthcare industry’s transformation into a quality based industry in which profitability has linked quality and vice versa. Schedule a demo with us to learn more about Chronic Care Management.