Tag Archives: physician

Why Referral Matters for Population Health?

Population Health has been the buzzword for some time now and is used excessively by healthcare providers of all kinds and large employers amongst others. One reason for this is, of course, the concept is in itself broad and can include many things.

The basic concept of population health can be defined as understanding healthcare needs of a patient population and proactive intervention based on group variations of healthcare requirements to achieve population health quality outcomes.

Population Health Management proposes a holistic approach to healthcare delivery and better outcome, that is the reason why managing referral network becomes important in the process.

Ensure Continuity of Care

The Providers participating in a population health model have a bigger stake in the continuity of care their patient population has been receiving.National statistics on referral indicates more than 40% of the referred patients do not go to recommended specialists therefore maybe unsettling to general providers. A referral Management solution can most definitely improve those numbers or at least identify the reasons why patients are reluctant to see a specialist.

Keeping the PCP in the Loop

An intelligent medical referral solution allows PCPs to consult with the specialist and make an informed decision in directing patient care. Referral management solution will ensure a good level of communication during and after the referral is complete. Primary providers in the absence of a medical referral solution have no means of knowing the status of the referral at regular intervals. After a referral Primary provider may not be able to know the specialist’s diagnosis and understand the outcome of the process closing the referral loop

Patient Population Requirements

The PCPs who consult several patients a day have no reliable well-documented source to understand the various needs of the population that they serve. The result of lack of capabilities will push PCPs to refer patients to specialists outside of their network to serve and address the needs of a patient.

Employing Analytics

Identifying the right data set from different sources to achieve the measureable outcome is not an easy task. Healthcare industry is slowly adapting to new age technologies and leveraging data insights from the information gathered by analytics tools. For example, if a PCP is able to evaluate the data from the past 6 to 12 months, it will help him understand the strength, weakness and yield more revenue opportunities for the practice and prevent revenue leakage through referrals made outside of the network.

Accidental Violation of HIPAA Compliance

Patient information secrecy is of utmost importance for any healthcare organization and medical professionals due to the risk of being compromised, exposed or accessed. With initiatives and innovation in healthcare IT space by various federal agencies (particularly CMS) and health care providers throughout the country over the years, have embraced healthcare IT innovations to secure healthcare data.

Most providers even today use conventional processes to send and receive medical referrals which could lead to an accidental violation of HIPAA (Health Insurance Portability and Accountability Act of 1996) rules which sets the standards to the use and share of patient-related information to ensure security.

In best practices, referrals are managed by referral coordinators who are in charge of sharing patient information, setting appointments and ensuring closure of the referral loop. The referral coordinator and other staff may be committing HIPAA violations in the following manner:

1. Triplicate Forms– Commonly, medical referrals are conducted using triplicate forms and it contains patient identification information. Such forms are circulated to the Specialists’ office and a copy is kept at the PCP’s office.

2. Patient Information Faxing– Hospitals and clinics relay a lot on faxing. Patient information for referrals are sent via faxes and it is not uncommon for providers to misplace such documents.

3. Use of Personal Portals and Storing Devices– For the ease of communication healthcare providers and referral coordinators repeatedly make use of their personal communication devices or portals like emails, cell phones etc.

According to HIPAA, all those above scenarios fall under the category of accidental violation of HIPAA regulations and such violators are subject to a penalty ranging from $100 dollars to $50,000 per violation depending on how the violation is categorized as.

It is not rare for providers to find themselves in these circumstances like many have in the recent past. Some due to negligence don’t comply with HIPAA regulations and on the other side of the spectrum for criminal activities involving staff misuse. Providers could take immediate actions against this issue and cut their risk in half.

a. Educating your staff on the threat to patient information, HIPAA violation and penalties involved.
b. Establishing standard procedures for staff to follow while dealing with medical referrals.
c. Likewise establishing security infrastructure to secure health data in hospital servers and cloud.

In the long run, these measures will not be enough. These methods do not have the capacity to manage large numbers of medical referrals and providers cannot divert much of their resources to maintain an IT team when there is always a shortage of helping hands.

Healthcare providers need to move away from paper triplicate forms and fax machines and embrace Referral Management Solution.

HealthViewX Referral Management Solution is a comprehensive, multi-channel solution that is secure as it is functional.

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.