Ask Adele: November questions answered by Adele Allison
Monday, November 18, 2013
Posted by: Joy Ingram
Adele Allison is the National Director of Government Affairs, SuccessEHS. SuccessEHS is a non-voting member of NWRPCA
Question: I understand that patient-centeredness is big under health care reform and reform is fully upon us. There is so much to take in! Are there any simple tips you can provide that will position my clinic to be successful?
Answer: You are correct. Healthcare reform is here and it can be overwhelming. Providers are now expected to meet new quality measures, and value is replacing volume as the determinant of physician compensation. Patients are also expecting more from their providers in terms of access and transparency. One of the intended goals of healthcare reform is to foster stronger relationships between patients and physicians, encouraging patients to become more educated and responsible for their health. In fact, patient-centeredness is mentioned in the Affordable Care Act 36 times.
As this shift from reactive care to prevention and wellness takes shape, providers have the opportunity to position their clinics to be at the forefront of healthcare reform by focusing on patient-centered care delivery. This means your operations, policies and procedures must place an emphasis on patient engagement and satisfaction, coordinated care and relationship building.
Accomplishing these goals may be easier said than done, but there are several tools available to help you receive reimbursements for the costs involved and ultimately achieve success amidst the challenging world of healthcare reform. For example, your health technology vendor may offer easy-to-use communication portals to help boost patient involvement. Also, becoming a Patient-Centered Medical Home (PCMH) can help improve the quality and efficiency of your community's healthcare delivery model.
The following 10 strategies can help guide your practice in the right direction as you make the transition to patient-centered operations:
- Improve transitions of care (TOC) to increase quality and decrease costs. Consult with patients on the steps they need to take toward wellness after they leave your clinic or another care setting to ensure care continuity. The AMA has five new CPT codes now being accepted by Medicare as well as other payers that relate to TOC discussions and coordinated care:
Check to see if your Medicaid agency and commercial payers also reimburse for these actions.
- 99495 – Requires a documented physician conversation with the patient/caregiver within 2 days of facility discharge about care transitions (not necessarily face-to-face) with a follow-up visit within 2 weeks;
- 99456 – Has the same requirements as 99495, except the face-to-face follow-up visit must occur within 1 week;
- 99487 – Billable for the first hour of staff time spent doing care coordination over a 30-day period in the absence of a face-to-face visit;
- 99488 – Used to report the first hour of staff time for care coordination over a 30-day period with a face-to-face visit; and,
- 99489 – Billable for subsequent 30-minute increments of staff time (directed by a physician) for care coordination beyond the initial hour billed under 99487 or 99488.
- Use Health IT to track patient adherence with evidence-based guidelines for disease management and preventive services. Utilize population management technology for outreach and disparity reduction. Not only does this promote quality of care for the patient, getting these patients in for needed care generates revenue for the practice.
- Expand access to care by implementing open access scheduling and expanded office hours. Open access, or same-day appointment scheduling, can have a significant impact on no-show rates. You may also wish to expand clinic hours to improve clinical access. Consider offering early morning, evening and weekend appointments to your patients.
- Coordinate with other community providers. Join forces with other clinicians in your area to expand access through an "on-call" provider after hours. This action can have a significant impact on patients accessing an appropriate level of care by offering extended call coverage for urgent care situations. You may also think about setting up a "nurse line" to manage after hours calls and triage patient for follow-up care, as appropriate.
- Measure physician access and staff responsiveness by utilizing a patient portal through your Health IT. Patient portals create a place for secured email messaging for medical questions, refill requests, Q&A and appointment requests. Secured messaging with patients is a new measure under Stage 2 Meaningful Use and can significantly cut down on unnecessary phone-tag workflows, promoting cost-efficient processes.
- Consider offering eVisits. An electronic visit or eVisit is a web-based encounter for non-urgent clinical questions through secured patient portal messaging. Virtual visits allow easy access to a provider anywhere at any time. Check to see what you can document to receive reimbursements for eVisit charges since there is a heightening awareness of the cost savings achievable with payers.
- Distribute patient satisfaction surveys with questions related to facilities, comfort, patient flow, etc., to identify internal issues as well as positive testimonials. Patients will appreciate your efforts, so make sure to answer all questions and concerns in a timely manner. Surveys will also establish a formal method for patient feedback. Additionally, research supports a link between strong provider-patient communication and patient satisfaction, guideline adherence and improved outcomes. For this reason, as value-based reimbursement moves forward under health care reform, metrics linked to patient experience will impact clinic revenue.
- Conduct annual staff training focusing on sensitivity to patient needs, cultural differences and customer service. Staff members should be trained to assess a patient's comprehension of treatment goals through such techniques as "teach-back" and should be able to educate them on treatment options for collaborative decision-making on care plans. This will not only assist with treatment adherence and outcomes, but will bolster ratings linked to patient experience.
- Openly display policies and procedures related to patient access and communication. Posting signs in waiting rooms and exams rooms or distributing policy information in new patient packets builds trust and credibility. Transparency will decrease issues linked to a breakdown in communication.
- Conduct regular training on your Health IT, especially when new technological enhancements are released. You should always improve your use of technology so that it is serving the practice to better serve the patient. As the country undergoes a shift to automating clinic workflows under reform, keeping abreast of software improvements will reduce the burden of manual, laborious processes. Utilize the support, maintenance and upgrades your EHR vendor provides to ensure your staff is taking full advantage of the technology's capabilities in order to enhance patient care.
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