Ask Adele: July questions answered by Adele Allison
Thursday, July 17, 2014
Posted by: Joy Ingram
Adele Allison is the National Director of Industry and Government Affairs, SuccessEHS, a Division of Greenway. SuccessEHS is a non-voting member of NWRPCA
10 Tips to Promote Patient-Centeredness
I know that health care reform is taking a growing approach of measuring patient-centeredness. Working in a safety-net market, we are challenged with finding ways to improve patient and family participation in care. Do you have some basic tips that you recommend to promote a culture of patient engagement?
Healthcare reform is here. Providers are expected to meet new quality measures that place the patient in the center of the equation; and, patient-centeredness is becoming a hallmark of value, replacing volume as the sole determinant of physician compensation. Policymaking is incorporating measured performance toward a patient-centered culture because it leads to an increase in quality and a decrease in costs. Regardless of policy, patients are also expecting more from their providers in terms of access and transparency.
The paradigm shift sought is to move from reactive, episodic care delivery to operations grounded in prevention, wellness and chronic disease management. As policy and patient expectations take shape, providers can position their clinics to be at the forefront of healthcare reform by focusing on ongoing process improvement in the area of patient-centered care delivery. This means operations, policies and procedures, and values must place an emphasis on patient and caregiver engagement and satisfaction, relationship building and care coordination.
Sounds great, but accomplishing these goals may be easier said than done. There are several tactics 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. Paired with a strategy of promoting use of this technology can create incremental gains in patient engagement and support efforts towards achieving true health home status. Not only can this impact the quality of care provided to the patient, it can result in differential payment for the value created.
I invite you to consider the following 10 tips to 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:
- 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.
Check to see if your Medicaid agency and commercial payers also reimburse for these actions.
- Use Health IT to track patient adherence with evidence-based guidelines for disease management and preventive services. It is no longer enough to manage the patient in front ofYou now need to manage the patient that is not in front of you. Population management technology should be available within your electronic health record (EHR) with pre-designed evidence-based guidelines that automatically monitors populations of patients for key clinical events based on triggers such as demographics, diagnosis and lab values. If the patient is non-adherent, good technology can provide point-of-care alerting to support a busy clinician’s cognitive process as well as generate lists of patients 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 clinicalConsider offering early morning, evening and weekend appointments to your patients. Not only will such steps help with the dynamics of feast or famine seen with double and triple booking, a shift in such operations empowers front desk staff to fill empty slots and can eliminate overbooking completely.
- 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. Patient portals create a place for secured email messaging for medical questions, refill requests, Q&A and appointmentSecured 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. Promote this online communication tool by:
- Holding a contest among your staff on who can sign-up the most new portal users;
- Add tag-lines to the bottom of patient statements or appointment documents, “ask us about our patient portal!”
- Instead of hold music, create education on the availability of the patient portal;
- Train staff to educate patients at opportune moments such as when requesting refills, having staff state, “you know you can also request refills through the patient portal!”
- Strategically place marketing materials or posters in waiting areas and exam rooms.
- 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 yourTake rapid action based on results and make sure to answer all expressed questions and concerns in a timely manner. Surveys 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 careAlso, simple etiquette training can go a long way to promoting patient-centeredness, for example: make sure you are knocking before entering a closed door; introduce yourself to the patient; let the patient tell you what they think is wrong; and, tell the patient is something is going to hurt. 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 andTransparency 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 theAs 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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