Archive for the ‘Physician Practices’ Category

3 Embedded Care Coordination Models Manage Diverse High-Risk, High-Cost Populations

June 30th, 2015 by Patricia Donovan

YNHHS embedded care coordination

YNHHS uses an embedded care coordination approach to manage its high-risk, high-cost medical home patients, geriatric homebound and health system employees.

When it comes to coordinating care for its highest-risk, highest-cost individuals—whether patients in a medical home, the geriatric homebound or its own employees—Yale New Haven Health System (YNHHS) believes an onsite, embedded face-to-face approach will best position it for success in a value-based healthcare industry.

The Connecticut-based health system shared its vision for managing patients across its continuum via three embedded care coordination models during a June 2015 webinar, Embedded Care Coordination for At-Risk Populations: A Case Study from Yale New Haven Health System, now available for replay.

In the first model, livingwellCARES, RN care coordinators at YNHHS's four health system campuses work with its high-risk, high-cost health system employees and their adult dependents with chronic disease.

"We help these employees access the care they need and identify their goals of care. We get under the surface a little bit to determine barriers to their being as healthy as they can be and manage them over time," explained Amanda Skinner, executive director, clinical integration and population health, adding that YNHHS offers employees incentives such as waived insurance co-pays for participation.

Launched three years ago, livingwellCARES was YNHHS's "on-the-job training for learning to manage care across the continuum," she continued. Starting with employees with diabetes, livingwellCARES expanded to care coordination of most chronic diseases. Having significantly impacted clinical metrics like A1Cs as well as hospital utilization and ED visits in the approximately 500 employees it manages, livingwellCARES is now transitioning to a more risk-based approach.

The second embedded care coordination model, a patient-centered medical home (PCMH), also launched three years ago. Focused on complex care management, the PCMH is heavily driven by data derived from its electronic health records and patient registries, Ms. Skinner continued.

Because five of eight PCMH care coordinators are embedded and cover multiple physician practices, YNHHS is exploring the use of televisits by care coordinators to manage patients in the practices served. Also important is schooling PCMH staff in the relatively new practice of "warm handovers" during critical transitions of care.

Nine challenges of the PCMH embedded model shared by Ms. Skinner include engaging patients and obtaining reimbursement for various pay for performance programs.

In the third model, outpatient geriatric care coordination, embedded high touch care coordinators manage frail elderly deemed homebound by Medicare standards—when it’s a severe and taxing effort to leave the home—and those in assisted living facilities, explained Dr. Vivian Argento, executive director of geriatric and palliative services at Bridgeport Hospital.

"There is a challenge not just with frailty but also with access—having these patients go into the physician offices—so that the care tends to get shifted into the hospital because it’s easier for those patients to get there," Dr. Argento explained.

Physicians and nurse practitioners provide care in the patient's home to break that utilization cycle, while embedded care coordinators constantly collaborate with the care team to risk-stratify and prioritize patients, resolve medication concerns, make referrals, manage care transitions, triage telephone calls—all tasks required to coordinate care for what Dr. Argento termed "a very sick Medicare population in in the last two to three years of life."

Well received by the geriatric patients, the program also has positively impacted healthcare utilization metrics: its annual hospital admission rate of 5.4-5.8 percent is significantly below Medicare's overall 28-30 percent hospitalization rate, and the program boasts a readmissions rate of 14 percent, versus Medicare's 20 percent national average, Dr. Argento added.

In Medicare Chronic Care Management Billing, Payoffs from Patient Relationships

June 2nd, 2015 by Patricia Donovan

Up to 2,300 Arcturus patients may qualify for CMS's new Medicare Chronic Care Management billing code.

The numbers can dazzle.

Computing revenue potential from CMS's new Medicare Chronic Care Management (CCM) code, Arcturus Healthcare estimated it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

And now, successfully billing Medicare for four enrolled patients, with more beneficiaries joining CCM rolls each month, Arcturus has discovered an added CCM payoff: the relationships forged with its patients.

"There's so much value to this. Our patients just love it," explained Arcturus's Clinical Quality Assurance Manager Debra Burbary, RN, during a May 2015 webinar, "Medicare Chronic Care Management Billing: Leveraging Population Health Management for Successful Claim Submission," now available for replay. "We have seen over the last year that our CCM work is creating one-on-one engagement with our patients. Patients really like the one-on-one attention. That relationship is what I really feel passionate about."

While all Arcturus patients benefit from evidence-based care, the Chronic Care Management code allows the staff to extend much-needed chronic care services, Ms. Burbary added.

Arcturus is fortunate to have physician leadership supporting Chronic Care Management. "If you're just starting with this process, you need to create within your group a physician buy-in for chronic disease management activities."

Medicare Chronic Care Management is one of several programs for high-risk patients Arcturus has rolled out over the last year, including High Intensity Care Management (HICM) for patients with six or more chronic conditions.

Two CCM challenges Arcturus has encountered include the time and cost required to identify, document and track participating patients. Once patients enroll, Ms. Burbary estimates it takes at least an hour for a nurse to complete the initial assessment—beyond time spent with providers to obtain their goals for CCM participants.

"Remember, most of these patients are very complex. We're identifying two chronic conditions that we want to work on with the patients, that we're setting up goals for." Between initial assessment and telephonic follow-up, Arcturus easily meets CMS's requirement of 20 minutes of staff time per month per CCM patient.

Currently, Arcturus uses its Allcripts® electronic health record (EHR) to develop the care plans, patient goals, and progress-tracking mechanisms CMS requires for CCM billing. In the future, it may explore a remote monitoring feature built into its EHR.

With the potential for 2,300 Arcturus patients to meet CCM requirements, Arcturus has considered a smartphone app to further streamline CCM documentation, but acknowledges the technology could distance providers from their patients.

"If someone else follows our patients, we're going to lose a little bit of that relationship, which we believe is very conducive to our success," Ms. Burbary said.

During the 45-minute webinar, Ms. Burbary also shared the patient participation agreement Arcturus developed to address CMS's seven requirements for CCM patient consent; patient response to the CCM co-pay; payment trends from secondary insurers, program expansion plans based on patient needs identified since CCM launch, and other program elements.

Infographic: Should You Outsource Healthcare Billing to Prepare for ICD-10?

April 13th, 2015 by Melanie Matthews

As the deadline to ICD-10 approaches, some physician practices may decide to outsource healthcare billing, according to CureMD.

CureMD has created an infographic to highlight the expected impact of ICD-10 and help physician practices determine if they'll need to outsource their billing for the code changes.

ICD-10-CM/PCS Implementation Action PlanOf all the tapes and books on the market about ICD-10, this important book by an Approved ICD-10 CM-PCS Trainer is a standout. Hospital, physician practice, ambulatory surgery center, freestanding clinics, and long-term care staff who are primary or secondary users of medical coding data will want it as their constant companion as they begin the implementation of ICD-10 at their facility.

ICD-10-CM/PCS Implementation Action Plan goes beyond its comprehensive coverage of ICD-10 CM/PCS to provide you with training tools, as well. This 135-page book also includes an 81-page customizeable document, as well as a customizeable spread sheet log.

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Infographic: Physicians and EHRs

April 6th, 2015 by Melanie Matthews

Electronic Health Records (EHRs) grew out of the computer system that runs a hospital's inner workings. Physicians' needs were an afterthought, according to a new infographic by PatientKeeper. As a result, the typical hospital EHR frequently makes doctors who use it less efficient and productive.

The infographic depicts the way it is today for physician users of EHRs, compared to the way it should (and could) be.

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable CareWhile widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

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Are Multi-Specialty Physician Groups ‘Next Generation’ to Transition to ACOs?

March 26th, 2015 by Cheryl Miller

In another step towards advancing models of care that reward value over volume, HHS recently announced the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, a new initiative designed to move an increasing percentage of Medicare payments into models that support value-based care, and which supports a number of tools including telehealth and post-discharge home services.

With their built-in cadre of healthcare providers, multi-specialty physician groups (referred to here as physician groups), which comprised about a tenth of survey respondents to the Healthcare Intelligence Network's third annual Accountable Care Organization survey administered in 2013, would seem ideally placed to transition to accountable care organizations. Percentage-wise, this sector has the highest rate of existing ACOs (57 percent participating in ACOs versus 34 percent of overall respondents) and twice the rate of participants in the CMS Pioneer ACO program (25 percent versus 13 percent).

Other characteristics of this sector follow.

In other deviations from the norm, twice the number of physician group-reported ACOs favor the hybrid FFS + care coordination + shared savings payment model (75 percent of physician-group ACOs versus 37 percent of overall respondents).

More than half of ACOs in this sector are administered by independent physician associations (IPAs), and most are smaller than the hospital-sized ACOs reported above, with three-quarters reporting a physician staff of less than 100. These ACOs benefit from having specialists on board in greater numbers to help with care coordination of the chronically ill (100 percent include specialists, versus 71 percent overall).

They also unanimously include nurse practitioners (versus 90 percent of overall respondents) and with 50 percent including clinical psychologists in the ACO (versus 42 percent overall), are a little further along on the path of integrating behavioral health into the accountable care initiative.

Cognizant of the full care continuum, these IPA-led ACOs are almost twice as likely as overall respondents to include skilled nursing facilities (50 percent versus 29 percent overall) and hospice (75 percent versus 42 percent overall) in their ACOs.

Perhaps because their organizational structure lends itself to the ACO model, the majority of this sector—75 percent—needed less than year to launch its accountable care organization (versus 29 percent of overall respondents, whose comfort level was between 18 months and two years).

These ACOs seem to have all the clinical pieces in place, reporting near-unanimous usage of evidence-based care, case management, care transition management and population health management. They are also unanimous in the review of clinical outcomes as an ACO success measurement, and much more likely than their counterparts to consider provider satisfaction in program evaluation (50 percent of physician group-led ACOs, versus 32 percent of overall respondents).

Technology-wise, however, there’s some catch-up to be done here: only three-fourths of responding physician groups report the use of EHRs and patient portals, versus near-global usage levels reported in other sectors. This could explain why this sector was three times more likely to report technology as a barrier to ACO creation

Source: 2013 Healthcare Benchmarks: Accountable Care Organizations

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Embedded-Case-Management-_p_4985.html

2013 Healthcare Benchmarks: Accountable Care Organizations documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year's respondents.

Infographic: How Many Doctors Are Using EHRs?

March 20th, 2015 by Melanie Matthews

More than half of U.S. physicians had adopted electronic health records (EHRs) by 2013, according to a new survey by The Commonwealth Fund.

An infographic on the study results breaks down the percentage of physicians who were early adopters, new adopters, partial implementers, planners (adopting in the next two years) and persistent non-adopters, as well as some demographic insight into these groups.

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable CareWhile widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

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Infographic: Physician Adoption of Mobile

March 16th, 2015 by Melanie Matthews

Improved quality and continuity of care, along with time efficiency are the top reasons physicians adopt mobile technology, according to a new study by MedData Group, depicted in a new infographic by the market research firm.

The infographic also examines the growth of physician mobile technology use, the top content physicians view on mobile devices and predictions for the most used healthcare app in 2015.

Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination ResultsNine mobile healthcare remote monitoring pilots integrated with a telephonic care management program are helping Humana to avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges.

Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results shares details of Humana's telephonic care management program and how these remote monitoring pilots enhance their care coordination efforts.

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Infographic: Revenue Cycle Management

March 11th, 2015 by Melanie Matthews

Some 76 percent of physician practices handle their billing function in-house, according to a new survey by NextGen Healthcare.

An infographic by NextGen highlights the survey findings, including key billing metrics, best practices for handling denials and overall physician practice performance as it relates to revenue cycle management.


The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third EditionWritten in plain language using nontechnical jargon, The Business of Medical Practice presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, and regulatory and academic perspectives with Health 2.0 examples, and blog and internet links, as well as charts, tables, diagrams, and Web site references, resulting in an all-encompassing resource.

The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition integrates various medical practice business disciplines-from finance and economics to marketing to the strategic management sciences-to improve patient outcomes and achieve best practices in the healthcare administration field.

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Infographic: Social Media Sites Outrank Physician and Hospital Websites in Search Results

February 6th, 2015 by Melanie Matthews

As Americans enroll in healthcare through the Affordable Care Act for the second year in a row, a new study reveals how physicians are being evaluated by prospective patients. The study released by Mercury360®, which helps companies manage their online reputation, found that for over half of physicians observed the first link on a search engine results page (SERP) is a social media site and the percentage is even higher for physicians practicing in several medical specialties. The study has implications for how physicians manage their reputation, communicate with their patients, and how patients come to learn about their doctor.

An infographic by Mercury360® looks at the importance of patient reviews and SERPs by physician specialty.

Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical PracticesOnline health information combined with social media channels like Twitter and Facebook has created a new generation of patients. They are empowered. They have a voice in their own care that they never had before, and more are using social media and physician review sites to choose their doctor or medical practice. Given these stakes, you can't afford to leave your online reputation to chance.

Kick off your social media efforts today with Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices, a comprehensive resource. In addition to unique insights from practicing physician and social media pioneer Kevin Pho, MD, this book offers doctors a step-by-step guide on how to use social media to manage an online reputation. It also provides insider tips on how to respond to online ratings and a guide to work with all of the major physician review sites.

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Infographic: 10 Things You Should Know About PQRS for 2015

January 21st, 2015 by Melanie Matthews

CMS’ Physician Compare website has begun listing physician participation in its Physician Quality Reporting System (PQRS), which could potentially mean a loss of new patients based on nonparticipation in the program, according to a new infographic by HealthFusion.

The infographic lists 10 key features of the PQRS program.

Physician Value-Based Reimbursement: Quality Rewards for Population Health With more than a quarter-century of experience with value-based reimbursement models, Humana is ideally positioned to help physician practices navigate the transition from fee for service to fee for value. The payor's multi-level Accountable Care Continuum rewards physician practices for care coordination of Medicare beneficiaries along the population health spectrum.

Physician Value-Based Reimbursement: Quality Rewards for Population Health describes the four tiers of Humana's Physician Quality Rewards program as well as the support, training, technologies and outcomes associated with these pay-for-value relationships.

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