Principal Care Management (PCM)

CMS pays for 30 or more minutes of non-face-to-face care performed for a patient with at least one chronic, high risk condition in a given month by clinical staff.  Very similar to CCM, principal care management (PCM) is intended mostly for specialists (although CMS did not specifically exclude primary care from providing this service). 

CMS pays for one of two codes:  either 30 minutes by the billing provider or 30 minutes by clinical staff (which can include qualifying time by the provider).  These codes require 1 condition for which a patient has received care for 3-12 months, which puts patient at risk for hospitalization, or has resulted in a recent hospitalization.  

While a practitioner (Primary Care or Specialist) may bill PCM concurrent with RPM, they may not bill PCM with other care management codes (e.g., CCM) for the same patient/month.  Concerned about paying for duplicative services, CMS includes two additional requirements for PCM: (1) the practitioner billing for PCM must document in the patient’s record ongoing communication and care coordination between all practitioners furnishing care to the beneficiary, and (2) the practitioner cannot bill for interprofessional consultations or other care management services (excluding remote patient monitoring for the same beneficiary for the same time period as PCM). There are other differences and requirements to consider when launching a PCM program.  We can help you apply this option to your practice.

Remote Physiologic Monitoring (RPM)

Also called 'remote patient monitoring' or RPM, remote monitoring of physiologic data goes back to NASA and the space program, if you think about it.  For modern application, Medicare made significant changes to it's RPM program in 2019 and 2020.

The new codes and coverages include an add-on code for additional periods of 20 minutes beyond the initial 20.  Many practices have patients with chronic conditions who come into the office periodically for what amount to vital checkups. With the PHE, these patients have often been told they must remain at home.  RPM not only provides a life-line for patients to the care they need, a well-run program allows providers to electronically collect and monitor health data, such as blood pressure, glucose, or weight, from their patients.

As of 2020, RPM can be furnished under Medicare's "general supervision" standard, meaning it can be conducted by auxiliary staff.

Telehealth / Telemedicine

Two terms often used interchangeably, but meaning two different things. 

Among independent single-provider practices, multispecialty groups, federally qualified health centers, and large health systems reporting for one study, nearly 30 percent of all visits were provided via telehealth and telemedicine by mid-March.  These services (enabled by CMS' relaxing requirements) have helped many patients and providers communicate needs and effectively treat since the beginning of the pandemic.

2020 AAFP Telehealth Toolkit

Risk Management

Risk management involves the identification, evaluation, and prioritization of potential risks alongside steps taken to avoid, mitigate or otherwise minimize the risk and potential impact.  Risk management touches every part of a business, especially healthcare.  Various approaches are used.

Practice Analytics

Surveys and reports suggest that 60 - 80% of hospital, physician, and medical organizations do not use data analytics in the planning and decision-making processes.  Larger organizations have access to the data necessary to drive informed decisions that can improve patient treatment, raise provider quality scores, and increase organizational revenue – truly a win-win-win proposition.  So, why would leadership not use a tool that could help reach those goals?  Most often it falls into one or more of the following areas:

• o data analytics confidence decreases as complexity increases; they cannot use what they cannot understand 
• o working with large amounts of data intimidates many and presents challenges most clinics cannot overcome with normal tools and personnel - this includes challenges for clinics to capture or access and then integrate data from multiple sources 
• o training staff for additional skillset is difficult – outside of aptitudes or interest is as common as citing limited resources for training 
• o lack of available resources (time, personnel, automation, and money) to invest in developing the capability
•  

Analytics can help organizational leadership and providers identify at-risk patients, predict patient utilization patterns (missed appointments, patient throughput), score chronic disease risk, track patient survey responses, improve preventive service management, identify revenue gaps and associated services, manage revenue cycle, track provider productivity, and many other areas to foster growth and efficiency.

Data can tell historical facts.  And it can support predictive analysis.  It can demonstrate where shortfalls occurred.  But it can also identify revenue opportunities, like missed revenue in the form of under-coded services, services performed but not billed, and services available but not performed.  For example, detailed analysis of the 2017 Medicare Part B claims data reveals more than 50 billion dollars in missed revenue from those categories by primary care, family medicine, and internal medicine providers across the country.  How much is your organization missing out on?  We can help answer that question and much more. 

Practice Assessments

The practice assessment is a powerful tool providers and healthcare leaders at every level have at their disposal - if they choose to use it and use it correctly.  A periodic review of a practice's clinical and business operations can be just as important as the "check-up" you perform for your patients.  In a similar wary, an assessment can identify an issue early before it becomes a larger problem.  The results and feedback then later inform successful decision making.  

An assessment is another source of data to which you can apply analysis and interpret a result that points toward answering a question or reaching a goal.  A carefully crafted assessment can gather information from different functional areas to reveal how well they work together or don't.  As a tool, you can zero in on one functional area or review an all encompassing top-down picture of your practice.

If you want more information about conducting a practice assessment, let us know.

HIPAA / HITECH

Enacted in 1996, the Health Insurance Portability and Accountability Act (HIPAA) requires healthcare organization to comply with published regulations concerning the handling, safeguarding, and privacy of personal health information (PHI).  The complexity and scope of the requirements increased with the HITECH Act provisions adopted as part of the 2009 American Reinvestment and Recovery Act (ARRA). 

Compliance policies and programs are serious matters for healthcare organizations.  If you have questions, we have answers - and we know the experts that have even more answers.  We are happy to introduce you to the resources you need to implement and maintain a legitimate and effective compliance program in your practice.

Home Health

Home health and home health care are terms that refer to a wide range of health care services that can be given in a patient’s home as part of treatment for an illness or injury. Medicare views this option as “usually less expensive , more convenient, and just as effective as care you get in a hospital or skilled nursing facility”.

Some examples for home health services are wound care after a surgical procedure, patient education, intravenous therapies, injections, and illness / vitals monitoring.  The goals of home health care are to help patients get better, regain independence, maintain or improve the current condition or level of function, help patients become more self-sufficient, and to slow the progression of condition(s).

This is often an under-utilized service. And frequently providers order home health but are not vigilant in submitting the claims for their periodic re-certifications; this represents a considerable amount of revenue unclaimed that correlates to work providers did.  As a result of the current PHE, non-physician providers can order and follow up on home health care for claims dating back to 1 March 2020.  If you would like to learn more about how home health care might be able to benefit your patients, we can answer your questions.

Lab Services

In-house lab resources increase the likelihood patients actually get the labs drawn when you place the order.  Even now when in-person visits are not common, having a dedicated lab space where you control patient flow via a schedule allows you to mitigate exposure risks better than any other public-access lab or draw locations.  This is a value-added for your patients going forward, as well, as the capability will be in place during flu season, foul weather, etc.

Dedicated, reliable assets ensure timely results and resolution of any issues in reporting.  If you were allocating clinical staff to draw and package samples, you can free them up for other patient-centered tasks.

Marketing

Marketing a medical practice is almost a requirement today as competition in some areas becomes more intense.  An important part of medical practice marketing is an active online presence through social media and the Internet.  This helps keep current patients up to date of any changes to clinic hours or services offered. 

Using a responsive Website as an integrated component of your marketing plan helps you engage with patients on whatever platform they prefer (PC, laptop, tablet, smartphone).  These devices help you leverage blog articles and videos to further reach your patients.

Patient Engagement

More and more patients are seeking engagement with their care teams.  Until cloning is perfected, you simply cannot create enough time to do it all without effective tools, such as an effective Website that also links into a patient portal and on-line patient education. 

A patient portal can put the power in your patients’ hands for scheduling, asking questions, requesting appointments or referrals, and more – but on your terms.  Collect co-pays, allow remote check-in, receive patient histories from their smart phones to your EMR chart.

Leveraging HIPAA-compliant email and texting will also help you connect with patients without violating HIPPA, HITECH or Privacy Act.  This works best when integrated to your EMR as it links conversations to the patient’s chart.

Medicare Annual Wellness Visits

The Medicare Annual Wellness Visit (MAWV) has been largely underutilized since first being fully covered back in 2011.  Other than the 'Welcome to Medicare' visit which requires a face-to-face encounter, all associated services can be accomplished remotely. 

When done correctly, this can generate revenue while providing an exceptional preventive care plan for reduced or delayed onset of disease. The AWV can be performed by a licensed nurse (LVN, LPN, RN) without the physician or NP or PA seeing the patient during the visit - per CMS.   It is a RECORD-KEEPING visit - and not a physical or exam. 

• Medicare Wellness Visits educational tool
• Medicare Preventive Services educational tool
• Preventive Services webpage
• Information for your patients on “Welcome to Medicare” preventive visit and Yearly Wellness Visit

Additional References