Author: Jim Nonneman

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HBPC in the News HCCIntel Legislative News Practice Management Press Releases

CMS Announces Request for Applications for Primary Care First Model Options

CMS Request For Applications

CMS Request For Applications

CMS Announces Request for Applications for Primary Care First Model Options

(Highlights for Consideration included below)

CMS released the Request for Applications (RFA) for the Primary Care First (PCF) and Seriously Ill Population (SIP) models last Thursday, October 24. The practice application period also started that day while the deadline to apply via the live portal is January 22, 2020.

The model will now begin in January 2021 (a delay of one year from the originally anticipated start date). CMS will select practices and payers during Winter/Spring 2020 and will onboard participating practices and payer partners to the model from July to December 2020.

Following are important highlights of the new program for practices to consider:

Fees and Measurements

  • Under PCF General, the primary care flat visit fee will be reduced to $40.82.
  • HCC Risk Group 4 will be the highest-level risk group with a payment of $175 Per Beneficiary Per Month (PBPM).
  • Practice risk groups 3 and 4 will not use the acute hospitalization performance measure; instead, performance for these groups will be measured on the Advance Care Plan and Total Per Capita Cost (TPCC).

SIP

  • SIP practices are expected to have an 8-month management and transition period for stabilization of their patients and then to transition them back to another primary care setting or practice.
    • This is known as the average length of attribution (LOA).
    • If the 8-month term is exceeded, a $50 PBPM reduction will apply to the monthly SIP payment through a quality adjustment.
  • SIP patients will require a face-to-face visit once every 60 days for them to remain attributed to the practice.
  • SIP payment redesign now states that after a practice conducts its initial face-to-face visit with the SIP patient, CMS will make a one-time payment of $325. With PCF, beginning the month following the initial visit, the practice will receive a $275 PBPM minus a $50 quality withhold that can be earned back with a potential quality bonus at the end of the first performance year.
  • SIP practices must describe the service area(s) in which they are interested in participating using zip codes and must define the maximum number of SIP patients the practice has the capacity and capability to manage.

Participation and Eligibility

  • Practices participating in the Independence at Home (IAH) Demonstration are eligible to participate even if it is not offered in the region(s) of the IAH practice.
  • Practices participating in the Comprehensive Primary Care Plus (CPC+) model cannot participate in 2021, however, they can participate in 2022.
  • Concierge practices, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are not eligible to participate.
  • Eligible practitioners are those practicing in internal medicine, general medicine, geriatric medicine, family medicine and/or hospice and palliative medicine.

Home Centered Care Institute Support

If you have questions about these changes or other home-based primary care questions, you can contact our HCCIntelligence™ Resource Center Hotline at 630-283-9222, 9:00am to 5:00pm (Central Time) Monday through Friday – or email us at [email protected]. The hotline and additional offerings in the Resource Center, including monthly webinars, virtual office hours, and tools and tips sheets are available at no charge due in part to a grant from The John A. Hartford Foundation.

 

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Event Events HCCIntel

HCCI participates in “special” C-TAC Summit on Advanced Care

C-TAC National Summit
Photo credit: Bear Gutierrez

There was something special about the National Summit on Advanced Illness Care held October 9-11 in Minneapolis, as the participating members of the Home Centered Care Institute (HCCI) quickly learned. That “something” was a mixture of collaboration, a continuous improvement mindset and a passion for the patient. A passion found in the meeting’s theme of “Lead. Innovate. Inspire.”

The summit, hosted by the Coalition to Transform Advanced Care (C-TAC), and sponsored by several organizations, including HCCI, brought together hundreds of providers, practices, organizations, innovators and thought leaders. Over the three days, the participants took part in presentations and panels, interactive “labs,” breakout sessions, exhibits and countless opportunities for networking.

One of the most compelling discussions at the Summit was between Jon Broyles, executive director of C-TAC, and “patient champion” Shirley Roberson, who shared her Blue Chair story focused on the critical importance of listening to, and honoring, a patient’s voice.

The summit also saw Broyles announce C-TAC’s new “moonshot” goal centered on providing millions of seriously ill patients with a high quality of life by 2030. (Learn more about what a moonshot goal is here.) In sharing his thoughts on the goal, Broyles explained, “Quality of life is the ultimate outcome we’re all seeking, not just during serious illness, but throughout our lives. The challenge is that each person defines it differently. We have to figure out how to quantify it because we must be accountable to Shirley and millions of others, and because groups like CMS [The Centers for Medicare and Medicaid Services] will need a formula to measure it.”

Where’s a good place to start with that definition of “quality of life”? According to Broyles, it’s asking ourselves what makes a good and joyful life, and what is the purpose of all the things we do, like going to work, getting married, having hobbies, and so forth? Then, he adds, we must ask that same question of each patient to see how they define it.

As with all big goals, Broyles discussed the fact that this is just the first iteration of the “moonshot” goal, and that the specifics, including the number of lives touched, could change over time. But, he explained, “It’s important to not only focus on the big numbers. If we only focus on the ‘millions,’ that can be too big, too overwhelming to understand and to really change behaviors. Instead, we at C-TAC say, ‘Millions start with one.’ What can we do to change one life? From that, others will follow.”

When asked how C-TAC and HCCI can work together, along with the other organizations in the advanced care space, to “focus on the one,” Broyles answered, “We’re all facing a significant human and societal challenge, where the need will so far outpace what individual groups can do, that we have to figure out how to do it together. We must be open to new ideas, while building on what’s working now. This includes thinking about the role that caregivers, volunteers, communities, employers and others play in supporting each patient.”

Focusing on the importance of taking into account the patient’s perspective in this collaboration, Broyles added, “We need to understand how patients experience care and view quality of life along a continuum. Then, all the providing groups, whether it’s palliative care, hospice care, home-based primary care or other models of care, must work together to create a seamless experience for the patient. The goal is an experience where patients’ needs are anticipated and met, without them having to do extra work or perform extra coordination to make it happen. After all, they have enough to think about and do.”

Reinforcing this focus on collaboration, HCCI presented a well-received video, entitled “The Intersection of Home-Based Primary and Home-Based Palliative Care.” In the video, Dr. Thomas Cornwell, CEO of HCCI and founder of Northwestern Medicine HomeCare Physicians, shared that, “Home-based primary care can add significant value to an existing home-based palliative care program. This effort can include providing education and technical assistance to palliative and hospice programs and the patients they serve.”

Watch for more information in future HCCI newsletters on how HCCI will be working together with C-TAC and other key partners to make person-centered care a reality for more of those who need it.

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Event Events

Blueprint for Success: Building and Growing Your Home-Based Primary Care Practice

Strategy Meeting

Blueprint for Success:
Building and Growing Your Home-Based Primary Care Practice

Friday, February 7– Saturday, February 8, 2020
Sheraton Crescent Hotel, Phoenix, AZ

Save-the-date to learn strategies for planning and operating a successful and sustainable home-based primary care practice!

Topics covered include personal readiness, managing change, creating a budget, deciding whether to outsource business services, ­­­staffing models, geographic scheduling, documentation and coding, straddling between fee-for-service and value-based environments, a telemedicine-EMR users’ panel, and interactive exercises that put it all together.

This conference is ideal for all providers and operations staff!

More information will be available soon at HCCInstitute.org or NNPEN.org.

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HCCIntel Practice Management Tip of the Month

Chronic Care Management: One Way to Maximize Fee-for-Service Reimbursement

Nurse checking patient's blood pressure.

Would you like to maximize your reimbursements by up to $42 dollars per patient per month for the care being provided? Chronic Care Management (CCM) involves much of what you may already be doing to provide high-quality care for your patients: maintaining a comprehensive electronic care plan, managing transitions, and coordinating care with other professionals within and/or outside of your practice. The good news is that with a basic understanding of Chronic Care Management (CCM) documentation and billing, along with an effective workflow process, you can be fairly paid for providing these valuable services!

In 2015, CCM became separately payable by Medicare; however, it is still underutilized by many providers due to concerns about the documentation requirements or simply because providers don’t understand how this could easily become part of their practice’s workflow.

One concern has been that although many Electronic Health Record (EHR)  systems allow providers to turn on a CCM module for time tracking and other features, it is typically an extra expense to the practice. Many providers find that just by enhancing their knowledge of CCM requirements and by implementing some standardized processes, a CCM module isn’t always needed.

Let’s start with the basics of what qualifies a patient for CCM:

  • Two or more chronic conditions, which are expected to last at least 12 months, or until the death of the patient.
  • Chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
  • Comprehensive care plan established, implemented, revised, or monitored.

The medically complex and homebound will all qualify for these services, and home-based primary care (HBPC) practices provide extensive care coordination and management services to their patients. It is pretty typical for providers and clinical staff to spend at least 20 minutes per calendar month to manage their patients’ medical and psychosocial needs.  So why not be reimbursed $42.84 (2019 CMS National Payment Amount) per patient per month? Only 20 minutes of combined clinical staff and providers’ time per calendar month is required to bill for CPT 99490 Chronic Care Management.

If your physicians or other qualified health care professionals (Nurse Practitioners, Physicians Assistants, Certified Nurse Midwives, and Clinical Nurse Specialists) are personally spending a complete 30 minutes within a calendar month addressing the medical and care coordination needs of their complex patients, then you can bill CPT 99491 which pays $83.97 (CMS National Payment Rate).

One potential barrier or source of confusion practices may feel limits their ability to provide CCM services to their patients is how to develop the CCM Comprehensive Care Plan that must be created, monitored, implemented, and provided to patient’s and/or caregivers receiving CCM services. Don’t let this stop you; consider if you have a nurse or other clinical staff that could be designated to support CCM and assist the providers in creating these care plans for patients. Below is an example that contains the care plan fields, which meet CMS requirements.

  • Problem List
  • Expected outcome or prognosis
  • Patient Goals of Care
  • Treatment Plan for each Chronic Condition
  • Symptom Management Plan/Education Resources Provided
  • Care Team (Include roles & responsibilities)
  • Medication List (Mark as reviewed/reconciliation last completed date)
  • Community and Social Services Involved in Care (include role and frequency of interventions)
  • Care Plan Review Date

What other elements are required when providing CCM services to your patients?

  • You must obtain and document either verbal or written consent for the patient to receive CCM services, and only one billing practitioner may provide and report CCM services per beneficiary.
  • Structured Recording of Patient Health Information: Practice utilizes certified EHR technology.
  • Access to Care & Care Continuity: Enable 24/7 access to provider team and other clinical staff with a means for after-hours coverage, designated relationship with a member of the care team, and provide enhanced communication opportunities.
  • Comprehensive Care Management: Systematic assessment/monitoring of all medical, functional, and psychosocial needs, medication reconciliation with review of adherence, potential interactions, and self-management, coordinate home and community-based services.
  • Transitional Care Management: Manage transitions as part of CCM.

For further explanation of the requirements in the CCM Comprehensive Care Plan refer to the following HCCI resource, CCM Care Plan Requirements.

Don’t let the list intimidate you! If you are currently providing longitudinal home-based primary care to your patients, chances are, you are already meeting the requirements but just not billing for it.  This means you could be leaving a significant amount of revenue on the table. To put this in perspective, let’s say you billed 300 traditional CCM charges within a six month period. That’s an extra $12,852 in revenue.

In today’s Fee-for-Service model, you must take advantage of all possible billing opportunities to be sustainable and properly reimbursed for the quality, compassionate care your team is already providing.

 

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Event Events

Join HCCI at GSA 2019 Annual Scientific Meeting

GSA 2019

GSA 2019

Join the Home Centered Care Institute (HCCI),
the American Academy of Home Care Medicine (AAHCM)
and other global leaders as we present the first-ever
International Workshop on Home Care Medicine

Friday, November 15 | 8:00 a.m. to 11:30 a.m.
Austin Convention Center | Austin, TX

Through the International Workshop on Home Care Medicine, GSA offers the opportunity to learn the latest trends and developments from home care medicine leaders, build strategic partnerships to address challenges, and network with peers.

Panel 1: Service Delivery and Interprofessional Care (1 hour)

  • Aaron Yao, Research Director, Home Centered Care Institute and Professor, Shandong University, Panel Chair
  • Irina Jara Calabuig, Home Care Physician at Alzira´s University Hospital in Valencia, Spain
  • Theresa Soriano, Regional Chief Health Officer at Cityblock Health and President-elect of American Academy of Home Care Medicine, USA
  • Noriko Yamamoto-Mitani, Professor of Medicine at the University of Tokyo School of Medicine, Japan


Panel 2: Technology (Mobile Diagnostics, EMR) in Home Care (30 minutes)

  • Aaron Yao, Research Director, Home Centered Care Institute and Professor, Shandong University, Panel Chair
  • Zia Agha, Chief Medical Officer and Executive Vice President at WestHealth, USA
  • Dai Yumino, Chief Director of Yumino Medical, Japan


Panel 3: Payments and Revenue Models (1 hour)

  • Eric DeJonge, Chief of Geriatrics, Capital Caring and President of American Academy of Home Care Medicine, USA, Panel Chair
  • Laurence Nivet, Director and Matthieu De Stampa, Head of Medical Staff, HAH-Larger Paris University Hospitals (AP-HP), France
  • Tadashi Wada, Clinical professor at Irahara Primary Care Hospital, Japan


Panel 4: Workforce Education and Training (1 hour)

  • Thomas Cornwell, CEO and Founder of Home-Centered Care Institute, USA, Panel Chair
  • Sabrina Akhtar, Physician Lead of the Home-Based Care Program, Toronto Western Family Health Team, Canada
  • Takashi Yamanaka, Chair and Associate Professor of Home Care Medicine, University of Tokyo, Japan

 

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Event Events

HCCI at the C-TAC National Summit

Lead. Innovate. Inspire.

Lead. Innovate. Inspire.

HCCI is proud to be a Gold Sponsor of the
C-TAC National Summit on Advanced Illness Care
October 9-11, 2019 in Minneapolis, MN

500 disruptors. One room.

You see the impact our healthcare system has on those with advanced illness. From uncoordinated, fragmented care to inadequate support for family caregivers, navigating advanced illness care has become a treacherous task.

Each year, the Summit gathers a diverse set of leaders – including payers, providers, health systems, entrepreneurs, foundations and advocates – to generate solutions that will change the reality of advanced care for millions of Americans.

The networking sessions, focusing on topics from policy and advocacy to building state coalitions, will give you the chance to meet leaders with the passion to drive change on advanced care and the resources to make it happen.

For more information and to register for the C-TAC Summit, visit https://www.ctacsummit.org/

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Event Events

AAHCM Preconference presented by HCCI

The American Academy of Home Care Medicine (AAHCM) has partnered with Home Centered Care Institute (HCCI), offering a preconference opportunity for a deep dive into areas critical to a successful home-based primary care practice.

House Calls:
Achieving Clinical Excellence and Sustainability

Thursday, October 17, 2019

Loews Chicago O’Hare Hotel
Louvre Ballroom
5300 N. River Road
Rosemont, IL

Clinical Session
9:00 am – 12:00 pm

Practice Management Session
1:00 pm – 4:00 pm

Optional Office Hours
4:00 pm – 5:00 pm

The AAHCM Preconference is designed to help you enhance your medical knowledge, patient care, and interpersonal and communication skills by illustrating the complex care needs of homebound patients with serious illness and their caregivers through case-based discussions, mini-lectures and question-and-answer sessions. Our faculty of national experts will help you to elevate the clinical care you provide to your home-based primary care patients, as well as to enhance your practice’s sustainability in both the current fee-for-service world and the ever-evolving value-based delivery system.

Clinical Session

Topics in the Clinical Session will include: treatment of homebound or home-limited patients with moderate- to late-stage dementia including behavioral disturbances; transitions of care and care coordination; palliative/supportive care and end-of-life care.

Practice Management Session

Topics in the Practice Management Session will include: advanced coding and billing, including HCC scoring; efficiency strategies to enhance practice operations; creating a value proposition to tell your practice’s story to payers, ACOs, and health systems.

Registration

To register for the AAHCM Annual Meeting and Preconference presented by HCCI, click or go to https://www.aahcm.org/page/2019_Annual_Meeting.
If you have already registered for the AAHCM annual meeting and want to add a preconference session, please contact member services at 847-375-4719 or [email protected].

Registration Fees
One Session/Both Sessions
Physicians $135/$240
Advanced Practice Providers $90/$165
Residents and Fellows $90/$165
Practice Managers and Operations staff $90/$165
Allied Health Professionals $90/$165

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Event Events

GAPNA Preconference presented by HCCI

GAPNA Preconference

Attending the GAPNA Annual Conference?
Register today for the Preconference presented by

The Gerontological Advanced Practice Nurses Association (GAPNA) has partnered with Home Centered Care Institute (HCCI), offering a preconference opportunity for a deep dive into areas critical to a successful home-based primary care practice.

House Calls:
APNs Navigating Challenges
and Implementing Solutions

Wednesday, October 2, 2019
12 pm – 5 pm

This Preconference practice management workshop is designed to explore the challenges faced and opportunities presented when caring for complex patients in the home. The aim of the session is to expose learners to the successes and failures in NP-driven practices. Time efficiencies, documentation and coding for house calls, valuing your practice, payer/ACO partnerships, and community resources also will be addressed.

To register for the GAPNA Annual Conference and Preconference presented by HCCI,
go to https://www.gapna.org/events/annual-conference.

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Benefits of HBPC Caregiver Stories HCCIntel Uncategorized

Community Paramedics Make House Calls and Change Lives

Ottawa Citizen.com  |  Elizabeth Payne  |  Aug 21, 2019

Maria Makkos greets Stephanie Rose at the front door of Makkos’s Arnprior apartment building.

“You are here to see me?” she asks, grinning broadly as she leads the community paramedic to her tidy unit.

Over her shoulder, Rose, the paramedic, carries a heavy black bag containing a blood pressure cuff, equipment for drawing blood, papers and other medical equipment.

Makkos, 82, is the third client the community paramedic has seen this morning.

Rose checks Makkos’s blood pressure, which is high. When they sort through her medication, Rose discovers the elderly woman hasn’t been taking it regularly.

“You are busted, I caught you red-handed,” says Rose with a laugh and a wag of the finger.

Makkos, who still drives and walks to stay fit, says she is determined to remain healthy so she doesn’t have to go into the hospital.

“Don’t’ worry, that is the last place we want you to be,” says Rose. “We are going to help you stay here, but we just want to make sure you are safe.” Taking her medicine on time, she tells Makkos, is crucial to staying healthy and in her own home.

Before she leaves, Makkos wistfully jokes that she wants Rose’s visit to last all day.

In a role reminiscent of a family doctor doing house calls, Rose visits clients to check on their health and just to chat. The conversations, sprinkled with laughter, are as important as the testing to determine what people need to remain independent and as healthy as possible, she says.  Read more

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HCCIntel Practice Management Tip of the Month Training

Geographic Scheduling: Impact on Home-Based Primary Care Productivity

Geographic scheduling

Geographic scheduling

One of the unique challenges home-based primary care practices face is determining an effective geographic scheduling and route planning process.  The ability to automate and/or optimize routing of patient visits is key to minimizing travel time for providers, boosting productivity and increasing face-to-face time with patients. Dedicating the time and thought into operationalizing the process of geographic scheduling will increase productivity, boost provider morale, and improve bottom line.

Some tips to remember when determining your scheduling outline and process:

  • Define provider scheduling zones utilizing zip codes and/or service areas within proximity.
  • Implement the use of Bing Maps and Google Maps can assist with defining appropriate zones and daily routes for providers.
  • Utilize mapping/scheduling software such as CareLink and RoadWarrior to create reliable multi-destination routes.
  • For smaller practices on a budget, the use of an Excel spreadsheet could assist in mapping out the areas the practice covers and grouping patients accordingly.
  • Establish a process for the scheduling staff to follow that allows for grouping of future appointments together on days in which the provider will be in a defined area.
  • When caring for patients in an assisted living or group home, ensure the scheduling staff maintains an accurate list of patients at each facility so patients are seen together when the provider is at the facility.
  • High patient volume within a facility is a great opportunity to maximize provider productivity by designating set facility days.
  • Recruit and hire providers who reside in a high patient population area so they can provide service with minimal travel time.

Interested in improving productivity Geographic Scheduling? Home Centered Care Institute will present a 30 minute HCCIntelligence™ Webinar on Wednesday, September 18 at 4 pm CST followed by Virtual Office Hours.