Category: HCCIntel

HCCIntelligence™ Update: COVID-19 Telehealth Billing Requirements

Post author By Jim Nonneman
Post date March 24, 2020

In our recent article, Providing Telephonic and Virtual Care Requirements as part of COVID-19 Precautions, available on HCCI’s COVID-19 Information Hub, we highlighted the requirements of virtual visits. We also provided an overview of the 1135 Telehealth Waiver as part of the president’s emergency declaration during the country’s current public health emergency.

We realize this is a challenging time for Home-Based Providers, and the Home Centered Care Institute (HCCI) is committed to supporting the field by providing timely information so you can make the best decisions for your practice. In response to recent questions, we’ve outlined more information below to clarify additional questions you may have.

Q: What are the current Evaluation and Management (E/M) codes that can be billed for when the services are provided via telehealth under the 1135 Waiver?

A: Here are the appropriate E/M codes:

Office/Outpatient CPT code range 99201-99215
Transitional Care Management CPT codes 99495 and 99496
Advance Care Planning CPT codes 99497 and 99498
Annual Wellness Visits HCPCS codes G0438 and G0439
Administration of caregiver-focused health risk assessment instrument CPT code 96161
Telehealth consultations ED or initial inpatient visits HCPCS code range G0425-G0427
Follow-up inpatient telehealth consultations in hospitals or SNF’s HCPCS range G0406-G0408

For a complete list of CPT codes, please refer to Medicare’s list of telehealth services

HCCI is awaiting official guidance from CMS on whether Home-Based Practices that historically bill only for home or domiciliary visits should be concerned about a potential heightened audit risk if they use the office visit code set during this pandemic. We realize, however, that many Home-Based Practices are choosing to use the set office visit code, in the interim, to maintain their practice. Our recommendation is to review all the facts before making the best decision for your practice and consider contacting your local Medicare Administrator Contractor (MAC) for specific guidance.

Q: What Place of Service (POS) and modifiers are required to bill for telehealth services?

A: For services furnished via telehealth, report Place of Service (02) for telehealth.

Per the CMS FAQs & The Medicare Learning Network’s March 20th update, CMS does not generally require additional or different modifiers on Medicare claims for telehealth services furnished under these waivers, except in the following three instances:

GQ – Telehealth services are furnished via asynchronous (store and forward) technology as part of a federal telemedicine demonstration project in Alaska and Hawaii
GT – Telehealth services are furnished under CAH Method II (Via interactive audio and video telecommunication systems)
G0 – Telehealth services are furnished for the purposes of diagnosis and treatment of an acute stroke

As an example of when receiving guidance from your local MAC is beneficial, a practice in Indiana reached out to their MAC (i.e., WPS Government Health Administrators) and was advised to use modifiers for telehealth claims.

Q: How do I contact and confirm who my local MAC is?

A: CMS has a contractor directory and map on their website that allows you to search by state to confirm your MAC along with links to each contractor’s site where you can find their Provider Contact Center phone number. You will need to call your MAC directly to request clarification on proper billing for home visits under the 1135 waiver. They may refer you to a specific governance email, however, HCCI is aware that practices are generally receiving timely responses within a few days.

It’s also important to note the requirement for practices to use an interactive audio and video telecommunications system that permits real-time communication between the provider and the patient at home even under the telehealth waiver. This means you cannot bill for an E/M visit via telehealth for phone call audio-only. However, under the U.S. Department of Health and Human Services (HHS), the Office of Civil Rights (OCR) Notification of Enforcement Discretion relaxed HIPAA requirements so that providers may use platforms such as Apple FaceTime, Skype, Zoom, the WhatsApp, etc., as a form of two-way audio and video telecommunications. Doxy.me, a free HIPAA-compliant telemedicine platform that allows for two-way audio and video interaction with patients and caregivers, is another option. Consider checking with your Electronic Health Record (EHR) vendor as they may have technologies available for video visits, too.

If you are providing virtual services to patients via phone call audio-only, you must refer to the Virtual Check-in Codes (requirements detailed in previous HCCI article), or use other forms of reimbursement, such as care management services (e.g., Chronic Care Management) to bill for your time.

The E-visits codes, which capture time over a 7-day period for communicating and reviewing patient information on a digital communication platform, such as a patient portal or secure email, are listed below in an HCCI chart for easy reference:

For additional information, refer to the CMS General Provider Telehealth and Telemedicine Tool-kit, or contact a member of the HCCIntelligence™ Hotline staff at 630-283-9222 or email [email protected].

Disclaimer: This information is current as of 3/23/2020. Coding regulations are subject to change annually, and COVID-19 guidelines are changing daily. Please note for the purposes of the Home-Based Primary Care (HBPC) population: The Home Centered Care Institute (HCCI) focuses our content on CMS guidelines relevant for traditional Medicare billing.

HCCIntel Legislative News Practice Management Training Training & Education

Providing Telephonic and Virtual Care Requirements as part of COVID-19 Precautions

Post author By Jim Nonneman
Post date March 17, 2020

The Home Centered Care Institute (HCCI) understands that many Home-Based Practices and Providers are increasing the use of virtual and telephonic care as an alternative to face-to-face care, as appropriate, due to the current COVID-19 pandemic.

Though a telehealth waiver is mentioned under recent legislation (H.R.6074 – Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020), CMS initially responded to the bill advising providers to use Communication-Technology Based Services (CTBS) and interprofessional consults.

In the CMS FAQ published on 3/5/2020, Medicare directs providers to use the current CTBS services as a means of telehealth for traditional Medicare purposes. There are, however, exceptions for Medicare Advantage (MA) patients whose MA Plan offers telemedicine as one of their supplemental benefits.

On 3/17/2020, a new Medicare Fact Sheet and FAQ’s (links below) were then published, indicating authority for the expansion of telehealth under the 1135 waiver to pay for Evaluation & Management (E/M) Office visits, Hospital visits, and other specified visits in the patient’s place of residence valid 3/6/2020.

Before billing for E/M Home Visits (CPT Code Range 99347-99350) or Domiciliary Visits, e.g., assisted living and group homes (CPT Code Range 99334-99337), however, please be advised these services are not included on the list of Medicare Telehealth Services. So, in summary, E/M Office visits (CPT Code Ranges 99201-99205 and 99211-99215) can be paid under telehealth, but E/M Home and E/M Domiciliary visits cannot at this time.

Below are the limited services included on Medicare’s list of telehealth services, which Home-Based Providers typically provide and can potentially bill for − if furnished via telehealth using Place of Service (POS) code 02 for telehealth:

CPT codes 99495 and 99496 for Transitional Care Management
CPT codes 99497 and 99498 for Advance Care Planning
Annual Wellness Visits CPT codes G0438 and G0439
CPT code 96161 − Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring, and documentation, per standardized instrument.

CTBS Services and E-Visits (CPT Code Range 99421-99423) can be provided and billed for now and prior to the telehealth waiver without Medicare telehealth restrictions. We’ve detailed the requirements to bill for these services below (currently, and per the 2019 Medicare Physician Fee Schedule Final Rule, there is no frequency limitation for G2012 and G2010):

G2012: Brief Communication Technology-Based Virtual Check-in

Includes a minimum of a 5-10-minute medical discussion by a physician or other qualified healthcare professional (e.g., Advanced Practice Providers) with the patient/caregiver; this cannot include clinical staff time
Communication may be audio-only (e.g., telephone) or two-way video
Can only be used for established patients
Intended to assess the patient’s condition to determine if a face-to-face (F2F) visit is needed
Cannot be related to an E/M F2F visit within the previous 7 days and cannot result in an E/M visit within the next 24 hours or the next available appointment
Requires a patient-initiated question or call
Verbal patient consent is required, however, please note that, as a result of the Medicare 2020 Physician Fee Schedule Final Rule, only a once-per-year annual consent is required for CTBS services as long as the patient is made aware of possible cost-sharing
CMS National Payment Amount: $14.80

G2010: Remote Evaluation of Recorded Video and/or images

Pre-recorded image and/or video of sufficient quality provided by the patient or caregiver
Requires documentation of consent at least once per year (may be verbal, written, or electronic)
Requires interpretation and follow-up to the patient and/or caregiver within 24 business hours (follow-up may be via a patient portal communication, telephone, secure text/email or two-way video)
Can only be used for established patients
CMS National Payment Amount: $12.27

Please note: In the CMS FAQ published on 3/17/20, CMS clarifies that, while these interactions must be patient-initiated, CMS does condone providers making their patients aware of these services and billing for them, as appropriate. Please keep in mind medical necessity is always a requirement of payment, and documentation needs to support the necessity and decision-making of the care provided.

Supporting excerpt from CMS FAQ: “We expect that these virtual services will be initiated by the patient, however, practitioners may need to educate beneficiaries on the availability of the service prior to patient initiation.”

CMS has explicitly stated that they do not consider Remote Patient Monitoring (RPM) Services and CTBS to be part of their definition of telehealth services. Therefore, you can bill for the above and below additional services without the regulatory restrictions of Medicare telehealth requirements (e.g., originating and distant site, geographic restrictions do not apply).

99451, 99452, 99446-99449 (Interprofessional Telephone/Internet/Electronic Health Record Consultation Services)
99453, 99454, 99457, 99458 (Remote Physiologic Monitoring)
99091 (Review and analysis of physiologic data)
99421, 99422, 99423 (Online Digital E/M by a qualified provider); Please note this service is bundled with Chronic Care Management (CCM); Refer to our 2/19/20 HCCIntelligence™ Webinar “What You Should Know About 2020 Coding Updates!” for further details regarding online E/M services
G2061, G2062, G2063 (Online Digital E/M by a nonphysician healthcare professional); Please note this service is bundled with CCM

Other Key Considerations:

CMS will not enforce an existing provider-patient relationship to furnish telehealth services. The Department of Health & Human Services (HHS) advised: “HHS will not conduct audits to ensure an existing provider relationship during this public health emergency.”
Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. For more information: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
HCCI encourages all Home-Based Providers and Practices to contact their local Medicare Administrator Contractor (MAC) to inquire if they will pay for E/M Home Visits furnished via telehealth under the current telehealth waiver.

For additional information on COVID-19 regulations and legislation, please visit the CMS current emergencies page or contact a member of the HCCIntelligence™ Hotline staff at 630-283-9222 or email [email protected]..

You can also visit the HCCI COVID-19 Information Hub for additional information and resources.

Disclaimer: This information is current as of 3/17/2020. Coding regulations are subject to change annually, and COVID-19 guidelines are changing daily. Please note for the purposes of the Home-Based Primary Care (HBPC) population; the Home Centered Care Institute focuses our content on CMS guidelines. All G codes are used for Medicare purposes, and commercial payors utilize a corresponding set of CPT codes.

HCCIntel Tip of the Month

Keep Your Practice Financially Healthy

Post author By Jim Nonneman
Post date March 13, 2020

Revenue cycle management (RCM) encompasses all the administrative and clinical functions that contribute to the identification, capture and management of patient service revenue. A periodic review of RCM basics may uncover opportunities for process improvement within your organization. Points to consider:

Do you have in-house support, or will you outsource RCM, billing and coding functions? If outsourced, do you receive consistent reports and feedback on your practice’s billing and coding?
Do your providers and support staff receive ongoing education on Evaluation and Management (E/M) and billing considerations specific to house calls?
Are your providers responsible for selecting their own billing codes or do you have an internal coding review?
Do you monitor certain services (e.g., time-based) for accuracy and completeness prior to claim submission?
Are progress notes locked and signed within 72 hours? Who monitors open encounter lags?
How quickly are claims being paid and who follows up on outstanding unpaid claims/denials?

Also, be sure not to overlook the following:

Credentialing – Documentation of each payer enrollment process and ensuring all providers are credentialed with each payer.
Office of the Inspector General (OIG) Compliance – Section 6401 of the Affordable Care Act (ACA) requires providers to develop and implement a formal health care compliance program.
Denial management process – Examine, resolve and/or appeal claims to recover lost revenues.

Finally, remember that, whether managed in-house or outsourced, successful RCM strategies depend on the accuracy and thoroughness of front-end tasks, such as verifying active insurance coverage prior to visits and the effective denial management process mentioned above.

Event HBPC in the News Training Training & Education Uncategorized

HCCI and NNPEN Conference: Different Strategies, Shared Vision

Post author By Jim Nonneman
Post date March 13, 2020

How can Nurse Practitioners (NPs) and others effectively start-up and/or expand a home-based primary care (HBPC) practice? Just ask the participants who attended the February 7- 8 joint conference hosted by the Home Centered Care Institute (HCCI) and the National Nurse Practitioner Entrepreneur Network (NNPEN) in Phoenix.

With NPs being the fastest-growing segment of HBPC providers, the conference provided attendees with critical information on planning and operating a successful and sustainable HBPC practice. Participants brought varying backgrounds and HBPC experience levels to the conference, entitled, “Blueprint for Success: Building and Growing Your Home-Based Primary Care Practice.” The first day concluded with a well-attended “Open Office Hours” segment, where participants were able to ask questions about their specific situations, which invariably applied to many in the room.

The two organizations’ strategies are necessarily distinct. HCCI focuses on professional development for NPs who have a specific interest in HBPC while NNPEN, as Sandy Berkowitz, RN, JD, and Co-founder and CEO of NNPEN, explains, “focuses on supporting nurse practitioners as professionals who want to be their own boss.”

At the same time, though, HCCI and NNPEN have a similar vision. “We share the same vision and passion to create access for a primary care population of frail and elderly patients who are vastly underserved,” Berkowitz continues, “and to explore how advanced practice providers can do well by doing good.”

In sharing her own conference takeaways, Heather Hodge, Director of Education for HCCI, said, “During the conference, I was struck again by how providers are offering HBPC through a variety of business models. It’s not a one-size-fits-all. Plus, people seemed to take something from every session that they could immediately apply to their own situations. Finally, the conference gave people a place to ask their top-of-mind questions and share their successes and challenges, like managing different state laws, payer requirements, and so on. In all, the event helped many see they weren’t alone and that, if they were having an issue, someone else probably was, too.”

For NPs and others with questions about developing or sustaining an HBPC practice, HCCIntelligence™ offers webinars and a hotline at 630-283-9222 and [email protected].

HCCIntel Tip of the Month Training

Optimizing Front Office Operations

Post author By Jim Nonneman
Post date March 5, 2020

House Call programs can become more efficient, drive collaboration and enhance overall effectiveness by optimizing their daily operations. These operations can include managing phone calls, paperwork, record requests, and geographic scheduling; confirming appointments and verifying insurance, conducting patient intake and processing referrals, and assisting with practice billing and coding, among other areas.

Here are several tips to help your practice be successful:

Develop scripting and decision-tree guides for the front office to follow when speaking with new patients
Use real-time eligibility within the Electronic Health Record (EHR) to verify active patients and correct insurance prior to patients being seen
Consider using an electronic fax platform with E-Signature capability to streamline orders and paperwork
Use clear and concise patient intake and referral checklists to ensure appropriate information is collected in advance and services are explained upon enrollment
Define territory zones for each provider and use map-based tools to plan visits and routes
Don’t confirm appointments until one week to a few days beforehand to allow for schedule flexibility and ensure patients/caregivers are expecting the provider
Explore Health Information Exchange (HIE) options in your area for prompt access to medical records
Determine which services may require a review to ensure documentation and coding requirements are met and provide real-time feedback to the providers
Taking the time upfront to optimize these operations will prevent task duplication, promote efficiency, and increase patient and team satisfaction.

HCCIntel Practice Management Training & Education Uncategorized

Annual Chart Audits Can Greatly Benefit HBPC Providers and Practices

Post author By Jim Nonneman
Post date February 12, 2020

About this Article:

Regular chart audits can significantly help home-based primary care (HBPC) practices improve their coding accuracy and the quality of their documentation, while also identifying lost revenue due to under-coding or missed billing. In this interview, HCCI’s Brianna Plencner discusses how chart audits can also uncover potential compliance issues and ensure documentation and coding practices are current and appropriate.

Article:

In addition to its education offerings in home-based primary care (HBPC), the Home Centered Care Institute (HCCI) offers consulting services, including chart audits, which are a valuable tool that HBPC practices can use to evaluate provider performance and improve coding and documentation. “A formal audit provides confidential, qualified feedback on a provider’s documentation and coding practices,” explains Brianna Plencner, HCCI’s Manager of Practice Improvement.

A Certified Professional Medical Coder and Certified Professional Medical Auditor, Plencner also holds a diploma in Medical Insurance Billing and Coding. Before joining HCCI, she also served as practice manager for Northwestern Medicine HomeCare Physicians, which was founded by Dr. Thomas Cornwell, CEO of HCCI. HCCInsights recently asked Plencner to share her perspective on the benefits of conducting a chart audit.

HCCInsights: Why would an HBPC practice consider using an outside agency to perform a formal chart audit?

Plencner: First, there are many reasons to conduct routine chart audits. Medical practices can use the audit process to educate providers and staff and foster a culture of continuous quality improvement. Expert reviews of patient charts also promote more accurate and complete documentation and maximize the likelihood the practice will receive appropriate reimbursement for the services provided. Because the home-based patient population is complex, the practice’s coding must fully represent the severity of each patient’s illnesses and all the services rendered. At the same time, the audit process can minimize compliance risks by identifying and correcting billing errors.

In terms of why an outside agency would be used, external auditors inherently provide an objective point of view. Their audit decisions are not influenced by an intimate knowledge of the practice and are solely based on the data examined.

HCCInsights: How does the chart audit process work? What should a practice anticipate?

Plencner: Following the execution of a Business Associate Agreement (BAA)*, a nationally certified medical auditor will first work with you to remotely access your practice’s medical record, review a sampling of patient charts, and evaluate the quality of provider documentation and coding accuracy. Then, after a preliminary conversation with our main contact and/or the leadership at your practice, our experts will conduct a virtual meeting with your providers and practice staff to walk through the charts reviewed and discuss the findings and recommendations.

Practices also have the option of requesting that a consultant travel to their location to provide onsite coaching in coding and documentation. As needed, the consultant can also develop customized documentation tools and training plans and assist with incorporating these into the practice’s procedures. Again, the goal of all these activities is to enhance your documentation and increase your reimbursement.

*Editor’s Note: A Business Associate Agreement (BAA) is a legal document signed between a healthcare provider and contractor/vendor. A provider enters into a BAA with a contractor/vendor who might, in the course of the proposed work engagement, (e.g., HCCI) receive access to Protected Health Information (PHI).

HCCInsights: What types of things do the auditors review?

Plencner: It’s a pretty extensive list. Everything from Evaluation and Management (E/M) coding, to ensure the correct level of service is selected and the documentation supports medical necessity, to whether the necessary information is recorded, and timely signatures have been obtained. The auditor will also check whether all services provided were billed out. These are just a few examples of what’s typically reviewed.

HCCInsights: Based on your personal experience, what are the most common issues discovered during a formal HBPC chart audit?

Plencner: Among the top issues we typically discover are: (1) failure to document a complete history of present illness (HPI); (2) failure to document all services being provided, such as reviewing patient records and history, talking to other providers, ordering tests, etc., which is important for determining the correct level of Medical Decision Making (MDM); and (3) under-coding** the correct level of service, which – believe it or not – is actually more common in HBPC practices than over-coding.

**Editor’s Note: Under-coding” is reporting a lower level of service than the documentation supports.

HCCInsights: It seems like there are changes to billing and coding nearly every day – how do auditors keep up?

Plencner: Nationally certified medical auditors are required to complete a variety of continuing education requirements every year to maintain their accreditation. As experts in their field, HCCI auditors actively participate in coding and documentation “boot camps,” webinars and other credential-specific programs.

HCCInsights: Are chart audits required or optional?

Plencner: At a minimum, internal chart audits are a required component of a practice compliance plan. The industry standard is an annual audit of 10 charts per provider to determine coding accuracy and compliance. Practices without an internal billing staff, or practices desiring an unbiased third-party review, would find a lot of value from doing an external chart audit.

HCCInsights: Does HCCI offer other types of consulting services?

Plencner: Yes, HCCI can conduct practice assessments to evaluate operational standards, clinical functions, policies and procedures, and opportunities for improvement. All our consulting services are customized to the practice’s specific needs and concerns. We also can offer practices customized education, such as exclusive webinars and onsite, interactive training for the entire team.

HCCInsights: How would a practice learn more about initiating a chart audit through HCCI?

Plencner: Call us at 630-283-9222 or email [email protected]. After an introductory call with your team, HCCI will be happy to provide you with a proposal that outlines the recommended scope of work and describes next steps.

Editor’s Note: Those interested in coding will also want to attend our free HCCIntelligence™ webinar this month (Wednesday, February 19, 4:00 pm-5:00 pm Central Time) featuring the topic, What You Should Know about 2020 Coding Updates!

Caregiver Stories HBPC in the News HCCIntel

Family Caregivers’ Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations

Post author By Jim Nonneman
Post date January 28, 2020

JAMA Article

Original Investigation | Geriatrics

January 24, 2020

Authors: Jennifer L. Wolff, PhD; Vicki A. Freedman, PhD; John F. Mulcahy, MSPH

Key Points

Question What are family and unpaid caregivers’ experiences with health care workers in the care of older adults with activity limitations?

Findings In this national survey study, most caregivers reported that older adults’ health care workers always (70.6%) or usually (18.2%) listened to them and always (54.4%) or usually (17.7%) asked about their understanding of the older adult’s treatments, but fewer caregivers reported being always (21.3%) or usually (6.9%) asked whether they need help managing older adults’ care.

Meaning These findings reinforce the need for health system strategies to support family and unpaid caregivers, who are the main source of assistance to older adults with physical and/or cognitive limitations.

Read the article

HBPC in the News HCCI in the News HCCIntel

Being Treated at Home Can Help People Save Money and Heal Faster

Post author By Jim Nonneman
Post date January 10, 2020

Healthline

A new study found that the home hospital model can potentially improve care while reducing costs.
The cost of care was nearly 40 percent lower.
Trial participants receiving hospital care in their homes had a 70 percent lower rate of readmission to the hospital.

People check into the hospital expecting to get better, but there are risks — and some even wind up getting sicker.

You can face the danger of complications, like bleeding or infection. There are also the constant check-ins from nurses or physicians that can disrupt sleep.

And none of that includes the cost.

Additionally, when in a hospital, people are stuck in their hospital beds and many experience negative health impacts from this physical inactivity.

However, a pilot study by investigators at Brigham and Women’s Hospital in Boston finds that the home hospital model can potentially improve care while reducing costs. The findings were published in Annals of Internal MedicineTrusted Source today.

“Hospital at Home (HaH) as the name states, cares for hospital-eligible patients at home. Models vary, but generally patients seen in the emergency room that require hospital-level care are given the option of intensive care at home,” said Thomas Cornwell, MD, founder of Northwestern Medicine HomeCare Physicians and chief executive officer, Home Centered Care Institute (HCCI).

First study of its kind

“To date, there has not yet been a randomized controlled trial of home hospital care performed in the U.S. other than our small pilot,” David Levine, MD, MPH, MA, the study’s corresponding author, told Healthline.

The results of Dr. Levine and team’s randomized controlled trial (RCT) can strengthen the case for home hospital care, showing that it reduces costs and readmissions while increasing physical activity compared with usual hospital care.

“We wanted to show with a very high level of evidence that home hospital care could be delivered to acutely ill adults with lower cost, better physical activity, high quality and safety, and excellent patient experience,” said Dr. Levine.

“In addition, we feel this gives all Americans the information they need to choose the care for themselves and their loved ones should they need hospitalization,” he said.

Cost of care was nearly 40 percent lower

Levine and team enrolled 91 adult patients into the trial.

Each participant had been admitted via the emergency department at Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital with acute conditions that included infection, worsening heart failure, worsening chronic obstructive pulmonary disease (COPD), and asthma, that lived within 5 miles of the hospital.

They were randomized either to stay at the hospital for standard care or to receive care at home, including nurse and physician visits, intravenous (IV) medications, remote monitoring, video communication, and point-of-care testing.

Researchers measured the total direct cost of care, including costs for nonphysician labor, supplies, tests, and medications.

The findings indicate that patients receiving at-home care had total costs that were almost 40 percent lower than for patients treated conventionally.

HCCIntel Practice Management Tip of the Month Training & Education

Evaluating Your Staffing Model

Post author By Jim Nonneman
Post date January 10, 2020

Staffing costs are responsible for the largest share of a house call program’s expenses, so it is essential that staffing is appropriate to meet the needs of patients in the service area without sacrificing productivity. To enhance sustainability, a house call program should be evaluating its staffing on a regular basis. Some questions to consider:

Are schedules full? Are patients able to schedule timely appointments?
Are patients experiencing long hold times or abandoned phone calls?
What is the average wait time for a new patient?
Does schedule allow for prompt post-acute follow up?
Are patients able to obtain timely RX refills, prior authorizations, and referrals or do you receive complaints often?
Are all team members working to the top of their scope or burdened with administrative tasks?
Are in-basket (EHR) or incoming messages addressed or reviewed by end of the day or do several remain unopened and/or unaddressed for the next day?
Are lab and diagnostic test results reviewed and responses provided to patients in a timely manner?

Also, don’t forget that your practice can leverage a variety of data and metrics to evaluate if the staffing is appropriate. For example:

Incoming call volume
Average messages per day addressed by clinical staff and provider team
Productivity per providers and practice as a whole
Average increase of new referrals and referral source
Days from referral to first visit and days to transitional care visits from discharge
Annual patient, provider, and employee satisfaction surveys

Remember, there is no “one size fits all” staffing model. Consider your program’s mission, business plan, and patient population to determine what’s best for your practice, and then capture and regularly review meaningful practice metrics. By keeping a regular focus on these critical data, you will be able to ensure your program’s staffing is aligned with productivity targets and is appropriate to meet needs within the service area.

HCCIntel Training Training & Education

New HCCI Online Course Helps Take the Mystery Out of Home-Based Primary Care

Post author By Jim Nonneman
Post date January 10, 2020

About the Article:

Have you ever wondered what a career in home-based primary care would be like? According to Heather Hodge, Director of Education for the Home Centered Care Institute (HCCI), the organization’s new online course, House Calls 101: An Introduction to HBPC, is a great way to find out.

Article:

While home-based primary care (HBPC) is a growing field, many providers may not fully appreciate the numerous benefits of seeing patients in a home-based setting, nor understand how practicing within an in-home environment may differ from an office-based setting. In addition, many HBPC practice managers and operations staff are seeking a better understanding of house call components.

The Home Centered Care Institute’s (HCCI) new online course, House Calls 101, was developed to offer providers, practice managers and operations staff the unique opportunity to virtually shadow an HBPC physician and her medical assistant on a simulated house call. The course also provides a detailed breakdown of the steps to be taken before, during, and after a home visit, and offers insight into the characteristics and personal qualities of successful HBPC providers.

House Calls 101 is HCCI’s newest online course. According to Heather Hodge, HCCI Director of Education, the course was developed as a tool to expand the HBPC provider talent pool and give practice managers and operations staff a closer look at what goes into a house call. “Only about 15% of the patients who truly need HBPC services receive them,” Hodge said, “which correlates directly to the need to expand the HBPC provider network and provide a strong practice management foundation.”

Hodge’s background in the design and development of continuing medical education programs played a key role in creating the 30-minute course. She sat down with HCCInsights to discuss her perspective on the course and its ability to realistically demonstrate what it’s like to be an HBPC provider.

HCCInsights: What was the main objective behind the development of the course?
Hodge: The course is part of HCCI’s overall commitment to developing the HBPC workforce. The demand for HBPC providers currently exceeds the supply, but not every provider is suited for a career in HBPC. We created this course to give prospective HBPC providers, practice managers and operations staff a realistic and impartial look at what HBPC is like in the real world.

HCCInsights: What are some of the unique features of the course?
Hodge: It’s more of a primer or introduction to HBPC in general versus some of our other online course offerings that focus on one specific topic, such as Telehealth or Coding. It also introduces video as part of our instruction material for the first time — and is highly engaging with interactive elements.

HCCInsights: What do you think course participants will find most valuable?
Hodge: House Calls 101 de-mystifies the house call process. It walks through each of the main components of a house call ─ from preparing for the day all the way through to completing post-visit activities. In addition, the course covers what it’s like to travel with a Medical Assistant (MA) and takes a deep dive into the Social Determinants of Health (SDOH) that can significantly impact a patient’s health and well-being, and health care utilization. Finally, the course profiles the characteristics and personal qualities required to be successful as an HBPC practitioner.

HCCInsights: Why is it important for HBPC providers, practice managers and operations staff to understand the “Geriatric 5Ms” covered in the course?
Hodge: The “Geriatric 5Ms” is a framework for caring for complex patients. It aligns perfectly with the home-based primary care model; this is what the providers do every day. It focuses on key areas: Mind, Mobility, Medications, Multi-complexity and Matters Most. These areas are critical to understand because most HBPC patients are older adults with multiple chronic conditions and functional impairments.

HCCInsights: Can course participants earn CME by taking House Calls 101?
Hodge: Yes. House Calls 101 was planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of PeerPoint Medical Education Institute, LLC and HCCI.

To learn more about House Calls 101: An Introduction to HBPC and to register, click here.