Category: HCCIntel

HCCI at the C-TAC National Summit

Post author By Jim Nonneman
Post date September 10, 2019

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/

Event Events

AAHCM Preconference presented by HCCI

Post author By Jim Nonneman
Post date September 10, 2019

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

Event Events

GAPNA Preconference presented by HCCI

Post author By Jim Nonneman
Post date September 10, 2019

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.

Benefits of HBPC Caregiver Stories HCCIntel Uncategorized

Community Paramedics Make House Calls and Change Lives

Post author By Jim Nonneman
Post date August 22, 2019

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

HCCIntel Practice Management Tip of the Month Training

Geographic Scheduling: Impact on Home-Based Primary Care Productivity

Post author By Jim Nonneman
Post date August 16, 2019

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.

Benefits of HBPC HCCIntel

Slowly Getting Serious: The New CMS Primary Care Models And Implications For Serious Illness Care

Post author By Jim Nonneman
Post date July 31, 2019

Doctor making a house call discussing serious illness

July 31, 2019 | Health Affairs | Mark Japinga, Mathew Alexander, David Casarett, William K. Bleser, Mark B. McClellan, Robert S. Saunders

In April, the Centers for Medicare and Medicaid Services (CMS) introduced five new payment models as part of its Primary Care First (PCF) and Direct Contracting (DC) programs. The models represent CMS’s latest push to move primary care providers away from fee-for-service payments and into care models that focus on total cost of care, using varying levels of capitated payments that can help facilitate investment in critical services not sufficiently reimbursed under fee-for-service, such as care coordination, 24-hour call centers, and home visiting.

Care for high-risk, high-need patients earns significant attention, especially in the Serious Illness Populations (SIP) track within PCF. This model specifically builds on proposals from the American Association for Hospice and Palliative Medicine (AAHPM) and the Coalition to Transform Advanced Care (C-TAC) and offers the clearest glimpse yet into how CMS is incorporating new delivery models targeting this population.

The implementation challenges for practices will be similar to those found by our recent work on serious illness care in accountable care organizations (ACOs). This includes a national survey and case studies on diverse ACOs with mature serious illness care programs and sustained success in ACO models, which chronicled how some ACOs are going beyond simply identifying a serious illness population and working to transform their care. This research is especially relevant given that PCF and SIP, as currently described, focus more on improving whole-person care for high-risk patients with multiple chronic conditions, centralized in primary care settings. This is a key distinction from the AAHPM and C-TAC models, which focus on advanced illness, pre-hospice, or end-of-life care with a strong role for palliative care teams. In other words, these models may serve as a bridge to more comprehensive, person-focused serious illness care approaches in the coming years.

Read the full article

Benefits of HBPC HCCIntel Training Training & Education

House Calls Are Reaching the Tipping Point — Now We Need the Workforce

Post author By Jim Nonneman
Post date July 30, 2019

home-based primary care training and education

7-29-2019
Written by: Thomas Cornwell, Home Centered Care Institute; Northwestern Medicine Regional Medical Group
Journal of Patient-Centered Research and Reviews

Abstract

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better prepared HBPC workforce, making St. Clair and colleagues’ article published within this same issue very timely. They showed residents exposed to HBPC had increased interests in providing HBPC in the future. They also found HBPC training fulfilled all 6 Accreditation Council of Graduate Medical Education core competencies and at least 16 of the 22 Family Medicine Milestone Project subcompetencies. Such medical education curricula are necessary to sufficiently develop a future workforce capable of appropriately providing HBPC to an increasing number of patients.

Recommended Citation

Cornwell T. House calls are reaching the tipping point — now we need the workforce. J Patient Cent Res Rev. 2019;6:188-91.

Benefits of HBPC Event Events HBPC in the News HCCIntel Legislative News Uncategorized

AAHCM and HCCI present a webinar on new CMS Primary Cares Payment Models

Post author By Jim Nonneman
Post date July 23, 2019

The American Academy of Home Care Medicine (AAHCM) in collaboration with the Home Centered Care Institute (HCCI) will host a webinar Tues. July 30 at 4 pm (ET) on the new CMS Primary Cares Initiative payment models relevant to home care medicine. The three different payment models will be discussed in detail; Primary Care First (PCF), Seriously Ill Population (SIP), and Direct Contracting (DC).

CMS Primary Cares Initiative

In April, the Center for Medicare and Medicaid Innovation (CMMI) announced a CMS Primary Cares Initiative which includes new payment demonstrations meant to promote value-based care, with a shift of up to 25 percent of primary care Medicare fee-for-service patients to these new models. Primary Care First (PCF), Seriously Ill Population (SIP), and Direct Contracting (DC) will offer enhanced payment for home care medicine and other providers to provide primary care for people with advanced illness.

Primary Care First (PCF) & Seriously Ill Population (SIP)

The Primary Care First (PCF) and Seriously Ill Population (SIP) models will be offered in 22 states and 4 regions for a January 2020 start date: STATEWIDE in Alaska, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maine, Massachusetts, Michigan, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, and Virginia. In Local Regions of Greater Buffalo, NY, Kansas City (Kansas and Missouri), Greater Philadelphia (Pennsylvania), North Hudson-Capital Area, NY, and Northern Kentucky.

PCF/SIP Timeline: A letter of intent (LOI) is not required for PCF or SIP. A request for application (RFA) will be released in the coming weeks and is required for participation. Both models are scheduled to begin January 2020.

Direct Contracting

The Direct Contracting (DC) path will engage practices or groups of providers who can reach 5,000 beneficiaries by Year 3 (with potential exceptions for smaller practices), as well as Health systems, Accountable Care Organizations, Medicare Advantage plans, and Medicaid Managed Care Organizations. DC builds upon the Next Generation ACO model and has no geographic limitations on who may apply. The DC path will include three models: Professional PBP, Global PBP, Geographic PBP (Proposed).

Timeline: A Letter of Intent (LOI) is required to apply for participation in the DC Models and is due on Friday, August 2. The LOI is non-binding. CMS will then release the request for application (RFA), which will be required for participation. All models are scheduled to begin January 2020 except the DC Geographic Option, which will begin at a later date.

HCCIntel Practice Management Tip of the Month Training & Education

Why is HCC Coding so Important for Home Care Medicine?

Post author By Jim Nonneman
Post date July 11, 2019

A hot topic in health care today is Hierarchical Condition Categories (HCCs), and there is no better time to consider the value of HCC coding to your home-based primary care program! HCC coding is the risk adjustment method used by Centers for Medicare and Medicaid Services (CMS) to determine the annual payments for patients in Medicare Advantage plans. HCC risk adjustment uses predictive modeling to determine the severity of patients’ conditions, health risk, and status to project the cost of health care coverage for that population. This is how CMS determines cost savings for patients enrolled in Accountable Care Organizations and the Independence at Home Medicare Demonstration, and HCC risk adjustment will also determine into which Practice Risk Group patients will be placed for the new Primary Care First Model.

Correct diagnosis coding is always important, but it is critical for accurate risk adjustment because it drives appropriate reimbursement for provider services in value-based payments. An easy “best practice” to initiate is to always code to the highest specificity. Unfortunately, Electronic Health Records (EHRs) complicate this because the search list populated for diagnosis codes frequently brings the unspecified codes to the top of the list. To overcome this challenge, we recommend creating a list of HCC diagnosis “favorites” that will more easily display for selection. Check if your EMR can highlight diagnoses that map to HCC scores. Partnering with a certified medical coder can assist in ensuring accuracy in the common conditions included as “favorites,” especially for disease combinations such as diabetes with chronic kidney disease. In addition, you can also consider running a diagnosis utilization report to identify your most frequently treated HCC diagnoses and then review and update your problem lists so you can be as specific as possible for patients with those conditions.

Correct coding is essential for accurately predicting future health care costs for patients and ensuring the appropriate reimbursement for providers.

To enhance your understanding of which conditions carry a risk adjustment factor, download our HCC Resource Sheet for Home-Based Primary Care (HBPC) which provides a list of common HBPC diagnoses for HCC scoring.

Benefits of HBPC HCCIntel

The Doctor Will See You Now, In Your Home

Post author By Jim Nonneman
Post date June 17, 2019

doctor house call medicine visit — senior woman gets a home visit from gpsame shoot

The old-fashioned house call is back in a big way. Here’s how it works.

June, 2019 | Harvard Health Newsletter |

It’s hard to get to the doctor when you don’t drive anymore or you’re struggling with several chronic medical conditions. The result may be missed appointments and a lack of needed care.

But a growing trend makes it far easier for older adults to get medical attention, bringing routine exams and diagnostic tests to the patient’s doorstep. It’s called home-based medical care — when doctors, nurse practitioners, physician assistants, or other providers visit and treat older adults right in their homes.

Different from home health care

Home-based medical care isn’t the same as home health care, which sends skilled nurses and therapists to your home specifically to help you recover from illness, injury, or surgery, with the goal of helping you get better and regain your independence.

Instead, home-based medical care is more like a beefed-up house call. “These are their regular visits. The only difference is that we bring the equipment to them,” says Dr. Diane McMullin, a geriatrician with the House Calls program at Harvard-affiliated Mount Auburn Hospital.

In some cases, the house call provider can visit when you develop a sudden illness, like an infection. Some providers can bring mobile x-ray or ultrasound machines and equipment to draw blood and collect urine.

Is it covered?

“Medicare began recognizing home visits about 20 years ago,” says Brent Feorene, executive director of the American Academy of Home Care Medicine. And the number of Medicare-funded house calls has been increasing. For example, Medicare paid for 1.6 million home care visits in 2001. By 2015, the number was 2.6 million.

But Medicare won’t pay for a house call as a simple matter of convenience. “The expert must certify that the visit was medically necessary,” Feorene says.

What’s considered medically necessary? Coverage generally applies when an older adult has a condition that restricts the ability to leave home, making a visit to the doctor’s office considerably taxing. For example, the person might need the help of an assistive walking device or wheelchair, the assistance of another person, or medical transportation; or the person may have a cognitive, psychiatric, or emotional issue that makes it hard to get to an appointment.

Whether your private insurance will pay for a house call is a different story. That depends on your insurer.