Designing Winning "Transitions of Care" Processes!

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2013 PAFP Regional Lectures Series …

2013 PAFP Regional Lectures Series

Session 2 - Southeast

Learn about best practices for transitions of care, how to bill for the new management codes payable by Medicare.
Bonus: pick up great resources to improve management.

Speaker:
Lee Radosh, MD, FAAFP
Reading Hospital – Family Health Care Center
West Reading, PA

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  • 1. Designing Winning “Transitions of Care” Processes! Lee Radosh, MD, FAAFP Faculty, PAFP Residency Collaborative (RPC) Director, Family Medicine Residency Reading Hospital of Reading Health System, Reading, PA Lee.Radosh@readinghealth.org October 9, 2013
  • 2. DISCLOSURE Neither I nor any immediate family member (parent, sibling, spouse or child) has a financial relationship with or interest in any commercial entity that may have a direct interest in the subject matter of this session.
  • 3. Objectives  By the end of this presentation, participants will be able to:  List key recent external forces related to transitional care  Identify “priority tasks” in transitional care  Utilize tools and processes to augment your planning  Identify new CPT codes
  • 4. Agenda  Define TOC  Make a cogent argument for four main areas to “attack”  Present tools to assist  Review newer CPT codes
  • 5. What is a Winning Transitions of Care Process?  One that is MEANINGFUL, to  You, the practice (efficient)  Patients (clinically important)  Insurers (financially sound)  Hospital/practice administrators (all of the above!)
  • 6. For Our Purposes, Transitional Care Is . . . “ . . . the actions of healthcare providers designed to ensure the coordination and continuity of health care during the movement, called care transition, between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness. Older adults who suffer from a variety of health conditions often need health care services in different settings to meet their many needs.” Wikipedia
  • 7. For a Different Time . . (But Two Minutes Please . . . )  Transitional care is also for young people  Moving successfully from child to adult health services  http://www.medicalhomeinfo.org/how/care_deliv ery/transitions.aspx  AAP medical home/transitions website  http://www.pafp.com/pafpcom.aspx?id=785  PAFP / AAP partnership
  • 8. A, Health care transition-planning algorithm for all youth and young adults within a medical home interaction. a For pediatric practices, transfer to adult provider; b the MCHB defines children with special health care needs as “[t]hose who have or are at i... American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians, Transitions Clinical Report Authoring Group Pediatrics 2011;128:182-200 ©2011 by American Academy of Pediatrics
  • 9. A, Health care transition-planning algorithm for all youth and young adults within a medical home interaction. a For pediatric practices, transfer to adult provider; b the MCHB defines children with special health care needs as “[t]hose who have or are at i... American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians, Transitions Clinical Report Authoring Group Pediatrics 2011;128:182-200 ©2011 by American Academy of Pediatrics
  • 10. Transitions of Care SHOW ME THE MONEY EVIDENCE!
  • 11. Ann Intern Med. 2009 Feb 3;150(3):178-87. “A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.” INTERVENTION: A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. CONCLUSION: A package of discharge services reduced hospital utilization within 30 days of discharge. Pharmacotherapy. 2008 Apr;28(4):444-52. “Clinical outcomes of a home-based medication reconciliation program after discharge from a skilled nursing facility.” INTERVENTION: Patients were assigned to the medication reconciliation program (113 patients) or to the usual care control group (408 patients) after discharge to home from an SNF. Assignment to the medication reconciliation group or to the control group was based on provider submission of a discharge summary within 0-48 hours of discharge or more than 48 hours after discharge, respectively. CONCLUSION: Our data support the hypothesis that a formal medication reconciliation process, with its increased coordination of information between health care providers and patients, can decrease mortality after discharge from an SNF. Our findings support the role of medication reconciliation as an integral step in the transitional care process and interests of health care accrediting agencies, such as the Joint Commission, that have included medication reconciliation as an important initiative.
  • 12.  Multidisciplinary team approach  Clinical protocols and regional guidelines  Enhanced palliative care consultation and support  Education (of patients and caregivers)  Coaching  Personal health record  Community supports Evidence-Based Care Transitions Strategies  Enhanced information transfer at discharge  Follow-up care established at discharge  Improved medication management  Post-discharge plan of care  Telephone follow-up  Telemedicine  Electronic health record (EHR) Ventura, T et al. (2010). Improving Care Transitions and Reducing Hospital Readmissions: Establishing the Evidence for Community-Based Implementation Strategies through the Care Transitions Theme. The Remington Report, 18(1), 24; 26-30.
  • 13. Which is NOT one of the programs for bundled payments for care improvement initiative by Medicare? 1. Acute care hospital stay only 2. Acute care stay + post-acute care 3. Just post-acute care 4. All care for a patient prospectively paid for a 180 day period
  • 14. In the final ACO rules by Medicare, providers will have to meet how many quality metrics to qualify for performance bonuses? 1. 3 2. 33 3. 100 4. 309
  • 15. What Does This Mean Now?  Here are the measures  33 quality metrics  Several domains
  • 16. Nice Summary of ACO Rule  http://www.aafp.org/online/etc/medialib/aafp_org/ documents/policy/fed/background/medicare-aco- summary.Par.0001.File.tmp/AAFP-Final- Medicare-ACO-Summary.pdf  Only 19 pages!
  • 17. Goal  Be ready for the requirements!  Kudos to the PAFP (and others) for having the vision to prepare us all for what’s to come
  • 18. Operationalize This: How to Quantify (metrics) - What To DO To Prevent Re-admissions  Have appointment made prior to discharge  Medication reconciliation (by phone/in person)  Discharged patient should be seen within __ days  High-risk patients (“frequent flyers”)  Develop a registry of some sort  Frequent contact  Maybe weekly after discharge  All on the list, at least monthly
  • 19. Communicate with Hospitals  Identify 1-3 main hospitals where your patients go  Communicate  Develop transition plans
  • 20. Other Tools to Assist?
  • 21. FMDRL (Family Medicine Digital Resource Library) or fmdrl.org
  • 22. PatientName(Last,First):_______________________________________ DOB:_______________ Date/TimeofCall(s)attemptedbutnotcompletedwithcallerinitials: 1)______________________________ 2)______________________________ 3)_______________________________ Messagescript:“Hellothisis_________. I‟mcallingfrom_________asafollowupfromyourhospitalization.Someonefrom ourofficewilltrytoreachyouagaintomorrow,butpleasefeelfreetocallbacktodayat(officenumber)andaskfor_________.” Ifunabletoreachpatientafterthreeattempts,datecertifiedlettersentwithmailerinitials:________________________ Date/Timecallcompletedwithcallerinitials:______________________________ With Discharge Instructions and Medication Reconciliation Forms in front of caller: “Hello this is _________, may I speak with _________(patient, caregiver, or parent of minor patient)? I‟m calling from _________as a follow up from your hospitalization. How you are doing today?” “If you have your discharge instructions and medication list handy, could you go get them so we can review them together?” (If patient does not have available, proceed without them.) If significant clinical issues arise or there are discrepancies with medications, action is required: immediate office visit, involve homecare or family, notify physician, or send to Emergency Department. Script Patient Response Action taken “I understand you were in the hospital for___.” (SeeDischargeInstructionsheet,sectionReasonfor Admission/DiagnosisandProblems) “Is this correct?” Yes / No. If no, explain: “How is your condition since you got home?” Comments: “Now that you‟re home, do you have any questions about your discharge instructions?” Yes / No. If yes, explain: If applicable, “Have you completed or scheduled your blood work for _______?” (list LAB TESTS on discharge instruction sheet) Yes / No. If no, explain: If applicable, “Have you completed or scheduled your ________ ? “ (listADDITIONAL TESTSondischargeinstructionsheet) Yes / No. If no, explain: „Let‟s review your medications”. Then go through each one on the Medication Reconciliation form. Confirm that if medication on the Medication reconciliation form is marked CONTINUE, that patient is taking as directed. Note discrepancies: Confirm that if medication on the Medication reconciliation form is marked NOT CONTINUE, that patient is not taking. Note discrepancies: “Are there any other medications that you are taking that are not on the list?” List: Do you have a scheduled appointment with your Family doctor? Yes / No. If no, schedule. If yes, remind about date/time. “Thank you for your time. We look forward to seeing you on (restate appointment date and time). Please bring all your medications and discharge instructions to your appointment.” 5.26.10(2) Glass G, Roehl B: UMH Hospital f/u phone script (available at fmdrl.org)
  • 23. IHI (Institute for Healthcare Improvement): http://www.ihi.org/knowledge/Pages/Tools/HowtoGuideImprovingTransitionstoR educeAvoidableRehospitalizations.aspx
  • 24. Some Examples (From FHCC)  FHCC = Family Health Care Center (clinical site of our residency)  Residents used to do EMR “Chart Note” at discharge  Now, Epic – “One patient, one chart”  F/u visits (if appropriate) made  All most discharges get phone call (or secure message from EMR) within 24 hrs from care manager/team nurse/physician  Placed on registry?
  • 25. Transition Care by FHCC Care Manager and/or Team Nurse  Receives/reviews lists (daily, monthly) of patients seen in ER and hospital discharges  Currently RH only  Calls all patients within 24 hours (business day)  Ensures follow-up appointments  Answers questions  Admittedly: low yield  Focuses upon high-utilizers (maintains registry)  Communicates with physicians about their patients (via EMR system)
  • 26. Name DOB MR# Date of D/C ER? Hosp discharge? TRHMC? Other (which?) Phone call made? Date of contact Contacted by FHCC F/U App't Made? Date of FHCC f/u In CM Registry prior to d/c? Responsible Provider Resp prov notified? Asthma CHF COPD Bronchitis/URI/ Pneumonia Ortho/MS Pain HA Hypergly cemia/La b issue Depression/ anxiety Other (list main dx) Was pt on FHCC service (adm only)? Non-FHCC referrals Action plan Safety issues Comments 11/30/1932 5/1/2011 X X had appt 5/9/2011 Cunningham X 6/19/1990 5/1/2011 X X X LM 5/2/2011 NMK Patel Pain all over Y 4/11/1978 5/1/2011 X X X 5/2/2011 NMK Peterson vomiting 8/17/1984 5/1/2011 X X X 5/2/2011 NMK not needed Shanmugam boil/mole change 10/19/1964 5/1/2011 X X appt tomorrow 5/2/2011 NMK 5/3/2011 Raff Diarrhea, Vomiting 11/30/1986 5/1/2011 X X X LM 5/2/2011 NMK Allergies 6/13/1971 5/1/2011 X X pt called X 5/2/2011 Dr Radosh Radosh CP 5/14/2012 5/2/2011 X X X Radosh 5/16/2011 difficulty breathing, bronchitis 9/30/1963 5/2/2011 X X X LM 5/3/2011 NMK Migraine 12/2/1993 5/2/2011 X X X 5/3/2011 NMK 5/11/2011 Baxter Chest tightness 2/18/1933 5/3/2011 X X X LM 5/4/2011 NMK Baxter Weakness, falls 1/9/1983 5/3/2011 X X appt 5/18/2011 Martin anxiety, MH eval 8/23/1932 5/3/2011 X X X 5/4/2011 NMK 5/4/2011 Tilich SIRS Y 11/12/1958 5/4/2011 X X X 5/5/2011 NMK 5/26/2011 Mancano Finger pain 3/20/1964 5/4/2011 X X X 5/5/2011 NMK 5/6/2011 Peterson Itchy all over 3/30/1961 5/4/2011 X X X 5/5/2011 NMK 5/6/2011 Peterson Change in mental status 12/24/1971 5/4/2011 X X X 5/5/2011 NMK 5/6/2011 Patel difficulty breathing 10/19/1992 5/5/2011 X Obs X Martin Chest Pain 7/8/1967 5/5/2011 X X X 5/6/2011 NMK 5/9/2011 Abou Saab Allergic RXN Can't swallow 12/31/1979 5/5/2011 X X X 5/6/2011 NMK not needed Raff Constipation, rectal pain 9/4/1955 5/6/2011 X X X 5/10/2011 NMK Abou Saab X 4/24/1980 5/6/2011 X X X 5/10/2011 NMK Peterson Sore throat 4/20/1947 5/7/2011 X X X 5/9/2011 5/9/2011 Hanafi Leg pain numbness 5/6/1973 5/7/2011 X X X LM 5/10/2010 NMK Weida Side back pain Nausea 4/23/1938 5/7/2011 X X appt today 5/10/2010 NMK 5/10/2010 Mancano Fall 7/11/1963 5/7/2011 X X pt called 5/10/2011 Baxter abdominal pain 9/29/1968 5/7/2001 X X appt today 5/9/2011 NMK 5/9/2011 Cunningham Cough, congestion 2/9/2007 5/7/2011 X X X 5/10/2011 NMK 5/20/2011 Peterson viral syndrome, chills 12/4/1933 5/8/2011 X X X 5/10/2011 NMK F/u cardiology Abn CV study Cardiology 4/3/1996 5/8/2011 X X pt called 5/10/2011 NMK F/u hershey Warfel Migraine Hershey 11/1/2008 5/8/2011 X X X 5/10/2011 NMK not needed Weida eye complaint, cough 10/19/1964 5/9/2011 X X appt NMK 5/17/2011 Raff X Diarrhea, Vomiting Y 2/9/1950 5/9/2011 X X pt scheduled 5/23/2011 Raff Poss HTN, HA 12/30/1971 5/10/2011 X X had appt 5/23/2011 Raff CP, Abn Stress Test Cardiology 1/1/1983 5/10/2011 X X pt called 5/10/2011 5/18/2011 Radosh Pain in shoulder 10/14/1975 5/10/2011 X X X 5/11/2011 NMK 5/12/2011 Shanmugam Shakey, multiple complaints 1/22/2008 5/10/2011 X X X 5/11/2011 NMK 5/13/2011 Murphy Vomiting 4/22/2011 5/10/2011 X X X LM 5/11/2011 NMK Lavrik Crying 7/1/1964 5/11/2011 X X had appt 5/19/2011 Martin MVC 7/8/1967 5/11/2011 X X X 5/12/2011 NMK 5/18/2011 Wang Anxiety Lt sided weakness 4/19/1969 5/11/2011 X X had appt 5/24/2011 Patel mouth pain 2/16/1976 5/11/2011 X X had appt 5/13/2011 Peterson MVA 9/10/1992 5/11/2011 X X had appt 6/2/2011 Lavrik abdominal pain 6/23/1991 5/11/2011 X X X LM 5/12/2011 NMK Martin shoulder injury 3/17/1972 5/12/2011 X X X LM 5/13/2011 NMK Peterson Chest Pain 10/9/1938 5/18/2011 transfer to SNF X Nsg home Radosh SVT hypotensive episode 7/2/1968 5/12/2011 X X X LM 5/13/2011 NMK Peterson injured toe 10/26/1979 5/12/2011 X X X NA 5/13/2011 NMK Patel abdominal pain 9/17/1995 5/12/2011 X X X NA 5/13/2011 NMK Shanmugam Burning with urination 4/10/1996 5/12/2011 X X X LM 5/13/2011 NMK Baxter Shoulder Pain 1/5/1938 5/12/2011 X X X LM 5/13/2011 NMK Patel Open Choley 1/11/1973 5/13/2011 X X pt called 5/13/2011 5/16/2011 Tucker abdominal pain 8/26/1953 5/13/2011 X X had appt 5/31/2011 Wang Finger Laceration 12/30/1991 5/13/2011 X X X LM 5/16/2011 NMK Abou Saab Ear Pain 9/17/2009 5/13/2011 X X pt called 5/13/2011 5/18/2011 Martin accidental ingestion 9/7/1963 5/14/2011 X X had appt 6/9/2011 Ekmark CP, SOB 12/1/1963 5/14/2011 X Obs X had appt 5/24/2011 Warfel CP, Asthma 7/27/1974 5/14/2011 X X X 5/16/2011 NMK 5/25/2011 Lavrik Bronchitis 12/30/1966 5/14/2011 X X X 5/16/2011 NMK not needed Radosh Chest tightness 5/5/1931 5/15/2011 X X X 5/16/2011 NMK 5/23/2011 Warfel Pneumonia 3/14/1966 5/15/2011 X X Baxter CP, High BP/cardiac cath cardiologist 9/30/1988 5/15/2011 X X X 5/16/2011 NMK 5/23/2011 Malik head laceration 3/24/1977 5/15/2011 X X X 5/16/2011 NMK 5/26/2011 Peterson HA, N & V 4/22/1984 5/15/2001 X X had appt 5/17/2011 Arzomand Dizzy, side numbness 1/2/2004 5/15/2011 X X had appt 6/2/2011 Peterson Dog bite 5/29/1970 5/16/2011 X X had appt 6/15/2011 Brigandi MVC 4/24/1969 5/16/2011 X X X 5/17/2011 NMK not needed Weida Back pain, sinusitis/Bronchitis 6/18/1950 5/16/2011 X X X 5/17/2011 NMK May-11 Wang Finger injury 11/5/1986 5/16/2011 X X 5/17/2011 NMK not needed Ekmark Back pain 11/8/1977 5/16/2011 X X had appt 5/20/2011 Tucker Coughing 4/18/1940 5/18/2011 X X x Deloris yes 5/24/2011 Weida CA 12/1/1963 5/19/2011 X X appt yes 5/24/2011 Warfel Asthma 3/10/1950 5/19/2011 X X appt Deloris yes 5/25/2011 Doshi fever/ chst pain 1/25/1962 5/21/2011 X X appt 6/2/2011 Radosh X 2/4/1939 5/20/2011 X X appt yes 5/24/2011 Arzamand cellulitus cancelled appoint 12/26/1927 5/25/2011 X X appt Deloris yes 6/2/2011 Mancano presyncope 5/20/1933 5/26/2011 transfer to SNF X Nsg Home Baxter CHF/ Pneumonia Deceased 8/30/1952 5/26/2011 X X Warfel Pneumonia Threshold Client 3/15/2029 5/27/2011 X X appt 6/15/2011 Lavrik Diarrhea/ Cervical Osteomylitis 4/5/1977 5/27/2011 X X appt 5/31/2011 Raff Pancreatitis 2/1/1947 5/28/2011 X X appt 6/1/2011 Campa Anemia 3/18/1960 5/27/2011 X X X LM 5/31/2011 NMK Patel Coughing blood 4/24/1980 5/27/2011 X X X 5/31/2011 NMK 6/9/2011 Peterson Abdominal pain 9/28/1951 5/27/2011 X X X LM 5/31/2011 NMK Baxter Toe injury 4/23/1976 5/27/2011 X X X 5/31/2011 NMK Brigandi Knee Injury 12/9/1964 5/28/2011 X X chart note 5/31/2011 6/8/2011 Weida Alcohol withdrawl Outpt detox 10/23/1978 5/28/2011 X X X 6/1/2011 NMK 6/6/2011 Lavrik Pelvic pain 12/22/1976 5/29/2011 X X had appt 6/1/2011 Weida Rash 7/19/1964 5/29/2011 X X X 6/1/2011 NMK not needed Lavrik HA, Nausea, Diarrhea 5/17/1995 5/29/2011 X X X LM 6/1/2011 NMK Warfel dizziness & vomiting 9/4/1932 5/30/2011 X X X LM 6/1/2011 NMK Brigandi Constipation 9/5/2001 5/30/2011 X X X 6/1/2011 NMK 6/7/2011 Baxter nosebleed, dizzy 3/28/2008 5/30/2011 X X had appt 6/3/2011 Doshi side face swollen 5/6/1951 5/31/2011 transfer to SNF chart note 5/31/2011 Malik Cunningham Osteomylitis RLE 7/10/1955 5/31/2011 X had appt 6/10/2011 Peterson spinal cord tumor 8/23/1957 5/31/2011 X X X LM 6/1/2011 NMK Warfel Leg Pain 4/24/1948 5/31/2011 X X X 6/1/2011 NMK 6/2/2011 Lavrik X 11/17/1942 5/31/2011 X X had appt 6/10/2011 Peterson Abdominal Pain 2/10/1987 5/31/2011 X X had appt 6/3/2011 Warfel Lump on neck 6/22/1998 5/31/2011 X X X 6/1/2011 Martin 6/3/2011 Murphy X Pneumonia 7/24/1963 5/31/2011 X X had appt 6/2/2011 Peterson Leg pain & swelling 11/3/2025 5/31/2011 X X X 6/1/2011 NMK 6/13/2011 Baxter Difficulty speaking FHCC follow-up? CM/PCP Notification? MAIN reason for ER visit/hospitilzationDemographic Information Setting Facility Contacted?
  • 27. Name DOB MR# Date of D/C ER? Hosp discharge? TRHMC? Other (which?) Phone call made? Date of contact Contacted by FHCC F/U App't Made? Date of FHCC f/u 11/30/1932 5/1/2011 X X had appt 5/9/2011 6/19/1990 5/1/2011 X X X LM 5/2/2011 NMK 4/11/1978 5/1/2011 X X X 5/2/2011 NMK 8/17/1984 5/1/2011 X X X 5/2/2011 NMK not needed 10/19/1964 5/1/2011 X X appt tomorrow 5/2/2011 NMK 5/3/2011 11/30/1986 5/1/2011 X X X LM 5/2/2011 NMK 6/13/1971 5/1/2011 X X pt called X 5/2/2011 Dr Radosh 5/14/2012 5/2/2011 X X X Radosh 5/16/2011 9/30/1963 5/2/2011 X X X LM 5/3/2011 NMK 12/2/1993 5/2/2011 X X X 5/3/2011 NMK 5/11/2011 2/18/1933 5/3/2011 X X X LM 5/4/2011 NMK 1/9/1983 5/3/2011 X X appt 5/18/2011 8/23/1932 5/3/2011 X X X 5/4/2011 NMK 5/4/2011 11/12/1958 5/4/2011 X X X 5/5/2011 NMK 5/26/2011 3/20/1964 5/4/2011 X X X 5/5/2011 NMK 5/6/2011 3/30/1961 5/4/2011 X X X 5/5/2011 NMK 5/6/2011 12/24/1971 5/4/2011 X X X 5/5/2011 NMK 5/6/2011 FHCC follow-up?Demographic Information Setting Facility Contacted?
  • 28. In CM Registry prior to d/c? Responsible Provider Resp prov notified? Asthma CHF COPD Bronchitis/URI/ Pneumonia Ortho/MS Pain HA Hypergly cemia/La b issue Depression/ anxiety Other (list main dx) Waspt on FHCC service (adm only)? Non-FHCC referrals Action plan Safety issues Comments Cunningham X Patel Pain all over Y Peterson vomiting Shanmugam boil/mole change Raff Diarrhea, Vomiting Allergies Radosh CP difficulty breathing, bronchitis Migraine Baxter Chest tightness Baxter Weakness, falls Martin anxiety, MH eval Tilich SIRS Y Mancano Finger pain Peterson Itchy all over Peterson Change in mental status Patel difficulty breathing CM/PCP Notification? MAIN reason for ER visit/hospitilzation
  • 29. Sample: EMR Chart Note (Done by Physician)
  • 30. Discharge Instructions: PDF Faxed at Moment of D/C
  • 31. RRC “Plug”  ACGME competencies require this kind of work  Transitional care counts!  Residents can:  Design plans/assist with development of policies  Do med rec, home visits Residents + transitional care = “system-based practice” competency
  • 32. $$$  Improved office efficiency?  More volume for 99214’s?  Piece of the pie?  Get money or assistance (care managers, etc.) via hospital bundled payments  Pay for performance?  TOC metrics part of clinical integration bonuses  New CPT codes?
  • 33. 99495 and 99496 • Cover transitional care management (TCM) services as the patient is transitioning from inpatient hospital care to his or her home or another community setting  Moderate decision-making: 99495  High-complexity medical decision-making: 99496  Approved by CMS last fall; became available to physician practices in January 2013
  • 34. Tools for New Codes  http://www.aafp.org/dam/AAFP/documents/practice_ management/payment/TCMFAQ.pdf  Great two-page PDF summary by AAFP  http://www.aafp.org/dam/AAFP/documents/practice_ management/payment/TCM30day.pdf  Great two-page PDF worksheet by AAFP  http://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/Transitional-Care- Management-Services-Fact-Sheet-ICN908628.pdf  Eight-page PDF by CMS delineating details
  • 35. Worth It?  Are the new codes worth the time and effort?  We’ll see . . .
  • 36. “This is way too complicated. I cannot track these charges and make sure they get billed out 30 days after discharge. We send claims same day or next day. Holding work for later is just asking for missed charges. Also I don't get DC info until 4-5 days after discharge, if ever. I have one staff member so saying staff can do this is ridiculous since she is already doing a lot and she is not a clinical person. What if send the charge out and find out later they were readmitted on day 28? This is not practical or feasible. I will not use this code. The increased pay is not worth the hassle.” From FPM Blog “. . .. I agree. It seems easier to continue to bill the usual E and M code rather than remember to bill the 30 th day. Seeing the patient is important after discharge so I wouldn't want to discourage that visit. Unless the coordination code pays a lot more than the usual 99214 it seems worthless. We will continue to do uncompensated work.”
  • 37. “How much are these new services worth?” (from AAFP link) “Payment allowances will vary by payer, and Medicare’s allowance will vary geographically. Also, Medicare’s allowance will depend on the conversion factor in force at the time claims are paid. Based on these RVUs and the current (2012) conversion factor, the Medicare allowance for code 99495 performed in a non-facility setting (e.g., a physician’s office) would be approximately $164; in a facility setting, the corresponding allowance would be approximately $135. For code 99496 performed in a non-facility setting, the Medicare payment allowance would be approximately $231.12; when performed in a facility setting, it would be approximately $197.76.”
  • 38. Finally . . .  Be an advocate!  This is where Family Medicine should shine  And get paid more . . .  Get involved  Clinically integrated entities – committees  Health system task forces  Medical societies
  • 39. Objectives (Met?)  By the end of this presentation, participants will be able to:  List external forces related to transitional care  Identify “priority tasks” in transitional care  Have appointment made prior to discharge  Medication reconciliation (by phone or in person)  Discharged patient should be seen within __ days  Develop a registry of some sort (high-risk patients)  Utilize tools to augment your planning  Identify new CPT codes
  • 40. To Do Tomorrow:  Inventory: what hospital(s) do your patients go to?  Complete the transitional tool  Call the contact – how can you get daily ED/discharge lists?  Have a meeting at your practice  How can hospital patients get app’t prior to d/c?  Meet with inpatient care managers?  Take inventory: what medication reconciliation processes do you have, if any?  Who can/should do it, when, how (phone?)  Are you seeing dc’d patients for hospital f/u soon?  Do you have some type of registry for high-risk patients (frequent flyers)?  Do patients get contacted?  When/how often/by whom?
  • 41. Take Home Messages  Transitional care is gaining press, importance, and soon - reimbursement  Choose key areas  Discharges, med rec, f/u visit, high-risk registry  Prevent re-admissions!  Start with specific tasks  Small, concrete steps  Do NOT re-invent the wheel  There is a lot of material out there  Be an advocate for this – don’t do it for free!
  • 42. THANK YOU FOR YOUR ATTENTION! Questions/comments? Experiences/ideas to share?