One of the latest and greatest advancements in medical care is the recent Chronic Care Management or CCM as it is commonly known. Most of you are probably familiar with the idea. Patients with chronic care problems including but not limited to:
Type 2 diabetes
Hypertension
Obesity
are identified within the medical record system and then given internet enabled instruments such as glucose meters bathroom scales even with BMI calculation and blood pressure cuffs. The patient is instructed how often to check these readings while proceeding with treatment either with medication or lifestyle adjustment or combination of the above in the hopes of optimizing and perhaps even improving the clinical situation.the readings are hopefully sent to a central repository where the contracted employee nurse etc. can view the grafted information when dealing with the patient online or on the telephone usually on the telephone.
This sounds like a great concept appropriate for the current technological age and it could except for a major disconnect. The disconnect is that it usually has to be outsourced and that the performance and coding and billing for the service are so complicated and onerous that it pretty much ends up being a no go financially for the practice. Frequently outsourced from the office to a specialized service,the physician ends up paying all cost even those that are not collectible and usually ends up making nothing on the proposition or even losing money or being sued for the difference between what is collected and what is anticipated. In other words being sued by the company you hired for Money that you have no hope of getting. For this reason the technology is understandably under utilized at this time.
CCM can only be profitable if it is low cost to operate. Average reimbursement from insurance is $40 for 20 minutes of time per month.. If the physician has to do this it is immediately not profitable. Using nursing staff or medical assistant staff can be very profitable if it doesn’t take any more time than the actual time spent with the patient. Properly done it can turn the MA from a loss leader financially into a Profit Center. That is why any inefficiency immediately starts to degrade probability.
Novoclinical EHR, the CCM is Unique, Reliable and Remarkably Profitable
The technology is integrated within the Novoclinical EHR in the following way
The care is performed in the same system as the rest of the medical record. In other words it is not a separate system it is part of Novoclinical so all of the documentation and work remains within the system. This way it is entirely visible and documented for possible future external audit. The system triggers reminders for office staff to contact the patient to call is made through the system with or without video linkage. Office staff can review the grafted measured data with the patient reviewing treatment protocols and making adjustments. Each manipulation is advanced to the position duty area immediately. That way the physician is aware of every change being made on every patient but doesn’t have to be in the call. Billing for the service is automated based on time spent by office staff and is sent electronically at the end of every month without any other human intervention.
A single nurse or MA properly trained can take care of up to 200 patients simultaneously with the system helping to keep everything in order All she has to do is speak and order within the system. Any medication changes are sent immediately to the physician for approval where he can review and look at the transcript of the entire interaction and modify the plan appropriately if he sees fit. Reimbursement is variable based on patient’s insurance. If you are not being reimbursed the system will identify and notify the office to make appropriate arrangements to either deal with reimbursement situation or stop performing the service on those patients with the insurance either does not cooperate or cooperates in an incomplete or difficult way. Either way this is a no harm no loss situation for the practice and the patient.
Usual CCM Flow
Patient is identified for monitoring given problem
Patient information and problem sent to separate service
Phone call from a nurse unfamiliar with the patient to discuss monitoring results
Documentation in a separate system with a copy sent to the physician
Physician’s office has to bill the insurance company for the service with no documentation
At the end of the month physician receives a bill from the service
3 months later he receives one third of the expected payment from the insurance company
After about 3 cycles if he is pain attention to his financial information he will cancel the service
Novoclinical CCM Flow
Patient is identified during a visit given the instruments, trained and integrated with blue tooth cell phone in the office
Patient starts recording the date at home
Called through the system using voice call from office computer to patient cell phone
During the call nurse from your office reviews the grafted information and patient satisfaction with care changes thus far.
The system brings the information to the physician through the duty sheet for review and approval
At the end of the month billing is automatic and because there is no human interface on coding billing and collections rejection rate is typically about 0.02% and typical time of payment is about 5-15 days (varies with insurance company).With Novoclinical CCM the entire process is self-contained, fully automated and safeguarded in terms of needed documentation and approval. It is another example of what we like to refer to as “over the shoulder technology” which is what we think we do best. We take the complex difficult aspects of the electronic medical record system and make them easy and sensible. Medical practice is difficult enough without your EHR making it worse.