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TABLE OF CONTENTS
3Basic Myths:
General Myths & Misunderstandings
7Overhead & Revenue:
How To Implement Without Significant Cost
11Autonomy & Existing Staff:
What About My Staff & What We Want?
(o) 402.807.7535 www.h3ci.com [email protected]
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GENERAL MYTHS & MISUNDERSTANDINGSNot everything is as scary as it seems...
It’s common for practices and hospitals to be wary of outsourcing and its warranted. There are a ton of organizations attempting to get rich by leveraging the inefficiencies of the healthcare system. Let’s face it, this industry suffers from a chronic lack of transparency and physicians are suffering under growing regulatory burden.
Being cautious is good, being afraid is not, the difference is education. There are a lot of myths floating on the internet about what happens when you outsource. What they fail to mention is that often it was who they selected as an outsource partner that was really the issue. So how do you know what’s what?
Let’s start with some basic myths and misunderstandings about outsourcing CCM. We’ve gotten a lot of questions from gun-shy physicians and practice managers and we want to share the answers with as many as people as we can.
MYTH#1 - Medicare doesn’t
want us billingnew codes.
On the contrary, Medicare developed the Chronic Care Management program and structured reimbursement in 2015.
The primary code 99490 was approved by CMS (Medicare) for reimbursement effective January 1, 2016. Thus far it
has been beneficial to Medicare, in fact, Medicare is such a firm supporter, that they made the program more robust in 2017 with the addition of two Complex Chronic Care Management codes.
They also eased the regulations to allow Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) to work with third-party off-site service support providers.
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MYTH#2 - Older patients don’t like being called on the phone.For a subset of patients this is true, however most patients with multiple chronic conditions enjoy being spoken to on a regular basis about their wellness. It frequently saves them from unnecessary ER visits, late night calls to the on call physician, and medication dosing errors. Not to mention the dedicated care team and local phone number allow for a quick and efficient way to reach someone for even the smallest questions.
For some of our rural patients or those without a robust support system, we are often the only person they talk to that day, we’ve found that this has generated a lot of relief for our patients.
MYTH#3 - Our patients will not enroll because there is a copay.There is a small copay (approximately $8) which patients are notified about prior to enrollment, however most patient’s copays are covered by their secondary or Medicare Advantage plans. The majority of patients love this service, in fact, for our enrolled patients the retention rate is over 90%.
MYTH#4 -Outsourcing services means non-clinical people calling our chronically ill patients.Generally False. Before you outsource, do your due diligence. It should only be clinical staff speaking with your patients. Part of the requirements from Medicare mandate that the management services be performed by clinical staff. This is essential for proper reconciliation of medications, for patient education, and to triage and escalate efficiently.
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“This is a way to try to decrease the number of ER visits, decrease the number of hospitalizations, so that we can be proactive about
their health earlier than when they end up in the ER.
I see them in a point in time, basically. I see them and then I won’t see them again for six months and I have no idea what’s going on
with them for the next six months.”
-Daniel McGowan, M.D.“
REAL PATIENTS REAL IMPACT
An H3C Care Team member reached out to an existing patient for their regular call. The patient reported they were doing well but the Care Team member noticed that the patient seemed to out of breath which was not his normal presentation. The patient was evaluated over the phone and a medication reconciliation was performed which identified a significant error in the patients use of their anti-coagulant.
The patient was escalated to the physician’s office who saw the patient same day and confirmed the patient was taking 4 times the dosage they were prescribed. Without this call the patients misunderstanding would not have been caught until
the patient’s 3-month follow-up.
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MYTH#5 - There won’t be any overhead if I implement in-house instead of outsourcing.If you implement in house you will need to hire additional staff and if you do not have an appropriate phone or EHR system you could be looking at additional expenses there as well. After hiring a couple of nurses and paying for phone/EHR changes the program would most likely be operating at a loss.
MYTH#6 - The costs to outsource can be astronomical.This depends entirely upon who you select as your third-party service provider. If you select an organization that requires a flat monthly fee or a mandatory long-term arrangement then this could most certainly be the case. However, if you have an organization that splits the reimbursement per patient and allows flexibility then you would be in a much better position. For instance, at H3C we try to be as flexible and adaptable as possible so that programs are profitable and not burdensome to practices.
MYTH#7 - This will reduce the number of face-to-face visits for our patients.False. This will only reduce the number of unnecessary face-to-face visits for your patients. All patients in a well-structured CCM program are encouraged and reminded to attend their regular face-to-face appointments. In addition, since patients are being called proactively, potential issues can be identified sooner. When this happens, CCM Care Team members will schedule a face-to-face visit, for the patient to see your physician, resulting in earlier intervention.
MYTH#8 - This will increase our no show rate.This is false. CCM programs have proven to decrease no show rates through regular appointment reminders and regular patient engagement. If no shows are a problem for you there are also services like Appointment Services that outsource companies can assist you with. For instance, at H3C we can perform all appointment scheduling services including all inbound and outbound call management if requested.
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What About My Staff?Implementing a new service line without drowning in overhead is possible
MYTH#10 - It’s easy enough for my front desk to do it when they have downtime.This is where we see a lot of clinics struggle. This is not a program to put on your front desk, they have enough to do. The CCM program was designed by CMS for Medicare patients in need of directed care management for their chronic conditions. CMS regulates that care plans must be physician-approved and that the services must be performed by clinical staff. Non-certified front desk receptionists would not qualify as clinical staff, they would qualify as administrative staff. In addition, the requirements of the code require a lot of time on the phone and a lot of time discussing the patient’s conditions and treatment plans. This would tie up a front desk employee with conversations that they generally are not prepared to have.
MYTH# 11 - If I outsource services I will end up losing staff that I really value.Finding an excellent clinical staff that you value and trust is an achievement and we don’t want to see you make sacrifices. The CCM program can be structured in many ways and the fact is your staff is probably already busy with their day-to-day activities. This is an additional service meaning it would need additional time and additional staff. Outsourcing this service means that this program will not place a burden on your existing staff nor will it require you to hire additional staff. It does not mean that you will have to lose great team members.
However, if you are looking for ways to reduce your staff there are additional services that an outsourced CCM Care Team could perform to assist in meeting those goals.
MYTH#9 - I can just do this with my existing staff.Chronic Care Management takes time to perform. Many believe that CCM is just 20 minutes per month but it is so much more. CCM is proactively reaching out to each enrolled patient sometimes several times per month, coordinating with all of their care providers and care givers, providing education to the patient and their families, reconciling their medications, identifying and triaging new symptoms, assisting them with locating community resources and much more.
Your existing staff already has a job to do. If they are not dedicated to the CCM program they will not have time to accurately document each patient conversation with time spent, to ensure all enrolled patients are being spoken to regularly, and to schedule those calls around the patient’s preference.
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MYTH#12 - Outsourcing means I lose autonomy over my patients treatment.Absolutely false. The care management plan is still 100% at the discretion of the physician. Care plans cannot improve the quality of life for the patient if they are not physician-directed and approved. In fact, any suggested changes to the physician-approved care plans are submitted for physician approval as well, ensuring that all instructions are given to the patient are in line with the physician’s treatment plans.
Losing Autonomy?If the program is implemented well then the care team is guided
100% by the physician’s treatment plan.
MYTH#13 - Outsource companies don’t understand how my practice works.In some instances this is probably true, look for outsource companies that have actually hired clinical staff, that have an advising board or governing board that is made up of physicians, hospital executives and other health business leaders. If the outsource company you are working with does not make an effort to understand your organization from front to back then they probably aren’t the right one for you.
Make an informed decision when choosing a third party to outsource services.
Many practices speak with only one company before making a decision. Even those that know better and do research on multiple companies often neglect to check references.
If you want to know that your practice is getting the best take the time to do the research. Check out your options, know what you’re choosing from and before you sign contracts talk to their references.
Speak with physicians or practice managers using that company. Make an informed decision.
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“At the first meeting I was thinking, oh no I do not have time to do this, and all of my concerns you guys have taken care of... I thought it was going to take a lot more time and it hasn’t, it’s been easy.”
-Practice Administrator, H3C Client“REAL PATIENTS REAL IMPACT
An H3C Care Team member reached out to an existing patient for their regular call. The patient reported they were doing well but as soon as their spouse left the room the patient stated that they were frightened about recent suicidal thoughts. The H3C Care Team member was able to put the patient at ease while they discussed recent the patient’s recent treatment changes.
The patient was then escalated to the physician’s office who saw the patient same day and confirmed that the new medication the patient was taking was causing the suicidal ideation. The physician changed the patient’s treatment plan and now, several months later, the patient reports regularly that she is doing much better.
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Time to Implement & MaintainImplementing a new CCM program is not like implementing a new EHR.
It can be much easier, much faster, and much smoother.
MYTH#14 - I don’t have time to implement a new program.This is true, YOU do not have time to implement a new program. Which is exactly why outsourcing may be a great option for you. Most physicians, practice managers, and clinical managers already have a full plate. It’s easy to tell if you do, you work through lunch more often than not, it’s dark when you arrive, it’s dark when you go home and you’re taking work with you. You are a hard worker and one more program to implement means burnout! This is not uncommon. When you are considering outsourcing talk to the available organizations and see what resources they provide during implementation. Do they have a dedicated account manager? What is their response time? At H3C, our implementations are guided by a former practice manager to ensure that we do the heavy lifting of implementation.
MYTH#15 - Outsourcing results in unnecessary calls to our office and unnecessary appointments being scheduled in our office.On the contrary, any CCM program worth its salt will have a structured method for triaging patients back to your office or the ER as appropriate. When you consider outsourcing your potential vendor what triage methods they use and how they perform hand-offs for transitions of care. An efficient program will perform a standardized triage, best practice hand-off, and thorough assessment before scheduling an appointment for the patient.
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When you partner with H3C, you can provide the benefit of CCM to your patients without the
distraction and without the financial risk.
THE REQUIREMENTS AND MANAGEMENT TO SUPPORT CCM MAY SEEM OVERWHELMING
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