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How to help physicians provide Medicare preventive care services

August 24, 2017

    Now is the time to refocus on orchestrated prevention services, particularly for Medicare patients, and determine how to use technology to assist in the effort.

    Many health systems and medical groups tried to coordinate Medicare preventive services when the Centers for Medicare and Medicaid Services first rolled out the programs in 2011, but the ensuing roadblocks proved to be too daunting—patients didn't understand the services, and providers didn't know how to deliver the services productively while also meeting the daunting compliance, documentation and patient eligibility requirements.

    Now, with heavy incentives from Medicare, health systems need to help their providers learn about these programs and make it easy for them to do the right thing for their patients' wellness. Here are a few tips to overcoming the challenges to delivering Medicare preventive services—and do so in a way that will use IT to support the effort and resonate with providers who just want to deliver the best patient care.

    1. Prove to physicians this work is meaningful to patients

    One of the physicians we're working with reported back to us on delivering a Medicare annual wellness visit to one of his regular patients. He said that most of the patient's screenings were negative but, during the Cognitive Screen, the patient only remembered one-third of the words during the word recall portion. The physician then scheduled a focused follow-up visit for further evaluation and is now adding the Mini Mental Status Exam to the Medicare annual wellness visit for those who have a positive Mini Cog screening test.

    Physicians need to be sure their work is going to be in the best interest of the patient. Experiences like this one go a long way in communicating the value. Health systems can set up a system of sharing and communicating these stories across their participating providers.

    Physicians also tend to be data and outcomes driven, so the anecdotal feedback may not be quite enough. That's why health systems can help make a compelling case by educating physicians on the different quality performance metrics that can be impacted by preventive care work. For example, quality metrics under MACRA, MIPS and CPC+ include depression, obesity and alcohol misuse screenings, all of which are provided during a Medicare annual wellness visit. There are other direct correlations in MSSP, HEDIS and the Medicare Advantage Star Rating System.

    2. Help providers know how to leverage the care team

    My favorite comment from a medical assistant is this: "I was in, out and done before he (the physician) was out of the room. They're just not that hard." While the physician was seeing another patient in a different room, the medical assistant worked to check in another patient for a Medicare annual wellness visit and completed the majority of the requirements to get appropriate credit for that preventive service.

    Considering most primary care physicians feel like they're at capacity, before asking them to add more visits onto their plate, health systems need to restructure the care model to better leverage all members of the care team. In most of the physician practices we've worked with, support staff members are typically tasked with getting vital information at the start of the visit and then moving the patient through the process.

    However, support staff can own most of the legwork like the HRA, patient history, screenings and assessing for preventive services, to reduce the amount of physician time needed. And having the right technology in place to facilitate and support the process also will speed the process along.

    3. Make the technology work for providers

    A couple of physicians at a health system that partners with us were highly skeptical about any concerted effort to deliver more preventive services. However, their practice leader later reported, "Once they went through the workflow with the informaticists, they both found it efficient and extremely easy."

    The electronic health record must be technically enabled to allow physicians and support staff to focus on their patients. For Medicare preventive services specifically, there are three areas that need technical attention. The first is automating the front-end process of determining patient eligibility. Second is optimizing the EHR's clinical workflows to capture all necessary components of the visit and ensure it meets CMS' requirements for documentation purposes. Third is automating the back-end process of billing and coding.

    A fully optimized EHR means the physician doesn't have to worry if the patient is covered for this service or worry about needing to add a specific CPT code to meet billing requirements. It enables physicians to focus on patients.

    4. Get patients involved in their own care

    A pre-service center scheduled a Medicare annual wellness visit with a patient who had not been seen by their doctor in more than six months. In the follow-up to scheduling, the pre-service center mailed the health risk assessment to the patient with instructions to bring the completed survey to the visit. The patient arrived for the visit 10 minutes early with the HRA completed. Thanks to the pre-service center's work, the patient came in educated and prepared for the preventive service, which enabled the clinical team to have more time to focus on addressing the patient's care needs.

    Activating patients in their own care can be tricky, but providers get frustrated when patients don't understand the service being provided. Health systems can help providers by training office staff and creating scripting and marketing materials to use to help educate their patients. Then the physicians can use the visits to help patients understand their own role in the management of their health.

    This article first appeared in Health Data Management's "HIT Think" blog.

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