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Case Study

How Carilion Clinic used workforce and coding techniques to overcome cost challenges in memory care

15 Minute Read


    The challenge

    Diagnosing Alzheimer’s and other dementias is a complex process. There are significant upfront costs and labor challenges. It is often difficult to reimburse for diagnostic testing such as amyloid positron emission tomography (PET) tracers or cerebrospinal fluid (CSF) tests. Diagnosis also requires a team-based, clinical approach with coordination among many different stakeholders to collect all the appropriate patient intake information.

    The organization

    Carilion Clinic is a Roanoke, Virginia-based non-profit integrated health care organization that provides care for nearly one million Virginians and West Virginians. Carilion Clinic's Center for Healthy Aging offers a comprehensive and integrated approach to addressing the unique needs of older people. They work with patients and their families to maximize the independence and functional ability of people as they age.

    The approach

    The Carilion Clinic created a billing and workforce strategy to meet the cost and labor challenges surrounding the diagnosis and management of memory care. Their strategy focuses on training nurses, therapists, nurse practitioners, and non-clinical staff to recognize and address symptoms associated with cognitive decline. This promotes more accurate patient screenings and reduces the burden on physicians to comprehensively evaluate the patient during their limited appointment time. Additionally, they bill CPT code 99483 to ensure appropriate payment for services.

    The result

    Carilion Clinic has made their workforce and coding strategy for memory care a systematic process and has generated substantial RVUs and revenue. A systemic process lays the groundwork for Carilion to scale their program, diagnose patients earlier, and prevent downstream hospitalizations and emergency department visits.



    How Carilion Clinic used workforce and coding strategies to save money on dementia diagnoses 

    Carilion Clinic recognizes the imperative for early detection and diagnosis of Alzheimer’s and other dementias, because it can help healthcare providers develop better care management plans that could delay the progression of the disease and improve quality of life.

    The three elements

    Carilion Clinic has identified that the detection of memory loss takes a collaborative effort between the doctor, nurse, and social worker or another trained person. The three elements to their success include:

    • Element

      Providing cognitive behavior training to care team staff

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    • Element

      Task shifting patient screening and post-appointment follow-up steps to care team

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    • Element

      Using CPT code 99483 to ensure appropriate payment for services

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    Is this strategy scalable?

    Creating a systemic process is a great strategy for long-term cost avoidance and scalability. Doctors alone cannot effectively use the limited time they have with a patient without some sort of screening process. There simply isn’t enough time for the patient intake. Using a team-based approach to handle patient screening and follow up steps mitigates the typical challenges in diagnosing memory care patients. There are also tools and resources available to train staff and conduct these assessments and be effective communicators and counselors for these patients and their families.

    Factors that may hinder scalability include pre-existing labor shortages. Additionally, some providers may experience a lack of technology or tools that limit effective patient screenings.


    The workforce and coding strategy at Carilion Clinic has generated 20% additional RVUs and increased their bottom line by 20%.

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