According to the Centers for Disease Control and Prevention, as of 2012, 49.8% of all US adults (117 million people) have one or more chronic diseases.
Taking patients' family and friends into account, we witness chronic conditions affecting all of us. That is why improving chronic conditions management is an extremely challenging yet a rewarding task. We can achieve better outcomes for the population's health, but prior to that, there is much to be changed and done in care delivery itself.
The challenge ahead
Any disease, and chronic conditions especially, should be treated consistently. The current way of treating chronic diseases, however, raises the issue of interrupted care. The challenge lies in ill-timed medical attention. As caregivers can't foresee patients' health deterioration, chronic care delivery frequently results in treating complications and exacerbations instead of preventing them.
As soon as a patient is discharged, their health status, including daily activities, nutrition behavior, and problems, becomes a mystery (up to the next appointment or admission), an equation with dozens of unknowns.
Solving this equation is nearly impossible without systematic care and continuous data flow between patients and caregivers. To help prolong a patient's life and avoid severe complications and disabilities, we need to reveal these unknowns and turn the person's condition into a complete history.
Finding the unknowns
Ensuring systematic face-to-face care is possible when chronic disease patients are hospitalized or placed in a retirement/ nursing home for the rest of their lives, which is not always the best option. We suggest using specialized healthcare software helping patients to control their disease in the comfort of their homes. Caregivers can assist them by staying in touch via, say, mobile applications as well as gather their objective and subjective and analyze the data to form a full picture of the patients' conditions.
Of course, we can try to count on "perfect" patients, who are motivated, well-organized and knowledgeable. However, according to the Medical Practice Insider, "even well run practices have a daily average of 12 percent no-shows and last-minute cancellations. Some practices actually experience a whopping 50 percent rate." The rate of missed appointments shows that patients tend to be careless or disorganized from time to time. Thus, we should enable technologies to remind patients about monitoring their health, taking medications, keeping nutrition balanced and seeing their physicians in due time.
Safeguarding care via technologies
EHR is the mother of technologies to handle patient data, though not enough to cover the whole remote care delivery. But caregivers can still use it as the main connection point between other technologies (e.g., mobile app) that interact with surgeons, physicians, nurses and patients.
Patient portals are a typical patient-facing technology with useful features allowing to schedule appointments, monitor lab results, share achievements in social media and more. However, patients need something more personal, friendly and integrated into their lives.
The alternative could be a mobile app that is specifically focused on chronic conditions. We elaborated on the concept of such a chronic disease management solution in our recent entry, so you are welcome to click and find out more, but for now, let us unveil several key points.
Always at patients' fingertips, an app would be more convenient, engaging and effective. As patients are used to the mHealth apps tracking their weight, wellness and nutrition, the idea will be a no-brainer for them. They will fill in the forms about their general well-being, subjective and objective, daily regimen and medications, and tap the 'Send' button to share this data with their caregivers.
At the same time, the app will notify health specialists about patients' updates (subjective and objective), upcoming appointments and negative trends in the patients' conditions.
This way, providers receive a symbiotic system with connected patients and physicians. Nevertheless, to make sure it works equally effective for everyone, we also have to remember about the incentives, i.e. reimbursement policy aspects.
Reimbursing distant care within chronic disease management
The Medicare Chronic Care Management (MCCM) program was adopted to allow health specialists offer their patients telemedicine care services and get paid for these services. In our opinion, it has some serious limitations for both patients and caregivers. Let's go into detail now.
The MCCM program has several requirements that are important to consider:
• "Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient..." This requirement looks like a leverage to reduce the scope of eligible patients. It's not clear why patients with single chronic diseases can't count on reimbursable distant care.
• "Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline."
• "Comprehensive care plan established, implemented, revised, or monitored." (Which can be perfectly achieved by the concept we described above).
• "Caregivers must provide at least 20 minutes of non-face-to-face care services per calendar month". The CMS defines the following types of services included into this requirement: performing medication reconciliation and supervising the patient's medication intake; ensuring receipt of all recommended preventive services; monitoring the patient's physical, mental and social conditions. These services are also covered by our concept.
• Patients must agree to receive remote care services and might have to pay a co-payment or deductible, so they have to understand the benefits of distant care. It is best to discuss it during a personal appointment.
• Only one practitioner receives the payment for CCM per calendar month. This condition can also cause problems if the patient's need will require several professionals to make a decision.
Complying with these requirements, caregivers also need to claim reimbursements correctly. There are a few quite routine conditions to fulfil:
• Use the CPT code 99490
• Bill it no more than one time per a 30-day period
• Don't use the code for a regular face-to-face appointment
Please note that you also might need to contact your legal advisers for more details.
Summing up
Chronic diseases are today's plague of the nation, and the reason to systematically control them. Yes, they are responsible for the 7 out of 10 deaths in the US. Moreover, chronic disease patients account for about 75% of the healthcare spending.
By adopting technologies that allow continuous and remote care delivery for patients, caregivers, and thus individuals, achieve multiple benefits:
• Constant patient-caregiver communication for improved health outcomes and reduced complications, exacerbations and readmissions
• Advanced patient engagement, leading to systematic care with fewer cases of interrupted care
• Earning more without seeing patients more (via telemedicine reimbursements)
We would like to know your opinion on this topic. What do you think about systematic care and technology as a tool to achieve it? What other benefits constant patient-caregiver interaction might bring? Please share your thoughts in the comments.
Bio: Uladzimir brings in 8 years of IT experience, 4 of which in custom healthcare software development.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.