Telephone triage services give modern practices a unique and powerful way to be compensated for managing patients with chronic care conditions. Currently, three in four Americans over the age of 65 have two or more chronic health conditions, such as hypertension, cancer, stroke, arthritis, and diabetes. By 2030, about one in five Americans will be older than 65. As they age and life expectancy increases, the number of individuals with chronic health conditions, and demand for health professionals to care for them, will grow.
Chronic care management (CCM), involves facilitating care in-between physician office visits for patients on Medicare with multiple chronic conditions. Care coordination between physician office visits can help individuals follow their care plan, adhere to their medication regimen, and keep doctor appointments. It can also help identify and pre-empt issues with the potential to turn into health tragedies.
Since 2015, eligible practitioners have been able to bill Medicare which provides reimbursement for chronic care management services. Despite government reimbursement, too few physicians take advantage of this program, and the impact spills over to hospitals.
So, why are providers slow to adopt a CCM program which could add thousands of dollars of significant revenue each month back into their practice?
It comes down to risk. There are a lot of essential requirements for proper delivery and billing that need to be met to avoid denied claims (or worse), and providers hesitate to add these services alone.
Here are the three main reasons for low practice adoption and the role of an outsourced telephone triage service can provide:
- Requires a lot of time, outside of the practice office hours.
These services need to provided when patients are not in the office. CMS states that CCM services are to be provided by clinical staff outside of face-to-face patient visits for a minimum of 20 minutes per month.
- Requires 24/7 access to health care professionals
Practices are required to provide “24/7 access to physicians or other qualified health care professionals or clinical staff.” Also, CCM patients must have a way to access their care team and have urgent needs addressed regardless of the time of day or day of the week, and that can seem like a tough ask for many primary care practices.
- Requires secure 2-way communication between patients and healthcare providers.
Not only do patients need 24/7 access to healthcare professionals, but the provider must also provide the patient with asynchronous non-face-to-face consultation methods, separated by both time and distance. This includes secure messaging, and audio and video communication tools.
At TriageLogic, we specialize in delivering care to patients outside of the office. While our name is well established for our nurse triage on-call programs which give patients 24/7 access to a healthcare provider (items 1 and 2 in the list above), we have now expanded our offering to include a secure mobile application for patients. The My24/7Healthcare mobile app can allow for 24/7 nurse access, 2-way secure video, secure messaging, reminders and multiple additional features to aid in the coordination services to help practices manage their CCM patients.
Organizations like TriageLogic who provide outsourced telephone triage services can increase access and utilization for chronic care patients, ensuring care transitions are smooth and patients receive appropriate care. This reduces the demand for clinical and administrative resources within a practice, reducing the burden on existing operations.
For more information about the value triage nurses provide to chronic care patients, contact TriageLogic.