What is the Clinical impact of COVID-19?

Telehealth is on the rise among outpatient healthcare providers, but the number of patient visits is declining at a much more rapid rate during the coronavirus outbreak. While primary care practices are reducing staff or closely entirely to protect themselves and their patients from COVID-19, many are still seeing patients virtually.

Researchers recently analyzed data involving 50,000 providers, including independent single-provider practices, multispecialty groups, Federally Qualified Health Centers, and large health systems, and found that:

  • The number of visits to ambulatory practices declined nearly 60 percent in mid-March and has remained low through mid-April.
  • The decline in visits was largest among school-age children and older adults.
  • The decline in visits was generally larger among surgical and procedural specialties and smaller in other specialties such as adult primary care, obstetrics/gynecology, oncology, and behavioral health.
  • As the number of in-person visits dropped, telehealth visits increased. But the increase in telehealth visits only partially offset the drop in in-person visits.
  • Nearly 30 percent of all visits at these ambulatory practices are now provided via telemedicine.

The study also found that, of all visits in a typical week before the pandemic, 47 percent were with primary care physicians (adult and pediatric) and 54 percent of visits were spread across more than 25 specialties.

Another study, focused on patient behavior during the COVID-19 pandemic, found that more than one in four patients (27 percent) said they had an elective surgery, appointment, or procedure delayed or canceled due to COVID-19. In addition, the Medical Group Management Association (MGMA) reported that practice revenue has declined by an average of 55 percent since the beginning of the coronavirus outbreak.

Elation Health supports primary care physicians by offering a COVID-19 Financial Guide, an overview of financial assistance available to independent practices during and after this difficult time.

Primary care physicians and other healthcare providers are adhering to recommendations set forth by the Centers for Medicare and Medicaid Services (CMS) and by the Centers for Disease Control and Prevention (CDC), including orders to stay at home and maintain social distancing. The CDC has recommended that physicians:

  • Consider reaching out to patients who may be a higher risk of COVID-19-related complications such as the elderly, those with medical co-morbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, to ensure adherence to current medications and therapeutic regimens, confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
  • Eliminate patient penalties for cancellations and missed appointments related to respiratory illness.

Regarding the telehealth option, the CDC suggests that:

  • Healthcare facilities can increase the use of telephone management and other remote methods of triaging, assessing, and caring for all patients to decrease the volume of persons seeking care in facilities.
  • If a formal telehealth system is not available, healthcare providers can still communicate with patients by telephone instead of in person visits, which will reduce the number of those who seek face-to-face care.

As states and local areas begin to ease COVID-19 restrictions, patients may desire to reschedule appointments. However, primary care physicians must continue to follow the guidance and restrictions for seeing patients in person again. Typically, communities must report declines in either the number of documented COVID-19 cases or positive tests in a 14-day period. States and regions must also meet other criteria in order to start reopening local economies.

Justin Egkan
May 5, 2020

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8 tips to improve patient satisfaction

Value-based care is driving the move toward an increased focus on patient satisfaction. Physician compensation is being impacted by patient satisfaction, but it also reflects on the practice as a whole. The independent physician can measure the success of the practice by gauging the level of satisfaction among the patient panel.

There are a number of myths that should be addressed as you work to improve patient satisfaction:

  • Very few patients fill out satisfaction surveys.
  • Patients who fill out surveys are generally unhappy with their care.
  • Only very unhappy or happy patients make comments on their surveys.
  • Patient satisfaction is primarily a popularity contest. Patient satisfaction and quality are not related. Patients can’t evaluate the quality of care that is being delivered.
  • You can’t improve patient satisfaction scores significantly in any reasonable timeframe.
  • If you build a nice new building, patient satisfaction scores will go up.

Following these eight tips to improve patient satisfaction will help you and your practice recognize and overcome these myths.

Track patient satisfaction with a survey

Send patients a brief, simple survey digitally. The survey should primarily focus on a single topic, such as the patient’s recent office visit. The patient is more likely to complete the survey if it is convenient and quick, taking no more than five minutes to complete. Send the survey via email or the patient portal within 24 to 48 hours after the patient’s office visit.

Examine data closely

In the survey, use primarily close-ended questions that can be answered with a “yes” or “no” or multiple-choice options. This will enable you to compile and examine hard data, in addition to reviewing any comments or suggestions included in the patient’s survey response.

Make the changes recommended

Use the feedback you receive from the survey and make a list of potential changes that will improve patient satisfaction in your practice. Share the survey results with your clinical staff and enlist their participation as you make the improvements.

Follow up to gauge patient opinions of the changes

Patient surveys should not be one and done. As you make improvements in your practice, continue to ask your patients’ opinions about the healthcare and the customer service they’ve received. If you’ve implemented new technology, for example, ask if they are able to use it and if it makes their experiences better. Asking for continued feedback emphasizes to your patients that you are committed to continuous improvement.

Leverage innovative technology

Innovative technology tools, such as electronic health records (EHRs) can enhance your patients’ experiences with your practice. Offering the patient the ability to view medical records, receive referrals, and communicate with you online can significantly improve patient satisfaction.

Improve employee engagement

Healthcare providers are beginning to realize the important connection between engaged, satisfied employees and happy patients. Patient satisfaction is directly related to the overall well-being of the practice, including the level of satisfaction among the clinical staff.

Optimize scheduling

Making it easier for patients to schedule appointments and reducing the wait time when the patient is in the office can contribute to a higher level of satisfaction.

Improve communications

Research has shown that patients consistently consider the level of interaction with the physician and staff as “paramount” in their evaluation of their healthcare experience. They look for consistent communications and clear explanations regarding diagnoses and treatment plans. Patients also appreciate the ability to communicate electronically after the visit to clarify information.

Justin Egkan
April 27, 2020

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How to communicate COVID-19 changes to patients

In these uncertain times, communication has become critical. Many people are in isolation, under orders to stay at home and to maintain social distances when they do venture out. Even though some aspects of life have been virtually suspended, some still need to be addressed. Your primary care patients are probably concerned about the COVID-19 pandemic, but they also continue to need you to help them with their ongoing healthcare needs. Here are some tips on how to communicate COVID-19 changes to your patients.

Delays and rescheduling

You may need to reschedule non-urgent appointments. Annual physicals or follow-up appointments that will not affect the health of your patients may have to wait until the orders to stay at home have been lifted. Rescheduling appointments is necessary to protect your patients and your staff. There may also be a delay in getting a new appointment if your staff has been reduced or you are overwhelmed with your patient load.

When patients do need to come in, let them know if you have established protocols related to the COVID-19 pandemic.

  • Will you require everyone to wear a face mask?
  • Have you taken extra precautions to clean and disinfect your practice spaces?
  • Have you established separate spaces in your waiting room for those suspected of being infected with the coronavirus?

The Centers for Disease Control & Prevention (CDC) advises primary care physicians to “Separate patients with respiratory symptoms so they are not waiting among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated.”

Communicating these changes is crucial for your primary care patients. Be proactive with phone calls to those patients who have appointments coming up in the next few months, to let them know of the possible need to reschedule and to anticipate waiting times. Other options include using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with COVID at home.

Telemedicine options

When patients need to be seen but cannot come to your office, you can take advantage of technology. As the American Health Information Management Association describes it, telemedicine is the “use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.” Quite simply, telemedicine involves an interaction between you and your patient via telephone or a secure online platform, including “videoconferencing, transmission of still images, e-health including patient portals, and remote monitoring of vital signs.”

Communications about your primary care practice’s telemedicine options should include notices on your website and social media posts. If you have an email database for your patients or a secure portal for messaging, consider sending regular updates to your patients regarding the options they have available to them regarding their healthcare during the COVID-19 pandemic.

Use EHR for communications

The electronic health record (EHR) solution will enable you to communicate securely with your patients through the portal. In such an environment, you can communicate with confidence. Elation Health’s online Patient Passport enables you to securely communicate with your patients about their health and about changes related to COVID-19 that you may implementing in your practice. Patients also have access to critical health information through their portal so they can share it with other providers when necessary.

Justin Egkan
April 22, 2020

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The importance of an efficient EHR

Primary care practices must operate efficiently to be financially viable. Optimizing a primary care practice involves a number of factors, streamlining practice operations, reducing overhead, and taking advantage of technology. An efficient electronic health record (EHR) system is also critical for the successful operation of a primary care practice.

Patient medical records, care coordination, and treatment plans are all housed in their EHR. Traditionally, this documentation has been kept on paper in files lined up at the nurse’s station or elsewhere in the practice office. Finding information in paper files was incredibly inefficient in itself, involving time spent searching through paperwork and waiting on paper documentation from other healthcare providers caring for the patient.

An inefficient EHR also causes the physician to spend time searching for information that could be critical to the patient’s healthcare plan. Streamlining the process results in less time spent on the computer, more time spent with the patient, and a higher quality level of care for that patient.

An efficient EHR, such as Elation’s Clinical First EHR, will benefit the physician, the practice, and the patient by enabling the provider to document visit notes, order lab tests, e-prescribe, and write referrals in any order, all from the same screen. The need to enter and re-enter information, often found in an inefficient system, is reduced with prioritized automation throughout the workflow.

Additionally, as the Office of the National Coordinator for Health Information Technology (ONC) describes, an efficient EHR is important for the physician and the patient as it will:

  • Provide accurate, up-to-date, and complete information about patients at the point of care
  • Enable quick access to patient records for more coordinated, efficient care
  • Securely share electronic information with patients and other clinicians
  • Enable safer, more reliable prescribing
  • Enhance the privacy and security of patient data
  • Reduce costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

Chris Anderson
March 31, 2020

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Why is there a decline in primary care visits?

Access to primary care has been shown to result in more positive healthcare outcomes and reduced costs. One study, conducted by Northwestern Medicine, concluded that “Americans with primary care received significantly more high-value healthcare — such as recommended cancer screenings and flu shots — and reported better patient experience and overall healthcare access, compared to those who don’t have primary care.” However, a separate research effort found that there has been a decline in primary care visits in recent years.

In a study involving the examination of insurance claims from 2008 to 2016 for adult health plan members aged 18 to 64 years, researchers discovered that “commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016.” In fact, visits to primary care physicians declined by 24.2%, while the proportion of adults who had no primary care physician visits in a given year rose from 38.1% to 46.4% over the period studied.

Primary care is defined by the National Academies of Sciences, Engineering, and Medicine as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The Office of Disease Prevention and Health Promotion (ODPHP) adds that access to primary care is associated with healthier outcomes. So why the decline in primary care visits?

ODPHP explains further that disparities in that access to healthcare definitely exist in the US. Obstacles that patients may face include:

  • Lack of health insurance
  • Language-related barriers
  • Disabilities
  • Inability to take time off from work for primary care appointments
  • Geographic and transportation barriers, particularly in rural areas
  • A shortage of primary care providers, particularly in rural areas

Many of these barriers intersect or overlap for patients who are not able to access primary care services.

A lack of health insurance has been found to decrease the use of preventive and primary care services. The ODPHP states that people who do not have health insurance may put off seeking care when they are ill or injured and are more likely to be hospitalized for chronic conditions, such as diabetes and hypertension, that could be treated by a primary care physician.

Issues with access in rural areas include the distance a patient may have to travel to be able to access primary care services. Rural communities tend to have fewer physicians than do urban areas and the shortage has been growing in recent years. Transportation barriers can keep patients from seeking preventive care such as vaccinations.

The researchers studying health insurance claims also theorize that the decline in primary care visits may be related to “decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care” among patients who would otherwise seek out primary care.

Justin Egkan
March 11, 2020

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Responding to coronavirus concerns as a primary care physician

A virus that began in Wuhan City, Hubei Province, China, in December 2019 has spread internationally. The coronavirus, now referred to as COVID-19, has been confirmed in 57 people in the US, including those who were onboard a cruise ship that had previously been quarantined. Across the globe, more than 80,000 cases have been reported with a death toll of more than 2,700. Naturally, many of your primary care patients will be near panic stage as news continues to spread about the growing number of infections.

As a primary care physician, you will be faced with a multitude of questions and concerns from your patients. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have issued guidelines and dispelled myths for patients who are worried about the rapid spread of COVID-19.

  • Travel: The biggest concern is whether it is safe to travel on airlines and cruise ships, particularly to destinations where the virus is prevalent. The CDC is recommending that travelers avoid all nonessential travel to China and South Korea. Older adults and patients with chronic medical conditions should consider postponing nonessential travel to Italy, Japan, and Iran.
  • Face Masks: Images of virtually everyone in China and other infected countries wearing face masks to protect themselves have your patients worried about whether they should also wear a face mask. WHO recommends that you only need to wear a mask if you are taking care of a person who may be infected with COVID-19 or if you are coughing or sneezing yourself, to protect others from your possible infection.
  • Hand Washing: During flu season, it is always advisable to wash your hands frequently and thoroughly, with soap and water, to prevent the spread of germs. Washing hands is critical during the coronavirus outbreak. You should regularly and thoroughly clean your hands with an alcohol-based hand rub and then wash with soap and water to kill any viruses that may be on your hands.
  • Pneumonia Vaccines: At this time, researchers are still working on an effective vaccine for COVID-19. Vaccines against pneumonia, although highly recommended to protect your health, are not effective against the new coronavirus.
  • Hand Dryers, Alcohol Sprays, and Other Myths: Unfortunately, when a virus such as COVID-19 continues to spread and infect thousands of people across the globe, your patients will hear many words of advice that just aren’t true. As a primary care physician, you can guide your patients to a better understanding of the facts:
    • Hand dryers do not kill the coronavirus
    • UV lamps should be not used in an attempt to sterilize hands or other areas of the skin
    • Spraying alcohol or chlorine over the body will not kill viruses that already exist within the body
    • Domestic pets such as dogs or cats are not infected and cannot transmit the new coronavirus
    • Regularly rinsing the nose with saline will not protect you from being infected with COVID-19.

While people of all ages can be infected, older people and people with chronic or pre-existing conditions are more vulnerable to becoming ill. As a primary care physician, you can reassure your patients who have concerns about the new coronavirus by presenting the facts and dispelling the myths. Patients should take the necessary precautions to avoid being infected, just as they would for any virus, including following good hand hygiene and good respiratory hygiene.

Justin Egkan
March 3, 2020

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The Primary Care Quarterback: How great primary care means better care management

In the game of football, the quarterback’s role is to coordinate and act as the leader of the offense. The quarterback works with other team members and coaches to produce the best possible play each time, so that the team can reach the goal at the end of the field. In healthcare, the primary care physician plays the role of quarterback. Your goal is a positive outcome for your patients, through better primary care and better care management.

It all starts with great primary care. Research has shown that the quality of healthcare, including the costs incurred, is strongly linked to the availability of a primary care physician for the patient. In fact, it has been found that patients with “access to a regular primary care physician have lower overall health care costs than those without one, and health outcomes improve.” Further, in “areas of the country where there are more primary care providers per person, death rates for cancer, heart disease, and stroke are lower and people are less likely to require hospitalization.”

The goals of care management include reducing those hospitalizations and reducing the costs of healthcare overall. Primary care can achieve these goals, as well as provide higher quality care to patients, by coordinating their care appropriately.

A study published in the Annals of Family Medicine found a number of attributes of high-value primary care practices that cohered into three themes:

  • Risk-stratified care management
  • Care selection of specialists
  • Coordination of care

These three areas “reflect physician recognition of the need for ‘care traffic control’ to help patients with complex conditions or treatment plans” navigate the healthcare system for better outcomes.

The study found that high-value primary care resulted in:

  • Decision support for evidence-based medicine. Primary care teams ensure that patients receive evidence-based care and treatment, noting guideline reminders in the patient’s electronic health records (EHRs) for other physicians.
  • Careful selection of specialists. Developing relationships with specialty providers whom the primary care physician trusts and continuing to communicate with those providers are critical to quality outcomes for the patient.
  • Standing orders and protocols. With protocols for uncomplicated illnesses and disease management, the primary care team can use standardized workflows for patient care.
  • Balanced compensation. Value-based care accounts for “care quality, patient experience, resource use,” and primary care practice improvement activities.
  • Care coordination. The primary care team monitors patients, including visits to specialty providers, labs, and diagnostic tests, to ensure patients complete their referrals, schedule follow-up appointments, and adhere to treatment and medication instructions.
  • Risk-stratified care management. Through the delivery of quality primary care, each patient receives care based on his or her unique needs, whether that involves office visits, monitoring and guidance provided by a care manager, or communication after the visit to clarify diagnoses and care instructions.

Justin Egkan
February 20, 2020

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Primary care physicians guide to 2020

The healthcare landscape for primary care physicians will include a number of rule updates and policy changes in 2020. Reimbursement rates and interoperability are issues to watch, as well as an increased emphasis on value-based care. Regulations such as Stark’s Law are being rewritten and strategies such as care management are becoming more important to the primary care physician’s practice.

CMS Updates

Rules that modify how physicians get paid for evaluation and management (E/M) services have been revised for 2020. The Centers for Medicare & Medicaid Services (CMS) has finalized the physician fee schedule for 2020, targeting primary care physicians and encouraging them to spend more time coordinating care for patients. CMS hopes these updates will:

  • Help address social determinants of health affecting primary care physicians’ patients
  • Increase patient adherence to treatment
  • Improve continuity of care.

In regard to social determinants of health, CMS Administrator Seema Verma believes increased payments will help providers:

  • Better coordinate care
  • Improve health outcomes
  • Cut spending.

For primary care physicians participating in the Merit-based Incentive Payment System (MIPS), the minimum score needed to avoid a penalty increases from 30 to 45 points in 2020. The score affects 2022 payments, with the maximum penalty also being increased, from 7% to 9%. In addition, while CMS had proposed setting the 2020 high-performer threshold at 80, the final rule actually raised that threshold to 85 points.

Stark Law

The Stark Law was enacted in 1989 to prevent physicians from referring Medicare or Medicaid patients to healthcare services from which the physician or a member of the physician’s family would profit financially. Regulations and exceptions have been added to the Stark Law in the years since and it is currently a vast collection of regulations and statutes. In 2020, CMS will look at making significant changes to the law, which was named after Rep. Pete Stark, a California Democrat.

More than likely, debate over the law’s current relevance and role in managed care will take place throughout 2020. CMS Administrator Verma says that the law is “outdated,” as preventing inappropriate financial incentives does not make as much sense in today’s managed care and value-based care systems as it did in the fee-for-service system.

Interoperability

Interoperability allows the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.

The US Department of Health and Human Services (HHS) is focused on hastening the adoption of interoperable electronic health records (EHRs) in 2020. The Interoperability and Patient Access proposed rule requires all Medicare, Medicaid, and federal exchange plans to share claims data electronically with healthcare enrollees. The rule is expected to take effect in 2020.

Elation’s Collaborative Health Record (CHR) aims at facilitating cross-communication between providers. The CHR is a centralized dashboard with a patient’s story, notes, and test results, managed by all the physicians treating your patient. All you have to do is open your patient’s longitudinal record and all of the information is right in front of you, allowing you to make more informed decisions about your patient’s health.

Justin Egkan
February 18, 2020

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Explaining the primary care shortage and the importance of primary care

As the population ages and needs more primary care services, the shortage of primary care physicians to treat those patients continues to increase. According to the Association of American Medical Colleges (AAMC), “there will be a shortage of between 21,100 and 55,200 primary care physicians by 2032.” In its recent publication, Myths and Facts: The Physician Shortage, the AAMC dispels the myth that the shortage is a result of fewer medical students choosing primary care and instead focuses on the situation being caused by more older patients needing that primary care access.

AAMC’s findings are the result of a survey conducted by the Life Science division of IHS Markit and reported in The Complexities of Physician Supply and Demand: Projections from 2017-2032. The fifth annual study includes “scenarios that have been refined and updated based on input from stakeholders, and new modeling that examines the impact of emerging health care delivery trends on physician shortages.”

In addressing the results of the survey, AAMC President and CEO Darrell G. Kirch, MD, explains that “The nation’s population is growing and aging, and as we continue to address population health goals like reducing obesity and tobacco use, more Americans will live longer lives. These factors and others mean we will need more doctors. Even with new ways of delivering care, America’s doctor shortage continues to remain real and significant.”

The physician shortage is not necessarily a result of fewer primary care physicians but rather is a result of more demand from patients who are growing older and who need more quality primary care services. Baby Boomers, those born between 1946 and 1964, are turning 65 “by the thousands” and are becoming more vigilant about their healthcare. The eldest members of this generation are also signing up for Medicare “by the thousands.”

Quality primary care has been shown to reduce the frequency of emergency room visits and hospitalizations. As the population ages, more patients are experiencing health conditions that can be better managed by a primary care physician. Preventive care becomes particularly important for older patients as well.

AAMC suggests that “Fixing the doctor shortage will require training a few thousand more doctors a year, working on new delivery models and technologies, and receiving help from nonphysician providers.”

Justin Egkan
February 5, 2020

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How to find the best EHR for your primary care practice

Electronic health records (EHRs) can ensure your patients’ medical information is accessible, accurate, and secure. The ability to input data into a patient’s EHR can save your practice from potential duplication and errors, as well as the delay created in using paper records and referrals. The question for many primary care physicians, though, is which EHR solution is best for the practice based on your specific needs.

All EHRs must offer conform to security requirements as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Patient data must be protected and accessible only by those providers who have the patient’s express permission. In addition to HIPAA regulations, electronic data is protected under the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was signed into law in 2009, as part of the American Recovery and Reinvestment Act (ARRA), to promote the adoption and meaningful use of health information technology.

Beyond the legal requirements, EHR solutions differ in terms of features, training, and customer support. One consideration for your primary care practice is whether you prefer to have EHRs housed on an internal service or on the cloud. Cloud-based EHR systems solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars are often spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is needed. Cloud-based EHR systems are already established by the EHR provider, meaning the expense of money and time diminishes dramatically.

To comply with Centers for Medicare & Medicaid Services (CMS) requirements, you may need a certified EHR. As CMS states, “CEHRT gives assurance … that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps health care providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.”

A vendor’s ability and willingness to assist with implementation and training and then provide customer support when you need it are also key factors to review when searching for the best EHR for your primary care practice. At Elation Health, we know that your time is valuable. That’s why we designed our clinical first, cloud-based EHR  to take less than an hour to learn. We’ll even migrate your previous patient data across for free. In addition, with Elation’s extraordinary 24/7 support, you’ll get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Justin Egkan
January 10, 2020

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