executive summary & background ideal workflow to complete preventive visits more than 10,000...

Executive Summary & Background

Ideal Workflow to Complete Preventive Visits

More than 10,000 Medicare patients are provided primary care services at MU via the Departments of Internal Medicine and Family & Community Medicine. Primary care services include primary, secondary and tertiary preventive services to patients. Since 2011, the Affordable Care Act has expanded coverage for preventive care visits in Medicare patients. Such preventive care visits under Medicare are of three types, namely

• Welcome to Medicare• Initial Annual Wellness Exam• Subsequent Annual Wellness Exam

These preventive visits are reimbursed at an attractive rate.

Each department has invested in measures to complete these preventive visits although ~500 such preventative care visits have been completed in the more than 10,000 Medicare patients over the last 2 years. Major barriers to the completion of these preventive visits include: 1)a strict requirement to fulfill a multitude of clinical assessments with corresponding documentation within a single visit, 2)a high degree of care coordination, practice workflow, organization, and EMR support.

Despite improvement measures thus far, the required practice organization has not yet been achieved.

LIGHT 2 (Leveraging Information Technology to Guide High Tech and High Touch Care) is a CMS grant funded project focused on improving primary care practice for Medicare patients. LIGHT2 presents a unique opportunity to both departments who can utilize both the Hi-Tech and Hi-Touch features to find the creative solutions necessary to complete preventive care visits in Medicare patients.

An interdisciplinary team with members from both Departments and the LIGHT2 team has formed with the purpose of collaboratively identifying barriers and developing solutions to increase the number of Medicare preventive visits completed.

Benefits of increasing number of completed preventive care visits

Possible

Hi-Tech and Hi-Touch

solutions via LIGHT2

Physician discusses and offers a preventive visit

as a future visit to patient

Offers explanation and details

Patient receives a reminder to come

prepared and bring all medications

PSR schedules

appropriate next visit

All documentation is completed efficiently

and in a timely manner

Patient agrees

Patient presents for preventative

care visit

Nurse completes the required assessments

Physician reviews and

completes all needed

assessments

Billing and reimbursement

occurs successfully

As the result of an efficient and

effective process more patients

receive Medicare preventive care visits

and MU is reimbursed for the

services

(Hi-Tech) EMR solutions can help identify patients who are due for a

preventive visit and alert the physician; alternatively Nurse Care Managers (Hi-Touch) can

educate and discuss with patients

Patients may be reminded by either Hi-Tech or Hi-Touch

modalities

Hi-Tech/Hi-Touch enhancements can be used to make

documentation less tedious and more efficient

• Development of practice and system level improvements that facilitate completion of Medicare preventive care visits will improve the quality of patient care as well as increase clinical revenue both of which serve MU School of Medicine strategic goals.

Hi-Tech Hi-Touch