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By Shirley Lee, CRNP-FNP, MPH
With specialty care practices like urology bracing for fee cuts below the Medicare Doctor Payment Schedule—and with the pandemic intensifying workforce shortages and burnout—how will care administration evolve to make sure remedy plans are delivered safer, sooner and with higher outcomes?
It’s a query that’s high of thoughts for specialty observe leaders within the new 12 months.
Though legislators prevented practically 10% in Medicare fee cuts from taking impact in 2022, specialty care suppliers will nonetheless really feel the monetary pinch of an uptick in scientific labor charges for non-facility-based surgical procedures. Unfold over 4 years, these updates will considerably have an effect on specialties with low scientific labor however excessive medical provide or gadget bills, similar to urology, interventional radiology and cardiology. Some consultants foresee a “winners vs. losers” state of affairs the place some specialties will see fee will increase with the replace whereas others will face decreased reimbursement.
There’s additionally the continued concern that sufferers’ tendency to delay care through the pandemic limits the flexibility to determine folks with critical rising situations, similar to most cancers. “I do know I ought to get one other examine quickly, however the nervousness of COVID seems like extra of a precedence than the nervousness of cervical most cancers,” one southern California lady who acquired an irregular Pap smear consequence a 12 months earlier instructed the California Well being Care Basis.
These are indicators that specialty care practices should reimagine their method to care administration to make sure sufferers get the precise care on the proper time. Listed below are three tendencies that may spur innovation in specialty care administration in 2022.
No. 1: The transfer towards further reimbursement for persistent care administration and principal care administration.
The 2022 Medicare Doctor Payment Schedule considerably boosted reimbursement for some persistent care administration providers. It additionally added 5 new CPT codes for persistent care administration and principal care administration. For specialty care practices, this opens the door to creating new income streams for persistent care and principal care administration. Key to success: a extra tightly coordinated course of for monitoring and managing take care of sufferers with advanced situations.
At Anne Arundel Urology (AAU), primarily based in Annapolis, Md., the observe revamped its method to persistent care administration in 2019. AAU invested in a care administration platform that might comb by way of complete knowledge units to determine situations the place sufferers had missed really useful screenings, lab checks and extra. The platform then prompts clinicians to comply with up with sufferers—lots of whom have advanced care wants—to shut gaps in care. It’s an method that not solely mitigates well being dangers, but additionally improves affected person satisfaction. For instance, data-informed follow-up with sufferers led AAU to detect most cancers development in 24 sufferers in a single 12 months, serving to sufferers obtain very important care sooner. It additionally led to the identification of 69 new remedies and improved signs of illness or diminished/eradicated unwanted effects in 99 sufferers.
No. 2: Challenges in attracting and retaining medical assistants.
At a time when demand for medical assistants is rising, 88% of medical observe leaders say they face issue recruiting medical assistants. Worse, lots of the most skilled medical assistants are leaving the occupation as a result of stress of offering care throughout a pandemic. For specialty practices—particularly those who take care of superior and sophisticated illness—this presents a critical dilemma: “How can we assist medical assistants really feel extra happy of their work and extra valued by our crew?”
Revolutionary practices lean into their medical assistants for care navigation, however they transcend offering medical assistants with a call tree on a poster or Phrase doc. As an alternative, these practices equip medical assistants with tech-enabled, disease-specific instruments or software program that immediate medical assistants to ask condition-specific questions that assist detect well being dangers earlier than they grow to be problems. When areas of concern are detected, these improvements immediate medical assistants to alert physicians of the necessity for follow-up.
At present, care navigation experience is hard to search out in some specialties—particularly for superior and sophisticated illness—and tough to afford in small practices. In 2022, tech-enabled care pathways current a possibility to up-level the abilities of medical assistants and allow them to ship care navigation. It’s an method that provides worth for sufferers and specialty practices.
No. 3: Extra intense concentrate on remedy adherence.
Specialties similar to oncology, urology and gastroenterology demand a extra longitudinal dedication to remedy adherence versus evaluating remedy adherence throughout episodic encounters. The extra adherent sufferers are to their remedy regimens, the sooner physicians can determine what’s working and what’s not—and the sooner sufferers qualify for extra or new remedy paths. It’s an method that improves well being outcomes and income.
On the better Los Angeles division of Genesis Healthcare Companions, P.C., efforts to determine and comply with up with undertreated sufferers helped workers determine new remedy choices for 147 sufferers with benign prostatic hyperplasia (BPH) over a nine-month interval. This initiative improved remedy adherence in addition to affected person outcomes. Many sufferers underwent a minimally invasive process and have been in a position to discontinue a every day medicine.
Staying Forward of the Curve
With the calls for in specialty care more likely to improve, exploring practical-yet-innovative methods to advance care administration is crucial. In 2022, emphasis on tech-enabled, data-driven decision-making will make a marked distinction in affected person outcomes, skilled satisfaction, and observe income.
Shirley H. Lee, CRNP-FNP, MPH, is Vice President of Scientific Technique for Preveta, a care coordination platform for specialty care. She can also be the director of a affected person navigation program and a nurse practitioner for the Larger Los Angeles Division of Genesis Healthcare Companions, P.C. Lee is a graduate of the Johns Hopkins Faculty of Nursing and Johns Hopkins Bloomberg Faculty of Public Well being.