Shirley H. Lee, CRNP-FNP, MPH

Two out of three physicians surveyed at the LUGPA regional meeting this past spring cited rising costs and declining reimbursement as one of the top challenges they face in a COVID-19 era of care. It’s a challenge that requires a new look at ways to increase efficiency and revenue, even as workforce shortages and pandemic-specific obstacles strain resources.

For instance, supply chain challenges—such as a 

 that prevents some patients from receiving CT scans to monitor tumors or even detect a kidney stone—not only make it hard to treat patients’ health conditions, but also monitor progression of disease. This creates scenarios where patients who are more symptomatic may receive diagnostic testing while others go without. It is too early to tell what the long-term impact of this crisis might be.

Then there are the factors that continue to keep people from pursuing needed care, from fear of exposure to the coronavirus to concerns about the cost of care, long wait times for appointments and a tendency among some patients to put family members’ care needs—

How can specialty care practices strengthen quality of care, access, and revenue amid challenges such as these? Here are three approaches to consider.

1.Explore opportunities to expand ancillary services offerings—and promote them widely

. For instance, at Genesis Healthcare Partners in Los Angeles, the urology practice offers genetic testing for family members of prostate cancer patients, given the 

increased risk for aggressive prostate cancer

 in men with a family history of this disease. Among the top ancillary investments for urology practices alone, according to a 

: radiation therapy, surgery centers, lithotripsy and on-site laboratories and pharmacies.

Ancillary services make care more convenient for patients by offering a one-stop experience for meeting their comprehensive care needs for a specific condition. It also eliminates travel to multiple destinations for patients whose health makes it physically difficult to navigate facilities. Increasingly, specialty practices are 

entering into administrative and capital partnerships

 to manage ancillary services and access funding to launch new services or grow existing services.

One way to more widely promote existing service lines: Leverage patient data to identify patients who might benefit from a particular in-house service. Examples across specialties include nutrition counseling, a sleep apnea clinic, a cystitis clinic, physical therapy, and behavioral health services.

2.Make chronic care management more meaningful

. Leading specialty practices are exploring chronic care management (CCM) and principal care management (PCM) to strengthen outcomes for patients with chronic conditions while boosting revenue. This year, the Centers for Medicare & Medicaid Services (CMS) added four new codes for PCM, which allows physicians to receive additional reimbursement for their work in managing a single chronic condition. To qualify, the condition must put the patient at risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, with reimbursement depending in part on a disease-specific care plan. CCM, on the other hand, reimburses physician practices for care provided to a Medicare patient with two or more chronic conditions outside the patient’s regular office visit. But capturing CCM and PCM activities—a necessity for reimbursement—requires a software platform for tracking and managing care activities for this population, many of whom have multiple health needs.

3.Look for ways to make virtual care more efficient

. As care shifts to a hybrid environment—part in-person, part virtual, depending on the patient’s preferences and needs and the provider’s comfort level—there are numerous opportunities to make the experience of virtual care better for physicians and patients alike. For instance, rather than having the physician initiate the virtual care appointment, assign this task to a medical assistant, who can prep the patient and the physician for the encounter, start the call and alert the patient and the physician when it’s time to “go live” with care. This ensures the visit kicks off as smoothly as possible. It also preserves physicians’ time for true patient care activities, rather than administrative work associated with the encounter.

Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) are two other activities that are eligible for reimbursement from CMS—and, when used effectively, they can significantly reduce hospital readmissions (by 

 alone). Key to operational efficiency and better outcomes: a tool that analyzes RPM and RTM data in real time and alerts medical assistants when the patient’s vital signs signal a need for intervention.

By exploring opportunities to strengthen patient care and services while creating new avenues for revenue, specialty practices will be better positioned to engage members with complex care needs, to minimize provider and clinical staff burnout, and to protect their bottom line.

Shirley H. Lee, CRNP-FNP, MPH, is Director of Patient Navigation and a Nurse Practitioner for Genesis Healthcare Partners, P.C. She is also Vice President of Clinical Strategy for

This article originally appeared on Medical Economics®.

Articles

3 tips and tricks for practices looking to boost the bottom line.

Tips for capturing specialty practice revenue

The healthcare industry is just beginning to uncover the impact of delayed cancer screenings and care on oncology outcomes. It’s a challenge that 

accelerated the use of artificial intelligence

 (AI) worldwide in monitoring cancer progression or recurrence—and it demonstrates AI’s strong potential for ensuring patients receive the right treatment at the right time.

Two out of three patients aren’t getting recommended cancer screenings during the pandemic, according to a 

. Further, 32% aren’t sure which screenings they should be getting. Among the top missed appointments, according to the foundation: mammograms, cervical cancer screenings and skin checks.

As a result, some researchers are already seeing patients 

, in part due to delayed screenings. These gaps in care puts intense pressure on physicians to devise creative ways to encourage individuals to get caught up on recommended screenings. They also heighten the need for physicians to lean on data and tech-enabled support to identify individuals at risk and coordinate the right care at the right time to save lives.

One emerging AI solution prompts medical assistants to ask questions that provide the information physicians need to make better treatment decisions—faster. For example, in California, researchers developed an AI algorithm to 

 best suited for treating specific subtypes of cancers. Meanwhile, in Texas, one medical center uses AI to predict which cancer patients are likely to visit the emergency department (ED) in the next month and recommend ways that physicians and clinicians can help patients avoid a costly ED visit.

How can physician practices leverage AI in cost-effective ways to improve care coordination and outcomes for cancer patients or those at risk for cancer while enhancing efficiency and revenue? Here are three approaches to consider.

No. 1: Use AI to identify critical gaps in patient data—and prompt staff for follow-up

. AI-fueled software can proactively identify the types of data that are needed—and when—based on each patient's unique profile and conditions. This includes not just delayed cancer screenings, but also missing lab tests or imaging scans, unfilled prescriptions, lack of information from specialty referrals or unscheduled follow-up appointments for care. From there, medical assistants automatically receive prompts to reach out to patients to determine why care has been postponed, engage them in the appropriate next steps in care, track down missing test results and connect with other specialty providers to assess whether patients were able to make an appointment and, if so, obtain feedback.

During office visits, AI also can direct medical assistants to ask specific questions that provide the information physicians need to make better treatment decisions faster. Getting to the 

 is critical. For example, for patients who are undergoing hormone therapy following a diagnosis of prostate cancer, questions might include, “I noticed you didn’t receive your last hormone injection. Tell me more. Did you have any concerns about it?” This type of questioning enables medical assistants to uncover barriers to care—such as apprehension regarding the side effects of treatment—and take action (in this instance, by exploring options for mitigating side effects or considering other treatment options). At one California urology practice, the use of AI-powered care coordination to uncover barriers to recommended care or screenings helps clinicians detect prostate cancer 20% sooner. It’s an approach that improves outcomes while boosting efficiency and revenue.

No. 2: Proactively eliminate barriers to cancer care

. Clinical automation, powered by AI, can assist patient navigators—health professionals who help facilitate access to care, including for individuals with complex care needs—in exploring creative ways to support earlier detection of disease or better outcomes.

Consider that social determinants of health, such as economic insecurity or lack of childcare or transportation, 

 in disadvantaged populations. With the help of AI-guided conversations and clinical workflows, patient navigators become empowered to dig deeper. They identify the factors that complicate access to care and leverage practice resources, community connections and more to ensure patients get the services they need.

This tactic is well-suited for urology, gastroenterology, obstetrics, dermatology and more. For example, one urology practice in the Southwest identified 223 new treatments for prostate cancer patients in nine months based on responses to condition-specific, AI-guided conversations. By meeting patients where they are, physician practices can more effectively reduce risk and improve health.

No. 3:Use AI to identify new and better ways to treat cancer

. By applying AI analyses to patient care, physicians gain greater insight around the types of medications that are best suited for specific populations. They also are alerted to alternative therapies for patients who have been newly diagnosed with other types of chronic illness, 

. Such modifications could improve cancer symptoms and decrease the side effects of cancer treatment. That’s a finding that proved true for the Southwest urology practice, where AI analyses helped physicians remove or reduce side effects and improve symptoms in 196 prostate cancer patients within a nine-month period.

 say patients’ lack of compliance with care recommendations affects quality performance. Relying on AI to automatically monitor adherence and stay alert to changes in medical history could uncover the need for early intervention, preventing problems before they start.

Advanced tools that enhance patient data collection and engagement can reduce gaps in care for patients with cancer or those at risk while minimizing the associated administrative burden on providers. It’s a more modern technique for care management and collaboration that leads to faster identification of disease progression and treatment options. As physician practices seek to optimize care resources to create a better experience for physicians and patients, incorporating AI-based software into specialty care coordination is a tactic that closes essential gaps in data, increases efficiency and saves lives.

Shirley H. Lee, CRNP-FNP, MPH, is vice president of clinical strategy for

, a care coordination platform for specialty care across medical practices and hospital systems. She is a graduate of the Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health.

This article was initially published by our sister publication Medical Economics.

As we move beyond COVID-19, the healthcare industry is just beginning to uncover the impact of delayed cancer screenings and care on oncology outcomes.

Shirley H. Lee, CRNP-FNP, MPH

Articles

Tips for capturing specialty practice revenue

Why cancer outcomes could depend on AI care coordination