Showing posts with label health communication urse. Show all posts
Showing posts with label health communication urse. Show all posts

Wednesday, September 30, 2020

Specialty telehealth supports chronic disease management and boosts Medicare Advantage value

Since chronic medical conditions are among the largest consumers of healthcare costs, telemedicine and telehealth solutions have emerged as potential cost-effective solutions to improve their management.


Approximately 80% of older adults have at least one chronic disease, and 77% have at least two, hence the urgent need to enhance and support the adoption of telemedicine and digital monitoring among Medicaid and Medicare Advantage (MA) patients. The Center for Medicare and Medicaid Services (CMS) has slowly come around to this realization, and cloud-based telehealth-based remote monitoring programs for managing chronic diseases are now reimbursable by CMS.


Utilizing Telemedicine for Chronic Disease Management


An Association of American Medical Colleges (AAMC) report in 2020 estimated a physician shortage in the United States of over 100,000 providers, distributed relatively evenly between primary and specialty doctors. Compounding the challenge of the physician shortage is the increased burden of chronic medical conditions.

For example, a Milken Institute report indicated that the U.S. health care costs for chronic diseases such as heart disease, cancer, diabetes, and Alzheimer’s disease totaled $1.1 trillion in 2016. When lost economic productivity is included, the total economic impact was $3.7 trillion. This is equivalent to nearly 20 percent of the U.S. gross domestic product.

Telemedicine and telehealth have been associated with improvements in patient’s HbA1c (17%, over 50% of patients)and 70% improvement in cholesterol management, important biomarkers for metabolic/chronic disease management. Telemedicine was also associated with significantly decreased wait times and improved visit attendance for patients with chronic conditions. This improved care led to 75% fewer hospitalizations and cost savings of almost $45,000 per patient per year.

Furthermore, managing a patient’s chronic condition from a distance reduces the need for office visits and in-person consultations, thereby mitigating viral transmission. Healthcare for the elderly and patients with chronic illnesses is being transformed to a virtual, home-based enterprise: a recent study indicated that a majority of MA participants used telemedicine services during the COVID pandemic, with over 90% satisfaction with the experience.

Telehealth and digital technologies are not only being used to help patients achieve long-term self-management of their chronic diseases, they can also facilitate collaboration among providers—an essential component in the management of patients with complicated chronic disease and comorbidities. This approach enhances symptom management and provides a channel to assess and improve patient compliance and adherence to prescribed regimens of care.


Rural Residents Increase Access to Specialized Care


With around 57 million Americans currently living in a rural area, many patients across the country lack adequate access to healthcare facilities and are forced to travel long distances to see their primary care provider or specialist. Individuals suffering from chronic diseases may face additional unique challenges such as a lack of mobility or difficulties sitting in a vehicle over long periods of time. Telemedicine resolves many of these issues, including the elimination of travel expenses, allowing patients to interact with specialty physicians or other providers from the comfort of their own home.


Monitor Patient Lifestyle Changes


As patients living with chronic conditions will benefit from lifestyle modifications, such as dietary changes, smoking cessation, and increased physical fitness, specialty telehealth consultations are critical to monitoring these changes. Digital devices, such as Bluetooth-enabled scales, blood pressure cuffs, and glucometers can monitor disease progression or regression. Physicians can also utilize mobile devices and live video and audio to quickly remind patients to take their medication, eat healthy, or find ways to stay active.



Reducing Hospital Admissions


Inpatient hospitalizations are among the most expensive component of managing patients with chronic diseases. By providing specialists the ability to remotely monitor a patient’s condition, treatment and management can be delivered in a timely and effective manner. This decreases care costs, promotes better care coordination, and reduces stress levels for both patients and families. Physicians can therefore utilize telemedicine to quickly respond to questions regarding medications or treatments and intervene on acute conditions that arise to reduce preventable hospital admissions.


Specialty Telemedicine for Chronic Diseases: Post-COVID-19 Safety


Undoubtedly, there is perhaps no more compelling benefit of telemedicine for chronic disease management than patient and provider safety, which has gained such importance during the COVID-19 pandemic. Specialty telemedicine in particular has been hailed as an imperative for CDM since it provides high quality care while still maintaining appropriate distancing measures, necessary to prevent viral transmission.

This is particularly relevant for MA beneficiaries whose underlying comorbid medical conditions place them at high risk for severe COVID-19 sequelae, yet simultaneously also necessitate relatively frequent medical consultations.

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Friday, September 25, 2020

Current legal, political issues effect physicians assets

With the election around the corner the country may be in for some significant legal and political changes that can affect physician’s assets.

Estate Planning for Affluent Physicians


We’ve examined various estate planning issues for physicians from many angles including the biggest mistakes physicians make and when you should update your estate plan. If the thought of your own mortality during the COVID19 crisis and the need to protect your heirs with an estate plan hasn’t prompted you to get an up to date estate plan in place already, perhaps this will. There are pending expected changes to the current estate tax exemption limits that will create an estate tax exposure for many physicians, the ‘mass affluent’, and ‘HNW’ categories.

I recently reviewed these issues with estate planner Mike Ferrin, a partner at the law firm of Davis, Miles McGuire Gardner* in Phoenix, AZ, who handles estate planning for HNW doctors and business owners. Mike shared some specific numbers, what the estate planning world thinks is going to happen and his concerns on why this issue should be considered time sensitive.

If your current net worth is at or above $3,500,000, or soon will be, you should seriously explore whether you need to do some additional estate tax planning before the end of the 2020 calendar year. Failure to do so could result in a significant estate tax exposure that would reduce what you leave to your heirs being taxed by as much as .40 cents on every dollar (current rate assumed as carrying forward) over the exemption amount.

The current federal estate tax exemption (a.k.a. “death tax”) for 2020 is $11,580,000 per individual and that doubles to a whopping $23,160,000 that a married couple can pass to anyone they want free of federal estate tax exposure. That’s a big number and frankly, a good problem to have, but that is set to decrease dramatically in 2026, decreasing to $5,000,000. Some current lawmakers and political candidates are calling to lower it even further, to $3,500.000 (estate tax) and $1,000,000 (for gift tax). If there is a new administration in place following the November election, the decrease may be enacted even sooner; legislation passed in 2021 could potentially be made retroactive to January 1st.

In plain English, you currently have a limited opportunity to transfer up to $11,580,000 double for married couple) of assets to one or more trusts that may not be subject to either gift tax while you are alive or estate taxes when you die. If you don’t act, that number could be reduced to as little $1,000,000 (double for married couple). This could result in a savings of over $4,000,000 (double for a married couple) in estate taxes.

Given these numbers, strategic gifting and sales to specialized trusts before the end of 2020 should immediately be considered by higher net worth doctors to take advantage of current high exemption rates, provide asset protection for the assets and to maintain the greatest degree of control and economic benefit possible, potentially including any income those assets currently produce. Planning strategies (fact specific, get expert help) may include the potential sale of gifting of assets to irrevocable trusts established for your spouse or children, including tools like ‘Spousal Lifetime Access Trusts’ (SLATs) or by using ‘Grantor Retained Annuity Trusts’ (GRATs).

These trusts hold assets outside your estate so they are exempt from estate taxes but can still be directed by you and/or your spouse subject to the terms established in the trust. Under current law, you are ‘grandfathered’ in and as long as the funds are formally transferred to a trust of this type before the exclusion amount changes, there should not be estate tax due upon death of the individual.

Those physicians to whom this discussion applies have typically put very significant educational efforts, labor, discipline and risk (and perhaps a little luck) into building their net worth. In many cases physicians say that one significant motivation for doing so is to provide a predictable future for their families, and in some cases that wealth can be multi-generational, invest in your legal planning accordingly. Please strongly consider your current and target financial position and planning needs now, while you can still act. I’m not the only person providing this information and top estate planners I work with across the country are already booked over a month out. Add the election, holidays and COVID related delays…the clock is ticking.

Medical Practice Supplies


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Manual Prescription Pad (Large - Yellow)


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Manual Prescription Pads (Light Yellow)

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Tuesday, September 22, 2020

Electronic Prescribing of Controlled Substances (EPCS) saves lives; now more than ever

Healthcare Delivery Organizations (HDOs) are fighting a pandemic within the COVID-19 pandemic...the opioid crisis. Disruptions in healthcare delivery and social services, coupled with social isolation and increased mental illness have all led to increasing morbidity and mortality from a familiar enemy: opioid addiction, dependency, and overdose. More people are suffering and dying from opioid use than ever.


As an emergency physician, I know from firsthand experience that we cannot ignore one disease to fight another. In fact, it has become more important than ever to implement technologies that fight both crises at once. Electronic Prescribing of Controlled Substances (EPCS) is one such tool whose time has come. HDOs should be implementing EPCS as soon as possible, and they can easily do so securely, efficiently, and in compliance with DEA requirements.

COVID-19 and the adoption of telehealth have made EPCS all the more important for providers and patients alike. Furthermore, the January 2021 deadline for healthcare providers to enable EPCS for Medicare Part D patients is rapidly approaching. In short, there are a number of reasons for healthcare organizations to make the switch as soon as possible.


For one, electronic prescriptions are a perfect fit for the telehealth model that many providers have adopted during the COVID-19 crisis. By prescribing electronically and cutting down on face-to-face interactions with patients, providers can limit patient-and-provider exposure to the virus. Providers can minimize the trips patients need to take outside their homes to obtain necessary medications—an especially important consideration for older and sicker patients, who are more at risk for negative outcomes if they are infected with coronavirus. 30 states have adopted their own EPCS regulatory mandates, with varying deadlines, and as anyone who has ever participated in a major healthcare IT initiative knows: things always seem to take a bit longer than planned. There is much coordination and planning involved to enroll providers in EPCS, and it shouldn’t be left to the last minute.

Renown Health, a Reno, NV-based healthcare system with three hospitals and more than 70 clinics, recently implemented EPCS to address patient safety concerns and regulatory compliance requirements. Here are some best practices they learned that other HDOs can follow to meet regulatory requirements and improve patient care through EPCS:


Know What You Know (and What You Don’t)


At Imprivata, we’ve worked with a large number of healthcare organizations on their EPCS rollouts, providing professional services that fill gaps in their internal IT staffers’ knowledge and experience. As one of the only healthcare systems in northern Nevada, Renown Health sees patients from a wide geographic area, meaning that the move to EPCS is saving some patients from having to drive several hours to see their physicians. Still, IT and clinical leaders at the healthcare system knew they needed help to make the transition. With 400 employed physicians and 1,400 credentialed affiliated physicians, the move was a major undertaking, and the organization relied on Imprivata professional services for about 85 percent of its enrollment effort.

“We certainly could have done many of these pieces on our own, but there’s a lot of regulatory risk, a lot of legal risk, a lot of trying to recreate a wheel that already exists,” Dr. Patrick Woodard, chief medical information officer and vice president of clinical systems for Renown Health, said in a recent webinar. “We simply felt it wasn’t something that we wanted to get into the business of doing.”


Don’t Forget the Human Component


Making a major change to a healthcare organization’s prescription system isn’t just a matter of implementing new technology. Clinical and IT leaders must also keep in mind that they’re requiring perhaps hundreds of professionals to adopt new tools and processes. That takes time.

“The hardest component of this, I think, is not the technological one,” Woodard said. “Anybody who’s gone through any sort of implementation knows that the human factor is the part that becomes difficult. There are a lot of folks who are going to have to be dragged kicking and screaming to something that’s new, even if it ultimately does benefit them.”


Adapt to Changing Conditions


Renown Health’s rollout of EPCS was interrupted by the COVID-19 crisis, forcing the organization to shift both its timeline and its enrollment process for physicians. Renown sped up implementation to accommodate telehealth workflows for patients, a move that was only possible because the DEA issued updated guidance clarifying that remote institutional identity proofing was allowed (as long as healthcare organizations met additional requirements). Leaders at Renown used prescribing data to identify the first round of physicians to be enrolled, prioritizing anyone who had prescribed a controlled substance in the previous three months. “

We no longer had to have physicians come into the office or to an enrollment fair to get enrolled,” Woodard noted. “That opened a lot of doors for us to be able to meet the criteria on a quick time frame.”


Simplify Authentication


Renown enrolled 50 percent of its total providers in about a month; three weeks after the organization’s EPCS go-live date, 47.5 percent of prescriptions were electronic. Much of this early success is due to the organization opting for enrollment and authentication options that met the needs of its clinicians. The DEA requires two-factor authentication for EPCS, and Renown leaders chose a password combined with an Imprivata ID phone-based token. Because this set-up doesn’t require providers to be physically near a fingerprint reader or other biometric scanning device, it’s a good fit for remote authentication.

“It’s just a push notification. You click approve, and then it goes,” Woodard said. “So it’s significantly faster than a lot of people are used to, which will help drive adoption.”

While many providers are already EPCS-enabled, much work remains to be done before widespread industry adoption takes hold. Meantime, a worrisome trend is taking shape. Amidst the COVID-19 pandemic, evidence shows the opioid abuse problem is getting worse. More than 30 states are now reporting increases in opioid-involved overdose deaths. The federal mandate slated to take effect this January will help curb opiate abuse by creating more accountable and secure practices for those who prescribe and dispense controlled substances. But hospitals and providers need to implement the technology now, as soon as possible, or we could undo all the critical progress that’s been made so far.

Medical Practice Supplies


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Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


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