Monday, April 16, 2018

Annual Wellness Visits

With Health Administrators changing place of service/employment and organizations expanding their presence in Primary Care Practices (PCP), there are many areas of focus for the PCP, of which one of them is Annual Wellness Visits.

An Annual Wellness Visit (AWV) has the following characteristics:
  • It is an enhanced visit that lasts 45-60 minutes, at no-cost to the patient, including preventive labs
  • The goal is to see every Medicare patient every year and for this service to be billed once per calendar year
  • The benefit refreshes January 1 of every year. There is no need for the PCP to wait 365 calendar days between visits
  • In addition to the traditional AWV CPT codes G0438 and G0439, some insurance plans offer the ability for the PCP to submit additional codes for reimbursement.  Check your local plans for details.
  • AWVs need to be performed by a primary care physician, contracted nurse practitioner, or PA

 During an Enhanced Annual Wellness Visit the practitioner must
  • Document patient’s current chronic conditions and ongoing treatment plans
  • Conduct preventive screenings for conditions such as high blood pressure, diabetes, depression, and heart disease
  • Review medications
  • Schedule preventative treatments: colonoscopy, blood work, mammogram, etc.
  • Complete lab work as necessary
  • Use a pre-populated template based on the requirements of the specific payer

Benefits of an Enhanced Annual Wellness Visit
  • Allows for accurate reporting/submission of patient’s chronic conditions to Medicare in the current year
  • Maintains best practice of seeing your patients at least once a year
  • Allows opportunity to identify care gaps and create a plan of care for the year
  • Ensures acceptable medical record documentation in the case of a Risk Adjustment Data Validation (RADV) audit.
  • Compliance with Star Measures is also required by CMS.
  • Other considerations:  
CMS measures outcomes in multiple domains, including measures focused on your efforts to manage chronic conditions/issues in the Medicare population:
                                          i.    Osteoporosis
                                        ii.    Diabetes (retinopathy, nephropathy, HgbA1c, and cholesterol control)
                                       iii.    Hypertension
                                       iv.    Rheumatoid arthritis
v.  Bladder control

This is just a quick overview of the Annual Wellness Visit. If you find yourself or your organization getting more involved in Primary Care Practice Management, this is one of several areas that you as a Healthcare Administrator can find areas of efficiency for both the practice, and most importantly, the patient.
Submitted by Kevin Harrington, MATS, MSHA, RHIA, CHP, Full-Time Faculty, SJC


Thursday, April 05, 2018

Cultural Agility & Long-Term Care Settings


In my opinion, in the service industry, whether it is elder care or kinder care, cultural competence is the nexus that can determine success and satisfaction in any service business. I learned this fact early in my education as a recreation therapist. I had to understand the specific cultural interests of each population so that I could engage clients in meaningful activities in which they felt connected. For example, my Hispanic students wanted to learn the salsa and liked the upbeat tempo of that genre. My African American students wanted to listen to hip-hop and dance like Michael Jackson. We all compromised and had fun and a lot of laughs learning the various styles of dance and music.
Likewise, as a recreation therapist in a nursing home, I had to provide a variety of activities which would connect to a multitude of cultural interests. The religious activities were where I saw the most distinguishable segregation in cultures. The African American religious groups were more robust, loud, and lasted hours. Whereas, the non-Hispanic white religious activities were conservative and quick. The Catholics preferred to take Mass in their room. We had both an English-speaking priest and a Spanish-speaking priest who would visit the Catholic residents in their room.
I have always worked in very culturally rich locations and have been mindful of cultural differences both in the client population and the workforce. In fact, in the Northern Virginia market, a common complaint among patients is that they don’t understand the staff. In our demographic area, many African workers from Sierra Leona have a strong dialect and speak broken English. We also have many Hispanic workers and Filipino workers. There exist language barriers between staff and residents who are of not a minority background. Equally, many of our workforces are Muslim, and employers have had to adjust workflow to accommodate Muslim traditions and religious observances. So, as a health administrator, I have had many experiences with implementing cultural competencies to serve minority elders effectively.  I equally have had to apply cultural appreciation and diversity training to my non-minority elders and workforce to get along with and accept the cultural differences of our minority workforce.
Competencies Needed in Skilled Nursing Facilities
            There are three competencies that I believe skilled nursing facilities in culturally rich areas could do more to integrate into their healthcare settings. These include coordinating with traditional healers, incorporating culture-specific attitudes and values into health promotion tools, and locating clinics in geographic areas that are easily accessible for specific populations.
            Many years ago, I contracted with a massage therapy school to provide therapeutic massage to our bedridden and chronic pain residents. For me, massage is healing to the body and mind and works much better for my aches and pains than pain medication. Traditional healing methods offer a holistic approach to healing. Common traditional healing methods include acupuncture, sauna and steam baths, herbal teas, and herbal or mineral body scrubs. When I think of traditional healing and the elderly, I think of the power of touch and the power of spirituality. Sometimes, a hug or sharing a prayer is all that is needed to ease some pain and suffering of our fragile elders. Bearing in mind the variances in cultures where touch or eye contact may be offensive or an untoward expression.
            In the context of meeting a specific cultural need, there are practicing traditional healers for the African populations, the Chinese populations, and Native American populations. In my opinion, skilled nursing facilities should consult with residents and families to see if they have these specific preferences and make the accommodations, as feasible, to provide traditional healing to these residents.
            Preventive medicine, healthy lifestyle choices, and chronic disease management are how we will help the influx of the older population age well. The use of health promotion tools such as educational seminars and workshops, published literature, e-health, m-health, telemedicine, and health screenings are all useful tools to manage our aging population. However, if we don’t implement cultural sensitivity into the tools, the message will be lost on the minority elder population.
            Something as simple as the standard rehab ladder could reflect cultural sensitivity. How difficult would it be to ask the patient what their rehab goals are and establish a personal ladder of achievement? Maybe there is a grandchild’s graduation in the future? Perhaps there is a 50th wedding anniversary party? Maybe it is to golf or possibly swim? I use this as a simple example of a complicated issue. However, awareness is half the battle.
            As a skilled nursing facility provider, I would like to see more referrals being made to outpatient therapies, home-health agencies, physicians and specialists, and social workers who share not only the demographics of the discharged patient but also the culture. Most insurance companies include in their directory of providers the languages that the provider speaks. I think the same should be included in a list of home health agencies, outpatient therapy clinics, and enrichment programs for the elderly.
Cultural Sensitivity & Patient-Centered Care
            To conclude the discussion of cultural competencies, I would be remiss not to parallel cultural sensitivity to patient-centered care. Both models aim to improve healthcare.  Whereas, 
“the primary aim of the cultural competence movement has been to balance quality, to improve equity and reduce disparities by specifically improving care for people of color and other disadvantaged populations. [And] the primary aim of patient-centeredness has been to individualize quality, to complement the healthcare quality movement’s focus on process measures and performance benchmarks with a return to an emphasis on personal relationships and customer service. As such, patient-centeredness aims to elevate quality for all patients” (Saha, Beach, & Cooper, 2010, p. 9).
About the Author


References
Saha, S., Beach, M.C. & Cooper, L.A. (2010, February 18). Patient centeredness, cultural            competence and healthcare quality. Retrieved from          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824588/


Contributed by Donna Rein, Graduate Student, MHA Program, Saint Joseph's College