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By Shirley Lee, CRNP-FNP, MPH
With specialty care practices like urology bracing for payment cuts under the Medicare Physician Fee Schedule—and with the pandemic intensifying workforce shortages and burnout—how will care management evolve to ensure treatment plans are delivered safer, faster and with better outcomes?
It’s a question that is top of mind for specialty practice leaders in the new year.
Although legislators prevented nearly 10% in Medicare payment cuts from taking effect in 2022, specialty care providers will still feel the financial pinch of an uptick in clinical labor rates for non-facility-based surgical procedures. Spread over four years, these updates will significantly affect specialties with low clinical labor but high medical supply or device expenses, such as urology, interventional radiology and cardiology. Some experts foresee a “winners vs. losers” scenario where some specialties will see payment increases with the update while others will face decreased reimbursement.
There’s also the continued concern that patients’ tendency to delay care during the pandemic limits the ability to identify people with serious emerging conditions, such as cancer. “I know I should get another check soon, but the anxiety of COVID feels like more of a priority than the anxiety of cervical cancer,” one southern California woman who received an abnormal Pap smear result a year earlier told the California Health Care Foundation.
These are signs that specialty care practices must reimagine their approach to care management to ensure patients get the right care at the right time. Here are three trends that will spur innovation in specialty care management in 2022.
No. 1: The move toward additional reimbursement for chronic care management and principal care management.
The 2022 Medicare Physician Fee Schedule significantly boosted reimbursement for some chronic care management services. It also added five new CPT codes for chronic care management and principal care management. For specialty care practices, this opens the door to creating new revenue streams for chronic care and principal care management. Key to success: a more tightly coordinated process for tracking and managing care for patients with complex conditions.
At Anne Arundel Urology (AAU), based in Annapolis, Md., the practice revamped its approach to chronic care management in 2019. AAU invested in a care management platform that could comb through comprehensive data sets to identify instances where patients had missed recommended screenings, lab tests and more. The platform then prompts clinicians to follow up with patients—many of whom have complex care needs—to close gaps in care. It’s an approach that not only mitigates health risks, but also improves patient satisfaction. For example, data-informed follow-up with patients led AAU to detect cancer progression in 24 patients in one year, helping patients receive vital care sooner. It also led to the identification of 69 new treatments and improved symptoms of disease or reduced/eliminated side effects in 99 patients.
No. 2: Challenges in attracting and retaining medical assistants.
At a time when demand for medical assistants is growing, 88% of medical practice leaders say they face difficulty recruiting medical assistants. Worse, many of the most experienced medical assistants are leaving the profession due to the stress of providing care during a pandemic. For specialty practices—especially those that deal with advanced and complex disease—this presents a serious dilemma: “How can we help medical assistants feel more satisfied in their work and more valued by our team?”
Innovative practices lean into their medical assistants for care navigation, but they go beyond providing medical assistants with a decision tree on a poster or Word doc. Instead, these practices equip medical assistants with tech-enabled, disease-specific tools or software that prompt medical assistants to ask condition-specific questions that help detect health risks before they become complications. When areas of concern are detected, these innovations prompt medical assistants to alert physicians of the need for follow-up.
Today, care navigation expertise is tough to find in some specialties—especially for advanced and complex disease—and difficult to afford in small practices. In 2022, tech-enabled care pathways present an opportunity to up-level the skills of medical assistants and enable them to deliver care navigation. It’s an approach that adds value for patients and specialty practices.
No. 3: More intense focus on treatment adherence.
Specialties such as oncology, urology and gastroenterology demand a more longitudinal commitment to treatment adherence as opposed to evaluating treatment adherence during episodic encounters. The more adherent patients are to their treatment regimens, the faster physicians can identify what’s working and what’s not—and the faster patients qualify for additional or new treatment paths. It’s an approach that improves health outcomes and revenue.
At the greater Los Angeles division of Genesis Healthcare Partners, P.C., efforts to identify and follow up with undertreated patients helped staff identify new treatment options for 147 patients with benign prostatic hyperplasia (BPH) over a nine-month period. This initiative improved treatment adherence as well as patient outcomes. Many patients underwent a minimally invasive procedure and were able to discontinue a daily medication.
Staying Ahead of the Curve
With the demands in specialty care likely to increase, exploring practical-yet-innovative ways to advance care management is critical. In 2022, emphasis on tech-enabled, data-driven decision-making will make a marked difference in patient outcomes, professional satisfaction, and practice revenue.
Shirley H. Lee, CRNP-FNP, MPH, is Vice President of Clinical Strategy for Preveta, a care coordination platform for specialty care. She is also the director of a patient navigation program and a nurse practitioner for the Greater Los Angeles Division of Genesis Healthcare Partners, P.C. Lee is a graduate of the Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health.