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Awad M, Furdich K, Webb D. Patient satisfaction with pharmacist-led chronic care management services combined with medication synchronization. Am J Health Syst Pharm 2023; 80:1350-1356. [PMID: 37368435 DOI: 10.1093/ajhp/zxad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE Chronic care management (CCM) improves clinical outcomes, enhances patients' adherence with medical treatments, reduces overall cost, and increases patient satisfaction. However, multiple reports have indicated the underutilization of CCM. Implementation literature has emphasized feasibility and different approaches to providing pharmacist-led CCM. This article examines patient acceptability and provides an innovative implementation approach combining both CCM and medication synchronization (MedSync) services. SUMMARY To introduce CCM services to underserved Medicare beneficiaries at a federally qualified health center, the pharmacy department of a federally qualified health center (FQHC) pilot tested a program whereby pharmacists provided CCM to Medicare beneficiaries enrolled in the MedSync service offered by the FQHC's in-house pharmacies. Both services were provided during the same phone call by the pharmacist. After successful completion of the pilot program, a retrospective chart review and patient satisfaction survey were conducted to enhance the quality of the service. A total of 49 patients were enrolled in the CCM program at the time of data collection. Overall, participants were satisfied with the service. The average number of medications per patient was 13.7. Pharmacists were able to identify an average of 4.8 medication-related problems (MRPs) per patient. Most of the MRPs (62%) were resolved directly by the pharmacists via education, over-the-counter medication adjustments, or interventions under consult agreements. CONCLUSION In addition to positive patient satisfaction, pharmacists were able to identify and address a significant number of MRPs when providing CCM.
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Affiliation(s)
- Magdi Awad
- Department of Pharmacy Practice, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kenneth Furdich
- Department of Pharmacy, AxessPointe Community Health Centers, Akron, OH, USA
| | - Dana Webb
- Department of Pharmacy, AxessPointe Community Health Centers, Akron, OH, USA
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Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA: The Cluster-randomized COMPASS Study. Med Care 2023; 61:137-144. [PMID: 36729552 DOI: 10.1097/mlr.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES We examined transitional care management within 90 days and 1 year following discharge home among acute stroke and transient ischemic attack patients from the Comprehensive Post-Acute Stroke Services (COMPASS) Study, a cluster-randomized pragmatic trial of early supported discharge conducted in 41 hospitals (40 hospital units) in North Carolina, United States. METHODS Data for 2262 of the total 6024 (37.6%; 1069 intervention and 1193 usual care) COMPASS patients were linked with the Centers for Medicare and Medicaid Services fee-for-service Medicare claims. Time to the first ambulatory care visit was examined using Cox proportional hazard models adjusted for patient characteristics not included in the randomization protocol. RESULTS Only 6% of the patients [mean (SD) age 74.9 (10.2) years, 52.1% women, 80.3% White)] did not have an ambulatory care visit within 90 days postdischarge. Mean time (SD) to first ambulatory care visit was 12.0 (26.0) and 16.3 (35.1) days in intervention and usual care arms, respectively, with the majority of visits in both study arms to primary care providers. The COMPASS intervention resulted in a 27% greater use of ambulatory care services within 1 year postdischarge, relative to usual care [HR=1.27 (95% CI: 1.14-1.41)]. The use of transitional care billing codes was significantly greater in the intervention arm as compared with usual care [OR=1.87 (95% CI: 1.54-2.27)]. DISCUSSION The COMPASS intervention, which was aimed at improving stroke post-acute care, was associated with an increase in the use of ambulatory care services by stroke and transient ischemic attack patients discharged home and an increased use of transitional care billing codes by ambulatory providers.
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Utilization of Medicare's chronic care management services by primary care providers. Nurs Outlook 2023; 71:101905. [PMID: 36588042 DOI: 10.1016/j.outlook.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Medicare billing codes introduced in 2015 reimburses primary care providers for non-face-to-face, chronic care management (CCM) services rendered by clinical staff. PURPOSE The purpose of this manuscript was to describe provider trends in billed CCM services and identify factors associated with CCM utilization. METHODS Observational study using Medicare Public Use Files, 2015 to 2018. General, family, geriatric, and internal medicine physicians, nurse practitioners (NPs), and physician assistants (PAs) with billed primary care services were included. Multivariable analyses modeled associations between the CCM services and type of provider, adjusting for year, primary care services, practice, and patient characteristics. FINDINGS Among 140,465 physicians and 141,118 NPs/PAs, CCM services increased each year, yet remained underutilized: 2% to 7% of physicians and 0.3% to 1.3% of NPs/PAs billed CCM in 2018. Increases in beneficiaries (p < .0001), percentage of dually enrolled (p = .0134), and primary care services (p < .0001) predicted higher CCM utilization. DISCUSSION CCM utilization reflects practice-based efforts to improve patient access to care by enhancing care delivery.
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McDaniel CC, Chou C, Camp C, Hohmann NS, Hastings TJ, Maciejewski ML, Farley JF, Domino ME, Hansen RA. Primary Care Physicians', Psychiatrists', and Oncologists' Coordination While Prescribing Medications for Patients With Multiple Chronic Conditions. J Patient Saf 2022; 18:e424-e430. [PMID: 35188930 DOI: 10.1097/pts.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Coordination of medication prescribing is important in the care of patients with multiple chronic conditions (MCC) given the involvement of multiple providers and multiple medications used to manage MCC. The objective of this study was to identify physician and practice factors associated with physicians' coordination of prescribing for complex patients with MCC. METHODS Our cross-sectional study used a 33-item anonymous, online survey to assess physicians' coordination practices while prescribing for patients with MCC. We sampled primary care physicians (PCPs), psychiatrists, and oncologists across the United States. Coordination of medication prescribing was measured on a 7-point Likert-type scale. χ2, Fisher exact test, and binomial logistic regression, adjusted for factors and covariates, were used to determine differences in coordination of prescribing. Average marginal effects were calculated for factors. RESULTS A total of 50 PCPs, 50 psychiatrists, and 50 oncologists participated. Most psychiatrists (56%) and oncologists (52%) reported frequently coordinating prescribing with other physicians, whereas less than half of the PCPs (42%) reported frequently coordinating prescribing. Female physicians were 25% points more likely to report coordinating prescribing than male physicians (P = 0.0186), and physicians not using electronic medical records were 30% points more likely to report coordinating prescribing than physicians using electronic medical records (P = 0.0230). Four additional factors were associated with lower likelihood of coordinating prescribing. CONCLUSIONS Physician and practice factors may influence differences in coordination of medication prescribing, despite physician specialty. These factors can provide a foundation for developing interventions to improve coordination of prescribing practices for MCC.
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Affiliation(s)
- Cassidi C McDaniel
- From the Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, Alabama
| | | | - Christina Camp
- From the Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, Alabama
| | - Natalie S Hohmann
- Department of Pharmacy Practice, Auburn University, Harrison School of Pharmacy, Auburn, Alabama
| | - Tessa J Hastings
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, Columbia, South Carolina
| | | | - Joel F Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | | | - Richard A Hansen
- From the Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, Alabama
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Fung V, McCarthy S, Price M, Hull P, Cook BL, Hsu J, Newhouse JP. Payment Discrepancies and Access to Primary Care Physicians for Dual-eligible Medicare-Medicaid Beneficiaries. Med Care 2021; 59:487-494. [PMID: 33973937 PMCID: PMC8486346 DOI: 10.1097/mlr.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physicians often receive lower payments for dual-eligible Medicare-Medicaid beneficiaries versus nondual Medicare beneficiaries because of state reimbursement caps. The Affordable Care Act (ACA) primary care fee bump temporarily eliminated this differential in 2013-2014. OBJECTIVE To examine how dual payment policy impacts primary care physicians' (PCP) acceptance of duals. RESEARCH DESIGN We assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. Using a triple-difference approach, we examined changes in dual caseloads for PCPs versus a control group of specialists in states with fee bumps versus no change during years postbump versus prebump. SUBJECTS PCPs and specialists (cardiologists, orthopedic surgeons, general surgeons) that billed fee-for-service Medicare. MEASURES State dual payment policies and physicians' dual caseloads as a percentage of their Medicare patients. RESULTS In 2012, 81% of PCPs had dual caseloads of ≥10% and this was less likely among PCPs in states with lower versus full dual reimbursement (eg, difference=-4.52 percentage points; 95% confidence interval, -6.80 to -2.25). The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017 and the fee bump was not consistently associated with increases in dual caseloads. CONCLUSIONS Pre-ACA, PCPs' participation in the dual program appeared to be lower in states with lower reimbursement for duals. Despite the ACA fee bump, dual caseloads declined over time, raising concerns of worsening access to care.
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Affiliation(s)
- Vicki Fung
- Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Mary Price
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Peter Hull
- Department of Economics, University of Chicago, Chicago, IL
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, MA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Kennedy School, Cambridge, MA
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Poghosyan L, Brooks JM, Hovsepian V, Pollifrone M, Schlak AE, Sadak T. The Growing Primary Care Nurse Practitioner Workforce: A Solution for the Aging Population Living With Dementia. Am J Geriatr Psychiatry 2021; 29:517-526. [PMID: 33622594 PMCID: PMC8855473 DOI: 10.1016/j.jagp.2021.01.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
Redesigning the healthcare workforce to meet the needs of the growing population of persons living with dementia (PLWD), most of whom reside in the community and receive care from primary care providers, is a national priority. Yet, the shortage of adequately trained providers is raising concerns that the primary care system is not equipped to care for PLWD. The growing nurse practitioner (NP) workforce could bridge this gap. In this review, the authors synthesized the existing evidence from fourteen studies on the utilization of NPs to care for PLWD in primary care. Although the authors found that most NPs were engaged in co-management roles, emerging evidence suggests that NPs also serve as primary care providers for PLWD. Findings describe the impact of NP care on the health system, PLWD, and caregiver outcomes. The authors conclude that the optimal utilization of NPs can increase the capacity of delivering dementia-capable primary care.
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Affiliation(s)
| | | | | | | | | | - Tatiana Sadak
- School of Nursing, University of Washington, Seattle, WA
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Agarwal SD, Barnett ML, Souza J, Landon BE. Medicare's Care Management Codes Might Not Support Primary Care As Expected. Health Aff (Millwood) 2021; 39:828-836. [PMID: 32364873 DOI: 10.1377/hlthaff.2019.00329] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To enhance compensation for primary care activities that occur outside of face-to-face visits, the Centers for Medicare and Medicaid Services recently introduced new billing codes for transitional care management (TCM) and chronic care management (CCM) services. Overall, rates of adoption of these codes have been low. To understand the patterns of adoption, we compared characteristics of the practices that billed for these services to those of the practices that did not and determined the extent to which a practice other than the beneficiary's usual primary care practice billed for the services. Larger practices and those using other novel billing codes were more likely to adopt TCM or CCM. Over a fifth of all TCM claims and nearly a quarter of all CCM claims were billed by a practice that was not the beneficiary's assigned primary care practice. Our results raise concerns about whether these codes are supporting primary care as originally expected.
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Affiliation(s)
- Sumit D Agarwal
- Sumit D. Agarwal ( sagarwal14@bwh. harvard. edu ) is a primary care physician at Brigham and Women's Hospital, in Boston, Massachusetts, and a PhD candidate in health policy at Harvard University, in Cambridge, Massachusetts
| | - Michael L Barnett
- Michael L. Barnett is an assistant professor of health policy and management in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, and a primary care physician at Brigham and Women's Hospital
| | - Jeffrey Souza
- Jeffrey Souza is a programmer and biostatistician in the Department of Health Care Policy, Harvard Medical School, in Boston
| | - Bruce E Landon
- Bruce E. Landon is a professor in the Departments of Health Care Policy and of Medicine and a faculty member in the Center for Primary Care, all at Harvard Medical School
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Hilliard RW, Haskell J, Gardner RL. Are specific elements of electronic health record use associated with clinician burnout more than others? J Am Med Inform Assoc 2021; 27:1401-1410. [PMID: 32719859 DOI: 10.1093/jamia/ocaa092] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/17/2020] [Accepted: 05/05/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. MATERIALS AND METHODS We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. RESULTS Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). DISCUSSION High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, "patient calls" encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. CONCLUSIONS Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.
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Affiliation(s)
- Ross W Hilliard
- Department of Medicine, Division of General Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Rebekah L Gardner
- Department of Medicine, Division of General Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Healthcentric Advisors, Providence, Rhode Island, USA
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9
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Qualitative Analysis of Health Systems Utilizing Non-Face-to-Face Chronic Care Management for Medicare-Insured Patients With Diabetes. J Ambul Care Manage 2020; 43:326-334. [DOI: 10.1097/jac.0000000000000342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Opportunities for Improving Chronic Care Management to Address Demands for Accessible Accountable Care During and After the Pandemic. J Ambul Care Manage 2020; 43:335-339. [DOI: 10.1097/jac.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reddy A, Marcotte LM, Zhou L, Fihn SD, Liao JM. Use of Chronic Care Management Among Primary Care Clinicians. Ann Fam Med 2020; 18:455-457. [PMID: 32928763 PMCID: PMC7489968 DOI: 10.1370/afm.2573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022] Open
Abstract
The Centers for Medicare and Medicade Services (CMS) initiated chronic care management (CCM) codes to reimburse clinicians for coordination activities, but little is known about uptake over time. We find that primary care clinicians drove increasing use over 4 years-a trend that may reflect either new coordination activities or new reimbursements for existing activities. That 5% of chronic care management was denied by Medicare underscores the need for future work evaluating facilitators and barriers to use. Such insight is especially vital given the large number of eligible beneficiaries that have not received chronic care management to date, as well as the limited number of clinicians who currently deliver these services.
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Affiliation(s)
- Ashok Reddy
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington .,Value & Systems Science Lab, Seattle, Washington
| | - Leah M Marcotte
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Value & Systems Science Lab, Seattle, Washington
| | - Lingmei Zhou
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Value & Systems Science Lab, Seattle, Washington
| | - Stephan D Fihn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Value & Systems Science Lab, Seattle, Washington.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Mills WR, Poltavski D, Douglas M, Owens L, King A, Roosa J, Pridham J, Dzina D, Weber D. A Platform and Clinical Model to Enable Medicare's Chronic Care Management Program. Popul Health Manag 2019; 23:107-114. [PMID: 31216255 PMCID: PMC7074917 DOI: 10.1089/pop.2019.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In 2015, the Centers for Medicare & Medicaid Services (CMS) implemented a new benefit called chronic care management (CCM). A recent CMS-commissioned study of the program showed that CCM is effective in increasing advance care planning and decreasing overall costs. Despite positive effects on care planning, utilization, and cost, the CCM program remains underutilized. The authors sought to develop a platform to enable scale of the CCM program, and to report outcomes associated with its use. A technology and integrated clinical staff platform was built to enable a scalable, evidence-based implementation of the Medicare CCM program. The model created care management data elements that were used to flag clinical and utilization risks such as falls, mortality, hospitalization and polypharmacy. In 2018, CCM support was provided for 26,500 patients. Logistic regression analyses were used to identify risk factors associated with hospitalization. The cohort experienced 2679 hospitalizations (184 admissions per 1000 patient months per year). Among patients residing in non-nursing home settings, a higher Gagne mortality risk was associated with a 32 times greater chance of being hospitalized. Other positive predictors of hospitalization included being a nursing home resident and being ambulatory without assistance. Negative predictors of hospitalization included being flagged as having a high hospitalization risk, and scoring in the low-risk category for falls or polypharmacy. This CCM model is a scalable method of supporting care management for people with multiple chronic conditions, and can help identify risk factors for hospitalization.
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Affiliation(s)
| | | | | | - Lisa Owens
- Chronic Care Management, Inc., Solon, Ohio
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