A Look at COTN Challenges
Things don't always go as planned. We are using this page to share with you COTN participants' reports of glitches along the way. We'll add solutions as they're found, too. If you are considering starting a similar project, the list of challenges may help you avoid similar situations.
Continued Billing Challenges
The CPT 99490 Chronic Care Management code available since
Jan 2016 continues to be an open discussion.
This topic will remain at the top of the TRCs' list of outstanding items
as the industry gets ready for ATA 2016 in Minneapolis the 3rd week
of May.
Billing Challenges
The CPT 99490 Chronic Care Management code available since Jan 2016 continues to be an open discussion. While RCCHC has made some progress on a workflow and determining how to achieve the specific requirements when using this code; Mosaic is still uncertain if it is worth it for them to pursue further. The biggest hurdle is having to collect the co-pay from patients and the fear they will opt out of the RPM program rather than pay the monthly co-pay. Trying to develop the procedures and have billing pursue this revenue stream has to be balanced with the amount of money which could be collected based on the number of Medicare patients on the program. This isn’t a large part of Mosaic’s population but is also something they are staying open to as a potential revenue stream. Additional action items were taken to help the team make a decision about the potential of this reimbursement option.
Interface Challenges
Aging Equipment
Equipment is now becoming older with some RPM equipment from 2011 and 2012. There isn’t an exact shelf-life to the equipment. Testing the equipment as part of refurbishment and re-using peripherals for new patients is the path we are taking. Testing, cleaning and reset of equipment, is done on each piece of equipment as part of inventory management processes. The TRCs and InScope are working on recommendations for retiring equipment.
Funding Challenge
Waiting for approval of carryover funds to support the program expansion to St. Charles has been challenging. A request has been made to get assistance but at this time we are holding with St. Charles expansion until we have a better understanding of the funding and what we can do for Mosaic and any expansion completed.
Interface Challenges
The lack of the interface is disappointing but the Providers are accepting the relaunch and support of the RPM team.
The lack of the interface is disappointing but the Providers are accepting the relaunch and support of the RPM team.
Interface Challenges
The interface has a couple of challenges:
- The wrong encounter being created requiring the workflow to be too much work. Now have acceptance to create a RPM encounter & episode. Manage several alerts within the same encounter and work with the provider. Until the encounter closes all alerts should be in there.
- Auto-close in 24 hours. Want to use that encounter until a clinical decision has been reached and there is a clinical decision to close. A new interface has to be built which is considered an add-on.
Interface Challenges
The Ideal Life – Epic interface continues to be a challenge. The go live date has been pushed back a couple more months. We are looking at changing how the encounters are being sent and starting back over. Scope of work from OCHIN is being provided to Mosaic. Certain readings do not flow into the chart as they should and the team is defining requirements. Everything is focused on how data flows to Becky and to the providers’ inbox. The Mosaic team is working to determine a specific path for the requirements to ensure we can get the interface back on track; while making it effective when it is completed.
Resource Challenges
There are still ongoing challenges regarding resource and workload management. There will be another per diem nurse joining the team in September. After OCHIN interface is fully integrated, Aimee will be working on refining the resource needs list.
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Equipment Challenges
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OCHIN Interface
OCHIN interface still in process; completion target dates have come an gone. Resources at our end are needed to support testing, yet as of June 18 there is no definite test date confirmed. We still don't have a committed resource to back-up our Regional RN, Aimee Priest. While we did finish training a per diem nurse, this resource may not be sufficient to cover all needs.
OHCHIN interface software testing and implementation continues to be a challenge. Reports from developers do not coincide with actions noted those involved in launch at sites. This translates into continued inefficiencies based on the need to maintain records in two seperate EMR systems.
OHCHIN interface software testing and implementation continues to be a challenge. Reports from developers do not coincide with actions noted those involved in launch at sites. This translates into continued inefficiencies based on the need to maintain records in two seperate EMR systems.
The interface is still in testing specifically comparing between ideal Life and Epic data. Fixes are being made to ensure data is matching up. The providers are excited to see things right away rather than waiting for reports to be sent to them but there is still the need to ensure the EPIC procedures are accurate. Re-prioritization of the detail needed to finish the interface is being defined. Unfortunately, the lead contact at OCHIN is leaving the organization so we will be working with a new contact.
Referrals
There is an ongoing effort to promote referrals in our clinics. Primarily we are trying to promote the use of the glucose enablers from all of the referring providers. Consideration of a per diem asset to assist with this will be viable.
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Ongoing Challenge
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Balancing Equipment with Demand
In general, patients enrolled in Telehealth participate in remote patient monitoring for a standard three months. This amount of time has been found to be effective in determining whether or not a patient will benefit from further monitoring. Some patients participating in the COTN have been enrolled for as long as ten months. This may be useful and or/necessary, depending on specific health issues and provider concerns.
Not all patients show much progress in the initial three months. After this time period has passed, it is up to the provider to extend the referral, requesting further remote patient monitoring. However, for patients who are not ready to willingly make lifestyle changes, continuing to monitor their health from afar may not be helpful to their care. Unfortunately, due to a potential increase in demand for equipment, it may be necessary to distribute limited equipment to new patients who may use the feedback from their daily readings to proactively take charge of their health.
Patient with Memory Loss
A patient with mild memory loss was recently referred to COTN. Because of the memory loss, family members would have to help the patient to remember to take her readings. This is not a typical “ideal” patient for the Telehealth program. However, there could be some benefits for the patient and the family. The primary care provider could receive readings so she is aware of the effectiveness of the medications being prescribed. Additionally the family members might see that the patient is or is not taking her meds, which could help identify another area of need for the patient, and the patient might benefit from the extra support. We are still contemplating whether or not this could be an effective program for this type of situation.
Keeping Referrals Flowing
Our most recent challenges have revolved around receiving referrals from the providers. We sent an email out three weeks ago to the providers encouraging them to send Telehealth patients our direction to help us reach our goal of 100 patients in the program at one time. So far we have received three referrals. Two of the three patients agreed to enroll in the program. We are also scrubbing the original patient list provided to us by the IT team. We have been able to enroll two people that were agreeable to the program from this list. The challenge is the decrease in flow of referrals.
Encouraging Buy-In
Provider and patient buy-in is sometimes a challenge for a program like this. Some patients start out excited and very compliant but seem to taper off in taking their readings. Providers were originally sending multiple referrals to the program. This has decreased substantially since program start.
EHR Challenges
We are in the process of changing the admission process for Telehealth. Switching from the paper questionnaires to electronic Medical Record (EMR) takes a little more time as does any new process.
Staff Retraining
We are now documenting the Plan of Care in the EMR. We have had to retrain ourselves and the providers. For the most part this is going smoothly. As this process goes on we are recognizing faults in the process so we are constantly refining this process.
Referral Process
The referral process has been rolled out in our electronic Medical record (EMR). This entails going back and having a referral placed for Telehealth patients who were placed on the program prior to the EMR referral roll out. We have changed where we are documenting the two-week report. It is now in the Result Notes section of the EMR. Now the PCPs may view all reports in one section instead of having to search for Telephone encounters. The challenge is that we need referrals for all of the patients so it may be documented in the result note. So, some patients that have been on the program since November 2013 have two-week reports in the Telephone encounter section and in results notes now. The process in which the PCP responds to the two-week report has been changed so there has been some confusion as to where to document further actions or orders. These are all “kinks” in the process that are being worked out. There is a lot of trial and error work going on.
Rapid Change
As the program grows it is a daily challenge to find balance between doing patient care and tackling the tasks and projects needed to be done for the further development of this program.
Equipment Challenges
We are currently having older cell PODs that are failing and are too old to be re-flashed. We do have new cell PODs to replace them. This is an example of an issue that slows down the workflow. As we go forward this will not happen as frequently thanks to the new equipment we have.
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