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What is Establishing Care: How providers can establish it for their patients?

Establishing care is a cornerstone of effective healthcare, creating a consistent and ongoing relationship between patients and providers.

This relationship is essential for delivering personalized, comprehensive, and continuous care tailored to each patient’s unique health needs.

By focusing on key components such as initial engagement, comprehensive assessments, and ongoing communication, healthcare providers can ensure a patient-centered approach that enhances satisfaction and health outcomes.

In this blog, we will learn what is establishing care and how healthcare providers can efficiently establish and maintain these crucial relationships.

What is Establishing Care?

Establishing care is the process of creating a consistent, ongoing relationship between a healthcare provider and a patient. This foundational relationship is crucial for delivering personalized, comprehensive, and continuous care tailored to the patient’s unique health needs.

Components of Establishing Care

The major components of establishing care include the initial assessment, comprehensive assessment, a strong relationship, and ongoing care and follow-up and administrative efficiency. These elements collectively work to create a supportive and efficient healthcare environment, promoting better health outcomes and patient satisfaction.

Components of Establishing Care

Let’s have a detailed look at each.

1). Initial Engagement

The journey of establishing care begins with the initial engagement when a patient first contacts your practice. This first contact can occur via phone, online platforms, or in person and is critical as it sets the tone for the future relationship between the patient and the practice.

A welcoming, professional, and responsive initial interaction can significantly influence the patient’s decision to continue with your services.

Additionally, the appointment scheduling process should be seamless and user-friendly. Providing clear instructions on how to schedule an appointment, what documents to bring, and what to expect during the first visit can alleviate any anxiety and ensure the patient is well-prepared.

💡 Example: A patient contacts a clinic for the first time. The receptionist greets him warmly, schedules the appointment, and sends a follow-up email with detailed instructions on what to expect and what documents to bring. This initial engagement helps the patient feel valued and reduces any apprehension about the visit.

2). Comprehensive Assessment

A thorough comprehensive assessment is vital during the patient’s first visit. This begins with an in-depth review of the patient’s medical history, including personal and family health history, as well as lifestyle factors such as diet, exercise, and habits. This holistic view is foundational for developing an effective and personalized care plan.

Following the medical history review, a detailed physical examination should be conducted to establish a baseline of the patient’s current health status. This initial examination provides essential insights that will guide future care and interventions.

💡 Example: At the first appointment, the physician spends time discussing the patient’s previous medical conditions, medications, and lifestyle. The clinician also conducts a physical exam, noting any immediate health concerns. This comprehensive assessment allows the doctor to develop a tailored care plan that addresses the patient’s specific health needs.

3). Building a Relationship

Building a strong, trusting relationship with the patient is an ongoing process that requires effective communication and empathy.

Trust is crucial as it encourages patients to openly share their health concerns, leading to more accurate diagnoses and effective treatment plans.

Clear, jargon-free communication helps in understanding medical conditions and treatments easily, making the patient feel more involved and in control of their health decisions.

Additionally, educating patients about their health conditions and involving them in the decision-making process fosters a collaborative environment, enhancing patient adherence to care plans and improving overall outcomes.

💡 Example: A diagnostic center explains a new diagnosis of hypertension to patient in simple terms, discussing the causes, potential complications, and treatment options. The doctor involves the patient in creating a management plan, considering their preferences and lifestyle. This approach not only informs the patient but also empowers them to take an active role in their health.

4). Ongoing Care and Follow-Up

The relationship between the healthcare provider and the patient should extend beyond the initial visit through regular, ongoing care. Scheduling regular follow-up appointments is essential to monitor the patient’s health, make necessary adjustments to treatment plans, and provide preventive care measures.

Consistent monitoring through tools like electronic health records (EHR) ensures that all health information is up-to-date and accessible, facilitating continuous and coordinated care. This ongoing engagement helps in early detection of potential health issues and maintaining overall well-being.

💡 Example: A provider schedules regular follow-ups with her patient to monitor their blood pressure, adjust medications as needed, and provide lifestyle advice. Using an EHR system, she tracks the patient’s progress and ensures that any changes in their health status are promptly addressed. This ongoing care helps in managing the patient’s hypertension effectively.

5). Administrative Efficiency

Efficiency in administrative processes is crucial for maintaining a smooth and patient-friendly experience.

Handling administrative tasks such as billing, insurance claims, and appointment reminders efficiently prevents disruptions in care and enhances patient satisfaction.

Utilizing patient portals can further streamline these processes by offering patients easy access to their health records, allowing them to schedule appointments, and facilitating communication with healthcare providers. This technological integration not only improves operational efficiency but also empowers patients to take an active role in managing their health.

💡 Example: A clinic uses a patient portal where patients can view their medical records, schedule appointments, and message the healthcare team directly. This system reduces administrative burden and enhances patient engagement and satisfaction by making healthcare more accessible and transparent.

Establishing Care Visit vs. Standard Visit

When comparing an establishing care visit to a standard visit, several key differences stand out, particularly in terms of purpose, content, and typical procedures.

Both visit types are crucial in a patient’s healthcare journey, with the establishing care visit laying the foundation for a long-term relationship and the standard visit addressing ongoing and immediate health concerns.

Here’s a detailed breakdown:

AspectEstablishing Care VisitStandard Visit
PurposeBuild patient-provider relationship, establish baseline healthAddress specific health concerns, routine follow-up
Medical HistoryComprehensive, including personal and family historyFocused on the issue at hand
Physical ExaminationThorough and comprehensiveTargeted to specific concern
Health AssessmentBaseline assessments, preventive screeningsSpecific diagnostics for current issue
DiscussionHealth goals, preventive careTreatment options, management plans
ProceduresBaseline lab tests, vaccinations, referralsDiagnostic tests, prescription adjustments, minor procedures
DurationLonger, typically 30-60 minutesShorter, typically 15-30 minutes
The table shares the key differences between a patient’s standard visit vs established care visit.

Why Establishing Care Is Essential For Healthcare Providers

Establishing care is a fundamental process for healthcare providers that significantly impacts both patient outcomes and the efficiency of healthcare delivery. Here’s why it is essential:

Continuity of Care

Establishing care ensures continuity of care, which is vital for managing chronic conditions and maintaining overall health. Regular interactions allow providers to monitor health changes over time, adjust treatments as needed, and provide timely interventions. This continuous oversight helps in the early detection of potential health issues, which can prevent complications and reduce the need for more intensive treatments later on.

Personalized Treatment

A long-term relationship with patients enables healthcare providers to deliver highly personalized care. Understanding a patient’s comprehensive medical history, lifestyle, and preferences allows for the creation of tailored care plans that are more effective and aligned with the patient’s specific needs. Personalized treatment plans increase patient adherence and satisfaction, leading to better health outcomes.

Preventive Health

Establishing care emphasizes the importance of preventive health measures. Regular check-ups, screenings, and health education help in identifying risk factors early and implementing preventive strategies. This proactive approach can significantly reduce the incidence of serious health issues, ultimately saving time and resources for both patients and providers.

Building Trust and Communication

A strong, ongoing relationship builds trust between patients and healthcare providers. Trust is a critical component of effective healthcare, as it encourages patients to openly communicate their health concerns and adhere to medical advice. Good communication enhances patient understanding of their conditions and treatments, fostering a collaborative environment where patients feel empowered and engaged in their own care.

Improved Health Outcomes

When care is established, healthcare providers can more effectively manage a patient’s overall health. This holistic approach, which includes regular monitoring, timely interventions, and continuous support, leads to improved health outcomes. Patients who regularly see the same provider are more likely to receive consistent, high-quality care that addresses both acute and chronic health issues comprehensively.

Operational Efficiency

For healthcare providers, establishing care with patients also leads to operational efficiency. Familiarity with a patient’s history and health status streamlines clinical workflows, reduces redundancy in testing and documentation, and enhances the accuracy of diagnoses and treatments. Efficient administrative processes, supported by electronic health records and patient portals, further contribute to a smoother healthcare delivery experience.

Patient Retention and Satisfaction

Establishing care helps in building long-term relationships with patients, which is crucial for patient retention and satisfaction. Satisfied patients are more likely to continue using the provider’s services, recommend the practice to others, and follow through with recommended care plans. High patient retention rates contribute to a stable practice and a positive reputation.

How to Bill an Established Patient Visit?

Billing for an established patient visit involves a series of steps to ensure accuracy and compliance with billing regulations. Here’s a guide to correctly bill for an established patient visit:

1. Determine Patient Status

Verify if the patient is new or established. An established patient is one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years.

Use the Current Procedural Terminology (CPT) codes to bill for the visit. For an established patient, the common CPT codes are 99211-99215. The code selection depends on the complexity and time of the visit.

  • 99211: Minimal problems, 5 minutes
  • 99212: Problem-focused, straightforward, 10 minutes
  • 99213: Expanded problem-focused, low complexity, 15 minutes
  • 99214: Detailed, moderate complexity, 25 minutes
  • 99215: Comprehensive, high complexity, 40 minutes

2. Document the Visit

Comprehensive documentation is crucial. Ensure that the medical record includes the history, examination, and medical decision-making components. Documentation should support the level of service billed.

3. Verify Insurance Information

Confirm the patient’s insurance coverage and obtain any necessary pre-authorization if required by the insurance provider.

4. Use Appropriate ICD-10 Codes

Assign the appropriate ICD-10 codes for the diagnoses made during the visit. These codes justify the medical necessity of the visit.

5. Submit the Claim

Submit the claim electronically or via paper, depending on the payer’s requirements. Ensure all required fields are accurately completed.

6. Follow-Up

Monitor the claim status and follow up with the insurance provider if there are any delays or denials. Be prepared to provide additional information or documentation if requested.

7. Patient Billing

Once the claim is processed, bill the patient for any remaining balance not covered by insurance, such as co-payments, deductibles, or co-insurance.

Established Patient Office Visit (CPT codes 99211–99215): Coverage and Documentation Requirements

CPT CodeLevel of SeverityTime SpentKey Components
99211Problem(s) are minimal.Typically 5 minutes spent to perform or supervise.None.
99212Problem(s) are self-limited or minor.Typically 15 minutes spent face-to-face with the patient and/or family.  Requires 2 of these 3 key components: – A problem focused history – A problem focused examination and – Straightforward medical decision making
99213Problem(s) are of low to moderate severity.Typically 15 minutes spent face-to-face with the patient and/or family.  Requires 2 of these 3 key components: – An expanded problem focused history – An expanded problem focused examination and – Medical decision making of low complexity
99214Presenting problem(s) are of moderate to high severity.Typically 25 minutes spent face-to-face with the patient and/or family.Requires 2 of these 3 key components: – A detailed history – A detailed examination and – Medical decision making of moderate complexity
99215Presenting problem(s) are of moderate to high severity.   Complex medical decision making involves at least 2 of the following: – extensive management options – extensive amount of data reviewed – high risk of complications and/or morbidity or mortalityTypically 40 minutes are spent face-to-face with the patient and/or family.Requires 2 of these 3 key components:  – A comprehensive history – A comprehensive examination and – Medical decision making of high complexity  

How to Establish Care Efficiently?

How to establish care in medical

Here’s how providers can efficiently establish care:

➜ Make Initial Contact Easy and Welcoming

  • Simplify Contact Methods: Ensure patients can easily reach your office through multiple channels such as phone, email, and online chat.
  • Friendly First Impressions: Train front-desk staff to greet patients warmly and address their concerns promptly and respectfully.
  • Clear Information: Provide concise and clear information about services, insurance accepted, and any necessary preparations before the first visit.
  • Accessible Website: Maintain a user-friendly website with easy navigation, clear instructions, and a FAQ section to address common inquiries.

Provide Clear Appointment Scheduling

  • Online Scheduling Tools: Implement an online scheduling system that allows patients to book, reschedule, or cancel appointments with ease.
  • Flexible Hours: Offer appointments outside of traditional business hours to accommodate patients’ varied schedules.
  • Timely Reminders: Send automated reminders via text, email, or phone calls to reduce no-show rates and ensure patients remember their appointments.
  • Transparency: Clearly communicate any wait times and policies regarding late arrivals or missed appointments.

Conduct a Comprehensive Initial Assessment

  • Thorough Medical History: Collect detailed information about the patient’s medical history, including previous treatments, medications, allergies, and family medical history.
  • Physical Examination: Perform a complete physical exam to understand the patient’s current health status.
  • Personalized Care Plan: Develop an individualized care plan based on the assessment, considering the patient’s specific health needs and lifestyle.
  • Initial Consultations: Allow ample time for the initial appointment to build rapport and thoroughly address any patient concerns.

Build Trust through Effective Communication

  • Active Listening: Show empathy and actively listen to patients’ concerns without interrupting them.
  • Clear Explanations: Use plain language to explain medical conditions, procedures, and treatment options, avoiding jargon.
  • Consistent Updates: Regularly update patients on their health status and progress, ensuring they understand the next steps in their care.
  • Open Channels: Encourage patients to ask questions and express any concerns, reassuring them that their input is valued.

Educate and Involve Patients in Their Care

  • Patient Education: Provide educational materials about their conditions and treatments, using brochures, videos, and online resources.
  • Shared Decision-Making: Involve patients in the decision-making process regarding their treatment plans, ensuring they feel empowered and informed.
  • Self-Care Instructions: Offer clear guidelines for self-care practices, such as diet, exercise, and medication adherence.
  • Support Groups: Recommend support groups or community resources that can help patients manage their conditions and connect with others in similar situations.

Schedule Regular Follow-Up Appointments

  • Consistent Follow-Up: Schedule follow-up appointments before patients leave the office to ensure continuity of care.
  • Automated Reminders: Utilize automated systems to remind patients of upcoming follow-ups.
  • Check-In Calls: Implement follow-up calls to check on patients’ progress and address any issues between visits.
  • Monitor Progress: Regularly review and adjust care plans based on follow-up assessments to ensure optimal patient outcomes.

Utilize Electronic Health Records (EHR)

  • Comprehensive Records: Maintain thorough and up-to-date EHRs for each patient, ensuring all relevant information is accurately recorded.
  • Accessibility: Ensure that EHRs are easily accessible to all healthcare providers involved in a patient’s care to facilitate coordinated treatment.
  • Data Security: Implement robust security measures to protect patient data and ensure compliance with privacy regulations.
  • Efficiency: Use EHRs to streamline administrative tasks, such as prescription refills, lab orders, and patient referrals.

Implement Efficient Administrative Processes

  • Streamlined Workflow: Develop efficient workflows to reduce wait times and improve patient throughput without compromising quality of care.
  • Training: Regularly train staff on best practices for administrative tasks and customer service.
  • Technology Integration: Utilize technology, such as automated medical billing and scheduling systems, to reduce administrative burdens and minimize errors.
  • Performance Metrics: Track and analyze performance metrics to identify areas for improvement and ensure high standards of care.

Use Patient Portals for Enhanced Communication

  • 24/7 Access: Provide patients with 24/7 access to their health information, appointment scheduling, and communication with healthcare providers through secure patient portals.
  • Messaging: Enable secure messaging for patients to communicate with their healthcare team, ask questions, and request prescription refills.
  • Educational Resources: Offer educational content and health resources within the patient portal to keep patients informed and engaged in their care.
  • Test Results: Allow patients to view their test results and receive explanations and follow-up instructions promptly through the portal.

Gather and Act on Patient Feedback

  • Surveys: Regularly distribute patient satisfaction surveys to gather feedback on their experiences and identify areas for improvement.
  • Review Systems: Monitor and respond to online reviews and ratings to address any concerns and improve your practice’s reputation.
  • Patient Advisory Panels: Establish patient advisory panels to gain insights directly from patients on how to enhance services and care delivery.
  • Continuous Improvement: Use patient feedback to implement changes and continuously improve the quality of care and patient satisfaction.

Final Thoughts

► Efficiently establishing care is crucial for building long-term, trusting relationships with patients, which significantly enhances their overall health outcomes and satisfaction.

► By implementing strategies such as making initial contact welcoming, providing clear appointment scheduling, conducting comprehensive assessments, and maintaining effective communication, healthcare providers can create a supportive and responsive care environment.

► Utilizing technology like EHRs and patient portals further enhances processes, ensuring that both administrative tasks and patient interactions are handled efficiently.

► Continuous feedback and improvement based on patient experiences are key to maintaining high standards of care and operational efficiency.

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