**CME available at the end of this blog**
“Apple recently announced a 28% profit margin. Google, 27%. Amazon, 10%. Meanwhile healthcare services profit margins across the entire industry in 2021 were just 4%.” – Forbes Article
Well this is incredibly disturbing.
Healthcare is already expensive enough, but a 4% margin is not only bad news for doctors, but also terrible news for patients. Traditional medical practice will undoubtedly be swallowed up by larger businesses. This is what the average US private practice doctor is going through right now. It doesn’t have to be that way, though.
Many technological firms have solutions to provide small and medium-sized doctor-owned or operated clinics with easy scalability. To do this, tech companies must provide financial alternatives that are not confined within the 1:1 doctor to patient delivery of healthcare. The 2mm shift can occur when technology companies embrace possibilities outside of the 1:1 fee-for-service model to significantly boost a medical practice’s bottom line.
In my previous blog article, I discussed how doctors may expand on their model of medicine by utilizing remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). The most important element in healthcare is patient behavior, as I will discuss in this post.
Traditional psychological services have utilized patient hehavioral assessment and intervention to assess mental health elements in patients. However, integrative and lifestyle medicine specialists like myself are using this opportunity to connect behavioral variables to other diseases, such as brain health, autoimmune disease, metabolic disease, and cancer.
While there are current procedure code phrases (CPT Codes) that describe neuropsychiatric and behavioral conditions, the majority are unable to be completed by physicians owing to time restrictions required to deliver these services.
Here is a great example of a company in the brain health space.
Case Study: Brain Check.
We’re very familiar with their platform at Texas Center for Lifestyle Medicine. They provide in-person and remote neurocognitive assessment to detect dementia and memory loss, which is a service we’ve have been utilizing since 2018.
They have an incredible billing guide that details CPT codes 96138, 96136, 96132, and 99483, which all can be conducted over telemedicine or even just telephone. If we break down these CPT codes, the descriptors take into account time. Both 96138 and 96136 designate services for the first 30 miniutes, CPT code 96132 designate services for the first hour. While 99483 CPT does have have a time designation, there amount of information needed to bill out this codes takes an incredibly long time in the traditional face-to-face visit.
What’s missing here is another CPT code set that describes behavioral assessment and intervetion family of CPT codes: 96156, 96158, 96159, 96164, 96165 , 96167, 96168, 96170, and 96171. These replaced an older set of CPT codes that were previously used in psychological health service settings. The code 96156 is for behavioral assessment (non-time based), but it reimbruses more than all the other codes related to behavioral health intervention.
In September of 2021, there was a change on the LCD language was changed which removed “services may only be performed by a clinical psychologist.” We conducted a trial submission period, which revealed that the majority of insurance plans would be reimbursed in full or in part. We were relieved to learn that we would be receiving this much payback because we are a primary care designation with no psychological services.
For physicians, the world of technology can be riddled with distraction. It’s not that physicians are unwilling to embrace technology, but it is difficult for them to make technological advancements work with the existing systems of care. Medical practices may use cloud-based technologies like Brain Check or others who already have a foundation in place to provide medical services that are adaptable and scalable.
Another case study: Brain View
This is a firm that develops in-office neurocognitive health technology. Brain View does not have a remote or virtual evaluation feature, unlike Brain Check.
The ability to conduct psychometric testing on this platform stems from the fact that it also gathers patient reported data. As a behavioral health assessment tool, therefore, it may be used because it is able to collect both patient reported and clinician-assessed data. CPT code 96156, on the other hand, can be utilized if the healthcare provider so wishes in order to evaluate the individual’s mental state.
Wow, how confusing…
Don’t worry if you’re unsure about any of this; it’s perplexing for everyone. CPT codes are subject to change, and at times they overlap. It is up to doctors and technology companies to develop methods for cost drivers that increase healthcare expenditure.
This is why I’m holding my live (both in-person and virtual) event: Brain View U Doctor’s Workshop, to show how to use brain-based technology to create a tremendous amount of value for your patients while enhancing the revenue cycle.
For early registration incentives, be sure to sign up by March 7, 2022.
This Journal / Blog Post Reflection is not approved for credit by CMEfy, however, you may reflect on how it applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ from point-of-care learning activities here: https://earnc.me/96lms4