This blog post is adapted from a section of our COVID Webinar last week which PCC then turned into content for our clients.  I've removed all the PCC specific advice (how to run these reports, what tools to use, etc.), so this advice goes out to everyone.  

As a result of CORONA-19, the volume of visits to pediatric practices has plummeted.  Patients are often afraid to visit their pediatricians. Independent pediatric practices can not assume patients and families will continue to visit. Ongoing patient care is at risk, and practices need to take steps to connect with families in order to stay open.

PCC recommends that all practices launch a patient recall initiative. Get in touch with your families and see your patients!

Why Should My Practice Increase Patient Recall Efforts Now?

Right now, your practice may be short staffed, visit volume is low, and it may feel like the correct thing to do is slow down and wait for the storm to pass. Why use this time to reach out to your patients and families?

PCC believes that the next few months are an essential time to perform recalls and get in touch with families. Here’s why:

• Preventative Care’s Normal Benefits Are Amplified Right Now: Every missed Bright Futures guideline is an evidence-based lost opportunity to address important developmental issues with children. Pediatric practices are on the front lines for issues around vision, hearing, height, weight, dental health, depression, ADHD, lead, and more. None of these has become less important during the pandemic, and patients are also skipping other visits (like dental, Physical Therapy, etc.) and are not seeing their teachers right now.

• Pediatricians Identify Abuse and Neglect: Pediatricians, teachers, and other mandated reporters who provide direct care are on the front line of identifying abuse and neglect. During the pandemic, there are fewer sets of eyes on kids.

• AAP Guidance Promotes Preventive Care: As of the date of this writing, the AAP strongly encourages pediatricians to continue with their preventive care services. “Pediatricians should identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in person appointments inclusive of newborns, infants, children, and adolescents.“

• Employment Uncertainty Means Health Insurance Uncertainty: As unemployment rises and the economy faces uncertainty, families will experience health insurance uncertainty. Get your patients seen now while families still have health insurance.

• This is a Slower Time for Many Families: Your practice can schedule patients more easily now while they aren’t trying to schedule around sports, school, and other activities.

• Your Performance-Based Measures Are Still In Play: Practices receiving performance-based payments nearly always depend on the services performed during preventive care visits. Performance-based payments will be vital this year.

• When Practices Reopen Fully, There Will Be Too Much Demand To See Everyone: Very few practices will have the scheduling availability required to handle the visits lost since March.  By definition, that means some children will go without their preventive care visits if they are missed now.

• Stay in Business So You Can Continue to Provide Care: Most pediatric practices are facing record low visit volume, which means record low revenue. Use patient recall to increase visit volume in order to stay in business, and you will be able to continue to care for your community when things return to normal.

Inform Patients of Your Practice’s New Safety Measures

Before you bring patients into your office, what are you doing to make your office safe? What additional measures and procedures will you put in place?

PCC recommends you share the details of your practice’s pandemic plan directly with your patients and where appropriate in social media. In addition to expanded use of PPE, many practices have switched to a “no waiting room” system, and send families a text message when an exam room is ready for them.

Inform your families that your office is open and has improved safety measures. In your communication, you can also reference recommendations from the AAP and your state’s health department supporting preventive care and chronic disease management visits.

Adjust Visit Workflow

As you plan for a patient recall initiative, your practice should decide which visits you are able to deliver at this time. Which visits can you perform using telemedicine and which will require an in-person visit?

Your decision may be impacted by payment and resources available to you. Your state’s payment rules and individual practice resources will dictate what is appropriate and possible.

After this evaluation, you’ll be able to direct patients to the proper visit method.

Clean Up Your Practice’s Patient List Before You Do a Large Recall

Before you contact large groups of your patients, your practice should do a quick review of your active patient lists.  For example, review a list of your active patients (those who have visited your practice in the past 3 years).

Flag any patients that you know should be marked as “inactive”, “transferred”, or “hospital only” (i.e., you saw them as a newborn but they never came to your practice). When you perform your patient recall, you can exclude patients with those flags.

Perform Recalls For Specific Patients and Needs

Which patients should you identify and recall for appointments, and when?

Consider the following groups of patients for your recall:

• • Overdue Well: Recall patients who are overdue (or are about to become overdue) for regular well visits. The screening and guidance directed by Bright Futures are vitally important.

  • Overdue Vaccines (Under 2): Recall patients who are overdue (or are about to become overdue) for any of the vaccines recommended by age 2. Preventing a measles outbreak is just as vital and important as ever.

  • Overdue Vaccines (Adolescent): Recall patients who are overdue (or are about to become overdue) for any of the adolescent vaccine series (HPV, Meningococcal, TdaP).

  • Overdue Vaccines (School/Daycare Required): Recall patients who are overdue (or are about to become overdue) for any of the vaccines needed for daycare or school. Families struggling to manage daycare coverage do not want to be held up by an overdue vaccine.

  • High BMI and Obesity Management: Recall patients who have a high BMI % or known obesity concerns. Follow up on nutrition plans and weight management, and provide additional resources these patients may need (for example, how to get healthy meals from school).*

  • Depression and Anxiety: Recall patients who have active depression or anxiety diagnoses (or active meds for these conditions) or other behavioral or developmental concerns.*

  • ADHD: Recall patients who are on ADHD medications who need a followup.*

  • Asthma: Recall patients with asthma diagnoses who need a medication followup or who need an adjustment to their Asthma Action Plans.*

  • Care Plans: Recall patients with active Care Plans that may need review or adjustment during the COVID crisis.*

  • Referrals: Follow up on open referrals and other incomplete orders. This work is a vital Care Management service.*

*Telemedicine-Friendly Visits: These encounters may work well as a telemedicine encounter or phone/portal message encounter. They may not require an in-person visit, and yet they are particularly valuable during a time of high stress and anxiety. If your practice provides integrated mental health services, you can work with your clinicians around a patient recall focus in that area.

How to Code and Bill For These Visits

Your practice may be changing aspects of the exam and other services. You may be providing telemedicine visits, scheduling followups to complete well exams, and more.

PCC is following news on payment for telemedicine and other services that have increased during the pandemic. We host a monthly web lab covering coding, billing, and practice management topics, and an ongoing webinar series on the Business Impact of COVID-19 on Pediatric Practices. Review these resources to track changes to the ongoing pediatric billing landscape.

You can also review specific COVID-19 billing scenarios by reading Code and Bill for a COVID-19 Related Encounter which includes a quick reference guide for billers, with tips on billing for remote services and more.

Create a Library of Resources and Links for Your Patients and Families

When you recall and see patients, what additional resources can you provide? PCC recommends you review your standard links, handouts, and materials and expand them to meet current topics.

Your practice’s library of resources will engage your patients before and after visits, make your in-person time more efficient and effective, and promote the value of pediatric work.