Several barriers may prevent your practice from sustaining the process of routinely using health assessments after trying it out: time, expense, lack of engagement from clinicians and practice staff, and low perception of value to patients. Below we address how to overcome some of these barriers.
Select a "high value" health assessment
The most important factor in deciding whether to continue health assessments is the perceived value to patients and clinicians. Some health assessment questions are considered high value by patients (such as those related to tobacco use and readiness to quit); others are considered high value by clinicians, health care payers, or regulatory bodies. The questions included in your assessment should align with your practice priorities and patient priorities and should reach enough patients on a regular basis so that using the health assessment becomes routine and delivers important information about your patients. Plan for tracking and reporting on health assessment data to be able to show who has or has not been assessed and to evaluate how it is going. While such tracking and reporting might not be required, it can help to demonstrate success as part of a planned, continuous quality improvement process.
Evaluate the financial incentives for health assessments
Clearly, financial incentives make a difference in the decision about whether to conduct and maintain health assessment. The Medicare Annual Wellness Visit is a comprehensive health assessment that, if done correctly, is a way to receive payment for the work you are doing. Other preventive health assessments and specific follow-up may also have reimbursement associated with them. For example, if you choose to ask all your patients about sexual behavior, you will inevitably find some risky behaviors, and then can use the diagnosis code for "high risk sexual behavior."
- Appendix 3: Coding and billing resources for adult preventive care.
- Appendix 5: Coding and billing resources for child preventive care.
- Appendix 6: Coding and billing resources for adolescent preventive care.
- Appendix 7: Coding and billing resources for seniors and the Annual Wellness Visit.
Consider the intangible incentives for conducting health assessment
By incorporating routine health assessments as part of your services to patients, your practice or institution may earn a reputation for its focus on health maintenance and prevention and, by doing so, you may bring more patients into your practice and increase patient satisfaction.
Ask your practice how the health assessment process is working
Once your health assessment is fully and routinely implemented, how do you know whether it is improving care for your patients and whether it is sustainable for the clinicians and staff? This could already be part of a planned quality improvement initiative or a less formal evaluation (see checklist below). Either way, remember to:
- Talk with clinicians to find out if they think the assessment helps to provide better care, how it affects the content of visits, and how it affects the flow of patients.
- Talk with practice staff to find out how much time the health assessment adds to their interactions with patients, whether they feel it has value, and how they perceive patients’ reactions to it.
- Ask a few patients from your practice to get their reactions.
- Share what you learned—and any successes—with your team. Show them data from the EHR or from chart reviews or patients about what has improved. Acknowledge team members’ roles and remind them how they contribute to improving the health of patients.
- Look at your clinical data to see where there have been improvements in your documentation and in patient health (e.g., better documentation of asking about health behaviors, fewer smokers, more patients reporting better quality of life.)
Here is a simple checklist that can help you and your practice think about what is working or not working:
Table 3: A Checklist for Reviewing Your Implementation Progress
|Questions for your practice or team||Yes||No||If, "No," how can you
improve this part of the
|In general, are patients completing the health assessments as expected?|
|In general, are patients responding positively to the assessment?|
|Are you reaching all or most of the patients you wanted to with the assessment?|
|Can most patients complete the assessment in a timely manner?|
|Do patients routinely complete all the questions on the
|Are staff members able to review the completed assessments as expected?|
|Are clinicians able to review the completed assessments as expected?|
|Are the clinicians in the practice providing acknowledgment and feedback to patients as expected?|
|Are assessments being entered into patient charts
|Are you able to respond to "positives" as expected?|
|Do you have data to show how the practice has improved screening/assessment rates?|
Appendix 9 provides more resources for implementing and assessing practice changes.