Remote In-Home Visit for the Evaluation and Management of an Established Patient (G9489)

Name of the Procedure:

• Common Name: Remote In-Home Visit
• Medical Term: Remote Evaluation and Management of an Established Patient

Summary

This procedure involves a healthcare provider evaluating and managing a patient from their home using remote communication technologies. It is specifically designed for Medicare-approved innovation center demonstration projects.

Purpose

• Medical Conditions or Problems Addressed: Chronic conditions, routine follow-ups, medication management, post-operative care, and ongoing monitoring of established patients.
• Goals or Expected Outcomes: To enhance patient access to care, reduce hospital readmissions, manage chronic conditions effectively, and improve patient satisfaction by providing care in a familiar and comfortable environment.

Indications

• Specific Symptoms or Conditions: Chronic disease management (e.g., diabetes, hypertension), mobility issues that make travel difficult, follow-up care after hospitalization, minor acute complaints that do not require a physical exam.
• Patient Criteria: Must be an established patient with a prior in-person consultation, enrolled in a Medicare-approved innovation project, and have access to necessary communication technology.

Preparation

• Pre-Procedure Instructions: Ensure a reliable internet connection, have a list of current medications, recent vital signs if possible (e.g., blood pressure readings), and any recent lab results.
• Diagnostic Tests or Assessments: No specific pre-procedure tests, but recent health data should be available for review.

Procedure Description

1. The patient schedules an appointment through the healthcare provider’s system.
2. On the appointment day, the patient connects with the healthcare provider via a secure video or phone call.
3. The provider takes a comprehensive history, including current symptoms, recent health changes, and medication adherence.
4. A virtual physical examination may be conducted, where the patient or a caregiver may assist.
5. The provider develops a management plan, which may include ordering tests, adjusting medications, or scheduling follow-ups.
6. The provider documents the visit and updates the patient’s health records.

• Tools and Technology Used: Laptop, tablet, or smartphone with video capabilities; secure telemedicine software.
• Anesthesia or Sedation: Not applicable.

Duration

Typically, a remote in-home visit lasts between 15 to 30 minutes.

Setting

The procedure is performed remotely, with the patient located at their home and the provider situated in their office or another remote location.

Personnel

• Main Healthcare Provider: Physician, Nurse Practitioner (NP), or Physician Assistant (PA).
• Supporting Staff: Medical Assistants or IT Support for technical issues.

Risks and Complications

• Common Risks: Technical issues such as poor internet connectivity, security breaches, or miscommunication.
• Management: Ensure a secure connection, clear communication guidelines, and technical support available.

Benefits

• Expected Benefits: Increased access to care, improved management of chronic conditions, convenience, and comfort of receiving care at home.
• Realization Timeline: Benefits can be immediate in terms of patient convenience and effective management of ongoing conditions.

Recovery

• Post-Procedure Care: Follow provider’s instructions for medication, tests, or lifestyle changes.
• Recovery Time: No physical recovery needed; patient can resume normal activities immediately.
• Follow-Up: Schedule as advised by the healthcare provider, usually via another remote visit or in-person if required.

Alternatives

• Other Treatment Options: In-person office visits, visits to urgent care or emergency departments, home health visits.
• Pros and Cons of Alternatives: In-person visits provide physical examinations but may be inconvenient or inaccessible for some patients. Urgent care and emergency visits are for acute issues but may not offer continuity of care. Home health visits involve providers traveling to the patient’s home but are resource-intensive.

Patient Experience

• During the Procedure: The patient interacts with the healthcare provider via a secure video or phone call, discussing their health status and any concerns.
• Post-Procedure: The patient should feel reassured and have a clear understanding of their health management plan.
• Pain Management and Comfort Measures: The procedure is non-invasive and should be comfortable, with the patient advised to remain in a quiet, private space during the call.