Name of the Procedure:

Disease Management Program; Per Diem (HCPCS Code: S0317)

Summary

The Disease Management Program is a comprehensive plan to help patients manage chronic diseases such as diabetes, hypertension, and heart disease on a day-to-day basis. This program involves daily support, monitoring, and education to improve patient outcomes and quality of life.

Purpose

The program is designed to address chronic medical conditions by:

• Reducing the frequency and severity of disease exacerbations.
• Improving the patient's overall quality of life.
• Enhancing patient self-management skills and adherence to treatment plans.
• Reducing hospital admissions and emergency room visits.

Indications

• Chronic conditions such as diabetes, heart disease, asthma, and hypertension.
• Frequent hospitalizations or emergency room visits due to disease exacerbations.
• Patients requiring continuous education and support to manage their condition.

Preparation

• Initial assessment by a healthcare provider to determine eligibility.
• Pre-program education about the importance of adherence and what to expect.
• Possibly adjusting medications with guidance from the healthcare team.
• Baseline diagnostic tests may include blood tests, blood pressure measurements, and other relevant assessments.

Procedure Description

1. Initial Assessment: Healthcare professionals evaluate the patient's medical history, current condition, and treatment plan.
2. Personalized Plan: Development of a customized disease management plan tailored to the patient's needs.
3. Daily Monitoring: Regular follow-ups through phone calls, video conferences, or in-person visits to monitor the patient's condition.
4. Education: Teaching the patient about their disease, medication management, lifestyle changes, and coping strategies.
5. Support: Emotional and psychological support, nutritional guidance, and coordination with other healthcare providers.
6. Adjustments: Modifications to the management plan based on the patient's progress and any new symptoms.

Tools and technology often include telehealth platforms, mobile apps for tracking health data, and electronic health records for coordinated care.

Duration

Ongoing daily support, typically reviewed on a weekly or monthly basis to assess progress.

Setting

• Outpatient clinics
• Patient's home through telehealth services
• Community health centers

Personnel

• Primary care physicians
• Nurses or nurse practitioners
• Dietitians
• Behavioral health specialists
• Pharmacists
• Disease management coordinators

Risks and Complications

• Potential for miscommunication in self-reported data.
• Risk of non-compliance to the disease management plan.
• Rarely, mismanagement of medications if the patient does not maintain regular communication.

Benefits

• Improved control over chronic disease symptoms.
• Lower risk of hospital admissions and ER visits.
• Enhanced patient confidence and self-management ability.
• Improved quality of life and functional status.

Recovery

• Continuous and gradual improvement; no specific "recovery" phase as it is an ongoing program.
• Regular follow-up appointments to monitor progress.
• Potential modification of the management plan based on patient response and condition stability.

Alternatives

• Standard physician-led care without daily monitoring.
• Inpatient care or temporary rehabilitation programs for acute exacerbations.
• Pros: Standard care can be less demanding and easier to adhere to for some patients. Inpatient care can provide more intensive observation.
• Cons: Lack of daily support can lead to poorer disease control. Inpatient care is more costly and less convenient.

Patient Experience

• Patients may feel more supported and less alone in managing their condition.
• Some patients might initially find frequent monitoring intrusive but will likely appreciate the benefits over time.
• Pain and comfort issues are minimal but depend on the specific health interventions involved in the daily management plan.