Laura Ross, PA-C: HeartBeet Clinic Offers Efficient, Reimbursable Avenue for Improving CV Risk Factors

Laura Ross, PA-C
Credit: LinkedIn

New data from the American College of Cardiology 2024 (ACC.24) Annual Scientific Session provide insight into the creation and reimbursement process for group visits to improve cardiovascular risk factors and lifestyle education.

Dubbed the HeartBeet Clinic, the program leverages a food as medicine approach to lifestyle education and data from the study, which were presented by Laura Ross, PA-C, clinical lipid specialist and president of the Academy of Physician Associates in Cardiology, indicate use of group visits resulted in a 675% increase in reimbursement relative to 1-on-1 visits, with participants also seeing notable improvements in lifestyle risk factors from pre- to post-study.

As part of the 8-week lifestyle medicine program, the HeartBeet Clinic offered participants the option to take part in group or individual visits with an advanced practice clinician. As part of the study, investigators obtained information related to vitals, labs food intake, and lifestyle habits at the beginning and end of the program.

The program consisted of 1-hour visits where participants were engaged on a multitude of topics and subject areas, including how plant forward eating can help improve cardiovascular risk factors, including cholesterol, glucose, and blood pressure. Investigators pointed out each visit included time to review resources and answer questions. Per study protocol, investigators documented total time with the group and individual time spent reviewing participants’ vitals, risk factors, family history of cardiovascular disease, labs, and calculating the ACC/AHA 10-year cardiovascular risk.

Of note, coding time also included also included developing and sending the plan to each participant through the electronic health record. Additionally, the organization’s compliance team approved codes based on individual time spent on preventive medicine counseling 99401 (15 minutes) or 99402 (30 minutes) within the 60-minute group visits.

Among the 46 participants in the HeartBeet Clinic program, 27 opted to participate in a group visit. In the ACC.24 presentation, Ross offered an overview of 2 in-person group visits with 17 participants and 2 virtual group visits with 10 participants. Upon analysis, investigators found group and individual lists were reimbursed at similar rates but offering group visits saved 23 hours of clinical time as well as increased revenue by 675% compared to offering 4 individual visits during the same time frame.

For more on this program, check out our Q&A with lead investigator Laura Ross, PA-C, president of the Academy of PAs in Cardiology, from the conference floor at ACC.24.

HCPLive: What were the specific educational components in this and how are these tailored to address cardiovascular risk factors?

Ross: So, lifestyle medicine is the cornerstone of all preventive guidelines, right? But this is easier said than done. So, we developed this 8-week program for our employees looking at the pillars of lifestyle medicine, including plant-forward eating, exercise, stress management, social connection, substance misuse, exercise, and getting good sleep. That is hard to cover in 1 visit. So, every week, we have a subject matter expert, meet with 30 to 50 participants and talk about that, meeting in small groups, but before the program starts, everyone would get their blood pressure labs, weight checked, and then see me. At the end of the program, they repeat that as well as some validated questionnaires about sleep, food intake, mood, and those sorts of things. So, we can compare before and after. I love it, there's nothing more gratifying than really seeing patients improve those risk factors. In fact, I've presented at ACC before with poster presentations about our positive findings, but this takes a lot of time and we enrolled more patients than ever last year.

So, I worked with our coding and compliance team to do group visits, and that's really what my moderated poster is on. We were able to have a 675% increase in reimbursement and 4 hours of group visits, compared to 4, 1-on-1 visits, which also saved 23 hours of clinician time. That would have taken me almost 2 weeks to see that many patients and, in 4 hours, I got it done and patients could pick if we wanted to do 1-on-1 or if we wanted to meet in group visits. We also found that the satisfaction was high over 5 out of 6 stars and our patients were able to respond to that. Lastly, as a clinician, I was able to really engage with patients, instead of repeating myself every day about the same thing, I got to talk about what is HDL, what is LDL, why is blood pressure control important, and then how can we use food as medicine. I was able to bring in coconut aminos and nutritional yeast and show them the package to really give them some real-world advice and how to go forward with food as medicine.

HCPLive: What were the primary findings from the study presented at ACC.24?

Ross: So, we compiled everyone's results, and we found a significant improvement in the Life's Essential 8 score, particularly driven by diet quality. Dr. Stephanie Hooker will be presenting these findings at a conference soon. Additionally, we observed a significant increase in physical activity, and overall, the Life's Essential 8 score improved. While the sample size was relatively small to detect differences between the group visit and 1-on-1 sessions, what I noticed is that patients were able to engage with each other during the group visit. Someone would ask a question that perhaps someone else was also thinking about, and we all learned from that format. Giving patients the option to choose between 1-on-1 or group sessions highlights our personalized approach to medicine.

HCPLive: Were there differences or challenges in navigating reimbursement for the group visits versus the individual ones and what would you want clinicians to be aware of as they might approach something similar to this?

Ross: So, there are a couple of ways we can code for group visits. One option is shared medical visits, which initially seemed overwhelming to me—you'd have to gather everyone in the same room and go through each patient's details one by one, discussing their blood pressure readings and individual plans. However, after working with our coding and compliance team, we realized I could bill based solely on time and education. Through our study, we checked everyone's weight and vitals, and we were reimbursed approximately $230 for each participant, whether they attended an individual or group visit—both in-person or virtual. This reimbursement was calculated based on the time spent with each participant during a 60-minute visit. The specific code I used was 99402, which I incorporated into my note using a dot phrase. My individual time was coded based on calculations of their 10-year cardiovascular risk, assessing family history, coordinating lab entries and interpretations, and determining the need for a coronary calcium score. For a few high-risk patients, I conducted a group visit, followed by repeat labs two months later. If necessary, I requested these patients to come in for a one-on-one visit. It was truly remarkable to see the high reimbursement rate and the consistency of reimbursement whether coding individually or in a group setting.

HCPLive: Is there anything else you would want to add about the program or the study for our audience members?

Ross: If I could add one more thing, it would be: Just do it. It might sound too overwhelming, but it's such a significant part of people's improvements. It's not just about cholesterol and blood pressure; we've seen improvements in sleep quality, mood, and social engagement. There are so many more benefits that we just don't have a pill for. So, if you can set up a program like we did, especially using an integrated health program with health coaches and dietitians, it's a game-changer. There's no cost for the patients, no cost for my department, and that sets the stage for guidelines that we can now roll out to any patient who wants to participate.

References:

Ross LJ, Hooker S. GROUP VISITS IMPROVE ACCESS TO LIFESTYLE MEDICINE EDUCATION AND CAN BE REIMBURSED. Presented at: American College of Cardiology (ACC.24) Annual Scientific Session. April 6 – 8, 2024. Atlanta, GA.