Nurses Drive Revenue and Outcomes in Lifestyle Medicine via CMS & Value-Based Care

Presentation Summary: Lifestyle Medicine (LM) has emerged as an approach to addressing lifestyle-related chronic diseases. Nurses, as integral members of multidisciplinary healthcare teams, are positioned to implement LM principles. Our presentation will focus on using nurses to attain the trifecta of healthcare: improving patient care, decreasing provider workload burden, and generating sustainable practice revenue. This session will provide attendees with a greater understanding of how nurses can be used to improve their LM practice. We’ll provide information in the session plus provide handouts with billing codes and EHR note templates for both providers and nurses. Nurses bring clinical expertise, critical thinking, and a holistic approach to patient care. The current guidelines and scope of practice from the American Nurses Association already align with the pillars of LM, however many remain unaware of this, leading to underutilization of nurses in this role. Our goal is for nurses to practice to the fullest extent of their education and licensure, and to do so to improve outpatient LM practices and patient care. We'll review ANA's key documents and ethical frameworks that empower nurses to practice at the top of their licensure. Understanding the capabilities of nurses enhances team collaboration and fosters mutual respect. By delineating clear roles and responsibilities, attendees will gain insights to maximize nursing contributions within LM practices. The upcoming LM registered nurse certificate will help empower nurses with these skills and provide a framework for how practices can integrate these nursing initiatives into their daily workflow. Nurses can serve as contributors to the clinical and financial success of LM practices via both Centers for Medicare & Medicaid Services (CMS) programs and value-based care models. Nurse-led initiatives can promote and enhance objective and subjective metrics of success.

The utilization of CMS programs including chronic condition management (CCM) should be the key vehicle for nurse generated revenue. We will review eligibility criteria, billing structures, and documentation requirements. Implementation strategies utilizing RNs will provide practical guidance for integrating CCM into efficient workflows. A discussion on transitional care management (TCM) will highlight the role of nurses in supporting patients transitioning from inpatient to outpatient care. Examples of nurse-led activities will highlight the benefits of RNs' critical thinking. Using TCM in LM practices should reduce readmissions and enhance recovery, improve patient outcomes for high-risk patients, and promote practice profitability. GUIDE is an emerging CMS program related to dementia and cognitive care that is rich with opportunities for nurses and the entire LM team. Improving patient and caregiver outcomes while also incentivizing practices are the objectives of GUIDE. Nurse-led efforts and expertise within value-based care models include population health management and tracking quality metrics. Nurses are experts on risk stratification and proactive care management, supporting cost savings and promoting incentives. This presentation will showcase the nurse’s role in quality improvement initiatives that demonstrate a positive impact on both clinical and financial outcomes.

The impact of nurses on LM practices extends beyond financial metrics. Their leadership abilities and contributions to non-revenue-generating activities are important for success in any LM program. Areas include nurse-led health coaching, care coordination, and patient education. Through telehealth initiatives and community outreach, nurses can extend the reach of LM services, ensuring equitable care to the underserved, vulnerable, and aging populations. Nurse-led health coaching is an untapped resource in LM. Training nurses in motivational interviewing and behavior change techniques will help patients adopt and sustain LM principles. Nurses can simplify complex medical concepts for patients and design educational materials and workshops. Having nurses take ownership of patient education, goal setting, and providing ongoing accountability for patients to reach their goals would directly operationalize LM's six pillars in clinical care. Nurses serve as a central point of contact to streamline communication. They collaborate to develop individualized care plans, monitor high risk patients, and are an essential part of multidisciplinary teams. This can enhance continuity of care, improve adherence and patient satisfaction, and result in better patient outcomes.

Nurses are essential to the success of Lifestyle Medicine. By clarifying their scope of practice, harnessing CMS programs and value-based care, and embracing their multifaceted roles, nurses can drive clinical excellence and financial growth. This session will provide a roadmap for integrating nurses into LM practices, ensuring they are recognized and utilized as key revenue generators and transformative healthcare leaders.