follow up home visit

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Telehealth for emergency departments

Telehealth for follow-up care.

Telehealth technology can be used to provide follow-up care for patients who were triaged but not sent to the emergency department, or for patients after they are discharged from the emergency department.

On this page:

Getting started.

Telehealth technology can be used for simple follow-up communication through audio, video, email, text messages, and even chatbots. You may also choose to use remote patient monitoring (RPM) devices. Some RPM devices record patient vitals automatically through a wearable device, while others require patients to report their readings through an online tool or by talking with their provider.

Including follow-up care services in your telehealth program is especially important because patients who don’t follow emergency department guidance are more likely to be readmitted, putting them at higher risk of health complications. This can result in increased utilization and cost burden on the emergency department.

Benefits of using telehealth for follow-up care:

• Provides an opportunity to further engage with the patient to perform more assessments, talk to family members, ensure they understand their follow-up instructions about medications, and encourage them to schedule any referral appointments
• Provides additional care to patients who need observation but aren’t so sick that they need constant care
• Detects potential problems and treats them before they warrant a return visit to the emergency room
• Provides emotional support, especially for patients in isolation
• Provides a training opportunity for resident physicians
• Reduces hospital costs associated with unnecessary readmissions and CMS penalties for readmission for certain conditions

Using telehealth for follow-up care is especially important during COVID-19 to help:

• Follow up with lower-acuity COVID-19 patients, allowing them to stay in the comfort of their home and not take up beds or other emergency department resources
• Encourage patients to stay up-to-date with routine vaccinations and COVID-19 vaccinations

In addition to the items on the getting started  page, consider:

• What follow-up services you will offer, including use of remote monitoring devices
• Who will coordinate your follow-up workflow
• When you will schedule the first follow-up appointment — ideally done before or during discharge
• How you will help patients understand the process for follow-up services
• How you will communicate with the patient for their follow-up appointment — if you’ll be calling, let them know when to expect the call so they’re more likely to answer (some may avoid the call if they think it’s the billing department)
• How often you will communicate with the patient

If exploring remote patient monitoring, also consider:

• Which devices will easily integrate with your electronic health records (EHR) platform
• How you will manage HIPAA compliance
• If you need features that help you track time for billing and reimbursement
• If you need features to help remind patients when they are due to report data
• How you will provide support to keep the devices operational
• How you will train staff

More information about follow-up care:

• Coronavirus (COVID-19) Update: FDA allows expanded use of devices to monitor patients’ vital signs remotely  — from the U.S. Food and Drug Administration

Medical University of South Carolina

The Medical University of South Carolina (MUSC) adapted their existing telehealth program to respond to COVID-19. MUSC redesigned their virtual urgent care to screen patients for COVID-19 with the goal of providing a needed service while reducing risk by limiting exposure at the emergency department. Remote patient monitoring is used to support COVID-19 patients that could be treated at home. Existing continuous virtual monitoring technology was also adapted in high contagion risk areas so clinicians could manage patients virtually when appropriate while conserving PPE. Read more about the MUSC telehealth program  and how they adapted telehealth to respond to COVID-19 .

• Getting started telehealth  →
• Planning your telehealth workflow  →
• Preparing patients for telehealth  →

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How to Establish an Effective Patient Follow-Up Protocol

It’s no coincidence that healthcare practices and clinicians often refer to the patient experience as a “journey.” It’s not just fancy marketing jargon but accurately describes the patient care delivery for most medical conditions as a “process” which requires ongoing treatment, management, and outreach.

For that reason, your patients’ care also includes a series of critical patient-provider interactions—or patient follow-ups—to ensure patients and caregivers adhere to provider instructions and care steps. Preventive care requires continual maintenance and vigilance as does managing long-term or chronic conditions so patients avoid gaps in care and poorer outcomes.

In this article, we’ll look at why patient follow-up is important, different options for follow-up, and how to create a follow-up strategy that stresses effectiveness, promotes efficiency, and minimizes manual staff workload.

What are the reasons for patient follow-up? Why is it important?

There are any number of critical reasons to reach out to patients following an appointment or in between appointments as a baseline:

• Monitor patients’ symptoms
• Reinforce care knowledge and action plans
• Provide relevant patient education
• Confirm medicine regimens
• Schedule follow-up visits
• Verify follow-through on referrals
• Share lab test results
• Get patients back in for ongoing preventive care and chronic disease management

In every scenario, follow-up is crucial to moving the care process forward, monitoring patients’ symptoms and level of improvement, and confirming that patients adhere to care instructions needed to attain better outcomes. Follow-up is a key component of “the continuum of care,” in which practices follow a patient from preventive care, through medical incidents, rehabilitation, and maintenance. The gist here is that coordinated, collaborative, and unbroken efforts to provide care lead to better health for patients and higher patient satisfaction.

Through your carefully coordinated follow-up interactions with patients, you’re able to achieve the following:

• Maintain positive outcomes
• Reduce hospital readmissions
• Foster stronger relationships with your patients
• Gain operational efficiencies

How do I structure a productive and workable follow-up plan? 

First things first, you’ve got to determine which specific types of patient encounters and conditions need patient follow-up and what form that follow-up should take. You’ll need to use different means of follow-up for various appointment types and diagnoses and set up reminders for the timing of your follow-up. While not an exhaustive list, these are some of the many variables you’ll need to consider:

• Who will follow up with patients?

Providers, nurses, admin staff, etc., may vary depending on whether the follow-up is clinical or administrative. If the follow-up is complex or sensitive in nature, you may opt to have a provider contact the patient.

• What method of follow-up will you use?

Text message, email, automated calling system, postal mail, or patient portal? For follow-up to be most effective at actually reaching the patient, you’ll want to match your follow-up method to individual patient communication preferences and language. You’ll also want to ensure that your follow-up method for each specific follow-up is HIPAA compliant.

• Determine the most appropriate schedule and time frame for follow-up.

It may be 24 to 48 hours after an appointment, three days, a week or whatever time frame you deem appropriate for the patient case you’re following up on.

• How will your follow-up be monitored and tracked?

Will you use an EHR, a PM, or a patient communications platform? Make sure you identify which staff members will be updating these tracking systems. With a patient communications tool, you can automatically follow up with patients by text, email, or voicemail.

How can I streamline and efficiently manage patient follow-up without placing a heavy burden on my front office staff?

You couldn’t possibly find enough time in the day to manually follow up with every patient and still run your office smoothly. That’s why the key to not overwhelming your admin staff with patient follow-up activities is to lean on technology like patient communications tools which lighten their workload.

These tools provide you with the automation, personalization, and customization to reliably and efficiently follow up with every patient while minimizing monotonous manual tasks such as making phone calls and composing emails from scratch. Instead of working harder, leverage software solutions to work smarter. Consider the following examples:

• Provide patients with a copy of the doctor’s care instructions after the visit: Because patients forget 40%–80% of the care instructions a doctor and/or care team gives them during the appointment, use a patient messaging tool to follow up with them. Automatically text or email patients a copy of the doctor’s care instructions after the appointment to increase adherence, re-emphasize the care plan, and help patients achieve better outcomes.
• Help patients remember to schedule appointments for follow-up care : Patients are often overwhelmed with information and instructions during office visits. Make it easy for them to book follow-up appointments by sending them a reminder via text/email/voice. If the reminder is sent as a text or email, you can also include a secure link for them to click to access your online scheduling tool . This saves them the hassle of having to call in and allows them to instantly select a day and time for their next visit.
• Share valuable patient education with patients on specific health topics : Better educated patients make better decisions about their health and help them more closely adhere to their care plans. For example, to help your diabetes patients better adhere to their diets, medications, glucose monitoring, and care plans, use a patient education newsletter tool to send them relevant articles about managing their Type I or Type II diabetes or potential side effects from new prescriptions. Narrow the email address list by selecting send criteria as only patients with a diabetes diagnosis.
• Leverage technology to extend your reach and overcome patient barriers to access care : For many types of follow-up, you may not necessarily need to physically have the patient in your exam room, dentist’s chair, or optometrist’s chair. For many types of routine follow-up or post-procedure check-ins, a live video call conducted via a telehealth tool may be exactly what the doctor ordered. If patients have to travel great distances to reach your office or if transportation or other access barriers to care exist, telehealth can be an attractive and beneficial alternative for patient follow-up. You can check up on a patient’s progress or symptoms while they can receive care from the comfort of their armchair.
• Minimize ineffective hours spent recalling patients by phone with a more productive approach: Recall more of your patients more efficiently by getting your staff off the phones with a recall notification tool . Automatically send overdue patients text reminders to schedule a visit for a dental hygiene visit, annual eye exam, or preventive screening. Even more efficient, use a batch messaging tool to recall patients by a variety of selection criteria such as age, sex, diagnosis, or date of last appointment.
• Give your patients the ability to ask questions, clarify a care instruction, or reschedule anytime, anywhere without calling : Patients get your texts and they want to be able to send texts to your office instead of calling in. Ensure patients needing to follow up with you can instantly reach you with a text via real-time, two-way texting to your main practice phone number. This ability frees up your staff from frequent call interruptions and allows them to easily reply to patient texts in between other tasks.

Key Takeaways

By carefully crafting a protocol for patient follow-up interactions, you’ll be able to more effectively reach out to patients after their appointment and more reliably and successfully guide them along the care journey. Applying best practices and patient communications tools will give you the speed and efficiency to follow up with large numbers of patients without creating an unmanageable burden for your front office staff.

More consistent and meaningful follow-up procedures and workflows will allow your practice to better support your patients in a continuum of care, avoid gaps in care, lead to better educated patients, and help them stick to their care plans and arrive at better patient outcomes.

To learn more about how to run a more efficient and productive front office in light of staff shortages, download the guide, “Seven Strategies to Solve Staffing Shortages.”

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Home Visiting Services During the COVID-19 Pandemic: Program Activity Analysis for Family Connects

Anna rybińska.

1 Center for Child and Family Policy, Duke University, Duke, Box 90539, Durham, NC 27708 USA

Debra L. Best

2 Department of Pediatrics, Duke University School of Medicine, UMC, Box 3675, Durham, NC 27710 USA

W. Benjamin Goodman

Winona weindling, kenneth a. dodge.

3 Sanford School of Public Policy, Duke University, Box 90245, Durham, NC 27708 USA

Early reports highlighted challenges in delivering home visiting programs virtually during the COVID-19 pandemic but the extent of the changes in program implementation and their implications remains unknown. We examine program activity and families’ perceptions of virtual home visiting during the first nine months of the pandemic using implementation data for Family Connects (FC), an evidence-based and MIECHV-eligible, postpartum nurse home visiting program.

Description

Aggregate program implementation data for five FC sites for January-November of 2019 and 2020 are compared. The COVID-19 Modification Survey is used to analyze families’ reactions to virtual program delivery.

Post-pandemic onset, FC’s program completion rates amounted to 86% of the pre-pandemic activity level. Activity in key components of the intervention—home-visitor education and referrals to community agencies—was maintained at 98% and 87% of the pre-pandemic level respectively. However, education and referrals rates declined among families of color and low-income families. Finally, families reported a positive response to the program, with declines in feelings of isolation and increases in positive attitudes toward in-person medical care-seeking due to FC visits.

Conclusions

During the first nine months of the COVID-19 pandemic, families’ interest in home visiting remained strong, performance metrics were maintained at high levels, and families responded positively to the virtual delivery of home visiting. Home visiting programs should continue implementation with virtual modifications during the remainder of the pandemic but attention is needed to address growing disparities in access to home visiting benefits among marginalized communities.

Significance

Home visiting programs temporarily transitioned to providing services virtually when the Covid-19 pandemic started. Reports about home-visiting program activity using virtual means post-pandemic onset remain scarce and families’ perceptions of virtual home-visiting services remain understudied. In this paper, we compare program activity for a universal postpartum home-visiting program (Family Connects) between pre-pandemic in-person services and post-pandemic onset virtual services. Families’ reactions to virtual home-visiting services are also described. Findings can be used to inform maternal, infant, and early childhood home visiting programs’ implementation during the continuing public health emergency to support program staff and participating families.

Introduction

Home visiting programs are an established public health service designed to promote maternal and infant health and family well-being. In the United States, $400 million in federal funds are allocated annually to evidence-based home visiting programs through the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) (Health Resources & Services Administration, 2020 ). In 2019 alone, 1,540,000 American parents and children participated in visiting programs supported by MIECHV (Health Resources & Services, Administration, 2020 ).

During the ongoing COVID-19 pandemic, most home visiting models transitioned from in-home visits to virtual visiting (Zero To Three, 2020 ) and faced a daunting challenge of delivering care and intervention without in-home presence. The shift generated questions about the feasibility of delivering federally-funded programs via virtual means and the appropriateness of using federal and local funds to support home visiting services which are delivered virtually rather than in-person. At the same time, families with small children have been severely affected by unemployment, lack of childcare, and isolation from extended family during the pandemic (Cluver et al., 2020 ). In these unprecedented times, virtual home visiting services constitute an essential connection for families, addressing immediate needs and connecting families to community agencies for further support (Williams et al., 2020 ).

How has home visiting fared during the pandemic? Early evidence about the impact of COVID-19 on home visiting comes from home visiting staffs’ self-reports collected in spring and summer of 2020 (Marshall et al., 2020 ; Self-Brown et al., 2020 ). These findings indicate that home visiting programs remained operational during the pandemic, but performance was affected by challenges in virtual program delivery (for instance, limited internet connectivity or lack of adequate devices to participate in telehealth) and COVID-19 related disruptions in providers’ and families’ daily routines (such as lack of adequate child care or need to home school) (Marshall et al., 2020 ; Self-Brown et al., 2020 ).

What remains unknown is the impact of virtual delivery and the pandemic on home visiting program performance metrics such as program uptake, follow-through rates, and adherence to evidence-based program components such as community referrals. In addition, little is known about families’ perception of receiving home visiting via virtual means during the pandemic. We address these questions by examining program activity during the pandemic for Family Connects (FC), a MIECHV-eligible, brief postnatal nurse home visiting program.

Additionally, research is needed to analyze home visiting program activity among marginalized populations in the United States post-pandemic onset. Populations with existing vulnerabilities and inequitable access to resources and health care constitute a large proportion of home visiting programs’ participants (Health Resources & Services Administration, 2016 ) and greatly benefit from home visiting services (Administration for Children and Families, 2020 ). Because marginalized communities are disproportionately affected by the pandemic (Kirby, 2020 ; Raifman & Raifman, 2020 ), home visiting programs are uniquely positioned to provide crucial support for vulnerable families in times of unprecedented hardship if equitable access to home visiting interventions and their key aspects is maintained. In this paper, we present FC program activity across racial and ethnic and social class lines with respect to evidence-based program components of nurse education provision and referral rates.

Family Connects Model and Its Modifications During Covid-19

FC is a universal nurse home visiting program first implemented in Durham, North Carolina in 2009 and currently serving families in 23 communities across the United States (Family Connects International, 2019a , 2019b ). Under the FC protocol, families residing in participating communities are invited to participate in the program shortly after birth. Enrolled families receive an integrated home visit (IHV) from a registered nurse about three weeks after the delivery. During the visit, family strengths and needs in four domains: health care, infant care, home safety, and parental well-being are assessed. When needs are identified, the nurse provides education and supportive guidance and—if need for long-term support is identified—connects the family with community resources. Nurses may also offer one to two follow-up home visits or phone calls for continued assessment and intervention, based on clinical judgment. Four weeks after the IHV, a FC team member follows up with a post-visit connection call to assess family satisfaction and confirm successful connections with community resources. Findings from two randomized controlled trials of FC have shown high participation rates, strong connections to community resources, high family satisfaction, and positive impact on reducing maternal mental health problems, infant emergency medical care costs, and Child Protective Services investigations (Alonso-Marsden et al., 2013 ; Dodge et al., 2013 , 2014 , 2019 ; Goodman et al., 2019 , 2021 ).

FC mandated all sites transition to provide services to families via virtual means on March 18, 2020. Within the modified virtual protocol, FC sites offer two approaches to substitute the traditional in-home visit: (1) a modified IHV or (2) a structured supportive call. During the modified IHV, the nurse follows the standard IHV procedure, but the physical assessment of the caregiver and the infant have been replaced by detailed questions about caregiver’s and infant’s health. The nurse also provides guidance across the domains indicated in the standard IHV. The supportive call is a shorter intervention which simulates the IHV protocol. The caregiver is asked about feeding, mood, healthcare access, concerns, and need for follow-up. Brief education is delivered with specific attention to postpartum warning signs. The call ends with a summary of family strengths, a review of recommendations, and a plan for follow-up. Post-pandemic onset, the follow-up protocol still includes one to two phone calls based on the nurse’s judgement and a final connection call at four weeks post-visit.

Data and Methods

Research protocols for this study were approved by the Duke University Health Systems IRB (Protocol #00105777) and Duke University Campus IRB (Protocol #2021-0197). The study received an IRB waiver of informed consent. Two data sources are used: the FC program activity data and the COVID-19 Modification Survey. We selected FC program activity data from March to November in 2019 and 2020 for five certified and mature sites (N = 7791 scheduled visits). Mature sites are defined as sites with over 18 months of activity before January 2020 and demonstrated program fidelity. Our selection of mature FC sites for the program performance analysis assures that no changes or expansion of the program in the respective areas took place in 2019 and 2020, and activity should be comparable between 2019 and 2020 net of any exogenous shocks. Consequently, changes in program activity in 2020 can be interpreted as resulting from the disruptions due to the pandemic and transition to virtual means.

First, several program performance metrics are analyzed: number of scheduled visits, visit completion rates, time to completed visit, frequency of guidance provision (that is, the percentage of visits during which the nurse addressed families’ needs through education and guidance), and community referral rates (that is, the percentage of visits during which the nurse offered a community referral to address needs in addition to providing education and guidance). Completion rates during the pandemic account for both the modified IHVs and the structured supportive calls.

Second, we report education/provision and community referral rates stratified by the caregiver’s race and ethnicity and by the family’s source of insurance. Race and ethnicity categories mirror the language used in the FC database: non-Hispanic white (thereafter white), non-Hispanic Black (thereafter Black), Hispanic, and non-Hispanic other. For source of insurance, we distinguish between families using private insurance and families using Medicaid or uninsured. Socio-demographic indicators are not available for families that did not complete the visit and we cannot comment on FC’s population reach across specific subpopulations.

To analyze changes in program implementation during the COVID-19 pandemic, performance metrics are compared for two periods: March 1st–Nov. 30th, 2019 (pre-pandemic) and March 1st–Nov. 30th 2020 (post-pandemic onset). The cut-off in March reflects the shift towards state mandated closures (White House Communications, 2020 ) and the beginning of the FC transition to virtual means in 2020. As a sensitivity analysis, we introduced a cut-off in mid-March and obtained numerically and substantively similar results. November was the last month for which the implementation data were available at the time of submission.

Last, to examine families’ perceptions of the FC virtual visits, we use the COVID-19 Modification Survey conducted between May and November 2020. The Modification Survey is a short, 6-item, questionnaire distributed via phone call or e-mail approximately four weeks after the completed visit. The survey was designed as anonymous and not linked to other information about the family or FC visit, in order to accelerate IRB protocol approval and facilitate survey distribution. Families are asked whether the amount of contact with FC was satisfactory and how FC affected their feelings of social isolation and concerns about in-person medical care seeking. Across the five selected sites, 330 families who received a FC visit completed the survey (response rate 54.8%). We present percentage distributions of answers for each relevant question item from the survey.

Changes in post-pandemic FC activity are presented in Fig.  1 and Table ​ Table1 1 below. Pre-pandemic, on average 438 visits were scheduled monthly in the five analyzed FC sites compared to 427 visits post-pandemic onset, indicating a 2.5% decline in scheduling activity. Completion rates averaged at 76.5% pre-pandemic and declined by 10.9% to 68.1% post-pandemic onset. In the first nine months post-pandemic onset, 78.9% of all virtual visits were completed as modified IHVs and 21.1% were completed as structured supportive calls.

Family Connects’ program activity. Pre-pandemic data for March-Nov. 2019. Post-pandemic data for March-Nov. 2020. Metrics calculated using infant’s date of birth to delineate analysis time period

Changes in Family Connects’ program activity post-pandemic onset

Family Connects’ program implementation data, five mature and certified Family Connects sites. Scheduling activity and completion rates calculated using a sample of 7,791 scheduled visits and using infant’s date of birth to delineate analysis time period. Education and referral activity metrics calculated using a sample of 5,112 completed visits (in-person IHVs and modified virtual IHVs) and using date of visit to define analysis time

The average age of the infant at the moment of the in-person visit pre-pandemic was 27.9 days. During the virtual delivery post-pandemic onset, the time to completed visit was shorter, with infants’ mean age at visit equaling to 23.2 days. Modified IHVs were completed sooner post-birth (mean infant age of 22.6) than structured supportive calls (mean infant age of 25.7 days).

Figure  2 represents frequency of education and guidance provision during the FC visit. Among families who completed traditional in-person IHVs before the pandemic, 96.4% of families received education and guidance during the in-person visit. In comparison 96.1% received these services during the modified virtual IHV post-pandemic onset. Further, across all four designated race/ethnicity subpopulations, the level of education provision was high pre-pandemic onset. On average, 98.3% of families with Black caregivers and 98.7% of families with Hispanic caregivers received guidance compared to 93.9% of families with white caregivers. After the pandemic onset, rates of education provision declined by 2.4% among Hispanic families but remained largely unchanged for all other groups (see also Table ​ Table1). 1 ). Respectively 98.1% of families using Medicaid or uninsured and 94.4% of families using private insurance received education provision pre-pandemic. The post-pandemic onset values for education provision remained very similar, at 97.5% for families with Medicaid or uninsured and 94.4% for families with private insurance.

Provision of education during FC visits. Pre-pandemic data for March-Nov. 2019. Post-pandemic data for March-Nov. 2020. Education provision calculated using a sample of 5112 completed visits (in-person IHVs and modified virtual IHVs) and using date of visit to define analysis time. Due to data limitation, no information about education and referral activity is available for post-pandemic structured supportive calls

FC staff offered community referrals to 49.9% of visited families pre-pandemic onset and to 43.7% of families post-pandemic onset, a decline of 12.3% (Fig.  3 and Table ​ Table1). 1 ). We observed variation in referral rates across families of different racial and ethnic background before the pandemic. About 61.6% of families with Black caregivers were offered a referral, compared to 70.0% of families with Hispanic caregivers and 36.0% of families with white caregivers. Among families of Black and Hispanic caregivers, referral rates declined post-pandemic onset, by 15.3% and 39.5% respectively. In contrast, more families of white caregivers received community referrals post-pandemic onset, an increase of 8.7%. Among families using Medicaid and uninsured families, 67.8% were offered a referral during the FC in-person visit pre-pandemic onset compared to 29.1% of families using private insurance. About 57.3% of Medicaid/uninsured families were offered a referral once the pandemic started, a decline of 15.5%. At the same time, the proportion offered a referral among families with private insurance increased by 3.5%, to 30.1%.

Community referral rates during FC visits. Pre-pandemic data for March-Nov. 2019. Post-pandemic data for March-Nov. 2020. Referral rates calculated using a sample of 5112 completed visits (in-person IHVs and modified virtual IHVs) and using date of visit to define analysis time. Due to data limitation, no information about education and referral activity is available for post-pandemic structured supportive calls

Based on data from the COVID-19 Modification Survey (Fig.  4 ), 89.0% of families reported that the frequency of conversations with FC nurses was just right post-pandemic onset. Further, 65.1% of surveyed families reported that their feelings of isolation during the pandemic decreased because of their contact with the FC nurse. In addition, 61.6% of families reported being worried about seeking in-person routine medical care for themselves or their newborn infant during the pandemic. Among these families, 61.7% reported that their concerns declined because of their conversations with the FC nurse.

Families’ self-reported reception of Family Connects’ visits during the COVID-19 pandemic from the COVID-19 Modification Survey (N=330). *Question asked only among respondents who reported mild to severe worries about seeking routine medical care during COVID-19 for themselves or their baby

Maternal, infant, and early childhood home visiting programs experienced a tremendous disruption in activities during the COVID-19 pandemic, a time when support for families with small children was extremely important. Data from Family Connects, a postpartum nurse home visiting intervention that transitioned to virtual delivery in March 2020, demonstrates that FC recruited comparable numbers of families into the program pre- versus post-pandemic onset. Completion rates declined slightly, by 10.9% post-pandemic onset compared to pre-pandemic, but remained high at 68.1% of scheduled visits. Further, key components of the intervention, the provision of education and community referrals with respect to four key domains of family well-being (health care, infant care, home safety, and parental well-being), were maintained at high levels during virtual delivery post-pandemic onset. FC staff provided education to 96.1% of the caregivers (compared to 96.4% pre-pandemic) and offered referrals for community agencies to 43.7% of caregivers (compared to 49.9% pre-pandemic). Finally, we report that families were satisfied with the level of communication with FC staff and reported decreased feelings of isolation and reduced concerns about seeking in-person services after the FC visit.

Taken together, these findings demonstrate the feasibility of transitioning a home visiting program to virtual means, meriting continued implementation and state support for home visiting interventions. We thus recommend that during the ongoing public health emergency, home visiting programs continue implementation with virtual modifications and that existing funding sources continue or grow. In addition, we suggest that the virtual home visiting protocol established during the COVID-19 pandemic can serve as a blueprint for virtual outreach in future emergency situations. During emergencies such as hurricane or wild fire evacuations, virtual services might provide necessary consultations and community connections for families. Similarly, virtual services can lead to expansion of the home visiting reach by offering virtual visits to families reluctant to welcome a nurse into their home or to families in remote areas. In summary, even though the COVID-19 imposed modifications to home visiting might be temporary, we expect the option of virtual delivery to remain within the portfolio of services offered by home visiting programs.

While we conclude that the transition to virtual means of home visiting delivery during COVID-19 was successful for FC, we recognize that in-person and in-home observations are evidence-based components of home visiting interventions, demonstrated to improve family well-being. The impact of virtual delivery (that is, whether this mode is associated with positive outcomes for families) is unknown. Consequently, a rigorous evaluation of the impact of virtual delivery on health outcomes, e.g., infant development, parental mental health or parent-infant relationship, is necessary. We also suggest future studies for FC about potential obstacles to virtual visit completion to remedy declining follow-through rates. Potential reasons for the small decline in program completion could include poor internet/cell data access, families’ lack of time to complete visits, or staffing shortages with home visiting nurses delegated to COVID-19 relief efforts.

Additionally, while we document declines in community referral rates, we cannot explain why these declines are observed. On one side, a decline in referrals might indicate that, during the pandemic, FC nurses recognize the difficulty families have in attending community services (because the services have closed or the family is reluctant to reach out) and so the nurses are taking on the task of addressing the need during the visit rather than connecting the family to a community agency. On the other hand, a decline in provision of education and referrals might indicate that some needs are not being reported adequately by the parents or assessed fully by the nurses, whilst before, needs would have been observed directly by the nurse visiting the home and performing physical examinations. Future research should address these unanswered questions.

As home visiting programs continue services virtually and consider future changes to the intervention protocols, careful consideration should be devoted to issues of equal access to the interventions and their benefits for all families within participating communities. Findings in this paper show that while the community connections of affluent families and white families increased during the pandemic, these linkages weakened for low-income families and families of color. These noteworthy differences in program activity might reflect lack of access to services necessary for virtual home visiting, such as broadband internet, but also disproportionate impact of the pandemic on these communities. Thus, a priority of future research ought to be a critical examination of the reasons behind lower community referrals among minority and low-income families and an investigation of potential community alignment solutions to improve connectedness among historically marginalized families.

Acknowledgements

We acknowledge the contributions of many staff members and community leaders in implementing Family Connects and its evaluation. The authors thank Phil Nousak for his assistance with data management and 4 anonymous reviewers for their helpful comments on previous versions of the manuscript.

Author Contributions

All Authors participated in study conception and design. Dr. Rybińska carried out the program activity analyses and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Best, Dodge, and Goodman participated in interpretation of data and reviewed and revised the manuscript. Ms. Weindling carried out analyses for the COVID19 Modification Survey and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work .

Funding for this research was provided by The Duke Endowment (TDE #20-01-SGO) and the R01HD069981 grant from the Eunice Kennedy Shiver National Institute for Child Health and Human Development.

Declarations

Drs. Best, Dodge, and Goodman acknowledge participation in Family Connects model dissemination. As the founder of Family Connects, Dr. Dodge provides periodic, in-kind consultation to sites implementing Family Connects. As director of research for Family Connects, Dr. Goodman supports local evaluation efforts at some dissemination sites. As medical director and national director of implementation for Family Connects, Dr. Best oversees site training and advises on local site clinical implementation work for dissemination sites. The other authors declare no conflict of interest.

Research protocols for this study were approved by the Duke University Health System’s IRB (Protocol #00105777) and the Duke University Campus IRB (Protocol #2021-0197).

Not applicable.

Data used in this research are deidentified participant data. Data are collected and managed by the Center for Child & Family Health, a community non-profit in Durham, NC, that serves as the national training and dissemination hub for Family Connects program. Data are not publicly available.

Code is not publicly available per study protocol guidelines.

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Contributor Information

Anna Rybińska, Email: [email protected] .

Debra L. Best, Email: [email protected] .

W. Benjamin Goodman, Email: [email protected] .

Winona Weindling, Email: [email protected] .

Kenneth A. Dodge, Email: ude.ekud@egdod .

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Effect of single follow-up home visit on readmission in a group of frail elderly patients - a Danish randomized clinical trial

Affiliations.

• 1 Department of Internal Medicine, Nykøbing Falster Hospital, Fjordvej 15, 4800, Nykøbing Falster, Denmark. [email protected].
• 2 National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark.
• 3 Department of Quality and Development, Sorø, Region Zealand, Denmark.
• 4 Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
• 5 Department of Internal Medicine, Nykøbing Falster Hospital, Fjordvej 15, 4800, Nykøbing Falster, Denmark.
• PMID: 31653219
• PMCID: PMC6815031
• DOI: 10.1186/s12913-019-4528-9

Background: Unplanned hospital admissions are costly and prevention of these has been a focus for research for decades. With this study we aimed to determine whether discharge planning including a single follow-up home visit reduces readmission rate. The intervention is not representing a new method but contributes to the evidence concerning intensity of the intervention in this patient group.

Methods: This study was a centrally randomized single-center controlled trial comparing intervention to usual care with investigator-blinded outcome assessment. Patients above the age of 65 were discharged from a single Danish hospital during 2013-2014 serving a rural and low socioeconomic area. For intervention patients study and department nurses reviewed discharge planning the day before discharge. On the day of discharge, study nurses accompanied the patient to their home, where they met with the municipal nurse. Together with the patient they reviewed cognitive skills, medicine, nutrition, mobility, functional status, and future appointments in the health care sector and intervened if appropriate. Readmission at any hospital in Denmark within 8, 30, and 180 days after discharge is reported. Secondary outcomes were time to first readmission, number of readmissions, length of stay, and readmission with Ambulatory Care Sensitive Conditions, visits to general practitioners, municipal services, and mortality.

Results: One thousand forty-nine patients aged > 65 years discharged from medical, geriatric, emergency, surgical or orthopedic departments met inclusion criteria characteristic of frailty, e.g. low functional status, need of more personal help and multiple medications. Among 945 eligible patients, 544 were randomized. Seven patients died before discharge. 56% in the intervention group and 54% in the control group were readmitted (p = 0.71) and 23% from the intervention group and 22% from the control group died within 180 days. There were no significant differences between intervention and control groups concerning other secondary outcomes.

Conclusions: There was no effect of a single follow-up home visit on readmission in a group of frail elderly patients discharged from hospital.

Trial registration: https://clinicaltrials.gov (identifier NCT02318680 ), retrospectively registered December 11, 2014.

Keywords: Clinical trial; Discharge planning; Elderly; Frailty; Readmission.

Publication types

• Randomized Controlled Trial
• Aged, 80 and over
• Follow-Up Studies
• Frail Elderly*
• House Calls*
• Outcome Assessment, Health Care*
• Patient Discharge
• Patient Readmission / statistics & numerical data*

Associated data

• ClinicalTrials.gov/NCT02318680

Home Visit Checklist for Social Workers

Schedule a home visit date and time.

Prepare essential tools and resources

• 4 Measuring tape
• 5 Specific case resources

Go over case file before the visit

Travel to client's home, introduce yourself and explain the purpose of the visit, inspect living conditions.

• 1 Cleanliness
• 2 Safety measures
• 3 Hygiene practices
• 4 Organization
• 5 Maintenance

Document observed conditions and any potential hazards

Interview clients to gather relevant information, approval: client interview.

• Interview clients to gather relevant information Will be submitted

Observe and assess client interactions with family members

Document all findings during home visit, leave contact information with the client, travel back from client's home, submit report of home visit, approval: home visit report.

• Submit report of home visit Will be submitted

Develop a plan of action based on findings

Schedule follow-up visit if needed, follow up interventions and referrals, update case file accordingly, archive home visit process, take control of your workflows today., more templates like this.

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When it comes to follow-up doctor visits, the variation is wide and evidence slim

Often we raise questions about the value of high tech, expensive specialty services, but we also frequently ask whether all the services we provide as primary care clinicians — screening tests, routine physicals, and other items from the Choosing Wisely campaign — improve care.

This recent JAMA article , which has gotten a lot of attention, raises questions about one of the most basic things we do as clinicians: patient visits. The article asks the question, What is the appropriate follow-up interval for patients?

The answer, of course, is that it depends on the situation. But what struck us about this article was how little is known about this topic. It is clear there are few evidence-based answers here. But we know from the Dartmouth Atlas of Health Care and other data sources that there is a wide variation in how frequently clinicians see their patients, and more frequent visits often do not correlate with better outcomes. In fact, visit frequency seems to be driven most strongly by payment structure, with fee-for-service systems resulting in shorter visit intervals.

Another important message from this article is that there is an opportunity for us to be more efficient as clinicians and to make accessing health care easier for patients by providing more telephone care, email, and patient portal communication. We recently learned that in the Kaiser system, approximately half of patient touches are by phone or portal.

If you have the time, take a look at this article, not because it provides any clear answers but rather because it will get you thinking about whether doctors can provide a bit more of patient care by phone or portal and email. We have found that patients are incredibly appreciative when you call them with test results rather than schedule a follow up visit, which has the added benefit of making our job as clinicians even more rewarding!

Top image by Oliver Symens  via Flickr .

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• Importance of Patient Follow Up

In this blog, Dr. Smart emphasizes the importance of patient follow-up, guiding beginners on how to monitor patients' progress, ensure treatment effectiveness, and provide ongoing support to achieve better healthcare outcomes with patient care management strategies .

What is Patient Follow-Up

Patient follow-up refers to the ongoing process of monitoring and providing continued care and support to patients after their initial medical evaluation or treatment. It involves scheduled appointments, communication, and assessments to track the patient's progress, address any new concerns, and ensure the effectiveness of the treatment plan.

Patient follow-up aims to promote continuity of care, enhance treatment outcomes, and maintain open lines of communication between patients and healthcare providers to address any changes or developments in the patient's health condition.

Patient Follow-Up Ideas for Hospitals:

• Schedule post-discharge follow-up appointments to monitor patients' recovery and address any concerns.
• Implement telemedicine services for remote patient follow-up, especially for non-urgent cases.
• Send automated reminders for upcoming appointments and medication refills to enhance patient compliance.
• Conduct patient satisfaction surveys after follow-up visits to gather feedback and improve care quality.
• Utilize electronic health records (EHRs) to track and share patient progress among healthcare providers.

Also Check: Best AI & Cloud-Based Hospital Software For Patient Followup

Patient Follow-Up Ideas for Pathology Lab:

• Notify patients of their test results promptly and provide clear explanations, either through secure online portals or phone calls.
• Offer personalized recommendations based on test results to guide patients on necessary lifestyle changes or follow-up actions.
• Collaborate with referring healthcare providers to ensure continuity of care and appropriate follow-up based on test findings.
• Implement a system to track and monitor patient follow-up appointments for further testing or consultations.
• Provide educational resources on understanding lab results and the importance of follow-up care.

Also Check: Best AI & Cloud-Based Pathology Lab Software For Patient Followup

Patient Follow-Up Ideas for Clinics:

• Establish a recall system for routine check-ups and preventive screenings based on patient demographics and medical history.
• Conduct regular phone or email check-ins with patients to assess their health status and address any questions or concerns.
• Develop patient education materials on managing chronic conditions and share them during follow-up visits.
• Implement patient portals for secure communication, allowing patients to access their health information and ask questions between appointments.
• Collaborate with community resources to offer support groups or wellness programs to enhance patient engagement and long-term health management.

Also Check: Best AI & Cloud-Based Clinic Software For Patient Followup

10 Main Importance Of Patient Follow-Up

Here are 10 Main Importance Of Patient Follow-Up.

• Continuity of Care : Patient follow-up ensures a seamless continuation of healthcare services, allowing providers to monitor progress and address any ongoing or new health concerns.
• Treatment Effectiveness : Regular follow-ups help assess the effectiveness of the treatment plan and make necessary adjustments for better outcomes.
• Patient Safety : Monitoring patients after medical interventions reduce the risk of complications and adverse events.
• Early Detection : Follow-up appointments enable the early detection of potential issues or relapses, facilitating prompt intervention.
• Medication Adherence : Regular follow-ups encourage patients to adhere to prescribed medications and treatment regimens.
• Patient Education : Follow-up visits provide opportunities to educate patients on self-care, lifestyle modifications, and disease management.
• Preventive Care : Patient follow-up allows for timely preventive care, such as health screenings and vaccinations.
• Emotional Support : Consistent follow-up shows patients that healthcare providers care about their well-being, enhancing emotional support and patient satisfaction.
• Patient Engagement : Regular follow-ups promote patient engagement in their healthcare decisions and treatment plans.
• Long-term Health Management : Patient follow-up is essential for managing chronic conditions and ensuring patients receive appropriate care and support over time.

3 Tips For Patient Follow-Up

Here are 3 main tips for Patient Follow-Up in Hospitals, Pathology Labs, and clinics.

Tips for Patient Follow-Up in Hospitals:

• Schedule follow-up appointments before discharge to ensure continuity of care.
• Utilize telemedicine for remote follow-ups, improving access for patients.
• Send post-visit surveys to gather feedback and identify areas for improvement.
• Establish a system for automated appointment reminders to reduce no-show rates.
• Collaborate with care teams to share patient progress and ensure coordinated follow-up care.

Tips for Patient Follow-Up in Pathology Labs:

• Provide timely and clear communication of test results to patients and their healthcare providers.
• Offer personalized recommendations based on test outcomes to guide patients in their next steps.
• Implement a recall system for patients needing additional testing or follow-up consultations.
• Use patient portals to facilitate secure access to lab results and communication with lab staff.
• Ensure compliance with privacy regulations to protect patient confidentiality.

Tips for Patient Follow-Up in Clinics:

• Establish a recall system for routine check-ups and preventive screenings based on patient needs.
• Conduct regular phone or email check-ins to monitor patient progress and address concerns.
• Offer patient education materials on managing chronic conditions and wellness practices.
• Implement patient portals for easy access to health information and secure communication.
• Collaborate with community resources to offer support groups and resources for patients' well-being.

10 Main Benefits of Patient Follow-Up in Healthcare

Here are 10 Main Benefits of Patient Follow-Up in Healthcare.

• Enhanced patient outcomes and treatment effectiveness.
• Improved patient satisfaction and trust in healthcare providers.
• Early detection and timely intervention for potential health issues.
• Increased medication adherence and treatment compliance.
• Continuity of care and seamless healthcare services.
• Better management of chronic conditions and long-term health.
• Reduction in hospital readmissions and healthcare costs.
• Improved patient engagement and empowerment in healthcare decisions.
• Opportunities for patient education and self-management support.
• Strengthened patient-provider communication and rapport.

Patient Care Management Strategies

A 14 steps comprehensive guide to Patient Care Management Strategies for healthcare and medical advisors from scratch to explore a full medical and patient growth potential like Dr. SMART for growing and expanding patient management operations in India with detailed information.

Summary Patient follow-up is a critical aspect of healthcare that involves monitoring patients' progress, ensuring treatment effectiveness, and providing ongoing support. It leads to improved patient outcomes, increased patient satisfaction, and better continuity of care.   If you want Patient engagement growth strategies or want to expand your medical practice, Drlogy will give you A to Z solutions to patient care practice growth strategies on 14 blog solutions of patient care management strategies . Please visit Drlogy series to get all your answers.

Patient Followup FAQ

Why is patient follow-up care essential for better healthcare outcomes.

• Patient follow-up care ensures continuity of treatment and ongoing monitoring of health conditions.
• It allows healthcare providers to assess treatment effectiveness and make timely adjustments.
• Follow-up care aids in early detection of complications, preventing potential health risks.
• Regular follow-up fosters patient engagement and adherence to treatment plans.

How does patient follow-up care impact patient satisfaction and well-being?

• Regular follow-up appointments show that healthcare providers value and prioritize patient health.
• Patients feel supported and cared for, leading to increased satisfaction with healthcare services.
• Continuity of care through follow-up visits improves patient confidence in their treatment plans.
• Better health outcomes and timely interventions contribute to an enhanced sense of well-being.

What are the long-term benefits of incorporating patient follow-up care?

• Reduced hospital readmissions and emergency visits, resulting in cost savings.
• Improved management of chronic conditions, promoting long-term health stability.
• Enhanced patient-provider communication, fostering a strong patient-provider relationship.
• Patient follow-up care leads to better health management, enabling patients to lead healthier lives.

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Homeschoolers visit Pioneer Museum

Published 5:23 pm Wednesday, April 24, 2024

By Jaine Treadwell

The Pioneer Museum of Alabama welcomed a group of home-school students from South Central Alabama including Elrod, Gordo and Aliceville. The students toured the museum and the structures on the grounds including the Little Red Schoolhouse, the Log Church and the Old Country Store. They were amused at the “outhouse” and fascinated by the Adams Country Store.

Art McKnatt, store keeper, enlightened the students by sharing with them the variety of items not available at today’s 7-11 markets. The shelves of Adams Store included sewing notions, snuff, hoop cheese, medicines in glass bottles, tin dishes, farm implements, a pickle barrel and a potbellied stove.

Just about anything you might need, McKnatt said.

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“Way back then, the saying bout an old country store was   “ I7f we don’t have it, you probably won’t need it.”

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A step-by-step approach that saves time coding E/M office visits can now be tailored to hospital and nursing home E/M visits as well.

KEITH W. MILLETTE, MD, FAAFP, RPh

Fam Pract Manag. 2023;30(1):8-12

Author disclosure: no relevant financial relationships.

Following the major revisions to coding evaluation and management (E/M) office visits in 2021, 1 a similar revamp has been made for coding E/M visits in other settings. Effective Jan. 1, 2023, the history and physical examination requirements have been eliminated for coding hospital and nursing home visits. 2 As with office visits, hospital and nursing home coding is now based solely on medical decision making (MDM) or total time (except for emergency department visits, which must be coded based on MDM, and hospital discharge visits, which must be coded based on time). This further streamlines E/M coding, creating one unified set of rules for office, nursing home, and hospital visits.

Hospital and nursing home E/M visits are divided into three groups: initial services (i.e., admissions), subsequent services, and discharge services. According to the American Medical Association (AMA), initial visits are “when the patient has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, during the inpatient, observation, or nursing facility admission and stay.” 2 After the patient has received care from that group once, all other visits are subsequent until the discharge service. When the patient transitions from inpatient to observation, or vice versa, that does not begin a new stay eligible for an initial services visit.

CPT codes 99234-99236 are for patients admitted to the hospital and discharged on the same date. For patients with multi-day stays, use 99221-99223 for initial services, 99231-99233 for subsequent visits, and 99238-99239 for discharge services.

Initial nursing home visits are coded with 99304-99306. CPT is deleting the code for nursing home annual exams (99318), which will instead be coded as subsequent nursing home visits (99307-99310).

Two sets of observation care codes (99217-99220 and 99224-99226) should no longer be used as of Jan. 1. Observation services have instead been merged into the corresponding initial service, subsequent service, and discharge codes.

These changes open the door to a simpler, quicker coding process. Many of the principles that already apply to E/M office visit coding now apply to hospital and nursing home E/M coding, but there are some differences in the details. This short guide can help physicians navigate the changes.

Coding for evaluation and management (E/M) visits in hospitals and nursing homes is now much like coding E/M office visits.

This unified set of coding rules allows physicians to quickly code nearly all visits using a template that starts with total time.

There are a few key differences to be aware of, such as total time spent past midnight on the date of service can be counted for hospital E/M visits, but not for office E/M visits.

MEDICAL DECISION MAKING

Determining the level of MDM for hospital and nursing home visits is now much like doing so for office visits. 3 The four MDM levels are straightforward, low, moderate, and high. They are determined by three factors: the number and complexity of problems addressed, the amount and complexity of data reviewed, and the patient's risk of complications, morbidity, or mortality.

If you feel confident coding office visits based on MDM, you can use that knowledge to code hospital and nursing home visits based on MDM as follows:

A level 1 initial or subsequent hospital visit requires the same MDM components as a level 3 office visit,

A level 2 initial or subsequent hospital visit requires the same MDM components as a level 4 office visit,

A level 3 initial or subsequent hospital visit requires the same MDM components as a level 5 office visit.

Several medical decisions that are more common in hospitals than office settings carry enough risk that, when paired with high-level problems, they call for the top visit level. These include the decision to escalate hospital care (e.g., transfer to the intensive care unit), the decision to deescalate care or discuss do-not-resuscitate orders due to poor prognosis, the decision to use IV narcotics or other drugs that require intensive monitoring, and decisions regarding emergency surgery for patients with or without risk factors or non-emergency surgery for patients with risk factors.

There are new time thresholds for each level of service for initial hospital visits, subsequent hospital visits, and nursing home visits to use when you are coding by total time. Instead of offering a time range like office visits (e.g., a 99214 office visit requires 30–39 minutes), nursing home and hospital care visits require that you meet or exceed specific times (e.g., a 99232 subsequent hospital visit requires 35 or more minutes).

When coding initial hospital visits by total time, you can count all the time you spend caring for the patient on admission even if some of it extends after midnight on the calendar day of the admission. According to the AMA, “a continuous service that spans the transition of two calendar dates is a single service and is reported on one calendar date. If the service is continuous before and through midnight, all the time may be applied to the reported date of service.” 3 This differs from office visits, for which you may count only the time on the date of the visit. Otherwise, the definition of total time for hospital and nursing home E/M visits is similar to that of office visits. It includes the time you personally spend on E/M for that patient before, during, and after the face-to-face services. It does not include staff time, time spent on separately reportable procedures, travel time, or teaching time.

A SIMPLER WAY TO CODE

Like the 2021 changes to office visit E/M coding, the 2023 changes should make coding hospital and nursing home E/M visits simpler and quicker.

The universal coding template suggests coding by time first if that will appropriately credit you for the work you did. It's the most straightforward and easy method. But if you believe MDM will credit you for a higher level of work, then step 2 is to determine what level of problems (low, moderate, or high) you addressed and whether you managed (prescribed, adjusted, or decided to keep the same) a prescription medication. Answering those two questions allows you to code most visits quickly using MDM. For the few visits that remain, you will need to proceed to steps 3 or 4, which may require you to tally data points and are therefore more time-consuming.

The template was adapted from a prior FPM article on office E/M coding 4 by adding nursing home and hospital visit times and relabeling office-visit level 3, 4, and 5 problems as low-, moderate-, and high-level problems.

UNIVERSAL CODING TEMPLATE

Step 3: MDM with simple data

Moderate-level problem PLUS one of the following:

• Interpret one study (e.g., “I personally looked at the x-ray, and it shows …”),
• Discuss patient management or a study with an external physician (one who is not in the same group practice as you or is in a different specialty or subspecialty),
• Modify workup or treatment because of social determinants of health.

EQUALS moderate-level visit, even without medication management (see codes in Step 2).

Step 4: MDM counting data points

Moderate-level problem PLUS at least three points from data counting (below),

EQUALS moderate-level visit (see codes in Step 2).

High-level problem PLUS at least two of these three:

• Interpret one study (e.g., "I personally looked at the x-ray, and it shows..."),
• Discuss patient management or a study with an external physician,
• At least three points from data counting (below),

EQUALS high-level visit (see codes in Step 2).

Data counting:

• Review/order unique test/study: 1 point for each,
• Review external notes: 1 point for each unique source,
• Assessment requiring use of an independent historian (family member or other person who can provide a reliable history for a patient who is unable to): 1 point max.

Documentation to support your coding should also be easier going forward. While documenting a medically appropriate history and physical exam is still certainly important for good patient care, it's no longer required for coding; therefore, you should be able to determine the code level from only a few lines of documentation. The quiz below provides some examples to pair with the coding template for practice.

Hopefully, using this step-by-step approach to the 2023 E/M coding changes will allow you to code many types of visits more quickly and accurately so you can spend more time with your patients and less time on the computer.

Millette KW. Countdown to the E/M coding changes. Fam Pract Manag . 2020;27(5):29-36.

CPT evaluation and management (E/M) code and guideline changes. American Medical Association. Accessed Nov. 2, 2022. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

Table 2 - CPT E/M office revisions level of medical decision making (MDM). American Medical Association. Accessed Nov. 2, 2022. https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf

Millette KW. A step-by-step time-saving approach to coding office visits. Fam Pract Manag . 2021;28(4):21-26.

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The Art of the Customer Visit: How to Plan One + Why You Should

When was the last time you visited a customer? Customer visits might seem extravagant and unnecessary on the surface.

Why not just get on a phone call or Zoom meeting? Or follow up with them via email? You could just send them a survey, or even dig into your product analytics to surface insights.

That said, if I’m talking to another entrepreneur and say something like, "It's super crucial you physically visit your customers", they all look at me as if I just said the most obvious thing in the universe.

Visiting customers is like working out or eating healthy: everybody knows they should do it, but very few people actually do.

And we’re not excluding ourselves here: We launched Close in January of 2013, but our first customer visit was more than a year later!

Some businesses put off visiting customers because it takes time, and it’s easy to push down on your long to-do list. Or, it may seem more urgent to focus on getting new customers to sign on, rather than visiting existing customers.

If this sounds like you, let’s discuss the benefits of visiting your customers, and how you can set up successful customer visits.

What Are the Benefits of Visiting Your Customers in Person?

It’s true: COVID has permanently altered the way B2B sales works. Studies by McKinsey show that companies have reduced their in-person efforts as a go-to-market strategy by more than 50 percent since the pandemic started.

That said, a decent number of B2B buyers still prefer in-person contact during the customer journey.

And this is exactly where the opportunity lies—fewer companies are vying for your customer’s attention in person. This opens the playing field for your company to perform more customer visits.

And trust me—it’s worth the effort. Here's a quick rundown of the value we got from our first customer visits.

Motivate Your Team to Serve Customers Better

Seeing real people use your product is incredibly inspiring. It energizes you. It recharges your batteries. It gives you a visceral sense of how your work actually impacts the life of your users, rather than just an intellectual understanding. It's like pouring gasoline on the fire that fuels your engine.

Everybody on your team—from the CEO to the intern—should visit a customer, for this reason alone.

It is different from hearing customers tell you how much they love your product or how great they think it is. You just have to experience customer satisfaction happening in real-time. You need to see real human beings depending on what you built. You need to witness how your product helps them to operate better, to be better at what they are doing.

The impact you make on other people's lives is a much stronger driver than any number on a spreadsheet can ever be. Do not underestimate how much this affects you. It's powerful.

Build Better Customer Relationships

Meeting someone in person adds another dimension to your relationship with your customer. You can do a lot of relationship-building via email, chat, phone, and Zoom, but nothing has the same effect as meeting someone in person. It creates a human bond between the two of you.

Jason Lemkin of SaaStr says he never lost a customer whom he had personally visited while he was CEO of EchoSign. Spending time with your customers transforms a transactional relationship into a partnership. It builds empathy on both sides, which ultimately leads to better business.

In-person customer visits are one of the best ways to build customer intimacy . It deepens the commitment on both sides. If one of the people we met needs help one day, we'll be more eager to support them. And I'm pretty sure they'll be more forgiving if there's ever an issue with Close and be more loyal to our product.

Get In-depth Product Feedback on the Customer Experience

Your customers are more than the sum of all their clicks on your product. Yes, you might be monitoring product usage and reading all the feedback people send you via email or even tell you on the phone, but you're missing a lot of crucial context if you can't see your customers using your product within their work environment.

• How exactly are they using your product?
• What's happening around them?
• What else is on their screen?
• What's competing for their attention?
• What's their workspace like?

When you visit your customers, you get to see the environment in which they use your software. You experience your product embedded into a user's workday and get a sense of the entire puzzle, rather than just a single piece of it.

And it's little things, like...

• What kind of headsets /chairs/desks are they using?
• What other software/apps are they using during their day?
• Which little hacks did they come up with to make them more productive and efficient?
• What makes them smile, and what makes them frown when interacting with your web or mobile app ?

It just gives you a better picture of what's working and what's not.

Here’s a real example: during one customer visit, we saw that the customer was using a TV to display our reporting in Close . But at the time, our reporting page wasn’t optimized for full-screen display—it looked crappy.

I remembered that one of our engineers had worked on a quick fix that would make this look better, but we had never released it. I sent a message to the team, and within an hour, this feature was released by our VP of Engineering, Phil Freo . It looked fantastic, and our customers loved it.

While visiting customers, you can gather more in-depth feedback about how they’re using your product and where they would like to see improvements in the customer experience. Product managers can then use this information to build out improvements.

Find Opportunities to Upsell

Years ago, during one customer visit, we found the customer was on a basic plan that didn’t include a specific feature. Instead, they were using a third-party provider to get this feature for their sales team.

Talking with the founder, we faced some resistance to upgrading their plan. But we gained an internal champion during that customer visit by chatting with the sales team manager. We gave him everything he needed to make the transition happen, and they soon upgraded their plan to start using this feature again.

Visiting customers in Germany in 2015

This is the power of in-person visits—not only did the extra revenue help us, but by upgrading their plan, the customer’s success with our product was significantly increased.

Create New Case Studies and Customer Stories

Using case studies and real-life examples of how your customers use your product is an excellent digital marketing strategy and one that will help build trust in your brand.

When planning customer visits, think about the customers you may want to interview for video testimonials or case studies on your website. Having these real customer stories also helps build better marketing alignment with your ideal customers and their needs.

All of these are examples of the kinds of benefits you can get from visiting your customers. You can't predict which benefits precisely you'll get—but you will always get value from a customer visit!

Get Your Copy of Talk to Your Customers →

How to Plan a Client Visit That Boosts Customer Loyalty in 7 Steps

By now, you should be sufficiently motivated to actually visit your customers. But what do you say and do? How do you get the most value out of these visits? How do you prepare for them? How do you wrap them up? How do you get started when you visit their office?

1. Identify Which Customers to Visit

Whether you have 10 customers or 10,000, it’s probably not feasible to visit everyone. So, which customers should you visit?

To start, make a list of the customers who already have a good rapport with you—your partners, advocates, and overall best customers.

Next, include customers who are using your product or purchasing from you on a regular basis. Learning about how they use your products and services, or why they keep coming back to you, will be great for your team.

Finally, make sure to include the customers who consistently give you critical feedback. These customers are already pushing your team to do better, and they will likely have super valuable insights to share with you when you visit in person.

2. Decide Who You’re Meeting With

Once you know which companies you’ll visit, decide which individuals inside the company you’ll need to meet with.

First of all, you set up a meeting with the founders or CEO. That's the person you'll be officially meeting. But it's not necessarily the person you'll spend most of the time with.

For SaaS companies, focus on the person managing the team that's using your product, as well as the end-users. If you’re a service-based business, talk to the people who are mainly affected by using your services.

The Close team visiting customers in Ottawa, Canada, 2014

3. Spend Time Getting to Know the Business Beforehand

Just like when prospecting, spend time doing research before the meeting—whether that’s on social media sites like LinkedIn, on the company’s website, or in B2B databases like Crunchbase.

When you walk into that client visit, you should know exactly who you’re talking to, what kind of business they are, which customers they serve, and how your product or service fits into that workflow.

4. Prepare and Share an Agenda

Having a clear agenda for your customer visit is essential to get the most out of the time you spend with your customers.

Start by setting out the agenda for your main meetings with the C-suite and with the managers of the teams that use your product. Set up talking points: such as updates to your product pricing, or upcoming feature launches in your product. Also, leave room in the agenda for their team to add any questions or comments. Leave a clear space for them to give you feedback.

Once your customer visit agenda is prepared, share it with their team. Let them have editing access so they can include their ideas. Make sure that expectations between you and your customer are aligned before you start asking them a lot of questions. Create a setting that encourages them to discuss and share their concerns openly.

Also, make sure to discuss confidentiality. If you plan to report back to your team after your customer visit, explicitly ask them if they're fine with you sharing their business processes, revenue numbers, etc, with your team. (If not, that's fine too—you can still share the learnings, without actual specifics, with your team.)

That way, both teams will be ready to get started when the day comes.

5. Learn About the Customer Experience in Real Time

So, the day of your customer visit has finally arrived! Start by talking in general, broad terms about their business and your business. Then, progress to more specific topics and product use cases.

Be both a student and a mentor. Learn as much as you can about your customers, and look for opportunities to help them. Learn about their workflows, and your product fits into those workflows.

Here are some questions you might ask during a client visit:

• How often do you use our product?
• Which team members use our product the most? How often do they use it?
• Are there secondary users that only use our product occasionally? If so, for what? How often?
• What are your business goals?
• How do you implement our product in your daily workflow?
• What bugs have you encountered?
• What features are you missing within our product?
• What do you like most about our product?
• What do you hate about our product? Which limitations do you find particularly frustrating?
• Which metrics does your team track within our product? (Or which KPIs does our product impact for your team?)
• If our product ceased to exist tomorrow, what alternatives would you consider to replace us?
• Are there any trends or changes in the industry that could affect the way you use our product in the future?

These questions and others like them will give you a clearer picture of how your customers use your product, and how it impacts their business.

The Close team doing a customer visit

6. Ask for and Give Referrals

Visiting customers is a great opportunity to get referrals . And to refer them to others as well. Don't just limit referrals to potential customers—any reason to put them in touch with other people is fair game, as long as you can see potential value for both parties.

Sometimes we see companies serving the same audience with complementary services—that's potential for a co-marketing initiative. If you introduce two happy customers to each other, and they collaborate together, and both get a ton of value out of it, you generate a lot of goodwill, and oftentimes very vocal brand advocates.

If you have a partner program set up, try to see if the customer you’re visiting would be a good candidate for that program, and help them understand how it works and the benefits they could get.

7. Create a Customer Visit Report for Your Team

If you do conduct a customer visit, make sure to document your learnings and take note of memorable moments. Then, you can share these insights with your team.

It's important that all the insights you gain during a customer visit actually become organizational knowledge—otherwise, your customer visits are basically useless.

So, set up a structured customer visit report that your team can peruse and learn from, both now and in the future. Inside this document, note specific items that will be of interest to the different teams in your company—for example, product feedback that your product managers may want to look at, customer journey insights that the marketing team should keep in mind, or product knowledge gaps that the customer success team may need to address.

To make sure everyone in the company benefits from customer visits, we try to share some pictures or highlights from our customer visits in Slack, and then during our weekly team meeting, a team member might give a quick 2-minute summary of their customer visit.

How Often Should You Plan Customer Visits?

There's no one-size-fits-all formula. It depends on your startup, but in general: you should meet them more often than you're meeting them now.

Jason Lemkin recommends every co-founder, CEO, and Customer Success Manager should meet on-site with five customers a month.

Being able to see the environment in which your customers use your product, the atmosphere at their workplace, and talking with the people who use your product daily is always an insightful experience.

Customer visits have been a crucial market research method for traditional businesses for many decades—but they're even more crucial for startups and SMBs . Your most powerful asset when you're in a market with established, large companies is your ability to understand your customers better and focus on their needs better than a large corporation can.

Michael Seibel, Managing Director at Y Combinator, said : "If you look around the startup ecosystem, you can find too many founders who believe that famous investors + lots of employees = winning. I bet most of our VC-backed competitors feel this way, and you can use this to defeat them (they aren't talking to customers nearly enough).”

Want more insights on talking to your customers? Get my book and learn more about building customer intimacy.

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