The Angry Biller
Welcome to the angry biller.
A show where we explore the people and the businesses behind-the-scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care.
The Angry Biller
Ep 27 - Building Trust in Healthcare through Chronic Management with Brenda Nunez
Ever wonder how chronic care management can transform patient-doctor relationships? Join us as we chat with Brenda Nunez, the Chief Experience Officer at J3 Medical Billing. Brenda's journey from her family of doctors in Venezuela to her role in healthcare administration in the U.S. is nothing short of inspiring. She shares her passion for chronic care management, a Medicare program focused on keeping patients out of hospitals and enhancing communication with doctors. Brenda walks us through her daily routine, emphasizing the importance of empathy, building trust with patients, and how technology is reshaping these interactions.
As we navigate the intricacies of patient care, Brenda sheds light on the importance of clear and open communication, even when it's awkward. Through her personal anecdotes, we uncover the emotional challenges healthcare professionals face, particularly in hospice care and the broader healthcare landscape. Brenda's dedication and passion highlight the vital role of maintaining strong patient-doctor relationships. Tune in to explore how these connections can lead to more fulfilling healthcare experiences for both patients and providers, and discover how persistence and direct communication can triumph over the obstacles within the healthcare industry.
Brenda Nunez
J3 Revenue Cycle Management (J3CRM)
LinkedIn: https://www.linkedin.com/in/brenda-nunez-maal-788299b2/
THE ANGRY BILLER, powered by J3 Revenue Cycle Management
Phone: (954) 544-2706
Website: https://www.j3rcm.com/
LinkedIn: https://www.linkedin.com/company/the-angry-biller/
Production of Podcast: VISUALS BY MOMO
Josh Fertel
00:04
Welcome to the Angry Biller, a show where we explore the people in the businesses behind the scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care. Welcome to the Angry Biller. My name is Josh Fertel, I'm the owner of J3 Medical Billing and I am your host. We are here at the Visuals by Momo Studios. The whole concept of this podcast was to showcase the people that are behind the scenes of healthcare. Probably the greatest invention in that is chronic care management, which Medicare has used to help doctors give great treatment to their patients. We are fortunate at J3 that we have Brenda Nunez on our team. She is our chief experience officer and she heads up the chronic care management division for us. How are you doing, Brenda?
Brenda Nunez
00:59
I'm good. I'm good, I'm excited to be here.
Josh Fertel
01:02
I'm very happy to say that Brenda is probably the gold standard when it comes to chronic care management and as a tool it is invaluable to a practice. So before we get into that, brenda, tell us about you. How did you get started? Tell us your background.
Brenda Nunez
01:20
Well, it all starts with my family. They're all doctors, well, it all starts with my family. They're all doctors, okay. So since I was little, I was like in this you know world.
Josh Fertel
01:32
Right.
Brenda Nunez
01:32
With patients getting to know people. But then I came here. I'm from Venezuela, so when I moved here I didn't know much what to do. Started college, blah blah blah, and then, out of nowhere, I was applying to jobs. I was 19 at the time. Okay, started college, blah blah blah, and then, out of nowhere, I was applying to jobs. I was 19 at the time. Right, I'm 28 now, so almost a decade ago.
01:51
You don't have to tell people that but okay, yeah, but you know, almost a decade ago. I think it's important to you, know it's. It's been a long time.
Josh Fertel
01:59
Yes.
Brenda Nunez
01:59
So I started applying to jobs and then I got into a company, a DME company. I used to work with hospice patients and patients that had accidents and went to different hospitals throughout.
Josh Fertel
02:13
South Florida.
Brenda Nunez
02:14
So I started working there and I fell in love with helping people. It's not, you have to be, you have to have a certain type of strength to do this, but also you have to be very caring.
Josh Fertel
02:29
Absolutely. One thing that you absolutely have is empathy.
Brenda Nunez
02:31
Yeah, so it's not easy. It's not easy to hear everyday stories of people that are going through a rough patch in their life.
Josh Fertel
02:38
Yes.
Brenda Nunez
02:40
But it's making them feel better. It makes me happy to do that. So I started working there and I started to. I wanted to be a nurse, I don't know why. I wanted to be a nurse, but I hate blood. So I did everything and when I was about to start I was like I hate blood, I can't do this. I want to do more like the administration. Okay, part of it. Okay, I fell in love with talking to the patients, getting to know them, but not necessarily like being hands-on gotcha so I started, I changed my career to healthcare administration right, and I finished that.
03:23
Okay, so I was there. Then I changed to a company that used to do like physical therapy, occupational therapy, and I worked with elder yes, patients, as well as children, through uh throughout different states. Okay, here okay and then I met you and I fell in love with what I do and it's I love it. I love to get to know the patients. I love to have a relationship with them.
Josh Fertel
03:51
Yes.
Brenda Nunez
03:52
And also be there for them. Sometimes they just need someone to listen to them.
Josh Fertel
03:58
A hundred percent, yeah, so in layman's terms, if we were speaking to somebody outside of the healthcare business, describe what chronic care management is.
Brenda Nunez
04:12
It's basically a program that Medicare promotes. The main goal is for or in my opinion, there's two main goals for that One of them to keep the patient out of the hospital, out of our emergency room.
04:29
Second goal, it's for the doctor to know more detail, on a monthly or weekly or daily basis, what's going on with the patient. Sometimes the doctor just knows when the patient has an appointment, which can be three months, six months, yearly but with this program we're making sure that the doctor knows what's going on with the patient. The patient feels like they have the support and they know they have the support from the office Right, and we were able to keep them out of the hospital and also we make their life easier and the office or the staff, the doctor, lives easier, right, just because we're like the messenger.
Josh Fertel
05:08
We're communicating.
Brenda Nunez
05:09
So we make sure that everything works like a clock.
Josh Fertel
05:12
Right.
Brenda Nunez
05:13
For the patient.
Josh Fertel
05:14
So give us an example of what your day is like.
Brenda Nunez
05:18
Okay, so I do have my patients. Usually I have the patients that I wait a little bit to call them just because sometimes, if not a long time has passed, they don't have much to talk about. So I usually wait a couple of weeks. I call them and I ask them how they're doing, depending on, of course, I know them already.
Josh Fertel
05:43
Right.
Brenda Nunez
05:43
So I kind of know their diagnosis, their condition. I try to be as detailed as possible when I talk to them, okay, so I make my notes Right. And then when I call them, I just ask them. First of all, I ask them routine questions. If they have diabetes or blood pressure, I ask questions regarding their conditions.
Josh Fertel
06:03
Okay.
Brenda Nunez
06:04
And then I just ask if there's anything that has changed in the past weeks, anything that they want me to let the doctor know, any assistance that they need, anything that's concerning for them right now. Sometimes it's something as simple as I ate something spicy last week and now I have you know, I have these symptoms. I feel I have like a stomach ache that's not going away. Sometimes they just need to bend yes, so yeah, that's mostly what I do. I try to be as encouraging as possible for them to open up with me.
Josh Fertel
06:41
Right.
Brenda Nunez
06:42
And make sure that I always finish my call letting them know that if they need anything, I'm here for them, even if it's just rent, rent. Sometimes they need to do that.
Josh Fertel
06:53
They just need somebody to speak to.
Brenda Nunez
06:54
Yeah, of course. Imagine if you have I don't know arthritis.
Josh Fertel
06:58
Right and you're in pain all the time Right.
Brenda Nunez
07:07
And you have someone that you can talk to and just be like I'm in pain. I want to feel better and that someone listens to you and is happy. And even though I may not have a solution for them, I care about listening to them and sometimes it's better. You feel better after letting it all go.
Josh Fertel
07:23
Imagine, because you're dealing with older generation, that many of the patients that you deal with are alone.
Brenda Nunez
07:30
Yeah, and don't have anybody to speak to that way Exactly.
Josh Fertel
07:35
Are there specific questions that you ask as part of your routine?
Brenda Nunez
07:39
Depending on there's different factors Depending on the practice different doctors want the patients to be treated differently okay, for example for example, I do have doctors that don't want me to ask, uh to go into much detail about their personal lives or how their feelings, but they just want me to focus on their chronic condition. But I try to be as you know, I try.
Josh Fertel
08:09
You're going to be you.
Brenda Nunez
08:10
Yeah, I'm going to be me, but I have doctors that want me to go in detail and in depth with them.
Josh Fertel
08:17
Right.
Brenda Nunez
08:18
So, depending on the doctor, depending on the patient, depending on what we spoke to during the last call, Okay. So always, I'm always going to read the chart, read their condition again, of course, go to our latest call, read my notes. I'm going to check the portal that the doctor has to see if anything has changed. If they had a visit, I try to inform myself as much as I can before I make the call.
Josh Fertel
08:48
That's great.
Brenda Nunez
08:49
So that way you don't want someone from the doctor's office calling and you'd be like, oh, you know, this happened to me and I saw the doctor.
Josh Fertel
08:56
Right.
Brenda Nunez
08:56
And you're like oh no, I didn't know no no, for sure so yeah, I try to be as informed as I can and, depending if a patient has diabetes, I always ask if they're monitoring their blood sugar, if they're having any issues with their glucose monitor, how has it been their sugar lately? How many times a day are they monitoring their blood sugar?
Josh Fertel
09:19
Right. Are there conditions that you see more than others? You've talked about diabetes, but obesity or hypertension, things like that.
Brenda Nunez
09:31
For me, the most common ones are diabetes and hypertension.
Josh Fertel
09:36
Right.
Brenda Nunez
09:36
Yeah, obesity. We do have patients that have obesity, right, patients that have obesity, but obesity, as I can see, it's like the root of other issues that the patients have. Okay good that they have to be on top of that. But if a patient has obesity, I always try to make sure that they're eating healthy, that you know they're having, they're following the diet that the doctor's recommending, that they're drinking a lot of water or not a lot, but just the recommended amount because not every patient.
Josh Fertel
10:16
So you're talking about their diet a lot.
Brenda Nunez
10:18
Yes, okay, and exercise.
Josh Fertel
10:20
You talk about exercise.
Brenda Nunez
10:21
Exercise activities, what they do, how the day goes. But you can imagine a lot of these patients being elderly. They don't, they're not as active.
Josh Fertel
10:34
Right.
Brenda Nunez
10:35
A lot of them. I always ask them if they fail, you know sometimes when you get to a certain age, you lose balance. You start to not be as active as you can be, and when you are, you lose balance. You start to not be as active as you can be, and when you are, you may fall. So, I have to be on top of that.
10:50
I have to make sure that they haven't fallen since our last call or since our last contact, and if they do, I have to make sure that they contact the doctor. I have to see if they went to the ER or to at least an urgent care.
Josh Fertel
11:07
So when, let's say, that example happened, what's your next steps after you hang up the phone with them?
Brenda Nunez
11:13
I always tell the doctor.
Josh Fertel
11:14
Right.
Brenda Nunez
11:15
Of course, before I hang up the phone I have to let them know that I have to tell the doctor Some of them, they don't want me to tell the doctor yes.
11:24
They feel I don't know. They may feel a certain type of way, right. So that's why they don't want me to tell the doctor, but I always let them know that I have to. So first thing that I do after I hang up the phone, I have to tell the doctor. That's great, I know the doctor, and it's not because I want them. They may feel a little bit ashamed that that happened.
Josh Fertel
11:50
Embarrassed.
Brenda Nunez
11:51
But at the same time the doctor wants to know. The doctor cares for them.
Josh Fertel
11:56
Right.
Brenda Nunez
12:08
And that small detail of them of the doctor knowing what happened to the patient. And you know, we scheduling an appointment as soon as we can with the patient, the doctor evaluating him. They may feel ashamed at first, but afterwards they feel like they have the care that they deserve. It's not something that you need. You need it.
Josh Fertel
12:19
Right.
Brenda Nunez
12:20
But you also deserve that, especially if you are you know, 65 and over. If maybe you have your family in other states, right, if you're alone, you deserve someone to be there for you.
Josh Fertel
12:34
Awesome. We're going to take a break, but we are just scratching the surface of chronic care, so when we come back, I have some more questions for you. Thank you.
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Josh Fertel
Welcome back. We're with Brenda Nunez, who is the greatest chronic care management leader in the industry. I could say that without any hesitation. Has anybody ever called you, any of your patients ever called you in an emergency situation?
Brenda Nunez
13:32
Yes.
Josh Fertel
13:33
And what tell me what happens then?
Brenda Nunez
13:34
Depending, of course. I'm not a doctor, I'm not a nurse.
13:38
I'm not a nurse practitioner. I'm not a PA, so I can't give medical advice. I do have several patients that call me. They're stressed out. Something happened with their medicine. They don't know if they should take it at the same time or if they should stop it, but I can't give them advice on that. That. For them there's something important about chronic care. It may not be an emergency for me, but if it's an emergency for the patient especially that I don't know what time should I take my pill I forgot my latest blood pressure pill it's an emergency for me.
Josh Fertel
14:12
It is an emergency for me.
Brenda Nunez
14:14
It actually and it automatically becomes an emergency for me, but I cannot give medical advice.
Josh Fertel
14:21
So what do you do?
Brenda Nunez
14:22
I call the office, I contact the office, I let them know that I'll be handling it with the urgency that it requires. So I do that and if it's something that I fell or I don't know, I feel heart palpitations, I feel dizzy. I always encourage them to call 911. It's the smartest thing to do. I don't want them to you know if they're having palpitations.
14:46
I don't want them to suffer from I don't know a heart attack and be alone. So I always tell them that and I recommend them to call me as soon they call me from the hospital. They call me, they, they, they want me, they want to give me updates even if they're in the hospital.
Josh Fertel
15:03
That's great.
Brenda Nunez
15:05
Yeah, and I I care about them a lot let's change it up a little bit.
Josh Fertel
15:11
How does uh tell me how you use technology and what you do?
Brenda Nunez
15:15
well, I try to be. We use different programs. Okay, depending on the practice they want us to handle it, a certain, a different type of way okay but we do have monitoring for phone calls to make sure that they're being not necessarily recorded but, they are going through our database, so we know. So we are according to Medicare guidelines.
15:43
That's also important for us. We not only want to be helping the patients and helping the doctor, but we want to be as compliant and perfect. Even if nothing's perfect, we want to be as perfect as we can. It's also important. It's important that you take care of the patients while being compliant with the guidelines that Medicare requires. So we do that and we also have. We have different systems where we note everything. Okay, we do.
16:13
we use charts that give us scores to make sure you know if a patient, if a blood pressure from a patient, a report is different, it alerts us. So we kind of know everything.
Josh Fertel
16:24
Right From the patients, you have a great picture of what's going on. Yeah, I know, I know you didn't mention this. I know that Medicare expects 20 minutes of contact with a patient every month.
Brenda Nunez
16:35
Yes, in order for them to reimburse the doctor for the service 20 minutes is the minimum you can and the maximum should be 60. Right, of course, the way that we do things. For example, I do have one patient. He always wants to talk to me for at least an hour. Right, but for that we go through the hour, but we're not doing anything extra. We have a relationship already. So for us, it's more than a reimbursement from Medicare. It's the relationship that we have.
Josh Fertel
17:10
Oh sure. So that's a great question. How do you feel that chronic care helps the practice? As far as the you know, how do the patients feel about the practice when you're doing these things? And I think you answered the question just now but they feel a better connection, for sure.
Brenda Nunez
17:27
For sure, and especially if they have any questions and they don't have to go through the whole process of calling the office asking the question. They just have a contact. They can even send me a text message and I'm going to be there and I'm going to answer and I'm going to and I'm going to follow up on everything that they want me to do. They feel cared and also knowing that they have someone that can contact, that they can contact 24-7.
Josh Fertel
17:54
Right.
Brenda Nunez
17:56
And it's going to be there for them. They also. It's important for them to know that if the doctor needs to relay a message, it can be done as quickly as they need it. Yeah, it can be done as quickly as they need it. They don't have to wait until they go again to the office. So they feel seen, they feel cared.
Josh Fertel
18:18
They feel protected, they feel listened, and I think that's important Nowadays it's important, of course, give me a good success story, give me one instance where it just clicked and everything you did was right and you helped somebody out of a situation.
Brenda Nunez
18:35
Well, we do have several, but especially patients.
Josh Fertel
18:39
You gave me more than one.
Brenda Nunez
18:40
Good, I had a patient that she could, and this was recently. She couldn't get her refill medication.
Josh Fertel
18:48
Okay.
Brenda Nunez
18:49
I have two actually Good, I want to hear both. She couldn't get her refill medication.
Josh Fertel
18:50
Okay, I have two. Actually good, I want to hear both she didn't have her refill medication.
Brenda Nunez
18:54
She wasn't able to find it. There was nothing they can do, and and she needed she had like pharmacy. There was at the pharmacy okay and the pharmacy needed a new, a new prescription. There was an issue with the prescription that they received, uh, and she had like two pills oh, oh wow. So I was just, you know, calling sending messages being on top of them, and she got it.
Josh Fertel
19:15
Oh good.
Brenda Nunez
19:16
She got it on time, okay.
Josh Fertel
19:17
And.
Brenda Nunez
19:18
I also had another patient. This was. It wasn't easy, because sometimes being the messenger, you have to be super sharp, you have to be you know, multitasking a lot.
Josh Fertel
19:31
Yes.
Brenda Nunez
19:32
So he was. He spent a few months in New York and then they sent the farm, they sent the medication. It was a refill for anxiety and depression. Oh my yeah, and, and he has. He has the chronic condition and it's pretty severe. So they sent by mistake of course everyone makes mistakes they sent the refill to New York. He didn't have any more pills.
Josh Fertel
19:59
Right.
Brenda Nunez
19:59
And the daughter calls me he's 93.
Josh Fertel
20:02
Oh my.
Brenda Nunez
20:04
The daughter calls me. She's worried that something's going to happen to his father. He cannot sleep without this pill. Wow, he cannot function properly without this pill, Right right. And she was so scared because it's in New York and you know now it could be a whole mess, right, but we got it, we made it.
Josh Fertel
20:23
What did you?
Brenda Nunez
20:24
do. He received it. Just, you know, calling the office, sending messages, I send it directly to the manager. When I feel like something is that important, I just send it directly to the manager because I know that they're going to have a more direct approach or they have probably, like a, you know, strongest connection with the doctor or closer connection with the doctor, they're going to be able to make it happen fast, and that happened.
Josh Fertel
20:53
What? What kind of challenges do you face, Whether it's from the, the office, or whether it's from a patient, or just in general, what challenges do you face that you think you need to be improved upon?
Brenda Nunez
21:08
Well, I mean challenges for me. I think the biggest challenge for me is understanding that some of them may go you know, it could be like they're moving right out of state, which is, I mean, the the best part, but losing them like they're dying or they're going into hospice and me being in hospice like understanding how hospice works. I have a lot of patients that have you know that are in hospice. I can take care of them while they're in hospice and I know it's a good buy.
21:47
So, that's the biggest challenge for me. I I have a relationship with them, so sometimes calling them and being like, um, how are you? And it's not them. It's a family member that tells me that that happened. I have an actual a story. I went on maternity leave beginning of this year before I had a patient. She was great.
22:12
We had a great relationship. She was great before I left, when I when I went back, when I came back, I would call her, and call her, and call her. She wouldn't pick up Like after after two months it was her sister she had passed away while I was on maternity leave, so I never got to say goodbye. Oh, man so that's a challenge for me, that that that's my biggest challenge working here right um that it never.
Josh Fertel
22:38
It's never easy and that is why you're so great at what you're doing.
Brenda Nunez
22:41
Yeah, it's not, it's never easy, but you know you do it, and sometimes with the offices I wouldn't. I would say it's a challenge, but at the same time I understand they're so busy.
Josh Fertel
22:53
Yes.
Brenda Nunez
22:53
Doctors are busy, we're understaffed.
Josh Fertel
22:55
Right.
Brenda Nunez
22:57
This industry. It requires a lot of heart and you have to be, you have to love what you do Right. But, we're short-staffed Right In the country, it's not you know it's not a secret. Right, so they're busy. So the patient, the doctors that we have, they're busy, they're working nonstop.
Josh Fertel
23:16
They're taking care of patients, right.
Brenda Nunez
23:17
They're taking care of patients, so sometimes getting the work done for a patient that may be a refill, may maybe a question that they want from a doctor, maybe a bone density test that they need the doctor to review. Sometimes they do have a patient that has an emergency that they're you know at the office. So that's a challenge. But I don't think it's.
23:41
I think they're just they're doing the best that they can with what they have, I think they're just doing the best that they can with what they have, with the resources that we have.
Josh Fertel
23:48
Yeah, how would you educate a doctor as to the benefits of the program? What would you say to them if you were, let's just say, going on a sales call to a practice? What would you say to them are the biggest benefits to them for what's going on?
Brenda Nunez
24:09
For them. I think the biggest benefit is, of course, having a. The patients are going to feel like they have a closer relationship to them, so of course, when they go into the office.
24:22
They're going to feel happier. They're going to be more open. They're going to be more open to talk about their conditions or how they're feeling, but also they're going to feel happier. They're going to be more open. They're going to be more open to talk about their conditions or how they're feeling, but also they're going to know it's not like they're going to be seeing the patient every four, six months or a year and they're just going to have to kind of rewind on what happened.
24:44
No, they're already going to know and they're going to be informed. So that's for us, I think, that's the biggest goal For them to know what's going on with the patients. It's not only like I see you, I follow up and sometimes, as we were talking the shortage that we have in the industry, it's like a 15, 30-minute appointment.
Josh Fertel
25:08
Right.
Brenda Nunez
25:09
But with the call it can be a 15 or 30-minute appointment, but the doctor is going to know, the doctor already knows and even sometimes I always check if the patient has an upcoming appointment. Right, and I ask the patient if they want me to note anything in the chart that the doctor needs to read before.
25:27
Great great, so I do that. And some patients they want to ask the doctor something that they just thought about while we were talking, and then I just note it in the chart or I send it to the office manager, or I ask for the staff to change the reason of the visit so the doctor knows it's not like any of the patient forgets, because we do have a lot of patients that forget. We even forget.
25:56
Imagine you know sure um, so they don't have to be constantly thinking about it. They know, everyone knows everybody's, everybody's.
Josh Fertel
26:03
The communication is the most important. Yes, I have one more question for you, but I want to just talk about the business side of chronic care. So in 2024, Medicare will pay an office $62 for a 20 minute once a month consultation visit from the chronic care to the patient by phone. It's a win-win-win.
Brenda Nunez
26:29
Yeah.
Josh Fertel
26:29
Right. It's a win for the patient because they get in the care, they're feeling more connected to the practice and they know the practice has their best interests. It's a win for the practice they have a more engaged patient and they are getting reimbursed for the work that's being done and it's a win for Medicare.
Brenda Nunez
26:45
Yeah, because this absolutely keeps people out of the hospital. Which is a higher cost than that.
Josh Fertel
26:51
If we know somebody is watching their blood pressure, if we know somebody's exercising, watching their weight, eating healthy, doing all the things they're supposed to do, their chances of going to the hospital are diminished. Yeah, if you had a magic wand and you can do anything you want, that would make chronic care or your job better. What would you do with it?
Brenda Nunez
27:14
that's a hard question because there's a lot of things go ahead, I'll give you two magic ones. Good okay, um, I would have, I would implement, if I would you know if I were someone that works at Medicare. I would implement that if a patient needs to be driven or to be someone to go to the doctor with.
Josh Fertel
27:38
Transportation.
Brenda Nunez
27:39
Transportation or even translation services, or even someone to be there during the appointment.
Josh Fertel
27:46
Right.
Brenda Nunez
27:47
Because sometimes I have a lot of patients that they ask me if I can go to the appointment with them. Oh, wow, but I can't you know Right. So I would offer that if it were part of the chronic care management program, great answer. And also sometimes, if they need someone to like, encourage them in person.
Josh Fertel
28:10
Okay.
Brenda Nunez
28:13
It could be like a part of the program chronic care management program a weekly exercise activity Right. That goes. You know where all the patients that we have get together and they can also make relationships. They're alone.
Josh Fertel
28:27
Right.
Brenda Nunez
28:28
So I think part of it would be good for them to create a community Right and you know, I feel like it would make them happier and they're going to, you know everything's going to work better.
Josh Fertel
28:41
I have to tell you you were my first big hire when the company got started many years ago. Well, not that many years ago but years ago. And we are so fortunate that you are heading up this for us, that you are our chief experience officer, and thank you for coming on and explaining everything. And we hope that you will come back again.
Brenda Nunez
29:02
We're going to make sure you come back again. Yeah, I will, I'll be here.
Josh Fertel
29:04
All right, thanks, brenda.
Brenda Nunez
29:06
Bye-bye.
Josh Fertel
29:08
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