September 22, 2015 / 4:45 PM / 4 years ago

How Medicare’s 'chronic care management' payments could affect primary care

(Reuters Health) - Medicare’s new “chronic care management” (CCM) payment program could make it more financially feasible for physicians to deliver services between visits.

Under the new program, Medicare could reimburse primary care practices about $40 month for such things as medication management and communication with other doctors for patients who have two or more chronic medical conditions. Patients would have to agree to be enrolled and would have a 20 percent copay.

“Patients who have multiple complex medical problems like heart failure diabetes, chronic debilitating arthritis, Parkinson’s, and dementia frequently visit multiple providers in different organizations. They and their families frequently face multiple, sometimes conflicting decisions. CCM has the potential to organize the coordination under one provider, help make the patient’s care reflect their values and choices, streamline the process, and by paying physicians, make it more effective and efficient,” Dr. Fitzhugh C. Pannill from the University of Connecticut School of Medicine in Farmington, who wrote an editorial related to this report, told Reuters Health by email,

“Most importantly, CCM requires that each patient’s personal goals for their health care and medical decisions be routinely and systematically solicited, recorded, and communicated as part of the ‘Patient-Centered Care Plan,’” Pannill said.

Dr. Sanjay Basu from Stanford University School of Medicine, Stanford, California and his team looked at how the program would affect the typical primary practice.

Practices could see substantial increases in annual revenue (ranging from $69,665 to $77,295 in year one) if they used registered nurses (RNs) or licensed practical nurses (LPNs) to conduct the required annual wellness visit and used auxiliary staff to do some of the month-to-month management.

If the physician did the annual wellness visit and relied on staff to manage the monthly care, the annual revenue increases could be 15 percent to 40 percent lower.

And if the physician did both the annual visit and the month-to-month management, the net revenue to the practice could decrease because of the loss of income from replacing the face-to-face visits.

It would make more sense to hire a registered nurse (RN) or licensed practical nurse (LPN), but only if at least 131 Medicare patients per RN or 76 Medicare patients per LPN enrolled in the CCM program, the researchers reported in Annals of Internal Medicine.

How much this would cost the patient “would vary based on the Medicare plan of the patient. I think the biggest inducement is more personalized care every month and the hope that poorly controlled chronic conditions would be more well controlled with this strategy,” Basu told Reuters Health by email.

He concluded, “This really reflects a major change in the way financing of primary care is done in the U.S., and likely is the start of many more non-visit-based financing and reimbursement strategies to move primary care more towards a comprehensive chronic disease management model.”

Carol Levine, director of United Hospital Fund’s Families and Health Care Project, New York, advises patients and family caregivers to “look carefully at this new Medicare benefit from the perspective of their own needs for care coordination.”

Patients “should talk about it with the family member who is most involved in their health care,” Levine told Reuters Health by email.” Are their chronic conditions well-controlled? Do they see many specialists whose recommendations need to be coordinated with the primary doctor? Are they skilled at coordinating care on their own?”

“If so, they may not need the additional service, or may not need it now,” Levine concluded. “If none of these apply, however, the new service may well be very useful.”

SOURCE: Annals of Internal Medicine, online September 21, 2015.

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