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Doctors to Be Paid for Coordinating Care of Chronically Ill Medicare Patients — Physician’s First Watch

Medical News |
August 18, 2014

Doctors to Be Paid for Coordinating Care of Chronically Ill Medicare Patients

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Healthcare providers will be paid monthly fees beginning in January for coordinating care of Medicare patients who have two or more chronic conditions, the New York Times reports. Currently, this work is largely not reimbursable.

Providers will assess the medical, psychological, and social health of each patient that signs up for the program and create a comprehensive care plan for the patient. They will also monitor any treatment provided by specialists, check medication compliance, and help ease the transition from hospital to home or to a nursing home.

For managing the care, healthcare providers — including nurse practitioners and physician assistants — could receive roughly $40 monthly, of which 20% is paid by the patient.

To handle patients' "urgent chronic care needs," healthcare providers are required to be accessible 24 hours a day, 7 days a week — a point of contention with physicians.

Reader Comments (9)

Myresa Boulware Other, Other, Libby Clinic

Would we be eligible for this under rural health? We are located in Montana.

KimSu Marder Other Healthcare Professional, Other, Tufts Health Plan

Yes, I agree that Case Managers have been doing this work all along. There are 24/7 vendors out there who have 24 hour 'nurse lines'. I find that these calls typically refer to the Emergency Department when in doubt, which we are trying to limit (unnecessary visits to ED). That might be a way to handle the 24/7 ruling, but it doesn't make the physician accessible 24/7; the phone will, however, be answered by a nurse, rather than an answering service.

LEWIS HAUT Physician, Nephrology, office and hospital

in order to qualify, do I need medicare approved electronic health record system

Christi Hill, RN, BA Other Healthcare Professional, Geriatrics, Patient's home

It would seem to me that managing care for patients with multiple chronic conditions would best be handled by seasoned RNs who are well versed in the variooous conditions and skilled in using check-off lists and in interviewing patients. Patients triaged this way could easily be referred to a NP or PA if there were any significant changes.... Please tell me where to apply...

Robert Hennessy MD Physician, Family Medicine/General Practice

24/7 available???!!!!!!????? You can't be serious!!! At that rate I'd expect very close to 0% signing up!!

j. walek, md Physician, Pulmonary Medicine, private practice

Isn't this what primary care providers are supposed to be doing anyways?

SHELDON BALL Physician, Geriatrics, Anvita Health

This is certainly a noble cause, the opportunity to improve care and reduce cost is significant, but the reimbursement amount is absurd. The prevention of untoward transitions alone is worth far more than the reimbursement. Having worked as a geriatrician in home-based primary care for 2 years, it became quite apparent that any hope of assessing medical compliance requires home visits... and 24/7 for $40/month ?

Margaret Mathison Other, Hospital Medicine

It would be wonderful if hospitals could also be reimbursed for coordination of care for an acute care patient who is admitted with numerous co- morbidities. I am a Nurse case Manager for our local hospital and there are hours spent with the patient and their Care Takers, home health agencies, Nursing homes, Rehab Facilities, etc., coordinating a safe and reliable discharge plan. The Hospitalists are very involved with this process as well as Hospitals are now adversely affected by readmissions.

Ronald Twilla MD Physician, Family Medicine/General Practice, Milan,tn

Thats exactly as we have been doing for the last 35 plus years here without any extra pay. I will believe the $40 per month per patient when I see it!

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