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Coordination of Chronic Care Patients Enhances Reimbursement


Doctors can now get reimbursed by Medicare for non-face-to-face check-ins with patients who have two or more chronic conditions. But a new survey shows physicians have been slow to take advantage.

Did you know that Medicare now pays for chronic care management? That’s right—primary care physicians can be reimbursed for non-face-to-face time with Medicare patients who have two or more chronic conditions.

But the results of a study by SmartCCM indicate that almost half (46%) of primary care physicians are unaware of that reimbursement option. That means significant dollars are being left on the table, depending on the size of the practice.

“Even a small primary care practice more than likely has 100 eligible patients,” says Michelle McKamy, director of special projects for SmartCCM. “A hundred patients represents roughly $2,000 a month. That in itself is a considerable amount of money.”

And when factoring in the needed care being provided to this population, well worth the investment.

Challenging Population

There’s no question that chronic care patients require extra time, and according to the study, 63% of primary care physicians say that lack of time to provide the extra guidance and reinforcement required of these patients is one of the top two challenges they face when working with this population.

For example, McKamy says that medication compliance is a huge issue with chronic care patients. And in fact, physicians surveyed characterize their Medicare patients with two or more chronic conditions as only “somewhat compliant.”

“These patients don’t really understand a lot of the information that is told to them, and they get nervous when they go into a physician’s office,” McKamy says. “But being able to go back over a physician’s care plan and ask questions in a phone setting is a lot less intimidating.”

McKamy explains that everyone needs assistance in achieving their goals, even the person who wants to keep a New Year’s resolution to lose weight needs a strong support system. For someone with a chronic condition, just having someone phone to ask, “Have you taken your insulin today?” or “The doctor wanted you to check your blood pressure twice a day—have you been doing that?” can make all the difference.

“I think there’s huge value in medication reconciliation,” she explains. “When it comes to savings and when it comes to reimbursement, it’s huge.”

Overcoming Challenges

Despite the challenges, McKamy says that physicians are 100% willing and ready to help this population of chronic care patients achieve better health outcomes.

“I have not talked with a physician in my 15 years of working with them who would not,” she says. “It’s more than monetary. Most physicians just want a higher level of care for their patients.”

Advancing healthcare technology, McKamy explains, is imperative. “Healthcare is one of the slowest adopters of technology,” but it’s still critically important where primary care physicians are already stretched thin for time. In addition, working with a third-party vendor can provide huge benefits.

“Technology can be very cumbersome to adopt,” she says. “But when you outsource to a third party, they not only specialize in the software, but also the processes, which really simplifies the opportunity for the physician.”

For example, McKamy explains that SmartCCM uses nurses to provide care coordination. In comparison, many physicians use their nurses for more direct face-to-face patient care and not as much time on the phone. As such, those who have attempted to provide coordinated care use non-clinical staff. That, she says, can be risky.

“Non-clinical staff doesn’t have the wherewithal to catch some of the details a clinician would, and interpret the information in a valuable way,” McKamy explains. “I definitely think the opportunity for the physician would be to seek out third party services that specialize in relieving that burden and increasing efficiency for his or her practice.”

Return on Investment

McKamy says that when it comes to being reimbursed for non-face-to-face time with Medicare patients who have two or more chronic conditions, the more patients the practice has, the more the practice can earn.

“There’s definitely a positive return on investment,” she says, referencing the cost of technology and/or use of a third part vendor, “especially if you’re giving your patients better care.”

Of course, a lot has to do with the vendor the physician selects and how much money is left over. But, she adds, even if the practice broke even, it would still have higher value due to the better quality of life for the patient, and better quality care.

And that’s really the key, McKamy stresses. Return on investment is much larger than money.

“I think most physicians will agree with that,” she says. “Regardless of the money, the return on investment is obviously very much worthwhile.”

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