Chronically ill  patients take far more of your time than a regular office visit, but a regular  office visit often is the only service for which you receive payment.

Addressing that  perennial complaint of primary care physicians, the American Medical  Association (AMA) recently recommended that Medicare pay doctors for time spent  coordinating care for patients. 

,  MD, chairwoman of the AMA/Specialty Society Relative Value Scale Update  Committee (RUC), to Donald Berwick, MD, administrator of the Centers for  Medicare and Medicaid Services (CMS), advocated payments for four kinds of  coordination starting next year: anticoagulant management, patient education  and training, medical team coordination meetings held in the patient’s absence,  and telephone calls made 7 or more days after an office visit and more than 24  hours before an in-person visit. 

All four services  have existing current procedural terminology (CPT) codes and relative values  published by CMS. Currently, CMS does not pay separately for these services,  instead considering them part of an evaluation and management (E/M) bundle. Lori  Heim, MD, chairwoman of the American Academy of Family Physicians (AAFP) 

 that CMS institute  payment for the four currently “non-covered services” in her letter to Berwick in  August.  

Levy estimated that  payment for anticoagulant management would be $41 per month for the first 90  days and $14 per month for each subsequent 90 days. Patient education and  training by a nonphysician health professional such as a nurse or registered  dietitian “are clearly separate and distinct from E/M” and require 30 minutes  of clinical staff time that cannot be separately billed today. Similarly,  medical team conferences cannot be billed by nonphysicians and cannot be billed  by a physician in the patient’s absence. 

“Not only will  payment for these services save Medicare money in unnecessary office and  emergency room visits, potential savings in Medicare Parts A and D will also  offset upfront payment for non-face-to-face-services,” Levy says.

The AMA  recommendations arose in response to 

CMS’s proposed 2012  Medicare physician fee schedule

. In that proposal, CMS requested “the AMA RUC  conduct a comprehensive review of all E/M codes” to identify potential  undervaluation. To ensure prioritization of this task, CMS asked the RUC to  complete the review of 91 E/M codes in 2012 and 2013. The AMA created a chronic  care coordination workgroup of CPT editorial panel and RUC members to “consider  specific alternatives to a re-review of the valuation” of the E/M codes.

The AAFP also would  like an alternative to a review of the E/M code values by the RUC. 
 “We believe that it  would not be productive to ask the RUC to revalue evaluation and management  services under the same structure, procedures, and methodology that it used to  establish the current values,” Heim wrote. The AAFP has created an alternate  task force to value primary care payments.

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Chronically ill patients take far more of your time than a regular office visit, a regular office visit often is the only service for which you receive payment. Addressing that perennial complaint of primary care physicians, the American Medical Association's payment panel recently recommended that Medicare pay doctors for time spent coordinating care for patients. Read on to learn the ins and outs of that proposal.