Looking Forward: 4 Boons Coming Your Way in 2014

Leigh Page


January 02, 2014

In This Article

Developments for Treating Chronic Conditions

3. Extra Payments to Manage Patients With Chronic Conditions

Medicare has been a notable holdout from the trend toward covering e-visits. In most cases, practices do not receive any Medicare payment for arrangements outside of an office visit.

Cetto said this has been a concern at Grove Medical Associates, which has a high proportion of Medicare patients with chronic conditions. She said some of the most frequent users of e-visits are the adult children of these patients. "It means they don't have to take time off from work and bring their parent in," she said. Although this helps improve care, the practice is not paid for the emails.

In 2015, however, Medicare would begin to pay for services outside of the patient visit under a proposed benefit. The new Complex Chronic Care Management program, outlined in a proposed rule[3] that the Centers for Medicare & Medicaid Services (CMS) issued in July, would pay a set fee every 90 days -- on top of fee-for-service payments -- to practices that use a certified electronic health record, agree to be available around the clock, and employ at least 1 nurse practitioner or physician assistant. CMS are also considering requiring recognition as a patient-centered medical home.

"That is exciting news for us," Cetto said. The practice appears to meet all the proposed criteria, including certification as a medical home, and the extra payment "would be very welcome," she added.

"There has been an undervaluing of all non-face-to-face care management that physicians do," said Andrew B. Bindman, MD, Professor of Medicine at University of California, San Francisco, School of Medicine. Dr. Bindman advised CMS on the new program and wrote an article[4] about it that was published in JAMA. Although more than two thirds of Medicare patients have more than 1 chronic condition and thus fit the program requirements, Dr. Bindman predicted that most practices would not qualify because of all of the strict qualifications.

Also, there may be reimbursement problems for practices that do qualify. The final rules, due in November, will specify a payment level based on the estimated relative value units (RVUs) for 60 minutes of staff time over the 90-day period. However, the American College of Physicians, American Academy of Pediatrics, and other physician organizations warned in a letter to CMS[5] that the RVU level is set too low and "practices would be dramatically underpaid for such care."

Before committing resources to the new program, such as hiring a nurse practitioner or arranging round-the-clock availability, practices should determine whether the extra payments will cover the costs.


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