Medicare To Pay Doctors Coordinating Care For Chronically Ill Patients

A recent change in Medicare policy means that starting in January of 2015 primary care physicians will get paid a monthly fee for coordinating the care of patients with two or more chronic illnesses. Physicians often provide chronic case management services between office visits, but Medicare did not pay for it.

With this new initiative, Medicare will adopt some of the practices of a health maintenance organization. Doctors will draft and carry out plans of care for each patient who signs up for one. These patients will have access to care 24 hours a day and seven days a week for urgent needs. Doctors will ensure they are taking prescribed medications, oversee smooth transitions when patients move from hospitals to their homes or to nursing homes and provide other coordination of care when patients have multiple doctors. They also will assess patients’ psychological and social needs.

For these services, Medicare will reimburse doctors approximately $42 a month.

In a recent New York Times article, Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, described paying doctors for chronic care management services as “a significant policy change.”

The change was a response to the disadvantages of managing care in a piecemeal way, which posed both an administrative challenge to care providers and heightened health risk to patients. The new policy reduces the risk of patients falling through the cracks and becoming victims of unintended consequences resulting from a lack of communication and coordination.

Going forward, Medicare may require doctors to use electronic health records to more easily share information with other doctors treating the same patient, but does not do so now.

For those concerned about a double standard with Medicare and the private Medicare Advantage, this policy change levels the playing field somewhat. “It shows that people do not have to leave traditional Medicare and go into a private Medicare Advantage plan to get coordinated care,” says Julie Stein, director of the Center for Medicare Advocacy.