- Starting this month, CMS will pay primary-care doctors a monthly fee to better coordinate care for the most vulnerable Medicare seniors who have multiple chronic illnesses--about two-thirds of beneficiaries have two or more chronic conditions.
- The goal is to help patients stay healthier between doctor visits and avoid expensive hospital stays or admitting patients to nursing homes.
- The new fee will be about $40 per month per beneficiary and marks a pretty significant policy shift on CMS' part.
In order to receive payment, physicians will have to demonstrate that they have come up with a care plan for qualified patients and spend time each month on such activities as coordinating their care with other health providers and monitoring their medications, according to reports. Also, patients must have a way to reach someone with the care team who can access their health records 24 hours a day, so after-hours complaints may be evaluated properly.
This is something some physicians already do, albeit without compensation.
"Quite honestly, I just didn't get paid for it," said Dr. Robert Wergin, president of the American Academy of Family Physicians. According to Wergin, physicians might now be able to hire extra nurses or care managers to assist with the workload.
Seniors will also have to agree to care coordination, which could present a stumbling stone for some physicians—the fee is subject to Medicare's normal deductible and coinsurance. Physicians will need to have a plan in place to explain the new fee to patients. Wergin's plan is say, "This is how we're going to hopefully manage your illnesses better at home."