Reimbursement, staffing seen as barriers to chronic care in alternate settings
Insufficient reimbursements are a major barrier to care delivery in nontraditional settings, according to a new survey of healthcare executives conducted earlier this year by Sage Growth Partners and commissioned by Signallamp Health.
Almost all healthcare leaders surveyed believe chronic care management is essential, but nearly half don't think their facilities are managing chronic care or preventing hospitalizations very well.
Hospital leaders were more likely to strongly support the need for care beyond facilities than physician practice leaders. The largest problem to getting more care delivered in the home, community or other setting is "insufficient human resources." Nearly two-thirds of both hospital and physician practice leaders pointed to that as a problem.
Almost all respondents said that chronic care management is a priority. However, the survey found that pay and people are what's restricting stronger growth.
Despite the focus on chronic care management, barriers remain in staffing, reimbursement and technology. The survey found that practices face more financial constraints than hospitals, but they agree that people are their "top constraint" to delivering care outside of medical facilities. Physician groups are more likely to point to inadequate reimbursements as a barrier, while hospitals are more apt to blame technology and capital constraints.
Only one-third of hospital executives believe their facilities are managing care well. That's compared to about two-thirds of practice leaders.
The report found the two sides don't agree on the best way to deliver chronic care management and whether they can offer that care.
"Physician groups are more confident but also appear more resistant to changing the current delivery system model to be more patient-centric — believing that the office is the most important chronic care setting — while health systems are more likely to see the value of services that reach patients where they live," Signallamp Health said in the report.
Population health has put more emphasis on care being done in the community, such as the home, and with help from telephonic nurse outreach and community groups. Hospital and physician leaders agree that telephonic nurse outreach is important to chronic care.
Healthcare leaders surveyed see technology as a way to support care, but not replace people delivering care.
The report found a disconnect between the importance of office-based chronic care. Three-quarters of practices highlighted office-based care while only one-fifth of hospital leaders were as positive. In fact, nearly half of hospital respondents rated office-based chronic care as of low importance in chronic care management.
Managing chronic care is a critical way to contain healthcare costs, particularly in Medicare. One possible solution is allowing more care outside of the office, which can keep healthcare providers connected to patients without an in-person visit. Telemedicine is making it easier for providers to keep tabs on their at-risk patients, but reimbursements for that care are currently lacking.
That said, payers are increasingly seeing the benefits of remote patient monitoring. CMS' physician fee schedule final rule unbundled a code for RPM. The move allows doctors to seek reimbursement for collecting and interpreting health data generated remotely by patients, digitally stored and sent to providers, with a minimum of 30 minutes involved.
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