Tony has a strong expertise in the healthcare and managed care/payer arena. He currently manages the workflow of Oncology Business Management, a business trade journal geared towards community oncologists/hematologists.

Medicare to Pay Docs for Chronic Care Coordination

Published: Monday, Aug 18, 2014

Starting in January 2015, Medicare will begin paying physicians for the care coordination they provide beneficiaries with chronic conditions. The New York Times reports that physicians will be paid $42 per month per beneficiary, and will require physicians to assess the medical, psychological, and social needs of the patient; check whether patients are taking medications as prescribed; monitor the care provided by other physicians; and make arrangements to ensure a smooth transition from the hospital setting to the patient’s home or nursing home.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, told the Times that, “Paying separately for chronic care management services is a significant policy change.” Patients often experience disjointed care from multiple providers, and it’s hoped this move will alleviate some of the confusion. Poor coordination can lead to duplication of services or worse, like missing the results of an abnormal laboratory test or an interaction between multiple drugs that a patient is taking.

To participate, beneficiaries will have to agree in writing to receive care management services. Patients will also be on the hook for paying about 20% of the $42 fee—the same proportion as for many other physician services. Each beneficiary will work with his physician to develop a comprehensive care plan and will have access to doctors and other health care providers on a doctor’s staff 24 hours a day and 7 days a week to handle urgent chronic care needs. As part of the new policy, care management services can be provided by nurse practitioners, physician assistants, and other health care providers.

Medicare officials said they expected doctors and other providers to focus on sicker patients with four or more chronic conditions, says the Times article. Two-thirds of Medicare beneficiaries have at least two chronic conditions, and they account for 93 percent of Medicare spending, said Kimberly A. Lochner, a statistician at the Department of Health and Human Services.

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