Medicare is offering physicians who coordinate care for patients with multiple chronic illnesses $40 per patient per month for their non–face-to-face work. But is it enough?
Physicians are calling the new chronic care management codes a good start, but not enough to cause them to make significant investments in their practices. And they have concerns about the numerous requirements for billing with the codes.
“While [the American College of Physicians] would have preferred to see the payment amount for the Chronic Care Management code be increased given the level of work involved in implementing this code, the College appreciates that [the Centers for Medicare & Medicaid Services] has now finalized its plan to provide payment to clinicians for the critically important non–face-to-face work involved in helping patients manage multiple chronic conditions,” said Shari Erickson, vice president for government affairs and medical practice at the American College of Physicians.
Dr. Robert L. Wergin, the president of the American Academy of Family Physicians, echoed that statement.
“We’re very positive that this is a step in the right direction of value-based payments that recognizes the value of coordinating a person’s care, particularly if they’re elderly or disabled,” Dr. Wergin said. “We feel it might even improve our ability to care for patients.”
It may, however, take more than $40 to set up the appropriate office infrastructure to support the required services. “As patients become more complex,” the fee probably should be increased, he said.
Dr. Kim K. Yu, a family physician in Frankenmuth, Mich. and president-elect of the Michigan Academy of Family Physicians, said the care coordination payment is “better than nothing” and a good recognition on the part of the Centers for Medicare & Medicaid Services (CMS) of the complex care that family physicians provide. But she worries about the lengthy list of requirements that physicians must meet in order to bill Medicare for the codes.
“My concern is the amount of paperwork and documentation required to be able to code for [this],” Dr. Yu said. “Simplifying processes but still delivering better health, better care, at lower cost should be a priority.”
As part of the 2015 Medicare Physician Fee Schedule released Oct. 31, the CMS officials finalized plans to begin paying physicians about $40 per patient per month for non–face-to-face chronic care management services, such as developing and revising the care plan, communicating with other providers, and managing medications.
Physicians can bill for the services using the CPT codes 99490, 99487, and 99489. The CMS plans to make a bundled payment for 99487 and 99489, according to the rule. The codes apply only to Medicare patients with two or more significant, chronic conditions.
Practices also must provide patients with a way to reach providers 24/7. There must be continuity of care that allows patients to see a designated member of the care team on a consistent basis. And practices must perform systematic assessments of the patient’s medical, functional, and psychosocial needs; and use systems-based approaches to ensure timely receipt of preventive care, medication reconciliation with review of adherence, and oversight of the patient’s self-management of their medications.
The fee schedule also specifies that practices must have certified electronic health records that they use for maintaining problem and medication lists, communicating with home and community-based providers, informing patients of the availability of chronic care management services, and obtaining patients’ written consent. In 2015, the CMS will allow practices to use EHRs certified in either 2011 or 2014.
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