Who’d a thunk it? Doctors leaving money on the table? Not billing for services we apparently are already providing? Surely not us greedy doctors.
The CMS says doctors tending to tens of millions of chronically ill Medicare patients aren’t taking advantage of federal dollars aimed at improving care and reducing hospital readmissions and overall costs.
This year, Medicare began paying an average of $42 per patient per month for non-face-to-face chronic-care management services, such as consulting with other doctors caring for the same patient who might be dealing with dementia, heart disease or arthritis.
The CMS estimates 70% of Medicare beneficiaries—roughly 35 million—would be eligible, but CMS has only received reimbursement requests for 100,000 beneficiaries thus far, Kathy Bryant, a senior technical adviser in the Center for Medicare, said last week at an Advisory Panel on Outreach and Education meeting. She added that even that number may be too high as some could be duplicate claims.
Now why wouldn’t I want to collect an extra $500 or so a year per Medicare patient? I mean, I’m already coordinating their care, calling specialists, keeping track of their tests, refilling meds and so forth without seeing a penny. Why not bill for it?
What would I have to do? (Following info from this CMS Fact Sheet)
First, I have to get the patient’s consent. No biggie. I’m sure most of my patients would be okay with it. Turns out that there’s a little bit more to it than that, though:
Patient consent requirements include:
- Inform the patient of the availability of the CCM service and obtain written agreement to have the services provided, including authorization for the electronic communication of medical information with other treating practitioners and providers.
- Explain and offer the CCM service to the patient. In the patient’s medical record, document this discussion and note the patient’s decision to accept or decline the service.
- Explain how to revoke the service.
- Inform the patient that only one practitioner can furnish and be paid for the service during a calendar month.
- How to access the elements of the service;
- How the patient’s information will be shared among practitioners and providers;
- How cost-sharing (co-insurance and deductibles) applies to these services
Sure, no problem. I can probably manage to squeeze that discussion in between going over their latest admission for CHF, refilling their COPD meds, reviewing their home glucose readings, updating their pneumococcal vaccine, making sure they got a flu shot, and discussing their wishes for end of life care.
Okay, say I get their consent, what exactly do I have to do? It boils down to creating, implementing, and monitoring a “Comprehensive Care Plan”.
What the hell is that?
A comprehensive care plan for all health issues typically includes, but is not limited to [italics mine], the following elements:
- Problem list;
- Expected outcome and prognosis;
- Measurable treatment goals;
- Symptom management;
- Planned interventions and identification of the individuals responsible for each intervention;
- Medication management;
- Community/social services ordered;
- A description of how services of agencies and specialists outside the practice will be directed/coordinated
- Schedule for periodic review and, when applicable, revision of the care plan.
Not only this, but it turns out that Medicare only pays 80% for this “service”, leaving patients footing the bill for things they basically never had to pay for previously.
As my eyes glaze over, I can’t help but wonder: Why is anyone surprised that doctors aren’t rushing to bill for this albatross of a “service”?