Upcoming Pay Changes for Primary-Care Physicians

December 4, 2013

CMS is moving forward with a proposal to pay doctors for managing more of a patient's care outside of a face-to-face office visit.

Things may be looking up for primary-care physicians - at least when it comes to new reimbursement opportunities.

CMS recently released its 2014 Physician Fee Schedule final rule, and it includes a proposal to support chronic care management outside routine face-to-face office visits beginning in 2015.

The move reflects the ongoing shift toward value-based payment, and efforts to ensure that patients are paid appropriately for their services, according to CMS. 

"... We believe that the resources required to furnish chronic care management services to beneficiaries with multiple (that is, two or more) chronic conditions are not adequately reflected in the existing E/M codes," CMS stated in the final rule.

The rule also notes that physicians in Patient-Centered Medical Homes have indicated that the care management included in E&M services does not adequately describe the non-face-to-face care management services they provide.

"Health care is changing, and part of delivery system reform is recognizing this and making sure payment systems account for these changes," CMS Principal Deputy Administrator Jonathan Blum said in a statement regarding the final rule. "We believe that successful efforts to improve chronic care management for these patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits."

A physician would be able to bill for chronic care management if he provides additional services to a patient that has multiple chronic conditions that are expected to last at least 12 months or until his death. The conditions also must place the patient at risk of death, acute exacerbation/decompensation, or functional decline, according to the rule.

The physician's practice would also need to meet certain standards to participate in chronic care management services. Possible standards could include use of a certified EHR and use of nonphysician providers. CMS said it would continue to develop and evaluate these standards.

The scope of chronic care management services could include:
• Availability of the physician to address a patient’s acute chronic care needs at any time;
• Continuity of care with a designated practitioner;
• Care management including system-based approaches to ensure timely receipt of all recommended preventive care services, medication reconciliation with review of adherence and potential interactions, and oversight of patient self-management of medications;
• Management of care transitions including referrals to other clinicians, visits following a patient visit to an emergency department, and visits following discharges from hospitals;
• Enhanced opportunities for a patient and caregiver to communicate with the physician through secure messaging, the Internet, or other non face-to-face consultation methods.

What do you think of the proposal to pay for chronic care management?