Federal Funds for Coordinated Care Go Unclaimed

Doctors who care for tens of millions of chronically ill Medicare patients are failing to take advantage of federal dollars intended to improve care and reduce hospital readmissions and overall costs, according to the Centers for Medicare and Medicaid Services (CMS). In 2015, the federal government 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. But, according to CMS estimates, while 70 percent of Medicare beneficiaries (roughly 35 million) are eligible, reimbursement requests have been received for only 100,000 of them to date. And, that number could be even lower since some of the claims could be duplicates.

A number of possible reasons for not participating in the program have been suggested. First is that physicians must get permission from patients who are responsible for a 20 percent co-pay each time the provider bills for services. A second is that CMS hasn’t provided information on how to properly bill under the codes. And, a third is a concern that the documentation workload to participate is not worth it for the money they would receive. However, a study from the Stanford University School of Medicine conducted in September, which looked at how much chronic-care management could affect the typical primary care practice, found substantial increases in annual revenue could be gained each year (as much as $77,295) if practices used registered nurses to conduct annual wellness visits and used other staff to handle more frequent management. Another study by Smartlink released in October found that less than 20 percent of 300 physicians interviewed are currently participating in the chronic-care management program. But, those who are participating believe it is improving patient care.