Few Physicians Using Medicare Coordinated Care Benefits, CMS Says

Physicians caring for tens of millions of Medicare beneficiaries with chronic conditions are not using federal funding dedicated to efforts to coordinate care, Modern Healthcare reports.

Background

CMS earlier this year implemented an initiative under which it pays an average of $42 per Medicare beneficiary per month for certain chronic-care management services that are not provided during in-person office visits, such as consulting with other physicians who care for the same patient with a chronic illness. The benefits are intended to help bolster quality of care and reduce costs and hospital readmission rates.

Lack of Participation

While CMS estimates that about 35 million Medicare beneficiaries would be eligible for such benefits, the agency has received reimbursement requests for just 100,000 beneficiaries so far, according to Kathy Bryant, a senior technical adviser at CMS. Bryant also noted that estimates of those using the benefits could be inflated because some claims could be duplicates.

Further, a Smartlink study released Tuesday found that fewer than 20% of 300 interviewed physicians currently take advantage of the reimbursement. Most of the physicians who are seeking such reimbursement said they believed the effort helps bolster care quality.

According to Modern Healthcare, one factor inhibiting physician participation could be that doctors must get permission from patients to submit such reimbursements and patients must pay a 20% copayment whenever a service is billed through the initiative. Some experts have said many providers are hesitant to tell patients that the case management services they had previously performed at no cost will now require a copay. Peter Hollmann, an internist and member of the American Geriatric Society Board, noted that some physicians are "concerned that their patients would be unwilling to pay the cost-sharing."

Meanwhile, other experts say CMS did not provide adequate instructions for properly billing under the benefit codes. Regina Mixon Bates, founder and CEO of the Physicians Practice S.O.S. Group, said, "Physicians are leery about using them because they don't know if they are doing so correctly."

In addition, some experts have raised the possibility that physicians do not want to invest large amounts of time in using electronic health record systems, which are required to use the benefits. Diane Calmus, government affairs and policy manager at the National Rural Health Association, said, "There is a concern all this documentation, along with their regular workload, is not worth it for the money they would receive."

However, Hollman said the main reason why so few physicians have sought reimbursement is likely because the program is fairly new. He noted, "There is an expected delay in uptake of new codes, especially when the rules are complicated," adding, "This requires that a practice use an electronic record, get patient consent to bill and have a written care plan in place," as well as "track the time in a calendar month." Hollman said, "None of this is part of a practice routine and Medicare only has data on early months" (Dickson, Modern Healthcare, 10/13).