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Sunday, August 17, 2014

Medicare care coordination payments

Medicare announced that it will begin to pay selected primary care physicians for care coordination beginning early next year. The article describing the announcement was published in the NY Times today. I welcome the idea that there is value in activities which happen outside of the office but as far as I can determine from the limited information available, the way that Medicare is undertaking deployment is seriously flawed.

It seems that the value to care coordination is assessed to be very modest with estimates of payments of about $42/month. The specifics of the deliverables is somewhat vague, with the exception being the requirement of 24/7 on call coverage. The language noted in the Times was:
Under federal rules, these patients will have access to doctors or other health care providers on a doctor’s staff 24 hours a day and seven days a week to deal with “urgent chronic care needs.”
Who knows what urgent chronic care needs might be? I suspect it will be defined as anything which is deemed urgent by the patient at any given point in time, which is a rather open ended commitment for 42 bucks per month.  However, if one has a large Medicare practice, it is not an insignificant sum of money which we are talking about. It is "concierge-iod" but at the low end of fees. At about $500/year, a practice which has 500 medicare patients will see an additional $250,000 per year. Is that enough to provide the additional services and enough left over for a bit or margin?

I have to raise the question as to whether now that Medicare offers this as a covered service, whether it makes the marketing of non-Medicare concierge services to Medicare patients  illegal?

While the story was reported on in major newspapers, I could not find anything on the CMS Website giving further details.  The one size fits all pricing fits with the typical contempt Medicare has with price signals in health care. It is an open invitation to cherry pick, assign the relevant chronic disease designations whenever possible, and look to amass the least sick, chronically ill populations that you can while developing the most effective strategies for avoiding patients who require after hours attention.

Let the games begin.. yet again




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