CMS Changes May Improve Care for Chronic Illness

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Medicare Changes

Doctors have complained for years that they’re not paid adequately for time-consuming work associated with managing care for chronically ill older patients: talking with families; and consulting with specialists and pharmacists.

Each year Medicare policies (or regulations) are reviewed and changes may be implemented. As of 1/1/2017, under the new rules, doctors will be compensated for legwork involved in working in teams — including nurses, social workers and psychiatrists — to improve care for seniors with chronic diseases such as diabetes, heart failure and hypertension.

These patients are considered “high need” or “high risk” and the goal is to better manage their care and outcomes. The new regulations also make efforts to ensure that seniors receive effective treatments for anxiety or depression which may result from these chronic diseases.
Also, new Medicare regulations give more attention to the costliest patients in the health care system — mostly older Americans who have multiple chronic conditions that put them at risk of increased care, including hospitalization. Note: 10 percent of patients account for 65 percent of the nation’s health spending.

Highlights of the new policies include:
Regarding cognitive impairment: Medicare has increased payments to doctors for the initial assessment and additional fees for care planning and care management. The goal is to provide incentive for doctors to provide dementia related services.

Two years ago, Medicare began paying nurses, social workers and medical assistants to coordinate care for seniors with two or more serious chronic conditions. However, Medicare reimbursement levels were low. New payments for “complex chronic care management” have been increased, making these services more practical to provide.

Many practices will be able to hire care managers with this increased reimbursement. This will help cover services such as managing seniors’ transitions from the hospital back home or to a rehabilitation center, coordinating home-based services, connecting patients with resources, and educating caregivers about their conditions.

Research has shown the seniors with depression, a frequent complication of serious illness, benefit when primary care physicians collaborate with psychologists or psychiatrists and care managers track their progress.

Now, Medicare will increase reimbursement for physicians and behavioral health providers to work together. Also reimbursed are services for a care manager who stays in touch with patients and tracks whether they’re improving.

In summary, it is hoped that an increase in Medicare reimbursements for people with chronic disease, complex health situations or mental health issues will cause better treatment This better treatment would then cause better control of the medical condition(s) and result in lower overall medical utilization and costs. The net result for seniors will hopefully be a better quality of life.

Medicare leads the path for insurance companies to follow. Expect insurance companies offering coverage to people under age 65 and not on Medicare to follow this concept. As always, feel free to contact our office if you have questions at 309-693-1060.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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