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To make the most of the Medicare chronic care management (CCM) payment, have a nurse or other nonphysician provider deliver the care.
That was the conclusion reached by Dr. Sanjay Basu of Stanford (Calif.) University and his colleagues based on their analysis of national practice data on patient use of primary care services, staffing costs, overhead, and reimbursements, published Sept. 21 in Annals of Internal Medicine (doi:10.7326/M14-2677).
Up to two-thirds of Medicare-covered patients on primary care patient panels are eligible for the new CCM payment, unveiled earlier this year as part of Medicare’s move away from fee-for-service medicine, according to the researchers.
Dr. Basu and his colleagues created microsimulation models to determine that net revenue gains were highest when CCM plans were developed at an annual preventive care visit and in partnership with nonphysician providers who were then tasked with delivering the care.
If services were delivered by a registered nurse, revenue increased $332/CCM patient. When delivered by a licensed practical nurse, the increase was $372/CCM patient. And when a medical assistent delivered the care, revenue increased by $385/CCM patient.
For primary care practices with patient panels of about 2,000, if a minimum of 76 CCM patients per full-time equivalent physician were enrolled and cared for by a registered nurse, the net annual revenue increase was $75,000 per full-time physician when combined with the cost of 12 hours of weekly nursing services.
The analysis could incentivize practices to adapt more team-based models of care, regardless of practice size, Dr. Basu noted.
On Twitter @whitneymcknight
Despite the analysis conducted by Dr. Basu and his colleagues, Medicare reimbursements for chronic care costs are still too vague to bank on such large estimated gains.
The $8-per-month CCM copayment may not be covered by insurance because many plans do not cover out-of-visit services. Patients may decline to pay for a service they do not see, believing that they already have their care coordinated. And because CCM is not limited to primary care, patients might also be unwilling to exclude their specialists from their care plans, because of a fear of losing access to them.
Because team-based models of CCM often require data sharing, the cost of electronic health records must also be factored into cost/revenue ratios, particularly since many EHR data systems still prevent successful information transfers, despite federal laws requiring interoperability.
If interoperability were truly effective and primary care providers had easy access to the data across systems required for care coordination, we might not have to hire other providers to do a job that has traditionally been ours alone.
Dr. Fitzhugh C. Pannill III is an internist at the University of Connecticut in Farmington. His comments were made in an editorial accompanying Dr. Basu’s report.
Despite the analysis conducted by Dr. Basu and his colleagues, Medicare reimbursements for chronic care costs are still too vague to bank on such large estimated gains.
The $8-per-month CCM copayment may not be covered by insurance because many plans do not cover out-of-visit services. Patients may decline to pay for a service they do not see, believing that they already have their care coordinated. And because CCM is not limited to primary care, patients might also be unwilling to exclude their specialists from their care plans, because of a fear of losing access to them.
Because team-based models of CCM often require data sharing, the cost of electronic health records must also be factored into cost/revenue ratios, particularly since many EHR data systems still prevent successful information transfers, despite federal laws requiring interoperability.
If interoperability were truly effective and primary care providers had easy access to the data across systems required for care coordination, we might not have to hire other providers to do a job that has traditionally been ours alone.
Dr. Fitzhugh C. Pannill III is an internist at the University of Connecticut in Farmington. His comments were made in an editorial accompanying Dr. Basu’s report.
Despite the analysis conducted by Dr. Basu and his colleagues, Medicare reimbursements for chronic care costs are still too vague to bank on such large estimated gains.
The $8-per-month CCM copayment may not be covered by insurance because many plans do not cover out-of-visit services. Patients may decline to pay for a service they do not see, believing that they already have their care coordinated. And because CCM is not limited to primary care, patients might also be unwilling to exclude their specialists from their care plans, because of a fear of losing access to them.
Because team-based models of CCM often require data sharing, the cost of electronic health records must also be factored into cost/revenue ratios, particularly since many EHR data systems still prevent successful information transfers, despite federal laws requiring interoperability.
If interoperability were truly effective and primary care providers had easy access to the data across systems required for care coordination, we might not have to hire other providers to do a job that has traditionally been ours alone.
Dr. Fitzhugh C. Pannill III is an internist at the University of Connecticut in Farmington. His comments were made in an editorial accompanying Dr. Basu’s report.
To make the most of the Medicare chronic care management (CCM) payment, have a nurse or other nonphysician provider deliver the care.
That was the conclusion reached by Dr. Sanjay Basu of Stanford (Calif.) University and his colleagues based on their analysis of national practice data on patient use of primary care services, staffing costs, overhead, and reimbursements, published Sept. 21 in Annals of Internal Medicine (doi:10.7326/M14-2677).
Up to two-thirds of Medicare-covered patients on primary care patient panels are eligible for the new CCM payment, unveiled earlier this year as part of Medicare’s move away from fee-for-service medicine, according to the researchers.
Dr. Basu and his colleagues created microsimulation models to determine that net revenue gains were highest when CCM plans were developed at an annual preventive care visit and in partnership with nonphysician providers who were then tasked with delivering the care.
If services were delivered by a registered nurse, revenue increased $332/CCM patient. When delivered by a licensed practical nurse, the increase was $372/CCM patient. And when a medical assistent delivered the care, revenue increased by $385/CCM patient.
For primary care practices with patient panels of about 2,000, if a minimum of 76 CCM patients per full-time equivalent physician were enrolled and cared for by a registered nurse, the net annual revenue increase was $75,000 per full-time physician when combined with the cost of 12 hours of weekly nursing services.
The analysis could incentivize practices to adapt more team-based models of care, regardless of practice size, Dr. Basu noted.
On Twitter @whitneymcknight
To make the most of the Medicare chronic care management (CCM) payment, have a nurse or other nonphysician provider deliver the care.
That was the conclusion reached by Dr. Sanjay Basu of Stanford (Calif.) University and his colleagues based on their analysis of national practice data on patient use of primary care services, staffing costs, overhead, and reimbursements, published Sept. 21 in Annals of Internal Medicine (doi:10.7326/M14-2677).
Up to two-thirds of Medicare-covered patients on primary care patient panels are eligible for the new CCM payment, unveiled earlier this year as part of Medicare’s move away from fee-for-service medicine, according to the researchers.
Dr. Basu and his colleagues created microsimulation models to determine that net revenue gains were highest when CCM plans were developed at an annual preventive care visit and in partnership with nonphysician providers who were then tasked with delivering the care.
If services were delivered by a registered nurse, revenue increased $332/CCM patient. When delivered by a licensed practical nurse, the increase was $372/CCM patient. And when a medical assistent delivered the care, revenue increased by $385/CCM patient.
For primary care practices with patient panels of about 2,000, if a minimum of 76 CCM patients per full-time equivalent physician were enrolled and cared for by a registered nurse, the net annual revenue increase was $75,000 per full-time physician when combined with the cost of 12 hours of weekly nursing services.
The analysis could incentivize practices to adapt more team-based models of care, regardless of practice size, Dr. Basu noted.
On Twitter @whitneymcknight
FROM ANNALS OF INTERNAL MEDICINE
Key clinical point: Hiring sufficient numbers of non-physician staff to manage chronic care patients can increase revenues.
Major finding: Net $75,000 annual revenue increase per full-time physician, combined with 12 hours of weekly nursing services, per 76 chronic care patients in a 2,000-patient panel.
Data source: Microsimulation models based on analysis of national practice data.
Disclosures: Dr. Asaf Bitton, a coauthor on the study, was senior adviser to the Centers for Medicare & Medicaid Innovation for the Comprehensive Primary Care initiative.