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    CMS changes impacting primary care for the better

    The U. S. Centers for Medicare & Medicaid Services (CMS) is increasingly willing to increase reimbursement rates for managing the care of high-need, high-cost patients with chronic conditions, according to a new report by the Robert Wood Johnson Foundation and Urban Institute revealed.

    Additionally, Medicare is adding new billing codes to the Physician Fee Schedule that can be used to pay for the behind-the-scenes calls, emails and faxes that are often exchanged to manage the care of a complex patient or coordinate a patient’s transition out of the hospital.   

    For example, prolonged E/M service without face-to-face contact with a patient, conducted before and/or after direct patient care and lasting 31–60 minutes now has a fee schedule of $131.41.


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    This is noteworthy because until a few years ago, Medicare didn’t pay doctors for tasks that weren’t part of a face-to-face visit—things like taking a phone call from a patient after hours, or communicating with other providers about a patient’s care.

    Studies have found that a quarter to half of a primary care physician’s day is spent on activities that were not usually billable, says Rachel Burton, MPP, one of the authors of the report and a senior research associate for the Urban Institute in Washington, D.C.

    “But new Medicare billing codes like the Chronic Care Management billing codes, which became available in 2015, are allowing physicians to get paid for this type of work—as are demonstrations like CMS’s Comprehensive Primary Care Plus (CPC+) model,” she says. “These new revenue sources could help increase incomes of primary care practitioners and attract more physicians to primary care specialties.”

    As noted in the report, 69 percent of traditional Medicare beneficiaries have multiple chronic conditions, yet they generate 93 percent of Medicare spending.

    “Providers should start making a point of asking the payers, health plans and networks they contract with what tools and services will be available to help better manage patients with chronic illnesses,” says Scott McFarland, president of HealthBI, a population health technology company based in Scottsdale, Ariz. “Bottom line: Successful management of such populations requires access to the right data—real time data that shows whole patient health.”

    Next: Benefits for primary care

    Keith Loria
    Keith Loria is a contributing writer to Medical Economics.


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