New Medicare Rules Help Assure High-Need Patients Get Better Care

New Medicare Rules Help Assure High-Need Patients Get Better Care

Did you know that only 10% of patients account for 65% of the country’s health care spending? These patients are the most sick, are often elderly and are coping with several chronic conditions. Physicians have long been frustrated that much of the legwork necessary to ensure good care and coordination of care for these patients is not compensated time. These demands put extra stress on doctors, their staff, and because of a lack of supported infrastructure for these needs, coordination and communication details in patients’ care can sometimes fall through the cracks.

Well, as of January 1, 2017, Medicare now has a new set of regulations in effect that will pay for much of this previously uncompensated time. Under the new rules,¬†physicians will get compensated for the extra team work involved in complex chronic care management, such as working with nurses, social workers, pharmacists, caregivers, psychiatrists, etc to improve the care for elders with diabetes, heart failure, and hypertension among other conditions. Physicians will receive higher pay for preforming comprehensive, time-intensive evaluations for cognitive impairments. Yet they must meet new standards to receive this pay, such as performing a physical exam, taking a detailed history, assessing the patient’s ability to perform activities of daily living, assessing their safety and any behavioral and neuropsychiatric symptoms, and the knowledge, needs and abilities of caregivers. They also must evaluate all the medications the patient takes and perform standardized cognition assessment tests. The patient’s goals and values must also be elicited in the context of advanced planning and a care plan needs to be formed and shared with caregivers.

In addition, the new regulations also help pay for care given in-between office visits, such as reviewing patient medical records at night or talking with caregivers with patient concerns, etc. The regulations offer compensation and coverage of services that help prevent and address depression as well.

For more details and a summary of the new regulations, see Kaiser Health News article, “New Medicare Rules Should Help ‘High Need’ Patients Get Better Treatment.”

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.