Dr. Fitzhugh C. Pannill, from the University of Connecticut School of Medicine, Farmington, wrote an editorial related to this report. He told Reuters Health by email, “I did not expect it might be cost effective to hire additional staff to do chronic care management and am surprised that in the model as reported, relatively few patients have to be enrolled to cover the costs.”
“If physicians have some confidence that they could break even financially, they will be more likely to see if CCM makes clinical sense for their patients and their practice,” Dr. Pannill said. “Both financial and clinical requirements will have to be met for most physicians. It is hard to justify a complex process, requiring hiring and training new staff, if it does not add anything to patient care or a patient’s experience, or does not make clinical sense (even if it increases revenues).”
“Studies of primary care show most providers spend over 20% of their time on the phone, reviewing discharge summaries, test results, and consultant reports, but do not get paid for this work,” he explained. “Up until now, Medicare would only reimburse providers when the patient was in the office. CCM, by reimbursing practices for the hours spent on a patient’s care when the patient is not in the office, will help primary care providers stay in business and remain available for their patients when needed the most.”
“Unfortunately, other than the time (20 minutes a month), it is not clear what is required for CCM and how much of these tasks really can be handled by non-MDs,” Dr. Pannill concluded. “Many patients may object to getting a bill for a service they did not ‘see’ being preformed.”
Carol Levine is director of United Hospital Fund’s Families and Health Care Project, New York. She told Reuters Health by email, “Even though the study was about money, I was surprised that the authors did not even mention whether this plan would benefit patients.”
“I would like to urge physicians to look beyond the revenue and staffing needs to consider how this service would affect their patients,” Levine said. “Perhaps it would help a majority but not all. Does everyone have to sign up? What will happen to those patients who, for whatever reason, do not? Will the family member most involved in care be involved in development the comprehensive care plan? Much of this involves things that happen in the community and at home and not in the doctor’s office. Care coordination, even without this new payment mechanism, is still a critical responsibility for physicians, and it needs to be done well.”
