New Medicare Rules Should Help ‘High Need’ Patients

New Medicare regulations went into effect on January 1, 2017, which require compensation for physicians who spend time working in teams to improve care for seniors with chronic illnesses. These care coordination teams, which often consist of doctors, nurses, social workers, and psychiatrists, focus on high-need patients who suffer from hypertension, diabetes, depression, anxiety, and heart failure. These patients often have multiple medical conditions that put them at a much higher risk of disability, hospitalization, and premature death.

One major purpose of these regulations is to focus on reducing the costs of those whom tend to be the costliest of all patients in the American health care system. The reality is that 10% of patients account for 65% of the nation’s total health care spending. Under these new Medicare regulations, complex chronic care management now is reimbursable at higher rates on a more frequent basis. This type of care management will include services such as transitioning seniors between hospital and home or hospital and rehabilitation center, arranging home-based services, and providing patients and caregivers with resources. The hope is that medical practices now will be able to hire care coordinators to continue to reduce the costs of medical care for these high-risk seniors.

Studies have found that primary care physicians often do not diagnose dementia on a timely basis. Medicare now has made enhanced reimbursement rates for comprehensive cognitive examinations that incorporate ten distinct elements. If the examination reveals dementia, then the physician’s office must create a care plan to address the patient’s needs and goals. Additional funds are available from Medicare for the care planning process. Plus, doctors will now receive reimbursement for patient care performed in between visits, such as after-hours phone calls and reviews of medical records.

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