How are you preparing for care coordination reimbursement?

By Leigh Ann Myers  /  29 Dec 2014

The ONC recently released their strategic plan for 2015 – 2020, which includes a focus on using healthcare technology to coordinate care among different healthcare providers, social services and payers. We all know that coordinated care can make a big difference in improving patient satisfaction and outcomes. But, it’s easier said than done. As I wrote earlier this fall, care coordination requires a review of clinician workflows, as well as strong clinician-to-clinician relationships to make communication easier.

As we look ahead to 2015, I see a bright spot on the horizon: beginning in January, Medicare will begin to reimburse clinicians for care coordination.

This important change is long overdue. Although the reimbursement amount will be small to start (roughly $40 per month, per patient), it represents another major shift in the way we deliver patient care. No longer are we operating in silos; instead, this program will require specialists and primary care physicians to collaborate.

So, how can physician practices prepare for the reimbursement changes?

First, doctors must carefully select the patients most in need of care coordination. These will be Medicare patients with two or more chronic conditions, who regularly need to see specialists, social services, pharmacists, and even visit nursing homes. After the group is selected, practices will need to get patient approval. Since there’s a required 20 percent copay for care coordination, practices should explain to patients how this program can improve their transition between care settings.

Second, practices must make sure they have the technology in place to support the care coordination required through this new program. Although Meaningful Use deadlines have been extended, doctors who desire reimbursement through this new care coordination program must use EHRs to exchange information with colleagues treating the same patient. In addition, care teams will need to find ways to reach each other quickly and easily to keep each other apprised of patient developments, consultations, or other care activities.

But reimbursements and technology aren’t enough to foster patient care coordination; instead, providers need to find ways to facilitate easier communication and collaboration. To comply with the new regulations, the PCPs, specialists and hospitalists need to work together to determine proper care coordination plans for each patient. It’s my hope that working together more closely will enable clinicians to build stronger relationships, so they can continue partnerships to improve patient care and outcomes.

Are you looking forward to receiving reimbursements for care coordination management? What steps are you taking before the new year to get ready?

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