What Endocrinologists Can Expect From Obamacare
What Endocrinologists Can Expect From Obamacare
Dr. Greenlee is testing the PCMN model. She applied for a grant through the Center for Medicare & Medicaid Innovation to expand it among doctors in the independent physician association in her region. She explains that the PCMN is an extension of the patient-centered medical home, which turns a primary care practice into hubs that helps to coordinate patient care. The PCMN provides a defined agreement between primary care physicians and specialists, so that each understands and respects the other's role. "Those roads [between primary care physicians and specialists] aren't paved right now," she says.
The primary care doctor agrees to appropriately triage patients. They also have to answer questions about the patients who are sent before appointments can be scheduled at her office. Those include the basics, such as the reason for the visit, patient histories, medical records, and whether the doctor wants her to weigh in on a specific problem or take over the management of the patient, among other issues.
In doing this previsit work, Dr. Greenlee says she can often get patients scheduled for needed imaging studies or blood tests before they come to see her, which saves them a second trip to her office.
The system works beautifully, she says. The only trouble is that currently there is no payment mechanism that compensates her for the extra preparation and coordination. She just does it because it's the right thing for her patients. "We need support," she says, "We need payment reform to allow these very important cost-saving, quality-enhancing things to take place so that we can do it sooner, rather than later," she says.
There may be some help on the horizon. In July, CMS proposed new rules that would compensate physicians who orchestrate complex chronic care management for Medicare patients with 2 or more chronic conditions. Under the new G codes, CMS will pay for non-face-to-face interactions necessary to revise care plans, coordinate with other treating health professionals, and manage medications. Endocrinologists will be eligible to use these codes, provided that certain staffing and record keeping requirements are met.
The PCMN Model
Dr. Greenlee is testing the PCMN model. She applied for a grant through the Center for Medicare & Medicaid Innovation to expand it among doctors in the independent physician association in her region. She explains that the PCMN is an extension of the patient-centered medical home, which turns a primary care practice into hubs that helps to coordinate patient care. The PCMN provides a defined agreement between primary care physicians and specialists, so that each understands and respects the other's role. "Those roads [between primary care physicians and specialists] aren't paved right now," she says.
The primary care doctor agrees to appropriately triage patients. They also have to answer questions about the patients who are sent before appointments can be scheduled at her office. Those include the basics, such as the reason for the visit, patient histories, medical records, and whether the doctor wants her to weigh in on a specific problem or take over the management of the patient, among other issues.
In doing this previsit work, Dr. Greenlee says she can often get patients scheduled for needed imaging studies or blood tests before they come to see her, which saves them a second trip to her office.
The system works beautifully, she says. The only trouble is that currently there is no payment mechanism that compensates her for the extra preparation and coordination. She just does it because it's the right thing for her patients. "We need support," she says, "We need payment reform to allow these very important cost-saving, quality-enhancing things to take place so that we can do it sooner, rather than later," she says.
There may be some help on the horizon. In July, CMS proposed new rules that would compensate physicians who orchestrate complex chronic care management for Medicare patients with 2 or more chronic conditions. Under the new G codes, CMS will pay for non-face-to-face interactions necessary to revise care plans, coordinate with other treating health professionals, and manage medications. Endocrinologists will be eligible to use these codes, provided that certain staffing and record keeping requirements are met.