To succeed in population health, reduce cost, and improve quality and patient
satisfaction, it has to begin with primary care physicians. Only via a
well functioning primary care workforce can we achieve better care by
way of a commitment to prevention, adherence to evidence based medicine
and reducing cost through a reduction in low value and unnecessary services.
As such, newer programs have been created to assist primary care physicians
with these goals.. Reimbursement for these services is recognized by both
CMS and the commercial plans. Transitioning from a strictly fee for service
to a fee for value methodology, PCPs should anticipate a larger portion
of their total income streaming from these types of initiatives. I would
like to utilize this article to review some of these programs which will
improve reimbursement for physician practices, and benefit MWHA as well.
Annual Wellness Visits (AWVs), are nothing new nor novel to Alliance physicians.
A great asset for physicians, it reimburses $175 for the initial AWV and
then $119 for each subsequent AWV. Likewise there is a great benefit to
the Alliance, as each AWV will augment our attribution, assist in achieving
our quality measures and close gaps in care. An example of the financial
benefit to physician practices, one of our internal medicine groups achieved
$260,000 in reimbursements from AWVs last year.
Transitional Care Management (TCM), reimburses physicians for overseeing
the care of a patient for the 30 day period post discharge from a hospital
or SNF. The concept is to intensely manage the patient during this high
risk time for readmission to an acute care hospital. Reimbursement for
this program ranges from $167 to $236 based on the level of complexity.
Chronic Care Management (CCM), is a program that reimburses for non face
to face services with Medicare beneficiaries who have multiple, significant
chronic conditions. These services include communications with the patient
or family members, or with other health professionals for care coordination
and medical management. A monthly stipend of $42 per month is provided
for each Medicare beneficiary enrolled in the program. CCM is a great
tool for assisting the high risk and rising risk patients within the Alliance
In addition to these programs, the Alliance offers our own care coordination
programs for both Medicare and commercial payments. Successful performance
in these programs will reimburse primary care physicians $9 per quarter
per attributable Medicare patient, and $1 per month for each commercial
insurance attributable patient.
Finally, with the passage of the ACA came reimbursement for assessments
of certain medical disorders such as depression screening, alcohol and
drug use and abuse, tobacco cessation counseling, as well as developmental
screening. These are all assessments primary care providers perform routinely,
but may not be coding and billing to receive reimbursement
If all the above modalities were performed on a regular basis, we would
be well on our way towards value based care and population healthcare
management. The utilization of these modalities will reduce the cost of
caring for our patients while at the same time enhancing both quality
and patient satisfaction. Perhaps just as important, it is justly paying
those providing these services.
For more information on any of these programs, please feel free to contact
either myself or the MWHA administrative staff.