I suspect it’s more likely an experience for Medicare beneficiaries…especially Medicare Advantage… as it was introduced by CMS a few years back. As the chronic conditions that are more common in the older population (T2D etc) are appearing in an increasingly younger demographic, more employer provided health insurance plans are covering these procedure codes.It’ something that crossed my radar screen a few years back when I still had an employer provided group plan…but no reimbursible chronic conditions(and not without subsequent adverse consequences)…but cropped up again yesterday at a follow up visit with my PCP.
Now, as we’re becoming more Chronologically Enriched, the need for more medical attention might become necessary in future…and that would certainly be deserving of extra compensation…but, in the few minutes chit chat designed to encourage us to participate, it seemed to me that there’s a lot of “checking in by the team”. I don’t mind a reminder for routine physicals, etc…but I surely don’t want to be bombarded by algorithm and guideline based emails in the way that my Medicare supplement plan clogs up my Gmail account!
FYI, I suspect a good many folk are unwittingly already on this programme and unaware as Medicare EOBs tend not to be as detailed as group health plans.
The idea of additional compensation for what is traditionally a routine doctor’s activity uses the doctor’s office as a leech
Did you actually read and understand what these procedure codes are designed to do?
Back in the times of blood letting and leeches, there was no fixed reimbursement by third party payers, little of the administration burden of managing multiple co morbidities without any extra reimbursement, etc, etc.
For most primary care physicians today, if they have a significant number of older patients in their patient demographic, the reality has become a steady reduction in reimbursement (more enrollees in Medicare Advantage plans) but an increase in the numbers of sicker patients placing a bigger administrative burden on the practice. Juggling referrals to multiple specialists or challenging insurance company denials for treatment, for instance, can hardly be considered a routine doctor’s activity.
Now to the original question…do you actually have practical experience of enrollment in this Chronic Care Management? Come to that, do you know whether or not you are??
Did you actually read and understand what these procedure codes are designed to do
I assume not…and the problem may well be that the link I chose to define CCM as an entity was aimed at practices rather than patients. Here’s an example of how it’s marketed to the consumer in order to encourage participation…
Now, it may still read a little like normal clinical management…the sort of thing that’s part of regular doctoring…until you give a bit of thought to what goes on behind the scenes to ensure that patients keep track of their medications, appointments, follow-up visits, specialty referrals etc. For but one example from the limited experience I have on the consumer side of health care, it’s been a long time since I was expected to remember a doctor’s appointment all by myself even though I made the appointment at a time chosen by me Over the years, this sort of handholding has multiplied as rapidly as the obesity epidemic and the multiple chronic conditions associated with it.
Now, here’s where it might be of impact to someone who doesn’t fall into the category that these services are aimed at: someone who, either because of good fortune, good lifestyle choices or a combination of both, have NONE of the chronic conditions that allow for a legitimate claim and whose clinical interactions with a practice amount to nothing more than annual wellness checks (such people do exist) There should be nothing to worry about, right? Well, scroll back on this board to my post on “Challenging underwriting decisions” for but one example of misuse of a good idea.
Quite apart from that, and the real reason I posted my initial question on personal experience, is that I don’t really want the constant reminders, check ins, nudges and whatnot that might very well be needed by some folk in order to maintain their health and I have a shrewd idea that this might be part of the deal should I elect to be part of the scheme