Message from Chairman of MWMD Board

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.

Categories: MWMD Newsletter