Resources for Physicians

Medicare Pays Doctors to Coordinate Seniors’ Chronic Care

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Medicare's new fee for care coordination is about $40 a month per qualified patient.

Medicare’s new fee for care coordination is about $40 a month per qualified patient.

BY Lauran Neergaard, Associated Press January 11, 2015 at 3:33 PM EST

WASHINGTON (AP) — Adjusting medications before someone gets sick enough to visit the doctor. Updating outside specialists so one doctor’s prescription doesn’t interfere with another’s.

Starting this month, Medicare will pay primary care doctors a monthly fee to better coordinate care for the most vulnerable seniors — those with multiple chronic illnesses — even if they don’t have a face-to-face exam.

The goal is to help patients stay healthier between doctor visits, and avoid pricey hospitals and nursing homes.

“We all need care coordination. Medicare patients need it more than ever,” said Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services.

About two-thirds of Medicare beneficiaries have two or more chronic conditions, such as diabetes, heart disease or kidney disease. Their care is infamously fragmented. They tend to visit numerous doctors for different illnesses. Read more


Medicare Proposes Lung Cancer Screening Coverage For Those At Risk

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Medicare beneficiaries at high risk for lung cancer may get free annual screenings if proposal is approved.

Medicare beneficiaries at high risk for lung cancer may get free annual screenings if proposal is approved.

Medicare is proposing to pay for annual lung cancer screenings for beneficiaries at high risk for lung cancer. Evidence suggests that properly done CT scans can help doctors find tiny lung tumors in longtime smokers while the cancer can still be treated effectively.

To qualify, patients would have to first meet with a doctor to talk through the pros and cons of scans, which involve a low-dose of radiation.

Patients would have to be:

*Between the ages 55 and 74;

*Have no symptoms of lung disease;

*Have smoked the equivalent of 30 pack-years (or a pack a day for 30 years);

*And be a current smoker or have given it up in the past 15 years.

Lung cancer is the No. 1 cause of cancer deaths in the U.S. More than 159,000 Americans are expected to die from cancers of the lung and bronchus in 2014, according to the National Cancer Institute.

About 4.9 million people with Medicare coverage would meet the criteria for screening. The average annual cost of Medicare screening was estimated at $241 for each person screened.

The Medicare proposal “likely means that thousands of Medicare beneficiaries will have access to this important and potentially life-saving service,” said Dr. Richard Wender in a statement on the American Cancer Society’s news blog. “This would place Medicare policy in line with current guidelines and the recommendations of many interested advocacy and professional organizations, including the Society.”

For more information on this topic, go to NPR’s Medicare Poised to Cover CT Scans To Screen for Lung Cancer

and

Medicare Proposes Paying for Lung Cancer Screenings for Older Longtime Smokers

 


Better Health, Lower Costs for People with Complex Needs

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IHI white paper outlines methods and opportunities to better coordinate care for people with multiple health and social needs.

IHI white paper outlines methods and opportunities to better coordinate care for people with multiple health and social needs.

Nearly half of all health care spending in the U.S. is driven by just five percent of the population (AHRQ, 2010), and this needn’t be the case, reports the Institute for Healthcare Improvement (IHI).

There is a tremendous opportunity to coordinate care for people with complex health and social needs, resulting in better health outcomes, improved care experience, and lower costs. The freely available IHI white paper, Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs, outlines methods and opportunities to improve care for people with complex needs, and highlights ways to better allocate resources to meet the range of needs in this population.

For those who want to take it one step further to improve health outcomes and lower costs for this population sustainably, and at full scale, consider IHI’s newest Collaborative, Better Health and Lower Costs for Patients with Complex Needs (begins July 23). During this 12-month Collaborative, participants will craft comprehensive care designs that meet this population’s needs more effectively at a significantly lower cost.