Do you want fries with that?
New flash: Doctors, in their role as providers of consumer goods and services, will soon start offering a new service! Coordinated Care is coming to a doctor’s office near you!
Medicare has decided to pay doctors to coordinate care. CMS is calling it a “new service”:
“As part of the new service, doctors will assess patients’ medical, psychological and social needs; check whether they are taking medications as prescribed; monitor the care provided by other doctors; and make arrangements to ensure a smooth transition when patients move from a hospital to their home or to a nursing home.” http://www.nytimes.com/2014/08/17/us/medicare-to-start-paying-doctors-who-coordinate-needs-of-chronically-ill-patients.html?ref=health&_r=0
Well, now it will. Here’s how it will work: Medicare will pay doctors a monthly fee to coordinate care of medicare patients with two or more chronic conditions (2/3 of all Medicare patients). The doctor drafts a comprehensive plan of care for each patient, using EMR, and provides 24/7 access to someone on the doctors’ staff. In order to be eligible the patient must sign up for the “service”. I can just imagine the conversation:
Doctor: “Mrs. Jones, I understand you have more than two chronic conditions.”
Patient: “Yes, doctor, I believe I do.”
Doctor: “Would you like me to coordinate your care for you?”
Patient: “Of course doctor. I thought that’s what you were already doing.”
Doctor: “Oh, no Mrs. Jones. I only assess your medical psychological and social needs, check if you are taking your medications, monitor the care provided by other doctors, and make arrangements to ensure a smooth transition from a hospital to your home or a nursing home. Things like that.”
Patient: “Oh. What does coordinated care get me?”
Doctor: “The same thing. But in electronic comprehensive care plan form, which I will draft and type up over the weekend during my kids’ soccer game.”
Patient: “Well, if it’s electronic and comprehensive…”
The fee for this “new service”? $42 dollars per month. Part of which Mrs. Jones will pay herself. All those care-coordinating doctors are rolling in money now. Especially after they pay their staff for that 24/7 coverage. Now, I understand that this fee is actually progress, in the sense that being able to bill for something you already do is progress. Being able to bill for something lends a certain legitimacy that doing the same thing for free does not. Forty-two dollars, while a bit insulting, is not nothing. However, doctors are going to coordinate care as best they can the same as they always have. But now they’re going to have to document it, code it, bill for it, prove the 24/7 coverage, draft the care plans, in short, do everything they already do plus a whole lot more. For the cost of a couple of Washington DC burgers with fries and a pickle.