'The right direction'

Medicare beneficiaries with chronic conditions generate a set fee for each visit to the Center for Primary Care in Augusta, Ga. Yet that visit will generate numerous tasks—including making referrals to calling in prescriptions to answering questions over the telephone from the patient's spouse. None is reimbursed by the CMS.

“For every E&M visit we get reimbursed for, there are seven other items of work that we don't get reimbursed for,” said Dr Paul Fischer, founder of the Center for Primary Care. “The vast majority of our work gets done outside of the 15 minutes you spend in the exam room.”

For hundreds of thousands of primary-care physicians across the country like the 27 who practice at the seven sites run by the Center for Primary Care, the era of unreimbursed evaluation-and-management, or E&M, care may finally be coming to an end. Recognizing that care coordination may hold the key to keeping healthcare costs in check for an aging population, the CMS last week proposed reimbursing doctors starting in 2015 for patient care-management activities that don't involve face-to-face contact.

The 605-page proposed rule, which set an unspecified fee for initial consultations and another for ongoing management of chronically ill patients, will be open for comment until 

Sept. 6 with its final release set for around Nov. 1.

“Philosophically, we totally agree with it, and it's what we've been advocating for,” said Amy Gibson, chief operating officer for the Patient-Centered Primary Care Collaborative, a coalition of 1,000 healthcare stakeholders dedicated to disseminating research, advocating for reforms and convening experts to promote medical homes. “One of the barriers to practicing as a medical home has been the lack of payment for care coordination and helping patients and families navigate the healthcare system.”