The American Medical Association wants Medicare to start paying doctors for four types of coordination services because they avoid more expensive patient care in the hospital down the line.
The services include responding to telephone calls seven days or more after a patient sees the doctor, education and training to enable patients to better manage their own health, better management of anticoagulation drugs such as warfarin, and time spent coordinating team-based care when the patient is not present.
In a letter last week to Centers for Medicare & Medicaid Services Administrator Donald Berwick, MD, the AMA explained that these services fit into a general category of chronic care coordination, which if incentivized with dedicated effort, would improve quality of care and avoid more costly hospitalizations, especially for patients with multiple co-morbidities. Some of these services are now provided by doctors, but they do it for free or with money paid for a previous visit.
“When treating patients with chronic conditions, such as heart disease and diabetes, physicians provide many services that are currently not recognized or compensated by Medicare," wrote Barbara Levy, MD, chairperson of the AMA's Specialty Society RVS (Relative Value Scale) Update Committee, known as the RUC. The AMA's RUC makes recommendations on how various types of physician services should be valued and paid by a variety of payers, and 94% of those recommendations have been upheld by CMS.
"Not only will payment for these services save Medicare money in unnecessary office and emergency room visits," Levy wrote in the letter, "potential savings in Medicare Parts A and D will also offset upfront payment for non–face-to-face services."