Diabetes Self-Management Blog

When it comes to treating chronic conditions like diabetes, one common complaint among both doctors and patients is that the health-care system is geared toward providing care for acute medical conditions: those that arise quickly and can usually be resolved quickly. Providing adequate chronic care can be difficult for many reasons, but among them is the way doctors are paid for providing care. As we noted back in 2011, doctors tend to lose money on patients with diabetes due to the extra time these people require. Doctor practices tend not to bill a patient’s insurance provider — whether that provider is a private insurer, or a government agency like Medicare or Medicaid — for longer visits because of the extra scrutiny (and delays in payment) that this would invite.

A new Medicare rule, however, might make it easier for doctors to prioritize the care of patients with chronic conditions. Introduced last week, the proposed rule would allow doctors to bill Medicare for “non-face-to-face complex chronic care management services for Medicare beneficiaries who have multiple, significant chronic conditions,” according to an article at Becker’s Hospital Review. This means that starting in 2015, primary-care doctors with patients who have two or more chronic conditions could spend time outside of regular appointments working on a plan of care or coordinating that care with other members of a patient’s health-care team. Rather than being paid for time spent, however, doctors would be paid a single fee first for developing a plan of care, and then for care management over each 90-day period. Doctors would need to obtain a patient’s consent each year to be eligible for these payments.

It remains to be seen, of course, whether a single payment every 90 days will let doctors spend enough time coordinating chronic care to make a significant difference in health outcomes. Due to its size and structure, Medicare will most likely be able to evaluate the effects of this policy eventually; it can look at claims filed on behalf of patients whose doctors are managing a plan of care to see whether these beneficiaries are more or less likely to be in good health than those without a plan of care. If no better outcomes are found, however, that still leaves open the question of whether the extra payments are a bad idea or simply inadequate.

What do you think — will paying doctors to develop a plan of care for patients with chronic conditions lead to improved health outcomes? Should such plans of care be mandatory for all patients who qualify under the proposed rule? Should Medicare keep the new payment system in place even if it ends up costing more than it saves by reducing medical expenses? Are there better ways to spend money to manage chronic conditions than by paying doctors for planning and coordination? Leave a comment below!


Medicare and Chronic Care
Medicare and Chronic Care

  1. Until the regulations are finalized - who knows!!! There are too many variables to be discovered. This may be a great advantage for patients and doctors, or another government boondoggle.

    Posted by Bob Fenton |
  2. I have no objection to paying them extra for “planning” as long as they DO it. That would be my question each year as they are asking me to consent; “What, exactly, are you doing to ‘plan’ in my absence my care?” Meanwhile, I wish at least part of the $$$s would be available to the patient to develop his/her plan. Like for counseling, life/exercise coaching, gym/exercise program fees–things like that that are proven “winners” in improving diabetes management & are also proven cost-savers both immediate in meds & longer-term in secondary & tertiary prevention of related complications. Being able to get the supplies (pump 5/or testing supplies) you need, in the amount needed for good control, would be nice too!

    Posted by Redneck Angel |

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