Are You Ready for 2015?

It’s that time of year again. Here in Michigan, autumn is in the air, the leaves are changing, the weather is turning colder and we are readying our homes and cars for winter. As our lives change with the seasons, so does health care. The title of this blog, “Are you ready for 2015?” is not a typographical error. In order to be ready for the future, we have to prepare in the present.

In July of this year, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update current payment policies and rates for services furnished under the Medicare Physician Fee Schedule on or after January 1, 2014. The proposed rule in its entirety can be found at www.federalregister.gov. If the proposed rule becomes a final rule, physicians will be able to bill for managing select Medicare patients’ complex chronic care management needs. This is a positive step toward rewarding physician practices that provide chronic care services, especially those patients with multiple conditions and needs requiring additional resources. CMS is delaying payment till January 2015 because it knows physician practices will need the extra time to develop, manage and put the systems and processes in place to meet the standards.

The scope of services in the proposed rule may include some of the following:
§  Patient access to a health care provider  24/7 for urgent chronic care needs with access to the patient’s full electronic medical record even after the office closes;
§  Creation of a comprehensive care plan to address all aspects of a person’s health, congruent with the patient’s choices and values;
§  Management of care transitions including  referrals to other clinicians and timely follow up care after discharge from an ER visit, inpatient stay or skilled nursing facility, including the electronic exchange of  information;
§  Coordination of community based referrals; and
§  Utilizing secure messaging or other non face-to-face consultation methods with the patient.

Many of the proposed standards for providing complex chronic care management services are tied to the most recent Health and Human Services regulatory standards for Meaningful Use. The EHR must be integrated into the practice to support access to care, care coordination, care management and communication. For physician practices that are operating as patient centered medical homes (PCMH), there are suggestions to consider a nationally recognized PCMH practice as one means of meeting the care coordination standards for complex chronic care management services.  

Practice Transformation Institute (PTI) is a southeast Michigan leader in helping primary care practice teams transform to a patient centered model of care. PTI has classes available to help your practice attain the proposed changes coming in 2015. To meet the needs of national PCMH programs, PTI has trained coaches for NCQA’s PCMH Recognition program and URAC PCMH Certified Auditors for their Achievement program.

PTI is ready. Are you?