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AMA Asks Medicare to Start Paying Doctors for Care Coordination

Cheryl Clark, for HealthLeaders Media, October 11, 2011

Levy added that the AMA's Chronic Care Coordination Workgroup, which settled on these recommendations, will continue meeting to consider longer-term changes that can "appropriately recognize physicians' work on patient care coordination and the prevention and maintenance of chronic diseases."

Levy's letter says the recommendations are of "immediate urgency" because the 2012 Medicare Physician Payment Schedule, which is now in draft form, will be finalized in November, setting payment policies starting Jan. 1, 2012. The draft version does not include any mechanism for paying doctors who coordinate care of Medicare patients.

The annual cost of paying physicians more for these services would be about $200 million, but that amount would be offset by savings from a major review last year in which the RUC reclassified certain overvalued physician services, the AMA contends.

For example, before this review, radiologists performing CTs of both the pelvis and the abdomen could bill under two separate billing codes, when in fact not much more work was required. Now those codes are bundled.

More than $1 billion was redistributed in physician payments last year, and the AMA believes some of those savings could be used to pay for care coordination when it requires a physician's expertise rather than a nurse's.

"The RUC's work on misvalued codes provides an opportunity to offset the costs [of the new recommendations], negating any impact to the Medicare conversion factor," Levy wrote.

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