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New Medicare Rules Should Help 'High Need' Patients Get Better Treatment

By Kaiser Health News  
   December 22, 2016

Physicians will also get extra reimbursement for extra time they spend in person with complex patients or their caregivers.

Dr. Paul Tatum, an associate professor of clinical family and community medicine at the University of Missouri School of Medicine recently scheduled a half hour for a patient in his mid-70s with high blood pressure, kidney disease, skin issues and cognitive impairment. But the visit ran to 90 minutes when it became clear the gentleman was more confused than ever, falling, not eating well, not taking medications, and needed more help.

"Much of what we did for this patient fits in the new Medicare codes, which recognize the extent of what's needed to care for people with complex illnesses," the doctor said.

Integrating Behavior Health
Research has shown the seniors with depression — a frequent complication of serious illness — benefit when primary care physicians collaborate with psychologists or psychiatrists and care managers track their progress.

Now, Medicare will begin paying $142.84 for the first 70 minutes that physicians and behavioral health providers work together, $126.33 for the next hour, and $66.04 per half hour for a care manager who stays in touch with patients and tracks whether they're improving.

Care managers may work on site or off; psychologists and psychiatrists will be called for consultations, as needed.

"Accessing mental health services is a really big problem for my patients, and having professionals ready to work with me and compensated to do so will be extraordinarily valuable," said Rodgers of the hospice and palliative medicine academy.

KHN's coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


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