Medicare Compliance & Reimbursement

Most providers enter the health care industry with a yearning to serve and help the communities where they live. With the onset of Medicare Access and CHIP Reauthorization Act (MACRA), and value-based care, innovations that put the patient’s health first are emerging and could be part of the advanced payment model (APM) package and options in the very near future.

“Patients are like submarines … out there submerged,” said Lawrence Kosinski, MD, a gastroenterologist and founder and chief medical officer of SonarMD in an AMA Wire press release on July 19, 2016. “We can’t see them; we don’t know how they are [because] they only come in when they’re in trouble. Which means that, number one, they have to recognize that they’re in trouble and, number two, realize that they can’t fix it themselves …. So we need a sonar system to ping them.”

Concerned about issues his Crohn’s patients might have between appointments, Kosinski, in coordination with Blue Cross Blue Shield of Illinois, devised a web-based system for connecting with his patients through EHR technology.

After an initial visit with a nurse manager who sets up a care plan with the patient, the innovative application called “SonarMD” reaches out to patients on the first Monday of each month with inquiries aimed at helping them cope with and track issues, alerting the physician to problems or irregularities.

In addition to tracking Crohn’s patients, Kosinski has added IBD patients to the program as well and hopes to offer the application to sufferers of other gastroenterological diseases. “Our goal is to be able to handle over 50 percent of the encounters for a gastroenterologist so we can actually function as an Alternative Payment Model (APM),” he said in the AMA Wire release.

Resources: For a closer look at this AMA Wire press release, visit http://www.ama-assn.org/ama/ama-wire/post/tracking-patients-between-visits-new-care-model.