Medicare Compliance & Reimbursement

There could be more associations between PCPs and specialists, expert predicts.

"Primary care is carrying new clout these days, a change that could shake up business as usual in healthcare, which is definitely on the federal government's agenda.

The Centers for Medicare & Medicaid Services is trying to shift more money to primary care, and in healthcare reform, there's essentially a 10 percent bonus for primary care physicians," observes Charles Root, PhD, president of CodeMap in Barrington, Ill.

Root predicts PCPs will also benefit from the Accountable Care Organization movement as it takes shape. "Organizations that want to participate as ACOs and so on are going to have to have a significant number of PCPs in an organization. So there's definitely going to be a shift toward primary care," he says.

"The most dramatic thing the Department of Health & Human Services has done in that regard" is the Medicare Medical Home demonstration, a three-year project now underway. In the demo, primary care doctors get $30 to $40 a month to coordinate care for a Medicare patient with a chronic condition, Root points out. And "probably 50 to 60 percent of Medicare patients may qualify as having a chronic illness," he says.

"The PCPs are very excited about this and hope it sticks, so to speak," Root adds. If it does pan out, he predicts there will be more associations between primary care physicians and specialists.

Root also sees where in "a lot of regs, CMS is including physician extenders in an effort to get more primary care in place because right now there are too many specialists. And that's what's costing Medicare a lot of money."

As an example of a small shift toward more primary care, Root points to the annual Medicare wellness exam, which can be performed by a physician or a non-physician practitioner.

Resource: For a FAQ sheet on the wellness exam, which went into effect on Jan. 1, go to www.alz.org/national/documents/MedicareAnnualWellnessVisit.pdf. Also see the article on billing the wellness visit on page 1 of this issue of Medicare Compliance & Reimbursement.