NDLI: Inadequate reimbursement for care management to primary care offices.

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Performance on the Maintenance of Certification for Family Physicians (MC-FP) examination: comparison of initial certfiers with experienced physicians.

An appetite for connection.

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Inadequate reimbursement for care management to primary care offices.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Holtrop, Jodi Summers Luo, Zhehui Alexanders, Lynn
Spatial Coverage	United States
Description	Author Affiliation: Holtrop JS ( From the Department of Family Medicine, University of Colorado Denver, Aurora, CO (JSH)); Luo Z ( From the Department of Family Medicine, University of Colorado Denver, Aurora, CO (JSH)); Alexanders L ( From the Department of Family Medicine, University of Colorado Denver, Aurora, CO (JSH))
Abstract	BACKGROUND: Care management in primary care can be effective in helping patients with chronic disease improve their health; however, primary care practices are often challenged to identify revenue to pay for it. This study explored the impact of direct reimbursement on the provision of care management in a primary care physician organization. METHODS: Using data on expenses and health plan reimbursement during the initial 16 months of care management implementation at 5 practices, we calculated the percentage of related costs that were covered by payments. Qualitative data from interviews with practice members were used to identify their perceived barriers to care management reimbursement and the impact of current reimbursement strategies on service delivery. RESULTS: Direct reimbursement for care management covered only 21% of the costs. Reimbursement varied by care manager background, patient diagnoses, insurer, and indication for the visit. Barriers to gaining reimbursement included patient resistance to copay, clinician hesitation to bill for care management visits (for fear the patient may receive a bill), differential reimbursement policies of insurers, and general lack of reimbursement for care management in many cases. Although practice-level quality improvement incentives were an alternative means of supporting care management, because these incentives were not directly tied to the service of care management, they were used for other activities ultimately supporting patient care. CONCLUSIONS: This study highlights the need for sufficient reimbursement to initiate and maintain care management for patients in primary care as proposed for service reforms under the Affordable Care Act.
File Format	HTM / HTML
ISSN	15572625
e-ISSN	15587118
Journal	The Journal of the American Board of Family Medicine
Issue Number	2
Volume Number	28
Language	English
Publisher	American Board of Family Medicine
Publisher Date	2015-03-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Primary Health Care Health Expenditures Physicians, Primary Care Primary Health Care Quality Improvement Chronic Disease Patient Protection And Affordable Care Act Retrospective Studies Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health Family Practice

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