Mrs. Jones, 78, may have diabetes, hyperlipidemia, hypertension, degenerative joint disease, chronic obstructive pulmonary disease, depression and memory problems. "That's a typical older patient," Thomas Weida, M.D., of Hershey, Pa., vice speaker of the AAFP Congress of Delegates, said in an interview recently.
Weida presented AAFP testimony on managing chronic care patients to the Practicing Physicians Advisory Council Feb. 23. PPAC makes recommendations about Medicare to the HHS secretary.
Weida told PPAC the Academy wants the Centers for Medicare & Medicaid Services to develop a chronic disease management model for primary care physicians. The model, he added, should also test the use of a fee for the services.
At first, PPAC members resisted the idea. Then they switched gears. PPAC tabled AAFP's recommendation but requested two hours be set aside at the council's May 17 meeting to discuss pilot projects in which CMS currently is engaged and whether the AAFP proposal would apply to any of those projects.
"Although I was disappointed by the council's decision to table, I was heartened the discussion regarding reimbursement for managing multiple chronic illnesses in Medicare has started," Weida said after his testimony. "We must overcome the inflexibility of a reimbursement system based on 'one illness, one visit' when dealing with Medicare patients with multiple illnesses that need to be addressed during and between visits."
A good care management system would make his practice more holistic and patient-centered rather than illness-centered, Weida said. "A good system would allow me to take more time with patients to handle their multiple problems, thus reducing the number of revisits. It would allow my staff or me the opportunity to coordinate their care when they are not in my office, such as by making calls to consultants, home health agencies and indigent medical programs."
In his testimony, Weida explained, "Family physician practices are at the front line of managing the multiple chronic diseases that beset America, and particularly its seniors."
He referred to data from the 1999 Medicare Standard Analytic File showing that Medicare patients without chronic conditions saw an average of 1.3 physicians in 1999. By contrast, those with a single chronic illness saw an average of 3.5 physicians, and those with two chronic conditions saw an average of 4.5 physicians. Seniors with six chronic conditions saw an average of 9.2 physicians.
"These figures argue for a single primary care physician who can provide cost-effective and coordinated care," he told PPAC.
Weida's testimony is available at http://www.aafp.org/x26272.xml.
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