New Legislation Includes Care Management Concept Proposed by Family Physicians

WASHINGTON - The American Academy of Family Physicians supports the Geriatric and Chronic Care Management Act, S. 2593, introduced by Sen. Blanche Lincoln (D-Ark.). The legislation authorizes payment for geriatric assessment and care management for Medicare beneficiaries. It incorporates elements of the care management fee concept advocated by the AAFP.

The AAFP proposes that a care management fee be paid to the patient's personal physician to coordinate the patient's health care. This fee would support the functions and technology necessary to care for patients with multiple chronic conditions: tracking and monitoring all aspects of patients' care, referring the patient to other health care providers and coordinating clinical reports, maintaining the patient's health record, and spending more time with the patient as needed. The care management fee would be paid per-patient-per-month by Medicare, Medicaid or private insurance plans as appropriate.

The care management fee is among the variety of options provided in S. 2593 for Medicare to reimburse physicians for caring for patients with chronic conditions. In addition, the legislation calls for a study by the Department of Health and Human Services to analyze which of these options may work best.

"The current health care system reimburses physicians based on lab tests, procedures and diagnoses," said Michael Fleming, M.D., AAFP president and a practicing family physician. "If I have a patient with five different chronic conditions, I can do a lot more for him or her when we sit down and discuss lifestyle, family medical history, goals, and relationships with family and friends. That way I can provide a comprehensive care plan, coordinate with other health care providers, and maintain an accurate record of patient care. Establishing this type of 'personal medical home' for a patient takes time, and taking time isn't valued in the present reimbursement system."

Making the care management fee part of the reimbursement system would assure that these services are available to everyone and not exclusive to those who can afford to pay more out-of-pocket for health care. Right now, the Medicare program rewards physicians for doing more tests and procedures, as often as possible, and penalizes them for actually consulting with people and integrating patients' overall health care.

The AAFP's recommendation arises from the need to transform the overall health care system into one that is more cohesive. "People benefit from having a usual source of care even if they have no insurance and regardless of their health status," Fleming said. "They get more appropriate preventive care and receive more appropriate medications than those without a usual source of care and do not rely on more costly emergency rooms for their health care." By contrast, he added, people without a usual source of care have more problems getting necessary health care and often delay or fail to seek appropriate medical care when they need it.

More than 12 times as many people are seen in primary care physicians' offices in the U.S. than in hospitals. The Institute of Medicine has stated that fee-for-service payments do not favor primary care services and that alternative payment options are needed. "We believe that some blend of fee-for-service and a care management fee is the best way to maintain access to urgent services and the benefits of a personal medical home," said Fleming.

"The AAFP is deeply appreciative of the work of Sen. Lincoln to assure that our seniors receive effective care for chronic conditions and for her recognition of the essential role family physicians have in providing that care," said Fleming.