Chronic Care Reimbursement Rumble

Nirvani H
2 min readJan 18, 2016

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Chronic illnesses are by far the most expensive and oftentimes preventable health issues in the United States. They require attention before, during, and after they arise and they pull responsibility from the patient, the doctor, and care givers. This chain of responsibility is plagued with gaps: doctors can only do so much from their offices which leaves the patient and care givers with the task of maintaining their own chronic care management. Alas, there is a solution; albeit one that requires incentives, personalization, and planning. Let’s take a look at those components:

Incentives: CMS Reimbursement

Who is incentivized? The Center for Medicare and Medicaid Services (CMS) will not only reimburse physicians for face-to-face visits but they will also incentivize physicians to conduct remote patient monitoring. This value-based reimbursement program will allow physicians to coordinate a patient’s care via mobile devices and other telehealth technologies.

Why the stall? Although the incentive is there, it requires significant upfront costs to implement this value-based care program. However, the long-term advantage of implementing the program early is that as the industry continues to advance, offices will be more pliable in accepting those advances without having to play catch-up (which is where healthcare is right now).

Personalization: Patient-Centered Care

Shifting the focus. Many healthcare enthusiasts are disturbed at the continued reimbursement system because they believe too much focus is being set on the incentives as opposed to patient care quality. They think, If hospitals are “reaping millions” in healthcare reimbursement, is population health showing the same vitality?

We could only hope that the reimbursements come to rely heavily on outcomes, readmission rates, and patient data analytics. Patient-centered care cannot only rely on the physicians — as I often write about — because it requires the patient to carry the baton in participating in their own wellness!

Planning: What does it require?

The population. Patients with chronic illnesses can be identified either through medical database management or through a trial period of identifying a set group of patients with chronic illnesses. Once a population is established, it’s important to verify that these patients possess the necessary technology needed to cooperate in remote patient monitoring.

The technology. Physicians must have access to their patient’s records at any time and to make that process easier, they would need their patient’s consent electronically. This can be accomplished using a personal health record exchange such as MediPortal, where patient’s medical/health information is consolidated and retrievable.

What are your thoughts? Do you think more focus is on reimbursement and not enough focus is on patient care? It’s ironic because the reimbursements were set in place to improve patient care in the first place. Feel free to weigh in!

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