Inadequate reimbursement for care management to primary care offices

Journal of the American Board of Family Medicine : JABFM
Jodi Summers HoltropLynn Alexanders

Abstract

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. 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. 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 qualit...Continue Reading

Citations

Apr 3, 2016·The Journal of Arthroplasty·Daniel H WizniaRichard R Pelker
Mar 29, 2018·International Journal of Integrated Care·P TimpelUNKNOWN MANAGE CARE Study Group
Mar 7, 2018·Journal of Clinical Psychology in Medical Settings·Dennis S FreemanJoel Hornberger
Nov 30, 2018·Professional Case Management·Kyle Bradford JonesPaul Carbone
Jun 25, 2017·Journal of Primary Care & Community Health·Jodi Summers HoltropJohn Piette
Mar 22, 2021·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·Ani BilazarianLusine Poghosyan

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