Yes, PHM Can Get You Paid

Stethoscope and cash sm

Skip Leavitt, PA, MBA, FACMPE

The case for effective population health management couldn’t be clearer. But still there is great reticence on the side of providers and health systems, many of whom believe that adding PHM activities will threaten fee-for-service revenue. They want to be able to increase quality and lower costs for their patients, but there are some commonly held concerns that don’t have to be true:

  • Myth 1. If they are successful with their PHM, then their fee-for-service revenue will drop, and it will drop faster than value-based revenue increases.
  • Myth 2. The tech cost will be very high and they think they have to pay for the technology up-front.

Here is what organizations that have been successful at a transition to PHM have figured out: There are activities documenting a track record of increasing quality that are also reimbursable under the current fee-for-service system.

Let’s take, for example, Chronic Care Management (CCM), which Medicare has just put in place.

If a provider has a Medicare patient who meets CCM criteria, they can get paid $42 per month per person for care coordination, which can be done by non-physician staff, such as an office nurse.  For a typical internist, who has 500 Medicare patients, that’s $21,000/month for doing care coordination. And that’s just one example.

By appropriately documenting the care coordination done for those patients, providers can build their record.  Also, it’s been shown practices doing chronic care management experience a higher rate of Medicare patients coming in for annual medical evaluation — which increases the compliance with the wellness evaluation.

Many practices would like to do care coordination, but are overwhelmed by the day-to-day issues of running the practice. Becoming part of a clinically integrated network can provide the needed expertise and resources at minimal cost.

Another example to show how PHM can get you paid is closing care gaps. We know most patients don’t get the preventive care they need; typically, less than half of the patients get the recommended preventive care measures. Simply identifying those patients, bringing them into the office, and arranging for preventive care increases FFS volumes and also increases the documented improved quality of care.

PHM can be game-changing for your practice, if you’re willing to make a few changes. Don’t let the misconceptions about transitioning to value-based care hold your practice back.  Not only can you set your practice up for success in this new healthcare landscape — but also increase your revenue during the change-over.

Skip Leavitt, PA, MBA, FACMPE, has more than 25 years of healthcare management experience, including clinical and executive positions in both the provider and payor sectors. On the leadership team of JHD Healthcare Partners, Mr. Leavitt puts that expertise to work helping physicians, hospitals and health systems succeed.

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