1. Wallis, Laura


NPs may now be paid for work they already do.


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Managing the care of patients with multiple chronic conditions and multiple providers is one of the great challenges of modern health care. It's vital that one person be able to see the whole picture at one time-ensuring that medications are taken correctly, facilitating transitions, and preventing overlaps or gaps in care. The Centers for Medicare and Medicaid Services (CMS) has made meeting this challenge a priority, establishing a new policy to pay providers separately for coordinating the care of patients with multiple chronic health conditions.

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According to the plan proposal, in January 2015 the policy will begin paying providers approximately $42 per month per qualified patient, specifically to compensate for "non-face-to-face" chronic care management (CCM). Services that fall into this category include developing and updating plans of care, communicating with other health care providers who are treating the same patient, and monitoring and managing medication. (Go to to read the CMS fact sheet on proposed changes to this year's Medicare physician fee schedule.)


Patients who will qualify for CCM are those who have "multiple chronic conditions that are expected to last at least 12 months or until the death of the patient and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline." Practitioners who will be eligible for compensation are physicians, NPs, and physician assistants.


"A lot of it is what we've always done but never charged for," says Jan Towers, senior policy advisor for the American Association of Nurse Practitioners. "Part of the idea is to provide relief for [work] that [currently] goes uncompensated."


The policy is a part of a larger CMS effort to improve access to primary care for Medicare beneficiaries, as well as the quality of that care. This effort also includes the Medicare Shared Savings Program and other initiatives designed to facilitate payment for and encourage long-term investment in care management services.


The policy includes a provision that access to health care providers be made available to patients 24 hours a day, seven days a week. Consequently, the proposal includes "greater flexibility in the supervision of clinical staff" providing CCM services, and nurses within a practice will likely provide much of the CCM.


As for whether the policy change will greatly increase the number of patients receiving CCM services, "the jury is out on whether it will really make a difference," says Towers. The required documentation, including a required "patient-centered plan of care document," may prove to be a motivating factor. "Anytime you have to document something, it adds to the likelihood that it will happen. People won't be as likely to fall through the cracks," she says.


That said, this level of care is already a regular part of the workday for NPs and other providers. "We have lots of Medicare patients out there who have received very good medical care from NPs and physicians," Towers says. "This is really just a matter of creating a system that's accountable."


To read the entire proposed ruling, go to Wallis