Personalized Care Planning

(cjs56) #1

I believe that so-called Personalized Care Planning is a COVERED service by Medicare. Correct?
This is a formal process between a patient and a physician whereby the two collaborate and create a so-called longitudinal treatment plan especially if the patient is a complex high need individual. In other words, your geriatric patient on 10 medications and that needs several visits to be properly medically managed.
The reason I ask is:

  1. that if it is NOT a covered service, then could a D.P.C. physician collect a separate fee from the PATIENT while still being enrolled in Medicare (still opted in)?
  2. If it is a COVERED service, then could this possible increase home visit physician reimbursement to a physician doing house calls if that house call physician remained enrolled in Medicare (still opted in)? If so, I wonder if the coding level could reach a higher level code…say…99350 (highest home visit code for an established patient) or 99345 (highest visit code for a new patient)?

(Robin Dickinson) #2

There are some people doing Medicare/DPC hybrid. They generally have a lawyer help with the details of making sure it’s legal. Here’s some information on that.

I also know someone who sat down and figured out she was only getting $20 per month per Medicare patient in her practice even with incentive payments…so just something to think about. How much would it actually cost to switch over completely?

(Jack Forbush, DO) #3

I suppose that if it is NOT a covered service, then the patient could sign an ABN for this service…deflection to @philsq

(Dr Phil Eskew, DO, JD, MBA) #4

Sorry guys I am all too weary of this discussion. The original poster is basically describing a concierge fee for noncovered services model. I don’t try to stay apprised of what Medicare does or does not cover. I don’t care. I don’t play this legally risky and expensive game and do not recommend others pursue it either. Medicare does have chronic care management codes that are a step towards DPC, but the games you play to get payment are not worth it and you still have high overhead and FFS billing obligations. My two cents: when you run a hybrid concierge model (aka MD VIP or One Medical Group) most of the “extra” money you get from your monthly (noncovered services) fee goes to your attorneys and other consultants that set up the complicated structure rather than your own bottom line (and all the legal risk stays with you BTW).

(cjs56) #5

Thanks Dr. Eskew.

(Jack Forbush, DO) #6

I agree @philsq . Every time this conversation comes up, I’m reminded of my childhood when I was “forced” to attend both Catholic Mass and the local Baptist service.

More Sundays than not, I had no idea whether I was supposed to stand, kneel, make the cross or what.

Sure, there may be some loopholes for “personalized care planning” or whatever bullshit interpretation one wants to envision, but I agree with you, I really don’t care. You’re either in or you’re out.

(cjs56) #7

I guess the C.M.S. rules are always changing as far as what is a covered service and what is not a covered service.
So, the D.P.C. physician keeps spending legal fees to try and keep up with any legal changes.
I spoke with a Concierge physician in Torrance, CA and one in Vermont.
Both seemed to think they could stay one step ahead of Medicare as far as charging a yearly membership fee to be guaranteed 24/7 access as well as other services that Medicare does not provide/cover.
Medicare assignment is accepted. Office billing is done only for Medicare covered services. Any discounts or reductions in pay from Medicare to the physician (accepting assignment, denial of payments, etc.) are just written off by the physician.
In other words, with the yearly payment, the patient is making the payment up front. The physician still is opted in with Medicare and takes what Medicare gives him’her and just writes off any discounts.
Sound good Jack?

(pouya bahrami) #8

I think you can take Medicare FFS, Medicare IPA contract, and have DPC model for those who don’t qualify for Medicare. You can also charge a fee for services that have nothing to do with medical coding, such as timeliness, increased access, telemedicine. This is gives a complete package for a practice. Why do we have to even contemplate taking Medicare FFS or HMO senior plans and charge the same population DPC monthly charges? It’s a false choice.