Survey: Half of primary care doctors aren't aware of chronic care reimbursement

A doctor examining a patient's eyes
Doctors cite coding complexity and burdensome paperwork as major barriers to participating in a chronic care management program. (Getty/monkeybusinessimages)

A majority of primary care physicians say they are unable to adequately address the needs of their patients with multiple chronic conditions.

But many are also unaware of a Medicare program that will reimburse them for services that help keep tabs on those patients between doctor visits, according to a new survey conducted by Quest Diagnostics.

Only half (51%) surveyed know that the Centers for Medicare & Medicaid Services (CMS) may reimburse for those services.

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The survey included 801 primary care physicians (PCPs) and Medicare patients with multiple chronic conditions. Only 9% of physicians are very satisfied that their Medicare patients with multiple chronic conditions are getting all the attention they need to care for all medical issues.

“Two in three Medicare patients have multiple chronic conditions that require ongoing medical attention and substantial resources from the healthcare system. Our survey findings show that PCPs desperately want to deliver high-quality care, but they feel they are failing their patients with the most complex care needs.,” said Jeffrey Dlott, M.D., medical director for chronic care management at Quest Diagnostics.

The biggest barrier for doctors to care for patients with multiple chronic conditions? Time constraints. Nearly all the physicians (95%) surveyed said they entered primary care to care for the “whole patient.” However, 85% said they are too pressed for time to address complex clinical conditions and 66% say they don’t have time to address patients’ social and behavioral issues, such as loneliness or financial worries, that could affect their health.

Recognizing the problem of caring for complex patients, CMS began reimbursing for CCM services in 2015 for Medicare patients with two or more chronic conditions to support patients in between physician visits, according to a report (PDF) based on the survey.

CCM services are non-face-to-face care, such as electronic and phone consultation, and often focus on medication management, coordinating care with hospitals and other providers, personalized guidance to set health goals and 24-access to providers. Further adjustments to the physician fee schedule to account for chronic care coordination kicked off at the beginning of 2017.

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Eighty-four percent of physicians said CCM services could be an extension of their practice to help provide quality care, but only 23% have implemented it, citing coding complexity and burdensome paperwork as major barriers.

“Physicians are open to adopting CCM, but it has to be easier to implement and a trusted extension to one’s practice,” said Katherine A. Evans, immediate past president of the Gerontological Advanced Practice Nurses Association.

Participation in CCM programs by PCPs has been slow, although CMS estimates 70% of Medicare beneficiaries—roughly 35 million people—would be eligible, the Quest report said.

CMS last year launched an education program aimed at encouraging more providers to take advantage of Medicare reimbursements for CCM services. The Connected Care initiative includes toolkits for both providers and partner organizations to better understand the program and how to code for those benefits. 

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