In a signal that care-coordination has gone well beyond lip service, there was news last week that the American Medical Association is adding new codes to its 2013 Bible on provider reimbursement. The book, 2013 CPT Professional Edition, is the essential link between providers office activity and the payments they receive from insurers.
These aren't the first CPT (Current Procedural Terminology) codes around care coordination, but they may be the first that allow providers to be reimbursed for activities even when the patient does not visit the office.
These online and telephone coordination activities cover a wide range -- connecting patients to community resources, helping to transition them from the hospital to the home or nursing home, or working on ways to avoid hospital readmissions.
All of those examples highlight where we are in 2012 in the midst of healthcare reform. Starting this year, the Centers for Medicare & Medicaid Services will penalize hospitals whose 30-day rates for unnecessary inpatient readmissions are high. Because dozens of hospitals are also at the center of accountable-care experiments, we'll also see thousands of physicians, nurse case managers and others working on improving these metrics, and in 2013 they could get paid to do so.
The huge growth in patient-centered medical homes also means providers have spent a lot more time on connecting patients with community resources making sure they have rides to the doctor's office, securing mental health services, checking on their refills with pharmacists. All of those things add up to time, and now, more money.
Like managed care in general, the CPT codes reflect the constant movement into new territory. The AMA says the new book deletes 119 codes, adds 186 more and changes 263 others a reminder that streamlining and improving our byzantine healthcare system will be a long, complicated haul.
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