Chronic Care

In 2010 the chronic care disease state was responsible for 7 of every 10 deaths in the US and over 75% of the total health care costs. What is the percentage of patient visits – new and established that have a chronic care diagnosis? How do you treat them?

Today, the provider is so busy completing PQRS/VBPM and Meaningful Use requirements that it is estimated that only 55% of the providers day is actually involved in directly providing patient care. In addition, the overall care that is provided addresses the immediate need and may not address the on-going needs for managing the chronic care needs of the patient.

What can you do improve chronic care to patients in your office?

• Develop treatment plans and protocols around those key disease states. 
• Consider multiple chronic care states, e.g. 20% of Medicare patients have five or more chronic diseases and 10,000 US citizens become eligible for Medicare on a daily basis 
• Seek others to join the team or care process such as dietitians, certified diabetic educators, exercise physiologists, behavioral health professionals. These may be contracted or employees. There are key codes today in transition management of post hospital patients and chronic care codes for services covering 30-days. Now is a good time to look at the volume, team and see if there is anything that can be done to expand services. 
• The team can also be used during “shared medical visits”, SMV. An SMV brings around 15 patients together for a group visit. There is education, answering questions (the same one once rather than 15 times), and time set aside for individual visits, e.g., extract a patient for a few minutes from the group for an individual visit. Use established visit E & M codes 
• Consider the local market and assume some responsibility for population health management, broaden the perspective of patients needs, know the resources available in the community, and communicate healthier measures to the patient 
• Work closely as referred and referee of patients to insure the patient is receiving well coordinated care. 

The coming changes in reimbursement, less emphasis on fee for service and more on risk sharing, performance based approaches lead me to believe that managing these patients well will be a positive benefit maybe not today but certainly tomorrow. Now is the time to think about it.