Advanced Primary Care Management $20/month charge to medicare

[folivier]

DW just noticed this, a $20.00/month charge to medicare for each of us. After talking with medicare rep. and then visiting the billing department at our primary doc's office it seems that medicare has changed their reimbursement model and has added a new program called Advanced Primary Care Management. Supposedly there won't be any charge to us but it is something we weren't told about by our doc.
This new program's services includes:
1. 24/7 access to our care team for urgent needs.
2. Communication through MyChart.
3. Offering Telehealth visits when deemed necessary.
4. Coordination of care with other providers and specialists.
5. Access to our individual care plan developed by our care team.
6. Scheduling routine appointments to monitor all health maintenance and our care plans progression.
7. Ensuring that we are up to date on preventative services (i.e. routine immunizations), medication management, and assessing your medical and psychosocial needs.
8. Various health reminders for preventative services like flu shots, colonoscopy, etc.

Has anyone else seen this? All 8 points above were always things we have been receiving. Granted we changed to this doctor this year from another practice.
Thoughts?

 

[MichaelB]

Interesting, I never heard of this. Something to look into.

Why would the primary care physician be collecting this without informing the patient? That’s odd.

A little web searching shows this to be something akin to an HMO. It requires patient verbal or written consent, and once engaged, the patient is not free to see another primary care physician.

This looks Iike a program that lends itself to people with chronic conditions that require regular treatment.

 

[PaunchyPirate]

That doesn't sound like a change to Medicare. That sounds like your doctor's office is changing to a "concierge practice". It's becoming more and more popular. You might want to do a google search on that topic. There have been others on this board who have mentioned they use a concierge doctor. So someone will likely pop in to comment on that.

But honestly, most of those things in your list are things that my regular PCP's office does already and they don't consider themselves concierge doctors.

Is Medicare/Medicare Advantage paying for this? I'd be curious to what code the doctor's office is using to submit a claim.

 

[folivier]

A bit more info, first is the medicare page for docs, second is the medicare page for us:

Advanced Primary Care Management Services | CMS

APCM services combine elements of several existing care management and communication technology-based services you may have already been billing for your patients.

www.cms.gov

Advanced Primary Care Management services

Discover Medicare Part B’s Advanced Primary Healthcare Management Services. Manage your health conditions with careful coordination, 24/7 access, and medication management.

www.medicare.gov

We have a followup appt. with our doc tomorrow so we'll ask about this to get his perspective.

 

[MBSC]

Is Medicare/Medicare Advantage paying for this? I'd be curious to what code the doctor's office is using to submit a claim.

G0556 (OM approved amount $18-$20 depending on location), G0557 ($53-$60) and G0558 (QMB only, $110-$140).

ETA: I was typing when the OP posted the above links.

Advanced Primary Care Management Services | CMS

APCM services combine elements of several existing care management and communication technology-based services you may have already been billing for your patients.

www.cms.gov

 

[folivier]

It looks like they're "giving" us all of these new benefits. But we've been receiving them all along. Now we have to pay for them. Yeah, I know it will only amount to a dollar or 2 if your provider even bills you for it. But someone is paying for this.
Higher insurance costs?
It also appears to benefit your doctor due to different billing practices. And it's coming for everybody.

 

[RetMD21]

Actually complying with the requirements from the professional side sounds complicated. I wonder how practices will do with audits.

 

[rk911]

Never heard of that but we have all of those 'features' with all of our docs, primary and specialty. No extra charge.

 

[folivier]

That's my point rk911. We've always had those features but now his practice is charging medicare $20/month for each of us. Supposedly we signed for it and had it explained to us. But that never happened.
Check your medicare statement, might be surprised.

 

[target2019]

I was asked to sign up and declined. I did notice my primary was very short in the last followup.

 

[rk911]

That's my point rk911. We've always had those features but now his practice is charging medicare $20/month for each of us. Supposedly we signed for it and had it explained to us. But that never happened.
Check your medicare statement, might be surprised.

I will. Thanks

 

[Koolau]

$20? Sorry, I can't get too upset about that. I just don't want to be "signed up" for something I don't understand, no matter the cost.

 

[folivier]

Didn't ask our doctor. First thing he said when he walked in was "I'm retiring." So we've spent the last couple days finding a new doctor. The ones he recommended were all recently out of residency. So we found one with 10 years and made our November appointments with her. She should be around for a while.

 

[RetiredHappy]

That doesn't sound like a change to Medicare. That sounds like your doctor's office is changing to a "concierge practice". It's becoming more and more popular. You might want to do a google search on that topic. There have been others on this board who have mentioned they use a concierge doctor. So someone will likely pop in to comment on that.

But honestly, most of those things in your list are things that my regular PCP's office does already and they don't consider themselves concierge doctors.

Is Medicare/Medicare Advantage paying for this? I'd be curious to what code the doctor's office is using to submit a claim.

This has nothing to do with concierge practice. Concierge PCP charges several thousands of dollars per year to the patients to be enrolled with them. Billings to insurance companies and Medicare do not change.

We each pay our concierge PCP $2,500 a year.

 

[rk911]

Didn't ask our doctor. First thing he said when he walked in was "I'm retiring." So we've spent the last couple days finding a new doctor. The ones he recommended were all recently out of residency. So we found one with 10 years and made our November appointments with her. She should be around for a while.

Had the same thing happen to us a few years back, sorta. He wasn't retiring he was just dropping all of his patients who were not on Medicare Advantage plans. But our doc had already transfered us to our current doc who we like much better.

 

[Dalton]

Sounds like they've found a way to be reimbursed for a lot of the clerical/admin stuff they've had to add staff (to meet insurance/regulatory requirements for) and that they have been complaining about it increasing costs for so long.

 

[grayv]

We each pay our concierge PCP $2,500 a year.

how many concierge patients does that PCP have?

 

[RetiredHappy]

how many concierge patients does that PCP have?

With this particular concierge doctor, my guess is fewer than 300. Concierge doctors are usually vague, throwing out numbers like fewer than 300/350/400/450. We had our previous concierge doctor for 6 years and we fired him and moved to this new concierge doctor.

 

[ShadowBloom]

I briefly considered signing up with a concierge practice. They weren't fully concierge--they had some traditional patients and some who paid $5K/year for extended access and supposedly more extensive care services. They wouldn't tell me the breakdown between concierge and non-concierge patients, or explain how timeslots were managed so concierge patients got easy access without causing significant delays for other patients. I did not sign up with them, but they're popular enough that they're now closed to new patients in both concierge and traditional models.

 

[Teacher Terry]

No thanks to being micromanaged by a primary care doctor. I had enough of that when I was employed by the state and the beautiful thing about Medicare and paying for my supplement plan is that I can go to any doctor that I want.

 

[RetiredHappy]

No thanks to being micromanaged by a primary care doctor. I had enough of that when I was employed by the state and the beautiful thing about Medicare and paying for my supplement plan is that I can go to any doctor that I want.

The advantage of a good concierge doctor is that you can see the doctor same day PLUS their connection to the best specialists. It is really the network of specialists that give the best value, and sometimes being able to see the specialists sooner than when we call them to schedule.

 

[Teacher Terry]

The advantage of a good concierge doctor is that you can see the doctor same day PLUS their connection to the best specialists. It is really the network of specialists that give the best value, and sometimes being able to see the specialists sooner than when we call them to schedule.

I totally agree with you. But what the OP was talking about is more like a HMO and limiting access to healthcare. I went on the Medicare website and read about it.

 

[RetiredHappy]

I totally agree with you. But what the OP was talking about is more like a HMO and limiting access to healthcare. I went on the Medicare website and read about it.

Got it. I wasn't sure if you were referring to the OP or my response to the question of concierge doctor. We were with Kaiser, and as good as they were as a HMO overall, their care of me was horrendous. I won't go back to a HMO.

 

[EastWest Gal]

DW just noticed this, a $20.00/month charge to medicare for each of us. After talking with medicare rep. and then visiting the billing department at our primary doc's office it seems that medicare has changed their reimbursement model and has added a new program called Advanced Primary Care Management. Supposedly there won't be any charge to us but it is something we weren't told about by our doc.
This new program's services includes:
1. 24/7 access to our care team for urgent needs.
2. Communication through MyChart.
3. Offering Telehealth visits when deemed necessary.
4. Coordination of care with other providers and specialists.
5. Access to our individual care plan developed by our care team.
6. Scheduling routine appointments to monitor all health maintenance and our care plans progression.
7. Ensuring that we are up to date on preventative services (i.e. routine immunizations), medication management, and assessing your medical and psychosocial needs.
8. Various health reminders for preventative services like flu shots, colonoscopy, etc.

Has anyone else seen this? All 8 points above were always things we have been receiving. Granted we changed to this doctor this year from another practice.
Thoughts?

That's a list what primary care doctors are supposed to be doing in the first place! 24/7 access to the practice can be abusive to the practitioners due to burnout, so most practices have advice nurse telephone services and send folks to the ER when needed. But the rest of it is the job of a primary care physician. It's a way for physicians to make more money from Medicare for doing what they've been trained to do. Since Medicare reimburses less than private insurance, I think this is a way the government and physician organizations thought up to keep doctors seeing Medicare patients.

 

[Teacher Terry]

Got it. I wasn't sure if you were referring to the OP or my response to the question of concierge doctor. We were with Kaiser, and as good as they were as a HMO overall, their care of me was horrendous. I won't go back to a HMO.

I was curious if Reno had any concierge doctors and they do. According to my research, they charge between 100–200 per month.

If I had a lot of serious things wrong with me and went to a doctor a lot it might be worth it. But some years, I don’t even see my doctor once a year so it’s not worth it to me now.