The new per-member, per-month (PMPM) care management fee is starting to get noticed as, well, a big nothing. As this article states, “That fee is designed to pay physicians for patient care that falls outside of a normal office visit, but the amount varies among payers and is almost universally considered too low by physicians.” Once again, I must interject the point that most hospitals take this fee and DO NOT give it to their employed physicians. (If anyone out there has a different story, please give me the details). Anyway, the article goes on to say that “the AAFP shifted into high gear to address some tough issues related to care management fees” and that is when I was caught between losing interest and laughing uncontrollably. Anyway, they go on to describe a study called Valuation of Care Management Performed by Primary Care Physicians, which was created for the Academy by Discern Health, a Baltimore-based consulting firm. Authors highlight the benefits of care management and, after conducting an extensive literature review, conclude that the “benefits of care management provided by primary care practices exceeds current payments by insurers.” No sh$t, Sherlock.
So, what is the discordance?:
They calculate the value of care management to insurers in terms of savings as $16.73 PMPM but insurers’ cost in payments to physicians for providing those cost-saving services as just $4.90 PMPM.
$4.90 to $16.73? Good luck with increasing that. And I bet there aren’t many hoops and hurdles for the doctors to overcome in order to get that money, huh?Tweet