Medicare to Pay ( a little) for Complex Care of Chronic Illinesses

On Jan, 1st of this year, Medicare agreed to pay for the time (in excess of one hour per month) outside of the typical office visit, that medical practices spend coordinating care for patients with complex problems. It is not clear if other private insurers are going to follow Medicare’s example or not.

This development is very important for the survivability of headache clinics.  No one goes into headache medicine to get rich and most struggle simply to stay solvent and to keep the lights on.  Good headache care is very time consuming and insurance payments are structured to favor invasive procedures and very short visits. Two of four major headache clinics closed in Seattle this year due to solvency issues and I know of others that are financially threatened despite being, like us, extremely busy and trying to survive on a shoe string budget.

Every patient is entitled to a reasonable phone call or two and that is not how this is applied.  However, when the management of complex situations requires extensive time on and off the phone, planning, changing treatments, calling in their prescriptions, ordering tests, or infusions, that is when the insurance say it is appropriate to bill for the time. When you include the time required for charting, calling pharmacies and etc., the typical phone call takes 30 minutes to complete. We receive on average ten phone calls per day totally five hours of management time. Until now, this took away from patient seeing time, which we could at least be marginally reimbursed for, and made it very difficult to stay in business.  Now, when a patient requires a total of one hour in a month for non-face to face management, by phone, e-mails or other means, we will be able to bill the insurance appropriately for that management time.

We regret if any insurance company tries to pass on this cost to the patient.  Or intent is not to cause any financial hardship on patients but for us to remain solvent so we can continue delivering the excellent care that we do well into the future.