title: Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study.
abstract: BACKGROUND
  Physicians have traditionally been reimbursed for face-to-face visits. A new non-visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015.
  
  
  OBJECTIVE
  To estimate financial implications of CCM payment for primary care practices.
  
  
  METHODS
  Microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements.
  
  
  METHODS
  National Ambulatory Medical Care Survey and other published sources.
  
  
  METHODS
  Medicare patients.
  
  
  METHODS
  10 years.
  
  
  CONCLUSIONS
  Practice-level.
  
  
  METHODS
  Comparison of CCM delivery approaches by staff and physicians.
  
  
  METHODS
  Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services.
  
  
  RESULTS
  If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services.
  
  
  RESULTS
  If physicians were to deliver all CCM services, approximately 25% of practices nationwide could expect net revenue losses due to opportunity costs of face-to-face visit time.
  
  
  CONCLUSIONS
  The CCM program may alter long-term primary care use, which is difficult to predict.
  
  
  CONCLUSIONS
  Practices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs.
  
  
  BACKGROUND
  None.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D019468:Disease Management; D019538:Health Care Surveys; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D006278:Medicare / Q000191:economics*; D008962:Models, Theoretical; D009722:Nurse Practitioners; D009726:Nurses; D010823:Physician Assistants; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D014481:United States