Chronic Care Enters the 21st Century

Nearly half of all American adults are struggling with at least one chronic health condition. That's about 117 million men and women. And as America grows older and heavier, this population will expand far faster than the ranks of primary-care physicians needed to treat it. This is the health challenge of our time, and we've been slow to find a solution to it. Until now.

On July 3, the Centers for Medicare and Medicaid Services (CMS) proposed a small but significant change to the way it pays physicians. Since the inception of Medicare, the emphasis of physician payments has always been on face-to-face encounters between a physician and patient -- office visits, surgeries, etc. This new payment rule would allow physicians, for the first time, to be reimbursed for "non-face-to-face" management of patients with chronic disease. CMS will announce whether the rule becomes law on Monday.

Under the new rule, no longer would physician and patient need to be in the same room. But more importantly, care for the patient could take place behind the scenes among a team of caregivers sharing vital data and optimizing treatment on a timely basis. And rather than try to play every role in a patient's health, the patient's physician could become the quarterback of a coordinated care team.

This is not the same as telemedicine, where a patient and physician might consult over a video link. Medicare already pays for some forms of telemedicine, and this proposed rule would also expand payments for telemedicine in certain areas, which is a good thing. But what is completely new in the rule is payment for chronic care management (CCM).

For example, say a patient has both a primary-care physician and a cardiologist. If these doctors' nursing staffs worked together for at least 20 minutes each month, the doctors would be able to bill Medicare for this work, even though neither doctor actually met with the patient. This kind of coordination would likely cut down on medical mistakes and result in better outcomes. With about 560 chronic-care patients for every primary-care physician in the United States, remote CCM offers overworked physicians a lifeline and an opportunity to get patients closer to their health goals while saving money in state health programs such as California's Medi-Cal and CALPERS.

Consider diabetes, a disease that can be managed to avoid painful and costly complications but often isn't because of the time and attention required. For millions of patients, diabetes care remains substandard and episodic, with blood-glucose readings stored on paper logs and medical advice available only during brief visits to the doctor every few months. The new reimbursement rule would pay the physician to gather blood-glucose data electronically, so his or her staff could examine accurate readings in real time, identify those patients who needed attention immediately, and alert the physician so he or she could take action long before complications set in. And patients adhering to their treatment could get an encouraging text message from the physician's staff to reinforce their healthy habits.

This isn't technology for technology's sake. This is smart technology in the service of person-to-person care. It scales the ability of a primary-care physician to deliver the best care to the most people and get paid for it.

For far too long we've faced a choice between traditional face-to-face care and impersonal data dumping. CMS is proposing a middle way -- a 21st-century approach to health care that recognizes the challenge of chronic care, understands the power of technology as a tool, and puts that tool in the hands of the physicians who can use it to deliver care where and when it's needed most. Through this tiny change in its enormous fee schedule, CMS could help to optimize the patient/physician relationship and restore physicians to their proper place at the center of American health care. We believe this would be a positive change to our health system's infrastructure.

Bill Smith is president of ALR Technologies, a chronic-care medical-device company. Liz Helms is president and CEO of the CA Chronic Care Coalition.