New Medicare Regulations Improve Senior Care and Doctor Pay

New Medicare Regulations Improve Senior Care and Doctor Pay

Older patients that are seriously ill require additional care that was not adequately compensated in previous years. Communicating with caregivers and families and consulting with specialists and other team members fell under the umbrella that required additional time from providers but received little in the way of financial reimbursement. New Medicare regulations may prove a boon to physicians and healthcare professionals in their ongoing efforts to provide high-quality care to seniors and communications with their family and caregivers. Additional measures are now available to pay for many of the additional requirements needed for senior patients with complex and chronic health conditions. New regulations that went into effect on January 1st may help both providers and the seniors that they serve. For “high need” patients, coordinated care will now be rewarded, as will other efforts on the part of hospital staff. Hospital policy makers, physicians, nurses, caregivers, families, case managers and other health professionals need to be aware of the new policies to be implemented when it comes to Medicare and senior care.

New Medicare Regulations Support Senior Care

Seniors with chronic health conditions may benefit from the higher quality of care that physicians will need to embrace. Seniors with multiple chronic conditions require a significant amount of attention. It was found that 10 percent of patients required care that amounted to 65 percent of health spending in the U.S. This data is available from The CommonWealth Fund December brief, How High-Need Patients Experience Health Care in the United States.

Comprehensive evaluations for older adults that may have a cognitive impairment is one area that may receive additional support from the new regulations. Additional incentives within the new regulations include:

  • More generous payments for “complex chronic care management.” Services are paid at a higher rate and are permitted to be billed more frequently. The average for the first hour is $93.67, with $47.01 for every following half hour.
  • Services covered include senior transitions from a hospital to a rehabilitation facility. Education of caregivers, offering resources to patients, and coordinating home-based services are within the scope of the covered management services.

The new financial support may help hospitals and facilities hire care managers that can improve quality of care, provide consistent outreach, and help prevent hospitalization. Dr. Peter Hollman, secretary of the American Geriatrics Society and chief medical officer of University Medicine, told NBC News of a 72-year-old patient with heart failure, hypertension and diabetes. He had poorly controlled blood sugar and was retaining fluid. The care manager checked on him every few days, asking about any weight gain and blood sugar management. Hollman adjusted dosage for both the diuretics and insulin. According to Hollman:

“The patient remained at home and he’s doing well, and we likely prevented a hospitalization.”

Other areas that will be addressed by the new Medicare regulations include dementia-related services and out-of-office interactions with patients or caregivers. A dementia diagnosis is not easy to do, but the new policies help by outlining what is necessary for a cognitive examination and providing higher payments. Dementia evaluations must meet 10 requirements including:

  • A detailed history;
  • A physical exam;
  • An understanding of the ability of the patient to perform daily living activities;
  • An evaluation of all current medications;
  • Standardized cognitive assessment tests;
  • Assistance with an advanced care plan to be shared with caregivers;
  • Their neuropsychiatric symptoms, behavioral and safety symptoms; and
  • Understanding the abilities, needs and knowledge of their caregiver.

In addition to payment for fees for the creation of a care plan and carrying out care management responsibilities, Medicare pays $238.30 for the first assessment. Dr. Robert Zorowitz, senior medical director at OptumCare CarePlus:

“Hopefully, this will kick-start the development of practices that provide these dementia-related services.”

Depression in seniors is a serious issue and often arises as a complication of illness, medication or social isolation. The topic of depression in seniors is addressed in the recent articles, How to Support Senior Citizens with Depression and Unusual Factors Producing Depression in the Elderly. Research supports the finding that collaborative treatment improves mood in depressed, older adults. New payments to foster collaboration between the patient’s physician, psychologists, psychiatrists and care managers are available. Medicare is slated to pay:

  • $142.84 for the first 70 minutes;
  • $126.33 for the following hour; and
  • $66.04 every half hour a care manager communicates and tracks patients.

Many of the efforts that were not being adequately compensated are now addressed in the new policy. This measure should support the abilities of healthcare providers, hospitals and facilities to provide enhanced care management for vulnerable populations.

Improved Communications with New Policy

When physicians take work home or communicate with caregivers at home, there was no way to bill for these efforts. With the new changes, Medicare will pay $113.41 for the initial hour in such activities and $54.55 for every half hour after. Extra reimbursement is available for additional time spent with complex patients or with their caregivers. Dr. Phillip Rodgers, co-chair of the public policy committee at the American Academy of Hospice and Palliative Medicine said:

“This recognizes the significant and valuable services that physicians perform in between face-to-face visits.”

The many measures that dedicated doctors take to communicate with concerned parties are now to be rewarded. It appears that healthcare professionals working with Medicare can have something to look forward to with the changes.

The new payments available through Medicare will provide necessary reimbursement to physicians, care managers and others dedicated to collaborative care for “high need” seniors. Healthcare professionals working diligently to improve their delivery of patient care will find support, guidance and enhanced payment schemes that recognize their efforts in the new Medicare regulations.


Lisa DiFalco is a leading writer for wellness and education. She has helped manage cases directly at halfway houses before extensive careers in education and wellness. She is passionate about vital issues and supports community improvement efforts.

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