To make the most of the Medicare chronic care management (CCM) payment, have a nurse or other nonphysician provider deliver the care.

That was the conclusion reached by Dr. Sanjay Basu of Stanford (Calif.) University and his colleagues based on their analysis of national practice data on patient use of primary care services, staffing costs, overhead, and reimbursements, published Sept. 21 in Annals of Internal Medicine (doi:10.7326/M14-2677).

Up to two-thirds of Medicare-covered patients on primary care patient panels are eligible for the new CCM payment, unveiled earlier this year as part of Medicare’s move away from fee-for-service medicine, according to the researchers.

Dr. Basu and his colleagues created microsimulation models to determine that net revenue gains were highest when CCM plans were developed at an annual preventive care visit and in partnership with nonphysician providers who were then tasked with delivering the care.

If services were delivered by a registered nurse, revenue increased $332/CCM patient. When delivered by a licensed practical nurse, the increase was $372/CCM patient. And when a medical assistent delivered the care, revenue increased by $385/CCM patient.

For primary care practices with patient panels of about 2,000, if a minimum of 76 CCM patients per full-time equivalent physician were enrolled and cared for by a registered nurse, the net annual revenue increase was $75,000 per full-time physician when combined with the cost of 12 hours of weekly nursing services.

The analysis could incentivize practices to adapt more team-based models of care, regardless of practice size, Dr. Basu noted.

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