1. Implications for the Future ©AAHCM Linda DeCherrie, MD Mount Sinai Visiting Doctors Program

2.  New Codes for Medicare  House call providers need to be at the table  House call providers need to think about the future and new models of payments ©AAHCM

3.  Chronic Care Coordination codes (complex care management services) ◦ Not face-to-face with patients ◦ 30-90 day period in discussion ◦ Different levels according to time spent ◦ At least 2 chronic medical conditions ◦ Office based staff can perform much of this work ◦ 24/7 access to practice by patient and that providers have access to EMR ©AAHCM

4.  Chronic Care Coordination codes ◦ Discussion re what to do if patient dies during that period ◦ “consent” to bill this at the Annual Wellness Visit ◦ Only 1 Provider can bill this per patient ◦ Will need to be accredited practice – poss. PCMH but AAHCM working on creating standards and met this week ©AAHCM

5.  Advanced Care Planning ◦ Most likely a time based code for face-to-face discussions with patients/family/surrogate by MD/NP/PA ◦ Possibly including other office staff members such as SW ©AAHCM

6.  ACO  IAH  Bundled payments  Partnerships with hospital systems  Risk contracts with insurance payers ©AAHCM

7.  Home based primary care  Transitional care home visits  Palliative care home visits  Hospital at home ©AAHCM

8.  Public Policy Committee of AAHCM led by George Taler  Work closely with organizations like AGS  Complete surveys requested by AAHCM  Have stakeholders understand our value and how we are different than an office setting (have your elevator talk ready) ©AAHCM

9.  Publish your data  Have EMR’s that can be examined for key data/quality metrics  Not just home based primary care but transitional care, or other house calls that you provide ©AAHCM

10.  Maintain patients in the lowest cost setting  Move palliative care upstream  Reduce readmissions  Manage the frailest, multi-morbid costliest patients  Mitigate overtreatment ©AAHCM

11.  New codes  New models of reimbursement  Be at the table ©AAHCM