AAFP handles difficult challenges in care management fees | Courtesy of Shutterstock
+ Regulatory
Amanda Rupp | Aug 26, 2016

AAFP handles difficult challenges in care management fees

The American Academy of Family Physicians (AAFP) recently recommitted to resolving issues that are related to care management fees, as the organization starts to overhaul its care management fee policy.

Family physicians are an important part of the health care system in the U.S., as they treat patients for every minor illness from birth to death. Their goal is to help patients stay healthy and independent.

Additionally, doctors have faced complications because of blended payment models. These models include a per-member, per-month (PMPM) care management fee. This fee is for doctors who care for patients outside of a regular office visit; unfortunately, the payment amount differs between patients. Many doctors consider this payment rate too low for the amount of work that goes into their practice.

"Family physicians now have some data to make a more informed and intelligent business decision about whether or not they want to accept the care management fees being offered to them by public and private payers -- and, if not, what they think that fee should be," Kent Moore, the AAFP's senior strategist for physician payment, said.

To resolve this problem, the AAFP has published a new policy that outlines “core activities” to be paid for through PMPM care management fees.

"Given the significant gap between the benefits health insurers are receiving and what they are paying physicians to offer care management, should physicians receive additional payment for the care management services they are providing?" the authors said. "If so, how can physicians and health insurers work together to set appropriate payment rates and enhance the value of the overall system?"

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