1. Fee-for-service reimbursement falls as quality performance pay increases
A 3.75% cut in the 2022 Medicare conversion factor, which calculates reimbursement for procedures under fee-for-service, is mandated under a budget neutrality provision and comes after a pay bump from Congress that expires in 2022. Meanwhile, quality performance pay is increasing. CPA healthcare analysts at the Tennessee firm PYA calculated the pay differences in 11 categories of reimbursement for CCM, Complex CCM, and PCM. The average of the increases is 49%.4
2. Virtual care a boon for underserved chronic care populations
Virtual care, normalized by the pandemic, is now common practice for providers and patients, especially at the primary care level–a boon in 2021 for underserved chronic care populations. In 2019 and 2020, there is a measurable difference in how televisits increased in underserved populations, specifically Medicaid, Medicare and minorities.2
3. Aduhelm earns FDA approval
Aduhelm was approved by the FDA in 2021 with clinical trials outcome data indicating the potential to slow the accumulation of amyloid plaques. Practitioners are cautious about its effectiveness, and Medicare has not decided whether to include it in its formulary. With an annual price per patient of nearly $56,000 per year, patients’ families are looking for solutions for their loved ones–with a huge price tag.3
4. Medications approved in 2021 for chronic care:
PharmD Live’s Chronic Care Medication Update Webinar covers the latest FDA-approved medications. See it here. Among the approved medications are:
- Gemtesa (vibegron) for Overactive Bladder (OAB);
- Verquvo (vericiguat) Heart Failure with reduced EF;
- Kerendia (finerenone) for prevention of kidney disease and cardiac complications in type 2 diabetes patients
5. Insulin turns 100, remote monitoring takes off
Insulin, first introduced in 1921, 100 years later, 2021, diabetes monitoring devices are added to Medicare’s durable medical equipment list coverage. Remote patient monitoring of devices improve patient adherence to therapy. Diabetes mellitus has been a known condition for centuries. The term Diabetes was coined in the 2nd Century, AD, by Aretaeus of Cappadocia, with mellitus (for the sweetness found in urine) added in the 17th Century by Thomas Willis.4
6. New Standard for Blood Pressure in Chronic Kidney Disease
The target of a systolic BP is set for chronic kidney patients at <120 mmHg (previously <140 mm Hg). PharmD Live urges remote patient monitoring targets to keep patients within boundaries. Kidney efficiency is critical to quality of life, and blood pressure monitoring has a direct relationship.
7. American Diabetes Association revises standards of care
For people with diabetes, the ADA makes new recommendations and strategies for classes of care, age and type, strategies to prevent or delay onset of T2 diabetes.5
Diabetes is prevalent in older adults, but the circumstances of when it developed versus when it was diagnosed account for making the group heterogenous at best.
Treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with diabetes are now individualized depending on the patient’s ability to follow therapy plans. Adherence is vital, but the value must be considered with the entirety of trade-offs.
8. Study reveals physicians want telehealth continued in multiple areas
Covid-19 Telehealth Impact Study released by The COVID-19 Healthcare Coalition indicates physicians want to see telehealth continued in these five areas: chronic disease management (73%); Medical management (64%); care coordination (60%); preventive care (53%); hospital or ED follow-up (48%).6
Resources
- https://www.pyapc.com/insights/2022-medicare-physician-fee-schedule-final-rule-increased-reimbursement-for-care-management-services/
- Ellen B. Franciosi, Alice J. Tan, Bina Kassamali, Nicholas Leonard, Guohai Zhou, Steven Krueger, Mehdi Rashighi, and Avery LaChance.Telemedicine and e-Health.Aug 2021.874-880.http://doi.org/10.1089/tmj.2020.0525
- https://www.pharmdlive.com/blog/aduhelm-the-new-alzheimers-drug-and-its-coverage-implications-with-alzheimers-disease/?&utm_source=EmployeeRef&utm_medium=Social&utm_campaign=BlogSupport&utm_term=AduhelmNewDrug&utm_content=EmployeeShare
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707300/ Milestones in the history of diabetes mellitus: The main contributors:Marianna Karamanou, Athanase Protogerou, Gregory Tsoucalas, George Androutsos, and Effie Poulakou-Rebelakou Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
- 12. Older Adults: Standards of Medical Care in Diabetes—2021
American Diabetes Association
Diabetes Care Jan 2021, 44 (Supplement 1) S168-S179; DOI: 10.2337/dc21-S012 - https://www.ama-assn.org/practice-management/digital/patients-doctors-telehealth-here-s-what-should-come-next
