FDA committee votes yes on romosozumab for osteoporosis. In a move that acknowledges the gauntlet the US health system poses for people facing serious and fatal illnesses, Medicare will pay for a new class of workers to help patients manage treatments for conditions like cancer and heart failure.
The Medicare physician fee schedule includes new billing codes, including G , to pay for 60 minutes a month of care coordination by certified or trained auxiliary personnel working under the direction of a clinician. A diagnosis of cancer or another serious illness takes a toll beyond the physical effects of the disease. Patients often scramble to make adjustments in family and work schedules to manage treatment, said Samyukta Mullangi, MD, MBA, medical director of oncology at Thyme Care, a Nashville, Tennesseeβbased firm that provides navigation and coordination services to oncology practices and insurers.
Mullangi told this news organization. Medicare has for many years paid for medical professionals to help patients cope with the complexities of disease, such as chronic care management CCM provided by physicians, nurses, and physician assistants.
The new principal illness navigation PIN payments are intended to pay for work that to date typically has been done by people without medical degrees, including those involved in peer support networks and community health programs. The new navigators may coordinate care transitions between medical settings, follow up with patients after emergency department ED visits, or communicate with skilled nursing facilities regarding the psychosocial needs and functional deficits of a patient, among other functions.
CMS expects the new navigators may:. The new navigators can be former patients who have undergone similar treatments for serious diseases, CMS said. This approach sets the new program apart from other care management services Medicare already covers, program officials wrote in the physician fee schedule. The agency has taken a broad initial approach in defining what kinds of illnesses a patient may have to qualify for services. Patients must have a serious condition that is expected to last at least 3 months, such as cancer, heart failure, or substance use disorder.
