Physicians need more time with older chronic condition patients

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

Ten to 20 minutes. That’s the length of time the average primary care physician spends during a consult with older patients with multiple chronic conditions, according to a 2017 study in medical journal BMJ Open. Often it’s even less, given time constraints and competing priorities. 

For most physicians, the most rewarding part of the job is the relationships we cultivate with our patients. And these relationships are especially true for the three in four Americans 65 years and older who have two or more chronic health conditions according to a 

. By developing strong relationships with our patients, we’re not only able to treat their immediate conditions, but also address any accompanying social and emotional issues that could influence health outcomes. 

But 10 minutes isn’t enough time to do all that we want to do and have all the conversations that we want to have with our patients. How do we address this gap in care so our sickest patients get the care they need? 

Not enough time

About two-thirds (66 percent) of primary care physicians say they don’t have the time and/or bandwidth to worry about patients’ social issues, and more than two in five patients (44 percent) don’t tell their doctor about those issues. And only 3 percent said a consult one to two times a year was sufficient to deliver care for these patients. These startling findings are from a recent survey commissioned by Quest Diagnostics to find out how primary care physicians and Medicare-age patients view managing their multiple chronic health conditions.   

Quest surveyed PCPs and adults aged 65 and older with multiple chronic conditions to better understand their perceptions of chronic conditions and care management. The responses underscore gaps in care related to behavioral health issues, and the solitary journey many patients feel they are on when it comes to their health. The survey found that two in five (44 percent) patients say that while they tell their doctor about their different medical conditions, they do not tell them about other issues they are facing such as loneliness, financial issues, and/or transportation issues. One-third of patients (32 percent) say sometimes they feel like no one understands all the things they are going though. 

An unnecessary disconnect

One can argue that there’s a disconnect between patients and their PCPs, but there doesn’t have to be.

CMS began to reimburse for chronic care management (CCM) services in January 2015 as a means of supporting patients in between physician visits. CCM services are non-face-to-face services provided to Medicare beneficiaries who have multiple chronic conditions. CCM services may provide 24-hour access to qualified providers for patients who could benefit from assistance on meeting care plans, scheduling doctor visits, medication management, and escalating emergency issues. 

CCM services reimbursed under these new rules include electronic and phone consultations with trained professionals. Under this arrangement, patients benefit from timely and specific consultations with trained professionals as part of chronic care management services. PCPs who engage in these services can rest easier knowing a trained professional is following up with patients and reporting back issues through EHRs. In fact, the Quest survey found that most PCPs-84 percent-said a CCM service could help them deliver care to chronic care patients. Yet about half did not know CMS reimburses for such services. 

While early participation in the program by PCPs has been slow, CMS estimates 70 percent of Medicare beneficiaries-roughly 35 million people-have two or more chronic conditions and would be eligible for the care services.

As the population ages, and develops more chronic conditions, services that help support patients between the traditional physician consult will be essential to effective care. CCM can be part of the solution. With better support, patients may experience better care and outcomes as major health issues are identified early and averted. And helping patients lead longer, more productive lives is time well spent. 

Jeffrey Dlott, MD is the medical director of Quest Chronic Care Management. In 2018, Quest Diagnostics, a leading provider of diagnostic information services, launched Chronic Care Management (CCM) services nationwide to help providers close gaps in care for patients with multiple chronic conditions.