Support for Illness Self-Management
  • Full coverage is provided for Health and Behavior Intervention CPT codes
  • Patient and family instruction/education in managing illness is provided for in E/M codes
  • Multiple care coordination demonstrations are teaching illness management practices
  • Patient and family instruction/education in managing illness is provided for in E/M codes, but Medicaid payment rates are lower than those of private insurance and Medicare, which may be a disincentive to provide these services

of Certification initiative.3 A CAHPS specialty version could be used in oncology practices as a way to systematically measure and help improve patient–provider communication.

Despite the above initiatives to help patients and providers communicate more effectively, the limited number and scope of such initiatives constrains improvement in this area. The new CAHPS Clinician and Group Survey instruments can provide a vehicle to help educate both patients and providers and facilitate clinicians’ adoption of new communication behaviors, but mechanisms need to be in place to collect the data from patients and relay them back to providers in ways that will improve communication. These mechanisms (discussed later in this chapter) are not yet in place. In addition, although ineffective patient–provider communication is not typically identified as resulting from a failure to reimburse for effective communication, financial incentives to see greater numbers of patients (and thereby limit providers’ time with each patient) are sometimes cited as

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3The ABMS Member Boards helped develop the three versions of the survey—one for adult primary care, one for proceduralists/surgeons, and one for pediatricians. The impetus for these efforts was the need for instruments to measure patient care experiences and physician–patient communication as an aspect of physician competence in the ABMS Maintenance of Competence Program. Personal communication, Stephen Miller, MD, President, ABMS, March 23, 2007.



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