Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services

Brian Esterly, CEO, TimeDoc Health

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

Brian Esterly: My name is Brian Esterly, and I am the CEO at TimeDoc Health, a virtual care management (VCM) company that provides chronic care management, remote patient monitoring, and behavioral health integration services. I have spent the past 30 years in health care with the last 20 working with tech-enabled health service companies. Most of my time has been serving frail elderly populations with services provided virtually or in the home. Functionally, I have fulfilled both chief growth officer and chief operating officer roles. Some of my more notable previous experiences include Matrix Medical (acquired by Providence Services Corporation), ExcelleRx (acquired by Omnicare), and Aspire Health (acquired by Anthem, Inc.). 

Could you offer insights into the 2024 Medicare Physician Fee Schedule and discuss the potential implications of these fee changes?

Brian Esterly: The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed VCM services to underserved populations. Specifically, we believe patients who receive care at Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) deserve access to the technology and services that extend their provider’s care outside the four walls of a clinic, just as their peers do at non-FQHCs/RHCs. Key changes include:

• Reimburses Remote Patient Monitoring (RPM) services delivered through FQHCs. All patients deserve access to the technology and services that enable better self-care management of chronic conditions and access to clinical monitoring. This new reimbursement helps improve access to these important services and optimizes outcomes.
• Multiple services reimbursed in the same billing period under the G0511 service code for FQHCs and RHCs. Given the wide range of services listed under the general G0511 service code it is important for providers to be able to submit claims for multiple services under this code. This is the only way for the full needs of the patient to be met (based upon medical necessity) and the outcomes to be optimized. Conversely, allowing only one service code per month will deny patients access to services vital to their health.

It is important to note that suggestions in the media that this change constitutes double-billing is incorrect and misinformed. These are discreet services, and the requirements for each service have to be met in order to qualify for reimbursement. No double counting of time for example, is allowed.

There was a reduction in the reimbursement rate for G0511 from $77.94 in 2023 to $72.98 in 2024. This reduction is compounded by the inflationary pressures that providers experience in hiring, training, and retaining talent as well as the increased service delivery costs of providing patient services. That said, this decrease is offset by the positive advancements noted above.

With Medicare’s recent push to improve chronic care, how have their efforts impacted providers?

Brian Esterly: For providers, the emphasis on chronic care results in a paradigm shift where providers shift their focus from episodic treatment to longitudinal care management. That is, the patient’s treatment plan needs to be integrated, ongoing, and actively managed. The increase in value-based care arrangements further reinforces the focus on proactive chronic care management to improve quality, satisfaction, and outcomes.

Provider organizations may or may not be adequately equipped for this paradigm shift and that is where organizations such as TimeDoc can help. We reach beyond the walls of the practice, we function as extenders for the providers, and we support the patient continually.

Provider organizations are facing the one-two punch of increased patient disease burden and the aging of the patient population at precisely the time there is a decrease in the number of providers and an acute provider shortage has emerged. The ability to leverage technology and extenders such as care coordinators, becomes more critical in this environment.

A recent KFF article stated that "Health policy experts say a host of factors limit participation in the program." What is your perspective on this statement?

Brian Esterly: The factors represented in the article do indeed represent barriers to accessing services such as a) voluntary opt-in enrollment, b) significant administrative requirements to ensure compliance with the service requirements, and c) a workflow not aligned with a practice’s visit oriented operating procedures.

There are other barriers as well such as 1) patient cost-sharing which adds a financial burden to patients and, 2) stringent service requirements that don’t improve the clinical outcomes but do represent a barrier to accessing services.

What impact does the recent CMS initiative to improve chronic care have on small practices?

Brian Esterly: The challenges outlined previously are similar for small practices, but even more so. They may be more resource constrained (staff limitations), less technologically developed, and have less ability to adapt to the workflow requirements. Often these types of challenges can also be acute in rural settings, health care deserts in urban areas, and other underserved geographies and patient populations.

The virtual and remote aspect of these services, coupled with the enduring patient support a care coordinator provides, both represent a way small practices can better support their patients.

What is one key takeaway you hope the audience gains from this interview?

Brian Esterly: When contemplating VCM services, providers and payers should “Just Do It.”

There is a compelling value proposition built around financial, clinical, quality, and service metrics that aligns well with common value-based or other incentive programs. These programs have quantified and demonstrated results.

While there are barriers to operating services such as these, there are also purpose-built partners, who can help make it easy for providers and can serve patients at scale.

Patients need this service and there are more and more everyday who are eligible for these programs. There needs to be a focus on helping one more.