GPSC Initiatives Update - August 2010

The Complex Care Incentives

The Complex Care Incentives compensate GPs for the management and coordination of care for complex patients who have chronic conditions from at least two of the following eight categories:

1. Diabetes mellitus (type 1 and 2)
2. Chronic renal failure with eGFR values less than 60
3. Congestive heart failure
4. Chronic respiratory condition (asthma, COPD, emphysema, chronic bronchitis, bronchiectasis, pulmonary fibrosis, fibrosing alveolitis, cystic fibrosis, etc.)
5. Cerebrovascular disease
6. Ischemic heart disease, excluding the acute phase of myocardial infarct
7. Chronic neurodegenerative diseases (multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke or other brain injury with a permanent neurological deficit, paraplegia or quadriplegia, etc.)
8. Chronic liver disease with evidence of hepatic dysfunction

In recognition of the additional time and effort required to deliver quality primary care to patients with co-morbid conditions, these incentives are designed to remove the financial barrier to providing this care, encouraging primary care physicians to take on hard-to-place patients rather than seeing more patients with simpler clinical conditions.

The Complex Care Incentives compensate the GP/FP for the creation of a clinical action plan for patients, and for the additional complexity of managing these patients over the following year. The annual complex care management fee (14033) is also a portal to the follow-up management fee (14039), which is payable a maximum of four times per patient for two-way communication with the patient or the patient's medical representative via telephone or email over the 18 months following creation of the plan.

 “Cared about, not just cared for”

Because of the complexity of their conditions, most of my patients with co-morbidities require an annual complete physical examination. I’ve found it very useful to incorporate the development of a care plan for the year into these visits and use the Complex Care Incentives for this purpose.

Depending on the patient, I book 45 minutes to 1 hour as my last appointment of the morning.  First I go over the patient’s current concerns, do a functional inquiry, and then the physical exam.  This takes about 20 minutes or so, and following this, the patient can get dressed and I let them know that I’ll return to go over all the findings, results, and medications and to discuss a plan for his or her care for the next year. 

Next we review everything, including the patient’s wishes regarding resuscitation. We develop a plan that takes into account which community resources we need to involve, etc. If the patient has COPD, this is an ideal time to review or give them a COPD Action Plan as part of that complex care planning process. 

After a pleasant 45- to 60-minute visit, patients tell me that they feel cared about, not just cared for. 

I bill the complete physical fee, the annual complex care management fee (14033), plus any CDM fees that may be due at that time (14050, 14051, 14052, 14053).  If I need to conference with an allied health professional about the plan (e.g., a home care nurse), I do so and then bill the community patient conferencing fee (14016).

I feel my efforts are valued and that my patients and I have a stronger doctor-patient relationship, and that's priceless.

--Dr Cathy Clelland,

Family physician and Executive Director,

Society of General Practitioners

Click here for more information on the Complex Care