Welcome to Valley Medical Group

July 1, 2027

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MY TURN COLUMN

Greenfield Recorder and Daily Hampshire Gazette

Medicare Had a Good Idea!

By: Concerned patients of Valley Medical Group: Gary Fentin, Susan Fentin, and Chris Sikes

Independent medical practices are struggling, and if you are covered by Medicare, by participating in Advanced Primary Care Management (APCM) you can make a significant difference in the continued viability of independent medical practices in Massachusetts.  As we all know, quality medical care is expensive, and in many cases, the income that medical practices receive from insurance programs like Medicare doesn’t cover the cost of providing that care. Part of the reason for this is that, until now, independent medical practices who see patients covered by Medicare have not been permitted to bill Medicare for essential care that they provide between in-person visits, like responding to questions via a patient portal or checking in on a patient who has just been released from the hospital.  Without being able to bill Medicare for this type of care, some medical practices have made the difficult decision to cut expenses by reducing staffing or eliminating certain services.  Recognizing this serious problem, the folks at Medicare came up with a good idea: Advanced Primary Care Management (APCM).  This new program allows medical practices that provide advanced care and services to patients covered by Medicare to be reimbursed by Medicare for the non-face-to-face work they provide on behalf of their patients.

How does APCM work?  Individuals who are covered by Medicare now have the option to enroll in APCM for a modest monthly fee.  Because the program is so new, it’s hard to determine the out- of-pocket expense. Many Medigap insurers cover the cost but for individuals who don’t have coverage, the most it might cost will be between $3.00 and $10.00 per month.  And if the individual is covered by MassHealth, the program is provided free of charge.  But there’s a catch: Patients who are covered by Medicare and who are therefore eligible under APCM must affirmatively select to be covered and agree to pay the modest premium.  Unless the patients choose to opt-in for APCM, independent medical practices cannot bill Medicare for many services that are so essential for the health of their older patients.   

What sort of treatment is covered under APCM?  This care can include virtual check-ins to  answer patient questions, help after patients leave the hospital or emergency room, urgent care visits 7 days a week, personal care plans in language that everyone can understand, online scheduling to make getting care easier, case management support for complex health conditions, real-time access to information through portals or electronic messaging --- in short all the extra benefits that make it easier for older patients and their families to take control of their health with the help of their medical professionals. 

By opting in for APCM, eligible patients are helping to support the independent medical practices in their communities, ensuring a steady income stream from Medicare for services that they already provide without reimbursement.  It’s a win-win for the patients, the medical practices, and the overall wellbeing of the health care system in our community.  If you are covered by Medicare, contact your health care practitioner to sign on to APCM and make a significant contribution to the continued viability of  your medical practice.

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