August 2023
Dear patients,
We are reaching out to inform you about a significant update to our Chronic Disease Management (CDM) Medicare / EPC program payment policy. The CDM program plays a crucial role in supporting patients dealing with chronic or terminal medical conditions such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions, and stroke, and we have seen its positive impact on the lives of many within our community.
Over the years, we have faced financial challenges with the CDM program due to Medicare not matching consumer price index (CPI) changes. To ensure we can continue delivering the highest standard of care, we have made necessary adjustments to our payment policy.
Why is the change required?
The Chronic Disease Management / EPC program was established with the primary goal of supporting patients dealing with chronic or terminal medical conditions. Over the years, we have witnessed the significant impact of this program on improving the lives of many patients. Unfortunately, due to Medicare not keeping up with inflation, we are faced with financial challenges that must be addressed to sustain the program and provide you with the care you deserve.
What is the process from August 14th for new plans?
From 14th August onwards, our practice will continue offering the CDM program and team care plans. However, there will be a change in the payment process. Going forward, the payment structure will resemble a rebate system, similar to how private health insurance operates. This means that patients will need to cover the out-of-pocket gap, which is the full fee minus the current Medicare rate.
For patients who fall under certain categories, such as those on a pension, holding a health care card, or are under the age of 18, we will charge the scheduled rate as follows:
Fee: $68.20, Benefit: $58.00 (85%)
Rest assured that we will provide guidance and support throughout the process, ensuring that you understand any costs involved.
What is the change if I am currently under a plan?
If you are currently enrolled in a care plan, the current fee structure will remain in place until your plan is used up or until 31 December 2023, whichever comes first. This means that you will not be affected by the new payment policy until your current plan expires. We will continue to deliver the same level of care and support you throughout your current plan’s duration.
We understand the importance of accessible healthcare, and we want to ensure that you can continue to receive the care you need without undue financial burden. Additionally, for patients who may face significant financial hardship due to these changes, we are committed to working with you on a case-by-case basis to find a suitable solution.
Our team will work closely with you to address any concerns and provide the necessary assistance.
If you have any questions or need further clarification about the changes taking place, please don’t hesitate to reach out to us. We are here to support you every step of the way. Together, we can continue to deliver the best possible care, with your health and wellbeing as our top priority.