Wondering how to assess the potential gains from implementing Care Plans in medical practice? Initially, some practices may not use Care Plans but later contemplate their adoption. How can you estimate the uptick in revenue? This calculation involves numerous variables.

To simplify, consider this: Suppose your practice caters to 1500 eligible patients, and each Care Plan is valued at $260, with a Care Plan Review worth $150. If you bill these services to the maximum (1500 Care Plans once a year, Care Plans reviews 3 times a year), the total potential benefit might be $1,065,000.

You can easily determine that by looking at your POLAR report. Alternatively, you can search the clinical software for major chronic illnesses among active patients.

Yet, it’s not as straightforward as it appears. Numerous factors come into play, such as the inclusion of new patients (about 20% of them may opt for a Care Plan) and Care Plans with just one item, like GPMP (item 721), among others.

To arrive at a ballpark estimate, you need to account for consultations that won’t be billed due to the presence of Care Plans. For instance, patients often visit for standard consultations and end up with a Care Plan. This happens because a GP appropriately assesses the patient’s needs and initiates the Plan. The GP might choose to defer a Care Plan for later or delay addressing certain issues that warrant a standard consultation. This way, both services can be billed. In practice, the consultation fee is absorbed into the Care Plan or Care Plan Review billing.

Here’s a new calculation: For Care Plans – 1500 x once a year x $260 – 1500 standard consultations (private) x $70, resulting in $285,000. For Care Plan Reviews – 3 times a year x $150 – 4500 standard consultations (private) x $70, leading to $360,000.

The total benefit, therefore, amounts to $645,000. But, the accuracy of this projection depends on your level of optimism or caution. Let’s say you decide to reasonably discount the total benefit by 50% for the first year of implementation. In that case, the adjusted total benefit absolute figure is $322,500.

*The item number values are rounded.

**This post is based on the information available at the time of publication. 03.11.2023