2024: The Year Patient Navigation Goes Mainstream
New Principal Illness Navigation Codes in the 2024 Physician Fee Schedule Signal an emphasis from CMS on Coordinated Care
Forget Oura Rings and Oat Milk Lattes—the trend in 2024 with the most staying power and impact will be four new billing codes buried in CMS 2024 Physician Fee Schedule.
Enter: PIN codes. They expand patient navigation to a broader audience, making it financially viable for smaller providers to do the right thing for their patients and enabling team-based approaches for larger organizations to achieve quality, holistic, patient-centric, and equitable coordinated care.
Think of PIN codes like the Fitbit for navigating complex healthcare journeys. Just as Fitbits incentivize healthy habits, these codes reimburse caregivers for dedicating time to guide patients through the labyrinth of tests, treatments, and decisions that come with serious illness. This approach represents a paradigm shift for CMS, recognizing that a doctor's job isn't just diagnosing and prescribing but equipping patients with the knowledge and support they need to get through complex care phases and stay healthy. Patient navigation is promising but has been mostly confined to academic settings or pockets of innovation.
Why? Because navigation is expensive to staff and challenging to execute well.
EHRs weren’t designed to co-manage patients across large, interprofessional teams. On top of staffing these crucial programs, additional tools outside the medical record are required to make them work effectively. These challenges have made it especially difficult to scale care navigation in rural hospitals, disadvantaged communities, and for patients with complex comorbidities.
The four HCPCS Codes focus on complex diagnoses and concierge-type care:
G0023: Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month.
G0024: Principal illness navigation services, additional 30 minutes per calendar month (listed separately from G0023).
G0140: Principal illness navigation services, peer support specialist, individual, 30 minutes.
G0146: Principal illness navigation services, peer support specialist, group (2 or more), 60 minutes.
How can these five-digit codes translate to better patient outcomes?
careMESH has been supporting the patient navigation efforts of Academic Medical Centers (AMC) since 2020. One of the programs we support is a Limb Preservation Program within a large, nationally-ranked AMC. Their navigation team was critical in driving improved throughput and outcomes for cardiac patients. Still, they needed new workflow tools to manage this complex population effectively with one or more chronic conditions across multidisciplinary teams. Their EHR workflows focused on episodic care rather than on holistic patient management.
To the patient navigators, these tools simplify everything, giving them flexible, dynamic digital task lists, task and communication automation, centralized patient management hubs, and sophisticated tracking and reporting. Navigators were able to reach more patients and prioritize who needed outreach ASAP. In conjunction with refined ED alerting, they reduced amputations by 32% in the first three months. This trend has continued. They attribute the result to their care teams working in unison, discovering the roadblocks, not dropping balls, and getting patients critical care faster and more reliably.
PIN codes represent a win-win-win for everyone involved in patient care:
Doctors don’t need to be bogged down with scut work
Health systems are paid for their efforts above and beyond a procedure, and
Patients receive the care they need without the associated anxiety of navigating a complex continuum of care.
There’s a lot more we could share with you on patient navigation strategies…but if you’ll excuse me, I need to take 1800 steps to Starbucks before my Oat Milk Latte gets cold.
Peter & Ryan