Can A Doctor Work 27 Hours Per Day? One Solution in Guideline-Based Chronic Disease Management.

October 2025

Many practice guidelines for the management of chronic diseases are inconsistent with the time demands of a standard primary care practice. In a study published in the Journal of General Internal Medicine, Justin Porter, MD and colleagues calculated that guideline-based care for a standard panel of 2,500 patients would require 26.7 hours of work per physician, per day.¹ Over seven hours of that daily was for chronic disease care alone, not counting documentation. Chronic disease care ranked as the second largest contributor to that overload, behind preventative care.

Of course, it is not the primary care practitioner’s job to do everything - only to make sure everything is done. Many physicians have discovered that Ideal Home Care serves as a useful team member in chronic disease management for an important subset of patients. If you know who among your patients meets homebound criteria, you know which patients you can refer to Ideal Home Care for a comprehensive chronic disease management program. From a practice management perspective, these elements of Ideal Home Care’s chronic disease management services are relevant:

• Chronic disease education referrals are usually straightforward cases requiring only initial certification paperwork (including face to face encounter) from a physician.
• Physicians can bill Medicare for the certification of the home health plan of care.
• Medicare pays 100% of allowable charges from Ideal Home Care, so patients incur no additional costs as the attention they receive becomes more intensive. 

A primary care practitioner’s goals for referring chronic disease management to home health would include:

• To improve the patient experience and enhance the patient’s self-management skills by expanding the practitioner encounter to include home-based follow-up and coaching.
• To enhance the workflow of primary care practitioners by offloading tasks that can be completed by nurses and therapists who are not a cost center to the practice.
• To reduce national healthcare spending by reducing unnecessary declines and complications through intensive management of high-risk and high-utilizing patients.

When you have elderly patients who do not restate their instructions correctly, who demonstrate non-adherence to the management plan, or who are not accomplishing disease management goals, a referral to Ideal Home Care for follow-up chronic disease management may be indicated. In addition to homebound criteria, Medicare requires a new skilled need. Health regimen teaching typically meets the skilled need requirement, but for it to be a new skilled need, you would look for a situation such as the following:

• Recently documented worsening of measures (for example: high glucose, high blood pressure, greater dyspnea, reduced function).
• Recently documented non-adherence to the health care regimen.
• Recent exacerbation.
• A documented likelihood of exacerbation in the next three weeks.
• New medications.
• New diagnosis.
• New health care regimen instructions, such as diet changes.
  

Reference

1. Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the time needed to provide adult pri-mary care. Journal of General Internal Medicine. 2023 Jan;38(1):147-55.