The perception that Medicare’s new Chronic Care Management (CCM) program is expensive and cumbersome has slowed adoption by physicians. New studies and services, and changes considered by Medicare are about to speed things up.

Slow Initial Adoption of CCM

A report from the Journal of the American Medical Association (JAMA) earlier this year found that just one percent of Medicare patients used Medicare’s new CCM program, introduced to improve care and reduce the costs of care for people with multiple chronic conditions. CCM marks a step towards value-based healthcare, reimbursing physicians for non-face-to-face check-ins by staff as a means of spotting issues before they blow up into full-fledged health problems requiring office visits or hospitalizations.

Critics of the CCM program say that the cost implementing it is not worth the revenue that might be realized. CCM can require the hiring and training of new staff, as well as training existing staff to implement the program. CCM also requires centralized electronic healthcare records that can be accessed by all physicians, therapists and pharmacists treating a patient. The goal is for the patient’s primary doctor to be able to see all the patient’s care in one place to better coordinate care.

Changes from the Top Coming

The JAMA article notes that Congress is working on changes to CCM to drive adoption, including the elimination of copayments for patients and increasing the number of billing codes to account for different levels of care.

The Road to Profitability

A separate study by the Annals of Internal Medicine found that, depending on which clinician (nurse, doctor, assistant) delivers CCMs, practices could expect $234 to $485 per patient, per year of additional revenue. “At a minimum,” the study found, “131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services.” These numbers suggest that implementing CCM will be more difficult for smaller, rural practices that don’t have a high medicare patient population.

A survey by medical consulting firm PYA found that physicians gave the following reasons for resisting CCM.

  • Program design, staffing, supportive technology, and participation in alternative payment models.
  • The challenge of physician engagement and patient education.
  • Actual time spent (in addition to the reimbursed 20 minutes), months billed, investments made, and expectations for economic return.

Outsourcing Logistics Accelerates Programs

One option for physicians wanting to implement CCM is to outsource the logistics of the program. CCM outsourcing has the potential to eliminate the most expensive and burdensome requirements of the program–staffing, training, and regulatory compliance. According to management consulting company McKesson, “A trusted chronic care management service provider would be able to facilitate these mandatory meetings and provide services ranging from patient care plans to claims queries to managing documentation and billing requirements. In any case, outsourcing puts far fewer requirements on the practice’s current medical and administrative staff.”

Less Disruption and Quicker Profits

If an outsourced CCM solution can deliver the service, and handle the related administrative work (documentation and billing), for less than the Medicare-budgeted fee, practices could implement CCM with less disruption and quicker profits. A medical practice can provide CCM services without some of the costs associated with building the service from scratch. A practice can contract for coordinators to act as extensions of the practice, engaging patients on behalf of the practice, building the care team connections, making sure appointments happen and that data flows both ways and netting positive income from Medicare for the service.

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