Since the beginning of 2015, the Centers for Medicare and Medicaid Services (CMS) has reimbursed physicians for the new CPT code 99490, which covers non-face-to-face consults of at least 20 minutes for patients with multiple (two or more) chronic conditions. There is no official “list” of chronic conditions but generally chronic conditions include Alzheimer’s disease, arthritis, asthma, atrial fibrillation, cancer, COPD, depression, diabetes, heart disease, hypertension, osteoporosis or others.
With 36 million Medicare patients suffering from two or more of those chronic conditions, the prospect of being reimbursed per patient, per month for coordinating their care has significant implications for population health.
Reimbursement for Chronic Care Management (CCM), the CMS name for the program, requires clinical summaries (demographics, meds, allergies) to be created in certified electronic health records, and the development of patient-centered care plans – made available and able to be exchanged electronically with the patient and with all of a patient’s doctors and caregivers. Also required are 24-hour phone support, regular reviews, medication management, and more.
Setting up the infrastructure for these services can be challenging, and many practices have balked at the paperwork, training, and logistics required. In response, a new type of medical service provider has emerged to build scalable CCM service infrastructures that practices “plug-in to” to get up and running with effective, compliant CCM quickly and cost-effectively.
Many of these service providers have developed their own care coordination technology as well as the ’round-the-clock nursing services to help enable providers to outsource their CCM initiatives. Communication with patients is key, as a new service needs explanation. CCM services allow doctors to essentially care for their patients 24/7 through what amounts to an extension of their existing staff. Put that way, most patients will embrace the new model of care.
If a patient calls at 2 a.m., there is a person there to answer the call with access to the patient’s records. If a patient has a concern about a medication, it can be immediately taken care of. Data flows much more freely among a patient’s providers, caregivers, and family members, all for the better.
Of course, improved outcomes are the measure of any change in medical service delivery. CCM promises to deliver better care by proactively coordinating, monitoring and responding to patient conditions; and to lower costs by keeping people healthier and out of the hospital and doctors’ offices due to lack of communication.
CCM service providers take physician practices and other healthcare providers out of the IT, call center, and mobile application businesses, providing all these services in a package that allows doctors to provide the care and giving them the tools they need to meet CCM requirements. The cost of the hardware, software, and people needed to deliver CCM is spread across multiple practices delivering the same services, reducing redundancy and allowing CCM service providers to learn and develop expert systems that individual providers would have a hard time supporting.
Universal Medication Management is a CCM service provider that has the technological and professional capabilities to deliver CCM services in partnership with healthcare providers. UMM allows practices to fulfill all or some of the CCM services that practice needs, with centralized communication, record keeping, and compliance.