Adoption for Medicare’s Chronic Care Management (CCM), where physicians are reimbursed for non-face-to-face patient check-ins and for quarterbacking care among multiple physicians, pharmacists, and facilities, has shown great promise but slow adoption. As with any new program, the regulations and requirements can seem daunting. But new CCM service providers are starting to make it easier, faster and more cost-effective to get up and running.
Worth the Investment?
Renal & Urology News recently interviewed a urologist regarding whether enrolling in CCM was worth the investment. CCM reimburses doctors for checking in on patients twice a month by phone or online, which promises to enable revenue streams, reduce office visits, and improve care. It also requires centralized records and monitoring of all of a patient’s doctors, medications, and therapies.
At first blush, interviewee Dr. Michael Shapiro was interested. Urologists deal with a lot of people with chronic conditions. “But when you look at the details, it becomes a little less attractive,” Dr. Shapiro said. “In our practice, we decided it wasn’t applicable.”
Two factors weighed against enrolling. First was the fact that the program requires patients to sign a consent form agreeing to their financial responsibility for copays. Shapiro feared it would rub patients the wrong way and stand out as abnormal.
“The consent issue drives people crazy,” said Martie Ross, principal at consultants Pershing, Yoakley & Associates (PYA) told the publication. “It is clunky and there is no other service where people have to have a specific signed consent form, so it calls it out as different to patients and creates confusion.”
Specialist or Primary Physician
Second was the fact that as a specialist, his practice was at a disadvantage. Just one of a patient’s physicians can be reimbursed for CMM services. Usually, a patient’s primary physician is the likely candidate for that role, as it involves quarterbacking the entire team of doctors, pharmacists, and therapists involved in a patient’s care.
Others see a path toward profits with CMM. A report by management consulting firm McKesson found that the return on investment can reach 56 percent, which means that for every dollar spent, a practice earns $1.56.
And resources are springing up to make it easier to get started. The American College of Physicians has published a Chronic Care Management Toolkit, which includes templates for consent forms and care logs. It also explains in detail how to bill for services.
Centers for Medicare and Medicaid Services (CMS) has also released a kind of Chronic Care Management cheat sheet for practices interested in the program.
There are also a growing number of service providers who have built their own CCM infrastructure that can be used by multiple practices, creating an outsourced CCM service. They handle the paperwork (actually the program requires electronic health records, another strike against it for some) and back-office administration, scheduling, billing, clinical documentation, and patient enrollment, and share the revenue.
Some also offer to staff the phone lines to perform monthly assessments and medication reconciliations, and other clinical efforts required by the program. They can also train a practice’s staff members to perform these functions.
This outsourced model allows practices to get up and running faster, and to realize profits more quickly as well.
Low Adoption Rates
For better or for worse, most physicians seem to share Dr. Shapiro’s reluctance to embrace CCM. In its first, year, adoption rates were below expectations. Because of this CMS is making or considering changes such as reducing or eliminating the consent and electronic record requirements, at least at first.
For doctors considering entering CCM, sooner may be better than later. With only one physician eligible for reimbursement per patient, it could become a first-come, first-served opportunity. Using an outsourcer to get started may prove to be a good place to start.