Medicare’s new Chronic Care Management (CCM) provides reimbursement and new services for doctors treating people with multiple chronic conditions. Reimbursement includes out of office monitoring by staff, and tools to monitor and coordinate care among a patient’s many providers. Still, some have resisted participating in CCM due to the perceived cost and complexity of implementing it. New outsourcing services are making it easier and more cost-effective to deliver CCM and improve patient care and quality of life.

The Reimbursement Doctors Want
According to health care business consulting firm PYA, “For years, physicians have complained – and rightfully so – that they receive no reimbursement for time, effort, and resources spent managing their patients’ care outside the four walls of the exam room.” Time spent on things like care coordination, medication management, intersecting with social service providers, and phone or email communication for patients and caregivers was, essentially, free.

The result has been that for many patients, especially those with serious conditions requiring multiple therapies, there was little in the way of centralized management. This is bad for patients, as going to multiple doctors, pharmacies, and therapists opens the door to health problems from a lack of knowledge of how all treatments impact the patient–for example, medications or therapies that don’t work together.

CCM Breakthrough
A breakthrough came in 2015 when Medicare launched its Chronic Care Management (CCM) program. CCM allows doctors to bill Medicare and other insurers for 20 minutes of “non-face-to-face” care management each month. It also requires practices to offer patients 24-hour access to a clinician for questions and answers, and centralizes all patient information in a single online location, giving all providers visibility into the entirety of the patient’s care.

Slow Adoption by Doctors
By October 2015, Medicare had received CCM claims for only 100,000 beneficiaries. That means less than one percent of eligible beneficiaries are now receiving these critical services. PYA surveyed 309 physicians to understand the slow uptake of the program and found that 26 percent of the organizations had launched a CCM program for their Medicare patients. Just 49.2 percent of these practices have successfully submitted a claim and received payment from Medicare for CCM.

While the participation has been low, it is not due to lack of awareness. Just over 64.3 percent of those surveyed said that they had “carefully analyzed” CMM. On the other hand, only 23 percent planned to launch a program within the next 12 months, and 11 percent of respondents said they have no plans to introduce CMM to their practices.

The survey found four primary obstacles to adoption:
– 60 percent said they feared that they would need to add more staff
– 47 percent cited insufficient reimbursement for the time and effort required
– 43 percent said they lack awareness of the program
– 39 percent expressed compliance concerns

A Better Approach
A trend that has emerged to address these concerns is the outsourcing of CCM to service providers that have the infrastructure to offer 24-hour phone support, records management, and trained staff to work on a practice’s behalf. The idea is that if the practice can pay a fee to plug-in to an existing organization’s program, the costs will be lower and the need for more staff could be eliminated.

Pay as You Grow
Small practices are especially concerned about the cost of offering CCM. Outsourcing CCM can make it much easier for practices to create a new, significant revenue stream, regardless of the size of the practice. Ideally, the CCM service provider becomes an extension of a physician’s team. As the entities work together over time, the program can grow organically, with the CCM service provider adding more staff or new technology as needed. Also, the outsourcing organization would not be distracted by the rest of the practice’s patients, freeing clinicians to focus on care delivery, not program management.

Leave a Reply

Your email address will not be published. Required fields are marked *

Post comment