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Readers Write: Making Chronic Care Management Work for Your Practice

August 16, 2016 News 2 Comments

Making Chronic Care Management Work for Your Practice
By Krista Sultan


Having spent the last several years dedicated to helping providers and healthcare organizations align their business practices with value-based payment models, watching 2015 unfold was extremely exciting for me. In January of 2015, HHS announced its most groundbreaking and aggressive plan to transition to new payment models, greatly accelerating the anticipated shift in reimbursement structure. This came in conjunction with the ratification of CPT code 99490, where providers could be reimbursed for non-face-to-face care coordination for the first time. This code can be billed when providers or certified clinical staff spend 20 minutes or more coordinating care for Medicare patients with two or more chronic conditions with an established comprehensive plan of care. The program is formally termed Chronic Care Management, but is more commonly referred to by its acronym, CCM.

While these changes were stimulating for those of us in the industry of facilitating the transition, they were met by reticence and skepticism by many outpatient providers. The initial reaction by so many physicians to CCM was to watch and wait. Despite the fact that programs like this have been successful in many European countries for quite some time, we had not yet seen a US proof of concept. This general consensus was confirmed early this year, when CMS announced that just over 100,000 patients had participated in the CCM program during its first year, and most of those patients only had an average of three CCM encounters.

However, this lack of enthusiasm did nothing to curb the tidal wave of healthcare reform initiatives. We saw MACRA passed into law in April, which actually established a quantitative measure for clinical practice improvement. CMS expanded CCM to include rural health clinics and FQHCs beginning in January of 2016, and then went right back to the drawing board to further expand CCM. The proposed changes for 2017 included additional time and reimbursement for the creation of the initial care plan, a modifier code for encounters that take longer than usual, and an overall relaxation around the enrollment process. The verbiage in these proposed changes also makes it very clear that the priority is around making the program accessible and increasing adoption rather than hunting for imperfections in provider documentation. The central message here is that CCM is here to stay and CMS is heavily invested in making it work.

CMS commitment to CCM is justified in light of the results of a recent patient satisfaction survey that my company, Hello Health, recently completed. Of 100 patient respondents, 86 percent offered a value of “satisfied” or “very satisfied” with the clinical engagement provided by CCM.

We also discovered:

  • 90 percent of respondents said they were satisfied/very satisfied with their chronic care coordinator.
  • 60 percent of respondents felt their health has already benefitted from receiving CCM monthly calls.
  • 78 percent of respondents would recommend CCM to their family and friends.

In other words, patients are finding value in CCM, and measurably benefitting from services that allow them to have a better understanding of their health and care routines. While we look forward to further peer-reviewed support on the inherent clinical value in this program, the initial results are in, and CCM is working. At the end of the day, this is the metric I am proudest of because, if our patients are loving this program and telling us it is making a difference, then I can go to bed at night knowing that we are doing something right. The challenge is now encouraging the broader adoption of CCM, and providing physicians with the resources necessary to offer this program to their patients.

What does this mean for providers considering adopting CCM? Please remember that CCM and other value-based programs do not require all-or-nothing adoption. There are a huge number of vendors available that providers can partner with based on their needs – from consulting services to in-house CCM implementation services, to technology solutions to lighten the workload, to full service solutions that handle everything from enrollment to patient coaching and care coordination.

That being said, for small to mid-sized practices, CCM is a huge undertaking and should not be underestimated. In general, smaller practices simply do not have the resources to set up the program design, finance the additional staff, and stay up to date with evolving regulations while maintaining existing or increasing patient volumes. Furthermore, many providers feel like this process can only be performed by RNs because of the care plan and clinical coordination components. With more and more RNs pursuing bachelor’s degrees in nursing as well as advanced degrees, many practices cannot afford to employ an RN for CCM with an average reimbursement of around $40. However, with proper training and oversight, different types of clinical staff can provide value in this program in a myriad of ways. It’s not necessarily one size fits all with the RN as the sole team member providing services for the patient.

Find the setup that best suits your current workflow and the resources available to you without betraying the core values of your organization that brought your patients to you in the first place. When done right, transitional value-based improvement programs like CCM will strengthen your relationships with patients and empower your staff to feel like they are able to give patients more. After all, improving the value and quality of patient care is really what this is all about.

Krista Sultan is vice president of clinical services at New York City-based Hello Health.


JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

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Comments 2
  • Great article and “I can go to bed at night knowing that we are doing something right” – but is it a pipe dream?
    Based on the challenges you itemized is CCM destined to be a “one-off” for a few patients as scaling is a real problem?

    Here are some questions:

    1. CPT code 99490 – how much does it pay ? how much does it cost to do? (in bundled payments – it’s about this difference (margin))
    2. Patients like it – according to the survey patient appreciate the monthly phone calls:
    “60 percent of respondents felt their health has already benefitted from receiving CCM monthly calls.” — are these 20 minute phone calls?
    3.  How does this communication affect outcomes vs. patient satisfaction (any data) ?
    4.  Is this a call-center business or an individual practice activity ?
    5.  If a practice activity – there would need to be a scheduling app tied to the EHR to organize the calls
    e.g. – a 2000 patient practice – with 10% chronic population would have 200 calls per month divided by 22 practice days that is about 10 (20 minute) calls per day or 3 hours of calling per day.
    6. not sure this would scale – how about you?

  • Hi George,

    Great questions!
    1) The national average for reimbursement is around $42.60, but you can find the exact reimbursement for your area by using this Medicare Fee Lookup Tool https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx. You will need your geographical area’s MAC, or location code, which can be found here https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Locality.html.
    2) In order to bill for CCM, you need to spend 20 minutes performing care coordination services directed by a care plan. This can consist of 20 minute patient calls, but more often the time spent is a combination between talking with patients, coordinating care, updating the care plan and providing the patient with the resources necessary to meet their care plan goals.
    3) There is not specific clinical outcomes data for CCM in the US at this point although several entities are working on this. There is data from Europe, where these kinds of programs have been in place for much longer, than support positive clinical outcomes.
    4) CCM can be outsourced to a vendor with a call center environment or done entirely by an individual practice. The choice varies generally by the size and resources a practice has available.
    5) Although some practices like the idea of scheduling calls, you may find that it ultimately impacts productivity, for instance if a patient does not answer your call, you could be potentially restricted from moving on to your next patient simply because it is not yet their scheduled time. You would however, want to be sure that you have a means of identifying in the EHR which patients are in the CCM program. Preferably that method would also allow you to extract a patient list that staff could use to call patients. Also, you always want to be careful assuming 100% productivity.
    6) Scaling always has its challenges. As with any other clinical activity it is imperative to imbed clinical practice guidelines in a way that the staff has them readily available to guide their activities and there are adequate infrastructure and quality assurance mechanisms in place to support growth.

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