Medicare patients who have two or more chronic conditions account for 93% of total Medicare spending. These patients are found to have higher rates of hospitalizations, pharmacy utilization, and specialist utilization, which increases costs for all stakeholders.
Basics of CCM
Chronic care management (CCM) is a separately billed, non-face-to-face CMS covered service that is designed to be delivered through the primary care setting. To participate in the Medicare program, the patient must have two or more chronic conditions (conditions lasting more than 12 months or until the death of the patient). Physicians are given financial incentives from CMS to talk with patients monthly, providing supportive and preventative check-ins. Medicare began paying for CCM services under the Physician Fee Schedule (PFS) in 2015 for Medicare patients (CPT Code 99490). This code allows eligible practitioners to bill $42 per member per month for at least 20 minutes of non-face-to-face clinical staff time, directed by a physician or other qualified health care professional. Additional codes were added in January 2017 for more complex and extensive care and management. The ultimate goal of CCM is to support patients in achieving improved quality of life by providing them more care and education. In a recent study, 71 eligible professionals were interviewed on their experience rendering CCM services. They reported seeing several positive outcomes for their beneficiaries, such as improved patient satisfaction, adherence to recommended therapies, improved clinician efficiency, and a decrease in hospitalizations and ED visits.
Barriers of CCM
While the benefits of CCM are easy to recognize, there are several barriers providers must overcome to begin the program. From technology and resources to beneficiary buy-in, it is important to consider all possible hindrances when getting started with CCM.
Tips for Presenting CCM
Timing, how you frame the conversation about copay and getting consent are the most important pieces to getting patients enrolled in CCM. Consent can be given verbally during an office visit and marked in the notes of the care provider. For some, it is difficult to get patients into the office to get this consent, so the first step is getting them in the door. Many find it easier to have the enrollment conversation with a patient when they are in the office for a wellness visit. A time that is not good to reach out to the patient about CCM is right after they are discharged from the hospital; it is better to wait until home health has left or caregivers have stopped immediate follow-up. We recommend waiting 60-90 days if they have recently been discharged because it can be hectic and overwhelming for a patient to have multiple people checking in with them. When timing is good for the enrollment conversation, the way the program is framed will often make or break whether a patient decides to enroll. Patients can easily get fixated on the copay of the program and not focus on all the benefits that CCM can provide. It is important to tell the patient how CCM will improve their health and help them better manage their chronic illnesses. The patient should also be told that CCM:
- Is a program designed to help keep them out of the hospital
- Gives them 24-hour access to their care team
- Provides a care manager who will reach out every month to help with their health needs
Once the patient understands how CCM will benefit their overall wellness, they should be told there could be a small monthly copay to participate in the CMS program, but that it will be made up of the money saved through fewer hospitalizations and in-person visits.
What are some of your best practices for getting your patients enrolled in CCM? We would love to hear from you!
Read more from Maha-Salah-Ud-Din, a Senior Advisor at Lightbeam.