October 30, 2015 | Avoid or Embrace CCM? Physicians With Broader View See Clear Choice

Word about Medicare’s Chronic Care Management Program is quickly growing. It seems like each day another article is published discussing the benefits for primary-care physicians who are able to provide telehealth services under the program.

However, taking advantage of CCM (now billable under CPT code 99490) and receiving timely reimbursements is often a herculean effort, as an article published in Modern Healthcare last week clearly demonstrated.

Here are three quotes from that article showing why primary-care physicians aren’t taking advantage of CCM and three quotes showing why they should be:

Weighing against CCM

  1. Not enough personnel:

    “They calculated that if a practice hired a registered nurse to work full time on care management, it would need to enroll at least 131 Medicare patients to break even. If they hired a licensed practical nurse, they would need to enroll 76.”

  2. No short-term ROI: 

    “One of the things that has been a barrier is the cost to provide this service without a clear return on an investment. So there’s always someone asking ‘Do we really need these people?’”

  3. Documentation struggles:

    “They aren’t using the [99490] code because of the resources needed to complete the documentation. ‘At first sight, your thought is, for 40 bucks you want us to do all this? Forget it. Then you read closer, and it’s stuff we’re already doing—and documenting.’ But the clinics’ EHR is not set up to record the minute-by-minute level of documentation required, so they’re taking a pass.”

Factors in favor of CCM

  1. Long-term patient outcomes: 

    “Long term, [CCM] pays for itself through reduced complications, reduced readmissions, and reduced emergency department visits. We cannot afford for [chronically ill patients] to not have this service.”

  2. High financial incentives:

    A ‘typical’ practice with about 2,000 Medicare patients could generate more than $75,000 net revenue per full-time physician if half of their eligible patients enrolled in chronic-care management.”

  3. Improved care coordination: 

    “If a chronically ill Medicare patient stops taking his medication, Dr. Jim King finds out about it within a week. That’s because one of his staff calls to find out, learns why and then follows up to remedy the issue. This way of working has improved the health of his patients and saved—even earned—his practice money.”

The takeaway from the article is clear: CCM is a program with significant benefits if you have the resources and time necessary to adhere to its strict requirements

Fortunately, our Chronic Care Management WellBox Solution successfully removes the pain points cited in the first three quotes, ultimately leaving you with the latter perspectives that show just how successful CCM can be for not only boosting your practice’s financial success but, more importantly, enhancing the health of your patients.

Read the entire Modern Healthcare article: