Changes to CCM, MACRA and Value-Based Care: What You Need to Know

For physicians offering Chronic Care Management (CCM) and other Medicare-funded programs, this week saw the announcement of several changes that could influence how patient-centered care is provided and reimbursed in the future.

For any primary-care physician looking to understand the potential practice impact, here are a few quick hits on how these updates could affect all those in the care continuum.

CMS drops 24/7 EHR Access for CCM

Responding to complaints that offering CCM may be too burdensome on understaffed practices, the CMS is now dropping a condition that participating providers must have 24/7 access to their patients’ EHRs.

With only 275,000 eligible patients currently enrolled in CCM, the agency is hopeful that easing the requirements for their caregivers could incentivize more practices to offer the telehealth service.

Certified EHRs no longer key in care coordination

The CMS’ latest update to its physician fee schedule came with one surprising detail: doctors no longer have to share clinical care summaries via certified EHRs when moving patients from one provider to another.

Rather, the patient’s physician will be asked to be timely when sharing records with other doctors.

No CCM cost sharing for some health plans

A bipartisan bill introduced in the House last week would let high-deductible insurance plans with health savings accounts allow pre-deductible coverage for managing chronic diseases.

Currently, insurance plans can cover only certain preventative services like immunizations and screenings for blood pressure or cholesterol without cost sharing before a deductible is met. The bill would add services for proactively managing illnesses and chronic conditions to the list of covered expenses.

With the CDC estimating that about 86% of healthcare spending is on chronic conditions, this change could further encourage patients to use preventative services that keep them from seeking costly ER visits or hospitalization.

MACRA delay on the horizon

CMS Acting Administrator Andy Slavitt went on record this week stating that his agency is now considering delaying the MACRA implementation date past its planned go-live of January 1, 2015.

According to Slavitt, this announcement is in response to mounting concerns that many small or rural practices may be forced to join larger hospitals or health systems as they lack the resources necessary to survive the transition to MACRA.

With over half of non-pediatric physicians admitting they have never heard of MACRA in a recent survey, it might be prudent for Slavitt and the CMS to hold off until practices are able to adjust to the reimbursement changes– especially since the goal of MACRA is to make physicians’ lives easier, not worse.

About the Author

Patrick Stevenson is the Vice President of Sales & Marketing for Wellbox, the all-inclusive solution for tracking and billing for Chronic Care Management and Annual Wellness Visits, as well as offering in-demand Telemedicine and Remote Patient Monitoring services.

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