An Ounce of Prevention
We have learned a lot about how healthcare works — or sometimes doesn't work — over the course of the COVID-19 pandemic. As providers struggled to respond effectively to the fast-spreading virus it became very apparent that we have some outdated and broken components of our healthcare system. COVID stretched our tired healthcare infrastructure to its limits, forcing us to become creative in providing care while accepting and adapting to modern technologies once thought to be prohibitively expensive or else categorized as passing novelties.
Comprehensive care management — also known as "virtual care management" — combines aspects of chronic care management (CCM), remote patient monitoring (RPM), and other billable preventive services to allow providers to take a whole patient approach to managing the medical, functional, and psychological needs for medium- and high-risk patients. For clinicians, comprehensive care management provides patients with the wraparound care they need, not only promoting wellness but also treating and helping prevent acute exacerbations of chronic health conditions. To be successful, it is important that any care management approach be a team effort, eliciting buy-in from the patient's entire healthcare team as well as the patient themselves.
Research supports that educational brochures placed and targeted at the right audience can provide great benefits. Since printed brochures are often available at in-person visits, they can facilitate patient interest, generate helpful questions, and encourage patients to initiate important conversations with their healthcare providers about treatments or services, such as chronic care management (CCM), that they otherwise may not have known about.
Chronic care management (CCM) is a valuable service to provide to patients that generates strong revenue for practices, and, as we recently discussed, is an "integral component" of the Centers for Medicare & Medicaid Services' (CMS) long-term patient care and coverage strategy. There may be no better time to add or grow a chronic care management program, especially with a reimbursement increase likely on the horizon.
One of the biggest care management challenges faced by modern daypractitioners is keeping patients focused on the immediate problem or reason for a visit. It's often easy to default into personal conversations with the patient as you connect as humans, but aimless conversations and off-topic detours can prove lethal to the typical practice schedule and mean certain essential aspects of the visit are overlooked or missed altogether, thus creating potential issues with reimbursement.
The Office of Inspector General (OIG) recently announced it had completed an audit of payments for chronic care management (CCM) services. The results of this audit have short- and long-term implications for providers of CCM services and for the vendors of CCM software that support those providers.
Update: The 2022 Physician Fee Schedule final rule has delivered a significant increase in reimbursement for some chronic care management services and finalized the addition of new CCM CPT codes. To learn more about the substantial changes to CCM, watch our webinar covering some of the final rule's most significant telehealth and care management developments. Tucked deep within the 2022 Medicare Physician Fee Schedule proposed rule, presumably where it would be easy to miss, the Centers for Medicare & Medicaid Services (CMS) has penned a love letter to chronic care management.
It's no secret that hypertension is one of the most widespread chronic diseases affecting Americans today. The average American diet and sedate lifestyle have begun to create confounding and devastating effects as Americans age into older adulthood. As more Americans are diagnosed with hypertension, it's important that we fully understand the true cost of this often-silent condition and constructively address ways to create a significant impact on mitigating this gateway chronic disease via solutions such as chronic care management (CCM) and remote patient monitoring (RPM).
Chronic care management (CCM) made its debut in 2015 when it was rolled out by the Centers for Medicare and Medicaid Services (CMS) as a separately paid service under the Medicare fee schedule. The rationale behind its inception was to offer an avenue of compensation for practitioners who provided care to their patients outside of the normal confines of the average office visit. The introduction of CCM coincidentally led to a more efficient means of care teams proactively engaging and managing patients with problematic chronic diseases, in turn improving outcomes and reducing treatment costs.
CMS recently finalized its Medicare coverage changes for 2020 and we’ve found a little something to be excited about. Officially dubbed Principal Care Management (PCM), this new program will allow medical providers to bill Medicare for providing care management services to beneficiaries who have only one high-risk qualifying condition or diagnosis.