New Chronic Care Code Could Quickly Boost Revenue

Dec 09, 2014 at 10:00 am by steve

Paul Roller, MD checks on a patient.

Starting in January, one simple code could regularly increase the income for physicians with Medicare patients. The Chronic Care Management (CCM) code will pay out $41.92 once a month in return for physicians and other healthcare professionals spending at least 20 minutes per qualifying patient managing their chronic conditions outside of an office visit.

“The idea is to pay physicians a little extra to manage chronic conditions in between visits,” says Paul Roller, MD, with SeniorCare Geriatric Healthcare Services and Concierge at Home, a service that brings doctors to seniors’ homes. “I’m happy to see CMS [Centers for Medicare and Medicaid Services] coming on board and doing something about chronic care like this. Management is more important than medications.”

The reason for the new code likely lies in preventing costly re-hospitalizations. “I think heart failure patients could be the instigator for all this because that chronic condition, if handled appropriately through a doctor’s office, can prevent a lot of costs, particularly from hospitalizations,” Roller says.

The patients must have at least two chronic conditions, but the services that a practice might perform to qualify for the code are vague, opening up flexibility for how practices might support their patients. For instance with a diabetic patient, the nurse might call to ensure the patient is sticking to their medications and monitoring their blood sugar levels.

Chronic heart condition patients are also a good example. “Because if they weigh themselves every day, then we can tell if they’re retaining fluid and going into acute exacerbation,” Roller says. Calling to check on weight fluctuations would count toward that 20 minutes a month.

“Basically anything you do for that patient that involves those two chronic conditions counts,” Roller says. “It doesn’t have to be direct contact. You could call the pharmacy to oversee their medications.”

For diabetes patients, Roller says, a practice could hold a 20 minute lecture on medication management and bill the $41.92 for each attendee. “If you have 100 patients who qualify, that’s $4,000 more in reimbursements that month,” Roller says.

Unlike many codes, this one does not restrict interactions to physicians. Nurses or nurse practitioners could, for example, review emails from patients who are sending in their blood sugar levels and then call or email them back to continue on their current medications or schedule an appointment.

“The other thing that’s important to note, is that it doesn’t have to be someone in your practice,” Roller says. “So I or my team could actually do this for other doctors.” Though, until the code definitions are finalized, this could change.

If this flexibility remains, it could open up the revenue stream to physicians or practices who don’t feel they have the resources to pull off a consistent chronic care outreach. Another physician or service could identify the patients and manage and provide the care. “It would not cost you, it provides better care for your patients, and you raise your bottom line,” Roller says.

With a service like this, the reimbursement could be split and the practice would pay the invoice provided by the service or physician. “It doesn’t sound like a lot when you talk about one patient, but if you’re a practice with 200 patients that qualify, that can mean thousands more every month for you,” Roller says.

Right now, both primary care and specialists can use the CCM code, but only one physician gets the reimbursement. “That’s going to create a lot of confusion,” Roller says. “But then heart failure is a great example of why it may be set up like this, because it’s the cardiologist who is mostly going to be dealing with that patient. So it makes sense that they would get the reimbursement.”

Roller thinks this is just the first phase for the CCM code. “I think, right now CMS is seeing if this will work,” Roller says. “And in the next round, they’re going to be a little stricter.” His thought is that Medicare will ultimately want to see specific structure in place to qualify for the reimbursement, like a dedicated healthcare advocate to manage the outreach.

Because of the pervasive sense in the medical community of this being a trial and also part of the tenuous Affordable Care Act, physicians may be distrustful of utilizing the new code. “I think the perception could be that it’s too difficult to track and too cumbersome to bill, and Medicare may not pay you anyway,” Roller says. “But I feel if it’s done properly, doctors could see a nice bonus every month for doing what we’re already doing.”

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