CCM use growing
Lucarelli’s change of heart about billing for chronic care management is part of a growing movement among healthcare providers. According to the Centers for Medicare & Medicaid Services (CMS), the number of billings under the code nearly doubled between the start of 2015 and September, 2017, from just over one million to two million. Over the same period, Medicare payments for CCM grew from $32.4 million to slightly more than $59 million, or about 82%.
But experts caution that using CCM codes involves a great deal more than just billing for services physicians are already providing. Despite the eased requirements, developing a strategy for billing CCM—from deciding which patients are eligible to developing care plans to tracking the time spent on their care—often is difficult and time-consuming.
TRENDING: The paradox in American healthcare
“All the infrastructure and workflow has to be in place and documented in order to validate the billing, and in order for the patient to understand what they are getting,” says Pam Ballou-Nelson, RN, Ph.D., a senior consultant with the Medical Group Management Association (MGMA). “It can be a struggle for some practices to develop a process.”
Reining in costs
Medicare’s focus on patients with multiple chronic conditions reflects a growing concern over how much the agency—and the country—spend to care for these patients, experts say. According to data compiled by the Medicare Learning Network, as of 2014 two-thirds of Medicare beneficiaries had two or more chronic conditions.
Virtually all (99%) of the agency’s $597 billion in benefits payments that year were to treat patients with chronic conditions. Moreover, 84% of all healthcare spending in the country was for patients with chronic conditions.
Reducing that spending by keeping patients out of expensive inpatient settings and emergency departments was one of the chief motivations behind development of the CCM codes, Ballou-Nelson explains.
“Research has shown that patients tend to be able to manage one chronic condition, but when they have more than one is when we start to see complications occur that often require an inpatient admission,” she says.
POPULAR ONLINE: 2018 Payment outlook
Lucarelli uses similar logic when explaining the program to her patients. She presents CCM as a way for Medicare to reduce spending by paying doctors to monitor patients with multiple chronic conditions, enabling them to address problems before they get to the point where the patient requires hospitalization.