Lucarelli built her CCM patient base gradually, beginning just with beneficiaries coming in for their Medicare Annual Wellness Visits. Then she expanded it to those coming in for physicals and other forms of routine medical evaluations.
“Now we’re at the point where we do it anytime a potentially eligible patient comes in for any kind of visit,” she says. “When a patient registers at the front desk the staff knows to flag them if they’re eligible and tuck the papers in with the routing slip when the patient gets roomed.”
CCM has brought some unexpected benefits as Lucarelli and her staff gain more experience with the program. For example, the practice’s care coordinator now reviews Lucarelli’s most recent note before calling a patient to check on progress with their care plan. “She’ll say, ‘Mr. Smith, I see that Dr. Lucarelli changed your blood pressure medication. How are you doing with the new one?’ And a couple of times we discovered patients weren’t taking them. So I’d make sure the pharmacy had the medication available and call [the patient] to see what was going on,” Lucarelli explains.
The care coordinator also uses her care plan check-in calls to remind patients to get flu shots and other vaccinations for which they are due. Lucarelli notes that patients in the CCM program are at high risk for contracting the flu simply by being elderly and having at least two chronic conditions.
Partly as a result of these reminders, her practice ran out of flu vaccine in October of last year—earlier than ever before—and had to order more. It also enabled the practice to earn more from administering vaccines than in previous years, she says.
Leisa Bailey, MD, a primary care physician with a practice in the Florida panhandle town of Bonifay, began planning to use the chronic care management code in 2014, when she first learned about it. So by the start of 2015, when the code became effective, she had the patient consent forms and all the other requirements completed.
Like Lucarelli, Bailey took a gradual approach to signing patients up. “Starting in January, as patients came in for physicals and other reasons, if they were appropriate for CCM, I told them about the plan and asked them to sign up. I’d have them fill out a short questionnaire, then over the weekend I’d develop their care plans,” she says.
At that point, Bailey handed off the patient’s care to her practice’s nurse, half of whose time had been allotted to chronic care management. When she had signed up more patients than her nurse could handle part-time, she hired another staff member, an LPN, to take on the responsibility full-time.
“She does nothing but take care of my 200 Medicare patients who have chronic conditions,” Bailey explains. “She follows up on every test they have and every referral, and she’s available any time they have a question. I call her my combination nurse/social worker/counselor, because she does it all.”
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The LPN also handles wellness visits for these patients. “Pretty soon they come to think of her as ‘their’ nurse, and the patients love it,” Bailey adds. “We get a lot of compliments from patients on how well everyone in the office takes care of them.”
At first, Bailey used the code only when treating severe problems such as chronic obstructive pulmonary disease (COPD) and diabetes. But then she learned that the time she spent treating conditions such as arthritis and depression could also be billed to it. “If a patient has one of the ‘biggies,’ like COPD, they almost always have something like arthritis,” she notes. “So I was able to include more patients when I realized I it included more conditions.”
Bailey estimates using the CCM code has increased her practice’s revenue by about $6,000 per month. “It’s not huge, but it’s enough that even after paying the LPN I have some left over that I can put into new equipment and some trips for CME,” she says.