You understand how it feels if you’re a medical practice or in charge of clinical care. You have completed a diabetes, hypertension and early-stage heart failure (HF) patient visit. Medications tweaks, diet and symptoms took 15 minutes. As soon as they leave the door, though, you know what usually happens, life gets in the way.
The forgetfulness, a slight rise in blood pressure, a missed lab test, and they find themselves in the ER 3 months later.
You’d love to call them every two weeks to just see how they were. But when is that supposed to happen, right? From back-to-back exam rooms to constant EHR chart notes, prior authorizations and administrative issues, there’s just not enough time in the day.
This is where Chronic Care Management companies step in.
What Is Chronic Care Management?
Patients with two or more chronic diseases that are expected to persist 12 months or more (or until the patient’s death) are eligible for Medicare’s Chronic Care Management program. common ailments include diabetes, heart disease, COPD, arthritis, depression, and high blood pressure.
Medicare has long recognized that it is costly and inefficient to treat chronic illnesses reactively, after a patient’s visit to their office or hospital admission. In order to compensate clinical teams for providing these patients with non-face-to-face treatment for at least 20 minutes each month, they created unique CPT codes, starting with code 99490.
Typically that 20 minutes each month consists of:
- Checking patients’ laboratory tests and vital signs from a distance
- Ideal to check medication adherence and refills
- Supporting arranging specialist appointments or rides to clinics
- Up to date comprehensive care plans
- The ability to answer rapid health-related questions on the telephone before they turn into large crises
Why Medical Practices Turn to Outsourced CCM Companies
The idea of having an in-house CCM program seems like a great idea in theory. The use of your own clinical staff, own patients and billing Medicare directly. However, in terms of practice, most of the clinics hit a wall pretty fast.
You have already overworked medical staff and nurses. Informing them to place hundreds of 20-minute care management calls monthly, attend walk-ins, track down the pharmacies to deal with phone tag is a recipe for burnout. It is also a risky and costly choice to add more full time employees just for the program of CCM itself, because of the variable participation of patients.
This is why many providers decide to tie up with companies dedicated to Chronic Care Management. These organizations are specialists that serve as an extension of your practice. They provide the clinical team (care coordinators, MAs, or RNs) and the software technology and the operational process to provide care to your patients every month, under your direction.
How Chronic Care Management Companies Work
Here is how ccm companies work.
Step 1: Identifying Eligible Patients
The CCM company looks at your patient panel (with your permission) or can access your EHR and identify patients as having 2+ chronic conditions, but without a recent patient visit to your CCM.
Step 2: Patient Enrollment and Consent
The last reason that Medicare will require patient consent before it begins CCM is that there is a small copay that patients will likely have, depending on their supplemental insurance.
A good CCM company will engage with patients who are eligible to the program and explain the advantages of the program in a warm and clear way; so that patients know this is an extra service provided by your office, not a random sales call.
Step 3: Creating and Updating Care Plans
For every registered patient, a care management team develops a customized treatment plan. Current diagnosis, treatment objectives, prescription drugs, and local resources will all be included in this paper. Your provider team reviews and approves these plans.
Step 4: Monthly Clinical Engagement
The patient has a care coordinator assigned to that patient who calls the patient monthly . They help schedule appointments and check for symptoms and ensure that the patient is following their treatment plan. If there are any red flags the co-ordinator will note these and pass the letter to your clinical team to action in a timely fashion.
Step 5: Seamless EHR Documentation & Billing Support
All information is recorded directly in your Electronic Health Record (EHR) or auto-synchronized. Your billing department can confidently submit claims knowing that the CCM company provides detailed audit proof time logs at the end of the month when the required amount of clinical minutes is achieved.
The Key Benefits of Partnering with a CCM Company
There are a number of advantages to collaborating with a CCM Company.
1. Drastically Improved Patient Outcomes
Regular phone calls allow small problems to be identified early with chronic patients. If missed, the dose is taken before a high sugar level occurs.
2. Consistent Revenue for Your Practice
Fee-for-service medicine can be like a roller coaster. Patients fail to show up, and revenue suffers, or if the weather keeps them inside, there is a drop in revenue. CCM provides monthly, regularly-incoming revenue for your practice. If you have a large panel, 200-500 patients can bring in extra consistent revenue each month without much extra effort for your primary care team.
3. No Added Burden on Your In-House Staff
Your office medical assistants and nurses can remain focused on the patients in their chair since the CCM partner will take the weighty responsibilities of placing calls, tracking time, updating charts and follow-up.
What to Look for in a CCM Partner
Not all Chronic Care Management companies are created equal. If you choose to pursue a partnership, here are some must does not have:
- The company should work inside your existing EHR (or offer seamless integration). If they force your staff to double-enter data into a separate portal, it will create unnecessary friction.
- Strict compliance is required for Medicare audits of CCM codes. Your partner is required to create brief, minute-by-minute activity reports for every patient engagement.
Common Mistakes
Although the use of CCM programs has great potential, there are some challenges in the use of practices. Avoid these mistakes:
- A CCM partner is not a magic wand. Escalated alerts and intervention during clinical situations where direct medical decisions are needed must still be reviewed by your clinical team.
- If they are not covered by secondary, explain to them what they will have to deal with in terms of out-of-pocket expenses at the outset.
- If your patients think that you are attempting to telemarket them, they will soon lose interest. Select a vendor that values attentive, caring, and relational care.
The Bottom Line
Chronic Care Management isn’t just another billing code or administrative fad. It is a tried and tested model that is able to close the loop in a way that supports patients most when they need it most in the office setting.
When you’re extremely busy, providing proactive, high-touch care to your highest-risk patients is a breeze with a trusted Chronic Care Management company like Tellihealth, as your clinic staff won’t be stretched thin or forced to work late in order to keep up with documentation. If it’s executed correctly, it’s a true win, win situation for patient health and practice viability.