Medicare's new chronic care management (CCM) program offers practices of all specialties a major opportunity to reap revenue from services they've thus far provided for free. With 1,000 qualified patients, a practice could earn an additional $511,200 per year, noted an article from Medscape.
IT concerns top the list of barriers to the program, FiercePracticeManagement has reported, and some practices may also need to add to their existing infrastructure and staff to implement code 99490. Family physician Matt T. Rosenberg, M.D., of MidMichigan Health Center, for example, told Medscape he hired a full-time nonclinical manager to obtain patients' consent to be enrolled in the program, which requires a 20 percent copay. The manager also ensures that clinicians are documenting CCM activities, including going over medications or insurance issues by phone.
But while practices such as Rosenberg's are doing their best to design programs that enhance patient care, there is little guidance available to do so, noted an opinion piece published in the Journal of the American Medical Association.
"Although there has been discussion of the fiscal and operational challenges posed by the new payment, less consideration has been given to the implications of the new policy for clinicians who will wonder what is required of them and how can they do it well," wrote authors Louise Aronson, M.D.; Christopher A. Bautista, M.D.; and Kenneth Covinsky, M.D.
Thus, they recommended four-step process for doctors to approach CCM with each patient:
- Determine the likelihood of care coordination needs (e.g., two or more chronic conditions)
- Establish goals of care (e.g., current life and health priorities, treatment preferences)
- Assess care needs (medical, functional, psychosocial and environmental)
- Match resources to needs (medical, functional, psychosocial and environmental)
With all of the effort that these measures entail, providers also have to ask themselves tough questions regarding patients who refuse to sign up for the program, noted Medscape. "The decision was tough," Rosenberg said. "The best decision we came to is that if you are eligible for this program and you chose not to sign the consent, then we will no longer offer non-face-to-face interactions."