Medicare sees slow adoption of chronic care management code

By Matt Kuhrt

In January 2015, Medicare put a new billing code into use to reimburse physician practices for the provision of care to patients with multiple chronic conditions. The chronic care management (CCM) billing code is part of a continuing shift toward reimbursement for services that do not necessarily require an office visit, but the medical community has been slow to adopt its use, according to an article in the Journal of the American Medical Association.

The physician community's reticence to make CCM claims is both understandable and tracks with the slow trajectory seen for adoption of the transitional care management code implemented in 2013, also designed to encourage non-face-to-face service provision, write Andrew B. Bindman, M.D., and Donald F. Cox, Ph.D. The primary issues plaguing adoption have revolved around the potential for patients to resist monthly copays for services they aren't necessarily physically present to receive, and the costly changes practices must make in order to comply with the code's requirements, according to previous reporting in FiercePracticeManagement.

The authors cite Congress' interest in tweaking the requirements as a reason for optimism with regard to CCM's future. Suggestions solicited through public comment included proposals to eliminate the beneficiary copayments and create a set of new, more-granular CCM payment codes to reflect the relative resource cost required to provide CCM-related services.

The Medicare Payment Advisory Commission has also recommended a change to capitated payments as a way of amassing enough beneficiaries to generate a return on the investment practices must make in staffing and other infrastructure in order to provide the 24-hour availability required by the billing code. This is a vital consideration, as the authors cite a study in the Annals of Internal Medicine suggesting practices would need to collect CCM payments for over 100 patients to recoup typical setup costs.

To learn more:
- read the Journal of the American Medical Association article
- see the study in Annals of Internal Medicine