Physician practices struggle to find profit in chronic care management, survey finds

Physicians have had the option to bill Medicare for non-face-to-face work they do to manage patients' chronic conditions for about 10 months now, but implementation of chronic care management (CCM) programs remains relatively low.

In fact, just 26 percent of practices report that they have launched a CCM program for their Medicare patients, according to the National Chronic Care Management Survey, conducted in late summer by Pershing Yoakley & Associates (PYA) and Enli Health Intelligence. What's more, only 49 percent of practices that have launched a CCM program have successfully submitted a claim and been paid for CCM services.

The report offers insights into what barriers are keeping CCM codes from getting used and offers recommendations for providers, policymakers and vendors to help increase adoption.

"While many had hoped that Medicare would simplify the CCM billing rules to encourage greater participation, the agency took no such action in the 2016 Medicare Physician Fee Schedule Final Rule released on October 30," Martie Ross, PYA principal, said in an announcement. "Now, we need to address CCM challenges head on, to ensure patients suffering with chronic conditions have access to these vital services."

Key findings of the report include the following:

  • More than 65 percent of respondents said they analyzed the opportunity to pursue CCM in the near future, but just 40 percent determined through this research that they could implement CCM profitably with their current staffs.
  • Out of the combined 63 percent of respondents who believed CCM would not be profitable or were unsure, insufficient reimbursement for the time and effort required was the most common problem identified, at 47 percent.
  • Among organizations that had adopted CCM programs, the median time they spent delivering CCM services to patients each month was 35 minutes--nearly twice the 20-minute minimum on which CMS' reimbursement was calculated.
  • Organizations with 11-50 physicians reported that nearly half (47 percent) of their doctors are now providing CCM services, while organizations with 100 doctors or more said they have engaged just 22 percent of their qualifying physicians.
  • Nearly half (47 percent) of early CCM adopters have hired additional staff, particularly care managers/coordinators (80 percent) and CCM coordinators (43 percent).

While any steps Medicare takes to reduce the administrative burden of CCM programs will help increase adoption, the authors concluded, providers must also work to better educate beneficiaries about CCM services and vendors should correct shortcomings with their existing technologies with respect to CCM.

To learn more:
- read the announcement
- download the report