Chronic Care Management Revenue Relies on Physician Momentum

Embedded in CMS's year-old Chronic Care Management codes is a dramatic potential for revenue—in both reduced costs and enhanced health outcomes for Medicare beneficiaries. But before primary care practices can tap into these opportunities, physician leadership must create momentum for CCM with staff and patients, advises Debra Burbary, RN, clinical quality assurance manager with Arcturus Health.

CMS recognizes that care management is a critical component of the primary care setting and that it can help contribute to the better health of our patients and also reduce spending as well. Our group has looked at this as an opportunity to capture more revenue as well as improve our patients' health conditions, she explained.

However, when we first began to study the Chronic Care Management (CCM) regulations, we found out that it wasn't going to be quite that easy, said Ms. Burbary. CMS has put into place many requirements and guidelines that need to be followed to qualify for this service. We think that one of the biggest messages that came through was the fact that 75 percent of healthcare spending is directly related to chronic conditions. The prevalence of co-morbid conditions also presents a challenge for disease management. Mostly, these patients fall into that category.

The CCM program was going to require a comprehensive effort to reconfigure our clinical workflows and processes to adjust to the needs of these chronically ill patients within a primary care setting. One of the main things we determined we needed was physician leadership. Involvement by our physicians to support this program was going to be a major key to success, she added.

"I was very fortunate to work with my physician medical director, who does provide that support for our department, and we were able to move forward," said Ms. Burbary. "One thing to look at if you’re just starting with this process is the creation within your group of physician buy-in for disease management activities in order to create that culture. Without this supportive culture, you will have a difficult time sustaining a chronic disease management effort."

The cost of disease management continues to drive many of our decisions related to encouraging our patients in self-management activities complementary to the patient-physician relationship—decisions that drive our strategies for supporting patients in becoming informed. Active participants must be extensively developed.

The potential revenue for the CCM code cannot be overlooked. It's remarkably very, very high, but at the same time very difficult to accomplish, Ms. Burbary added.

Excerpted from: Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue, which traces the incorporation of CCM into Arcturus Healthcare's existing care management efforts for high-risk patients, as well as the unexpected bonus that resulted from CCM code adoption. For more information, please visit:
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