MACRAeconomics: Chronic Care Management
Is the Future of Medicare Reimbursement
Managing a Medicare population, particularly when the majority has two or more chronic illnesses, can be daunting. But in the current realm of healthcare reimbursement, the care of these beneficiaries is rife with opportunity.
"Depending on the manner in which you're managing your Medicare Part B demographic, you have an opportunity to generate from 100 to 120 percent of the Medicare fee schedule under MACRA," noted Barry Allison, chief information officer, the Center for Primary Care, during Physician Chronic Care Management Reimbursement: Setting MACRA's MIPS Path for 2017
In case you missed this webinar, you still have a chance to watch this highly-rated program.
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During this October 2016 webinar now available for replay, Allison described how early adoption of Medicare's Chronic Care Management (CCM) Reimbursement program enhanced the Center's MACRA-readiness under the Merit-based Incentive Payment System (MIPS) path. By identifying the more than three-quarters of its 24,000 active Medicare beneficiaries that met CMS's CCM requirements, the Center had a ready pool of patients on which to overlay CMS's care coordination best practices and begin earning crucial CCM revenue.
"CMS recognizes that care management is a critical component of primary care. It contributes to better health and care for individuals, as well as reduced spending," said Allison, who estimates his 40-provider organization is the largest chronic care management initiative in the Southeast.
Using the value-based modifier data available within CMS's Quality Use and Resource Report (QRUR), The Center for Primary Care further identified its percentage of high-risk Medicare patients for more focused care management.
Accessing and reviewing QRUR reports, available from the CMS Enterprise Identity Management (EIDM) desk, is an essential prerequisite to MACRA participation, advised Allison, who also detailed the type of reports and data available from the QRUR. "Procure that data as soon as possible, because you can learn a lot about what CMS will be looking for in the future, and how the value-based modifier will actually become a part of that MACRA multi-pronged approach."
While his organization's CCM program utilized ENLI software to identify 'hot-spotter' data elements such as unfilled prescriptions or ER visits for specific conditions, physician practices that lack this technology still have many tools at their disposal—even appointment scheduling software—to identify high-risk patients.
"Open up consistent lines of dialogue and engage your providers. Sit down with them and say, 'You know your patients better than anyone else. Tell us who to reach out to.'" With or without CCM software, practices should "document, document, document" the amount of time devoted to CCM, as well as how that time benefited patients.
Long-term planning rather than a reactive view will better position physician practices for success under MACRA's Quality Payment Program, Allison concluded. The Center is already estimating how it will fare under Medicare's newly finalized 2017 Physician Fee Schedule (PFS). Next year's PFS significantly updates CCM, offering new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
"For us, CCM is not really focused on the near term revenue as much as it is about the long term action-reaction we can have in the patient's life, and how our physicians are paid over the next three years."
You can "attend" this program right in your office and learn about the Center for Primary Care's strategy. It's so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer — any time of the day or night, whenever convenient for you and your colleagues — and benefit from the archived recording of the conference, including the Q&A period.
You'll get to listen to the question and answer session to hear details on: what a MIPS top performing physician practice might look like; managing chronic diseases without access to software; using QRUR data to improve performance; preparing for a CMS audit; developing an effective patient outreach strategy for chronic care management; and the role of the Medicare wellness visit in chronic care management and MIPS.
To register for the on-demand re-broadcast, download an .MP3 file or order the training DVD or CD-ROM of Physician Chronic Care Management Reimbursement: Setting MACRA's MIPS Path for 2017, please visit:
P.S. -- You may also be interested in these MACRA and chronic care management resources: