Process Improvement for Chronic Care Management

As part of an ongoing effort to improve care coordination for Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) began reimbursing physicians for chronic care management (CCM) in January of 2015. As of January 1, 2017, these services are paid under CPT codes 99490, 99487, 99489 and G0506 . Two thirds of traditional Medicare beneficiaries suffer from multiple chronic conditions and according to statistics from the Center for Disease Control and Prevention more than 133 million Americans suffer from at least one chronic disease . Despite the benefits to value-based initiatives, many providers have resisted offering CCM due to insufficient staffing, technology, training and processes to deliver these services. Streamlining a CCM process requires the effective use of support staff and other resources needed for a successful program. The goal is to provide opportunities to improve care and promote the health of the patients through comprehensive, well-coordinated activities. The American College of Physicians (ACP) provides the following recommendations for a successful CCM program :

An important step of a CCM program implementation is to create and document comprehensive Care Plans for the patient. Practices must electronically capture care plan information and make it available 24 hours a day, seven days a week to all clinicians involved in providing CCM services. Given the non-face-to-face nature of the service, establishing a proper documentation and reporting process is crucial. Some recommendations for improvement are:

As the U.S population ages, the number of chronically ill is anticipated to increase. Care Management for these chronically ill patients has proven to improve outcomes and reduce cost. Depending upon the number of eligible patients enrolled, CCM revenue can be a significant incremental revenue stream for a practice.

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Reference: hfm “Managing Transitional and Chronic Care Profitably: A Guide for Hospital-Owned Physician” Practices, Cathy Zito and Joette P. Derricks, April 2017 CMS, “Chronic Care Management Services,” December 2016. Centers for Disease Control and Prevention, “Chronic Diseases: The Leading Causes of Death MGMA Connection “Process improvement for streamlining chronic care management”, October 2017