Are You Leaving Money on the Table With Chronic Care Management?

In January 2015, Medicare began a generous reimbursement program for primary care physicians to better coordinate chronic conditions with patients and other providers. The idea was to give physicians, clinics and medical systems a financial incentive for helping patients manage their conditions –  without any face-to-face interaction.

Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services, told the Associated Press that Medicare was “hoping to spur change, getting physicians to be much more willing to spend time working on the needs of these patients without necessitating the patient to come into the office.”

In total, this is part of the shift away from fee-for-service and towards patient-centered care. If the vision plays out in the healthcare system, it would result in better outcomes and lower expenses – or so the philosophy goes.

Yet, a year later, the reimbursement, which can add $40 per month per qualified patient, is barely being used. Of the 35 million Medicare patients eligible for the program, just 100,000 reimbursement requests have been received. That’s a dismal 0.2 percent rate.

Part of the reason that this utilization rate is so low is that without the right technology, the burden of the Chronic Care Management (CCM) reimbursement is high on practices and clinics. Not only does the practice have to hire and train auxiliary staff to do the month-to-month management, but it has to document each minute spent discussing or planning care. For already burdened practices and clinics, there is an opportunity cost.

But by far, the largest reason that utilization is low is because providers aren’t aware of the reimbursement. One survey of 300 primary-care physicians suggested that two-thirds are unaware of the program, whether in whole or in part – a staggering number.

And this is to be expected. Healthcare is a slow-moving industry, and with providers currently being stretched in multiple directions, it’s easy to understand how it can be met with skepticism.

However, for most practices, the CCM reimbursement could be a very large opportunity. Dr. Sanjay Basu from Stanford University School of Medicine estimated in the Annals of Internal Medicine that an “average” practice could see net revenues increase by $75,000 per physician if just half of their eligible Medicare patients enrolled.

That is real money. And by incorporating the right technology partner, like 4D Healthware, that money can come at a lower incremental cost – automating much of the reporting and contact, while providing patients with an easy-to-use platform.

We’d love to talk to your practice, clinic or healthcare system about how you can take advantage of the CCM reimbursement. Contact us here.