Chronic care management: CMS built it, did providers come?

Despite an appreciation for the benefits of CCM, providers are struggling to add it to current operations
By Tom Sullivan
07:01 AM

On Jan. 1, 2015 hospitals became eligible for reimbursement when treating patients with two or more chronic conditions.

Under CPT code 99490, in fact, the Centers for Medicare and Medicaid Services will pay clinicians an average of $43.12 for spending at least 20 minutes in non-face-to-face consults. There's little questioning the financial opportunity.

CareSync CEO Travis Bond estimated that CMS could pay out as much as $17 billion a year under chronic care management and suggested that total might triple when commercial payers, as they are prone to do, start following CMS' lead.

With just two months left in the year, though, a surprisingly small number of providers have thus far taken to 99490.

[Innovation Pulse: Meet the new CMS code worth $17 billion annually.]

"While there is a strong appreciation of the benefits of chronic care management, both as fee-for-service revenue for physicians and as a foundation for population health management, providers are struggling to incorporate CCM in their current operations," said Martie Ross, principal at consultancy Pershing Yoakley and Associates, PYA.

Indeed, a mere 26 percent of responding organizations have launched a CCM program, according to The National Chronic Care Management Survey. "And just less than half of these (49.2 percent) early adopters have successfully submitted a claim and received payment from Medicare for CCM.

Healthcare IT News got an exclusive early look at the survey, conducted by PYA in conjunction with Enli Health Intelligence.

What's the hold up?

Survey respondents cited three obstacles: insufficient reimbursement for the time required, lack of awareness about the opportunity, and compliance concerns.

Researchers also found "the median time spent delivering the service is 35 minutes per patient per month, 15 minutes more than the 20-minute minimum requirement. And, although non-face-to-face services may be furnished by any qualified clinical staff member, half of respondents are using registered nurses – a more expensive resource than other types of clinical staff – to engage patients."

The survey pointed to evidence that hospitals' interest in chronic care management will rise. Nearly 65 percent of respondents had "carefully analyzed" chronic care management and 23 percent plan to launch a program within the next 12 months. Only 11 percent said they do not intend to participate in CCM.

"This represents, in a small way, the bigger challenges ahead in the transition from volume-based to value-based reimbursement," Ross said. "Right now, there are three critical issues providers must address to be successful with CCM:  physician engagement, patient education and efficient processes for delivering CCM."

PYA and Enli based the results on 309 responding healthcare professionals in hospital systems, multi-specialty physician groups, and independent practices. 

Related articles: 

Big data holds keys to population health

An early glimpse into the shape a learning health system might take

Chronic care management tools forge bridge to value-based care


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