Success with CMS’s Chronic Care Management (CCM)
In January 2015, The Centers for Medicare & Medicaid Services (CMS) began covering monthly expenses for chronic care management (CCM) of Medicare patients not conducted in a face-to-face visit with a provider. This could include follow-up calls to patients, monitoring patient care plans and consulting with patients’ other providers.
CMS recognizes CCM as one of the critical components of primary care that contributes to better health and care for individuals. To support this objective, Medicare will pay physicians and other qualified healthcare professionals approximately $44 per patient, per calendar month for these services. This requires that clinical staff spend at least 20 minutes per patient, per month, to establish, implement, revise and monitor a comprehensive care plan for patients with multiple (two or more) chronic conditions expected to last at least 12 months.
The Challenges of CCM
The intention of CCM is laudable, as patients benefit from these efforts and providers are reimbursed for these importance services. However, providers’ capacity is already stretched thin as patient demand continuously increases, so adding an incremental 20 minutes of attention per month for each Medicare patient may prove infeasible in many instances.
Moreover, CCM requires what many providers consider lengthy documentation, integration with an Electronic Health Record (EHR) and the ability to track the 20 minutes per patient for auditing purposes. These challenges are not impossible to overcome: as Dr. Jim King explains in the Modern Healthcare article “Why most docs skip Medicare’s chronic-care management fee (and how some are making it work),” he has hired a registered nurse, two licensed practical nurses and a clerk to join the five doctors and six nurse practitioners at his three-clinic practice in rural western Tennessee.
Unfortunately, many practices may not be in a position to add as many FTE’s in an effort to meet CMS’s requirements for CCM. In fact, at the time of the Modern Healthcare article in October 2015, while CMS reported that about 35 million Medicare beneficiaries were eligible to receive these billable care management services, the agency had only received reimbursement requests for only about 100,000.
This is about to change.
New Innovation Allows Efficient Delivery of CCM Services
PatientKinect is a new venture launched by retired NFL player Troy Evans to help providers achieve CCM requirements in an efficient and effective way. Evans was the special teams captain for the New Orleans Saints during the 2009 season, highlighted by a 31-17 win against the Indianapolis Colts in Super Bowl XLIV. In all, Evans played ten seasons with the NFL, including stints with the St. Louis Rams and Houston Texans.
PatientKinect is a spinoff of MedKinect, which provides physician groups and hospitals with ancillary products and services that enhance patient care. Evans co-owns and runs MedKinect with a former Saints teammate, Mark Campbell, who also played for the Cleveland Browns.
PatientKinect analyzes a provider’s patient population and identifies patients who may qualify for CCM through a certified EHR. PatientKinect dedicates a care team coordinator to a participating practice to help develop and facilitate care plans for patients, monitor medication and serve as a liaison between patient and care team.
PatientKinect teamed with the founders of c2b solutions and PatientBond to develop the backend system for reaching out to patients via email, texts and Interactive Voice Response (IVR). PatientBond is a platform for automating patient communications with a proven track record of patient behavior change. The series of patient communications are tailored to the patient’s care plan, and the minutes spent with these non-face to face communications can be tracked and measured for auditing purposes and care adjustment.
PatientKinect helps optimize patient care while representing a minimum of effort or resource requirement for providers. The first practice using PatientKinect had a 62% response rate among eligible patients on Day 1 of launch, signing up 8 patients in the first hour. A practice with a sizable Medicare population stands to realize significant reimbursement. Most importantly, Medicare beneficiaries will receive much needed follow-up care.