The Center for Medicare and Medicaid Services (CMS) introduced Chronic Care Management (CCM) in 2015 to reimburse providers for non-face-to-face services between office visits. The intent was to improve outcomes and reduce costs of caring for patients with chronic conditions with ongoing, remote care coordination. CCM is designed for patients that have two or more chronic conditions expected to last at least 12 months that put the patient at significant risk. 86% of Americans over the age of 65 have two or more chronic conditions, implying that most Medicare patients could be eligible for CCM.
CCM Proven Effective
CMS has demonstrated that care coordination is effective. Their claims analysis demonstrated that CCM:
- Reduced hospitalizations by almost 5%
- Reduced Emergency Department visits by 2.3%
- Increased preventative care visits by 8%
With these results, it’s no surprise that CMS has increased reimbursement on several CCM CPT® codes, including a 55% increase for CPT code 99490, which reimburses the first 20 minutes of clinical staff time and a 29% increase for CPT code 99439, which covers additional 20 minute increments of clinical staff time.
What Makes a Good CCM Program?
According to the American Academy of Family Medicine (AAFP), a strong CCM program drives value by “delivering continuous, comprehensive, and connected health care.”
The value of remote care programs is engaging with your patients on a more regular basis between office visits. Medical Economics concludes that a CCM program combined with remote patient monitoring (RPM), behavioral health integration (BHI), and other services can “provide patients with timelier, more personalized, and highly efficient remote care.”
If a prevention plan is at the heart of a CCM program, what better way to ensure that prevention plan is working and up-to-date than with daily or regular vital sign monitoring? That’s exactly what RPM can do as a complement to your CCM program. RPM provides unique access to more patient data without putting the burden of manually tracking readings on the patients.
Having real-time access to trends in blood pressure, weight, blood sugar, or blood oxygenation can help inform a care team on how to manage chronic conditions.
RPM + CCM Makes Clinical and Financial Sense
Not only do RPM and CCM complement each other clinically, they also work together financially. Because each service has its own set of CPT® Codes, practices can bill for both services. However, they cannot count the same minutes of clinician time towards both services.
In addition, RPM does not require a specific diagnosis like CCM does, so there may be patients that are eligible for RPM that are not eligible for CCM.
Overcoming Barriers to Remote Care
While thousands of healthcare providers have incorporated remote care into their practice, many others have understandable concerns about the barriers to remote care adoption. Some are taking a more selective approach to remote care, even though patients want more options that provide quality and convenience.
Of all the remote care options, remote monitoring can overcome many of the perceived barriers of telehealth.
- Staffing resources: Daily monitoring of patients does require an investment of clinical resources. However, it doesn’t have to be your office’s resources. Some RPM partners, including Optimize Health, offer monitoring services, where their nurses act as an extension of your staff. Outsourced nurses conduct the monitoring, provide health coaching, and communicate with your RPM patients while providing daily communication to your team with relevant patient updates.
- Technology Too Difficult for Patients: Cellular RPM devices look just like “regular” devices. For example, with a cellular blood pressure cuff, the patient pushes one button to take the reading and it automatically transmits to your practice. With a cellular scale, they simply step on and off. With cellular devices, no smartphone, computer, or high-speed internet connection is necessary. Communication with patients can be conducted via phone — video chat is not a requirement.
- Not Affordable for Patients: RPM is covered by Medicare. Patients do not need access to high-speed internet, smartphones, or any other technology, which can be expensive for patients on a fixed budget. Cellular devices work with any cell tower at no cost to the patient.
- Technology Too Difficult for Staff: There are RPM solutions that are intuitive and extremely easy for your staff to use. Furthermore, if you are using outsourced monitoring staff and integrating with your EHR, your team does not even have to learn a new system.
Are you Ready to Enhance your CCM Program?
If you have a successful CCM program or are considering launching one, RPM can make it even better. Set up a free consultation with one of our remote care experts to see how RPM can drive better outcomes (and reimbursement) for your chronic care patients.